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State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 November 1, 2012

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1 Agenda Annual Enrollment Transfer Period Using ESS in Edison Whats Changing for 2013? Health Benefits Overview 2013 Partnership Promise Dental Benefits Overview www.partnersforhealthtn.gov

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2 Annual Enrollment Transfer Period Open Enrollment: October 1 November 1, 2012 No increase to monthly late applicant fee Employees can make the following changes: Switch PPOs (subject to eligibility) Change health insurance carriers Enroll in health insurance with a monthly late applicant fee Cancel health coverage Enroll in or cancel dental www.partnersforhealthtn.gov

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3 Annual Enrollment Transfer Period 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 2013 Partnership Promise If you DO want to make changes You must use Employee Self Service (ESS) in Edison Benefits Administration will not accept paper forms www.partnersforhealthtn.gov

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4 Annual Enrollment Transfer Period Changes take effect on January 1, 2013 Selections remain in effect through December 31, 2013 A qualifying event or family status change is something that results in a covered person losing coverage or becoming newly eligible for other coverage Contact your agency benefits coordinator if you experience a special qualifying event www.partnersforhealthtn.gov

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5 Using Edison ESS To make changes to your 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 www.edison.tn.gov Local Education: your User ID and a temporary password will be mailed to your home address If you did not receive this or are having trouble logging in, please call Benefits Administration at 1-800-253-9981, option 3 Instructions on how to use ESS are available in the Decision Guide or from your Agency Benefits Coordinator www.partnersforhealthtn.gov

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6 Whats Changing for 2013 Member cost sharing Pharmacy coverage changes www.partnersforhealthtn.gov

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7 Whats Changing for 2013 Member Cost Sharing: Health and Dental Premiums Health insurance premiums will increase by the following percentages: Local Education Plan = 9.2% Dental insurance premiums will increase by 3% for both plans www.partnersforhealthtn.gov Prepaid PlanPDO Plan Employee Only$9.63$20.46 Employee + Child(ren)$20.00$47.03 Employee + Spouse$17.07$38.69 Employee + Spouse + Child(ren)$23.47$75.71

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8 Whats Changing for 2013 Member Cost Sharing: Deductibles The deductibles for each PPO will increase in 2013 The amount of the increase depends on your premium tier www.partnersforhealthtn.gov Employee Only$100 increase Employee + Child(ren)$150 increase Employee + Spouse$200 increase Employee + Spouse + Child(ren)$250 increase

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9 Whats Changing for 2013 Member Cost Sharing: Out-of-Pocket Maximums The out-of-pocket co-insurance maximums will also increase in 2013 The amount of the increase depends on your premium tier www.partnersforhealthtn.gov Employee Only$200 increase Employee + Child(ren)$300 increase Employee + Spouse$400 increase Employee + Spouse + Child(ren)$500 increase

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10 Whats Changing for 2013 Member Cost Sharing: Network Differential Depending on where you live, BlueCross BlueShield of Tennessee and Cigna premiums vary because the networks have different costs in each region If the State pays less, you will pay less too If you select the more expensive carrier in your region, the difference you pay will be more in 2013: Employee-only coverage will cost $20 more Those with family coverage (all levels above employee-only) will pay $40 more www.partnersforhealthtn.gov

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11 Member Cost Sharing: Specialist Office Visit Co-Pays The co-pays for specialist office visits will increase by $5 in 2013 Specialist office visit co-pays for 2013 (including surgery in office setting): Partnership PPO (in-network) = $45 Partnership PPO (out-of-network) = $70 Standard PPO (in-network) = $50 Standard PPO (out-of-network) = $75 Co-pays will not change for the following: Co-pays for primary care Mental health and substance abuse treatment Allergy injections with a primary care office visit Chiropractic visits (visits 1-20) Whats Changing for 2013 www.partnersforhealthtn.gov

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12 Whats Changing for 2013 Member Cost Sharing: Emergency Room Co-Pays Co-pays for emergency room visits will increase by $45 in 2013 Partnership PPO = $125 Standard PPO = $145 The emergency room co-pay will still be waived if the member is admitted to the hospital Members will continue to have access to urgent care clinics as an alternative to the emergency room Partnership PPO = $30 Standard PPO = $35 These rates will not change in 2013 www.partnersforhealthtn.gov

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13 Whats Changing for 2013 Pharmacy: Womens Contraceptives Generic contraceptives and brand name contraceptives without a generic equivalent will be covered at $0 co-pay, including: Oral contraceptives Emergency contraceptives Implantable devices/vaginal ring Co-pays will still apply to brand contraceptives with generics available Once a brand drug in these categories has a generic equivalent on the market, only the generic will be covered at $0 co-pay and the brand drug will require the brand co-pay www.partnersforhealthtn.gov Contraceptive transdermal patches Barrier methods Injectable contraceptives (limit four per year)

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14 Whats Changing for 2013 www.partnersforhealthtn.gov Pharmacy: Co-pay changes Prescription drug co-pays will increase by $5 for: Tier 2 (Preferred brand) Tier 3 (Non-preferred brand) The increase does not apply to: Tier 1 (Generic) Drugs in the 90-day maintenance tier Statins Antihypertensives Oral diabetic drugs, insulins and diabetic needles/test strips/lancets

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15 Pharmacy: Dispense as Written Policy When a generic is available and your doctor indicates may substitute but you request the brand name drug from the pharmacy, you will pay the difference between the brand name drug and the generic drug plus the brand co-pay. Whats Changing for 2013 www.partnersforhealthtn.gov

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16 Pharmacy: Preferred Specialty Drug Plan New users of the following must use a preferred specialty drug before the plan will cover other non-preferred specialty drugs in the same drug class Tumor necrosis factor (TNF) inhibitors (for inflammatory and autoimmune diseases) Multiple Sclerosis drugs This requirement is referred to as step therapy This policy will not apply to current users of these drugs Whats Changing for 2013 www.partnersforhealthtn.gov Drug ClassCovered Medications Preferred TNF inhibitorsEnbrel and Humira Preferred Multiple Sclerosis drugsAvonex, Copaxone and Betaseron

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17 Health Benefits Your Health Insurance Options Subject to eligibility, you will continue to have the same health insurance options. Preferred Provider Organization (PPO) Options Partnership PPO Standard PPO Four Premium Levels Employee Employee + child(ren) Employee + spouse Employee + spouse + children Two Insurance Carriers BlueCross BlueShield of Tennessee Cigna www.partnersforhealthtn.gov

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18 Health Benefits Both PPOs cover services, treatments and products, such as: In-network preventive care, x-ray, lab and diagnostics at no cost Primary and specialist doctor office visits for a fixed co-pay without having to meet a deductible Prescription drugs for a fixed co-pay without having to meet a deductible Both PPOs offer: Deductibles and co-insurance for certain services Out-of-pocket maximums to limit your co-insurance and physician visit co-pay costs Both carriers also offer discounts for services not covered. Refer to the carriers member handbooks or websites for more information.

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19 Health Benefits Free preventive health services include, but are not limited to: Flu vaccination and pneumococcal vaccinations Annual preventive visit (i.e., physical exam) Annual well-woman visit Cholesterol test Osteoporosis screening for women Screenings for colon, breast or cervical cancer or prostate cancer If other services or related treatments are received during the same visit, an office visit co-pay may apply You need to visit an in-network provider to receive preventive care services at no cost.

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20 Health Benefits Each carrier has its own network Both BlueCross and Cigna have made significant changes to their networks for 2013 Be sure to check the networks carefully when making your decision Provider directories are available on the ParTNers for Health website, by calling the carrier or from your ABC BlueCross BlueShield offers Network S CIGNA offers Open Access Plus, OA Plus, Choice Fund OA Plus www.partnersforhealthtn.gov

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21 Health Benefits Carrier costs vary by grand division In East and Middle Tennessee, CIGNA costs $20 more per month for employee only coverage and $40 more per month for all other premium levels In West Tennessee, BlueCross BlueShield costs $20 more per month for employee only coverage and $40 more per month for all other premium levels www.partnersforhealthtn.gov

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22 Covered Services Services that Require Co-Pays The following are some of the services that require co-pays: * Subject to Out-of-Pocket Co-pay Maximum Primary Care Office Visit * Pharmacy Specialist Office Visit* Emergency Room Visit Urgent Care Allergy Injection (with office visit*) Mental Health and Substance Abuse* Chiropractors www.partnersforhealthtn.gov

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23 Covered Services Services that Require Co-Insurance The following are some of the services that require co-insurance: Hospital/Facility Services Maternity Home Care Equipment and Supplies Ambulance Hospice Care Rehabilitation and Therapy Services Dental Advanced X-Ray, Scans and Imaging Out-of-Country Charges www.partnersforhealthtn.gov

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24 2013 Deductibles and Out-of- Pocket Co-insurance Maximums Partnership PPOStandard PPO In-NetworkOut-of-NetworkIn-NetworkOut-of-Network Annual Deductible Employee only$450$800 $1,500 Employee + Child(ren)$700$1,250 $2,350 Employee + Spouse$900$1,600 $3,000 Employee + Spouse + Child(ren)$1,150$2,050 $3,850 Out-of-Pocket Co-Insurance Maximum Employee only$1,550$2,900$1,900$3,600 Employee + Child(ren)$2,450$4,600$3,100$5,900 Employee + Spouse$3,100$5,800$3,800$7,200 Employee + Spouse + Child(ren)$4,000$7,500$4,000$9,500 www.partnersforhealthtn.gov

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25 Premiums for 2013: Local Education Total Monthly Premiums Premium LevelPartnership PPOStandard PPO Employee Only$512.04$537.04 Employee + Child(ren)$844.87$869.87 Employee + Spouse$998.48$1,048.48 Employee + Spouse + Child(ren)$1,331.30$1,381.30 The State pays 45% of the total premium cost for certified instructional employees Premiums shown are for the least expensive carrier in the region. A complete chart is available in the Decision Guide and on the ParTNers for Health website. www.partnersforhealthtn.gov

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26 Partnership Promise In 2013, members and covered spouses must: Complete the online Healthways Well-Being Assessment (health questionnaire) by March 15 Engage in ONE ParTNers for Health wellness activity by July 15 Keep your contact information current with your employer Engage in tobacco cessation program if you are a tobacco user www.partnersforhealthtn.gov A health screening for all members is not required in 2013.

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27 At-risk members and covered spouses must also: Complete a biometric screening at your health care providers office between July 15 2012, and July 15 2013 Participate in health coaching and/or case management, if identified Partnership Promise Healthways will manage the Partnership Promise in 2013.

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28 Partnership Promise Online Well-Being Assessment (WBA) Summarizes your overall health and offers steps you can take to improve By completing the confidential assessment, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-being Beginning January 1, 2013, visit www.partnersforhealthtn.gov and create a new, online well-being account to access the assessment www.partnersforhealthtn.gov The Well-Being Assessment must be completed between January 1 and March 15, 2013.

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29 Partnership Promise www.partnersforhealthtn.gov Wellness Activities Wellness activities are easy actions you can take to work towards better health. You must engage in only ONE of the following wellness activities. Receive an age- appropriate preventive service Annual physical Well-woman visit Flu and pneumonia shots Screenings for colon, breast and prostate cancers Complete Your Well- Being Plan and Three Action Items Create plan with recommended focus areas from WBA Complete 3 simple action items Join a ParTNers for Health Wellness Challenge Fun way to develop healthier lifestyle with group support Choose one of the first two quarterly challenges Offered online OR

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30 Partnership Promise Updating Contact Information You must make sure that your phone number, mailing address and email address, if you have one, are current with your employer. If your information changes during the year, you must notify your employer to update your record. Local Education employees: Change your contact information yourself in Edison, by contacting your agency benefits coordinator, Tiffany Latta or by calling the Benefits Administration Service Center at 1-800-253-9981 and selecting option 6. www.partnersforhealthtn.gov

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31 Partnership Promise Tobacco Cessation Partnership PPO members must be tobacco free or agree to participate in the tobacco cessation program and work toward becoming tobacco free Members who use tobacco must answer Yes to the question are you a tobacco user on the required WBA Healthways will reach out to enroll you in a tobacco cessation program You will not be required to stop using tobacco by the end of 2013, but you must complete the tobacco cessation program and make an effort to quit This requirement applies to both you and your covered spouse www.partnersforhealthtn.gov

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32 Partnership Promise At-Risk Members Members who are identified as at risk will be required to take extra steps to manage their current conditions and prevent new health risks from developing Complete a biometric screening with your health care provider Participate in health coaching or case management during 2013 Healthways will determine who is at risk based on medical conditions and behaviors that may cause current or future health issues Your health risks are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results. www.partnersforhealthtn.gov

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33 Partnership Promise Biometric Health Screening If identified, you must get a health screening from your health care provider by July 15, 2013 You may use screening results from a doctors visit between July 15, 2012, and July 15, 2013 Worksite screenings will not be available in 2013 Simply ask your doctor to complete the Physician Screening Form, which will be available online on January 1, 2013, and send the completed form to Healthways by the July 15 deadline www.partnersforhealthtn.gov

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34 Partnership Promise Health Coaching Lifestyle management helps you form better health habits. Coaches help with: High blood pressure High cholesterol Disease management is for those with chronic conditions such as: Diabetes Asthma Coronary artery disease Case management is administered by BlueCross, Cigna and Magellan Promotes quality and cost-effective coordination of care for those with complicated medical needs, chronic conditions and/or catastrophic illnesses or injuries Weight management Tobacco use Congestive heart failure Chronic obstructive pulmonary disease (COPD)

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35 Health Coaching A health coach works with you and your provider to help you with self- management skills to make sure that you are taking medicines and getting the right care Health coaches are trained health care professionals All conversations with your health coach are confidential When you participate in coaching, your frequency of calls will be tailored to your individual plan of care Your health coach will communicate with you using telephone calls, mailings and the web Partnership Promise Healthways hours of operation: Monday Friday 7:30 a.m. 9:30 p.m. Saturday 8:00 a.m. 6:30 p.m. (Central Time)

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36 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 dont ask to change your current dental carrier or cancel coverage, you will keep your current coverage. Dental Benefits Prepaid Plan Fixed co-pays Participating dentists only PDO Plan Any dentist Pay less with network providers www.partnersforhealthtn.gov HENRY COUNTY SCHOOL SYSTEM EMPLOYEES SHOULD NOT CHOOSE THIS PLAN. THERE ARE NO DENTIST IN WEST TN THAT ACCEPT THIS TYPE OF INSURANCE

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37 Dental Benefits Preferred Dental Organization (PDO) Administered by Delta Dental Use any dentist Members have access to Delta Dentals PPO network You pay co-insurance for covered services A deductible applies for out-of-network dental care You or your dentist will file claims for covered services Some services require waiting periods and limitations/exclusions apply Premiums will increase by 3% in 2013 for the PDO www.partnersforhealthtn.gov

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38 Dental Benefits 2013 PremiumsAssurant PrepaidDelta Dental PDO Employee Only$9.63$20.46 Employee + Child(ren)$20.00$47.03 Employee + Spouse$17.07$38.69 Employee + Spouse + Child(ren)$23.47$75.71 Dental services for both the Prepaid Plan and the Dental PDO include: Periodic oral evaluations Routine Cleanings Amalgam fillings Endodontic X-rays Extractions Major restorations Orthodontics Dentures www.partnersforhealthtn.gov

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39 Additional Benefits Employee Assistance Program (EAP) Provides support tools that help you and your family deal with personal issues and situations All services are confidential and available at no cost to members Services can be easily accessed by calling Magellan, 24/7 You and your eligible dependents may get up to five free counseling sessions per problem episode Contact ParTNers EAP: 1.855.HERE4TN (1.855.437.3486) www.Here4TN.com www.partnersforhealthtn.gov

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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, 2012 You must click submit in ESS to finalize your selections by 11:59 p.m. on November 1, 2012 No changes until the next Annual Enrollment Transfer Period www.partnersforhealthtn.gov 40

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Member Communications www.partnersforhealthtn.gov 41 Current members will receive a copy of the 2013 Decision Guide at their homes in mid- September.

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42 Who to Contact Primary point of contact Tiffany Latta, 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 Our ParTNers for Health website www.partnersforhealthtn.gov www.partnersforhealthtn.gov Enrollment forms and handbooks www.tn.gov/finance/inswww.tn.gov/finance/ins www.partnersforhealthtn.gov

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Agency Benefits Coordinator Contact Information Tiffany Latta Henry County School System Secretary to the Director/Agency Benefits Coordinator 642-9733 Office 642-8073 Fax lattat@henryk12.net 43

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44 Questions?