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
• 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
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1
Resource Materials
For more detailed information, refer to
the Eligibility and Enrollment Guide
provided by your ABC.
You will also be provided with an Employee
Checklist to confirm that you have been
informed of important benefits information
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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.
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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
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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
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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
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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
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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.
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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
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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
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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 innetwork 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.
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Choosing Your Health
Insurance Options
 Choose between
Two Preferred
Provider
Organization (PPO)
Options
 Partnership PPO
 Standard PPO
 Choose an
Insurance Carrier
• BlueCross BlueShield of
Tennessee
• Cigna - Open Access
Plus or LocalPlus
Networks (LocalPlus is
available in Middle
Tennessee only)
 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.
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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
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Comparing Your PPO Options

Step 1: Choose Your PPO Option
Partnership PPO
Standard PPO
 Rewards members for taking
an active role in their health
 No incentives for healthy
behaviors
 Commitment to Partnership
Promise is required
 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.
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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
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Partnership Promise –
2014 New Members
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
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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).
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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
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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
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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
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20
Choosing an Insurance Carrier
 Step Two: 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
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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
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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
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Choosing Your Premium Level
 Step Three: 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.
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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
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Premiums:
Higher Education Plan
Employee Share of Monthly Premiums*
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
*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.
The State pays 80% of the total premium cost for active employees.
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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
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Copays
Partnership PPO
In-Network
Out-of-Network*
Standard PPO
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
$5 copay
generic
Copay for applicable
tier plus amount
over Maximum
Allowable Charge
(MAC)
$10 copay
generic
Copay for applicable
tier plus amount
over Maximum
Allowable Charge
(MAC)
(30-day supply at Retail
Pharmacy)
$35 copay
preferred brand
$85 copay
non-preferred brand
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$45 copay
preferred brand
$95 copay
non-preferred brand
28
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.
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Co-Insurance
Partnership PPO
In-Network
Out-of-Network*
Standard PPO
In-Network
Out-of-Network*
Inpatient Care
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%
(Including Mental Health
and Substance Abuse)
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
Annual Deductible
Standard PPO
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
$1,150
$2,050
$2,050
$3,850
Employee + Spouse + Child(ren)
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
Out-of-Pocket Co-insurance
Maximum
Standard PPO
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
Out-of-Pocket Copay Maximum
Per Individual
Standard PPO
In-Network
Out-of-Network*
In-Network
Out-of-Network*
$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
In-Network
• Services received out-of-network
count toward your out-of-network
deductible and out-of-pocket
maximum
Out-of-Network
Deductible
Out-of-Pocket Max
$450
$1,550
Deductible
Out-of-Pocket Max
$800
$2,900
Ineligible expenses, including non-covered services
and expenses over the MAC don’t count toward
deductibles and out-of-pocket maximums.
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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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Pharmacy Benefits
• 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
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Prescription Drug Copays
Partnership PPO
In-Network
Out-of-Network
Standard PPO
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 nonpreferred 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 nonpreferred brand
Copay, plus any
amount exceeding
MAC
$20 copay for
generic
$85 copay for
preferred brand
$185 copay for nonpreferred 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 nonpreferred brand
Copay, plus any
amount exceeding
MAC
$10 copay generic
$40 copay preferred
brand
$180 copay nonpreferred 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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Optional Dental Benefits
Eligible employees can choose between two dental options:
Assurant Prepaid Plan
Delta Dental PDO Plan
• Participating dentists only
• Coinsurance and deductible
• Fixed copays
• Any dentist
• Pay less with network
providers
• 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
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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
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
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
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Optional Vision Benefits
Eligible employees can choose between two State vision plans
Basic Plan
Expanded Plan
• Discounted rates
• Co-pays
• Allowances
• Allowances
• Discounted rates
• 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
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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
Instead of eyeglass lenses
1
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
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Did You Know?
All State employees have access
to the ParTNers for Health
Wellness Program even if
enrolled in the Standard PPO.
46
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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48
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
www.partnersforhealthtn.gov
1-800-253-9981
49
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
www.partnersforhealthtn.gov
1-800-253-9981
50
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
www.partnersforhealthtn.gov
1-800-253-9981
51
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
www.partnersforhealthtn.gov
1-800-253-9981
52
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
• Adult day care
• Hospice program service
• 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
www.partnersforhealthtn.gov
1-800-253-9981
53
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.
www.partnersforhealthtn.gov
1-800-253-9981
54
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
www.partnersforhealthtn.gov
1-800-253-9981
55
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
www.partnersforhealthtn.gov
1-800-253-9981
56
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
www.partnersforhealthtn.gov
1-800-253-9981
57
When Will My ID Cards Arrive?
• Within three weeks of the date your application is processed
BlueCross BlueShield
Cigna
• Will send up to two ID cards
automatically, both with the member’s
name
• Will send separate ID cards for each
• These may be used by any covered
dependent
• There may be up to four ID cards in
insured family member with each
participant’s name
each envelope
• 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
www.partnersforhealthtn.gov
1-800-253-9981
58
Your Privacy
• 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
www.partnersforhealthtn.gov
1-800-253-9981
59
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
 CVS Caremark
www.caremark.com
www.partnersforhealthtn.gov
1-800-253-9981
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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
• ParTNers for Health
www.partnersforhealthtn.gov
www.partnersforhealthtn.gov
• Benefits Administration
www.tn.gov/finance/ins
1-800-253-9981
61
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.
62