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State of Tennessee Group Insurance Program Annual Enrollment Period

State of Tennessee Group Insurance Program Annual Enrollment Period October 1 – November 1, 2014. Annual Enrollment Period Using ESS in Edison What’ s Changing for 2015 Health Benefits Overview 2015 Partnership Promise Dental, Vision and Additional Benefits Overview. Agenda.

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State of Tennessee Group Insurance Program Annual Enrollment Period

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  1. State of Tennessee Group Insurance ProgramAnnual Enrollment Period October 1 – November 1, 2014

  2. Annual Enrollment Period Using ESS in Edison What’s Changing for 2015 Health Benefits Overview 2015 Partnership Promise Dental, Vision and Additional Benefits Overview Agenda www.partnersforhealthtn.gov

  3. Open Enrollment: October 1 – November 1, 2014 Annual Enrollment Period (AEP) is an open enrollment for most programs Employees can make the following changes: Choose or switch PPOs (subject to eligibility) Select or change your health insurance carrier Enroll, cancel or make changes to health insurance Enroll in, cancel or transfer between dental options Enroll in, cancel or transfer between vision coverage State/Higher Ed only: Enroll in or cancel optional accidental death coverage Apply for, cancel, increase or decrease optional term life coverage amounts (if eligible) Annual Enrollment Period www.partnersforhealthtn.gov

  4. If you DO NOT want to make changes No action is required during annual enrollment If you stay in the Partnership PPO, you (and your covered spouse) are agreeing to fulfill the 2015 Partnership Promise If you DO want to make changes to have TCS Combo Plan You must use Employee Self Service (ESS) in Edison Benefits Administration will not accept paper forms (exception for Local Gov with fewer than 100 employees) State/Higher Ed: Use the Minnesota Life website for optional term life insurance Annual Enrollment Period www.partnersforhealthtn.gov

  5. Changes take effect on January 1, 2015 Selections remain in effect through December 31, 2015, 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 Contact your Agency Benefits Coordinator if you experience a qualifying event Annual Enrollment Period www.partnersforhealthtn.gov

  6. Using Edison ESS • To make changes and have the TCS Combo Plan with the Limited PPO and Colonial Medical Gap Plan, you must use Employee Self Service (ESS) in Edison • To use ESS, log on to Edison at www.edison.tn.gov • Instructions on how to use ESS are available in the Decision Guide or from your Agency Benefits Coordinator. Your access information should be mailed to your home address in September. www.partnersforhealthtn.gov

  7. Using Edison ESS • State and Higher Ed: • Designating Life Insurance Beneficiaries: • You can now designate beneficiaries in Edison for Basic Term Life, AD&D and Optional AD&D • If submitting changes during annual enrollment, the beneficiary page will display after submitting changes • To add beneficiaries through the main menu select ESS, Benefits, Dependents and Beneficiaries and Life Insurance Beneficiaries • State only: You must also use ESS to enroll in Flexible Benefits by November 1, 2014 Not Applicable to TCS www.partnersforhealthtn.gov

  8. Health Insurance Changes Health insurance premiums will not increase in 2015. Single medical out-of-pocket maximum for the Standard and Partnership PPOs – the medical copay and medical coinsurance are now combined. Out-of-pocket maximums for medical and pharmacy are changing for all PPOs. Your total in-network out-of-pocket maximum will be less in 2015. Local Ed and Local Gov: For the Limited PPO, the in-network pharmacy and medical out-of-pocket maximums are combined into a single out-of-pocket maximum. What’s Changing for 2015 www.partnersforhealthtn.gov

  9. What’s Changing for 2015 • Dental and Vision plan changes (if offered by your agency) • Dental insurance premiums will increase by 2.1% for both plans • Vision insurance premiums will increase by approximately 2.4% Not Applicable for TCS www.partnersforhealthtn.gov

  10. What’s Changing for 2015 • 2015 Partnership Promise Requirement Changes • In 2015, everyPartnership PPO plan member must complete these requirements as a part of the Partnership Promise: • Complete the online Well-Being Assessment(WBA) between January 1 and March 15, 2015 • If you are called, actively participate in health coaching: • If called for health coaching, you must get a biometric screening by July 15, 2015 • Health coaching could include a tobacco cessation program or case management • Keep your contact information current with your employer • Covered spouses – keep contact information current with Healthways www.partnersforhealthtn.gov

  11. Health Benefits Your Health Insurance Options You have these health insurance options    Preferred Provider Organization (PPO) Options • Partnership PPO • Standard PPO • Limited PPO (Local Education and Local Government) Two Insurance Carriers • BlueCross BlueShield of Tennessee • Cigna Four Premium Levels (tiers) • Employee • Employee + child(ren) • Employee + spouse • Employee + spouse + child(ren) www.partnersforhealthtn.gov

  12. Health Benefits • PPOs cover the same services, treatments and products: • In-network preventive care, x-rays, lab and diagnostics at no cost • Free preventive health services (must visit an in-network provider) • Fixed copays for some services • Different medical criteria may apply based on carriers • PPOsoffer: • Deductibles and co-insurance for certain services • Out-of-pocket maximums to limit costs Carriersmay offer discounts for services not covered. Refer to the carrier’s member handbooks or websites for more information. www.partnersforhealthtn.gov

  13. Limited PPO available to Local Ed and Local Gov About the Limited PPO: Same benefits and services as the other PPOs, but the premiums and out-of-pocket costs are different Monthly premiums are lower – out-of-pocket costs for medical and pharmacy expenses are higher Copays are higher than the other PPOs Deductible is higher than the other PPOs Coinsurance is higher than the other PPOs Pharmacy deductible of $100 before benefits begin Health BenefitsLocal Ed and Local Gov www.partnersforhealthtn.gov

  14. BlueCross BlueShield (BCBST) and Cigna each have their own network Both carriers have made changes to their networks for 2015 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 Available Networks: BlueCross BlueShield offers Network S Cigna offers Open Access Plus (statewide) or LocalPlus Network (middle Tennessee eligible individuals only) Health Benefits www.partnersforhealthtn.gov

  15. In Middle Tennessee (only): If you select Cigna as your insurance carrier, you can choose between two different Cigna options: Cigna Open Access Plus or Cigna LocalPlus Cigna Open Access Plus costs more in Middle Tennessee than Cigna LocalPlus, but Cigna LocalPlus has a narrower (or smaller) network With Cigna LocalPlus, certain hospital systems are not included. Check the network carefully before making this choice Cigna LocalPlus premiums are the same as BlueCross BlueShield of Tennessee in Middle Tennessee Health Benefits www.partnersforhealthtn.gov

  16. Carrier costs vary by your region In East and Middle Tennessee: Cigna Open Access costs $20 more per month for employee only coverage and $40 more per month for all other tiers (coverage levels) In Middle Tennessee (only): Cigna LocalPlus costs the same as BCBST. Cigna Open Access Plus costs more than BCBST and Cigna LocalPlus In West Tennessee: BlueCross BlueShield costs $20 more per month for employee only coverage and $40 more per month for all other premium tiers Health Benefits www.partnersforhealthtn.gov

  17. ParTNers for Health Wellness Program The ParTNers for Health Wellness Program is FREE to all health insurance plan members, eligible spouses and dependents Wellness Resources: Health coaching – call Healthways and get support from a health coach Well-Being Assessment (WBA) – online questionnaire Nurse advice line – medical information and support at no cost to you Wellness challenges - a fun way to help develop a healthier lifestyle with group support Weight Watchers at Work discounts and Fitness Center discounts Additional wellness and fitness discounts through the EAPprogram and our carriers BCBST and Cigna Additional Health Resources www.partnersforhealthtn.gov

  18. Pharmacy Benefits • PharmacyBenefits • CVS/caremark is the pharmacy benefits manager for all plan members • PPOs require a copay for prescription drugs • 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 Tobacco Cessation: The state’s prescription drug coverage provides free tobacco quit aids to members who want to stop using tobacco products. www.partnersforhealthtn.gov

  19. Behavioral Health and Employee Assistance Program (EAP) Both are included for everyone with medical benefits in all plans Not an optional or additional benefit – provided for all with medical benefits State and Higher Ed: You and your dependents receive EAP benefits even if you do not participate in the State Group Insurance Program. Local Ed and Local Gov: If you are enrolled in health benefits, you receive EAP benefits. Your eligible dependents do not have to be enrolled in health benefits to receive EAP benefits. Behavioral Health Benefits and Employee Assistance Program www.partnersforhealthtn.gov

  20. Employee Assistance Program (EAP) All services are confidential and available at no cost to members 24/7 You and your eligible dependents may get up to five, no cost counseling sessions per problem episode, per year Just a few issues EAP can help with: Contact ParTNers EAP: Toll Free 24/7 at 1.855.HERE4TN (1.855.437.3486) Or at www.Here4TN.com Employee Assistance Program (EAP) www.partnersforhealthtn.gov

  21. Behavioral Health and Substance Abuse Treatment Members of the State Group Health Insurance Plan and their dependents enrolled in health coverage have behavioral health and substance abuse treatment benefits through Magellan. • Call 1.855.HERE.4.TN (1.855.437.3486 ) or www.HERE4TN.com • Outpatient assessment and treatment • Inpatient assessment and treatment • Alternative care such as partial hospitalization, residential treatment and intensive outpatient treatment • Treatment follow-up and aftercare www.partnersforhealthtn.gov 20

  22. 2015 Deductibles and Out-of-Pocket Co-insurance Maximums www.partnersforhealthtn.gov

  23. 2015 Limited PPO Deductible and Out-of-Pocket Maximum Local Government and Local Education Only www.partnersforhealthtn.gov

  24. Premiums for 2015: State and Higher Education Employee Share of Monthly Premiums • Premiums shown are for active employees and 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 State and Higher Education employees. www.partnersforhealthtn.gov

  25. Premiums for 2015: Local Education Total Monthly Premiums • Premiums shown are for active employees and the least expensive carrier in the region. A complete chart is available in the Decision Guide and on the ParTNers for Health website. www.partnersforhealthtn.gov

  26. Premiums for 2015: Local Government Total Monthly Premiums • Premiums shown are for active employees and the least expensive carrier in the region for Premium Level 1. A complete chart is available in the Decision Guide and on the ParTNers for Health website. The State does not pay any premiums for Local Government Plan employees. However, some Local Government employers may pay a portion. www.partnersforhealthtn.gov

  27. The State Group Insurance Program determines the Partnership Promise requirements and Healthways administers the Partnership Promise Partnership PPO members save money on premiums and out-of-pocket costs versus the Standard PPO Members and enrolled spouses must complete the Partnership Promise each year 2015 Partnership Promise On average, an employee with no dependents can save $506 on premiums and out-of-pocket costs through the Partnership PPO instead of the Standard PPO. An employee with a covered spouse and dependents can save $1,041 on average. Estimated savings are based on a full year of health insurance premiums and average out-of-pocket costs. www.partnersforhealthtn.gov

  28. In 2015, Partnership PPO members and covered spouses must: Complete the online Healthways Well-Being Assessment™ (health questionnaire) between January 1 and March 15, 2015 Actively participate in health coaching if you are called If called for coaching, you must complete a biometric screening by July 15, 2015 Health coaching could include a Healthways’ tobacco cessation program and/or case management Update your contact information with your employer if it changes 2015 Partnership Promise www.partnersforhealthtn.gov

  29. Required Online Well-Being Assessment (WBA) Summarizes your overall health and offers steps you can take to improve The Well-Being Assessment must be completed between January 1 and March 15, 2015 To complete the assessment, visit partnersforhealthtn.govand click on the “My Wellness Tab” Note: A person who knowingly provides false information to maintain Partnership PPO benefits may be moved to the Standard PPO plan. The State Group Insurance Plans have the right to recover the cost of benefits from any member who received these benefits through false information. 2015 Partnership Promise www.partnersforhealthtn.gov

  30. 2015 Partnership Promise • Health Coaching • Members and spouses who are called by Healthways to coach must fully participate • If called for coaching, you • must complete a biometric • screening by July 15, 2015. • Coaching could include • a tobacco cessation program • and/or case management which is • administered by our carriers BlueCross • BlueShield, Cigna and Magellan. Healthways hours of operation: Monday – Friday 8:00 a.m. to 8:00 p.m. CT Coaches are also available on Saturday: 8:00 a.m. to 6:30 p.m. CT www.partnersforhealthtn.gov

  31. 2015 Partnership Promise • Health Coaching • Coaching programs include: • Lifestyle management • Disease management • Tobacco cessation • Case management • Coaches include licensed registered nurses, licensed dieticians and those with degrees in exercise physiology, exercise science, health promotion and psychology. All calls with your health coach are private. • Case management is administered by BlueCross BlueShield, Cigna and Magellan. www.partnersforhealthtn.gov

  32. Biometric Screening Any newmembers and members who are called for health coaching must complete a biometric health screening by July 15, 2015. Members can get this screening from your healthcare provider. Biometric screenings include height, weight, blood pressure and waist circumference. A sample of your blood is collected to determine blood sugar and cholesterol levels. Visit the Quick Links box on the ParTNers for Health website to print a Physician Screening Form (PSF). Take the form with you when you visit your doctor. You and your doctor must complete and sign the form. Send the form by fax or mail to the address on the form 2015 Partnership Promise www.partnersforhealthtn.gov

  33. Tobacco Cessation Partnership PPO members who use tobacco must participate in and complete a Healthways’ tobacco cessation program andwork toward quitting tobacco. Partnership PPO members who use tobacco products must answer “yes” to the question “are you a tobacco user” when completing the required online Well-Being Assessment (WBA). When you confirm you are a tobacco user, Healthways will reach out to you to enroll in a program. You are not required to quit by the end of 2015 – just participate and try to quit. 2015 Partnership Promise www.partnersforhealthtn.gov

  34. Updating Contact Information Phone number, mailing address and email address, if you have one, must be kept current with your employer. If your information changes during the year, you must notify your employer to update your record. Covered spouses must keep contact information current with Healthways. 2015 Partnership Promise www.partnersforhealthtn.gov

  35. Dental Benefits Local Ed and Local Gov: If offered by your agency During annual enrollment, eligible employees can choose between two dental options: • 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 carrier or cancel coverage AssurantPrepaid Plan • Fixed copays • Participating dentists only Delta Dental PDO Plan • Coinsurance and deductibles • Any dentist • Pay less with network providers Not Applicable to TCS www.partnersforhealthtn.gov

  36. Prepaid Plan Administered by Assurant Employee Benefits The Prepaid plan provides services at predetermined copay amounts from a limited network of participating dentists and specialists. You must select a dentist from the Prepaid Plan list and notify Assurant There are some areas in the state where network dentists are not available You must use your selected dentist to receive benefits Services are provided at predetermined member copay amount No deductible, no claims and no waiting period Referrals are not required In 2015, premiums will increase by 2.1% Dental BenefitsLocal Ed and Local Gov: If offered by your agency Not Applicable to TCS www.partnersforhealthtn.gov

  37. Delta Dental Preferred Dental Organization (PDO) Plan The PDO plan provides services with member coinsurance rates. Choose any dentist (maximum benefits when visiting an in-network Delta Dental PPO provider) You pay co-insurance for covered services A deductible applies for out-of-network dental care only You or your dentist will file claims for covered services Referrals are not required Some services require a 12-month waiting period There are some limitations and exclusions In 2015, premiums will increase by 2.1% Dental Benefits Not Applicable to TCS www.partnersforhealthtn.gov

  38. Dental Benefits Monthly Premiums for Active Members Dental services for both the Prepaid Plan and the Dental PDO include: www.partnersforhealthtn.gov

  39. Vision Plan Administered by EyeMed Vision Care Available to employees at participating agencies There are two plan options: Both plans offer the same services In 2015, premiums will be approximately 2.4 % higher for both plans Vision BenefitsLocal Ed and Local Gov: If offered by your agency www.partnersforhealthtn.gov

  40. Vision Benefits • Vision Plan • Monthly premiums for Active Members Not Applicable to TCS • EyeMed offers some additional discounts www.partnersforhealthtn.gov

  41. Additional Benefits Basic Term Life / Accidental Death Insurance State and Higher Education Only • 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 Not Applicable to TCS Local Education Plan and Local Government Plan members should check with their Agency Benefits Coordinator to see if accident and life insurance is offered by their agency. www.partnersforhealthtn.gov

  42. Additional Benefits • Optional Accidental Death & Dismemberment Insurance • State and Higher Education Only • Additional accident protection for yourself and your dependents • Coverage is available at low group rates—no questions asked • Premiums vary by salary • The maximum benefit available to employees is $60,000 • Members can enroll through ESS Not Applicable to TCS www.partnersforhealthtn.gov

  43. Optional Term Life Insurance State and Higher Education Only If you qualify, you may be able to purchase optional coverage from Minnesota Life for yourself and your dependent spouse and children. If you are currently enrolled and are eligible for employee guaranteed issue increase, information will be mailed to you. If you and/or your dependent spouse are not presently enrolled, you will be required to present evidence of insurability through a health questionnaire. Enroll through the Minnesota Life website at lifebenefits.com/stateoftn Additional Benefits Not Applicable to TCS www.partnersforhealthtn.gov

  44. Long-Term Care Insurance Your agency must choose to participate (Local Ed and Local Gov) Who is eligible? Qualified employees Eligible dependents Covers services for individuals who are no longer able to care for themselves Nursing home care Assisted living Home healthcare Additional Benefits Not Applicable to TCS • Retirees • Parents and parents-in-law • Home care • Adult day care Apply for coverage at any time through medical underwriting. www.partnersforhealthtn.gov

  45. Long-Term Care Insurance Benefits available for different daily benefit amounts ($100, $150 or $200) for either three- year or five-year coverage Available with or without inflation protection You pay 100 percent of the premium Premiums are based on age at the time of enrollment Choose to have the premium taken from your payroll check or opt for a direct bill arrangement with MedAmerica Additional Benefits Not Applicable to TCS Long-Term Care Insurance is administered by MedAmerica www.partnersforhealthtn.gov

  46. Flexible Benefits – State Only Designed to lower your taxes You can be reimbursed for certain expenses from your pre-tax income by enrolling in one of the following reimbursement accounts: Medical expenses Dependent care expenses Parking expenses Transportation expenses You must sign up between October 1 – November 1, 2014 No enrollments can be made after November 1, 2014 Additional Benefits Not Applicable to TCS Flexible Benefits are administered by the Department of Treasury. Visit www.treasury.tn.gov/flex for more information www.partnersforhealthtn.gov

  47. Employee Sick Leave Bank – State Only Administered by Tennessee Department of Human Resources Provides sick leave to qualifying members A member may receive a maximum of 90 days from the Bank Open enrollment is August 1 – October 31 each year Must be a full-time state employee for 12 consecutive months and have at least six days of sick leave by November 1 of your enrollment year Must contribute four sick leave days to enroll Additional Benefits Not Applicable to TCS For more information or to enroll, visit www.tn.gov/dohr/ and click on the “For Employees” link. www.partnersforhealthtn.gov

  48. Deferred Compensation Plan– State Only State employees are eligible to participate in two optional, tax-deferred retirement savings plans operated by the State: a 457 plan and a 401(k) plan Deferred Compensation program is part of the Tennessee Treasury department If you choose to participate, you make contributions through regular payroll deductions Depending on the percentage of salary, the state contributes a maximum of $50 per month to a 401(k) plan Refer to the participant guide on the Treasury’s website Additional Benefits Not Applicable to TCS Great West is the chosen record-keeper. www.partnersforhealthtn.gov

  49. If you do not want to make changes, no action is required. If you do want to make changes to the TCS Combo Plan or add coverage, you must use ESS and meet the enrollment deadline of November 1, 2014. Access information to be mailed to home. Don’t Wait ─ Enroll early! You must click “submit” in ESS to finalize your selections by 11:59 p.m. CT on November 1, 2014. No changes until the next Annual Enrollment Period Take Note! www.partnersforhealthtn.gov

  50. Member Communications Current eligible employees received a copy of the 2015 Decision Guide at their homes in mid-September. www.partnersforhealthtn.gov

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