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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.
State of Tennessee Group Insurance ProgramAnnual Enrollment Transfer Period
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 optionsAnnual Enrollment Transfer Period
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 formsAnnual Enrollment Transfer Period
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 eventAnnual Enrollment Transfer Period
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.
Generic contraceptives and brand name contraceptives without a generic equivalent will be covered at $0 co-pay, including:
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-payWhat’s Changing for 2013
Your Health Insurance Options
Subject to eligibility, you will continue to have the same health insurance options.
Preferred Provider Organization (PPO) Options
(Local Government only)
Two Insurance Carriers
Four Premium Levels
Both carriers also offer discounts for services
not covered. Refer to the carrier’s member
handbooks or websites for more information.
Flu vaccination and pneumococcal vaccinations
Annual preventive visit (i.e., physical exam)
Annual well-woman visit
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
You need to visit an in-network provider to receive preventive care services at no cost.
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
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 levelsHealth Benefits
Employee Share of Monthly Premiums - Cigna
The State pays 80% of the total premium cost for active employees.
Employee Share of Monthly Premiums - Blue Cross/Blue Shield
The State pays 80% of the total premium cost for active employees.
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 userPartnership Promise
A health screening for all members is not required in 2013.
Healthways will manage the Partnership Promise in 2013.
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 www.partnersforhealthtn.gov and create a new, online well-being account to access the assessmentPartnership Promise
The Well-Being Assessment must be completed
between January 1 and March 15, 2013.
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
Join a ParTNers for Health Wellness Challenge
Complete Your Well-Being Plan and Three Action Items
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 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 spousePartnership Promise
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 issuesPartnership Promise
Your health risks are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results.
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 deadlinePartnership Promise
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)
Eligible employees can choose between two dental options
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 planDental Benefits
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 PDODental Benefits
Dental services for both the Prepaid Plan and the Dental PDO include:
Basic Term Life and Accidental Death Insurance
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 yearAdditional Benefits
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:
Your agency must choose to participate (Local Ed and Local Gov)
Who is eligible?
Covers services for individuals who are no longer able to care for themselves
Nursing home care
Home health careAdditional Benefits
Apply for coverage at any time
through medical underwriting.
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 www.ltc-tn.com or call MedAmerica at 1.866.615.5824Additional Benefits
Medical Expense Reimbursement Account
Dependent Day Care Reimbursement Account
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 PeriodTake Note!
Current members should have received a copy of the 2013 Decision Guide at their homes in mid-September.
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 – www.partnersforhealthtn.gov
Enrollment forms and handbooks – www.tn.gov/finance/insWho to Contact