Submitted by Kent Ervin:

The Public Employees’ Benefits Program (PEBP) Board met on December 12, 2025, to make decisions about plan design changes for Plan Year 2027, beginning 7/1/2026. Benefits are being reduced, but not uniformly by plan option. The following are the major changes from the current plan year for the self-funded PEBP plans.

High-deductible (“consumer-driven”) health plan with Health Savings Account:

• Increase the annual deductible from $1650/$3300 (individual/family) to $1700/$3400, the new IRS minimum for plans eligible for Health Savings Accounts.
• Increase the annual out-of-pocket maximum from $4000/$8000 (individual/family) to $5000/$10000. This will increase the costs for the 7% to 10% of participants who meet the out-of-pocket maximum, after which coinsurance does not apply.
• These changes decrease the expected actuarial value of the high-deductible plan from 79.0% to 77.0% (percent of covered charges paid by the plan, the remainder paid by the participants).

No action was taken on increasing the employer contributions to HSAs for the high-deductible plan to offset the higher deductibles and out-of-pocket maximums, but that can still be considered at the January or March board meetings.

Low-deductible PPO health plan:

• Increase the annual deductible from $0/$0 (individual/family) to $300/$600.
• Increase the annual out-of-pocket maximum from $4000/$8000 (individual/family) to $5000/$10000.
• These changes decrease the expected actuarial value from 85.1% to 83.0%.

Exclusive Provider Organization plan (northern Nevada):

• Decrease the annual out-of-pocket maximum from $5000/$10000 (individual/family) to $4000/$8000.
• This change increases the actuarial value from 88.7% to 89.1%.

These changes will make the three self-funded plan options more differentiated, with a larger range of actuarial values. Not considering medical inflation, these changes are expected to reduce the total plan expenditures by $4 to $5 million—by shifting charges to participants who are meeting the current deductibles and out-of-pocket maximums. The PEBP Board modified the actuary’s proposal to increase the out-of-pocket cost on the high-deductible plan even more to $6000/$10000. The high-deductible plan is already subsidizing the other two plan options. The new actuarial values will directly affect total plan rates and employee premiums, which will be determined at the March board meeting. Total rates scale with actuarial values, so significant changes in employee premiums for the three plan options are to be expected. The board also was presented with but did not act upon proposed changes to the employer contributions from flat-dollar amounts across to the three plan options to a system with employed contribution percentages varying by plan option and dependent tier, which would also significantly affect employee premiums for play year 2027. Further consideration is expected in January or March.

A new pharmacy coupon program for in-hospital drugs, promoted to save money for both the plan and patients, was approved. Diagnostic breast imaging and colonoscopies will be covered at 100% (as for preventive services). Prior authorizations will no longer be required for biopsies, MRIs, and dialysis. The Board considered but did not approve enhancements to vision benefits and restoration of long-term disability insurance.

In good news for state employees, Carson Tahoe Hospital and UMR have finally agreed to extend their contract for in-network services for PEBP participants through 7/30/2027.

Kent Ervin and Doug Unger provided public comments at the board meeting. Kent’s written comments, including a discussion of PEBP’s deficient reserve levels, are available at the https://pebp.nv.gov/Meetings/archived-board-meetings/PEBP website.

Submitted by Kent Ervin 12/23/2025