Importance of Your Decisions

State of TennesseeGroup Insurance ProgramNew Employee Benefits Orientation Higher Education Employees - 2013

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 Importance of Your Decisions

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

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

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 About the Plan

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

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 Notice to TennCare Enrollees

Adding Coverage There are only three times you may add health coverage: • As a new employee • During the fall annual enrollment transfer period • 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

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.

You may only cancel health, dental or vision coverage for yourself or your dependents: During the Annual Enrollment Transfer Period If you become ineligible to continue coverage 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 Canceling Coverage

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

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 • BlueCross BlueShield of Tennessee • Cigna Choose between Four Premium Levels • Employee • 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.

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

Partnership PPO Rewards members for taking an active role in their health Commitment to Partnership Promise is required Comparing Your PPO Options Standard PPO • No incentives for healthy behaviors • 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.

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 Partnership PPO

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.

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 well-being account to access the assessment You will have 120 days to complete the Well-Being Assessment.

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

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

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 Standard PPO

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 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 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 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 Choosing an Insurance Carrier Each carrier offers statewide and national networks, regardless of the region where you live

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) Choosing Your Premium Level Remember: The Partnership PPO premiums are lower than the premiums for the Standard PPO.

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. Choosing Your Premium Level

Employee Share of Monthly Premiums* Premiums: Higher Education Plan *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.

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

Co-Pays

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 Free In-Network Preventive Care Regular preventive care is one of the most important things you can do to stay healthy.

Co-Insurance Note: Prior authorization is required for inpatient care, advanced x-ray, scans and imaging, inpatient therapy and certain medical equipment.

Annual Deductibles You pay the annual deductible before co-insurance benefits kick in.

Out-of-Pocket Maximums *Members are responsible for 100% of non-emergency out-of-network provider charges above the maximum allowable charge (MAC). *Out-of-Pocket Co-Pay maximum does not apply to out-of-network providers.

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.

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 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 Pharmacy Benefits

Prescription Drug Co-pays

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 Mental Health and Substance Abuse Treatment

Optional Dental Benefits Eligible employees can choose between two dental options • 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 Prepaid Plan • Participating dentists only • Fixed co-pays PDO Plan • Any dentist • Pay less with network providers

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 Prepaid Plan

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 Preferred Dental Organization

Optional Dental Benefits Dental services for both the Prepaid Plan and the Dental PDO include:

Optional Vision Insurance Eligible employees can choose between two 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 42 42

Optional Vision Insurance Both plans offer the same services: Each year during AETP, eligible employees can enroll in or transfer between vision options. 43

Higher Education employees are also eligible for: ParTNers Employee Assistance Program ParTNers for Health Wellness Program Life Insurance Long-Term Care Insurance Your ABC will provide you with information about additional benefits your employer may offer, such as a flexible benefits or deferred compensation Additional Benefits Did You Know? 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.

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

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.

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)

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

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

Importance of Your Decisions