importance of your decisions
DESCRIPTION
State of Tennessee Group Insurance Program New Employee Benefits Orientation Higher Education Employees - 2014. Importance of Your Decisions. The decisions you make now as a new employee will have lasting effects on your benefits - PowerPoint PPT PresentationTRANSCRIPT
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State of TennesseeGroup Insurance Program
New Employee Benefits Orientation Higher Education Employees - 2014
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Importance of Your Decisions
• The decisions you make now as a new employee will have lasting effects on your benefits
• Please note: some of your decisions can only be made during the new hire period
• Please make sure that you are aware of all the options available to you and that you make an informed decision
• Submit any questions to your Agency Benefits Coordinator (ABC) or Benefits Administration
www.partnersforhealthtn.gov 1-800-253-9981
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Resource Materials
You will also be provided with an Employee Checklist to confirm that you have been informed of important benefits information
For more detailed information, refer to the Eligibility and Enrollment Guide
provided by your ABC.
www.partnersforhealthtn.gov 1-800-253-9981
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Resource Materials
The Summary of Benefits Coverage (SBC) describes your health coverage options. You can print a copy on the
Benefits Administration website, or ask your ABC for a copy.
www.partnersforhealthtn.gov 1-800-253-9981
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About the Plan
• The State Group Insurance Program (also called the Plan) covers three different populations:
• State and Higher Education Employees
• Local Education Employees
• Local Government Employees
• We spend about $1.3 billion annually and cover nearly 300,000 members
• The health plan is self-insured, meaning that the State, not an insurance company, pays claims from premiums collected from members and their employers
• The Division of Benefits Administration manages the State Group Insurance Program and works with your Agency Benefits Coordinator (ABC) to serve our Plan members
www.partnersforhealthtn.gov 1-800-253-9981
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Who is Eligible for Coverage?
• Generally, full time employees are eligible for health insurance coverage as well as their dependents, who may include:
• Legally married spouses
• Children up to age 26, including natural, adopted or step-children or children for whom the employee is the legal guardian
• There are special circumstances for employees with disabled dependents that may allow for coverage of these dependents after age 26
• For more information about disabled dependents, refer to the Eligibility and Enrollment Guide or consult your ABC
www.partnersforhealthtn.gov 1-800-253-9981
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Notice to TennCare Enrollees
• You must contact your caseworker at the TennCare within 10 days of your date of employment
• Report to TennCare your new job, salary and that you have access to medical insurance with your new employer
• Employees cannot be enrolled in both TennCare and a State Group Health Insurance plan
www.partnersforhealthtn.gov 1-800-253-9981
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Adding Coverage
There are only three times you may add health coverage:
1. As a new employee
2. During the fall Annual Enrollment
3. If you experience a special qualifying event A specific life change, such as marriage, the birth of a baby or something that
results in loss of other coverage Must submit paperwork within 60 days of the event or loss of other coverage A complete list is provided on page three of the enrollment application
www.partnersforhealthtn.gov 1-800-253-9981
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Annual Enrollment
• During Annual Enrollment, you may:
• Add health insurance coverage
• Change health insurance carriers
• Choose a different PPO or health insurance carrier
• Cancel health insurance coverage
• Changes are effective January 1 of the following year
• Add, cancel or make changes to optional benefits during Annual Enrollment
Annual Enrollment occurs each year during the fall, usually around October.
www.partnersforhealthtn.gov 1-800-253-9981
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Canceling Coverage
• You may only cancel health, dental or vision coverage for yourself or your dependents:
1. During Annual Enrollment
2. If you become ineligible to continue coverage
3. If you experience a qualifying event listed on the Insurance Cancel Request Application
• You cannot cancel coverage during the plan year, outside of Annual Enrollment, unless you have a qualifying event or lose eligibility under the plan
www.partnersforhealthtn.gov 1-800-253-9981
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Definitions
• Premiums are the amount you pay each month for your coverage regardless of whether or not you receive health services
• A copay is a flat dollar amount you pay for services and products, like office visits and prescriptions
• A deductible is a set dollar amount that you pay out-of-pocket each year for services
• Co-insurance is a form of payment where you pay a percentage of the cost for a service, after meeting your deductible
www.partnersforhealthtn.gov 1-800-253-9981
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Definitions
• The out-of-pocket co-insurance maximum is the limit on the amount of money you will have to pay each year in deductibles and co-insurance
• The out-of-pocket copay maximum limits how much you pay for certain in-network services that require copays
• A network is a group of doctors, hospitals and other health care providers contracted with a health insurance plan to provide services to members at pre-negotiated (and usually discounted) fees
• The maximum allowable charge (MAC) is the most a plan will pay for a service
For a complete list of definitions, see the Eligibility and Enrollment Guide or visit our website.
www.partnersforhealthtn.gov 1-800-253-9981
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Choosing Your Health Insurance Options
Choose between Two Preferred Provider Organization (PPO) Options
Partnership PPO
Standard PPO
Choose between Four Premium Levels
• Employee
• Employee + child(ren)
• Employee + spouse
• Employee + spouse + children
After the initial new hire period, changes can only be made if you experience a special qualifying event or during Annual Enrollment in the fall.
Choose an Insurance Carrier
• BlueCross BlueShield of Tennessee
• Cigna - Open Access Plus or LocalPlus Networks (LocalPlus is available in Middle Tennessee only)
www.partnersforhealthtn.gov 1-800-253-9981
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PPO Options
• There are two health insurance options available to you:• Partnership PPO
• Standard PPO
• Both of these options are Preferred Provider Organizations (PPOs)
• How a PPO Works:
• Visit any doctor or hospital you want
• However, the PPO has a list of in-network doctors, hospitals and other providers that you are encouraged to use
• These in-network providers have agreed to take lower fees so you pay less for services
• You will pay more for non-emergency services from out-of-network providers
www.partnersforhealthtn.gov 1-800-253-9981
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Comparing Your PPO Options
Partnership PPO
Rewards members for taking an active role in their health
Commitment to Partnership Promise is required
Standard PPO
No incentives for healthy behaviors
Members pay a greater share of costs
Both options cover the same services and treatments. However, you will always pay less for services if you are enrolled in the Partnership PPO.
www.partnersforhealthtn.gov 1-800-253-9981
Step 1: Choose Your PPO Option
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Partnership PPO
• Healthways administers the Partnership Promise
• Partnership PPO members pay much lower premiums
• The Partnership Promise is an annual commitment
• In order to remain in the Partnership PPO, members and covered spouses must complete the Partnership Promise each year
• The Partnership Promise requirements may change from one year to the next
www.partnersforhealthtn.gov 1-800-253-9981
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Partnership Promise – 2014 New Members
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2014 new members and covered spouses must:
• Complete the online Well-Being Assessment (WBA)
• Get a biometric health screening
* Both requirements must be completed within 120 days of your insurance coverage effective date
www.partnersforhealthtn.gov 1-800-253-9981
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Partnership Promise
Online Well-Being Assessment (WBA)
• Summarizes your overall health and offers steps you can take to improve
• By completing the confidential assessment online, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-being
• Go to www.partnersforhealthtn.gov and create an online well-being account to access the assessment
You (and your covered spouse) will have 120 days from your coverage effective date to complete the Well-Being Assessment (WBA).
www.partnersforhealthtn.gov 1-800-253-9981
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Partnership Promise
Biometric Health Screening• A biometric health screening is required within 120 days of your insurance
coverage effective date Screening includes height, weight, waist circumference, blood sugar, blood
pressure and cholesterol levels
• There are two ways to get a screening in 2014:• At a worksite screening
• Go to www.partnersforhealthtn.gov, and in the QuickLinks box, click on Complete Your Biometric Screening to register for a worksite screening in your area
• At your doctor’s office• You may use screening results from a doctor’s visit within the last 12 months• Ask your doctor to complete the Physician Screening Form. Go to
www.partnersforhealthtn.gov, and in the QuickLinks box, click on Complete Your Biometric Screening to download the form
www.partnersforhealthtn.gov 1-800-253-9981
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If You Cover Your Spouse
• Same PPO Option
• Your spouse must also commit to the 2014 Partnership Promise
• Exception: If you and your spouse both work for a Participating Employer you can choose different PPO options
• Partnership Promise is not required for covered children
www.partnersforhealthtn.gov 1-800-253-9981
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Standard PPO
• The Standard PPO offers the same services as the Partnership PPO, but you will pay more for monthly premiums, annual deductibles, pharmacy copays, medical care co-insurance and out-of-pocket maximums
• Members enrolled in the Standard PPO are not required to fulfill the Partnership Promise - but these members do have access to the ParTNers for Health Wellness Program
www.partnersforhealthtn.gov 1-800-253-9981
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Choosing an Insurance Carrier
• Once you choose your PPO, you have a choice of two carriers:
• BlueCross BlueShield of Tennessee offers Network S
• Cigna offers Open Access Plus (statewide) or LocalPlus (middle TN only) • The Cigna LocalPlus network is a pilot program
• Cigna LocalPlus has a narrower network than Cigna Open Access Plus
• You may choose between these two carriers, regardless of the PPO option you select
• Check the networks carefully to make sure your preferred doctors and hospitals are in the network you choose
www.partnersforhealthtn.gov 1-800-253-9981
Step Two: Choosing an Insurance Carrier
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Choosing an Insurance Carrier
• Each carrier has its own network of preferred doctors, hospitals and other health care providers
• Check the networks for each carrier carefully when making your decision
• Provider directories are available
• Online
• By calling the carrier’s customer service phone line
• From your ABC
www.partnersforhealthtn.gov 1-800-253-9981
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Choosing an Insurance Carrier
• Carrier costs vary by grand division
• In East and Middle Tennessee• Cigna Open Access Plus costs $20 more per month
for employee only coverage and $40 more per month for all other tiers
• In Middle Tennessee, Cigna LocalPlus costs the same as BCBST
• In West Tennessee, BlueCross BlueShield costs $20 more per month for employee only coverage and $40 more per month for all other premium tiers
Each carrier offers statewide and national networks, regardless of the region where you live
www.partnersforhealthtn.gov 1-800-253-9981
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Choosing Your Premium Level
• The amount you pay in premiums depends on the PPO you choose and the number of people you cover under the plan
• There are four premium levels (tiers) available:
• Employee Only
• Employee + Child(ren)
• Employee + Spouse
• Employee + Spouse + Child(ren)
Remember: The Partnership PPO premiums are lower than the premiums for the Standard PPO.
www.partnersforhealthtn.gov 1-800-253-9981
Step Three: Choosing Your Premium Level
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Choosing Your Premium Level
• If your spouse works for a participating employer, you have another option:
• Choose premium level (dependent on your situation either employee-only or employee + child or children), PPO and insurance carrier separately
• If you and your spouse are both State and Higher Education employees:
• You may each want to consider enrolling in employee only coverage or employee + children, if you have children, to ensure that you receive the maximum life insurance benefit. However, an individual may only be covered under one policy
www.partnersforhealthtn.gov 1-800-253-9981
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Premiums: Higher Education Plan
Premium Level Partnership PPO Standard PPO
Employee Only $114.49 $139.49
Employee + Child(ren) $171.73 $196.73
Employee + Spouse $240.42 $290.42
Employee + Spouse + Child(ren) $297.67 $347.67
Employee Share of Monthly Premiums*
The State pays 80% of the total premium cost for active employees.
*Premiums shown are for the least expensive carrier in the region. A complete chart is available in the Eligibility and Enrollment Guide and the ParTNers for Health website.
www.partnersforhealthtn.gov 1-800-253-9981
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Covered Services
• The Partnership PPO and the Standard PPO both cover the same services, treatments and products, including the following:
• Preventive care
• Primary care
• Specialty care
• Hospitalization and surgery
• Laboratory and x-rays
• A comparison chart that lists covered services and their costs is available in the Eligibility and Enrollment guide and on the ParTNers for Health website
www.partnersforhealthtn.gov 1-800-253-9981
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Copays
Partnership PPO Standard PPO
In-Network Out-of-Network* In-Network Out-of-Network*
Preventive Care No charge $45 copay No charge $50 copay
Well-baby or Well-child Visits
No charge $45 copay No charge $50 copay
Primary Care $25 copay $45 copay $30 copay $50 copay
Specialty Care $45 copay $70 copay $50 copay $75 copay
Prescription Drugs (30-day supply at Retail Pharmacy)
$5 copay generic
$35 copay preferred brand
$85 copay non-preferred brand
Copay for applicable tier plus amount over Maximum Allowable Charge (MAC)
$10 copay generic
$45 copay preferred brand
$95 copay non-preferred brand
Copay for applicable tier plus amount over Maximum Allowable Charge (MAC)
www.partnersforhealthtn.gov 1-800-253-9981
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Free In-Network Preventive Care
• Annual preventive care check-up offered to members at no cost
• Lab work related to the preventive care visit covered at 100%
• You need to visit an in-network provider to receive preventive care services at no cost
Regular preventive care is one of the most important things you can do to stay healthy.
www.partnersforhealthtn.gov 1-800-253-9981
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Co-Insurance
Partnership PPO Standard PPO
In-Network Out-of-Network* In-Network Out-of-Network*
Inpatient Care (Including Mental Health and Substance Abuse)
You pay 10% You pay 40% You pay 20% You pay 40%
Advanced X-ray, Scans and Imaging You pay 10% You pay 40% You pay 20% You pay 40%
Occupational Therapy, Physical Therapy, Speech Therapy
You pay 10% You pay 40% You pay 20% You pay 40%
Durable Medical Equipment You pay 10% You pay 40% You pay 20% You pay 40%
www.partnersforhealthtn.gov 1-800-253-9981
Prior authorization is required for inpatient care, advanced x-ray, scans and imaging, inpatient therapy and certain medical equipment.
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Annual Deductibles
Partnership PPO Standard PPO
Annual Deductible In-Network Out-of-Network In-Network Out-of-Network
Employee only $450 $800 $800 $1,500
Employee + Child(ren) $700 $1,250 $1,250 $2,350
Employee + Spouse $900 $1,600 $1,600 $3,000
Employee + Spouse + Child(ren) $1,150 $2,050 $2,050 $3,850
You pay the annual deductible before co-insurance benefits kick in. But, any costs you pay toward your deductible will apply to your out-of-pocket maximum.
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Out-of-Pocket Maximums
Partnership PPO Standard PPO
Out-of-Pocket Co-insurance Maximum In-Network Out-of-Network* In-Network Out-of-Network*
Employee Only $1,550 $2,900 $1,900 $3,600
Employee + Child(ren) $2,450 $4,600 $3,100 $5,900
Employee + Spouse $3,100 $5,800 $3,800 $7,200
Employee + Spouse + Child(ren) $4,000 $7,500 $5,000 $9,500
*Members are responsible for 100% of non-emergency out-of-network provider charges above the maximum allowable charge (MAC).
Partnership PPO Standard PPO
Out-of-Pocket Copay Maximum In-Network Out-of-Network* In-Network Out-of-Network*
Per Individual $900 N/A $1,100 N/A
*Out-of-Pocket copay maximum does not apply to out-of-network providers.
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Take Note!
• Deductibles and out-of-pocket maximums for in-network and out-of-network services add up separately
• Services received in-network count toward your in-network deductible and out-of-pocket maximum
• Services received out-of-network count toward your out-of-network deductible and out-of-pocket maximum
Ineligible expenses, including non-covered services and expenses over the MAC don’t count toward
deductibles and out-of-pocket maximums.
Deductible Out-of-Pocket Max
In-Network $450 $1,550
Deductible Out-of-Pocket Max
Out-of-Network $800 $2,900
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Pharmacy Benefits
• Your health plan also includes pharmacy benefits
• The covered drug list is the same for both the Partnership PPO and Standard PPO, although copays differ between the two
• There is a $3,750 in-network pharmacy out-of-pocket copay maximum
• Pharmacy benefits are administered by CVS Caremark, one of the largest pharmacy benefits managers in the country with over 1,600 in-network pharmacies statewide
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• Copay amounts are based on three different factors: the type of pharmacy you use, your PPO option and the drug level (tier) of the medication
• There are three drug levels:
Generic Drug (tier one) is a generic medicine that is FDA-approved and equal to the brand-name product in safety, effectiveness, quality and performance
– Least expensive option
Preferred Brand (tier two) is a brand-name drug included on the drug list
– More expensive option
Non-preferred Brand (tier three) is a brand-name drug not on the drug list
– Most expensive option
Pharmacy Benefits
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Prescription Drug Copays
Partnership PPO Standard PPO
In-Network Out-of-Network In-Network Out-of-Network
30-Day Supply
(only from pharmacies in the 30-day network)
$5 copay generic
$35 copay preferred brand
$85 copay non-preferred brand
Copay, plus any amount exceeding MAC
$10 copay for generic
$45 copay for preferred brand
$95 copay for non-preferred brand
Copay, plus any amount exceeding MAC
90-Day Supply
(90-day network pharmacy or mail order)
$10 copay generic
$65 copay preferred brand
$165 copay non-preferred brand
Copay, plus any amount exceeding MAC
$20 copay for generic
$85 copay for preferred brand
$185 copay for non-preferred brand
Copay, plus any amount exceeding MAC
90-Day Supply
(certain maintenance medications from 90-day pharmacy or mail order)
$5 copay generic
$30 copay preferred brand
$160 copay non-preferred brand
Copay, plus any amount exceeding MAC
$10 copay generic
$40 copay preferred brand
$180 copay non-preferred brand
Copay, plus any amount exceeding MAC
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Employee Assistance Program (EAP)• Provided at no cost to all benefits eligible employees and your benefits
eligible dependents
• ParTNers Employee Assistance Program (EAP) helps you and your family members deal with problems we all experience during our daily lives
• Up to five no-cost sessions per incident
• Your EAP can handle issues related to:• Stress, depression and anxiety
• Family, relationship or marital issues
• Child and elder care
• Grief and loss
• Your EAP also offers no cost financial and legal consultations
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Employee Assistance Program (EAP)
• All services are confidential and available at no cost to members 24/7
• You and your eligible dependents may get up to five, no cost counseling sessions per problem episode, per year
• Your EAP also offers work-life services, financial and legal services, assistance finding eldercare and dependent care services and much more
• Contact ParTNers EAP:
• Toll Free 24/7 at 1.855.HERE4TN (1.855.437.3486)
• Or at www.Here4TN.com
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Mental Health and Substance Abuse Treatment
• Members and dependents who are enrolled in health coverage are enrolled in the Mental Health and Substance Abuse services
• Services generally include:
• Outpatient assessment and treatment
• Inpatient assessment and treatment
• Alternative care such as partial hospitalization, residential treatment and intensive outpatient treatment
• Treatment follow-up and aftercare
• Costs are based on your health plan
• Prior authorization is required for some services
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Eligible employees can choose between two dental options:
• Each year during Annual Enrollment, eligible employees can enroll in or transfer between dental options
• Unlike health insurance where a portion of the premium is paid by the employer, dental insurance is paid 100% by the employee
Optional Dental Benefits
Assurant Prepaid Plan
• Participating dentists only
• Fixed copays
Delta Dental PDO Plan
• Coinsurance and deductible
• Any dentist
• Pay less with network providers
www.partnersforhealthtn.gov 1-800-253-9981
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Prepaid Plan
Prepaid Plan Administered by Assurant Employee Benefits
• The network is DentiCare
• Predetermined copay amounts (reduced fees) for dental treatments
• There are no deductibles to meet, no claims to file, no waiting periods for covered members, no annual dollar maximum and pre-existing conditions are covered
• Referrals are not required
• To receive benefits, you must select a dentist from the Prepaid Plan list
• Note: There are some areas in the state where Assurant network dentists are not available
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Preferred Dental Organization
• The Preferred Dental Organization (PDO) is administered by Delta Dental of Tennessee
• Use Delta Dental’s PDO network
• You pay co-insurance for covered services
• A deductible applies for out-of-network dental care
• Referrals are not required
• You or your dentist will file claims for covered services
• Some services require waiting periods and limitations/exclusions apply
• To find a dentist in Delta Dental’s network, visit the dental section of the ParTNers for Health website or call the number listed on the inside cover
of the Eligibility and Enrollment Guide
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Dental Premiums
Dental services for both the Prepaid Plan and the Dental PDO include:
• Periodic oral evaluations • Routine Cleanings • Amalgam fillings
• Endodontic – Root Canals • X-rays • Extractions
• Major restorations • Orthodontics • Dentures
Premiums Prepaid Plan PDO Plan
Employee Only $9.92 $21.07
Employee + Child(ren) $20.60 $48.44
Employee + Spouse $17.58 $39.85
Employee + Spouse + Child(ren) $24.17 $77.98
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Optional Vision Benefits
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Eligible employees can choose between two State vision plans
• Full list of vision benefits is available in the Eligibility and Enrollment Guide and on the ParTNers for Health website
• Administered by EyeMed Vision Care
• Members have access to EyeMed’s Select Network
Basic Plan
• Discounted rates
• Allowances
Expanded Plan
• Co-pays
• Allowances
• Discounted rates
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Vision Premiums
Premiums Basic Plan Expanded Plan
Employee Only $3.27 $5.73
Employee + Child(ren) $6.54 $11.46
Employee + Spouse $6.21 $10.89
Employee + Spouse + Child(ren) $9.61 $16.84
Both plans offer the same services:
• Annual routine eye exam (1x/year) • Eyeglass lenses (1x per year)
• Frames (1x every 2 years) • Contact lenses (1x per year)1
• Discount on Lasik/refractive surgery 1Instead of eyeglass lenses
Each year during Annual Enrollment, eligible employees can enroll in or transfer between vision options.
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Additional Benefits
• Higher Education employees are also eligible for:
• ParTNers for Health Wellness Program
• Life Insurance
• Long-Term Care Insurance
Did You Know?
All State employees have access to the ParTNers for Health Wellness Program even if enrolled in the Standard PPO.
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ParTNers for Health Wellness Program
• The Wellness Program is designed to provide opportunities to manage and improve your health
• Services are free to all members enrolled in health coverage and their spouses and dependents enrolled in the health plan
The Nurse Advice Line gives you medical information and support 24/7
Health coaching offers professional support to create and meet goals to improve your health
Well-Being Connect, the ParTNers for Health Web Portal, links you to powerful online tools and health information at your fingertips (look for My Wellness Login)
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ParTNers for Health Wellness Program
An online Well-Being Assessment (WBA) is available to help you learn more about your health and identify any potential health risks
Sign up for weekly health tips by email to receive a short email with each week’s healthy living tip.
Fitness center discounts are available to plan members for fitness centers across the state
• To access any of the services listed here, visit the wellness webpage
on the ParTNers for Health website
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Working for a Healthier Tennessee
The goal of Working for a Healthier Tennessee is to encourage and enable State employees and our plan members to lead healthier lives
• Initiative implemented under the leadership of Governor Bill Haslam and is supported by the ParTNers for Health Wellness Program and the ParTNers Employee Assistance Program
Some of our agencies will have Site Champions who provide ideas and activities to help employees improve in three key areas:
• Physical activity• Healthy eating• Tobacco cessation
All Higher Education plan members have access to ParTNers for Health tools and resources like Well-Being Connect, the Well-Being Assessment (WBA) and Nutrition and Fitness Challenges
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Basic Term Life and Accidental Death and Dismemberment
• The State provides, at no cost to every full-time employee:
• $20,000 of basic term life insurance
• $40,000 of basic accidental death and dismemberment (AD&D)
• If you are enrolled in health insurance, your coverage automatically increases with your salary up to:
• $50,000 for term life insurance
• $100,000 for AD&D insurance
• If you enroll in family health insurance, your dependents enrolled in health insurance are also covered for $3,000 of basic dependent term life coverage and an amount for basic AD&D based on your salary and family composition
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Optional AD&D Insurance
• In addition to basic coverage, you and your dependents may also enroll in optional accidental death and dismemberment insurance
• For a premium, this coverage pays an additional amount in the case of accidental death or dismemberment
• You may enroll as a new employee or during Annual Enrollment
• For new hires, coverage is available at low group rates, no questions asked
Basic Term Life, Basic AD&D and Optional AD&D are administered by Minnesota Life
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Optional Term Life Insurance
• Premiums are based on age and the amount of coverage requested
• Coverage is also available for spouses and dependent children
Spouses: maximum level of coverage is $30,000 Children: $5,000 or $10,000 term rider
• Must enroll in first 30 days of employment for guaranteed issue coverage and coverage is effective after 3 full months of employment
• You can apply later during Annual Enrollment by answering health questions
• Select up to five times your annual base salary when first eligible
Minimum coverage level: $5,000 Maximum coverage level: $500,000
Optional Term Life Insurance is administered by Minnesota Life
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Long-Term Care Insurance
• Covers services for qualified members who are unable to care for themselves without the assistance of others
• Nursing facility care
• Assisted living facility care
• Home care
• You have 90 days to enroll with guaranteed-issue coverage
• Your spouse, dependent children, parents and parents-in-law may also apply through medical underwriting
• Premiums are based on the age of the insured at the time of enrollment
• Plan administered by MedAmerica
• Adult day care
• Hospice program service
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Enrolling in Benefits
• All Higher Education employees must enroll using Edison Employee Self Service (ESS) for health, dental and vision coverage, and optional AD&D insurance
• Enrollment must be completed within 31 days of your hire date
• Any required dependent verification must also be submitted during this timeframe
• Example dependent verification documents include:
• Federal Income Tax Return for a spouse
• Birth certificate for a child
To enroll in optional benefit products such as life insurance, use the separate enrollment forms provided by your ABC.
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Online Enrollment through ESS
• To select your health insurance and other benefit options online
• Log on to Edison» www.edison.tn.gov
» Use username and temporary password provided by your Human Resource office
» Navigate to Employee Self Service > Benefits > Benefits Enrollment
» Click the SELECT button
» Follow the prompts to enroll
• If you are covering dependents, you can submit dependent verification by:
» Uploading electronic documentation
» Faxing documentation to Benefits Administration service center
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When Will Coverage Begin?
• Health, dental and vision coverage begin on the first day of the month following your hire date
• For example, if you are hired on September 15th, your coverage would begin on October 1st
• Optional Term Life coverage begins after three full calendar months from employment/eligibility
• Optional Long-Term Care effective date is included with the Certificate of Coverage issued by MedAmerica
• Ask your ABC if you have questions about when your coverage begins
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When Are Premiums Paid?
• Your ABC will tell you when your premiums will be deducted from your paycheck
• To avoid a large deduction from your first paycheck, submit your benefit selections in ESS or your enrollment forms to your ABC as soon as possible
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When Will My ID Cards Arrive?
• Within three weeks of the date your application is processed
• CVS Caremark will send separate ID cards for your pharmacy benefits (Note: each family member’s card may arrive in a separate envelope)
• If you enroll in dental or vision benefits, you will also receive your ID cards within three weeks
BlueCross BlueShield
• Will send up to two ID cards automatically, both with the member’s name
• These may be used by any covered dependent
Cigna
• Will send separate ID cards for each insured family member with each participant’s name
• There may be up to four ID cards in each envelope
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Your Privacy
www.partnersforhealthtn.gov 1-800-253-9981
• Your personal health information is strictly confidential
• Your health privacy rights are protected through a federal law called “HIPAA”
• Benefits Administration can only discuss benefits information with the head of contract (HOC)
• The Authorization for Release of Protected Health Information form must be completed before Benefits Administration can discuss benefits information with your spouse or other authorized representative
To print and complete a release form, visit http://www.tn.gov/finance/ins/forms.html
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Insurance Carrier Websites
• BlueCross BlueShield, Cigna and CVS Caremark each offer member websites that allow you to:
• View detailed information about your claims
• Print temporary ID cards
• Access other helpful member services
BlueCross BlueShield Cigna
www.bcbst.com/members/tn_state/ www.cigna.com/site/stateoftn
www.partnersforhealthtn.gov 1-800-253-9981
CVS Caremark
www.caremark.com
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Who to Contact
• Your primary point of contact is your Agency Benefits Coordinator (ABC)
• If you have questions about a provider or insurance claim, contact your insurance carrier directly at the number listed on the inside cover of the Eligibility and Enrollment Guide, visit your carrier’s member website or use the number on the back of your ID card
• If you have questions about eligibility and enrollment, call the Benefits Administration service center at 1-800-253-9981
• Benefits Administration www.tn.gov/finance/ins
• ParTNers for Health www.partnersforhealthtn.gov
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Thank you for your attention during this presentation.
More information is available at www.TN.gov/finance/ins.
If you have questions, please ask your Agency Benefits Coordinator at this time.