State of Tennessee
Group Insurance Program
New Employee Benefits Orientation
Higher Education Employees - 2013
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
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
2
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.
3
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
4
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
5
Notice to TennCare Enrollees
• You must contact your caseworker at the Department of
Human Services (DHS) within 10 days of your date of
employment
• Report to DHS your new job, salary and that you have access
to medical insurance with your new employer
6
Adding Coverage
There are only three times you may add health coverage:
1. As a new employee
2. During the fall annual enrollment transfer period
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
7
Annual Enrollment Transfer Period
• During the Annual Enrollment Transfer Period (AETP), you may:
•
•
•
•
Add health insurance coverage
Change health insurance carriers
Choose a different PPO
Cancel health insurance coverage
• Changes are effective January 1 of the following year
• Add, cancel or make changes to optional benefits during AETP
The Annual Enrollment Transfer Period occurs each
year during the fall, usually around October.
8
Canceling Coverage
•
You may only cancel health, dental or vision coverage for
yourself or your dependents:
1. During the Annual Enrollment Transfer Period
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
AETP, unless you have a qualifying event or lose eligibility
under the plan
9
Definitions
• Premiums are the amount you pay each month for your coverage
regardless of whether or not you receive health services
• A co-pay 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 that require co-insurance
• Co-insurance is a form of payment where you pay a percentage of the
cost for a service, after meeting your deductible
10
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 co-pay maximum limits how much you pay for certain
in-network services that require co-pays
• 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.
11
Choosing Your Health
Insurance Options
 Choose between
Two Preferred
Provider
Organization (PPO)
Options
 Partnership PPO
 Standard PPO
 Choose an
Insurance Carrier
 Choose between
Four Premium
Levels
• BlueCross BlueShield of
Tennessee
• Employee
• Cigna
• Employee + child(ren)
• Employee + spouse
• Employee + spouse +
children
All members have the same choices. After the initial new hire
period, changes can only be made if you experience
a special qualifying event or during AETP in the fall.
12
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 services from out-of-network providers
13
Comparing Your PPO Options
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, treatments and products.
However, under the Partnership PPO, when you take an active role in
your health, you will pay less.
14
Partnership PPO
• The Partnership PPO option allows you to pay less for your coverage
by taking an active role in your health and fulfilling the Partnership
Promise
• The Partnership Promise is an annual commitment
• In order to remain in the Partnership PPO, you must meet your
commitment each year by the deadline
• The Partnership Promise requirements may change from one year to
the next
15
Partnership Promise
New members and their covered spouses must:
• Complete the online Well-Being Assessment
• Get a biometric health screening
* Both requirements must be completed within 120 days
of your insurance coverage effective date.
16
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
• You must visit www.partnersforhealthtn.gov and create an online wellbeing account to access the assessment
You will have 120 days to complete the Well-Being Assessment.
17
Partnership Promise
Biometric Health Screening
• You must get a health screening from your health care provider

This includes height, weight, blood sugar, blood pressure and cholesterol level
• You may use screening results from a doctor’s visit within the last 12
months
• Simply ask your doctor to complete the Physician Screening Form, which is
available online at www.partnersforhealthtn.gov
• Send the completed form to Healthways by the 120-day deadline
18
If You Cover Your Spouse
• Same PPO Option
• Your spouse must also commit to the Partnership Promise
• Exception: If you and your spouse both work for a
Participating Employer you can choose different options
• Partnership Promise is not required for covered children
19
Standard PPO
• The Standard PPO offers the same services as the
Partnership PPO, but you will pay more for monthly
premiums, annual deductibles, pharmacy co-pays, medical
care co-insurance and out-of-pocket maximums
• Members enrolled in the Standard PPO are not required to
fulfill the Partnership Promise
20
Choosing an Insurance Carrier
• Once you choose your PPO, you have a choice of two
carriers:
• BlueCross BlueShield of Tennessee (Network S)
• Cigna (Open Access Plus)
• You may choose between these two carriers, regardless of
the PPO option you select
21
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
22
Choosing an Insurance Carrier
• There are three regions (grand divisions): East, Middle and West
• Carrier costs vary by grand division
• CIGNA is more expensive in the East and Middle
grand divisions
• BlueCross BlueShield of Tennessee is more
expensive in the West grand division
STEWART
LAKE
OBION
ROBE RTSON
JACKSON
WILSON
PUTNAM
RUTHERFORD
ROANE
CANNON
VAN BURE N
BLEDSOE
MAURY
LEWIS
BEDFORD
CHESTER
HARDEMAN
MCNAI RY
HARDIN
WAYNE
LAWRENC E
GILES
LINCOLN
MCMINN
BLOUNT
MONROE
SEQUATCHIE
MOORE
FAYETT E
LOUDON
MEIGS
GRUNDY
SEVIER
RHEA
COFFEE
MARSHALL
SHELBY
COCKE
WARRE N
PERRY
DECATUR
GREENE
JEFFERSON
CUMBERLAND
WHITE
WILLIAMSON
HENDERSON
HAMBLEN
UNICOI
ANDERSON
KNOX
DEKALB
HICKMAN
MADISON
MORGAN
CARTER
GRAINGER
SMITH
DAVIDSO N
DICKSON
LAUDERDALE
HAYWOO D
WASHINGTON
UNION
JOHNSON
HAWKIN S
CAMPBELL
FENTRESS
HUMPHREYS
CARROLL
CROCKETT
TIPTON
OVERTON
SULLI VAN
HANCOCK
CLAIBORNE
SCOTT
TROUSDALE
BENTON
PICKETT
CLAY
MACON
SUMNER
CHEATHAM
HOUS TON
DYER
GIBSON
MONTGOME RY
HENRY
WEAKLEY
FRANKLIN
MARION
HAMILTON
BRADLEY
POLK
• If you live and work in different regions, you can choose between the two
• Before selecting a carrier, review the premium rate and provider network to
help you decide
Each carrier offers statewide and national networks,
regardless of the region where you live
23
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.
24
Choosing Your Premium Level
• If your spouse works for a participating employer, you have another
option:
• Choose premium level separately (employee only)
• Choose your PPO option 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.
25
Premiums:
Higher Education Plan
Employee Share of Monthly Premiums*
Premium Level
Partnership PPO
Standard PPO
Employee Only
$108.52
$133.52
Employee + Child(ren)
$162.78
$187.78
Employee + Spouse
$227.89
$277.89
Employee + Spouse + Child(ren)
$282.15
$332.15
*This chart shows the premiums for the less expensive carrier in your region
The State pays 80% of the total premium cost for active employees.
26
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
• A pre-existing condition exclusion period of 12 months may apply
unless you can provide proof of prior creditable coverage
27
Co-Pays
Partnership PPO
In-Network
Out-of-Network*
Standard PPO
In-Network
Out-of-Network*
Preventive Care
No charge
$45 co-pay
No charge
$50 co-pay
Well-baby or Well-child
Visits
No charge
$45 co-pay
No charge
$50 co-pay
Primary Care
$25 co-pay
$45 co-pay
$30 co-pay
$50 co-pay
Specialty Care
$45 co-pay
$70 co-pay
$50 co-pay
$75 co-pay
Prescription Drugs
$5 co-pay
generic
Co-pay for applicable
tier plus amount
over MAC
$10 co-pay
generic
Co-pay for applicable
tier plus amount
over MAC
(30-day supply at Retail
Pharmacy)
$35 co-pay
preferred brand
$85 co-pay
non-preferred brand
$45 co-pay
preferred brand
$95 co-pay
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.
29
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)
Note: Prior authorization is required for inpatient care, advanced x-ray, scans and imaging, inpatient therapy and certain medical equipment.
30
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.
31
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 Co-pay 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 Co-Pay maximum does not apply to out-of-network providers.
32
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
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
$450
$1,550
Deductible
Out-of-Pocket Max
$800
$2,900
33
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 co-pays differ between the two
• 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
34
Pharmacy Benefits
• Co-pay 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
35
Prescription Drug Co-pays
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 co-pay generic
$35 co-pay preferred
brand
$85 co-pay nonpreferred brand
Co-pay, plus any
amount exceeding
MAC
$10 co-pay for
generic
$45 co-pay for
preferred brand
$95 co-pay for nonpreferred brand
Co-pay, plus any
amount exceeding
MAC
90-Day Supply
(90-day network pharmacy
or mail order)
$10 co-pay generic
$65 co-pay preferred
brand
$165 co-pay nonpreferred brand
Co-pay, plus any
amount exceeding
MAC
$20 co-pay for
generic
$85 co-pay for
preferred brand
$185 co-pay for
non-preferred brand
Co-pay, plus any
amount exceeding
MAC
90-Day Supply
(certain maintenance
medications from 90-day
pharmacy or mail order)
$5 co-pay generic
$30 co-pay preferred
brand
$160 co-pay nonpreferred brand
Co-pay, plus any
amount exceeding
MAC
$10 co-pay generic
$40 co-pay
preferred brand
$180 co-pay nonpreferred brand
Co-pay, plus any
amount exceeding
MAC
36
Mental Health and Substance
Abuse Treatment
• Employees and dependents who are enrolled in health coverage
are also eligible for mental health and substance abuse services
• Mental Health and Substance Abuse services generally include:
• Individual and group treatment
• Hospitalization
• Aftercare
• Costs are based on your health plan
• Prior authorization is required for some services
37
Optional Dental Benefits
Eligible employees can choose between two dental options
Prepaid Plan
PDO Plan
• Participating dentists only
• Any dentist
• Fixed co-pays
• Pay less with network
providers
• Each year during the Annual Enrollment Transfer Period, 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 member
38
Prepaid Plan
• The Prepaid plan is administered by Assurant Employee Benefits
• The Prepaid Plan provides dental services at predetermined co-pay
amounts from a limited network of participating dentists and specialists
• This means you must select a provider from a limited network of dentists
and submit your selection to Assurant before any services will be covered
• The are no deductibles, no claims to file, no waiting periods, no annual
dollar maximum, pre-existing conditions are covered and referrals are not
required
• To find a dentist in Assurant’s network, visit the dental section of the
ParTNers for Health website or call the Assurant number listed in the
Eligibility and Enrollment Guide
39
Preferred Dental Organization
• The PDO is administered by Delta Dental of Tennessee
• Under the Preferred Dental Organization (PDO), you may use any
dentist
• Referrals are not necessary with the PDO and you or your dentist file
claims for covered services
• There is a one-year waiting period for some services, such as orthodontia
• Calendar year maximum of $1,500 per person
• Lifetime orthodontics maximum of $1,250 per person
• 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
40
Optional Dental Benefits
Premiums
Prepaid Plan
PDO Plan
Employee Only
$9.63
$20.46
Employee + Child(ren)
$20.00
$47.03
Employee + Spouse
$17.07
$38.69
Employee + Spouse + Child(ren)
$23.47
$75.71
Dental services for both the Prepaid Plan and the Dental PDO include:
• Periodic oral evaluations
• Routine Cleanings
• Amalgam fillings
• Endodontic
• X-rays
• Extractions
• Major restorations
• Orthodontics
• Dentures
41
Optional Vision Insurance
Eligible employees can choose between two 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
42
Optional Vision Insurance
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
• Eyeglass lenses
• Frames
• Contact lenses
• Discount on Lasik/refractive surgery
Each year during AETP, eligible employees can enroll
in or transfer between vision options.
43
Additional Benefits
• Higher Education employees are also
eligible for:
•
•
•
•
Did You Know?
ParTNers Employee Assistance Program
ParTNers for Health Wellness Program
Life Insurance
Long-Term Care Insurance
• Your ABC will provide you with information
Services provided by
ParTNers EAP are FREE
regardless of whether you
enroll in health insurance!
Learn more about these
valuable services on the
following slides.
about additional benefits your employer may
offer, such as a flexible benefits or deferred
compensation
44
ParTNers EAP
• ParTNers Employee Assistance Program (EAP) helps you and your
family members deal with problems we all experience during our
daily lives
• Your EAP can handle issues related to:
• Stress, depression and anxiety
• Family, relationship or marital issues
• Child and elder care
• Grief and loss
• You receive up to 5 free counseling sessions per separate incident
• Your EAP also offers free financial and legal consultations
45
ParTNers EAP
• There is no cost to you for services provided by ParTNers EAP, and
your confidentiality is always a top priority
• ParTNers EAP is administered by Magellan Health Services
• Services are available 24/7 at www.Here4TN.com or by calling
Magellan at the number listed on the inside cover of your Eligibility
and Enrollment Guide.
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 covered spouses and dependents

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)
47
ParTNers for Health
Wellness Program
 An
online Well-Being Assessment is available to help you learn more
about your health and identify any potential 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
48
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 increases with your
salary up to:
• $50,000 for term life insurance
• $100,000 for AD&D insurance
•
If you enroll in health insurance, your eligible dependents 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
49
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 AETP
• Coverage is available at low group rates, no questions asked
Basic Term Life, Basic AD&D and Optional AD&D
are administered by Dearborn National
50
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 months of employment
• You can apply later during AETP by answering health questions
• Select up to 5 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
51
Long-Term Care Insurance
• Covers services for qualified members who are unable to care for
themselves without the assistance of others
• Nursing home care
• Assisted living
• Home health care
• Home care
• Adult day 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
52
Enrolling in Benefits
• Two ways to enroll:
• Enrollment Change Application
• Edison Employee Self Service (ESS)
STATE OF TENNESSEE GROUP INSURANCE PROGRAM
ENROLLMENT CHANGE APPLICATION
State of Tennessee • Department of Finance and Adminis
tration • Benefits Administration
312 Rosa L.Parks Avenue • Suite 2600 • Nashville, TN
37243 • Fax:615.741.8196
Part 1: Action Requested —please see page 4 for instructions
Type of Action
Coverage
Affected
Health
Dental
Vision
Add Coverage
Change Coverage
Terminate Coverage
Participants
Affected
Employee
Spouse
Child(ren)
Reason for This Action
New Hire/ Newly Eligible
Terminate Employment
Special Qualifying Event
(also complete page 3)
Court Order
Legal Guardianship
Newborn/ Adoption
Other (specify)
Marriage
Divorce
Death
Part 2: Employee Information
First Name
MI
Last Name
Date of Birth
Gender
Marital Status
M
Social Security Number
Employing Agency
Employer Group:
State
Home Address
City
Local Ed
ST
F
UT
S
M
D
W
Your Current Status
TBR
Active
COBRA
Local Gov
ZIP Code
County
Part 3: Health Coverage Selection
• Enrollment must be completed within
31 days of your hire date
Select a Benefit Option
Select a Carrier
Standard PPO
Partnership PPO
Limited PPO (available
to local government only)
BlueCross BlueShield
Network S
Cigna
Open Access Plus
Select Region Where You Live or Work
See page 4 for map and
East
Middle information for out of state
residents
West
Select a Health Premium Level
employee only
employee + child(ren)
employee + spouse
employee + spouse + child(ren)
Part 4: Dental Coverage Selection
Part 5: Vision Coverage Selection
Select a Plan
Delta PDO
Assurant Prepaid
Select a Plan
Basic Plan
Expanded Plan
Select a Dental Premium Level
employee only
employee + child(ren)
employee + spouse
employee + spouse + child(ren)
Select a Vision Premium Level
employee only
employee + child(ren)
employee + spouse
employee + spouse + child(ren)
Part 6: Dependent Information —attach a separate sheet if necessar y
Name (First, MI, Last)
• Any required dependent verification must
also be submitted during this timeframe
• See page 2 of the enrollment application or the
forms and publications section of our website
for information about dependent verification
Date of Birth
Relationship
Gender
Acquire date *
M
F
M
F
M
F
Social Security Number Health Dental Vision
* The acquire date is the date of mar
riage, birth, adoption or guardianship.
Proof of a dependent’s eligibility mus
t be submitted with this application for all new dependents (see page 2).
A separate sheet with more
dependents is attached
Part 7: Employee Authorization
Accept
Refuse
I confirm that all of the information above is true. If I chose the Partnership PPO, then I agree to the terms and conditions of the Partnership
Promise for the plan year indicated on page 4. I know that I can lose my insurance if I give false information. I may also face disciplinar y and legal
charges. If my dependents lose eligibilit y, I know that I must tell my benefits coordinator within one calendar month. If I do not, then I will have to pay
the plan back for all of my dependent’s healthcare bills. I author ize my employer to take deductions from my paycheck to pay for my benefits costs.
Finally, I authorize healthcare providers to give my insurance carrier the medical and insurance records for me and my dependents.
I have been given the oppor tunity by my employer to apply for the group insurance program and have decided not to take advantage of this offer.
I understand that if I later wish to apply, I or my dependents will have to provide proof of a special qualifying event.
Employee Signature
Date
Home Phone (REQUIRED)
Email Address (REQUIRED)
Agency Section —Return this Form to your Agency Benefits Coordinator
Original Hire Date
Coverage Begin/ End Date Position Number
Agency Benefits Coordinator Signature
Edison ID
(Optional) Notes to Benefi ts Administration
Date
Active employees should return this completed form to your agency benefi
ts coordinator. COBRA participants should send to Benefi
ts Administration.
FA-1043 (rev 9/ 12)
To enroll in optional benefit products such as life insurance,
use the separate enrollment forms provided by your ABC.
53
Online Enrollment through ESS
• 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 ABC
» 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
54
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
• Ask your ABC if you have questions about when your
coverage begins
55
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
56
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
57
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 the forms section of www.tn.gov/finance/ins.
58
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
 CVS Caremark
www.bcbst.com/blueaccess
www.mycigna.com
www.caremark.com
59
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
• Benefits Administration
www.tn.gov/finance/ins
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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.
61