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State of Tennessee Group Insurance Program
Open Enrollment/Annual Enrollment
Transfer Period
October 1 – November 1, 2013
Open Enrollment/Annual
Enrollment Transfer Period
• Open Enrollment: October 1 – November 1, 2013
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
Annual Enrollment Period (AETP) is now an Open Enrollment
Late applicant fee will no longer apply in 2014
• Employees can make the following changes:
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Switch PPOs (subject to eligibility)
Enroll in Cigna LocalPlus PPO (Middle TN only)
Change health insurance carriers
Enroll, cancel or make changes to health insurance
Enroll in, cancel or transfer between dental options
www.partnersforhealthtn.gov
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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 (exception for Local
Gov with fewer than 100 employees)
• Use the Minnesota Life website for the optional term life insurance
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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 make changes to your health 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
•
Instructions on how to use ESS are available in the Decision
Guide or from your Agency Benefits Coordinator
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What’s Changing for 2014
Health and Dental Premiums
•
Health insurance premiums will increase by the following percentages:
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State and Higher Ed Plan = 5.5%
Local Education Plan = 5.6%
Local Government Plan = 5.3%
Dental insurance premiums will increase by 3% for both plans
Prepaid Plan
PDO Plan
Employee Only
$9.92
$21.07
Employee + Child(ren)
$20.60
$48.44
Employee + Spouse
$17.58
$39.85
Employee + Spouse + Child(ren)
$24.17
$77.98
www.partnersforhealthtn.gov
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What’s Changing for 2014
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 at the end of November 2013
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What’s Changing for 2014
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
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What’s Changing for 2014
Limited PPO available to Local Education
• Now available to both Local Government and Local Education
• What you should know about the Limited PPO
• Monthly premiums are low, but the deductibles and out-ofpocket maximums have changed
• Be sure to look at out-of-pocket costs carefully
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What’s Changing for 2014
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
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What’s Changing for 2014
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
•
Increase for Limited PPO copays – Local Gov and Local Ed
• Copays in bold have changed
Limited PPO
30-day supply
• Human Growth Hormone
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Will implement step therapy; must try
preferred drug first
Currently two preferred specialty drugs
Impacts very few members
No grandfathering
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90-day supply
(mail order or
Retail 90)
Certain
maintenance
medications
$10 /$55 / $105
$20 / $105 / $205
$10 / $50 / $200
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Health Benefits
Your Health Insurance Options
You have these health insurance options
Provider
Two Insurance
 Preferred

Organization
Carriers
(PPO) Options
 Partnership PPO
• BlueCross BlueShield of
Tennessee
 Standard PPO
• Cigna
 Limited PPO
(Local Education and
Local Government)
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 Four Premium
Levels
• Employee
• Employee + child(ren)
• Employee + spouse
• Employee + spouse +
child(ren)
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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, by calling the
carrier or from your ABC
Available Networks:
• BlueCross BlueShield offers Network S
• CIGNA offers Open Access Plus
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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
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2014 Deductibles and Out-ofPocket Co-insurance Maximums
Partnership PPO
Standard PPO
Limited PPO
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
In-Network
Out-ofNetwork
Employee only
$450
$800
$800
$1,500
$ 1,200
$ 2,300
Employee + Child(ren)
$700
$1,250
$1,250
$2,350
$ 1,800
$ 3,350
Employee + Spouse
$900
$1,600
$1,600
$3,000
$ 2,100
$ 3,900
$1,150
$2,050
$2,050
$3,850
$ 2,600
$ 4,950
Annual Deductible
Employee + Spouse +
Child(ren)
Out-of-Pocket Co-Insurance Maximum
Employee only
$1,550
$2,900
$1,900
$3,600
$ 6,350
$ 12,700
Employee + Child(ren)
$2,450
$4,600
$3,100
$5,900
$ 12,700
$ 25,400
Employee + Spouse
$3,100
$5,800
$3,800
$7,200
$ 12,700
$ 25,400
Employee + Spouse +
Child(ren)
$4,000
$7,500
$5,000
$9,500
$ 12,700
$ 25,400
www.partnersforhealthtn.gov
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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
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 Promise
2014 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
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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 Screening
You must get a biometric health screening by July 15, 2014
There 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
www.partnersforhealthtn.gov
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2014 Partnership Promise
Health Coaching
• Members and spouses who are identified by Healthways must participate
• Health coaching programs include:
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Healthways’ hours of operation:
 Lifestyle management
Monday – Friday 7:30 a.m. to 9:30 p.m. CT
 Disease management
Saturday – 8:00 a.m. – 6:30 p.m. CT
Case Management is managed by BlueCross BlueShield, Cigna and
Magellan
The Partnership Promise is managed by Healthways
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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
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Dental Benefits
Eligible employees can choose between two dental options:
Assurant Prepaid Plan
Delta Dental PDO Plan
• Fixed copays
• Coinsurance and deductibles
• Participating dentists only
• Any dentist
• Pay less with network providers
• During the enrollment period, eligible employees can enroll in or transfer
between the two options
• If you don’t change your current dental carrier or cancel coverage, you
will keep your current coverage
www.partnersforhealthtn.gov
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Dental Benefits
No Carriers
in West TN
Prepaid Plan Administered by Assurant Employee Benefits
• The network is DentiCare
• Predetermined copay amounts (reduced fees) for dental treatments
• There are no deductibles to meet, no claims to file, no waiting periods for
covered members, no annual dollar maximum and pre-existing conditions
are covered
• Referrals are not required
• To receive benefits, you must select a dentist from the Prepaid Plan list
• Premiums will increase by 3% in 2014
• Note: There are some areas in the state where Assurant network dentists
are not available
www.partnersforhealthtn.gov
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Dental Benefits
Monthly Premiums for Active Members
2014 Premiums
Assurant Prepaid
Delta Dental PDO
Employee Only
$9.92
$21.07
Employee + Child(ren)
$20.60
$48.44
Employee + Spouse
$17.58
$39.85
Employee + Spouse + Child(ren)
$24.17
$77.98
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
www.partnersforhealthtn.gov
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Vision Benefits
Optional Vision Plan
Henry County School System
does NOT participate in the
State Vision Plan. We offer
vision through Superior
Vision which will be offered
by an USAble Rep.
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Administered by EyeMed Vision Care
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Available to employees at participating agencies
Basic Plan
Expanded Plan
Discounted rates
Copays
Allowances
Allowances
Discounted rates
• Both plans offer the same services
• There are no premium changes for the Basic Plan or Expanded Plans
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,
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
Current members will receive
a copy of the 2014 Decision
Guide at their homes in midSeptember.
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HENRY COUNTY SCHOOL SYSTEM
HEALTH INSURANCE PLAN RATES
EFFECTIVE JANUARY 1, 2014
STATE HEALTH INSURANCE
(TOTAL MONTHLY PREMIUMS)
PARTNERSHIP
BCBS
CIGNA
Employee Only
$560.71
$540.71
Employee + Child(ren)
$932.18
$892.18
Employee + Spouse
$1,094.39
$1,054.39
Employee + Spouse + Child(ren)
$1,445.85
$1,405.85
STANDARD
BCBS
CIGNA
Employee Only
$585.71
$565.71
Employee + Child(ren)
$957.18
$917.18
Employee + Spouse
$1,144.39
$1,079.39
Employee + Spouse + Child(ren)
$1,495.85
$1,455.85
LIMITED PPO
Employee Only
$366.06
$346.06
Employee + Child(ren)
$611.00
$571.00
Employee + Spouse
$714.81
$674.81
Employee + Spouse + Child(ren)
$939.75
$899.75
EMPLOYEE PREMIUMS
MONTHLY PAYROLL DEDUCTIONS
Employee Only
Employee + Child(ren)
Employee + Spouse
Employee + Spouse + Child(ren)
Employee Only
Employee + Child(ren)
Employee + Spouse
Employee + Spouse + Child(ren)
Employee Only
Employee + Child(ren)
Employee + Spouse
Employee + Spouse + Child(ren)
PARTNERSHIP
BCBS
CIGNA
$117.50
$106.50
$320.88
$298.88
$409.67
$387.67
$602.04
$580.04
STANDARD
BCBS
CIGNA
$131.25
$120.25
$334.63
$312.63
$437.16
$402.67
$629.54
$607.54
LIMITED
$76.71
$68.16
$210.32
$191.28
$267.58
$248.11
$391.30
$371.23
DELTA DENTAL (MONTHLY PREMIUMS)
Employee Only
$21.07
Employee + Child(ren)
$48.44
Employee + Spouse
$39.85
Employee + Spouse + Child(ren)
$77.98
5.6%
Increase in
Total
Premium
Increase
to
Employee
Employee Only
28.67
14.34
Employee + Child(ren)
47.31
23.66
Employee + Spouse
55.91
27.96
Employee + Spouse +
Child(ren)
74.55
37.28
INCREASE AMOUNT
Who to Contact
• Primary point of contact - Agency Benefits Coordinator
Tiffany Latta, 642-9733
• 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
www.partnersforhealthtn.gov
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Questions?
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