state of tennessee group insurance program local education and local government annual enrollment...

State of Tennessee Group Insurance Program

Local Education and Local GovernmentAnnual Enrollment Period

October 1 – October 30, 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 PeriodLocal Education/Local Government

• Enrollment: October 1 – October 30, 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)

** New health insurance options ** Select or change your health insurance carrier Enroll in or cancel health insurance for yourself or your eligible dependents Enroll in, cancel or transfer between dental options (if offered by your agency)

**New dental vendors** Enroll in, cancel or transfer between vision coverage (if offered by your agency)


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What’s New and Changing - 2016

• Health insurance premiums will stay the same in 2016.• Vision premiums will not increase (if offered by your agency).• Increase in the prepaid dental plan premium, but dental preferred provider

organization premium will not increase (if offered by your agency). • 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 will be available.

• 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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What’s New and Changing - 2016

• 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 (emphysema and chronic bronchitis), 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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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. All members must get a biometric screening by July 15, 2016

3. If you are called, actively participate in coaching:• Coaching could include a tobacco cessation program or case

management

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

What’s Changing for 2016


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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Annual Enrollment Period

If you DO NOT want to make changes, you don’t have to do anything,

BUT NOTE:

• Health insurance – 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 (if offered by your agency):

• 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, 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

• Unless you are a Local Government agency with fewer than 100 employees

• 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 30.

• Also, all new dependent verification documents must be received by 4:30 p.m. Central on October 30.


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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• Unless you are with a Local Government agency with less

than 100 employees• 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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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.

Local Ed and Local Gov 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

Options

Partnership PPO*

Standard PPO

Limited PPO

HealthSavings CDHP

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 during 2016.

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

• In-network preventive care 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)

• Partnership and Standard PPOs:

• 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


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Health Benefits

Limited PPO (Local Ed and Local Gov only)

• About the Limited PPO:

• Offers the same services and treatments as the other plan options, but the premiums and out-of-pocket costs are different

• Monthly premiums are lower than the Partnership and Standard PPOs, but higher than the HealthSavings CDHP

• Out-of-pocket maximum for pharmacy is included with medical, but the out-of-pocket maximum is higher that all of the other plan options

• Copays for doctor visits, including specialists, are higher than the PPOs• Deductible is higher than the other PPOs• Coinsurance is higher than the other PPOs• Pharmacy deductible of $100 before benefits begin


Health BenefitsHealthSavings CDHP

• The state is offering a new insurance plan: • HealthSavings CDHP - employees may fund the HSA

• Can help you save money• Offered in addition to existing PPOs

• Includes 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

19www.partnersforhealthtn.gov

Health BenefitsWith the HealthSavings CDHP option 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 Partnership or Standard PPO’s separate out-of-pocket maximums for pharmacy and medical/behavioral health.


Health Benefits Like the PPOs, the HealthSavings CDHP:

• Provides comprehensive health insurance coverage• Covers preventive care in-network at no cost • Offers 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 CDHP:


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:• Both employer and employee contributions are tax free.• 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 the 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 money to your HSA up to the annual IRS allowable

maximums to cover your qualified medical expenses, including your deductible. You can 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). 26www.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?• Flexible Benefits: There are restrictions with having both a flexible benefits

account and a CDHP/HSA plan. If you enroll in the HealthSavings CDHP plan, you can only have a Limited Purpose Flexible Spending Account in 2016. Any previous FSA balances must be spent down to $0 by December 31, 2015, to access funds in your HSA to pay for approved medical costs.

• For example:• 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 the 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

• 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 online30www.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 the 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), or by calling the carrier


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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• 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 CDHP requires 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

• You do not have to sign-up to receive this benefit


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Employee Assistance Program (EAP)

Employee Assistance Program (EAP) • Services are confidential and available at no cost to state group insurance plan

members and their eligible dependents

• Services are available 24 hours a day, 365 days a year • Members and 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 36

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Premiums for 2016: Local Education

Total Monthly Premiums

Premium Level Partnership PPO

Standard PPO

Limited PPO HealthSavings CDHP

Employee Only $540.71 $565.71 $346.06 $321.06

Employee + Child(ren) $892.18 $917.18 $571.00 $529.75

Employee + Spouse $1,054.39 $1,104.39 $674.81 $626.06

Employee + Spouse + Child(ren)

$1,405.85 $1,455.85 $899.75 $834.75

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


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Premiums for 2016: Local Government

Total Monthly Premiums

Premium Level Partnership PPO

Standard PPO

Limited PPO

HealthSavings CDHP

Employee Only $611.55 $636.55 $391.61 366.61

Employee + Child(ren) $947.90 $972.90 $606.99 568.24

Employee + Spouse $1,314.81 $1,364.81 $841.96 788.21

Employee + Spouse + Child(ren)

$1,651.18 $1,701.18 $1,057.35 989.85

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 for Premium Level 1. 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

Limited PPO HealthSavings CDHP

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

Annual Deductible

Employee only $ 1,200 $2,300 $1,500 $3,000

Employee + Child(ren) $ 1,800 $3,350 $3,000 $6,000

Employee + Spouse $ 2,100 $3,900 $3,000 $6,000

Employee + Spouse + Child(ren) $ 2,600 $4,950 $3,000 $6,000

Out-Of-Pocket Maximum

Employee only $ 6,600 $12,700 $3,800 $7,600

Employee + Child(ren) $ 13,200 $25,400 $7,600 $15,200

Employee + Spouse $ 13,200 $25,400 $7,600 $15,200

Employee + Spouse + Child(ren) $ 13,200 $25,400 $7,600 $15,200


Limited PPO: $100 pharmacy deductible per member

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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 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 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 (if offered by your agency):

• 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 option or cancel coverage

Dental Benefits – New Vendors (If offered by your agency)

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 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 (if offered by your agency)

• 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

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 meet the enrollment deadline of October 30, 2015.

Don’t Wait ─ Enroll early! 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 30, 2015.

Dependent verification documents must be submitted by October 30 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 prior to the

enrollment period.

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://tn.gov/finance/topic/fa-benefits-publicationsforms

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


http://www.partnersforhealthtn.gov/

http://tn.gov/finance/topic/fa-benefits-publicationsforms

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Questions?

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