Full-time employees or employees (75%+) may enroll in health coverage through the state group insurance program. Enrollment in health insurance must be made within the first 31 days of employment. Coverage becomes effective on the first day of the month following the completion of one full calendar month of employment if all applicable forms are completed. State Group Health Insurance also includes basic term life and basic accidental death insurance. New employees will complete insurance forms during new hire orientation.
- Employees who do not enroll in a health insurance plan during the first 31 days of
employment may apply for health coverage if they experience a Special Qualifying Event.
(see pg. 3 of the Health/Dental/Vision Enrollment Forms ) Application for enrollment must be made within 60 days of the loss of insurance
coverage or within 60 days of a new dependent’s acquire date.
- Available Health Insurance Options include the Partnership PPO (Promise or the No Promise), the Standard PPO, the Health Savings CDHP (Promise or the No Promise), and the Health Savings CDHP. All options covers the same type of services, treatments and products.
- You can cancel medical or dental coverage outside of the Annual Enrollment period if you and/or your dependent(s) become newly eligible for coverage under another plan (proof is required and only the individual or individuals who become newly eligible for other coverage may cancel).
- If enrolled in the prepaid dental option and there is no participating general dentist within a 40-mile radius of your home.
- You have 60 days from the date that you and/or your dependent(s) become newly eligible for coverage to submit documentation. An insurance cancel request application must be submitted along with the required documentation.
Partnership PPO and Standard PPO
- Pay less in copays and coinsurance with the Partnership PPO versus the Standard PPO
- Pay deductible first before coinsurance applies
- The medical and pharmacy out-of-pocket maximums will be combined.
- Pay for prescriptions with copays
- When out-of-pocket maximum reached the plan pays 100% for in-network services
- Higher monthly premiums but a lower deductible.
Health Savings CDHPs
- Lower monthly premiums but a higher deductible.
- A tax-free Health Savings Account – which you own.
- Must meet your deductible before the plan starts paying for covered expenses.
- No separate deductible or out-of-pocket maximum for pharmacy.
- Coinsurance after you meet your deductible.
- Lower total out-of-pocket maximum compared to PPOs
Employees can refer to the Comparison Chart for the plans deductibles, co-pays, co-insurance, and out-of-pocket maximum amounts.
No Partnership Promise
- This option does not include the Partnership Promise
- You pay a higher premium but will receive the same services as the Partnership Plan.
Partnership Promise Requirements
Individuals who select the Partnership PPO (Promise Plan) or the Health Savings CDHP (Promise Plan) must commit to the Partnership Promise each year.
The Partnership Promise requires all employees and covered spouses to:
- Complete the online Healthways Well-Being Assessment™ (WBA) by March 15, 2017 (Dependent children ARE NOT required to complete a Well Being Assessment.)
- Complete a biometric health screening by July 15, 2017
- Actively participate in coaching if you are called. Coaching could include a tobacco cessation program and/or case management, which is managed by BlueCross BlueShield, Cigna and Magellan.
- Keep your contact information current with your employer; or, if a covered spouse, keep your contact information current with Healthways, if it changes.
New Employees and New Covered Employees or Spouses
- Must complete the online Healthways Well-Being Assessment™ (WBA) and the get a biometric health screening within 120 days of your insurance coverage effective date.
You may review the following web link: http://partnersforhealthtn.gov/promise.shtml to review more details regarding the Partnership Promise.
Health Savings Account (HSA)
If you enroll in the Promise Health Savings CDHP, which includes the Partnership Promise, the state will put $500 for employee coverage or $1,000 for family coverage into your Health Savings Account.
The No Promise Health Savings CDHP does not include the Partnership Promise and no funds will be contributed from the state. However, employees may fund the Health Savings Account.
- A tax-free savings account that you can use to pay for your deductible and coinsurance expenses.
- The banking vendor who helps administer your Health Savings Account is PayFlex
- The money in the HSA is your money. The balance rolls over at the end of the year. As long as you use it for Eligible Medical Expenses, it will be tax free.
- You can have additional funds deducted pretax from your payroll check and deposited into your Health Savings Account. (Form)
Employees can refer to the comparison chart for the plans' deductibles, co-pays, co-insurance, and out-of-pocket maximum amounts.
Flexible Spending Account (LPFSA)
- Employees that are enrolled in the HealthSavings CDHP Plan, can use the limited purpose FSA to pay for certain dental and vision cost not covered by insurance.
- Contribute pretax dollars from your paycheck, up to the Internal Revenue Service (IRS) limit of $2,550.
- Your full contribution is available at the start of the plan year.
- Eligible expenses may include: Dental and orthodontia care, like fillings, X-rays and braces, vision care, including eyeglasses, contact lenses and LASIK laser eye surgery.
Health Insurance Carriers Information
Plans are administered by BlueCross BlueShield of Tennessee(Network S), Cigna(Local Plus Network), and Cigna (Open Access Plus).
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