Your Medical Plan Choices
Active employees have two medical plan choices:
PPO Plan (Anthem Blue Cross Blue Shield Network)
This plan is a preferred provider organization (PPO). It gives you the flexibility to see any medical provider. However, you save money when you use in-network providers. Refer to your Summary Plan Description for details on this plan. This plan is self-funded, which means the Fund pays the claims for participants’ eligible health care services, not Anthem or Zenith American Solutions.
HMO Plan (Health Plan of Nevada)
This plan is a health maintenance organization (HMO). You must always see Health Plan of Nevada providers in order to receive coverage, except for life-threatening emergencies. If you see an out-of-network provider, you will pay all costs for those services. Your enrollment packet includes a folder from Health Plan of Nevada with details on this plan. This plan is fully insured, which means Health Plan of Nevada pays the claims for participants’ eligible health care services.
Medical Plan Comparison Chart
Benefit
PPO Plan
(Anthem Blue Cross Blue Shield)
In-Network Coverage*
Family: $1,500
(All items shown below are subject to the deductible, except preventive care and prescription drugs.)
Single: $5,600
Family: $11,200
Prescription:
Single: $1,000
Family: $2,000
Specialist: $15 copay
Lab: $5 per service
Preferred brand: Greater of $20 copay or 20% coinsurance
Non-preferred: Greater of $45 copay or 45% coinsurance
Specialty: $50 copay (mail order available at different amounts)
HMO Plan
(Health Plan of Nevada)
In-Network Required
Family: $12,500
(includes prescription drugs)
Physician extender or assistant: $25 copay
Specialist: $70 copay
Lab: $15 per service
(waived if admitted)
Midrange cost: $50 copay
Highest cost: $75 copay
(mail order available)
*Note that non-network coverage is different than in-network coverage. See the Summary Plan Description for details.
**If you visit the emergency room for non-life-threatening treatment, the PPO plan pays $75 of emergency room charges, and you pay the balance; the HMO plan pays nothing in this case.
Transparency in Coverage
The Transparency in Coverage Rules require certain group health plans to disclose, on a public website, information regarding in-network provider rates and historical out-of-network allowed amounts and billed charges for covered items and services.
Zenith American Solutions, in partnership with benefit vendors, creates and publishes the Machine-Readable Files (MFRs) on behalf of Teamsters Local 986.