State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 – November 1, 2012
Transcript
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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
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
[email protected] 43