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State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 – November 1, 2012. Annual Enrollment Transfer Period Using ESS in Edison What ’ s Changing for 2013? Health Benefits Overview 2013 Partnership Promise Vision, Dental and Additional Benefits Overview.

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State of Tennessee Group Insurance ProgramAnnual Enrollment Transfer Period

October 1 – November 1, 2012

Annual Enrollment Transfer Period

Using ESS in Edison

What’s Changing for 2013?

Health Benefits Overview

2013 Partnership Promise

Vision, Dental and Additional Benefits Overview


annual enrollment transfer period
Open Enrollment: October 1 – November 1, 2012

No increase to monthly late applicant fee

Employees can make the following changes:

Switch PPOs (subject to eligibility)

Change health insurance carriers

Enroll in health insurance with a monthly late applicant fee

Cancel health coverage

Enroll in optional vision coverage

Enroll in, cancel or transfer between dental options

Annual Enrollment Transfer Period

annual enrollment transfer period1
If you DO NOT want to make changes

No action is required this year

If you stay in the Partnership PPO, you (and your covered spouse) are agreeing to fulfill the 2013 Partnership Promise

If you DO want to make changes

You must use Employee Self Service (ESS) in Edison

Benefits Administration will not accept paper forms

Annual Enrollment Transfer Period

annual enrollment transfer period2
Changes take effect on January 1, 2013

Selections remain in effect through December 31, 2013

A qualifying event or family status change is something that results in a covered person losing coverage or becoming newly eligible for other coverage

Contact your agency benefits coordinator (Sherry) if you experience a special qualifying event

Annual Enrollment Transfer Period

using edison ess
Using Edison ESS
  • To make changes to your coverage or add dental or vision insurance, you must use Employee Self Service (ESS) in Edison
  • To use ESS, log on to Edison at
    • Higher Education : your User ID and a temporary password will be mailed to your home address
      • If you did not receive this or are having trouble logging in, please call Benefits Administration at 1-800-253-9981, option 3
  • Instructions on how to use ESS are available in the Decision Guide or from your Agency Benefits Coordinator. Computer labs will be reserved to assist those who wish to make changes.

computer labs will be set up in gooch 325 on the following dates and times
Computer labs will be set up in Gooch 325 on the following dates and times:

Tuesday, October 9, 2012 3:30-5:00 p.m.

Monday, October 15, 2012 9:00-12:00 a.m.

Tuesday, October 16, 2012 9:00-12:00 a.m.

Friday, October 19, 2012 1:00-3:00 p.m.

Wednesday, October 24, 2012 3:00-4:00 p.m.

Tuesday, October 30, 2012 3:30-5:00 p.m.

Wednesday, October 31, 2012 3:00-4:00 p.m.

You MUST bring all documentation needed when attending a lab.

what s changing for 2013
New, optional vision plan

Member cost sharing

Pharmacy coverage changes

Closing optional universal life insurance to new enrollments (State Plan only)

What’s Changing for 2013

what s changing for 20131
Optional Vision Plan

Available to employees at participating agencies

Choose from two plans:

Basic Plan

Expanded Plan

Both plans offer the same services

Annual routine eye exam


Eyeglass lenses

Contact lenses

Discount of Lasik/Refractive surgery

What’s Changing for 2013

what s changing for 20132
What’s Changing for 2013
  • Optional Vision Plan
  • What you pay for services depends on the plan you choose
    • Expanded plan:
        • Co-pays
        • Allowances
        • Discounted rates
  • Administered by EyeMed Vision Care
  • Members have access to their Select Network
  • Basic plan:
      • Discounted rates
      • Allowances

what s changing for 20133
What’s Changing for 2013
  • Optional Vision Plan
  • Employee pay-all option (members pay full premium)
  • Monthly premiums for Active Members

what s changing for 20134
Member Cost Sharing: Health and Dental Premiums

Health insurance premiums will increase by the following percentages:

State Plan = 2%

Dental insurance premiums will increase by 3% for both plans

What’s Changing for 2013

what s changing for 20135
Member Cost Sharing: Deductibles

The deductibles for each PPO will increase in 2013

The amount of the increase depends on your premium tier

What’s Changing for 2013

what s changing for 20136
Member Cost Sharing: Out-of-Pocket Maximums

The out-of-pocket co-insurance maximums will also increase in 2013

The amount of the increase depends on your premium tier

What’s Changing for 2013

what s changing for 20137
What’s Changing for 2013
  • Member Cost Sharing: Network Differential
  • Depending on where you live, BlueCross BlueShield of Tennessee and Cigna premiums vary because the networks have different costs in each region
  • If the State pays less, you will pay less too
  • If you select the more expensive carrier in your region, the difference you pay will be more in 2013:
    • Employee-only coverage will cost $20 more
    • Those with family coverage (all levels above employee-only) will pay $40 more

what s changing for 20138
What’s Changing for 2013
  • Member Cost Sharing: Specialist Office Visit Co-Pays
  • The co-pays for specialist office visits will increase by $5 in 2013
  • Specialist office visit co-pays for 2013 (including surgery in office setting):
    • Partnership PPO (in-network) = $45
    • Partnership PPO (out-of-network) = $70
    • Standard PPO (in-network) = $50
    • Standard PPO (out-of-network) = $75
  • Co-pays will not change for the following:
    • Co-pays for primary care
    • Mental health and substance abuse treatment
    • Allergy injections with a primary care office visit
    • Chiropractic visits (visits 1-20)

what s changing for 20139
What’s Changing for 2013
  • Member Cost Sharing: Emergency Room Co-Pays
  • Co-pays for emergency room visits will increase by $45 in 2013
    • Partnership PPO = $125
    • Standard PPO = $145
    • The emergency room co-pay will still be waived if the member is admitted to the hospital
    • Members will continue to have access to urgent care clinics as an alternative to the emergency room
      • Partnership PPO = $30
      • Standard PPO = $35
      • These rates will not change in 2013

what s changing for 201310
Pharmacy: Women’s Contraceptives

Generic contraceptives and brand name contraceptives without a generic equivalent will be covered at $0 co-pay, including:

Oral contraceptives

Emergency contraceptives

Implantable devices/vaginal ring

Co-pays will still apply to brand contraceptives with generics available

Once a brand drug in these categories has a generic equivalent on the market, only the generic will be covered at $0 co-pay and the brand drug will require the brand co-pay

What’s Changing for 2013
  • Contraceptive transdermal patches
  • Barrier methods
    • Injectable contraceptives (limit four per year)

what s changing for 201311
What’s Changing for 2013
  • Pharmacy: Co-pay changes
  • Prescription drug co-pays will increase by $5 for:
    • Tier 2 (Preferred brand)
    • Tier 3 (Non-preferred brand)
  • The increase does not apply to:
    • Tier 1 (Generic)
    • Drugs in the 90-day maintenance tier
      • Statins
      • Antihypertensives
      • Oral diabetic drugs, insulins and diabetic needles/test strips/lancets

what s changing for 201312
What’s Changing for 2013
  • IMPORTANT - Pharmacy: Dispense as Written Policy
  • When a generic is available and your doctor indicates “may substitute” but you request the brand name drug from the pharmacy, you will pay the difference between the brand name drug and the generic drug plus the brand co-pay.

what s changing for 201313
What’s Changing for 2013
  • Pharmacy: Preferred Specialty Drug Plan
  • New users of the following must use a preferred specialty drug before the plan will cover other non-preferred specialty drugs in the same drug class
    • Tumor necrosis factor (TNF) inhibitors (for inflammatory and autoimmune diseases)
    • Multiple Sclerosis drugs
  • This requirement is referred to as “step therapy”
  • This policy will not apply to current users of these drugs

what s changing for 201314
What’s Changing for 2013
  • Optional Universal Life Insurance – State Only
  • The state is closing optional universal life insurance plan to new enrollments
  • No new enrollments will be allowed during this transfer period or after the first of the year
  • Members currently enrolled in this coverage can continue the benefit
  • If enrolled, you will receive a letter in the fall with details about continuing your coverage



Health Benefits

Your Health Insurance Options

Subject to eligibility, you will continue to have the same health insurance options.

Preferred Provider Organization (PPO) Options

  • Partnership PPO
  • Standard PPO
  • Limited PPO

(Local Government only)

Two Insurance Carriers

  • BlueCross BlueShield of Tennessee
  • Cigna

Four Premium Levels

  • Employee
  • Employee + child(ren)
  • Employee + spouse
  • Employee + spouse + children

health benefits
Health Benefits
  • Both PPOs cover services, treatments and products, such as:
    • In-network preventive care, x-ray, lab and diagnostics at no cost
    • Primary and specialist doctor office visits for a fixed co-pay without having to meet a deductible
    • Prescription drugs for a fixed co-pay without having to meet a deductible
  • Both PPOs offer:
    • Deductibles and co-insurance for certain services
    • Out-of-pocket maximums to limit your co-insurance and physician visit co-pay costs

Both carriers also offer discounts for services

not covered. Refer to the carrier’s member

handbooks or websites for more information.

Free preventive health services include, but are not limited to:

Flu vaccination and pneumococcal vaccinations

Annual preventive visit (i.e., physical exam)

Annual well-woman visit

Cholesterol test

Osteoporosis screening for women

Screenings for colon, breast or cervical cancer or prostate cancer

If other services or related treatments are received during the same visit, an office visit co-pay may apply

Health Benefits

You need to visit an in-network provider to receive preventive care services at no cost.

Each carrier has its own network

Both BlueCross and Cigna have made significant changes to their networks for 2013

Be sure to check the networks carefully when making your decision

Provider directories are available on the ParTNers for Health website, by calling the carrier or from your ABC

BlueCross BlueShield offers Network S

CIGNA offers Open Access Plus, OA Plus, Choice Fund OA Plus

Health Benefits

health benefits1
Carrier costs vary by grand division

In East and Middle Tennessee,

CIGNA costs $20 more per month for

employee only coverage and $40 more

per month for all other premium levels

In West Tennessee, BlueCross BlueShield costs $20 more per month for employee only coverage and $40 more per month for all other premium levels

Health Benefits

covered services
Services that Require Co-Pays

The following are some of the services that require co-pays:

* Subject to Out-of-Pocket Co-pay Maximum

Covered Services

covered services1
Services that Require Co-Insurance

The following are some of the services that require co-insurance:

Covered Services


Premiums for 2013: State and Higher Education

Employee Share of Monthly Premiums - Cigna

  • Premiums shown are for the least expensive carrier in the region. A complete chart is available in the Decision Guide and on the ParTNers for Health website.

The State pays 80% of the total premium cost for active employees.

premiums for 2013 state and higher education
Premiums for 2013: State and Higher Education

Employee Share of Monthly Premiums - Blue Cross/Blue Shield

The State pays 80% of the total premium cost for active employees.

partnership promise
In 2013,members and covered spouses must:

Complete the online Healthways Well-Being Assessment™ (health questionnaire) by March 15

Engage in ONE ParTNers for Health wellness activity by July 15

Keep your contact information current with your employer

Engage in tobacco cessation program if you are a tobacco user

Partnership Promise

A health screening for all members is not required in 2013.

partnership promise1
Partnership Promise
  • At-risk members and covered spouses must also:
    • Complete a biometric screening at your health care provider’s office between July 15 2012, and July 15 2013
    • Participate in health coaching and/or case management, if identified

Healthways will manage the Partnership Promise in 2013.

partnership promise2
Online Well-Being Assessment (WBA)

Summarizes your overall health and offers steps you can take to improve

By completing the confidential assessment, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-being

Beginning January 1, 2013, visit and create a new, online well-being account to access the assessment

Partnership Promise

The Well-Being Assessment must be completed

between January 1 and March 15, 2013.

partnership promise3
Partnership Promise

Wellness Activities

Wellness activities are easy actions you can take to work towards better health. You must engage in only ONE of the following wellness activities.

Receive an age-appropriate preventive service

  • Annual physical
  • Well-woman visit
  • Flu and pneumonia shots
  • Screenings for colon, breast and prostate cancers

Join a ParTNers for Health Wellness Challenge

  • Fun way to develop healthier lifestyle with group support
  • Choose one of the first two quarterly challenges
  • Offered online

Complete Your Well-Being Plan and Three Action Items

  • Create plan with recommended focus areas from WBA
  • Complete 3 simple action items



Updating Contact Information

You must make sure that your phone number, mailing address and email address, if you have one, are current with your employer.

If your information changes during the year, you must notify your employer to update your record.

Higher Education, Local Education and Local Government employees: Change your contact information yourself in Edison, by contacting your agency benefits coordinator or by calling the Benefits Administration Service Center at 1-800-253-9981 and selecting option 6.

Partnership Promise

partnership promise4
Tobacco Cessation

Partnership PPO members must be tobacco free or agree to participate in the tobacco cessation program andwork toward becoming tobacco free

Members who use tobacco must answer “Yes” to the question “are you a tobacco user” on the required WBA

Healthways will reach out to enroll you in a tobacco cessation program

You will not be required to stop using tobacco by the end of 2013, but you must complete the tobacco cessation program and make an effort to quit

This requirement applies to both you and your covered spouse

Partnership Promise

partnership promise5
At-Risk Members

Members who are identified as at risk will be required to take extra steps to manage their current conditions and prevent new health risks from developing

Complete a biometric screening with your health care provider

Participate in health coaching or case management during 2013

Healthways will determine who is at risk based on medical conditions and behaviors that may cause current or future health issues

Partnership Promise

Your health risks are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results.

partnership promise6
Biometric Health Screening

If identified, you must get a health screening from your health care provider by July 15, 2013

You may use screening results from a doctor’s visit between July 15, 2012, and July 15, 2013

Worksite screenings will not be available in 2013

Simply ask your doctor to complete the Physician Screening Form, which will be available online on January 1, 2013, and send the completed form to Healthways by the July 15 deadline

Partnership Promise

partnership promise7
Partnership Promise
  • Health Coaching
  • Lifestyle management helps you form better health habits. Coaches help with:
    • High blood pressure
    • High cholesterol
  • Disease management is for those with chronic conditions such as:
    • Diabetes
    • Asthma
    • Coronary artery disease
  • Case management is administered by BlueCross, Cigna and Magellan
    • Promotes quality and cost-effective coordination of care for those with complicated medical needs, chronic conditions and/or catastrophic illnesses or injuries
  • Weight management
  • Tobacco use
  • Congestive heart failure
  • Chronic obstructive pulmonary disease (COPD)
partnership promise8
Partnership Promise
  • Health Coaching
  • A health coach works with you and your provider to help you with self-management skills to make sure that you are taking medicines and getting the right care
  • Health coaches are trained health care professionals
  • All conversations with your health coach are confidential
  • When you participate in coaching, your frequency of calls will be tailored to your individual plan of care
  • Your health coach will communicate with you using telephone calls, mailings and the web

Healthways’ hours of operation:

Monday – Friday 7:30 a.m. – 9:30 p.m.

Saturday 8:00 a.m. – 6:30 p.m. (Central Time)

dental benefits
Dental Benefits

Eligible employees can choose between two dental options

  • During the enrollment period, eligible employees can enroll in or transfer between the two options.
  • If you don’t ask to change your current dental carrier or cancel coverage, you will keep your current coverage.

Prepaid Plan

  • Fixed co-pays
  • Participating dentists only

PDO Plan

  • Any dentist
  • Pay less with network providers

dental benefits1
Prepaid Plan

Administered by Assurant Employee Benefits

Predetermined co-pay amounts

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

To receive benefits, you must select a dentist from the Prepaid Plan list

Premiums will increase by 3% in 2013 in the prepaid plan

Dental Benefits

dental benefits2
Preferred Dental Organization (PDO)

Administered by Delta Dental

Use any dentist in the network

Members have access to Delta Dental’s PPO network

You pay co-insurance for covered services

A deductible applies for out-of-network dental care

You or your dentist will file claims for covered services

Some services require waiting periods and limitations/exclusions apply

Premiums will increase by 3% in 2013 for the PDO

Dental Benefits

dental benefits3
Dental Benefits

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

additional benefits
Additional Benefits

Basic Term Life and Accidental Death Insurance

  • The State provides $20,000 of basic term life and $40,000 of accidental death and dismemberment insurance
  • If you are enrolled in health insurance as the head of contract, your coverage increases with your salary — to a maximum of $50,000 for basic term life insurance and $100,000 for accidental death insurance.
  • Coverage provided by Dearborn National

additional benefits1
Additional Benefits
  • Optional Accidental Death Insurance – STATE ONLY
  • Additional accident protection for yourself and your dependents
  • Coverage is available at low group rates—no questions asked
  • Premiums vary by age and salary
  • The maximum benefit available to employees is $60,000
  • Enrollment form is available on the ParTNers for Health website
  • Coverage provided by Dearborn National

additional benefits2
Optional Term Life Insurance – STATE ONLY

Cannot enroll or make changes in optional term life insurance during AETP

The state is procuring a new contract for optional term life

An open enrollment with the selected carrier is planned during 2013

At that time, individuals interested in enrolling will be provided with guaranteed issue of coverage up to the guaranteed maximum

Those currently enrolled will be able to increase or decrease coverage during the spring open enrollment period

We will provide details of the new term life insurance later this year

Additional Benefits
additional benefits3
Employee Assistance Program (EAP)

Provides support tools that help you and your family deal with personal issues and situations

All services are confidential and available at no cost to members

Services can be easily accessed by calling Magellan, 24/7

You and your eligible dependents may get up to five free counseling sessions per problem episode

Contact ParTNers EAP:

1.855.HERE4TN (1.855.437.3486)

Additional Benefits

additional benefits4
Long-Term Care Insurance

Your agency must choose to participate (Local Ed and Local Gov)

Who is eligible?

Qualified employees

Eligible dependents

Covers services for individuals who are no longer able to care for themselves

Nursing home care

Assisted living

Home health care

Additional Benefits
  • Retirees
  • Parents and parents-in-law
  • Home care
  • Adult day care

Apply for coverage at any time

through medical underwriting.

additional benefits5
Long-Term Care Insurance

Benefits available for different daily benefit amounts ($100, $150 or $200) for either three- or five-year coverage

Available with or without inflation protection

You pay 100 percent of the premium

Premiums are based on age at the time of enrollment

Choose to have the premium taken from your payroll check or opt for a direct bill arrangement with MedAmerica

Visit or call MedAmerica at 1.866.615.5824

Additional Benefits

additional benefits6
Flexible Benefits

Lowers your income taxes

Use pre-tax earnings to pay for health or dental insurance premiums

Set aside pre-tax earnings to pay for:

Medical expenses

Dependent care expenses

Additional Benefits
additional benefits7
Additional Benefits

Medical Expense Reimbursement Account

  • Use the account to reimburse yourself for eligible medical, dental and vision care expenses
  • Contribute up to $2,500 per year

Dependent Day Care Reimbursement Account

  • Use the account to reimburse yourself for eligible dependent day care expenses
  • Contribution depends on tax filing status
  • Sign up for this benefit will be held in November.

take note
If you do not want to make changes,

no action is required

If you do want to make changes or add coverage,

you must use ESS and meet the enrollment deadline of November 1, 2012

You must click “submit” in ESS to finalize your selections by 11:59 p.m. on November 1, 2012

No changes until the next Annual Enrollment Transfer Period

Take Note!

member communications
Member Communications

Current members should have received a copy of the 2013 Decision Guide at their homes in mid-September.

who to contact
Primary point of contact - agency benefits coordinator (ABC) Sherry Shanklin – or 881-7850.

Questions about a provider or claim – contact your insurance carrier

Questions about eligibility and enrollment – call Benefits Administration service center at 1-800-253-9981

Our ParTNers for Health website –

Enrollment forms and handbooks –

Who to Contact