state of tennessee group insurance program state and higher education annual enrollment period...

State of Tennessee Group Insurance Program

State and Higher EducationAnnual Enrollment Period

September 15 – October 15, 2015Enrollment ends at 4:30 p.m. Central

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Agenda

• Annual Enrollment Period

• What’s New or Changing for 2016

• Using ESS in Edison

• Health Benefits Overview

• 2016 Partnership Promise

• Dental, Vision and Additional Benefits Overview

www.partnersforhealthtn.gov

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Annual Enrollment Period

• Enrollment: September 15 – October 15, 2015, 4:30 p.m. Central Annual Enrollment Period (AEP) is an open enrollment for most programs

• Employees can make the following changes: Choose, switch or cancel health insurance plans (subject to eligibility) for yourself or your

eligible dependents ** New health insurance options **

Select or change your health insurance carrier Enroll in, cancel or transfer between dental options

**New dental vendors** Enroll in, cancel or transfer between vision coverage options

State/Higher Education: Enroll in or cancel voluntary (optional) accidental death & dismemberment coverage Apply for, cancel, increase or decrease voluntary (optional) term life coverage amounts (if eligible)State only: Enroll in flexible benefits


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What’s New and Changing - 2016

• Health insurance premiums will increase by 3.5 percent in 2016. • Vision premiums will not increase in 2016.• Dental prepaid premiums will increase and the dental preferred plan provider premiums will not increase.

• Cigna will offer the LocalPlus network in all regions and BlueCross BlueShield of

Tennessee will offer Network S in all regions.

• Carrier surcharge will be removed from all health plan option premium costs. The premium costs will be the same for both BlueCross and Cigna.

• **New healthcare option – the HealthSavings CDHP (with or without Wellness option) - will be available.

• A new Decision Tool – ALEX , is your confidential, personal online benefits expert. ALEX can help you compare your insurance options based on your own situation. We’ll have more about ALEX later.


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• Copays for convenience clinics (often located in grocery stores or drug stores) will be lowered to the same as primary care visits.

• Copays for urgent care centers (often near a hospital) will be raised to the same level as a specialist visit.

• Chiropractic coverage will be limited to 50 visits per year.

• Pharmacy lower cost 90-day maintenance tier will be expanded to include medications for asthma, depression, COPD, and additional anti-hypertensives for coronary artery disease (CAD) and congestive heart failure (CHF).

• **New dental plan vendors: The prepaid plan vendor will be Cigna (replacing Assurant) and the dental preferred provider will be MetLife (replacing Delta Dental).


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The State is offering new health insurance plan options that could save you money

• HealthSavings CDHP/HSA plans (Consumer Driven Health Plan with a Health Savings Account)

• Two HealthSavings CDHP options are available:• Wellness HealthSavings CDHP (includes the Partnership Promise and funds from

the State)

• HealthSavings CDHP

• Provide same comprehensive health insurance coverage as the PPO options

• More information about the HealthSavings CDHPs is included later in the presentation


What is ALEX?

ALEX is a smart, funny benefits expert who explains benefits options and may help members choose what’s best for them.

Go to www.partnersforhealthtn.gov

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2016 Partnership Promise Requirement Changes

• In 2016, every Partnership PPO plan member must complete these requirements as a part of the Partnership Promise:

1. Complete the online Well-Being Assessment (WBA) between January 1 and March 15, 2016

2. Get a biometric screening by July 15, 20163. If you are called, actively participate in coaching:

• Coaching could include a tobacco cessation program or case management

3. Keep your contact information current with your employer• Covered spouses – keep contact information current with Healthways

What’s Changing for 2016


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If you DO NOT want to make changes

If you are happy with your current benefit selections, you don’t have to do anything,

BUT NOTE:

• Health insurance carriers – check the networks carefully!

• Cigna network for 2016 is LocalPlus. If you are currently enrolled in Cigna and you do not want to change carriers, you do not have to do anything. You’ll stay enrolled in Cigna and providers in LocalPlus will be your in-network providers. Cigna will mail new insurance cards.

• BlueCross BlueShield network for 2016 is Network S. If you are currently enrolled in BlueCross and you do not change carriers, you will continue to use Network S. BlueCross will mail new insurance cards.


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If you DO NOT want to make changes (continued)

• The dental carriers will change:

• Prepaid Dental Plan vendor will be Cigna (replaces Assurant). If you are currently enrolled in the prepaid plan and you do not make a change, you will automatically be enrolled in Cigna dental. You may be required to select a general dentist. Cigna will mail new insurance cards.

• Dental Preferred Provider Organization vendor will be MetLife (replaces Delta Dental). If you are currently enrolled in the preferred provider plan and you do not make a change, you will automatically be enrolled in MetLife Dental. MetLife will mail new insurance cards.

• Partnership Promise: If you stay in the Partnership PPO or enroll in the new Wellness HealthSavings CDHP, you and your covered spouse (if applicable) automatically agree to fulfill the 2016 Partnership Promise.


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If you DO want to make changes

• You must use Employee Self Service (ESS) in Edison.

• Benefits Administration will not accept paper forms

• Enroll early! We expect many people will make changes this year and you should submit your changes as early as possible.

• Enrollment ends at 4:30 p.m. Central on October 15.

• All new dependent verification documents must be received by 4:30 p.m. Central on October 15.

• Life Insurance: Use the Minnesota Life website for voluntary (optional) term life insurance.


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• Changes take effect on January 1, 2016

• Selections remain in effect through December 31, 2016, 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


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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://www.edison.tn.gov

• Instructions on how to use ESS are available in the Decision Guide or from your Agency Benefits Coordinator


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Using Edison ESS

Designating Life Insurance Beneficiaries:• You can now designate beneficiaries in Edison for Basic Term Life,

AD&D and Voluntary (Optional) AD&D• If submitting changes during annual enrollment, the beneficiary page

will display after submitting changes• To add beneficiaries through the main menu select ESS, Benefits,

Dependents and Beneficiaries and Life Insurance Beneficiaries

• State only: You must also use ESS to enroll in Flexible Benefits by October 15, 2015


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Recommended Browsers

You will probably not be able to complete your benefits enrollment selections if you use the following browser or devices: Chrome Any mobile devices:

iPads iPhones Android Phones Android Tablets Windows Phones Windows Tablets

When you use Employee Self Service (ESS) in Edison to add or make changes in your benefits, Internet Explorer 9.0 and 10.0, are your best recommended choices.

State employees can call the Edison help desk at 866.376.0104 for assistance Higher Education employees can call the Password Reset Call Center for help:

Password Reset Call Center Helpline: 844.330.9100 Hours of Operation: 8:00 a.m. – 4:30 p.m. Central


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Health Benefits

• As healthcare changes, employees are taking a more active role in their health and making smarter healthcare choices

• All healthcare options offer:

• In-network preventive care at no additional cost

• Access to the ParTNers for Health Wellness program

• Be sure to review your health insurance coverage options carefully


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Health Benefits

Your Health Insurance Options

State and Higher Ed Employees

Options

Partnership PPO*

Standard PPO

Wellness HealthSavings CDHP/HSA*

HealthSavings CDHP/HSA (no Partnership Promise)

Four Premium Levels (tiers)

• Employee

• Employee + child(ren)

• Employee + spouse

• Employee + spouse + child(ren)

Two Insurance Carriers

• BlueCross BlueShield of Tennessee (Network S)

• Cigna (LocalPlus network)


*If you enrolled in the Partnership PPO for 2015 and you or your spouse did not fulfill the Partnership Promise, you are not eligible to continue in the Partnership PPO or enroll in the Wellness HealthSavings CDHP during 2016.

**COBRA participants and retirees are not eligible for the Wellness HealthSavings CDHP.

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Health Benefits• All insurance plans cover the same services and treatments*:

• In-network preventive care, x-rays, lab and diagnostics at no cost• Free preventive health services (must visit an in-network provider)

*Medical necessity determinations vary by carrier

• Health plans include: • Medical, behavioral health and pharmacy benefits• Fixed copays or coinsurance for some services depending on plan• Out-of-pocket maximums to limit costs

Carriers may offer discounts for services not covered. Refer to the carrier’s member

handbooks or websites for more information.


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Health Benefits

Preferred Provider Organizations (PPOs)

• Both the Partnership PPO and Standard PPO

• Offer the same services and treatments

• You’ll pay less in copays and coinsurance with the Partnership PPO versus the Standard PPO

• You’ll pay your deductible first before coinsurance applies

• Separate out-of-pocket maximums for medical and pharmacy

• You’ll pay for prescriptions with copays

• Once you reach your out-of-pocket maximum, the plan pays 100% for in-network services


Health BenefitsHealthSavings CDHPs• The state is offering two new insurance plans:

1. Wellness HealthSavings CDHP – includes the Partnership Promise and the state will put $500 for employee coverage or $1,000 for family coverage into your HSA*

2. HealthSavings CDHP - does not include the Partnership Promise and no funds from the state. Employees may fund the HSA

• Can help you save money• Offered in addition to existing PPOs• Include a Health Savings Account (HSA)

• 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 HSA• New enrollees with coverage effective dates Sept 2 through Dec 1, 2016, will not receive a

state contribution in 2016. This plan is only available to state and higher ed active employees.

20www.partnersforhealthtn.gov

Health BenefitsWith the HealthSavings CDHP options you have:

A lower monthly premium but a higher deductible. A tax-free HSA – which you own. To meet your deductible before the plan starts paying for covered expenses. But

you can use the money in your HSA to pay for qualified medical expenses, including your deductible.

No separate deductible or out-of-pocket maximum for pharmacy. Coinsurance (a set percentage of the discounted network rates) instead of

copays (a set amount), after you meet your deductible, until your reach your out-of-pocket maximum.

A total out-of-pocket maximum that is lower when compared to the total of the PPO’s separate out-of-pocket maximums for pharmacy and medical/behavioral health.


Health Benefits Like the PPOs, the HealthSavings CDHPs:

• Provide comprehensive health insurance coverage• Cover preventive care in-network at no cost • Offer the same provider networks

• BCBST Network S• Cigna LocalPlus network

• Include pharmacy coverage – but the way you pay for drug costs is different


Health Benefits


Health BenefitsDifference Between PPOs and HealthSavings CDHPs:


*New enrollees with coverage effective dates Sept. 2 through Dec. 1, 2016 – the state will not contribute funds to your HSA in 2016.

Health Benefits

Wellness HealthSavings CDHP:

• Only available to State and Higher Education employees

• Must agree to complete the 2016 Partnership Promise

Receive $500/individual or $1,000/family from State*· Deposited in HSA January 2016· Lower co-insurance than non-wellness HealthSavings CDHP

NOTE: Not available to COBRA participants or Retirees

*New enrollees with coverage effective dates Sept. 2 through Dec. 1, 2016 – the state will not contribute funds to your HSA in 2016.


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 out-of-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.) pay coinsurance only – don’t have to meet deductible first when filled through mail order or a Retail-90 network pharmacy.

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Important Note:Member pays for the medication 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


Health Benefits

What are the benefits of an HSA?• The money you save in the HSA (both yours and any employer contributions) rolls

over each year and collects interest. You don’t lose it at the end of the year.

• You can use money in your account to pay your deductible and qualified expenses.

• The money is yours! You take your HSA with you if you leave or retire.

• The 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.

• The HSA can be used to pay for qualified medical expenses that may not be covered by your health insurance plan (like vision and dental expenses, hearing aids, contact lens supplies, acupuncture and more) with a great tax advantage.

• It also serves as another retirement savings account option. Money in your account can be used tax free for health expenses even after you retire. And, when you turn 65, it can be used for non-medical expenses. But non-medical expenses will be taxed.


Health Benefits How does the Health Savings Account (HSA) work?

• If you enroll in a HealthSavings CDHP option, a Health Savings Account (HSA) will be set up for you. • You own your HSA account• The HSA is managed by PayFlex, a company selected and contracted by the state

• You can contribute pre-tax money to your HSA up to the annual IRS allowable maximums through payroll deduction to cover your qualified medical expenses, including your deductible. You can also make post-tax contributions and claim it on your taxes.

Allowable maximum contribution:

In 2016, IRS guidelines allow total tax-free contributions up to $3,350 for individuals

and $6,750 for families annually.

At age 55 and older, you can make an additional $1,000/year contribution ($4,350 for

individuals or $ 7,750 for families).

If the state contributes money to your account, it counts toward the maximum.28www.partnersforhealthtn.gov

Health Benefits CDHP Enrollment Restrictions

• You cannot have a CDHP with a HSA and be enrolled in another plan, including a PPO, your spouse’s plan, or any government plan (e.g., Medicare A and/or B, Medicaid, TRICARE).

• If you are eligible for VA medical benefits and did not receive benefits during the preceding three months, you can enroll in and make contributions to your HSA.

• If you receive VA benefits in the future, then you are NOT entitled to contribute to your account for another three months.

• You can’t be claimed as a dependent by someone else.

• Other restrictions may apply. Go to IRS.gov to learn more


Health Benefits Health Savings Account – are you eligible?

• Other rules:• If you have an FSA with a grace period allowing you to incur claims

until 3/15 and:• Your FSA balance is zero on 12/31, you are eligible to open your

HSA on January 1.• Your FSA balance is not at zero on 12/31, you are not eligible to

open your HSA until the first of the month following the grace period (4/1).• Any funds posted to your HSA cannot be used for claims incurred

prior to 4/1 or the date you opened.


Health Benefits PayFlex – Health Savings Account • If you choose to enroll in a HealthSavings CDHP, you will need to

activate your account with PayFlex

• You will register and access your PayFlex HSA online at www.stateoftn.payflexdirect.com

• PayFlex will send you additional information about the account after you enroll

• Once funds are available in your HSA, PayFlex will send you a card to pay for your eligible expenses


Health Benefits PayFlex – Health Savings Account• Use the PayFlex Card

• Convenient way to pay for eligible expenses• Expenses are paid automatically, as long as funds are available• Keep your receipts for audit purposes

• Higher Ed employees: Anyone who enrolls in the HSA will get a new card from PayFlex, even if you have a PayFlex FSA card.

• 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 online32www.partnersforhealthtn.gov

Health Benefits PayFlex – Health Savings Account

• PayFlex free mobile app• Makes it easy for you to manage your account 24/7• Available for iPhone and iPad mobile digital devices, Android and BlackBerry • Access to your online account• Can upload photos of your receipts of qualified expenses for tax purposes

• Earn interest and invest your money• Earn interest each month on the money in your HSA• When your account balance reaches $1,000 - you can invest the funds over this amount• You can access options and set up investments through your online PayFlex account

• Account fees: The state will pay your 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.


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Health Benefits

Health Insurance Carriers

Available carriers and networks:• BlueCross BlueShield offers Network S • Cigna offers the LocalPlus network (this network has changed)

• Each health insurance carrier has its own network• Be sure to check the networks carefully when making your

decision

• Provider directories are available on the ParTNers for Health website (partnersforhealthtn.gov), by calling the carrier or from your ABC


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Additional Health Resources

ParTNers for Health Wellness Program• The ParTNers for Health Wellness Program is provided at no additional cost

to all health insurance plan members, eligible spouses and dependents

• Wellness Resources:• Coaching – call Healthways and get support from a coach• 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 help 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 and Cigna


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CVS/caremark is the pharmacy benefits manager for all plan members• PPOs require a copay for prescription drugs

• HealthSavings CDHPs require members to pay the full negotiated cost of prescription drugs* up to annual deductible, then coinsurance

*For 90-day chronic maintenance drugs (e.g. hypertension; statins to treat high cholesterol; medications for asthma; oral diabetic medications, insulin and diabetic supplies; COPD; depression; etc.) pay coinsurance only – don’t have to meet deductible first

• How much you pay depends on the prescription tier:•Lowest cost: Tier one/generic drug•Higher cost: Tier two/preferred drug•Highest cost: Tier three/non-preferred brand

• More than 67,000 independent and chain pharmacies throughout the U.S.• About 916 Tennessee pharmacies fill 90-day prescriptions in the Retail 90 Network

Pharmacy Benefits


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Behavioral Health Benefits and Employee Assistance Program

Behavioral Health and Employee Assistance Program (EAP)

• Both behavioral health and EAP are included for everyone with medical benefits in all plans

• State and Higher Education: All benefits eligible employees and their dependents receive EAP benefits even if you do not participate in the State Group Insurance Program.


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Employee Assistance Program (EAP)

Employee Assistance Program (EAP) • Services are confidential and available at no cost to benefits eligible employees and

dependents

• Services are available 24 hours a day, 365 days a year • You and your eligible dependents may get up to five, no cost counseling

sessions per problem episode, per year• Just a few issues EAP can help with:

ParTNers EAP:• Toll Free 24/7 at 1.855.HERE4TN (855.437.3486) • Or at www.HERE4TNcom


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

Behavioral Health and Substance Abuse Treatment

Members of the State Group Health Insurance Plan and their dependents enrolled in health coverage have behavioral health and substance abuse treatment benefits through Magellan.

• Call 1.855.HERE.4.TN (1.855.437.3486) or www.HERE4TN.com

• Outpatient assessment and treatment

• Inpatient assessment and treatment

• Alternative care such as partial hospitalization, residential treatment and intensive outpatient treatment

• Treatment follow-up and aftercare

www.partnersforhealthtn.gov 38

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Premiums for 2016: State and Higher Education

Premium Level Partnership PPO

Standard PPO

Wellness HealthSavings

CDHP

HealthSavings CDHP

Employee Only $118.50 $143.50 $81.00 $81.00

Employee + Child(ren) $177.74 $202.74 $122.50 $122.50

Employee + Spouse $248.84 $298.84 $170.50 $170.50

Employee + Spouse + Child(ren)

$308.09 $358.09 $212.00 $212.00

Employee Share of Monthly Premiums

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

• Premiums shown are for the employee share for active employees. Premiums are the same for both carriers in all regions. A complete chart is available in the Decision Guide and on the ParTNers for Health website.


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2016 Deductibles and Out-of-Pocket Co-insurance Maximums

Partnership PPO Standard PPO

In-Network Out-of-Network In-Network Out-of-Network

Annual Deductible

Employee only $450 $800 $800 $1,500

Employee + Child(ren) $700 $1,250 $1,250 $2,350

Employee + Spouse $900 $1,600 $1,600 $3,000

Employee + Spouse + Child(ren) $1,150 $2,050 $2,050 $3,850

Out-of-Pocket Maximum

Employee only $2.300 $3,500 $2,600 $3,900

Employee + Child(ren) $3,200 $4,600 $3,800 $5,900

Employee + Spouse $3,700 $5,800 $4,500 $7,200

Employee + Spouse + Child(ren) $4,600 $7,500 $5,200 $9,500


There is a separate out-of-pocket maximum for pharmacy

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2016 Deductibles and Out-of-Pocket Co-insurance Maximums

Wellness HealthSavings CDHP HealthSavings CDHP

In-Network Out-of-Network In-Network Out-of-Network

Annual Deductible

Employee only $1,400 $2,800 $1,500 $3,000


Employee + Spouse $2,800 $5,600 $3,000 $6,000Employee + Spouse + Child(ren) $2,800 $5,600 $3,000 $6,000

Out of Pocket Maximum

Employee only $2,300 $4,600 $3,800 $7,600


Employee + Spouse $4,600 $9,200 $7,600 $15,200Employee + Spouse + Child(ren) $4,600 $9,200 $7,600 $15,200


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2016 Partnership Promise

The State Group Insurance Program determines the Partnership Promise requirements and Healthways administers the Partnership Promise.

• The goal of the Partnership Promise is to help you get and stay healthy.

• Members and enrolled spouses who enroll in a plan with the Partnership Promise agree to take steps to improve their health. These steps are called the Partnership Promise.


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In 2016, Partnership PPO members and covered spouses must:

1. Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2016

2. Complete a biometric health screening by July 15, 20163. Actively participate in coaching if you are called

• Coaching could include a Healthways’ tobacco cessation program and/or case management

4. Update your contact information with your employer if it changes• Spouses must keep contact information current with Healthways


The benefits of the Partnership Promise are open to all plan members. If you think you might be unable to fulfill the Partnership Promise, call our ParTNers for Health Wellness Program at 888.741.3390, and they will work with you and/or your physician, if you wish, to find an alternate way for you to meet the Promise.

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Required Online Well-Being Assessment (WBA)

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

• The Well-Being Assessment must be completed between January 1 and March 15, 2016

• To complete the assessment, visit partnersforhealthtn.gov and click on the “My Wellness Tab”

Note: A person who knowingly provides false information to maintain benefits may be moved to a different plan. The State Group Insurance Plans have the right to recover the cost of benefits from any member who received these benefits through false information.


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CoachingMembers and spouses who are called by Healthways to coach must fully participate

• Coaching could include a tobacco cessation program and/or case management which is administered by our carriers

BlueCross BlueShield, Cigna and Magellan.


Healthways hours of operation:

Monday – Friday 8:00 a.m. to 8:00 p.m. Central

Coaches are also available on Saturday:

8:00 a.m. to 6:30 p.m. Central


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Coaching

• Coaching programs include:

• Lifestyle management• Disease management• Tobacco cessation• Case management

Coaches include licensed registered nurses, licensed dieticians and those with degrees in exercise physiology, exercise science, health promotion and psychology. All calls with your health coach are private.

Case management is administered by BlueCross BlueShield, Cigna and Magellan.



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Biometric Screening

• All Partnership PPO and Wellness HealthSavings CDHP members must complete a biometric health screening by July 15, 2016.

• Members can get this screening in two ways:

• Worksite screening: Screening sites will be available across the state beginning in the spring of 2016.

• Healthcare Provider: Healthways will accept screening results from a doctor’s visit between July 16, 2015, and July 15, 2016.

• Visit the Quick Links box on the ParTNers for Health website to print a Physician Screening Form (PSF). Take the form with you when you visit your doctor. You must use this form. You and your doctor must complete and sign the form.

• Return the form as directed.


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Tobacco Cessation• Partnership PPO and Wellness HealthSavings CDHP members who use

tobacco must participate in and complete a Healthways’ tobacco cessation program and work toward quitting tobacco.

• Members who use tobacco products must answer “yes” to the question “are you a tobacco user” when completing the required online Well-Being Assessment (WBA).

• When you confirm you are a tobacco user, Healthways will reach out to you to enroll in a program.

• You are not required to quit by the end of 2016 – just participate and try to quit.

• This requirement applies to both you and your spouse if he or she is covered by your insurance and is a tobacco user.


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Updating Contact Information

• Phone number, mailing address and email address, if you have one, must be kept current with your employer.

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

• Covered spouses must keep contact information current with Healthways.

• Retirees must keep contact information current with Benefits Administration, but must contact Healthways to update email addresses.


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During annual enrollment, eligible employees can choose between two dental options:

• 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

Dental Benefits – New Vendors

Cigna Prepaid Plan• Fixed copays

• Participating dentists only

MetLife Dental Preferred Plan• Coinsurance and deductibles

• Any dentist

• Pay less with network providers


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Dental Benefits – New Vendor

Prepaid Plan Administered by Cigna

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.

• 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 in 2016.


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Dental Benefits – New Vendor

Dental Preferred Provider Organization administered by MetLife

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, major and out-of-network 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 6-

month 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.• Time enrolled in Delta Dental during 2015 will count toward waiting periods in 2016.• Referrals to specialists are not required. Pre-treatment estimates are recommended for services

with significant expense.• Premiums will not increase in 2016.


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Dental Benefits

2014 Premiums Cigna Prepaid MetLife DPPO

Employee Only $12.61 $21.51

Employee + Child(ren) $26.18 $49.46

Employee + Spouse $22.35 $40.69

Employee + Spouse + Child(ren) $30.73 $79.62

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


Monthly Premiums for Active Members

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Vision Benefits

Vision Plan

• Administered by EyeMed Vision Care

• There are two plan options:

• Both plans offer the same services

• Premiums will not increase in 2016


Basic Plan Expanded Plan

Discounted rates Copays

Allowances Allowances

Discounted rates

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Vision Plan

• Monthly premiums for Active Members

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

Vision Benefits


• EyeMed offers some additional discounts

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Additional Benefits

Basic Term Life / Accidental Death InsuranceState 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


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Additional Benefits

Voluntary (Optional) 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


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Additional Benefits

Voluntary (Optional) Term Life Insurance State and Higher Education Only

• If you qualify, you may be able to purchase voluntary (optional) 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


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Additional Benefits

Long-Term Care Insurance

• 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 healthcare

Apply for coverage at any time through medical underwriting.

Retirees Parents and parents-in-law

Home care Adult day care


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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 with MedAmerica


Long-Term Care Insurance is administered by MedAmerica

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Additional Benefits

Flexible Benefits – State Only (does not apply to offline agencies)• Designed to lower your taxes

• You can be reimbursed for certain expenses from your pre-tax income by enrolling in one of the following reimbursement accounts:

Medical expenses Dependent care expenses Parking expenses Transportation expenses

• For enrollments and changes effective January 1, you must sign up for all accounts between Sept. 15 through Oct. 15 online in ESS during the annual enrollment period. No online (ESS) enrollments can be made after October 15, 2015

• Note: If you enroll in a HealthSavings CDHP – you can only have a Limited Purpose FSA.


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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 November 1 of your enrollment year

• Must contribute four sick leave days to enroll

• If you are already enrolled you do not need to take any action

For more information or to enroll, visit the SLB websitehttps://dohrslb.tn.gov/slb/enroll/login.aspx


https://dohrslb.tn.gov/slb/enroll/login.aspx

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Additional BenefitsRetire 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.

• 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 www.treasury.tn.gov/dc.

Plans are administered by the Department of Treasury and Empower Retirement providing record keeping and financial education


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 October 15, 2015.

Don’t Wait ─ Enroll early! We anticipate more people will have changes this year so enroll as soon as possible.

You must click “submit” in ESS to finalize your selections by 4:30 p.m. Central on October 15, 2015.

Dependent verification documents must also be submitted by October 15 at 4:30 p.m. Central or the dependent will not be enrolled.

• You can’t make changes until the next Annual Enrollment Period – unless you have a qualifying event.


Member Communications


Current eligible employees will receive a copy of the 2016

Decision Guide in early September.

What is ALEX?

ALEX is a smart, funny benefits expert who explains benefits options and may help members choose what’s best for them.

Go to www.partnersforhealthtn.gov

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Who to Contact

• Primary point of 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, Monday – Friday, 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-insurprod

• ALEX – your decision support tool found on the ParTNers for Health website


http://www.partnersforhealthtn.gov/

http://www.tn.gov/finance/topic/fa-benefits-insurprod



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Questions?

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