State of Tennessee Group Insurance Program Open Enrollment/Annual Enrollment Transfer Period October 1 – November 1, 2013

State of Tennessee Group Insurance Program

Open Enrollment/Annual Enrollment Transfer Period

October 1 – November 1, 2013

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• Open Enrollment: October 1 – November 1, 2013 Annual Enrollment Period (AETP) is now an Open Enrollment Late applicant fee will no longer apply in 2014

• Employees can make the following changes: Switch PPOs (subject to eligibility) Enroll in Cigna LocalPlus PPO (Middle TN only) Change health insurance carriers Enroll, cancel or make changes to health insurance Enroll in, cancel or transfer between dental options

www.partnersforhealthtn.gov

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If you DO NOT want to make changes

• No action is required this year

• If you stay in the Partnership PPO, you (and your covered spouse) are agreeing to fulfill the 2014 Partnership Promise

If you DO want to make changes

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

• Benefits Administration will not accept paper forms (exception for Local Gov with fewer than 100 employees)

• Use the Minnesota Life website for the optional term life insurance


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• Changes take effect on January 1, 2014

• Selections remain in effect through December 31, 2014, unless you lose eligibility or have a qualifying event

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

• Contact your agency benefits coordinator if you experience a qualifying event


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Using Edison ESS

• To make changes to your health coverage or add dental insurance, you must use Employee Self Service (ESS) in Edison

• To use ESS, log on to Edison at www.edison.tn.gov

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


http://www.edison.tn.gov/

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What’s Changing for 2014

Health and Dental Premiums

• Health insurance premiums will increase by the following percentages: State and Higher Ed Plan = 5.5% Local Education Plan = 5.6% Local Government Plan = 5.3%

• Dental insurance premiums will increase by 3% for both plans


Prepaid Plan PDO Plan

Employee Only $9.92 $21.07

Employee + Child(ren) $20.60 $48.44

Employee + Spouse $17.58 $39.85

Employee + Spouse + Child(ren) $24.17 $77.98

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Late applicant fee • Beginning in January 2014, the late applicant fee will no longer apply

For those currently paying the monthly late applicant fee, the last payroll deduction will occur at the end of November 2013



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2014 Partnership Promise Requirement Changes

• In 2014 every Partnership PPO plan member must complete two things as a part of the Partnership Promise:

1. Complete the online Well-Being Assessment (WBA) by March 15, 2014

2. Get a biometric screening at your doctor’s office or at a worksite location between July 16, 2013 and July 15, 2014



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Limited PPO available to Local Education

• Now available to both Local Government and Local Education

• What you should know about the Limited PPO

• Monthly premiums are low, but the deductibles and out-of-pocket maximums have changed

• Be sure to look at out-of-pocket costs carefully


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Additional services apply to out-of-pocket copay maximum

• Addition of three services: Emergency room In-network chiropractic In-network urgent care visits

• To provide additional financial protection for members, copays for these three services will now count towards the in-network out-of-pocket copay maximum for the Partnership and Standard PPOs and the overall maximum out-of-pocket for the Limited PPO



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Pharmacy Benefits• $3,750 in-network pharmacy out-of-pocket copay maximum

• New benefit this year: Once maximum is reached members will pay $0 in copayments for remainder of year

• Increase for Limited PPO copays – Local Gov and Local Ed• Copays in bold have changed

• Human Growth Hormone• Will implement step therapy; must try

preferred drug first • Currently two preferred specialty drugs• Impacts very few members• No grandfathering



Limited PPO30-day supply

$10 /$55 / $105

90-day supply (mail order or Retail 90)

$20 / $105 / $205

Certain maintenance medications

$10 / $50 / $200

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Health Benefits

Your Health Insurance Options You have these health insurance options

Preferred Provider Organization (PPO) Options

Partnership PPO

Standard PPO

Limited PPO (Local Education and

Local Government)

Four Premium Levels

• Employee

• Employee + child(ren)

• Employee + spouse

• Employee + spouse + child(ren)

Two Insurance Carriers

• BlueCross BlueShield of Tennessee

• Cigna


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Health Benefits

• BlueCross BlueShield (BCBST) and Cigna each have their own network

• Both carriers have made significant changes to their networks for 2014

• 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

Available Networks:

• BlueCross BlueShield offers Network S

• CIGNA offers Open Access Plus


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Employee Assistance Program (EAP)

Employee Assistance Program (EAP) • All services are confidential and available at no cost to members 24/7

• You and your eligible dependents may get up to five, no cost counseling sessions per problem episode, per year

• Your EAP also offers work-life services, financial and legal services, assistance finding eldercare and dependent care services and much more

• Contact ParTNers EAP:

• Toll Free 24/7 at 1.855.HERE4TN (1.855.437.3486)

• Or at www.Here4TN.com


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2014 Deductibles and Out-of-Pocket Co-insurance Maximums

Partnership PPO Standard PPO Limited PPO

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

Network In-Network Out-of-Network

Annual Deductible

Employee only $450 $800 $800 $1,500 $ 1,200 $ 2,300

Employee + Child(ren) $700 $1,250 $1,250 $2,350 $ 1,800 $ 3,350

Employee + Spouse $900 $1,600 $1,600 $3,000 $ 2,100 $ 3,900

Employee + Spouse + Child(ren) $1,150 $2,050 $2,050 $3,850 $ 2,600 $ 4,950

Out-of-Pocket Co-Insurance Maximum

Employee only $1,550 $2,900 $1,900 $3,600 $ 6,350 $ 12,700

Employee + Child(ren) $2,450 $4,600 $3,100 $5,900 $ 12,700 $ 25,400

Employee + Spouse $3,100 $5,800 $3,800 $7,200 $ 12,700 $ 25,400

Employee + Spouse + Child(ren) $4,000 $7,500 $5,000 $9,500 $ 12,700 $ 25,400


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2014 Partnership Promise

Healthways administers the Partnership Promise

• Partnership PPO members pay much lower premiums

• Members and enrolled spouses must complete the Partnership Promise each year


If you or your spouse fail to fulfill any requirement of the 2014 Partnership Promise, you will both be transferred to the Standard PPO in 2015.

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2014 Partnership PPO members and covered spouses must:1. Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2014

2. Complete a biometric health screening between July 16, 2013, and July 15, 2014

Members and covered spouses may have to do the following if applicable:

• Participate in health coaching and/or case management if identified

• Engage in the Healthways tobacco cessation program if you are a tobacco user

• Update your contact information with your employer if it changes


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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, 2014

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


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Required Biometric Health Screening

You must get a biometric health screening by July 15, 2014

There are two ways to get a biometric screening:

• At a worksite screening

• At your doctor’s office:• You may use screening results from a doctor’s visit between

July 16, 2013, and July 15, 2014


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Health Coaching

• Members and spouses who are identified by Healthways must participate

• Health coaching programs include:

Lifestyle management

Disease management

• Case Management is managed by BlueCross BlueShield, Cigna and Magellan


The Partnership Promise is managed by Healthways

Healthways’ hours of operation:

Monday – Friday 7:30 a.m. to 9:30 p.m. CT

Saturday – 8:00 a.m. – 6:30 p.m. CT


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Tobacco Cessation

• Partnership PPO members who use tobacco must participate in Healthways tobacco cessation program and work toward becoming tobacco free

• Partnership PPO members who use tobacco products must answer “Yes” to the question “are you a tobacco user” when completing the required online Well-Being Assessment

• Healthways will reach out to tobacco users to enroll

• You are not required to quit by the end of 2014 – but must make an effort to quit


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Updating Contact Information

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

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


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Eligible employees can choose between two dental options:

• During the enrollment period, eligible employees can enroll in or transfer between the two options

• If you don’t change your current dental carrier or cancel coverage, you will keep your current coverage

Dental Benefits

Assurant Prepaid Plan• Fixed copays

• Participating dentists only

Delta Dental PDO Plan• Coinsurance and deductibles

• Any dentist

• Pay less with network providers


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Dental Benefits

Prepaid Plan Administered by Assurant Employee Benefits

• The network is DentiCare

• Predetermined copay amounts (reduced fees) for dental treatments

• 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

• Referrals are not required

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

• Premiums will increase by 3% in 2014

• Note: There are some areas in the state where Assurant network dentists are not available


No Carriers in West TN

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Dental Benefits

2014 Premiums Assurant Prepaid Delta Dental PDO

Employee Only $9.92 $21.07

Employee + Child(ren) $20.60 $48.44

Employee + Spouse $17.58 $39.85

Employee + Spouse + Child(ren) $24.17 $77.98

Dental services for both the Prepaid Plan and the Dental PDO 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

Optional Vision Plan

• Administered by EyeMed Vision Care

• Available to employees at participating agencies

• Both plans offer the same services

• There are no premium changes for the Basic Plan or Expanded Plans


Basic Plan Expanded Plan

Discounted rates Copays

Allowances Allowances

Discounted rates

Henry County School System does NOT participate in the State Vision Plan. We offer vision through Superior Vision which will be offered

by an USAble Rep.

Take Note!

• If you do not want to make changes, no action is required

• If you do want to make changes or add coverage, you must use ESS and meet the enrollment deadline of November 1, 2013

Don’t Wait ─ Enroll early! You must click “submit” in ESS to finalize your selections by 11:59 p.m. CT on November 1, 2013

• No changes until the next Open Enrollment/Annual Enrollment Transfer Period

www.partnersforhealthtn.gov 29

Member Communications

www.partnersforhealthtn.gov 30

Current members will receive a copy of the 2014 Decision

Guide at their homes in mid-September.

HENRY COUNTY SCHOOL SYSTEMHEALTH INSURANCE PLAN RATES

EFFECTIVE JANUARY 1, 2014STATE HEALTH INSURANCE

(TOTAL MONTHLY PREMIUMS)PARTNERSHIP

BCBS CIGNAEmployee Only $560.71 $540.71Employee + Child(ren) $932.18 $892.18Employee + Spouse $1,094.39 $1,054.39Employee + Spouse + Child(ren) $1,445.85 $1,405.85

STANDARDBCBS CIGNA

Employee Only $585.71 $565.71Employee + Child(ren) $957.18 $917.18Employee + Spouse $1,144.39 $1,079.39Employee + Spouse + Child(ren) $1,495.85 $1,455.85

LIMITED PPOEmployee Only $366.06 $346.06Employee + Child(ren) $611.00 $571.00Employee + Spouse $714.81 $674.81Employee + Spouse + Child(ren) $939.75 $899.75

EMPLOYEE PREMIUMSMONTHLY PAYROLL DEDUCTIONS

PARTNERSHIPBCBS CIGNA

Employee Only $117.50 $106.50Employee + Child(ren) $320.88 $298.88Employee + Spouse $409.67 $387.67Employee + Spouse + Child(ren) $602.04 $580.04

STANDARDBCBS CIGNA

Employee Only $131.25 $120.25Employee + Child(ren) $334.63 $312.63Employee + Spouse $437.16 $402.67Employee + Spouse + Child(ren) $629.54 $607.54

LIMITEDEmployee Only $76.71 $68.16Employee + Child(ren) $210.32 $191.28Employee + Spouse $267.58 $248.11Employee + Spouse + Child(ren) $391.30 $371.23

DELTA DENTAL (MONTHLY PREMIUMS)Employee Only $21.07Employee + Child(ren) $48.44Employee + Spouse $39.85Employee + Spouse + Child(ren) $77.98

INCREASE AMOUNT5.6%

Increase in Total

Premium

Increase to

Employee

Employee Only 28.67 14.34

Employee + Child(ren) 47.31 23.66

Employee + Spouse 55.91 27.96

Employee + Spouse + Child(ren)

74.55 37.28

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Who to Contact

• Primary point of contact - Agency Benefits Coordinator Tiffany Latta, 642-9733

• 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

• Handbook publications and forms – www.tn.gov/finance/ins


http://www.partnersforhealthtn.gov/

http://www.tn.gov/finance/ins

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Questions?

Documents

State of Tennessee Group Insurance Program Open Enrollment/Annual Enrollment Transfer Period October 1 – November 1, 2013