1 / 58

State of Tennessee Group Insurance Program Annual Enrollment Transfer Period

State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 – November 1, 2012. 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.

fadey
Download Presentation

State of Tennessee Group Insurance Program Annual Enrollment Transfer Period

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. State of Tennessee Group Insurance ProgramAnnual Enrollment Transfer Period October 1 – November 1, 2012

  2. 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 Agenda www.partnersforhealthtn.gov

  3. 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 Annual Enrollment Transfer Period www.partnersforhealthtn.gov

  4. 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 Annual Enrollment Transfer Period www.partnersforhealthtn.gov

  5. 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 Annual Enrollment Transfer Period www.partnersforhealthtn.gov

  6. 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

  7. 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.

  8. New, optional vision plan Member cost sharing Pharmacy coverage changes Closing optional universal life insurance to new enrollments (State Plan only) What’s Changing for 2013 www.partnersforhealthtn.gov

  9. 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 What’s Changing for 2013 www.partnersforhealthtn.gov

  10. 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 • Administered by EyeMed Vision Care • Members have access to their Select Network • Basic plan: • Discounted rates • Allowances www.partnersforhealthtn.gov

  11. What’s Changing for 2013 • Optional Vision Plan • Employee pay-all option (members pay full premium) • Monthly premiums for Active Members www.partnersforhealthtn.gov

  12. 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 What’s Changing for 2013 www.partnersforhealthtn.gov

  13. Member Cost Sharing: Deductibles The deductibles for each PPO will increase in 2013 The amount of the increase depends on your premium tier What’s Changing for 2013 www.partnersforhealthtn.gov

  14. 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 What’s Changing for 2013 www.partnersforhealthtn.gov

  15. 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

  16. 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

  17. 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

  18. 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 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 What’s Changing for 2013 • Contraceptive transdermal patches • Barrier methods • Injectable contraceptives (limit four per year) www.partnersforhealthtn.gov

  19. 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

  20. 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

  21. 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” • This policy will not apply to current users of these drugs www.partnersforhealthtn.gov

  22. 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 21 www.partnersforhealthtn.gov

  23. 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 • Limited PPO (Local Government only) Two Insurance Carriers • BlueCross BlueShield of Tennessee • Cigna Four Premium Levels • Employee • Employee + child(ren) • Employee + spouse • Employee + spouse + children www.partnersforhealthtn.gov

  24. 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.

  25. 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 Health Benefits You need to visit an in-network provider to receive preventive care services at no cost.

  26. 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 Health Benefits www.partnersforhealthtn.gov

  27. 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 Health Benefits www.partnersforhealthtn.gov

  28. Services that Require Co-Pays The following are some of the services that require co-pays: * Subject to Out-of-Pocket Co-pay Maximum Covered Services www.partnersforhealthtn.gov

  29. Services that Require Co-Insurance The following are some of the services that require co-insurance: Covered Services www.partnersforhealthtn.gov

  30. 2013 Deductibles and Out-of-Pocket Co-insurance Maximums www.partnersforhealthtn.gov

  31. Premiums for 2013: State and Higher Education Employee Share of Monthly Premiums - Cigna • 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

  32. Premiums for 2013: State and Higher Education Employee Share of Monthly Premiums - Blue Cross/Blue Shield The State pays 80% of the total premium cost for active employees.

  33. 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 Partnership Promise A health screening for all members is not required in 2013. www.partnersforhealthtn.gov

  34. 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.

  35. 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 Partnership Promise The Well-Being Assessment must be completed between January 1 and March 15, 2013. www.partnersforhealthtn.gov

  36. 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 age-appropriate preventive service • Annual physical • Well-woman visit • Flu and pneumonia shots • Screenings for colon, breast and prostate cancers 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 Complete Your Well-Being Plan and Three Action Items • Create plan with recommended focus areas from WBA • Complete 3 simple action items OR OR www.partnersforhealthtn.gov

  37. 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. Partnership Promise www.partnersforhealthtn.gov

  38. Tobacco Cessation Partnership PPO members must be tobacco free or agree to participate in the tobacco cessation program andwork 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 Partnership Promise www.partnersforhealthtn.gov

  39. 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 Partnership Promise Your health risks are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results. www.partnersforhealthtn.gov

  40. 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 Partnership Promise www.partnersforhealthtn.gov

  41. 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)

  42. Partnership Promise • 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 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)

  43. Dental Benefits 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 don’t ask to change your current dental carrier or cancel coverage, you will keep your current coverage. Prepaid Plan • Fixed co-pays • Participating dentists only PDO Plan • Any dentist • Pay less with network providers www.partnersforhealthtn.gov

  44. 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 Dental Benefits www.partnersforhealthtn.gov

  45. 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 Dental Benefits www.partnersforhealthtn.gov

  46. Dental Benefits Dental services for both the Prepaid Plan and the Dental PDO include: www.partnersforhealthtn.gov

  47. 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

  48. 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

  49. 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 Additional Benefits

  50. 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 Additional Benefits www.partnersforhealthtn.gov

More Related