Tennessee State University New Employee Benefits Orientation - 2015 Resource Materials

1. State of Tennessee & Tennessee Board of Regents Group Insurance Program

2. Tennessee State University New Employee Benefits Orientation 2015

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

4. 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 3

5. 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 ptrent@tnstate.edu if you have questions When to Enroll

6. 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 When Will Coverage Begin?

7. 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 When Will My ID Cards Arrive? 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

8. 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 About the Plan

9. 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

10. 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 Notice to TennCare Enrollees

11. Adding or Changing Coverage There are only three times you may add health coverage: • As a new employee • During the fall annual enrollment transfer period • 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

12. 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.

13. You may only cancel health, dental or vision coverage for yourself or your dependents: During the Annual Enrollment Transfer Period If you become ineligible to continue coverage 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 Canceling Coverage

14. 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

15. Definitions • 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. 14

16. 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

17. Choosing Your Health Insurance Options    Choose between Two Preferred Provider Organization (PPO) Options • Partnership PPO • Standard PPO Choose an Insurance Carrier • BlueCross BlueShield of Tennessee • Cigna 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.

18. 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

19. Partnership PPO Rewards members for taking an active role in their health Commitment to Partnership Promise is required Comparing Your PPO Options 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.

20. 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 Partnership PPO

21. 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.

22. Partnership Promise • 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 You will have 120 days to complete the Well-Being Assessment.

23. 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.

24. 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

25. The Standard PPO offers the same services as the Partnership PPO, but you will pay morefor 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 Standard PPO

26. 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 Choosing an Insurance Carrier

27. 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 Choosing an Insurance Carrier

28. 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 Choosing an Insurance Carrier Each carrier offers statewide and national networks, regardless of the region where you live

29. 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) Choosing Your Premium Level Remember: The Partnership PPO premiums are lower than the premiums for the Standard PPO.

30. 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. Choosing Your Premium Level

31. *Blue Cross Blue Shield & Cigna LocalPlus Premiums Medical for Middle Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

32. * Cigna Open Access Premiums Medical for Middle Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

33. *Blue Cross Blue Shield Premiums Medical for East Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

34. *Cigna Premiums Medical for East Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

35. *Blue Cross Blue Shield Premiums Medical for West Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

36. *Cigna Premiums Medical for West Tennessee *This chart shows the Employee portion of premiums The State pays 80% of the total premium cost for active employees.

37. Co-Insurance

38. 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 Free In-Network Preventive Care Regular preventive care is one of the most important things you can do to stay healthy.

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

40. Out-of-Pocket Maximums

41. 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.

42. 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 Pharmacy Benefits

43. 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

44. 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 Mental Health and Substance Abuse Treatment

45. Optional Dental Benefits 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 AssurantPrepaid Plan • Participating dentists only • Fixed co-pays Delta PDO Plan • Any dentist • Pay less with network providers

46. 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 Dental - Assurant

47. 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/ Dental – Delta

48. Dental Premiums Dental services for both the Prepaid Plan and the Dental PDO include:

49. 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 Vision

50. Vision - EyeMed Both plans offer the same services: Each year during AETP, eligible employees can enroll in or transfer between vision options. 49