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Agency Benefits Coordinators (ABCs)
PPACA FAQs
- ? Why is my Form 1095-C not showing the correct monthly premium amount?
- Our Agency has less than 50 employees. Do we need to file 1094/1095 forms?
- 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?
PPACA Documents
- Patient Protection and Affordable Care Act (PPACA) Information Sheet (state only)
- PPACA Update - Local Education and Local Government
- Minimum Value Certification
- Full to Part Time Changes (State Only)
- Local Government Required Federal Marketplace Notice
- Local Education Required Federal Marketplace Notice
State New Hire Documentation for 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)
- ? How do I run a collections applied report?
- 1095-B Sponsor of Self-Insured Plan
- How to Terminate an Employee in Edison (Non-Payroll Agency)
- I have an employee that requested a copy of their 1095C tax form from a year prior to 2015. How does the member acquire the needed tax form?
- Vendor Contacts for ABCs
- How to terminate an employee in Edison
Retirees
General
- Retirement Insurance Counseling
- Employee Assistance Program
- What will happen to my dependent’s medical coverage on the retiree plan when I turn 65?
- Coverage for Dependents in the Event of Your Death
- May I continue my voluntary term life insurance when I retire?
- Does the state offer a part D plan to retirees?
The Tennessee Plan Medicare Supplement
- Can I apply for the Tennessee Plan (Medicare Supplement) during the Medicare Open Enrollment Period?
- 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
- PPACA Term Life Eligibility
- 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?
Employees
PPACA (Affordable Care Act)
- 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?
- What if I already have coverage through my spouse’s employer?
- The healthcare law states that employees must now have health insurance coverage. Does that mean I have to sign up now if I do not have coverage?
Workers Compensation
Leave of Absence
- If I miss one end-of-the-month payroll check and I have not been enrolled in direct bill, how will my missed premium be caught up?
- Can I pay my bill before I get an invoice?
- What are my options if my benefits are canceled due to nonpayment of premiums?
- When will I get my invoice?
- I received another invoice, but I am back at work. Do I need to pay this amount?
- When am I responsible for the full employee and employer portions of my insurance?
Disability-State and Higher Education Only
- What is Disability Insurance?
- What is Short Term Disability (STD) Insurance?
- What is Long Term Disability (LTD) insurance?
- Am I required to enroll in the Short Term and Long Term Disability plans?
- When am I eligible to enroll in Short Term and Long Term Disability plans?
- Is Disability Insurance right for me?
Deferred Compensation
- 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 percent 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?
- I am enrolled in the Hybrid 401k plan, but I should be enrolled in regular 401k. How can this be corrected?
COBRA
- ? What do I do when I get a "bad request" error in Edison?
- How Do I Cancel COBRA?
- Is COBRA different than active benefits?
- What is COBRA?
- Who is eligible for COBRA?
- How do I enroll?
General Questions
- ? What are my premiums for 2018?
- ? Does sick leave run concurrent with the Disability Elimination Period
- ? Payroll Call Center
- ? I am attempting to enroll in Benefits in Edison, but cannot click the "Benefits Enrollment" link.
- ? Higher Education Online Enrollment Guide
- ? How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?
Announcements
- ? The state will offer voluntary vision benefits through a new vendor in 2018, Davis Vision.
- For general information about the Wellness Program including wellness and fitness discounts and Weight Watchers at Work, visit the Wellness Program page (http://partnersforhealthtn.gov/wellness.shtml).
- 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 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
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)
- What is a flexible spending account (FSA)?
- How much can I contribute to my flexible spending accounts (FSAs)?
- Can I have both a health savings account (HSA) and a medical flexible spending account (medical FSA)?
- Does a flexible spending account (FSA) hurt my other benefits?
- What is the benefit of a medical flexible spending account (medical FSA)?
- What are some common medical flexible spending account (medical FSA) eligible expenses?
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 Dental
- What happened to my Delta Dental/Assurant Benefits 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?
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 Davis Vision 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 Davis Vision member website?
ParTNers Employee Assistance Program (EAP)
- I am an employee with health coverage through State sponsored insurance, and I have a dependent that lives at home with me but is not enrolled in my health coverage but they are benefit eligible. Is that dependent able to utilize the EAP/Behavioral Health
- If I am contacted by Optum for case management, am I required to participate?
- 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 and Cigna
- BCBST Network S Hospitals 2017 as of 7/17/2017
- 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?
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?
CDHP/HSA and Local CDHP/HSA
- ? 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 CDHP to one of the PPO options next year and then rejoin the CDHP the following year?
- ? Who is eligible for the CDHP?
- I am turning 65 next July and will be taking Medicare. I am currently on the CDHP plan. Do I need to change my plan during Annual Enrollment or will that be a special qualifying event in July?
- Do the Funds in My HSA Accrue Interest?
ParTNers for Health Wellness Program
Enrollment and Eligibility
- Can any school board member enroll in the State's health insurance plan?
- Is my newborn baby automatically covered for 30 days after he/she is born?
- Return to Active Employment Within 13 Weeks
- 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?
Billing/Payments
Promoted articles
- Why is my Form 1095-C not showing the correct monthly premium amount?
- How do I run a collections applied report?
- What do I do when I get a "bad request" error in Edison?
- What are my premiums for 2018?
- Does sick leave run concurrent with the Disability Elimination Period
- Payroll Call Center
- I am attempting to enroll in Benefits in Edison, but cannot click the "Benefits Enrollment" link.
- Higher Education Online Enrollment Guide
- How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?
- The state will offer voluntary vision benefits through a new vendor in 2018, Davis Vision.
- 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 CDHP to one of the PPO options next year and then rejoin the CDHP the following year?
- Who is eligible for the CDHP?