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State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 – November 1, 2012 Agenda • Annual Enrollment Transfer Period • Using ESS in Edison • What’s Changing for 2013? • Health Benefits Overview • 2013 Partnership Promise • Vision, Dental and Additional Benefits Overview www.partnersforhealthtn.gov 1 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 optional vision coverage Enroll in, cancel or transfer between dental options www.partnersforhealthtn.gov 2 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 3 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 (Sherry) if you experience a special qualifying event www.partnersforhealthtn.gov 4 Using Edison ESS • To make changes to your coverage or add dental or vision insurance, you must use Employee Self Service (ESS) in Edison • To use ESS, log on to Edison at www.edison.tn.gov » Higher 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. Computer labs will be reserved to assist those who wish to make changes. www.partnersforhealthtn.gov 5 Computer labs will be set up in Gooch 325 on the following dates and times: Tuesday, October 9, 2012 3:30-5:00 p.m. Monday, October 15, 2012 9:00-12:00 a.m. Tuesday, October 16, 2012 9:00-12:00 a.m. Friday, October 19, 2012 1:00-3:00 p.m. Wednesday, October 24, 2012 3:00-4:00 p.m. Tuesday, October 30, 2012 3:30-5:00 p.m. Wednesday, October 31, 2012 3:00-4:00 p.m. You MUST bring all documentation needed when attending a lab. 6 What’s Changing for 2013 New, optional vision plan Member cost sharing Pharmacy coverage changes Closing optional universal life insurance to new enrollments (State Plan only) www.partnersforhealthtn.gov 7 What’s Changing for 2013 Optional Vision Plan • Available to employees at participating agencies • Choose from two plans: • Basic Plan Expanded Plan Both plans offer the same services Annual routine eye exam Frames Eyeglass lenses Contact lenses Discount of Lasik/Refractive surgery www.partnersforhealthtn.gov 8 What’s Changing for 2013 Optional Vision Plan • What you pay for services depends on the plan you choose • Expanded plan: Co-pays Allowances Discounted rates • Basic plan: Discounted rates Allowances • Administered by EyeMed Vision Care • Members have access to their Select Network www.partnersforhealthtn.gov 9 What’s Changing for 2013 Optional Vision Plan • Employee pay-all option (members pay full premium) • Monthly premiums for Active Members Basic Expanded Employee Only $3.27 $5.73 Employee + Child(ren) $6.54 $11.46 Employee + Spouse $6.21 $10.89 Employee + Spouse + Child(ren) $9.61 $16.84 www.partnersforhealthtn.gov 10 What’s Changing for 2013 Member Cost Sharing: Health and Dental Premiums • Health insurance premiums will increase by the following percentages: • State Plan = 2% Dental insurance premiums will increase by 3% for both plans Prepaid Plan PDO 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 www.partnersforhealthtn.gov 11 What’s 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 Employee Only $100 increase Employee + Child(ren) $150 increase Employee + Spouse $200 increase Employee + Spouse + Child(ren) $250 increase www.partnersforhealthtn.gov 12 What’s 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 Employee Only $200 increase Employee + Child(ren) $300 increase Employee + Spouse $400 increase Employee + Spouse + Child(ren) $500 increase www.partnersforhealthtn.gov 13 What’s 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 14 What’s Changing for 2013 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) www.partnersforhealthtn.gov 15 What’s 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 16 What’s Changing for 2013 Pharmacy: Women’s 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 Contraceptive transdermal patches Barrier methods Injectable contraceptives (limit four per year) • 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 17 What’s Changing for 2013 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 www.partnersforhealthtn.gov 18 What’s Changing for 2013 IMPORTANT - 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. www.partnersforhealthtn.gov 19 What’s Changing for 2013 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” Drug Class Covered Medications Preferred TNF inhibitors Enbrel and Humira Preferred Multiple Sclerosis drugs Avonex, Copaxone and Betaseron • This policy will not apply to current users of these drugs www.partnersforhealthtn.gov 20 What’s Changing for 2013 Optional Universal Life Insurance – State Only • The state is closing optional universal life insurance plan to new enrollments • No new enrollments will be allowed during this transfer period or after the first of the year • Members currently enrolled in this coverage can continue the benefit • If enrolled, you will receive a letter in the fall with details about continuing your coverage www.partnersforhealthtn.gov 21 Health Benefits Your Health Insurance Options Subject to eligibility, you will continue to have the same health insurance options. Provider Two Insurance Preferred Organization Carriers (PPO) Options Four Premium Levels • Employee Partnership PPO • BlueCross BlueShield of Tennessee Standard PPO • Cigna • Employee + spouse Limited PPO (Local Government only) www.partnersforhealthtn.gov • Employee + child(ren) • Employee + spouse + children 22 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 carrier’s member handbooks or websites for more information. 23 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. 24 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 25 Health Benefits • Carrier costs vary by grand division STEWART • In East and Middle Tennessee, LAKE OBION ROBE RTSON JACKSON WILSON PUTNAM RUTHERFORD CIGNA costs $20 more per month for employee only coverage and $40 more per month for all other premium levels ROANE CANNON VAN BURE N BLEDSOE MAURY LEWIS BEDFORD CHESTER HARDEMAN MCNAI RY HARDIN WAYNE LAWRENC E GILES LINCOLN MCMINN BLOUNT MONROE SEQUATCHIE MOORE FAYETT E LOUDON MEIGS GRUNDY SEVIER RHEA COFFEE MARSHALL SHELBY COCKE WARRE N PERRY DECATUR GREENE JEFFERSON CUMBERLAND WHITE WILLIAMSON HENDERSON HAMBLEN UNICOI ANDERSON KNOX DEKALB HICKMAN MADISON MORGAN CARTER GRAINGER SMITH DAVIDSO N DICKSON LAUDERDALE HAYWOO D WASHINGTON UNION JOHNSON HAWKIN S CAMPBELL FENTRESS HUMPHREYS CARROLL CROCKETT TIPTON OVERTON SULLI VAN HANCOCK CLAIBORNE SCOTT TROUSDALE BENTON PICKETT CLAY MACON SUMNER CHEATHAM HOUS TON DYER GIBSON MONTGOME RY HENRY WEAKLEY FRANKLIN MARION HAMILTON BRADLEY POLK • 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 26 Covered Services Services that Require Co-Pays • The following are some of the services that require co-pays: • Primary Care Office Visit * • Pharmacy • Specialist Office Visit* • Emergency Room Visit • Urgent Care • Urgent Care • Allergy Injection (with office visit*) • Mental Health and Substance Abuse* • Chiropractors * Subject to Out-of-Pocket Co-pay Maximum www.partnersforhealthtn.gov 27 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 28 2013 Deductibles and Out-ofPocket Co-insurance Maximums Partnership PPO Standard PPO In-Network Out-of-Network In-Network Out-of-Network 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 $1,150 $2,050 $2,050 $3,850 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 Annual Deductible Employee + Spouse + Child(ren) Out-of-Pocket Co-Insurance Maximum www.partnersforhealthtn.gov 29 Premiums for 2013: State and Higher Education Employee Share of Monthly Premiums - Cigna Premium Level Partnership PPO Standard PPO Employee Only $108.52 $133.52 Employee + Child(ren) $162.78 $187.78 Employee + Spouse $227.89 $277.89 Employee + Spouse + Child(ren) $282.15 $332.15 • 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. The State pays 80% of the total premium cost for active employees. www.partnersforhealthtn.gov 30 Premiums for 2013: State and Higher Education Employee Share of Monthly Premiums - Blue Cross/Blue Shield Premium Level Partnership PPO Standard PPO Employee Only $128.52 $153.52 Employee + Child(ren) $202.78 $227.78 Employee + Spouse $267.89 $317.89 Employee + Spouse + Child(ren) $322.15 $372.15 The State pays 80% of the total premium cost for active employees. 31 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 A health screening for all members is not required in 2013. www.partnersforhealthtn.gov 32 Partnership Promise At-risk members and covered spouses must also: • Complete a biometric screening at your health care provider’s office between July 15 2012, and July 15 2013 • Participate in health coaching and/or case management, if identified Healthways will manage the Partnership Promise in 2013. 33 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 The Well-Being Assessment must be completed between January 1 and March 15, 2013. www.partnersforhealthtn.gov 34 Partnership Promise 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 ageappropriate preventive service Annual physical Well-woman visit Flu and pneumonia shots Screenings for colon, breast and prostate cancers www.partnersforhealthtn.gov OR Join a ParTNers for Health Wellness Challenge OR • Fun way to develop healthier lifestyle with group support • Choose one of the first two quarterly challenges • Offered online Complete Your WellBeing Plan and Three Action Items • Create plan with recommended focus areas from WBA • Complete 3 simple action items 35 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. Higher Education, Local Education and Local Government employees: Change your contact information yourself in Edison, by contacting your agency benefits coordinator or by calling the Benefits Administration Service Center at 1-800-253-9981 and selecting option 6. www.partnersforhealthtn.gov 36 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 37 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 38 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 doctor’s 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 39 Partnership Promise Health Coaching • Lifestyle management helps you form better health habits. Coaches help with: High blood pressure Weight management High cholesterol Tobacco use • Disease management is for those with chronic conditions such as: Diabetes Asthma Coronary artery disease Congestive heart failure Chronic obstructive pulmonary disease (COPD) • 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 40 Partnership Promise Health Coaching • A health coach works with you and your provider to help you with selfmanagement 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 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) 41 Dental Benefits Eligible employees can choose between two dental options Prepaid Plan PDO Plan • Fixed co-pays • Any dentist • Participating dentists only • Pay less with network providers • During the enrollment period, eligible employees can enroll in or transfer between the two options. • If you don’t ask to change your current dental carrier or cancel coverage, you will keep your current coverage. www.partnersforhealthtn.gov 42 Dental Benefits Prepaid Plan • Administered by Assurant Employee Benefits • Predetermined co-pay amounts • 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 • To receive benefits, you must select a dentist from the Prepaid Plan list • Premiums will increase by 3% in 2013 in the prepaid plan www.partnersforhealthtn.gov 43 Dental Benefits Preferred Dental Organization (PDO) • Administered by Delta Dental • Use any dentist in the network • Members have access to Delta Dental’s 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 44 Dental Benefits 2013 Premiums Assurant Prepaid Delta 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 45 Additional Benefits Basic Term Life and Accidental Death Insurance • The State provides $20,000 of basic term life and $40,000 of accidental death and dismemberment insurance • If you are enrolled in health insurance as the head of contract, your coverage increases with your salary — to a maximum of $50,000 for basic term life insurance and $100,000 for accidental death insurance. • Coverage provided by Dearborn National www.partnersforhealthtn.gov 46 Additional Benefits Optional Accidental Death Insurance – STATE ONLY • Additional accident protection for yourself and your dependents • Coverage is available at low group rates—no questions asked • Premiums vary by age and salary • The maximum benefit available to employees is $60,000 • Enrollment form is available on the ParTNers for Health website • Coverage provided by Dearborn National www.partnersforhealthtn.gov 47 Additional Benefits Optional Term Life Insurance – STATE ONLY • Cannot enroll or make changes in optional term life insurance during AETP • The state is procuring a new contract for optional term life • An open enrollment with the selected carrier is planned during 2013 • At that time, individuals interested in enrolling will be provided with guaranteed issue of coverage up to the guaranteed maximum • Those currently enrolled will be able to increase or decrease coverage during the spring open enrollment period • We will provide details of the new term life insurance later this year 48 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 49 Additional Benefits Long-Term Care Insurance • Your agency must choose to participate (Local Ed and Local Gov) • Who is eligible? Qualified employees Retirees Eligible dependents Parents and parents-in-law • Covers services for individuals who are no longer able to care for themselves Nursing home care Home care Assisted living Adult day care Home health care Apply for coverage at any time through medical underwriting. 50 Additional Benefits Long-Term Care Insurance • Benefits available for different daily benefit amounts ($100, $150 or $200) for either three- or five-year coverage • Available with or without inflation protection • You pay 100 percent of the premium • Premiums are based on age at the time of enrollment • Choose to have the premium taken from your payroll check or opt for a direct bill arrangement with MedAmerica • Visit www.ltc-tn.com or call MedAmerica at 1.866.615.5824 www.partnersforhealthtn.gov 51 Additional Benefits Flexible Benefits • Lowers your income taxes • Use pre-tax earnings to pay for health or dental insurance premiums • Set aside pre-tax earnings to pay for: Medical expenses Dependent care expenses 52 Additional Benefits Medical Expense Reimbursement Account Dependent Day Care Reimbursement Account • Use the account to reimburse yourself for eligible medical, dental and vision care expenses • Use the account to reimburse yourself for eligible dependent day care expenses • Contribute up to $2,500 per year • Contribution depends on tax filing status Sign up for this benefit will be held in November. www.partnersforhealthtn.gov 53 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 54 Member Communications Current members should have received a copy of the 2013 Decision Guide at their homes in mid-September. www.partnersforhealthtn.gov 55 Who to Contact • Primary point of contact - agency benefits coordinator (ABC) Sherry Shanklin – [email protected] or 881-7850. • 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 • Enrollment forms and handbooks – www.tn.gov/finance/ins www.partnersforhealthtn.gov 56 Questions? 57