State of Tennessee Group Insurance Program Local Education Annual Enrollment Period October 1 – October 30, 2015 Enrollment ends at 4:30 p.m. Central

State of Tennessee Group Insurance Program

Local Education Annual Enrollment Period

October 1 – October 30, 2015Enrollment ends at 4:30 p.m. Central

2

Agenda

• Annual Enrollment Period

• What’s New or Changing for 2016

• Using ESS in Edison

• Health Benefits Overview

• 2016 Partnership Promise

• Dental, Vision and Additional Benefits Overview

www.partnersforhealthtn.gov

3

Annual Enrollment PeriodLocal Education

Enrollment: October 1 – October 30, 2015, 4:30 p.m. Central Annual Enrollment Period (AEP) is an open enrollment for most programs

• Employees can make the following changes: Choose, switch or cancel health insurance plans (subject to eligibility)

** New health insurance options ** Select or change your health insurance carrier Enroll in or cancel health insurance for yourself or your eligible dependents Enroll in, cancel or transfer between dental options

**New dental vendors** Enroll in, cancel or transfer between vision coverage


4

What’s New and Changing - 2016

• Cigna will offer the LocalPlus network in all regions and BlueCross BlueShield of

Tennessee will offer Network S in all regions.

• Carrier surcharge will be removed from all health plan option premium costs. The premium costs will be the same for both BlueCross and Cigna.

• New healthcare option – the HealthSavings CDHP will be available.

• New decision tool, ALEX, is your confidential, personal online benefits expert. ALEX can help you compare your insurance options based on your own situation. We’ll have more about ALEX later.


5

What’s New and Changing - 2016

• Copays for convenience clinics (often located in grocery stores or drug stores) will be lowered to the same as primary care visits. Copays for urgent care centers (often near a hospital) will be raised to the same level as a specialist visit.

• Chiropractic coverage will be limited to 50 visits per year.

• Pharmacy lower cost 90-day maintenance tier will be expanded to include medications for asthma, depression, COPD (emphysema and chronic bronchitis), and additional anti-hypertensives for coronary artery disease (CAD) and congestive heart failure (CHF).

• **New dental plan vendors: Dental preferred provider will be MetLife (replacing Delta Dental).

If you are currently enrolled in the preferred provider plan and you do not make a change, you will automatically be enrolled in MetLife Dental. MetLife will mail new insurance cards.


6

2016 Partnership Promise Requirement Changes

In 2016, every Partnership PPO plan member must complete these requirements as a part of the Partnership Promise:

1. Complete the online Well-Being Assessment (WBA) between January 1 and March 15, 2016

2. All members must get a biometric screening by July 15, 2016

3. If you are called, actively participate in coaching:• Coaching could include a tobacco cessation program or case

management

4. Keep your contact information current with your employer• Covered spouses – keep contact information current with Healthways

What’s Changing for 2016


7

Annual Enrollment Period

If you DO NOT want to make changes, you don’t have to do anything,

BUT NOTE:

• Health insurance – check the networks carefully!

• Cigna network for 2016 is LocalPlus. If you are currently enrolled in Cigna and you do not want to change carriers, you do not have to do anything. You’ll stay enrolled in Cigna and providers in LocalPlus will be your in-network providers. Cigna will mail new insurance cards.

• BlueCross BlueShield network for 2016 is Network S. If you are currently enrolled in BlueCross and you do not change carriers, you will continue to use Network S. BlueCross will mail new insurance cards.


How to Check Provider Directories

The right provider network for you and your family's health needs is an important decision. Check the networks carefully for your preferred doctor or hospital when making your selection.

Each carrier has its own network of preferred doctors, hospitals and other healthcare providers. Many doctors are in more than one network. You may find yours listed under both carriers.

You can find out if your providers are in the networks as follows:

1.Call member services:a) BlueCross BlueShield of Tennessee — 800.558.6213b) Cigna — 800.997.1617

2.Search for your providers online through the carriers’ websites:1. www.bcbst.com/members/tn_state (Network S)2. www.cigna.com/sites/stateoftn (LocalPlus)

8

9


If you DO want to make changes

• You must use Employee Self Service (ESS) in Edison

• Benefits Administration will not accept paper forms

• Enroll early! We expect many people will make changes this year and you should submit your changes as early as possible.

• Enrollment ends at 4:30 p.m. Central on October 30.

• Also, all new dependent verification documents must be received by 4:30 p.m. Central on October 30.


10


• Changes take effect on January 1, 2016

• Selections remain in effect through December 31, 2016, unless you lose eligibility or have a qualifying event

• A qualifying event or family status change is something that results in a person losing coverage under another plan or becoming newly eligible for coverage

• Examples include birth, a change in marital status or new employment

• Contact your Agency Benefits Coordinator (ABC) if you experience a qualifying event


11

Health Benefits

Your Health Insurance Options

Options

Partnership PPO*

Standard PPO

Limited PPO

HealthSavings CDHP

Four Premium Levels (tiers)

• Employee

• Employee + child(ren)

• Employee + spouse

• Employee + spouse + child(ren)

Two Insurance Carriers

• BlueCross BlueShield of Tennessee (Network S)

• Cigna (LocalPlus network)


*If you enrolled in the Partnership PPO for 2015 and you or your spouse did not fulfill the Partnership Promise, you are not eligible to continue in the Partnership PPO during 2016.

12

Health Benefits• All insurance plans cover the same services and treatments*:

• In-network preventive care at no cost• Free preventive health services (must visit an in-network provider)

*Medical necessity determinations vary by carrier. For some procedures, different medical criteria may apply based on the carrier you select. You will pay less for services and procedures when you choose the Partnership PPO. For detailed information on covered services, exclusions and how the plans work, view the insurance carriers' member handbooks.

• Health plans include: • Medical, behavioral health and pharmacy benefits• Fixed copays or coinsurance for some services depending on plan• Out-of-pocket maximums to limit costs


13

Health Benefits

Preferred Provider Organizations (PPOs)

• Partnership and Standard PPOs:

• Offer the same services and treatments

• You’ll pay less in copays and coinsurance with the Partnership PPO versus the Standard PPO

• You’ll pay your deductible first before coinsurance applies

• Separate out-of-pocket maximums for medical and pharmacy

• You’ll pay for prescriptions with copays

• Once you reach your out-of-pocket maximum, the plan pays 100% for in-network services


14

2016 Deductibles and Out-of-Pocket Co-insurance Maximums

Partnership PPO Standard PPO

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

Annual Deductible

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

Out-of-Pocket Maximum

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


There is a separate out-of-pocket maximum for pharmacy

15

Health Benefits

Limited PPO

About the Limited PPO:

• Offers the same services and treatments as the other plan options, but the premiums and out-of-pocket costs are different

• Monthly premiums are lower than the Partnership and Standard PPOs, but higher than the HealthSavings CDHP

• Out-of-pocket maximum for pharmacy is included with medical, but the out-of-pocket maximum is higher that all of the other plan options

• Copays for doctor visits, including specialists, are higher than the PPOs• Deductible is higher than the other PPOs• Coinsurance is higher than the other PPOs• Pharmacy deductible of $100 before benefits begin


Health BenefitsHealthSavings CDHP

• The state is offering a new insurance plan: • HealthSavings CDHP - employees may fund the HSA

• Can help you save money• Offered in addition to existing PPOs

• Includes a Health Savings Account (HSA)• Can be used to pay for qualified medical, behavioral health, dental

and vision expenses• Employees can make post-tax contributions into the HSA

directly with PayFlex vendor. Henry County Schools will NOT offer payroll deductions this year.

16www.partnersforhealthtn.gov

Health Benefits


Health BenefitsWith the HealthSavings CDHP option you have:

A lower monthly premium but a higher deductible. Coinsurance (a set percentage of the discounted network rates) instead of

copays (a set amount), after you meet your deductible, until your reach your out-of-pocket maximum.

To meet your deductible before the plan starts paying for covered expenses. But you can use the money in your HSA to pay for qualified medical expenses, including your deductible.

No separate deductible or out-of-pocket maximum for pharmacy. A total out-of-pocket maximum that is lower when compared to the total of the

Partnership or Standard PPO’s separate out-of-pocket maximums for pharmacy and medical/behavioral health.


Health Benefits Like the PPOs, the HealthSavings CDHP:

• Provides comprehensive health insurance coverage• Covers preventive care in-network at no cost • Offers the same provider networks

• BCBST Network S• Cigna LocalPlus network

• Include pharmacy coverage – but the way you pay for drug costs is different


20

2016 Deductibles and Out-of-Pocket Co-insurance Maximums

Limited PPO HealthSavings CDHP

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

Annual Deductible

Employee only $ 1,200 $2,300 $1,500 $3,000

Employee + Child(ren) $ 1,800 $3,350 $3,000 $6,000

Employee + Spouse $ 2,100 $3,900 $3,000 $6,000

Employee + Spouse + Child(ren) $ 2,600 $4,950 $3,000 $6,000

Out-Of-Pocket Maximum

Employee only $ 6,600 $12,700 $3,800 $7,600

Employee + Child(ren) $ 13,200 $25,400 $7,600 $15,200

Employee + Spouse $ 13,200 $25,400 $7,600 $15,200

Employee + Spouse + Child(ren) $ 13,200 $25,400 $7,600 $15,200


Limited PPO: $100 pharmacy deductible per member

Health BenefitsDifference Between PPOs and HealthSavings CDHP:


Health Benefits

HealthSavings CDHP Pharmacy Benefits

1. You pay the full negotiated cost of prescription drugs up to annual deductible

2. Then you pay coinsurance until the annual out-of-pocket maximum is reached

3. Plan covers 100% of in-network costs after you reach the out-of-pocket maximum

For 90-day chronic maintenance drugs (e.g., hypertension, high cholesterol, etc.) pay coinsurance only – don’t have to meet deductible first when filled through mail order or a Retail-90 network pharmacy.

22

Important Note:Member pays for the medication at the time of purchase. Even at the negotiated or discounted rate, some drugs can be expensive, particularly specialty drugs, so CDHP members may need to know costs and plan for those costs until the deductible is met


Health Benefits

Health Savings Account

Flexible Benefits: There are restrictions with having both a flexible benefits account and a CDHP/HSA plan. Any previous FSA balances must be spent down to $0 by December 31, 2015, to access funds in your HSA to pay for approved medical costs.

HSA is not a “use-it-or-lose-it” account like the FSA

IRS Limits Annual Contributions• Maximum Individual Contribution - $3,350• Maximum Family Contribution - $6,750

At age 55 and older, you can make additional $1,000/year contributions.


Health Benefits PayFlex – Health Savings Account • If you choose to enroll in the HealthSavings CDHP, you will need to

activate your account with PayFlex

• You will register and access your PayFlex HSA online at www.stateoftn.payflexdirect.com

• PayFlex will send you additional information about the account after you enroll

• Once funds are available in your HSA, PayFlex will send you a card to pay for your eligible expenses


Health Benefits

PayFlex – Health Savings Account• Use the PayFlex Card

• Convenient way to pay for eligible expenses• Expenses are paid automatically, as long as funds are available• Keep your receipts for audit purposes

• Pay yourself back• Pay for your eligible medical expenses with cash, check or personal

credit card• Then withdraw funds for your HSA to pay yourself back• Can have your payment deposited directly into your checking or

savings account

• Pay your provider• Use PayFlex’s online feature to pay your provider directly from your

account

• Contribute post-tax dollars from your checking or savings account online25www.partnersforhealthtn.gov

26

CVS/caremark is the pharmacy benefits manager for all plan members• PPOs require a copay for prescription drugs

• HealthSavings CDHP requires members to pay the full negotiated cost of prescription drugs* up to annual deductible, then coinsurance

*For 90-day chronic maintenance drugs (e.g. hypertension; statins to treat high cholesterol; medications for asthma; oral diabetic medications, insulin and diabetic supplies; COPD; depression; etc.) pay coinsurance only – don’t have to meet deductible first

• How much you pay depends on the prescription tier:•Lowest cost: Tier one/generic drug•Higher cost: Tier two/preferred drug•Highest cost: Tier three/non-preferred brand

• More than 67,000 independent and chain pharmacies throughout the U.S.• About 916 Tennessee pharmacies fill 90-day prescriptions in the Retail 90 Network

Pharmacy Benefits


2016 Health Premiums

27

PLAN TYPE COVERAGE LEVEL

TOTAL MONTHLY EMPLOYEE

COST

TOTAL MONTHLY EMPLOYER COST

% OF TOTAL PREMIUM AMOUNT PAID BY

EMPLOYER

TOTAL MONTHLY PREMIUM COST

TOTAL ANNUAL EMPLOYEE COST

TOTAL ANNUAL EMPLOYER COST

Partnership PPO Employee 101.11$ 439.60$ 81.30% 540.71$ 1,213.32$ 5,275.20$

Partnership PPO Employee + Child(ren) 298.88$ 593.30$ 66.50% 892.18$ 3,586.56$ 7,119.60$

Partnership PPO Employee + Spouse 387.67$ 666.72$ 63.23% 1,054.39$ 4,652.04$ 8,000.64$

Partnership PPO Family 580.04$ 825.81$ 58.74% 1,405.85$ 6,960.48$ 9,909.72$

Standard PPO Employee 126.12$ 439.60$ 77.71% 565.71$ 1,513.44$ 5,275.20$

Standard PPO Employee + Child(ren) 323.88$ 593.30$ 64.69% 917.18$ 3,886.56$ 7,119.60$

Standard PPO Employee + Spouse 437.67$ 666.72$ 60.37% 1,104.39$ 5,252.04$ 8,000.64$

Standard PPO Family 630.04$ 825.81$ 56.72% 1,455.85$ 7,560.48$ 9,909.72$

Limited PPO Employee 64.71$ 281.35$ 81.30% 346.06$ 776.52$ 3,376.20$

Limited PPO Employee + Child(ren) 191.28$ 379.72$ 66.50% 571.00$ 2,295.36$ 4,556.64$

Limited PPO Employee + Spouse 248.11$ 426.70$ 63.23% 674.81$ 2,977.32$ 5,120.40$

Limited PPO Family 371.23$ 528.52$ 58.74% 899.75$ 4,454.76$ 6,342.24$

CDHP Employee 60.04$ 261.02$ 81.30% 321.06$ 720.48$ 3,132.24$

CDHP Employee + Child(ren) 177.47$ 352.28$ 66.50% 529.75$ 2,129.64$ 4,227.36$

CDHP Employee + Spouse 230.20$ 395.86$ 63.23% 626.06$ 2,762.40$ 4,750.32$

CDHP Family 344.42$ 490.33$ 58.74% 834.75$ 4,133.04$ 5,883.96$

HEALTH PREMIUMS

28

Let’s Review Medical Changes

Health Insurance Carriers

Available carriers and networks:• BlueCross BlueShield offers Network S • Cigna offers the LocalPlus network (this network has changed)

• Each health insurance carrier has its own network• Be sure to check the networks carefully when making your

decision

• Provider directories are available on the ParTNers for Health website (partnersforhealthtn.gov), or by calling the carrier


29

2016 Partnership Promise

In 2016, Partnership PPO members and covered spouses must:

1. Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2016

2. Complete a biometric health screening by July 15, 20163. Actively participate in coaching if you are called

• Coaching could include a Healthways’ tobacco cessation program and/or case management

4. Update your contact information with your employer if it changes• Spouses must keep contact information current with Healthways


The benefits of the Partnership Promise are open to all plan members. If you think you might be unable to fulfill the Partnership Promise, call our ParTNers for Health Wellness Program at 888.741.3390, and they will work with you and/or your physician, if you wish, to find an alternate way for you to meet the Promise.

30

During annual enrollment, eligible employees can choose between two dental options (if offered by your agency):

• During the enrollment period, eligible employees can enroll in or transfer between the two options

• You will keep your current coverage if you don’t change your current dental option or cancel coverage

Dental Benefits – New Vendors (If offered by your agency)

Cigna Prepaid Plan• Fixed copays

• Participating dentists only

MetLife Dental Preferred Plan• Coinsurance and deductibles

• Any dentist

• Pay less with network providers


NO PROVIDERS IN WEST TN IN NETWORK

31

Dental Benefits – New Vendor

Dental Preferred Provider Organization administered by MetLife

Provides services with coinsurance. Any dentist may be used to receive benefits but you will pay less if an in-network provider is used.• Can use any dentist — receive maximum benefits when visiting an in-network MetLife DPPO

provider. Network is PDP.• Deductible applies for basic, major and out-of-network dental care.• You pay coinsurance for basic, major, orthodontic and out-of-network covered services.• You or your dentist will file claims for covered services.• Some services (e.g., crowns, dentures, implants and complete or partial dentures) require a 6-

month waiting period from member’s effective date before benefits begin.• There is a 12-month waiting period from the member’s effective coverage date on replacement

of a missing tooth and for orthodontics.• Time enrolled in Delta Dental during 2015 will count toward waiting periods in 2016.• Referrals to specialists are not required. Pre-treatment estimates are recommended for services

with significant expense.• Premiums will not increase in 2016.


32

Dental Benefits

2014 Premiums Cigna Prepaid MetLife DPPO

Employee Only $12.61 $21.51

Employee + Child(ren) $26.18 $49.46

Employee + Spouse $22.35 $40.69

Employee + Spouse + Child(ren) $30.73 $79.62

Dental services for both the Prepaid Plan and the DPPO Plan include:

• Periodic oral evaluations • Routine Cleanings • Amalgam fillings

• Endodontics-Root Canal • X-rays • Extractions

• Major restorations • Orthodontics • Dentures


Monthly Premiums for Active Members

33

Vision Benefits

Vision Plan

• Administered by EyeMed Vision Care

• There are two plan options:

• Both plans offer the same services

• Premiums will not increase in 2016


Basic Plan Expanded Plan

Discounted rates Copays

Allowances Allowances

Discounted rates

34

Vision Plan

• Monthly premiums for Active Members

Basic Expanded

Employee Only $3.35 $5.86

Employee + Child(ren) $6.69 $11.72

Employee + Spouse $6.35 $11.14

Employee + Spouse + Child(ren) $9.83 $17.23

Vision Benefits


• EyeMed offers some additional discounts

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 meet the enrollment deadline of October 30, 2015.

Don’t Wait ─ Enroll early! More people will have changes this year so enroll as soon as possible.

You must click “submit” in ESS to finalize your selections by 4:30 p.m. Central on October 30, 2015.

Dependent verification documents must be submitted by October 30 at 4:30 p.m. Central or the dependent will not be enrolled.

• You can’t make changes until the next Annual Enrollment Period – unless you have a qualifying event.

www.partnersforhealthtn.gov 35

36

Using Edison ESS

• To make changes, you must use Employee Self Service (ESS) in Edison

• To use ESS, log on to Edison at https://www.edison.tn.gov

• Instructions on how to use ESS are available in the Decision Guide on page 2 or from your Agency Benefits Coordinator


37

Recommended Browsers You will probably not be able to complete your benefits enrollment selections if you use

the following browser or devices: Chrome Any mobile devices:

iPads iPhones Android Phones Android Tablets Windows Phones Windows Tablets

When you use Employee Self Service (ESS) in Edison to add or make changes in your benefits, Internet Explorer 9.0 and 10.0, are your best recommended choices.

Local Ed employees can call the Password Reset Call Center for help: Password Reset Call Center Helpline: 844.330.9100 Hours of Operation: 8:00 a.m. – 4:30 p.m. Central


Member Communications

www.partnersforhealthtn.gov 38

Current eligible employees will receive a copy of the 2016 Decision Guide prior to the

enrollment period.

What is ALEX?

ALEX is a smart, funny benefits expert who explains benefits options and may help members choose what’s best for them.

Go to www.partnersforhealthtn.gov

39

40

Who to Contact

• Primary point of contact - Agency Benefits Coordinator, Tiffany Latta ([email protected]) 642-9733

• Questions about a provider or claim – contact your insurance carrier

• Questions about eligibility and enrollment – call Benefits Administration Service Center at 800.253.9981, Monday – Friday, 8:00 a.m. to 4:30 p.m. Central

• ParTNers for Health website – www.partnersforhealthtn.gov

• Handbook publications and forms – http://tn.gov/finance/topic/fa-benefits-publicationsforms

• ALEX – your decision support tool found on the ParTNers for Health website


mailto:[email protected]

http://www.partnersforhealthtn.gov/

http://tn.gov/finance/topic/fa-benefits-publicationsforms

41

Questions?

Documents

State of Tennessee Group Insurance Program Local Education Annual Enrollment Period October 1 – October 30, 2015 Enrollment ends at 4:30 p.m. Central