state of tennessee group insurance program annual enrollment period october 1 – november 1, 2014

State of Tennessee Group Insurance Program

Annual Enrollment Period October 1 – November 1, 2014

2

Agenda

• Annual Enrollment Period

• Using ESS in Edison

• What’s Changing for 2015

• Health Benefits Overview

• 2015 Partnership Promise

• Dental, Vision and Additional Benefits Overview

www.partnersforhealthtn.gov

3

Annual Enrollment Period

• Open Enrollment: October 1 – November 1, 2014 Annual Enrollment Period (AEP) is an open enrollment for most programs

• Employees can make the following changes: Choose or switch PPOs (subject to eligibility) Select or change your health insurance carrier Enroll, cancel or make changes to health insurance Enroll in, cancel or transfer between dental options Enroll in, cancel or transfer between vision coverage

State/Higher Ed only: Enroll in or cancel optional accidental death coverage Apply for, cancel, increase or decrease optional term life coverage amounts (if

eligible)


4


If you DO NOT want to make changes

• No action is required during annual enrollment

• If you stay in the Partnership PPO, you (and your covered spouse) are agreeing to fulfill the 2015 Partnership Promise

If you DO want to make changes to have TCS Combo Plan

• 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)

• State/Higher Ed: Use the Minnesota Life website for optional term life insurance


5


• Changes take effect on January 1, 2015

• Selections remain in effect through December 31, 2015, 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

• Contact your Agency Benefits Coordinator if you experience a qualifying event


6

Using Edison ESS

• To make changes and have the TCS Combo Plan with the Limited PPO and Colonial Medical Gap Plan, 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. Your access information should be mailed to your home address in September.


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

7

Using Edison ESS

State and Higher Ed:• Designating Life Insurance Beneficiaries:

• You can now designate beneficiaries in Edison for Basic Term Life, AD&D and 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 November 1, 2014


Not Applic

able to TCS

8

What’s Changing for 2015

Health Insurance Changes

• Health insurance premiums will not increase in 2015.

• Single medical out-of-pocket maximum for the Standard and Partnership PPOs – the medical copay and medical coinsurance are now combined.

• Out-of-pocket maximums for medical and pharmacy are changing for all PPOs. Your total in-network out-of-pocket maximum will be less in 2015.

• Local Ed and Local Gov: For the Limited PPO, the in-network pharmacy and medical out-of-pocket maximums are combined into a single out-of-pocket maximum.


9

Dental and Vision plan changes (if offered by your agency)

• Dental insurance premiums will increase by 2.1% for both plans

• Vision insurance premiums will increase by approximately 2.4%



Active Employees Prepaid Plan PDO Plan

Employee Only $10.13 $21.51

Employee + Child(ren) $21.03 $49.46

Employee + Spouse $17.95 $40.69

Employee + Spouse + Child(ren) $24.68 $79.62

Active Employees Basic plan Expanded plan





Not Applicable for T

CS

10

2015 Partnership Promise Requirement Changes

• In 2015, 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, 2015

2. If you are called, actively participate in health coaching:

• If called for health coaching, you must get a biometric screening by July 15, 2015

• Health 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



11

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 (tiers)

• Employee

• Employee + child(ren)

• Employee + spouse

• Employee + spouse + child(ren)

Two Insurance Carriers

• BlueCross BlueShield of Tennessee

• Cigna


12

Health Benefits

• PPOs cover the same services, treatments and products:• In-network preventive care, x-rays, lab and diagnostics at no cost• Free preventive health services (must visit an in-network provider)• Fixed copays for some services• Different medical criteria may apply based on carriers

• PPOs offer: • Deductibles and co-insurance for certain services • 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.


13

Health BenefitsLocal Ed and Local Gov

Limited PPO available to Local Ed and Local Gov

• About the Limited PPO:

• Same benefits and services as the other PPOs, but the premiums and out-of-pocket costs are different

Monthly premiums are lower – out-of-pocket costs for medical and pharmacy expenses are higher

Copays are higher than the other PPOsDeductible is higher than the other PPOsCoinsurance is higher than the other PPOsPharmacy deductible of $100 before benefits begin


14

Health Benefits

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

• Both carriers have made changes to their networks for 2015

• 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 (statewide) or LocalPlus Network (middle Tennessee eligible individuals only)


15

Health Benefits

In Middle Tennessee (only):

• If you select Cigna as your insurance carrier, you can choose between two different Cigna options:

• Cigna Open Access Plus or Cigna LocalPlus• Cigna Open Access Plus costs more in Middle Tennessee than Cigna LocalPlus, but

Cigna LocalPlus has a narrower (or smaller) network

• With Cigna LocalPlus, certain hospital systems are not included. Check the network carefully before making this choice

• Cigna LocalPlus premiums are the same as BlueCross BlueShield of Tennessee in Middle Tennessee


16

Health Benefits

Carrier costs vary by your region

• In East and Middle Tennessee:

Cigna Open Access costs $20 moreper month for employee only coverage and $40 more per month for all other tiers (coverage levels)

• In Middle Tennessee (only): Cigna LocalPlus costs the same as BCBST. Cigna Open Access Plus costs more than BCBST and Cigna LocalPlus

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


17

Additional Health Resources

ParTNers for Health Wellness Program• The ParTNers for Health Wellness Program is FREE to all health insurance

plan members, eligible spouses and dependents

• Wellness Resources:• Health coaching – call Healthways and get support from a health coach• Well-Being Assessment (WBA) – online 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 discounts and Fitness Center discounts• Additional wellness and fitness discounts through the EAP program and our carriers

BCBST and Cigna


18

Pharmacy Benefits CVS/caremark is the pharmacy benefits manager for all plan

members• PPOs require a copay for prescription drugs

• 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


Tobacco Cessation: The state’s prescription drug coverage provides free tobacco quit aids to members who want to stop using tobacco products.

19

Behavioral Health Benefits and Employee Assistance Program

Behavioral Health and Employee Assistance Program (EAP)• Both are included for everyone with medical benefits in all plans

• Not an optional or additional benefit – provided for all with medical benefits

• State and Higher Ed: You and your dependents receive EAP benefits even if you do not participate in the State Group Insurance Program.

• Local Ed and Local Gov: If you are enrolled in health benefits, you receive EAP benefits. Your eligible dependents do not have to be enrolled in health benefits to receive EAP benefits.


20

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

• Just a few issues EAP can help with:

• Contact ParTNers EAP:• Toll Free 24/7 at 1.855.HERE4TN (1.855.437.3486)• Or at www.Here4TN.com


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 20

22

2015 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


23

2015 Limited PPO Deductible and Out-of-Pocket Maximum


Local Government and Local Education Only

In-Network Out-of-Network

Deductible

Employee Only $ 1,200 $ 2,300

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

Employee + Spouse $ 2,100 $ 3,900

Employee + Spouse + Child(ren) $ 2,600 $ 4,950

Out-Of-Pocket Maximum

Employee Only $ 6,600 $ 12,700

Employee + Child(ren) $ 13,200 $ 25,400

Employee + Spouse $ 13,200 $ 25,400

Employee + Spouse + Child(ren) $ 13,200 $ 25,400

24

Premiums for 2015: State and Higher Education

Premium Level Partnership PPO Standard PPO





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 active employees and the least expensive carrier in the region. A complete chart is available in the Decision Guide and on the ParTNers for Health website.


25

Premiums for 2015: Local Education

Total Monthly Premiums

Premium Level Partnership PPO Standard PPO Limited PPO

Employee Only $540.71 $565.71 $346.06

Employee + Child(ren) $892.18 $917.18 $571.00

Employee + Spouse $1,054.39 $1,104.39 $674.81

Employee + Spouse + Child(ren) $1,405.85 $1,455.85 $899.75

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


26

Premiums for 2015: Local Government

Total Monthly Premiums

Premium Level Partnership PPO Standard PPO Limited PPO

Employee Only $611.55 $636.55 $391.61

Employee + Child(ren) $947.90 $972.90 $606.99

Employee + Spouse $1,314.81 $1,364.81 $841.96

Employee + Spouse + Child(ren) $1,651.18 $1,701.18 $1,057.35

The State does not pay any premiums for Local Government Plan employees. However, some

Local Government employers may pay a portion.

• Premiums shown are for active employees and the least expensive carrier in the region for Premium Level 1. A complete chart is available in the Decision Guide and on the ParTNers for Health website.


27

2015 Partnership Promise

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

• Partnership PPO members save money on premiums and out-of-pocket costs versus the Standard PPO

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


On average, an employee with no dependents can save $506 on premiums and out-of-pocket costs through the Partnership PPO instead of the Standard PPO. An employee with a covered spouse and dependents can save $1,041 on average. Estimated savings are based on a full year of health insurance premiums and average out-of-pocket costs.

28


In 2015, Partnership PPO members and covered spouses must:

1. Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2015

2. Actively participate in health coaching if you are called

• If called for coaching, you must complete a biometric screening by July 15, 2015

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

3. Update your contact information with your employer if it changes


29


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, 2015

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

Note: A person who knowingly provides false information to maintain Partnership PPO benefits may be moved to the Standard PPO 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.


30

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

• If called for coaching, you must complete a biometric screening by July 15, 2015.

• Coaching could include a tobacco cessation program and/or case management which is

administered by our carriers BlueCrossBlueShield, Cigna and Magellan.


Healthways hours of operation:

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

Coaches are also available on Saturday:

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


31

Health 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.



32


Biometric Screening

• Any new members and members who are called for health coaching must complete a biometric health screening by July 15, 2015.

• Members can get this screening from your healthcare provider.

• Biometric screenings include height, weight, blood pressure and waist circumference. A sample of your blood is collected to determine blood sugar and cholesterol levels.

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 and your doctor must complete and sign the form.

Send the form by fax or mail to the address on the form


33


Tobacco Cessation

• Partnership PPO members who use tobacco must participate in and complete a Healthways’ tobacco cessation program and work toward quitting tobacco.

• 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 (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 2015 – just participate and try to quit.


34


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.


35

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 Local Ed and Local Gov: If offered by your agency

Assurant Prepaid Plan• Fixed copays

• Participating dentists only

Delta Dental PDO Plan• Coinsurance and deductibles

• Any dentist

• Pay less with network providers


Not Applic

able to TCS

36

Dental BenefitsLocal Ed and Local Gov: If offered by your agency

Prepaid Plan Administered by Assurant Employee Benefits

The Prepaid plan provides services at predetermined copay amounts from a limited network of participating dentists and specialists.

• You must select a dentist from the Prepaid Plan list and notify Assurant

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

• You must use your selected dentist to receive benefits• Services are provided at predetermined member copay amount • No deductible, no claims and no waiting period• Referrals are not required• In 2015, premiums will increase by 2.1%


Not Applic

able to TCS

37

Dental Benefits

Delta Dental Preferred Dental Organization (PDO) PlanThe PDO plan provides services with member coinsurance rates.

• Choose any dentist (maximum benefits when visiting an in-network Delta Dental PPO provider)

• You pay co-insurance for covered services

• A deductible applies for out-of-network dental care only

• You or your dentist will file claims for covered services

• Referrals are not required

• Some services require a 12-month waiting period

• There are some limitations and exclusions

• In 2015, premiums will increase by 2.1%


Not Applic

able to TCS

38

Dental Benefits

2014 Premiums Assurant Prepaid Delta Dental PDO





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

39

Vision BenefitsLocal Ed and Local Gov: If offered by your agency

Vision Plan

• Administered by EyeMed Vision Care

• Available to employees at participating agencies • There are two plan options:

• Both plans offer the same services

• In 2015, premiums will be approximately 2.4 % higher for both plans


Basic Plan Expanded Plan

Discounted rates Copays

Allowances Allowances

Discounted rates

40

Vision Plan

• Monthly premiums for Active Members

Basic Expanded





Vision Benefits


• EyeMed offers some additional discounts

Not Applic

able to TCS

41

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

Local Education Plan and Local Government Plan members should check with their Agency Benefits Coordinator to see if

accident and life insurance is offered by their agency.


Not Applic

able to TCS

42

Additional Benefits

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


Not Applic

able to TCS

43

Additional Benefits

Optional Term Life Insurance State and Higher Education Only

• If you qualify, you may be able to purchase 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


Not Applic

able to TCS

44

Additional Benefits

Long-Term Care Insurance

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

• Who is eligible?

Qualified employees Eligible dependents

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

Nursing home care Assisted living Home healthcare

Apply for coverage at any time through medical underwriting.

Retirees Parents and parents-in-law

Home care Adult day care


Not Applic

able to TCS

45

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 percent of the premium

• Premiums are based on age at the time of enrollment

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


Long-Term Care Insurance is administered by MedAmericaNot Applic

able to TCS

46

Additional Benefits

Flexible Benefits – State Only• 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

• You must sign up between October 1 – November 1, 2014

• No enrollments can be made after November 1, 2014

Flexible Benefits are administered by the Department of Treasury. Visit www.treasury.tn.gov/flex for more information


Not Applic

able to TCS

http://www.treasury.tn.gov/flex

47

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

For more information or to enroll, visit www.tn.gov/dohr/ and click on the “For Employees” link.


Not Applic

able to TCS

http://www.tn.gov/dohr/

48

Additional Benefits

Deferred Compensation Plan– State Only

State employees are eligible to participate in two optional, tax-deferred retirement savings plans operated by the State: a 457 plan and a 401(k) plan

• Deferred Compensation program is part of the Tennessee Treasury department

• If you choose to participate, you make contributions through regular payroll deductions

• Depending on the percentage of salary, the state contributes a maximum of $50 per month to a 401(k) plan

• Refer to the participant guide on the Treasury’s website

Great West is the chosen record-keeper.


Not Applic

able to TCS

Take Note!

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

• If you do want to make changes to the TCS Combo Plan or add coverage, you must use ESS and meet the enrollment deadline of November 1, 2014. Access information to be mailed to home. Don’t Wait ─ Enroll early! You must click “submit” in ESS to

finalize your selections by 11:59 p.m. CT on November 1, 2014.

• No changes until the next Annual Enrollment Period


Member Communications


Current eligible employees received a copy of the 2015

Decision Guide at their homes in mid-September.

51

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 1-800-253-9981, Monday – Friday, 8:00 a.m. to 4:30 p.m. CT

• 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

52

Questions?

state of tennessee group insurance program annual enrollment period october 1 – november 1, 2014

Documents

edison ess state

annual enrollment period

optional term life insurance

edison benefits administration

following changes

health benefits overview

health insurance carrier

optional term life coverage