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State of Tennessee Group Insurance Program Open Enrollment/Annual Enrollment Transfer Period October 1 – November 1, 2013
State of Tennessee Group Insurance Program
Open Enrollment/Annual Enrollment Transfer Period
October 1 – November 1, 2013
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Agenda• Open Enrollment/Annual Enrollment Transfer Period• Using ESS in Edison • What’s Changing for 2014• Health Benefits Overview• 2014 Partnership Promise
www.partnersforhealthtn.gov
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Open Enrollment/Annual Enrollment Transfer Period
• Open Enrollment: October 1 – November 1, 2013 Annual Enrollment Period (AETP) is now an Open Enrollment Late applicant fee will no longer apply in 2014
• Employees can make the following changes: Switch PPOs (subject to eligibility) Change health insurance carriers Enroll, cancel or make changes to health insurance
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Open Enrollment/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 2014 Partnership Promise
If you DO want to make changes• You must use Employee Self Service (ESS) in Edison
• Benefits Administration will not accept paper forms
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Open Enrollment/Annual Enrollment Transfer Period• Changes take effect on January 1, 2014
• Selections remain in effect through December 31, 2014, unless you lose eligibility or have a qualifying event • A qualifying event or family status change is something that results in
a covered person losing coverage under another plan or becoming newly eligible for coverage
• Contact your agency benefits coordinator if you experience a qualifying event
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Using Edison ESS• To add or make changes to your health coverage, 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
• Username and password will be mailed to you
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Late applicant fee • Beginning in January 2014, the late applicant fee will no longer apply
For those currently paying the monthly late applicant fee, the last payroll deduction will occur in December 2013.
What’s Changing for 2014
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2014 Partnership Promise Requirement Changes• In 2014 every Partnership PPO plan member must complete two
things as a part of the Partnership Promise: 1. Complete the online Well-Being Assessment (WBA) by March 15, 2014
2. Get a biometric screening at your doctor’s office or at a worksite location between July 16, 2013 and July 15, 2014
What’s Changing for 2014
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What’s Changing for 2014Limited PPO available to Local Education• Now available to Local Education
• What you should know about the Limited PPO
• Monthly premiums are low, but the deductibles and out-of-pocket maximums have changed
• Be sure to look at out-of-pocket costs carefully
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Additional services apply to out-of-pocket copay maximum
• Addition of three services: Emergency room In-network chiropractic In-network urgent care visits
• To provide additional financial protection for members, copays for these three services will now count towards the in-network out-of-pocket copay maximum for the Partnership and Standard PPOs and the overall maximum out-of-pocket for the Limited PPO
What’s Changing for 2014
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Pharmacy Benefits• $3,750 in-network pharmacy out-of-pocket copay maximum
• New benefit this year: Once maximum is reached members will pay $0 in copayments for remainder of year
What’s Changing for 2014
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Health BenefitsYour Health Insurance Options You have these health insurance options
Preferred Provider Organization (PPO) Options
Partnership PPO Standard PPO Limited PPO
Four Premium Levels
• Employee• Employee + child(ren)• Employee + spouse• Employee + spouse +
child(ren)
Two Insurance Carriers
• BlueCross BlueShield of Tennessee
• Cigna
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Health Benefits• 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 co-insurance and copay costs
Carriers also offer discounts for services not covered. Refer to the carrier’s member
handbooks or websites for more information.
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Health Benefits• BlueCross BlueShield (BCBST) and Cigna each have their own network
• Both carriers have made significant changes to their networks for 2014• Be sure to check the networks carefully when making your decision
• Provider directories are available on the ParTNers for Health website or by calling the carrier
Available Networks:• BlueCross BlueShield offers Network S • CIGNA offers Open Access Plus (statewide)
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Health Benefits
• 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
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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
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Tobacco Cessation: The state’s prescription drug coverage provides free tobacco quit aids to members who want to stop using tobacco products.
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Behavioral Health Benefits and Employee Assistance ProgramBehavioral 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
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Employee Assistance Program (EAP)Employee Assistance Program (EAP) • All services are confidential and available at no cost to members 24/7
• You and your eligible dependents may get up to five, no cost counseling sessions per problem episode, per year
• Your EAP also offers work-life services, financial and legal services, assistance finding eldercare and dependent care services and much more
• Contact ParTNers EAP:
• Toll Free 24/7 at 1.855.HERE4TN (1.855.437.3486)• Or at www.Here4TN.com
www.partnersforhealthtn.gov
Behavioral Health and Substance Abuse TreatmentMembers and their dependents enrolled in health coverage are eligible for mental health and substance abuse benefits, which are administered by Magellan Health Services
• Call 1.855.437.3486 to access services 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
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2014 Deductibles and Out-of-Pocket Co-insurance Maximums
Partnership PPO Standard PPOIn-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 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 $5,000 $9,500
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2014 Limited PPO Deductible and Out-of-Pocket Maximum
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Local Education
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 $ 6,350 $ 12,700
Employee + Child(ren) $ 12,700 $ 25,400
Employee + Spouse $ 12,700 $ 25,400
Employee + Spouse + Child(ren) $ 12,700 $ 25,400
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Premiums for 2014: Local EducationTotal Monthly Premiums
Premium Level Partnership PPO Standard PPO Limited PPOEmployee Only $540.71 $565.71 $346.06Employee + Child(ren) $892.18 $917.18 $571.00Employee + Spouse $1,054.39 $1,104.39 $674.81Employee + Spouse + Child(ren) $1,405.85 $1,455.85 $899.75
• 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
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2014 Partnership Promise
Healthways administers the Partnership Promise
• Partnership PPO members pay much lower premiums
• Members and enrolled spouses must complete the Partnership Promise each year
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If you or your spouse fail to fulfill any requirement of the 2014 Partnership Promise, you will both be transferred to the Standard PPO in 2015.
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2014 Partnership Promise2014 Partnership PPO members and covered spouses must:
1. Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2014
2. Complete a biometric health screening between July 16, 2013, and July 15, 2014
Members and covered spouses may have to do the following if applicable:
• Participate in health coaching and/or case management if identified• Engage in the Healthways tobacco cessation program if you are a
tobacco user• Update your contact information with your employer if it changes
www.partnersforhealthtn.gov
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2014 Partnership Promise
Required Online Well-Being Assessment (WBA) • Summarizes your overall health and offers steps you can take to
improve
• The Well-Being Assessment must be completed between January 1 and March 15, 2014 • To complete the assessment, visit partnersforhealthtn.gov and click on the
“My Wellness Tab”
www.partnersforhealthtn.gov
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2014 Partnership Promise
Required Biometric Health ScreeningYou must get a biometric health screening by July 15, 2014There are two ways to get a biometric screening:
• At a worksite screening • At your doctor’s office:
• You may use screening results from a doctor’s visit between July 16, 2013, and July 15, 2014
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Health Coaching
• Members and spouses who are identified by Healthways must participate
• Health coaching programs include: Lifestyle management
Disease management
• Case Management is managed by BlueCross BlueShield, Cigna and Magellan
2014 Partnership Promise
The Partnership Promise is managed by Healthways
Healthways’ hours of operation:Monday – Friday 7:30 a.m. to 9:30 p.m. CT
Saturday – 8:00 a.m. – 6:30 p.m. CT
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Health Coaching • 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 and mailings
2014 Partnership Promise
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2014 Partnership Promise
Tobacco Cessation
• Partnership PPO members who use tobacco must participate in Healthways tobacco cessation program and work toward becoming tobacco free
• Partnership PPO members who use tobacco products must answer “Yes” to the question “are you a tobacco user” when completing the required online Well-Being Assessment
• Healthways will reach out to tobacco users to enroll
• You are not required to quit by the end of 2014 – but must make an effort to quit
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2014 Partnership Promise
Updating Contact Information • Phone number, mailing address and email address, if you have one, must be
current with your employer
• If your information changes during the year, you must notify your employer to update your record
www.partnersforhealthtn.gov
Take Note!
• If you do not want to make changes, no action is required • If you do want to make changes or add coverage, you must
use ESS and meet the enrollment deadline of November 1, 2013 Don’t Wait ─ Enroll early! You must click “submit” in ESS to
finalize your selections by 11:59 p.m. CT on November 1, 2013
• No changes until the next Open Enrollment/Annual Enrollment Transfer Period
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Member Communications
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Current members will receive a copy of the 2014 Decision
Guide at their homes in mid-September.
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Who to Contact• Primary point of contact – Karen Haynie 354-1055 or Tina
Dade 354-1085• Questions about a provider or claim – contact your insurance
carrier• Questions about eligibility and enrollment – call Benefits
Administration service center at 1-800-253-9981• Our ParTNers for Health website –
www.partnersforhealthtn.gov • Handbook publications and forms – www.tn.gov/finance/ins
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Questions?
