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PPACA
Documents
- PPACA Update - Local Education and Local Government
- Minimum Value Certification
- Information Sheet (State Only)
- Full to Part Time Changes (State Only)
- Local Government Required Federal Marketplace Notice
- Local Education Required Federal Marketplace Notice
Frequently Asked Questions (FAQs)
- ? I have an employee that was full-time but has now reduced their hours to part-time. They are still eligible for insurance due to PPACA. Can they make changes to their coverage due to this status change?
- State Required Federal Marketplace Notice
- Can I get insurance through the Marketplace?
- What is the Health Insurance Marketplace?
- If I drop my health coverage, am I subject to the healthcare reform law’s penalty?
- Do the ParTNers for Health plans meet the healthcare reform law’s minimum value requirements?
State New Hire Documentation for ABCs
Documentation
Agency Benefits Coordinators (ABCs)
HSA/CDHP Questions
- HSA Employer ID
- If an agency has started payroll deductions for an employee, but PayFlex is not able to open the employee’s account during the Customer Identification Process (CIP), will the agency be responsible for refunding the employee’s deductions?
- Is there a minimum amount that employees must contribute?
- If a member has a medical expense early in the year but does not have enough money available to pay for it in his or her HSA, can he or she save that receipt and turn it in later on?
- How can an employee determine the cost of a service in order to compare expected coinsurance amounts to copays?
- When an employee reaches the age of 55, is the extra contribution allowed at the beginning of the tax year, not just after the employee turns 55?
Frequently Asked Questions (FAQ)
- Local Government Probationary Period vs Eligibility Period
- Appeals and Administrative Error Letters
- Late Terminations
- Where do I get information for my Form 5500 Schedule A reporting?
- How do I run a PPACA report to assist my agency in completing the 1094 and 1095 form?
- What is a Proof of Joint Ownership document?
COBRA
Frequently Asked Questions (FAQ)
- COBRA And Divorce
- Adding dependents while on COBRA
- Can COBRA be used outside the state of Tennessee?
- Can I pay the COBRA premium with a debit or credit card?
- What if the employee (my spouse/parent) becomes entitled to Medicare within 18 months prior to termination of employment?
- What is the longest amount of time I can be enrolled in COBRA?
Retirees
General
The Tennessee Plan Medicare Supplement
- How do I cancel coverage in The Tennessee Plan (Medicare supplement)?
- How much will my premium be for coverage in The Tennessee Plan (Medicare supplement)?
- I would like information about The Tennessee Plan (Medicare supplement).
- Am I eligible for The Tennessee Plan (Medicare supplement)?
- Is my spouse eligible for the Medicare supplement plan?
Vision for Retirees
- I am receiving a monthly TCRS pension or I am a higher education ORP retiree and I am continuing single coverage on the retiree group health plan, can I enroll in retiree plus spouse coverage on the vision plan?
- I am continuing spouse only coverage on the retiree group health plan. Can I enroll my spouse on the retiree vision plan?
- I am over 65 and enrolled on the Tennessee Plan Medicare supplement. Am I eligible to enroll in coverage on the retiree vision plan?
Dental for Retirees
- Who do I call if I have specific questions about my dental benefit?
- Can I cancel retiree dental coverage if I change my mind?
- What if I recently retired and now have COBRA dental coverage?
- If I live out of state, can I still enroll in dental coverage?
- How will the state deduct my dental premiums?
- My old school system provides other dental coverage. Can I still apply for state-sponsored dental coverage?
Local Government Retiree Group Health
- Can I change my health insurance carrier when I continue coverage at retirement?
- If I do not continue group health coverage when I retire because I will have coverage through my spouse , can I apply for coverage later?
- If I become eligible for Medicare prior to the age of 65, will my insurance be terminated?
- If I am Medicare eligible when I retire, can I still continue to cover a spouse who is not yet Medicare eligible?
Local Education Retiree Group Health
- Can I change my health insurance carrier when I continue coverage at retirement?
- If I do not continue group health coverage when I retire because I will have coverage through my spouse, can I apply for coverage later?
- If I become eligible for Medicare prior to the age of 65, will my insurance be terminated?
- If I am Medicare eligible when I retire, can I still continue to cover a spouse who is not yet Medicare eligible?
Higher Education (UT/TBR) Retiree Group Health
- Can I change my health insurance carrier when I continue coverage at retirement?
- If I do not continue group health coverage when I retire because I will have coverage through my spouse, can I apply for coverage later?
- If I become eligible for Medicare prior to the age of 65, will my insurance be terminated?
- If I am Medicare eligible when I retire, can I still continue to cover a spouse who is not yet Medicare eligible?
State Retiree Group Health
- Can I change my health insurance carrier when I continue coverage at retirement?
- If I do not continue group health coverage when I retire because I will have coverage through my spouse, can I apply for coverage later?
- If I become eligible for Medicare prior to the age of 65, will my insurance be terminated?
- If I am Medicare eligible when I retire, can I still continue to cover a spouse who is not yet Medicare eligible?
Active Employees
Deferred Compensation
- ? I am enrolled in the Hybrid 401k plan, but I should be enrolled in regular 401k. How can this be corrected?
- I recently had a change in job status (examples: rehired, transferred from one agency to another, or returned from a leave of absence). How is my 401k deferral affected?
- Why is there a 2% 401k deduction on my paycheck? I never enrolled in 401k.
- I recently made a change to my 401k (or 457) contribution amount, when will it be updated in Edison?
- I am a 120-day retiree. Am I eligible to enroll in 401k?
- My 401k loan has been paid off, but deductions are still being deducted from my paycheck. How can this be corrected?
Flexible Benefits
- ? FAQ regarding maximum limits on healthcare FSA and limited purpose FSA’s for 2017
- I entered the hospital December 12, but my child was not born until December 14. Are my hospital expenses prior to my child’s birth eligible for Flex reimbursement?
- When will my remaining Transportation or Parking Funds rollover to the next plan year?
- Can I open a Transportation FSA for UBER or TAXI services?
- 2017 Flex Benefits FAQs
- My husband and I are both State employees, and we both enrolled in Flex Medical. Can both Flex plans cover medications for my husband?
Frequently Asked Questions (FAQ)
- ? Higher Education Online Enrollment Guide
- Why is my Social Security Number provided to the medical, dental, and vision insurance carriers and providers?
- Recently, I’ve had an employee who has changed employment status from full-time to part-time. Would this be a special qualifying event that would allow the employee to make coverage changes?
- Enroll now in your benefits!
- I was hired in the last few months and obtained health insurance, and just received a Partnership Promise transfer letter. Was this letter sent in error?
- What qualifies as a Special Qualifying Event?
General
Announcements
- For general information about EAP including services and behavioral health information, visit the EAP page (http://partnersforhealthtn.gov/behavioral_health.shtml) or www.Here4TN.com.
- For general information about carrier information including provider directories and premiums costs, visit the Carrier Information page. (http://partnersforhealthtn.gov/hlth_carrier_information.shtml)
- When looking at the HealthSavings CDHP and the HSA, it is best to consult a tax professional regarding your personal finances and the impact on our federal income taxes.
- For general information about pharmacy including finding a network pharmacy, flu and pneumococcal vaccine and tobacco quit aids, visit the Pharmacy page http://partnersforhealthtn.gov/pharmacy.shtml
- If you are looking for information about the Partnership Promise requirements and deadlines, visit our Partnership Promise website (http://www.partnersforhealthtn.gov/promise.shtml)
- If you are looking for enrollment and eligibility information, visit our publications page http://tn.gov/finance/article/fa-benefits-publications to find the eligibility and enrollment guide and plan documents.
Terms and Definitions
Payflex
- HSA Debit Card
- HSA Retail Account
- When will I receive my Form 5498?
- Debit Card Wait Time
- FSA Beneficiary
- PayFlex Address Correction
Flexible Spending Account (FSA)
- ? Is there a list of FSA exclusions?
- ? Can Flex Medical be carried over from year to year?
- FSA – Carry Over to Next Plan Year
- How do you access your FSA funds?
- How do you register your PayFlex FSA online?
- Which types of FSA come with a debit card?
Life Insurance - State and Higher Education Only
- May I continue my voluntary term life insurance when I retire or terminate employment?
- Basic Life/AD&D - How do I designate a beneficiary or see who I have named as a beneficiary?
- Voluntary Universal Life Insurance
- Voluntary Accidental Death and Dismemberment (AD&D) Insurance
- What option do I have for voluntary term life if I am rehired?
- May a spouse, who is also a state or higher education employee, enroll as an employee and as a dependent of the other spouse?
Voluntary Long-Term Care Insurance
- How do I get more information on enrolling in long-term care insurance?
- When can I enroll in the long-term care insurance plan?
- What are the eligibility requirements for a retiree to enroll in long-term care insurance?
- Who is eligible to enroll in the state’s long-term care insurance plan?
- For general information about long-term care insurance, visit the Long-Term Care Insurance page. (http://partnersforhealthtn.gov/long_term_care.shtml)
Voluntary Dental
- How can I find out how much a procedure will cost under my MetLife DPPO plan?
- How do I find a network dentist in the MetLife network?
- What if I am out of the area and need emergency care? Will Cigna Prepaid Dental cover some or all of the services?
- How do I find a Cigna Prepaid Dental network dentist?
- Do I have to select a primary dentist in the Cigna Prepaid Dental plan? Can I change my dentist?
- What happens if my dentist leaves Cigna’s dental network?
Voluntary Vision
- If I work for a Tennessee Board of Regents (TBR) institution can I enroll in the state EyeMed Vision Program?
- The Tennessee Board of Regents’ (TBR) separate vision plan with VSP will terminate as of January 1, 2017.
- Who is eligible to enroll in the state EyeMed vision plan?
- Can I use a portion of my allowance during the calendar year and then use the remaining balance during that same calendar year?
- Can I get a discount on additional replacement contact lenses?
- Who should I contact if I have trouble logging into the EyeMed member website?
ParTNers Employee Assistance Program (EAP)
- If I am contacted by Optum for case management, what do I need to do to fulfill my Partnership Promise?
- Is preauthorization required for outpatient behavioral health?
- What happens if I utilize all of my available EAP sessions, but would like to continue seeing my provider?
- How many sessions do I have through the EAP?
BlueCross BlueShield & Cigna
- What network options are offered by the State of Tennessee?
- What happens when I go to a provider outside LocalPlus but within other Cigna networks?
- Is the plan design any different for the Cigna LocalPlus, Cigna Open Access Plus or the BCBS Network S?
- What is the Informed Choice Outreach Program offered by Cigna?
- If I live in the east region, does that mean I can only go to doctors in that region?
- What do I do if I have a question regarding my insurance claims?
Other Covered Services
- What happens if I have several covered medical expenses within the same year? Will I have to keep paying part of the cost?
- How is durable medical equipment (DME) covered?
- How is chemotherapy covered?
- How are maternity benefits covered?
- Does dialysis require a copay or coinsurance?
- Do advanced imaging and outpatient surgery require a copay or coinsurance?
Pharmacy
- Help! My specialty prescription has gone way up in cost (even to $150). What is going on?
- My pharmacy said my doctor needs to request prior authorization to refill my prescription. How do I do this?
- I would like to appeal my prescription drug benefits paid with Caremark. What should I do?
- There is a quantity limit on my prescription drug; however, my doctor says I need an amount higher than the limit. What do I do?
- I tried to get a prescription filled but my claim was denied because the medication is now available over the counter. Does this mean my pharmacy benefits are becoming more limited?
- What if I take a drug that is not on the Caremark drug list?
HealthSavings CDHP
- ? HSA Account Funds Deposit and FSA Previous Year Balance
- ? I am an active employee enrolled in CDHP, what actions do I take to stay enrolled for next year?
- ? Can I change from the HealthSavings CDHP to one of the PPO options next year and then rejoin the HealthSavings CDHP the following year?
- ? Who is eligible for the HealthSavings CDHP?
- My HSA account was deactivated by PayFlex because I did not meet vetting requirements. I have now completed the requirements for vetting. Am I allowed to re-open my HSA account and qualify for the EmployER Contributions?
- If I have an HSA this year and switch to an FSA next year will I still have access to any remaining funds in my HSA account from the previous enrollment?
ParTNers for Health Wellness Program
Partnership Promise
- ? Can I submit the Physician Screening Form or should it come from my doctor?
- ? If I am unable to complete all of the tests of the biometric screening (e.g., blood tests due to needles) will I still meet the requirement?
- ? Can my covered spouse participate in an onsite screening event?
- ? How do I sign up for an onsite screening?
- What if I don't have an email address?
- If I update my contact information in employee self service (ESS) in Edison, will my coach receive my new information?
Enrollment and Eligibility
- Are preexisting conditions covered?
- Can a dependent be dropped from coverage in the middle of the plan year?
- If two employees in the same plan (state, local education or local government) are married, are you required to choose the employee + spouse premium level, or can each sign up for employee only coverage? What if there are children?
- Can incapacitated children be covered beyond age 26?
- Can children under age 26 be covered as dependents on their parents' plan if they are eligible for their own coverage (e.g., at another job)?
Billing/Payments
FAQ
- ? Payroll Call Center
- ? Secure Email - How to Open Secure Emails
- ? I am attempting to enroll in Benefits in Edison, but cannot click the "Benefits Enrollment" link.
- ? How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?
- Benefits Administration Review Team (BART)
- Receiving and responding to encrypted messages
Promoted articles
- I have an employee that was full-time but has now reduced their hours to part-time. They are still eligible for insurance due to PPACA. Can they make changes to their coverage due to this status change?
- FAQ regarding maximum limits on healthcare FSA and limited purpose FSA’s for 2017
- Higher Education Online Enrollment Guide
- I am enrolled in the Hybrid 401k plan, but I should be enrolled in regular 401k. How can this be corrected?
- Is there a list of FSA exclusions?
- Can Flex Medical be carried over from year to year?
- HSA Account Funds Deposit and FSA Previous Year Balance
- I am an active employee enrolled in CDHP, what actions do I take to stay enrolled for next year?
- Can I change from the HealthSavings CDHP to one of the PPO options next year and then rejoin the HealthSavings CDHP the following year?
- Who is eligible for the HealthSavings CDHP?
- Can I submit the Physician Screening Form or should it come from my doctor?
- If I am unable to complete all of the tests of the biometric screening (e.g., blood tests due to needles) will I still meet the requirement?
- Can my covered spouse participate in an onsite screening event?
- How do I sign up for an onsite screening?
- Payroll Call Center
- Secure Email - How to Open Secure Emails
- I am attempting to enroll in Benefits in Edison, but cannot click the "Benefits Enrollment" link.
- How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?