State of Tennessee Group Insurance Program
State and Higher Education
Annual Enrollment Period
October 3 – October 14, 2016
Enrollment ends at 4:30 p.m. Central
Agenda
• Annual Enrollment Period
• What’s Important for 2017
• Using ESS in Edison
• Health Benefits Overview
• 2017 Partnership Promise
• Dental, Vision and Additional Benefits Overview
www.partnersforhealthtn.gov
1
Annual Enrollment Period
October 3 to October 14 - ends at 4:30 p.m. Central


Annual Enrollment Period (AEP) is an open enrollment for most programs
Shorter time period this year! Only two business weeks!
• You can make the following changes:


Change, enroll or cancel health insurance for yourself or your eligible dependents
Choose or change your health insurance network/carrier
 New network option this year – you have the choice of three networks
 Enroll in, cancel or transfer between dental options
 Enroll in, cancel or transfer between vision coverage options
 Enroll in or cancel voluntary accidental death & dismemberment coverage
 Apply for, cancel, increase or decrease voluntary term life coverage amounts (if eligible)
 Enroll in flexible spending accounts (flexible benefits)
www.partnersforhealthtn.gov
2
Very Important Changes
• Premiums, copays, coinsurance and deductibles are changing. You should
look closely at all costs in your plan options for 2017.
Partnership Promise Change
• Due to federal rule changes, all members can enroll in any health option.
• If you and your spouse are currently in the Partnership PPO or the Wellness
HealthSavings CDHP in 2016 and you do not complete the 2016 Partnership
Promise, you can stay in your plan, but you do not qualify for the lower Partnership
PPO premium or state health savings account (HSA) money.
• This means you will pay a higher premium if you stay in the Partnership PPO. Or, if
you stay in the HealthSavings CDHP, the state will not put money in your HSA.
• Cost changes take place automatically – you could pay more if you don’t make a change
• You can choose a different plan option during annual enrollment
www.partnersforhealthtn.gov
3
What is ALEX?
ALEX is a smart, funny benefits expert who
explains benefits and may help members choose
what’s best for them.
Go to www.partnersforhealthtn.gov
4
Annual Enrollment Period
If you DO NOT want to make changes …
• You will keep your current benefits. This means you will stay in your current options (PPO or
CDHP) with your current network (BCBS Network S or Cigna LocalPlus).
• Remember, if you are in the Partnership PPO or the Wellness HealthSavings CDHP and
you do not complete the 2016 Partnership Promise, you will pay a higher premium in
the Partnership PPO in 2017. Or, if in the HealthSavings CDHP, the state will not put
funds in your HSA. Cost changes will take place automatically
2017 Partnership Promise Plan Members:
• Members and spouses who enroll in or stay in a plan with the Partnership Promise agree to
fulfill the 2017 Partnership Promise.
Three health insurance networks!
• You will have the choice between three different health insurance networks. Check the
networks and provider directories carefully!
• If you want to change networks - you must make this change
www.partnersforhealthtn.gov
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Annual Enrollment Period
If you DO want to make changes
• You must use Employee Self Service (ESS) in Edison
• Enroll early! The enrollment period is shorter - submit your changes as early
as possible.
• Enrollment ends at 4:30 p.m. Central on October 14.
• All new dependent verification documents must be received by 4:30 p.m.
Central on October 14.
• Life Insurance: Use the Minnesota Life website for voluntary term life insurance.
• Flexible benefits:
• State employees: October 3 to October 14 in ESS
• Higher education employees: October 1 – October 31 on PayFlex website
www.partnersforhealthtn.gov
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Annual Enrollment Period
• Changes take effect on January 1, 2017
• Selections remain in effect through December 31, 2017, unless you lose
eligibility or have a qualifying event
• A qualifying event or family status change is something that results in a person
losing coverage under another plan or becoming newly eligible for coverage
• Examples include birth, a change in marital status or new employment
• Contact your Agency Benefits Coordinator (ABC) if you experience a qualifying
event
www.partnersforhealthtn.gov
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What’s Important for 2017
• Health insurance premiums will increase for the Partnership PPO and the
HealthSavings CDHP. Premiums will decrease in the Standard PPO plan, but other
costs are higher than the Partnership PPO.
Your Decision Guide has more information
• Change – Health insurance networks: There will be three different network
options. You choose one:
• New - Cigna Open Access Plus (OAP): This is a large network. You will have a choice
of more doctors and facilities including Baptist Memphis. But you will pay more each
month.
• BlueCross BlueShield (BCBS) Network S: This network was offered last year. No
additional cost for this network.
• Cigna LocalPlus: This network was offered last year. Baptist Physician Group has
been added. No additional cost for this network. This network is different from Cigna
Open Access Plus.
You will stay in your current network (BCBS Network S or Cigna LocalPlus) if
you do not make a change
www.partnersforhealthtn.gov
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What’s Important for 2017
• Member cost sharing is changing in all options
• Out-of-pocket maximums: (Partnership PPO and Standard PPO): The medical and
pharmacy out-of-pocket maximums will be combined. The total out-of-pocket
maximums for the PPOs will be less in 2017.
• Partnership PPO options: In 2017, the plan benefits (copays, deductible and
coinsurance) will be the same for both options. Difference - you will pay lower
premiums if you agree to the Partnership Promise.
• Standard PPO: The deductible is twice as much as the Partnership PPO, and the
copays and coinsurance are higher. But the premiums are lower.
• HealthSavings CDHP options: In 2017, the plan benefits (deductibles and
coinsurance) will be the same for both CDHP options. Difference - the state will put
money in your HSA if you agree to the Partnership Promise.
www.partnersforhealthtn.gov
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What’s Important for 2017
• Coinsurance for labs, diagnostics and x-ray: Will have coinsurance for all plan
options. Preventive services still covered at 100%
• Pharmacy copays and coinsurance: Copays in the PPOs will go up slightly (up
$2-$15). For specialty drugs in the PPOs, coinsurance will apply with a member
minimum ($50) and maximum ($150) out-of-pocket.
• Brand Obesity Medications Now Covered: Gives members a less costly, nonsurgical option for losing weight. Members must meet certain criteria to qualify.
• Change - Partnership Promise - Coaching: Only members in disease
management (diabetes, heart failure, coronary artery disease, asthma and COPD)
and case management will have to coach. Lifestyle management coaching is not
required in 2017 – members can voluntarily participate but will not be
contacted
www.partnersforhealthtn.gov
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What’s Important for 2017
• Change - Optum Health will be the new behavioral health, substance abuse and
Employee Assistance Program (EAP) vendor replacing Magellan. Behavioral health
and substance abuse doctors may change. Benefits will include a new
TeleBehavioral Health service.
• Dental and Vision Premiums:
• Cigna dental premiums will increase by 3%
• MetLife dental premiums will increase by 4%
• Vision premiums will not change
www.partnersforhealthtn.gov
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What’s Important for 2017
• Change - Flexible Spending Accounts (FSA): PayFlex will manage flexible spending
accounts (FSA) for state and higher education employees (except for
parking/transportation, managed by Benefits Administration for state employees).
• You will have a debit card to pay for medical services (Healthcare FSA/limited
purpose FSA) or you can submit receipts
• Telehealth: You can contact a doctor for minor illnesses such as cold and flu, infections,
fever and more. Schedule a visit for you or your covered dependents from anywhere, at
any time. Cost is only $15 for all PPOs. CDHP members pay $38 until the deductible is
met.
www.partnersforhealthtn.gov
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Using Edison ESS
To make changes, you must use Employee Self Service (ESS) in Edison .
To use ESS, log on to Edison at
• https://sso.edison.tn.gov/psp/paprd/EMPLOYEE/EMPL/h/?tab=PAPP_G
UEST
•
Health Insurance option names in Edison:
• In Edison, the names of four health insurance options are shortened
• Check the chart below before making your choice
Health insurance options
Partnership Promise PPO
No Partnership Promise PPO
Standard PPO
Promise HealthSavings CDHP
No Promise HealthSavings CDHP
www.partnersforhealthtn.gov
Names as they appear in Edison
Partners Promise PPO
No Partners Promise PPO
Standard PPO
Promise CDHP
No Promise CDHP
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Using Edison ESS
Designating Life Insurance Beneficiaries:
• You can designate beneficiaries in Edison for Basic Term Life, AD&D and
voluntary AD&D
• If submitting changes during annual enrollment, the beneficiary page will
display after submitting changes
Flexible Benefits
• State: You must also use ESS to enroll in flexible benefits from Oct. 3 - Oct. 14
• Higher ed: Use the PayFlex website to enroll in flexible benefits from Oct. 1 –
Oct. 31
• More information about flexible benefits is in your Decision Guide
www.partnersforhealthtn.gov
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Recommended Browsers
 When you use ESS in Edison to add or make changes in your benefits,
Internet Explorer 11 is your best choice. You may not be able to enroll in
your benefits if you use the Chrome browser or any mobile devices.
 Although not recommended, other browsers might work. But all of your
information may not be on the enrollment screens, which could mean that
you are not enrolled in your choices. If these issues cannot be resolved,
you will need to use a recommended browser.
www.partnersforhealthtn.gov
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Using Edison ESS
Passwords
• Higher education employees: Using the Edison system for the first time or
having trouble logging in, go to the Edison homepage and click on 1st Time
Login/Password Reset and follow the steps. Call Benefits Administration Service
Center at 800-253-9981 if you need help after following the steps.
• State employees: Trouble logging in to Edison, go to the Edison homepage and
click on 1st Time Login/Password Reset and follow the steps to reset your
password or call the Edison help desk at 866.376.0104.
• Instructions on how to use ESS are in the Decision Guide
www.partnersforhealthtn.gov
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Health Benefits
Your Enrollment Decision Steps
• Partnership
PPO
• Standard PPO
• HealthSavings
CDHP
Plan
Coverage Type
• Employee Only
• Employee +
Spouse
• Employee +
Child(ren)
• Employee+
Spouse +
Children
• BCBST Network S
• Cigna LocalPlus
• Cigna Open Access
Plus (OAP) (new
option)
Network
Member Choice
• Plan
• Coverage
Type
• Network
• Voluntary
Benefits
If you enrolled in the Partnership PPO or Wellness HealthSavings CDHP in 2016 and did not complete the 2016 Partnership
Promise, you do not qualify for the lower premium Partnership PPO. Or if enrolled in the HealthSavings CDHP, you do not qualify
for state HSA funds.
COBRA participants and retirees are not eligible for state HSA funds.
www.partnersforhealthtn.gov
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Health Insurance Options
First, you choose your health insurance option
• Partnership PPO - Two options give you the same benefits, but the cost is different:
• Partnership Promise PPO – Agree to the 2017 Partnership Promise, and you will save money! Your
premiums will be $50 or $100 dollars less than the No Partnership Promise PPO each month.
• No Partnership Promise PPO – This option does not include the Partnership Promise. Your premiums
will be $50 to $100 more than the Partnership Promise PPO each month.
• Standard PPO - Current Standard PPO members can stay or move to any plan option, including
Partnership Promise options.
• HealthSavings CDHP - Two options give you the same benefits and cost the same, but only one
includes state HSA funds:
• Promise HealthSavings CDHP – Agree to the 2017 Partnership Promise, and the state will put $500 or
$1,000 into your HSA!
• No Promise HealthSavings CDHP – This option does not include the Partnership Promise and the
state will not put money into your HSA.
www.partnersforhealthtn.gov
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Health Insurance Options
• All health options cover the same services and treatments:
• In-network preventive care at no cost
• But medical necessity decisions can vary by carrier (BCBS or Cigna)
• All health options include:
•
•
•
•
Medical, behavioral health and pharmacy benefits
Fixed copays or coinsurance for some services depending on plan
Out-of-pocket maximums to limit costs
Access to the wellness program
Carriers may offer discounts for services not covered. Refer to the carrier’s
member handbooks or websites for more information.
www.partnersforhealthtn.gov
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Health Insurance Networks
Next, you would choose your health insurance network
• BlueCross BlueShield of Tennessee Network S
• Cigna LocalPlus
• New - Cigna Open Access Plus (OAP) – this is a large network, includes
Baptist Memphis and will cost you more each month.
•
A surcharge applies:
• $40 more employee/employee+children coverage each month
• $80 more for employee+spouse/employee+spouse+children coverage
each month
www.partnersforhealthtn.gov
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Health Insurance Networks
Another look at your network options:
BlueCross BlueShield Cigna LocalPlus
Network S
New Cigna Open Access
Plus (OAP)
Type of
Network
Offered last year.
Smaller network than
Cigna Open Access
Plus
Offered last year.
Smaller network. NOT
Open Access Plus
network.
Baptist Physician
Group has been
added.
Large network with more
doctors and hospitals.
Includes Baptist Memphis
Additional
Cost (in
addition to
your monthly
premium)
$0
$0
$40 more per month Employee
$40 more per month Employee + Children
$80 more per month Employee + Spouse
$80 more per month Employee + Spouse +
Children
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Voluntary Benefits
Then, you choose your voluntary benefits
•
•
•
•
•
•
Dental
Vision
Life (voluntary term – not available in Edison)
Flexible spending accounts (FSA)
Long-term care (not available in Edison)
AD&D
• Voluntary benefits are all employee paid premium
www.partnersforhealthtn.gov
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Health Benefits
HealthSavings CDHP
• Two different CDHP options:
• Promise HealthSavings CDHP – includes the Partnership Promise and the
state will put $500 or $1,000 into your HSA*
• No Promise HealthSavings CDHP - does not include the Partnership
Promise and no funds from the state. Employees may fund the HSA
CDHPs:
• Lower monthly premium - but a higher deductible
• Can help you save money
• Includes a tax-free health savings account (HSA), which you own
• Can be used to pay for qualified medical, behavioral health, dental and
vision expenses
• Employees can make pre-tax payroll deduction contributions or post-tax
contributions into the HAS
*New enrollees with coverage effective dates Sept 2 through Dec 1, 2017, will not receive
a state contribution in 2017. The Promise HealthSavings CDHP is only available to state
and higher ed active employees.
www.partnersforhealthtn.gov
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Health Benefits
How does a CDHP work?
• You pay for services up to your deductible before the plan starts paying for
anything — but you can use the money in your HSA to pay for your deductible
and qualified medical costs
• After meeting the deductible, you pay coinsurance (a set percentage of the
discounted network cost) instead of copays (a set amount), until your reach
your out-of-pocket maximum
www.partnersforhealthtn.gov
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Health Benefits
HealthSavings CDHP Pharmacy Benefits
1. You pay the full negotiated cost of prescription
drugs up to annual deductible
2. Then you pay coinsurance until the annual outof-pocket maximum is reached
3. Plan covers 100% of in-network costs after you
reach the out-of-pocket maximum
For 90-day chronic maintenance drugs (e.g.,
hypertension, high cholesterol, etc.) you pay
coinsurance only – don’t have to meet the deductible
first when filled through mail order or a Retail-90
network pharmacy.
www.partnersforhealthtn.gov
Important Note:
Members pay
medications at the time
of purchase. Even at
the negotiated or
discounted rate, some
drugs can be
expensive, particularly
specialty drugs, so
CDHP members may
need to know costs
and plan for those
costs until the
deductible is met
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Health Benefits
CDHP Enrollment Restrictions
•
You cannot enroll in a HealthSavings CDHP if you are enrolled in another plan,
including the PPO, your spouse’s plan or any government plan (e.g., Medicare A
and/or B, Medicaid, or Social Security benefits). Also, if your spouse has a FSA
or HRA you cannot contribute to a HSA.
•
Retirees and COBRA participants are not eligible for state funds contributed to
your HSA.
•
If you are eligible for VA, Tricare or Indian Health Service (IHS) medical benefits
and did not get benefits during the past three months, you can enroll in and put
money in your HSA. If you get VA benefits in the future, then you CANNOT put
money in your account for another three months.
•
Other restrictions may apply. Go to IRS.gov to learn more.
www.partnersforhealthtn.gov
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Health Benefits
HSA Benefits:
• Money in your HSA rolls over each year – you keep it when you leave or retire
• Your HSA earns interest
• You can invest your HSA money (when HSA is over $1,000)
• HSA offers tax advantages on money in your account:
• 1. Both employer and employee contributions are tax free
• 2. Withdrawals for qualified medical expenses are tax free
• You can use your HSA card to pay for your qualified medical expenses (from
payroll deductions and other contributions) and your deductible
• Qualified expenses such as hearing aids, contact lenses, acupuncture, etc., that
may not be covered by your plan
• HSA can also serve as a retirement savings account. Money in the account can be
used tax free for health costs when you retire. And, when you turn 65, it can be
used for non-medical expenses. Non-medical expenses are taxed prior to age 65
www.partnersforhealthtn.gov
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Health Benefits
How does the Health Savings Account (HSA) work?
•
Once you enroll in a CDHP, a HSA is set up for you. You can put money in your
HSA by taking money from your paycheck and/or putting money directly into your
account. There is a maximum amount you can contribute each year.
What is the maximum I contribute to a HSA each year?
•
•
•
In 2017, IRS guidelines allow total annual tax-free contributions up to $3,400 for
individuals and $6,750 for families.
At age 55 and older, you can make an additional $1,000/year contribution ($4,400
for individuals or $7,750 for families).
The maximum includes any employer contribution.
www.partnersforhealthtn.gov
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Health Benefits
HSA vs. FSA
•
If you enroll in a HealthSavings CDHP, you cannot use a flexible spending account
(FSA) for medical costs. You can enroll in a limited purpose FSA (LPFSA) to use
for dental and vision costs.
• Remember, HSA dollars are not “use-it-or-lose-it” like an FSA, so you may put
the maximum amount allowed in your HSA without fear of losing those dollars.
•
Very Important: If you have money in your FSA and choose a HealthSavings
CDHP/HSA, you must spend all of your FSA money by Dec. 31, 2016, or your HSA
will not open, and neither you nor your employer can put money in your account
until April 1, 2017.
www.partnersforhealthtn.gov
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Health Benefits
Health Savings Account
• After you enroll in a HealthSavings CDHP, you will need to activate your account
with PayFlex
• You will register and access your PayFlex HSA online at
stateoftn.payflexdirect.com
• PayFlex will send you additional information about the account after you enroll
• Go to their website for a Quick Reference guide and other information
• PayFlex will send you a debit card to pay for your eligible expenses
• Convenient way to pay for eligible expenses
• Expenses are paid automatically, as long as funds are available
• Keep your receipts for audit purposes
www.partnersforhealthtn.gov
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Health Benefits
Health Savings Account
Pay yourself back
• Pay for your eligible medical expenses with cash, check or personal credit card
• Then withdraw funds for your HSA to pay yourself back
• Can have your payment deposited directly into your checking or savings account
• Pay your provider
• Use PayFlex’s online feature to pay your provider directly from your account
• Contribute post-tax dollars from your checking or savings account online
• Account fees: The state will pay the monthly maintenance fee for your HSA as long as you
are enrolled in a HealthSavings CDHP. You are responsible for standard banking fees.
However, if you leave your job, retire or choose a PPO option in the future, you will be
responsible for paying any applicable HSA fees.
www.partnersforhealthtn.gov
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Pharmacy Benefits
CVS/caremark is the Pharmacy Benefits Manager
• All state health insurance plans include pharmacy benefits
• The covered drug list is the same in each insurance plan but costs differ from plan
to plan
• For each plan, how much you pay depends on the prescription tier:
•
•
•
•
Lowest cost: Tier one/generic drug
Higher cost: Tier two/preferred brand drug
Highest cost: Tier three/non-preferred brand
New specialty pharmacy tier
• Copays in the PPOs will go up slightly from $2 to $15 depending on the tier
• For specialty drugs in the PPOs, coinsurance will apply with a member minimum
($50) and maximum ($150) out-of-pocket
• A chart in the Decision Guide compares pharmacy costs by plan
www.partnersforhealthtn.gov
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Pharmacy Benefits
New Copay Installment Program for Maintenance Medications
• You can spread the cost of your 90-day mail order prescriptions over a threemonth period – at no additional cost to you
• Enroll online or by calling CVS/caremark customer care:
• 877.522.8679
• Info.caremark.com/stateoftn > register and log in
www.partnersforhealthtn.gov
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Behavioral Health Benefits
Optum Health – Behavioral Health Vendor
• Optum Health is your new behavioral health and substance abuse vendor, replacing
Magellan. This is a different network, and your doctor may or may not be in it. You
will need to check the network carefully.
• Members enrolled in health coverage automatically have access to this benefit.
• Also, you now have the option of TeleBehavioral Health counseling services and
can have a counseling session with a provider over the phone.
• To get maximum benefits, you should use an in-network provider and some services
require prior authorization.
Learn more by visiting HERE4TN.com or calling 855.437.3486
www.partnersforhealthtn.gov
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Employee Assistance Program
(EAP)
The Employee Assistance Program (EAP) provides you and your family with both
workplace and personal resources. Benefits are administered by Optum Health.
• Services are confidential and available at no cost to eligible employees and their
•
•
•
•
eligible dependents – even if they don’t have medical coverage.
COBRA participants are also eligible.
Services are available 24 hours a day, 365 days a year
New -TeleBehavioral Health – talk to a provider over the phone
You may use up to five counseling sessions per episode
• EAP has resources that can help you and your family with:
Family or relationship issues
Child and elder care
Feeling anxious or depressed
Difficulties and conflicts at work
Dealing with addiction
Grief and loss
Legal or financial issues
Work/life balance
• Call Toll Free 24/7 at 1.855.HERE4TN (855.437.3486)
www.partnersforhealthtn.gov
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ParTNers for Health Wellness
Program
ParTNers for Health Wellness Program
• All health plan members have access to the ParTNers for Health Wellness
Program, which gives you the tools, information and support you need to take
charge of your health and feel your best.
• ParTNers for Health Wellness Program is provided at no additional cost to all
members.
• Wellness Resources:
• Coaching – call and get support from a coach on your well-being goals
• Well-Being Assessment (WBA) – online well-being questionnaire
• Nurse advice line – medical information and support at no cost to you
• Wellness challenges - a fun way to develop a healthier lifestyle with group support
• Weight Watchers at Work and Fitness Center discounts
• Additional wellness and fitness discounts through the EAP program and our carriers
BlueCross BlueShield and Cigna
www.partnersforhealthtn.gov
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Premiums for 2017:
State and Higher Education
Employee Share of Monthly Premiums
Premium Level
Partnership
Promise
PPO
No
Partnership
Promise PPO
Standard
PPO
Employee Only
$133
$183
$130
$84
Employee + Child(ren)
$200
$250
$197
$127
Employee + Spouse
$280
$380
$275
$177
Employee + Spouse +
Child(ren)
$346
$446
$340
$219
HealthSavings
CDHP
(promise and no
promise)
• Premiums shown are for the employee share for active employees. A complete chart is available
in the Decision Guide and on the ParTNers for Health website.
• Premiums are for the BCBS Network S or Cigna LocalPlus network
• Premiums do NOT include the cost for the larger Cigna Open Access Plus network – which would
add $40 to $80 more EACH MONTH depending on your tier
www.partnersforhealthtn.gov
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2017 Deductibles and Out-ofPocket Co-insurance Maximums
Partnership PPO
Standard PPO
HealthSavings
CDHP
In-Network
In-Network
In-Network
Employee only
$500
$1,000
$1,500
Employee + Child(ren)
$750
$1,500
$3,000
Employee + Spouse
$1,000
$2,000
$3,000
Employee + Spouse + Child(ren)
$1,250
$2,500
$3,000
Deductibles
Out of Pocket Max (medical and pharmacy combined)
Employee only
$3,600
$4,000
$2,500
Employee + Child(ren)
$5,400
$6,000
$5,000
Employee + Spouse
$7,200
$8,000
$5,000
Employee + Spouse + Child(ren)
$9,000
$10,000
$5,000
www.partnersforhealthtn.gov
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2017 Partnership Promise
Take Action – Save Money – Improve Health
• The goal of the Partnership Promise is to help you get and stay healthy –
while saving you money.
• We can cut healthcare costs with our own personal choices. Members who
agree to the 2017 Partnership Promise are not only taking steps toward
better health, they can save money on premiums or get state HSA funds.
• If you choose the Partnership Promise PPO, you will pay $50 to $100 less
in monthly premiums than if enrolled in the No Partnership Promise PPO.
• If you choose the Promise HealthSavings CDHP, the state will put money,
either $500 or $1,000, into your health savings account (HSA).
www.partnersforhealthtn.gov
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2017 Partnership Promise
In 2017, all Partnership Promise members and covered spouses must:
1. Complete the online Healthways Well-Being Assessment™ (health
questionnaire) between January 1 and March 15, 2017
2. Complete a biometric health screening by July 15, 2017
3. Actively participate in coaching if you are called
• Coaching only required for members in disease management and case
management. Disease management is diabetes, COPD, asthma, coronary
artery disease and heart failure.
• Lifestyle management coaching not required in 2017
4. Update your contact information with your employer if it changes
• Spouses must keep contact information current with Healthways
www.partnersforhealthtn.gov
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Dental Benefits
During annual enrollment, eligible employees can choose between
two dental options:
Cigna Prepaid Plan
MetLife Dental Preferred Plan
• Fixed copays
• Coinsurance and deductibles
• Participating dentists only
• Any dentist
• Pay less with network providers
• During the enrollment period, eligible employees can enroll in or transfer
between the two options
• You will keep your current coverage if you don’t change your current
dental carrier or cancel coverage
www.partnersforhealthtn.gov
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Dental Benefits
Cigna Prepaid Plan
Provides services at fixed copay amounts. A limited network of participating
dentists and specialists must be used to receive benefits.
• Must select a general dentist from the Cigna dental provider list and notify Cigna of your
choice. You must use your selected dentist to receive benefits. The network is Dental Care
(HMO).
• There may be some areas in the state where network dentists are limited or not available. Be
sure to carefully review the provider directory for your location.
• With this plan, you can cancel coverage during the year if there are no network general dentists within a
40-mile radius of your home
•
•
•
•
•
•
You pay predetermined member copay amounts (reduced fees) for dental treatments.
No deductibles to meet, no claims to file, no waiting periods, no annual dollar maximum.
Preexisting conditions are covered.
Orthodontic treatment fee lifetime maximum.
Referrals to specialists are not required.
Premiums will increase by 3 percent in 2017.
www.partnersforhealthtn.gov
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Dental Benefits
MetLife Dental
Provides services with coinsurance. Any dentist may be used to receive benefits
but you will pay less if an in-network provider is used.
• Can use any dentist — receive maximum benefits when visiting an in-network MetLife DPPO
•
•
•
•
•
•
•
provider. Network is PDP.
Deductible applies for basic and major dental care.
You pay coinsurance for basic, major, orthodontic and out-of-network covered services.
You or your dentist will file claims for covered services.
Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a 6month waiting period from member’s effective date before benefits begin.
There is a 12-month waiting period from the member’s effective coverage date on replacement
of a missing tooth and for orthodontics.
Referrals to specialists are not required. Pre-treatment estimates are recommended for services
with significant expense.
Premiums will increase by 4 percent in 2017.
www.partnersforhealthtn.gov
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Dental Benefits
Monthly Premiums for Active Members
Premiums
Cigna Prepaid
MetLife DPPO
Employee Only
$12.99
$22.37
Employee + Child(ren)
$26.97
$51.44
Employee + Spouse
$23.02
$42.32
Employee + Spouse + Child(ren)
$31.65
$82.80
Dental services for both the Prepaid Plan and the DPPO Plan include:
• Periodic oral evaluations
• Routine Cleanings
• Amalgam fillings
• Endodontics-Root Canal
• X-rays
• Extractions
• Major restorations
• Orthodontics
• Dentures
www.partnersforhealthtn.gov
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Vision Benefits
Vision Plan - Administered by EyeMed Vision Care
• There are two plan options – both plans offer the same services:
Basic Plan
Expanded Plan
Discounted rates
Copays
Allowances
Allowances
Discounted rates
• Premiums will not increase in 2017
Basic
Expanded
Employee Only
$3.35
$5.86
Employee + Child(ren)
$6.69
$11.72
Employee + Spouse
$6.35
$11.14
Employee + Spouse + Child(ren)
$9.83
$17.23
www.partnersforhealthtn.gov
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Additional Benefits
Basic Term Life / Accidental Death Insurance
State and Higher Education Only
•
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
Important: Keep your life insurance beneficiary information up to date
You can make updates online
More information is in your Decision Guide
www.partnersforhealthtn.gov
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Additional Benefits
Voluntary Accidental Death & Dismemberment Insurance
State and Higher Education Only
•
Additional accident protection for yourself and your dependents
•
Coverage is available at low group rates—no questions asked
•
Premiums vary by salary
•
The maximum benefit available to employees is $60,000
•
Members can enroll through ESS
www.partnersforhealthtn.gov
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Additional Benefits
Voluntary Term Life Insurance
State and Higher Education Only
• If you qualify, you may be able to purchase voluntary term coverage from
Minnesota Life for yourself and your dependent spouse and children.
• If you are currently enrolled and are eligible for employee guaranteed
issue increase, information will be mailed to you.
• If you and/or your dependent spouse are not presently enrolled, you will
be required to present evidence of insurability through a health
questionnaire.
• Enroll through the Minnesota Life website at lifebenefits.com/stateoftn
www.partnersforhealthtn.gov
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Additional Benefits
Long-Term Care Insurance
• Who is eligible?

Qualified employees

Retirees

Eligible dependents

Parents and parents-in-law
• Covers services for individuals who are no longer able to care for
themselves

Nursing home care

Home care

Assisted living

Adult day care

Home healthcare
Apply for coverage at any time
through medical underwriting.
www.partnersforhealthtn.gov
49
Additional Benefits
Long-Term Care Insurance
• Benefits available for different daily benefit amounts ($100, $150 or $200) for
either three- year or five-year coverage
• Available with or without inflation protection
• You pay 100% 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
www.partnersforhealthtn.gov
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Additional Benefits
Flexible Benefits – State and Higher Ed
• In 2017, PayFlex will manage medical, dependent care and limited purpose FSA
programs
• State employees: Parking and transportation flexible benefits will be managed by
Benefits Administration
• State employees will no longer send claims to Treasury
• PayFlex will send all medical FSA participants a debit card in December. You can
use it at pharmacies, doctor’s offices and other healthcare facilities for instant
payment from your medical FSA
• Important: State employees should file 2016 FSA claims with the Treasury as soon a
as possible. Claims must be submitted before December 31, 2016
• State employees must enroll during annual enrollment from Oct. 3 – Oct. 14
• Higher ed employees enroll on PayFlex website from Oct 1. – Oct. 31
www.partnersforhealthtn.gov
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Additional Benefits
Flexible Benefits – State and Higher Ed
• Medical FSA: For certain medical, dental, vision and prescription costs not covered by
insurance. You do NOT qualify if enrolled in a CDHP. But you can put money in a limited
purpose FSA for dental and vision
• Limited Purpose FSA: For certain dental and vision costs not covered by insurance.
• Dependent Care FSA: For certain dependent care costs such as after school care, baby-sitting
fees, adult or child daycare and pre-school
• State employees only: Transportation and Parking FSA: For certain work-related
commuting and/or parking expenses.
• Contribution limits: Set by the IRS. Go to IRS.gov for contribution limits
• If you were enrolled in a FSA in 2016, you need to re-enroll. The exception is parking and
transportation – you do not have to re-enroll
• Currently have a HSA with a debit card and plan to enroll in a limited-purpose FSA – in 2017 you will
use the same debit card for both
www.partnersforhealthtn.gov
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Additional Benefits
Employee Sick Leave Bank – State Only
• Administered by Tennessee Department of Human Resources
• Provides sick leave to qualifying members
• A member may receive a maximum of 90 days from the Bank
• Open enrollment is August 1 – October 31 each year
• Must be a full-time state employee for 12 consecutive months and have at least
six days of sick leave by October 31 of your enrollment year
• Must contribute four sick leave days to enroll
• One day of sick leave thereafter assessed each Oct 1 to maintain membership
• If you are already enrolled you do not need to take any action
For more information or to enroll, visit the SLB website
https://dohrslb.tn.gov/slb/enroll/login.aspx
www.partnersforhealthtn.gov
53
Additional Benefits
Retire Ready Tennessee Deferred Compensation Program
(401(k) and 457) – State Only
• State employees have a retirement plan comprised of the TCRS defined
benefit pension and two tax-deferred retirement savings plans, 401(k) and
457.
• State employees are eligible for an additional $50 monthly match from the
State into their 401K accounts.
• Those hired after July 1, 2014, are automatically enrolled in the 401K plan at
2%, but have the option to increase their contribution as needed to help meet
their retirement savings goals.
• More information is available on the Treasury’s website at treasury.tn.gov/dc
trewww.treasury.tn.gov/dc.
Plans
are administered by the Department of Treasury and Empower Retirement
providing record keeping and financial education
www.partnersforhealthtn.gov
54
Take Note!
• If you do not make changes, you will stay in your current options (except
for medical and dependent care FSA).
• If you do want to make changes or add coverage, you must use ESS
and meet the enrollment deadline of October 14, 2016.
 Don’t
Wait ─ Enroll early! Enrollment period is shorter this year.
 You
must click “submit” in ESS to finalize your selections by 4:30 p.m.
Central on October 14, 2016.
 Dependent
verification documents must also be submitted by October 14 at
4:30 p.m. Central or the dependents WILL NOT be enrolled.
• You can’t make changes until the next Annual Enrollment Period – unless
you have a qualifying event.
www.partnersforhealthtn.gov
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ID/Debit Card Information
• All health insurance plan members will get new medical ID cards because of changes in
deductibles, copays and coinsurance in December.
• New to health insurance or made a change to current coverage, you will get a new pharmacy
ID card in December.
• New to dental coverage or made a change to current coverage, you will get a new dental ID
card in December.
• New to vision coverage or made a change to current coverage, you will get a new vision ID
card in December.
HSA and FSA debit cards:
• Current HealthSavings CDHP/HSA plan member, you will get a new debit card this fall
• Note the new phone number
• New 2017 HealthSavings CDHP/HSA member, you will get a debit card in December
• All state and higher ed members who enroll in a medical or limited-purpose FSA will get new
debit cards
• Enroll in the CDHP/HSA and choose a limited-purpose FSA for dental and vision expenses only, you
will get one debit card from PayFlex in December will all of your information loaded. The limitedpurpose funds, when applicable, will be used before your HSA funds.
www.partnersforhealthtn.gov
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Member Communications
Current eligible employees will
receive a copy of the 2017
Decision Guide in early
September.
www.partnersforhealthtn.gov
57
Employee Webinars
Want to learn more about the HealthSavings CDHP ?
Benefits Administration will have employee webinars for state and higher
ed employees:
• October 4 – 2:30 p.m. to 3:30 p.m. Central time
• October 5 – 10:30 a.m. to 11:30 a.m. Central time
• October 11 – 2:30 p.m. to 3:30 p.m. Central time
• October 12 – 2 p.m. to 3 p.m. Central time
Go to partnersforhealthtn.gov for login instructions
www.partnersforhealthtn.gov
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Don’t forget Alex!!
ALEX is a smart, funny benefits expert who
explains benefits and may help members choose
what’s best for them.
Go to www.partnersforhealthtn.gov
59
Who to Contact
• Agency Benefits Coordinator (ABC)
• Questions about a provider or claim – contact your insurance
carrier
• Questions about eligibility and enrollment – call Benefits
Administration Service Center at
• 800.253.9981, Mon. – Fri., 8:00 a.m. to 4:30 p.m. Central
• ParTNers for Health website – www.partnersforhealthtn.gov
• Handbook publications and forms –
http://www.tn.gov/finance/topic/fa-benefits-publicationsforms
• ALEX – your decision support tool found on the ParTNers for
Health website
www.partnersforhealthtn.gov
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Questions?
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