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UPDATE:  The PEBP Board voted to retain the current HMO/EPO plan option and plan design, at least for FY2026.  They also accepted the bid for the Southern HMO plan from Health Plan of Nevada, the incumbent provider, contingent on successful contract negotiation.  Thanks to all members and other state employees who gave public comment!

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At the Thursday, January 23, meeting of the Public Employees' Benefits Program Board, the Board will consider PEBP staff's recommendation to eliminate the HMO/EPO plan options.  The southern-Nevada HMO (Health Maintenance Organization) option has been chosen by over 3000 state employees. The northern Nevada EPO (Exclusive Provider Organization) is option used by another 3000 employees.  The HMO/EPO plan options provide certainty in copays for health services in exchange for higher monthly premiums, compared with the high-deductible and low-deductible plan options, that are borne entirely by the employee with no additional state contribution.  NFA's written public comment opposing the elimination of the HMO/EPO is copied below.

To object to the elimination of the HMO/EPO, participants may provide public comment by telephone at 9:00 am on Thursday, Jan. 23, using the instructions in the agenda:

There are two agenda items designated for public comment. If you wish to provide verbal public comment during those agenda items, please follow the instructions below:

Option #1 Join the webinar as an attendee https://us06web.zoom.us/j/87092730987 This link is only for those who want to make public comment. If you are just listening to the webinar, please use the YouTube Link located in the “Video Conferencing” field above.

Option #2 Dial: (669) 900-6833. When prompted to provide your Meeting ID, please enter: 870 9273 0987 then press #. When prompted for a Participant ID, please enter #.

Participants that call in will be muted until it is time for public comment. A moderator will then unmute callers one at a time for public comment. To resolve any issues related to dialing in to provide public comment for this meeting, please call (775) 684-7016 or email jcrane@peb.nv.gov 

NEVADA FACULTY ALLIANCE
840 S. Rancho Dr., Suite 4-571
Las Vegas, Nevada 89106

Date:   January 20, 2025

To:      PEBP Board Members

From: Kent Ervin, Director of Government Relations, Nevada Faculty Alliance

Subject:   HMO/EPO plan options

We have reviewed the Segal presentation on “EPO and HMO Considerations”.  We appreciate the response to some of the Board’s requests for additional information on the EPO and HMO plans and possible modification to the low-deductible PPO plan. Unfortunately, the presentation is extremely one-sided and biased. It argues for a certain outcome, the elimination of the HMO and EPO plan options, rather than providing balanced information for the Board’s consideration.  Among the issues with the report:

• The decline in EPO enrollment is provided, but the HMO enrollment trend –which is relatively stable—is missing (page 3).
• Projecting high future cost trends for the HMO (much higher than the self-funded plans) without reference to the actual bids from the recent Request for Proposals (page 5).
• Comparing the High-Deductible, Low-Deductible, and EPO plans but not the HMO plan or blended HMO/EPO plan (pages 8-11).
• Comparing plan design with other states but not with other public employers in Nevada, with whom the State competes for employees (pages 13-19).
• For the PPO 1 and PPO 2 options, no estimates of the total rate or employee premiums in comparison with the High-Deductible, current Low-Deductible, HMO, EPO, or blended HMO/EPO plans (pages 21-23). The “cost savings” appear to come mostly from decreased payments on participant claims and the high projected trend for the HMO. 
• ·       No estimates of total rates or employee premiums for Plan Year 2026, which should be possible for all options since the recent release of the Executive Budget with PEBP subsidies per employee (pages 24-25). What is the savings in total rate or employee premiums with the addition of a $500/$1000 deductible in PPO option 2 compared with PPO option 1 or the current Low-Deductible PPO?

The best solution is continuing the three current plan options for Plan Year 2026, with further study of plan design after open enrollment and after the legislative session.Alternatively, a decision should be deferred to the March rate-setting meeting with presentation of full rates and premiums for all options for the Board’s consideration.

My comments submitted on January 7, before the canceled board meeting on January 16 and release of the Segal report, are still valid and are repeated here:

As you consider plan design changes this month, the Nevada Faculty Alliance would like to emphasize the importance of the HMO/EPO plan option to many of our participants. 

• The HMO/EPO plan provides certainty in out-of-pocket costs, which some participants are willing to pay for through higher monthly premiums.
• The southern HMO especially includes network providers who are essential to the health and well-being of their patients, including mental and behavioral health, and the productivity of employees. Disruptions to provider access must  be avoided. Are providers within the various networks actually accepting new patients?
• Because the employer contributions (state subsidies) are identical for all three plan options, PEBP has no extra costs to provide the HMO/EPO option other than administrative oversight.
• Because the high-deductible plan, the low- (or zero-) deductible plan, and the EPO option are underwritten as a single risk pool, migration between the self-funded options should not affect overall costs or the viability of individual options.
• We are not privy to the HMO Request For Proposals results, but actual competitive bids are more reliable than consultant projections. Ideally, a cost-effective statewide HMO with a broad network would be chosen.
• Major plan design changes should be deferred to Plan Year 2027, after the legislative session and to see how enrollment trends stabilize several years after the introduction of the low-deductible middle plan option.

We surveyed all rank-and-file faculty at the seven NSHE colleges and universities in November, with a stellar 40% response rate (survey results on benefits questions). Our faculty rate lower out-of-pocket costs for health care as slightly more important than lower monthly premiums.  While access to the low-deductible plan option is most popular (88% rate it as somewhat or very important), 65% of respondents say the availability of HMO/EPO is somewhat or very important.  

Retain the HMO/EPO option. Thank you for your consideration.

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The Nevada Faculty Alliance is the independent statewide association of professional employees of the colleges and universities of the Nevada System of Higher Education. The NFA is affiliated with the American Association of University Professors, which advocates for academic freedom, shared governance, and faculty rights, and the American Federation of Teachers/AFL-CIO, representing over 300,000 higher education professionals nationwide. The NFA works to empower our members to be wholly engaged in our mission to help students succeed.