state of tennessee & tennessee board of regents group insurance program

State of Tennessee

&

Tennessee Board of Regents

Group Insurance Program

Tennessee State University

New Employee Benefits Orientation

2015

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Resource Materials

For more detailed information, refer to the Eligibility and Enrollment Guide.

What’s Available To You

• Medical (Blue Cross Blue Shield or Cigna)

• Dental (Delta or Assurant)

• Vision (EyeMed or VSP)

• Optional Term Life Insurance (Minnesota Life)

• Optional Special Accident Insurance (Minnesota Life)

• Long Term Disability (Prudential)

• Long Term Care (MedAmerica)

• Aflac

• TNStars 529 Plan (contact Pam Trent, Benefits Specialist for details)

• Retirement (Tennessee Consolidated Retirement System) or Optional Retirement Plans (TIAA-CREF, Valic, Voya); 401k, 401kROTH,m 403b, 457

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When to Enroll

• The decisions you make now as a new employee will have lasting effects on your benefits

• You have 31 days (including weekends & holidays) from your date of hire (NOT the date you signed your contract) to enroll

• If you are NOT enrolling in coverage, you still need to submit the Enrollment form waiving coverage

• Contact Pam Trent, Benefits Specialist at 615-963-7433 or [email protected] if you have questions

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When Will Coverage Begin?

• Health, dental, vision and life insurance coverage begin on the first day of the month following your hire date

• For example, if you are hired on September 15th, your coverage would begin on October 1st

• Please note that depending on when you enroll, you may incur a double premium deduction of your elections the following month

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When Will My ID Cards Arrive?

• Within three weeks of the date your application is processed

• CVS Caremark will send separate ID cards for your pharmacy benefits (Note: each family member’s card may arrive in a separate envelope)

• If you enroll in dental or vision benefits, you will also receive your ID cards within three weeks

Blue Cross Blue Shield

• Will send up to two ID cards automatically, both with the member’s name

• These may be used by any covered dependent

Cigna

• Will send separate ID cards for each insured family member with each participant’s name

• There may be up to four ID cards in each envelope

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About the Plan

• The State Group Insurance Program (also called the Plan) covers three different populations:

• State and Higher Education Employees

• Local Education Employees

• Local Government Employees

• We spend about $1.3 billion annually and cover nearly 300,000 members

• The health plan is self-insured, meaning that the State, not an insurance company, pays claims from premiums collected from members and their employers

• The Division of Benefits Administration manages the State Group Insurance Program and works with your Agency Benefits Coordinator (Benefits Specialist) to serve our Plan members

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Who is Eligible for Coverage?

• Full time employees as well as some temporary and part time employees who work 30 hours per week

• Eligible employees may enroll for health insurance coverage as well as their dependents, who may include:

• Spouse (must be legally married)

• Children up to age 26, including natural, adopted or step-children or children for whom the employee is the legal guardian

• There are special circumstances for employees with disabled dependents that may allow for coverage of these dependents after age 26

• For more information about disabled dependents, refer to the Eligibility and Enrollment Guide or contact Pam Trent, Benefits Specialist

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Notice to TennCare Enrollees

• You must contact your caseworker at the Department of Human Services (DHS) within 10 days of your date of employment

• Report to DHS your new job, salary and that you have access to medical insurance with your new employer

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Adding or Changing Coverage

There are only three times you may add health coverage:

1. As a new employee

2. During the fall annual enrollment transfer period

3. If you experience a special qualifying event A specific life change, such as marriage, the birth of a baby or something that

results in loss of other coverage Must submit paperwork within 60 days of the event or loss of other coverage A complete list is provided on page three of the enrollment application

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Annual Enrollment Transfer Period

• During the Annual Enrollment Transfer Period (AETP), you may:

• Add health insurance coverage

• Change health insurance carriers

• Choose a different PPO

• Cancel health insurance coverage

• Changes are effective January 1 of the following year

• Add, cancel or make changes to optional benefits during AETP

The Annual Enrollment Transfer Period occurs each year during the fall, usually around October.

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Canceling Coverage

• You may only cancel health, dental or vision coverage for yourself or your dependents:

1. During the Annual Enrollment Transfer Period

2. If you become ineligible to continue coverage

3. If you experience a qualifying event listed on the Insurance Cancel Request Application

• You cannot cancel coverage during the plan year, outside of AETP, unless you have a qualifying event or lose eligibility under the plan

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Definitions

• Premiums are the amount you pay each month for your coverage regardless of whether or not you receive health services

• A co-pay is a flat dollar amount you pay for services and products, like office visits and prescriptions

• A deductible is a set dollar amount that you pay out-of-pocket each year for services that require co-insurance

• Co-insurance is a form of payment where you pay a percentage of the cost for a service, after meeting your deductible

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Definitions

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• The out-of-pocket co-insurance maximum is the limit on the amount of money you will have to pay each year in deductibles and co-insurance

• The out-of-pocket co-pay maximum limits how much you pay for certain in-network services that require co-pays

• A network is a group of doctors, hospitals and other health care providers contracted with a health insurance plan to provide services to members at pre-negotiated (and usually discounted) fees

• The maximum allowable charge (MAC) is the most a plan will pay for a service

For a complete list of definitions, see the Eligibility and Enrollment Guide.

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Covered Services

• The Partnership PPO and the Standard PPO both cover the exact same services, treatments and products, including the following:

• Preventive care

• Primary care

• Specialty care

• Hospitalization and surgery

• Laboratory and x-rays

• A comparison chart that lists covered services and their costs is available in the Eligibility and Enrollment guide

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Choosing Your Health Insurance Options

Choose between Two Preferred Provider Organization (PPO) Options

Partnership PPO

Standard PPO

Choose between Four Premium Levels

• Employee

• Employee + child(ren)

• Employee + spouse

• Employee + spouse + children

All members have the same choices. After the initial new hire period, changes can only be made if you experience a special qualifying event or during AETP in the fall.

Choose an Insurance Carrier

• BlueCross BlueShield of Tennessee

• Cigna

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Health Care Options

• There are two health insurance options available to you:• Partnership PPO

• Standard PPO

• Both of these options are Preferred Provider Organizations (PPOs)

• How a PPO Works:

• Visit any doctor or hospital you want

• However, the PPO has a list of in-network doctors, hospitals and other providers that you are encouraged to use

• These in-network providers have agreed to take lower fees so you pay less for services

• You will pay more for services from out-of-network providers

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Comparing Your PPO Options

Partnership PPO

Rewards members for taking an active role in their health

Commitment to Partnership Promise is required

Standard PPO

No incentives for healthy behaviors

Members pay a greater share of costs

Both options cover the same services, treatments and products. However, under the Partnership PPO, when you take an active role in

your health, you will pay less.

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Partnership PPO

• The Partnership PPO option allows you to pay less for your coverage by taking an active role in your health and fulfilling the Partnership Promise

• The Partnership Promise is an annual commitment. You must complete the requirements (complete the online well-being assessment & get a biometric screening) each year.

• In order to remain in the Partnership PPO, you must meet your commitment each year by the deadlines (March 15th for the well-being assessment & July 15th for the biometric screening.) See the next slide for new hire deadlines.

• You and you spouse (if applicable) must complete the requirements

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Partnership Promise

New hires and their covered spouses must:

• Complete the online Well-Being Assessment

• Get a biometric health screening

• Visit Partners for Health for details

* Both requirements must be completed within 120 days of your insurance coverage effective date.

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Partnership Promise

You will have 120 days to complete the Well-Being Assessment.

Online Well-Being Assessment (WBA)

• Summarizes your overall health and offers steps you can take to improve

• By completing the confidential assessment online, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-being

• You must visit www.partnersforhealthtn.gov and create an online well-being account to access the assessment

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Partnership Promise

Biometric Health Screening

• You must get a health screening from your health care provider

• You may use screening results from a doctor’s visit within the last 12 months

• Simply ask your doctor to complete the Physician Screening Form, which is available online at www.partnersforhealthtn.gov

• Follow-up with your doctor to ensure your biometric screening form has been forwarded to Healthways. Contact Healthways at 888-741-3390 to confirm receipt.

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If You Cover Your Spouse

• Same PPO Options

• Your spouse must also commit to the Partnership Promise

• Exception: If you and your spouse both work for a Participating Employer you can choose different options

• Partnership Promise is not required for covered children

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Standard PPO

• The Standard PPO offers the same services as the Partnership PPO, but you will pay more for monthly premiums, annual deductibles, pharmacy co-pays, medical care co-insurance and out-of-pocket maximums

• Members enrolled in the Standard PPO are not required to fulfill the Partnership Promise

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Choosing an Insurance Carrier

• Once you choose your PPO, you have a choice of two carriers:

• BlueCross BlueShield of Tennessee (Network S)

• Cigna (Open Access Plus)

• Cigna (LocalPlus is only available in middle Tennessee)

• Partnership PPO and Standard PPO are available for each option

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• Each carrier has its own network of preferred doctors, hospitals and other health care providers

• Check the networks for each carrier carefully when making your decision

• Provider directories are available

• Online

• By calling the carrier’s customer service phone line

• Blue Cross Blue Shield - http://www.bcbst.com/members/tn_state/ or 800-558-6213

• Cigna - http://www.cigna.com/sites/stateoftn/index.html or 800-997-1617

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• There are three regions (grand divisions): East, Middle and West

• Carrier costs vary by grand division• CIGNA is more expensive in the East and Middle grand divisions (with the exception of Cigna

LocalPlus, which is available only in middle Tennessee)• BlueCross BlueShield of Tennessee is more expensive in the West grand division

• If you live and work in different regions, you can choose between the two

• Before selecting a carrier, review the premium rate and provider network to help you decide

Each carrier offers statewide and national networks, regardless of the region where you live

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Choosing Your Premium Level

• The amount you pay in premiums depends on the PPO you choose and the number of people you cover under the plan

• There are four premium levels (tiers) available:

• Employee Only

• Employee + Child(ren)

• Employee + Spouse

• Employee + Spouse + Child(ren)

Remember: The Partnership PPO premiums are lower than the premiums for the Standard PPO.

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Choosing Your Premium Level

• If your spouse works for a participating employer, you have another option:

• Choose premium level separately (employee only)

• Choose your PPO option and insurance carrier separately

• If you and your spouse are both State and Higher Education employees:

• You may each want to consider enrolling in employee only coverage or employee + children, if you have children, to ensure that you receive the maximum life insurance benefit.

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Premiums Medical for Middle

Tennessee

*Blue Cross Blue Shield & Cigna LocalPlus

The State pays 80% of the total premium cost for active employees.

*This chart shows the Employee portion of premiums

Premium Level Partnership PPO Standard PPO

Employee Only $114.49 $139.49

Employee + Child(ren) $171.73 $196.73

Employee + Spouse $240.42 $290.42

Employee + Spouse + Child(ren) $297.67 $347.67

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Premiums Medical for Middle

Tennessee

* Cigna Open Access








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Premiums Medical for East Tennessee

*Blue Cross Blue Shield








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Premiums Medical for East Tennessee

*Cigna








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Premiums Medical for West Tennessee

*Blue Cross Blue Shield








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Premiums Medical for West Tennessee

*Cigna








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Co-Insurance

Partnership PPO Standard PPO

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

Inpatient Care (Including Mental Health and Substance Abuse)

You pay 10% You pay 40% You pay 20% You pay 40%

Advanced X-ray, Scans and Imaging You pay 10% You pay 40% You pay 20% You pay 40%

Occupational Therapy, Physical Therapy, Speech Therapy

You pay 10% You pay 40% You pay 20% You pay 40%

Durable Medical Equipment You pay 10% You pay 40% You pay 20% You pay 40%

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Free In-Network Preventive Care

• Annual preventive care check-up offered to members at no cost

• Lab work related to the preventive care visit covered at 100%

• You need to visit an in-network provider to receive preventive care services at no cost

Regular preventive care is one of the most important things you can do to stay healthy.

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Annual Deductibles

You pay the annual deductible before co-insurance benefits kick in.


Annual Deductible 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

Employee + Spouse + Child(ren) $1,150 $2,050 $2,050 $3,850

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Out-of-Pocket Maximums


Out-of-Pocket Co-insurance Maximum In-Network Out-of-Network* In-Network Out-of-Network*

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

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Take Note!

• Deductibles and out-of-pocket maximums for in-network and out-of-network services add up separately

• Services received in network count toward your in-network deductible and out-of-pocket maximum

• Services received out of network count toward your out-of-network deductible and out-of-pocket maximum

Ineligible expenses, including non-covered services and expenses over the MAC don’t count toward

deductibles and out-of-pocket maximums.

Deductible Out-of-Pocket Max

In-Network $450 $2,300

Deductible Out-of-Pocket Max

Out-of-Network $800 $3,500

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Pharmacy Benefits

• Your health plan also includes pharmacy benefits

• The covered drug list is the same for both the Partnership PPO and Standard PPO, although co-pays differ between the two

• Pharmacy benefits are administered by CVS Caremark, one of the largest pharmacy benefits managers in the country with over 1,600 in-network pharmacies statewide

• Please do not submit your Blue Cross Blue Shield or Cigna card to your pharmacist. There are no pharmacy benefits associated with these state plans.

• Please visit http://info.caremark.com/stateoftn for more information

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• Co-pay amounts are based on three different factors: the type of pharmacy you use, your PPO option and the drug level (tier) of the medication

• There are three drug levels:

Generic Drug (tier one) is a generic medicine that is FDA-approved and equal to the brand-name product in safety, effectiveness, quality and performance

– Least expensive option

Preferred Brand (tier two) is a brand-name drug included on the drug list

– More expensive option

Non-preferred Brand (tier three) is a brand-name drug not on the drug list

– Most expensive option

Pharmacy Benefits

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Mental Health and Substance Abuse Treatment

• Employees and dependents who are enrolled in health coverage are also eligible for mental health and substance abuse services

• Mental Health and Substance Abuse services generally include:

• Individual and group treatment

• Hospitalization

• Aftercare

• Costs are based on your health plan

• Prior authorization is required for some services

• Visit http://www.here4tn.com/ for more details

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Eligible employees can choose between two dental options

• Each year during the Annual Enrollment Transfer Period, eligible employees can enroll in or transfer between dental options

• Unlike health insurance where a portion of the premium is paid by the employer, dental insurance is paid 100% by the member

Optional Dental Benefits

Assurant Prepaid Plan

• Participating dentists only

• Fixed co-pays

Delta PDO Plan

• Any dentist

• Pay less with network providers

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Dental - Assurant

• The Prepaid plan is administered by Assurant Employee Benefits

• The Prepaid Plan provides dental services at predetermined co-pay amounts from a limited network of participating dentists and specialists

• This means you must select a provider from a limited network of dentists and submit your selection to Assurant before any services will be covered

• You must select an Assurant dentist within 30 days of enrollment to avoid possible delays in treatment

• The are no deductibles, no claims to file, no waiting periods, no annual dollar maximum, pre-existing conditions are covered and referrals are not required

• To find a dentist in Assurant’s network, visit http://www3.employeebenefitsonline.com/l/813/2009-09-21/EYVJN

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Dental – Delta

• The PDO is administered by Delta Dental of Tennessee

• Under the Preferred Dental Organization (PDO), you may use any dentist

• Referrals are not necessary with the PDO and you or your dentist file claims for covered services

• There is a one-year waiting period for some services, such as orthodontia

• Calendar year maximum of $1,500 per person

• Lifetime orthodontics maximum of $1,250 per person

• To find a dentist in Delta Dental’s network, visit http://www.deltadentaltn.com/statetn/

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Dental Premiums

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

Premiums Assurant Delta





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Vision

• Tennessee State University offers 2 vision plans; one is EyeMed, which is through the state and the other is VSP which is offered through the Tennessee Board of Regents (TBR)

• Visit VSP for more information and to enroll

• Visit EyeMed for more information. You enroll in this plan on the enrollment form

5050

Vision - EyeMed

Premiums Basic Plan Expanded Plan





Both plans offer the same services:

• Annual routine eye exam • Eyeglass lenses

• Frames • Contact lenses

• Discount on Lasik/refractive surgery

Each year during AETP, eligible employees can enroll in or transfer between vision options.

5151

Vision - VSP

Premiums Bronze Plan Gold Plan





Both plans offer the same services:

• Annual routine eye exam • Eyeglass lenses

• Frames • Contact lenses

• Discount on Lasik/refractive surgery

Each year during AETP, eligible employees can enroll in or transfer between vision options.

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Basic Term Life and Accidental Death and Dismemberment

• The State provides, at no cost to every full-time employee who does not enroll in health coverage:

• $20,000 of basic term life insurance

• $40,000 of basic accidental death and dismemberment (AD&D)

• If you are enrolled in health insurance, your coverage increases with your salary up to:

• $50,000 for term life insurance

• $100,000 for AD&D insurance

• If you enroll in health insurance, your eligible dependents are also covered for $3,000 of basic dependent term life coverage and an amount for basic AD&D based on your salary and family composition

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Optional AD&D Insurance

• In addition to basic coverage, you and your dependents may also enroll in optional accidental death and dismemberment insurance

• For a premium, this coverage pays an additional amount in the case of accidental death or dismemberment

• You may enroll as a new employee or during AETP

• Coverage is available at low group rates, no questions asked

Basic Term Life, Basic AD&D and Optional AD&D are administered by Minnesota Life

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Optional Term Life Insurance

• Premiums are based on age and the amount of coverage requested

• Coverage is also available for spouses and dependent children

Spouses: maximum level of coverage is $30,000 Children: $5,000 or $10,000 term rider

• Must enroll in first 30 days of employment for guaranteed issue coverage and coverage is effective after 3 months of employment

• You can apply later during AETP by answering health questions

• Select up to 5 times your annual base salary when first eligible with guaranteed issue. You may request up to 7 times your annual base salary with evidence of insurability

Optional Term Life Insurance is administered by Minnesota Life

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Long-Term Care Insurance

• Covers services for qualified members who are unable to care for themselves without the assistance of others

• Nursing home care

• Assisted living

• Home health care

• You have 90 days to enroll with guaranteed-issue coverage

• Your spouse, dependent children, parents and parents-in-law may also apply through medical underwriting

• Premiums are based on the age of the insured at the time of enrollment

• Plan administered by MedAmerica

• Home care

• Adult day care

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Long-Term Disability (LTD) Insurance - Prudential

• Eligibility – All active, full-time regular employees

• The plan pays through at least your normal retirement age (depends on year of birth)

• Elimination Period - This is the amount of time you must be disabled before benefits become payable.

• Option 1 – 180 day elimination period; pays 50% of your monthly salary



• Please review the Exempt and Non-Exempt Summary Plan Descriptions for details.

• Premiums are based on age and salary

• If you are NOT interested in coverage, you must complete the form and DECLINE coverage

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Aflac

• Aflac offers a full range of products to include:

• Hospitalization

• Critical Illness

• Cancer

• Sickness

• Accident

Visit Aflac TBR for details and to enroll.

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Flex Spending

• Flexible spending is available through PayFlex for:

• Medical Expenses – Set aside up to $2,500 pre-tax per month for approved medical expenses. Spend funds through March 15, 2016 and submit claims through March 31, 2016.

• Dependent Care - Set aside up to $5,000 pre-tax per month for approved child care expenses

Visit PayFlex for details.

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Retirement

• Any person hired by the state of Tennessee or who participated in TCRS after July 1, 2014 will be enrolled in the Hybrid plan. The Legacy plan is for people hired or who participated in TCRS prior to July 1, 2014.

• The state of Tennessee offers 2 retirement plan options for employees of higher education

• The Tennessee Consolidated Retirement System (TCRS) – Requires a 5 year vesting period

• The Optional Retirement Plans (ORP) – Consists of TIAA-CREF, Valic & Voya

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Retirement: Non-Exempt

• If you are a Non-Exempt employee (paid twice a month), you will enroll in the Tennessee State Consolidated Retirement System (TCRS) retirement plan.

• Any person hired by the state of Tennessee or who participated in TCRS after July 1, 2014 will be enrolled in the Hybrid plan.

• The Legacy plan is for people hired or who participated in TCRS prior to July 1, 2014.

• If you have worked for the state of Tennessee, or if you have participated in TCRS previously, you will be enrolled in the Legacy plan. The Legacy plan provides that you will have 15% of your salary contributed toward your retirement at no cost to you.

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Retirement: Exempt

• If you are an Exempt employee (paid once a month), you have the option of enrolling in the Tennessee State Consolidated Retirement System (TCRS) retirement plan or the Optional Retirement Plans (ORP).

• Any person hired by the state of Tennessee or who participated in TCRS after July 1, 2014 will be enrolled in the Hybrid plan.

• The Legacy plan is for people hired or who participated in TCRS prior to July 1, 2014.

• If you have worked for the state of Tennessee, or if you have participated in TCRS previously, you will be enrolled in the Legacy plan. The Legacy plan provides that you will have 10% of your salary contributed toward your retirement at no cost to you.

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Retirement: Hybrid Plans

• If you have never worked for the state of Tennessee nor have you participated in TCRS previously, Exempt & Non-Exempt employees will enroll in the Hybrid plan.

• Under the Hybrid plan, 5% of your salary will be deducted and contributed toward your retirement. An additional 2% will also be deducted and contributed toward your retirement, but you will have the option to opt out of this 2%. You may not opt out of the 5%.

• For employees (Exempt & Non-Exempt) who enroll in the TCRS Hybrid plan:

• The state will contribute 8.87% of your salary toward your retirement at no cost to you

• For Exempt employees who enroll in the ORP Hybrid plans:

• The state will contribute 9% of your salary at no cost to you

• If no designation is selected, the employee will default into TCRS.

• You will receive a package from Great-West Retirement Services with details.

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Retirement: Other Plans

• All eligible employees have the option of enrolling in Great-West Retirement Services plans:

• 401k, 401k ROTH, or 457 plans

All eligible employees have the option to enroll in 403b plans through the following vendors:

TIAA-CREF, Valic or Voya

See Pam Trent, Benefits Specialist for details

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ParTNers EAP

• ParTNers Employee Assistance Program (EAP) helps you and your family members deal with problems we all experience during our daily lives

• Your EAP can handle issues related to:

• Stress, depression and anxiety

• Family, relationship or marital issues

• Child and elder care

• Grief and loss

• You receive up to 5 free counseling sessions per separate incident

• Your EAP also offers free financial and legal consultations

• Visit http://www.here4tn.com/ for more information

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Your Privacy

• Your personal health information is strictly confidential

• Your health privacy rights are protected through a federal law called “HIPAA”

• Benefits Administration can only discuss benefits information with the head of contract (HOC)

• The Authorization for Release of Protected Health Information form must be completed before Benefits Administration can discuss benefits information with your spouse or other authorized representative

To print and complete a release form, Visit the forms section of www.tn.gov/finance/ins.

state of tennessee & tennessee board of regents group insurance program

Documents

life insurance coverage

vision benefits

health insurance coverage

envelope slide

state group insurance

pharmacy benefits

separate id cards

plan members