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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
- I am a retiree receiving a TCRS pension check. Can I have my HSA contributions deducted from my TCRS pension check pre-tax?
- Do I have access to Behavioral Health & Substance Use Services?
- Retirement Insurance Counseling
- Are retirees eligible for the Employee Assistance Program?
- What will happen to my dependent’s medical coverage on the retiree plan when I turn 65?
- Will my dependents be covered if I die?
The Tennessee Plan Medicare Supplement
- Can I apply for the Tennessee Plan during the Medicare Open Enrollment Period?
- How do I cancel coverage in The Tennessee Plan?
- How much will my premium be for coverage in The Tennessee Plan?
- Am I eligible for The Tennessee Plan?
- Is my spouse eligible for The Tennessee Plan (Supplemental Medical Insurance For Retirees With Medicare)?
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. 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
- I retired from the state and was rehired within 13 weeks to my former agency making me PPACA eligible. I am eligible for ACTIVE coverage. Does my eligibility include TERM Life?
- 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)
- Where to locate the 1095-C form in Edison
- 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?
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?
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?
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?
Enrollment and Eligibility
- 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)?
- If two employees in the same plan (state, local education or local government) are married, are they required to choose the employee + spouse premium level, or can each sign up for employee only coverage? What if there are children?
- Can a dependent be dropped from coverage in the middle of the plan year?
- Are preexisting conditions covered?
- Can I cancel my insurance for any reason and what documentation is required?
- My child is about to turn 26, what do I need to do to remove him or her from coverage?
BlueCross BlueShield and Cigna
- What happened to the insurance company that used to provide my benefits and why did the insurance carrier change?
- I am enrolled in a PPO medical plan. My dependents and I have visited the doctor many times this year, but I was told by BCBS/Cigna that we haven’t met our deductible. How can this be?
- What is the difference between the telemedicine technology program offered by our agency and the State Telehealth Program?
- 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?
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?
- Can I use my HSA debit card after I terminate employment?
- 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?
Flexible Spending Account (FSA)
- Can I disenroll from the FSA, limited purpose FSA or dependent care FSA during the plan year?
- May I reimburse a family member for expenses associated with dependent care?
- Am I allowed to enroll in both a medical flexible savings account (medical FSA) and a limited purpose flexible savings account (L-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)?
Payflex
- HSA Debit Card
- HSA Retail Account
- When will I receive my Form 5498?
- Debit Card Wait Time
- FSA Beneficiary
- PayFlex Address Correction
Pharmacy
- Help! My specialty prescription has gone way up in cost (even to $150). What is going on?
- I would like to appeal my prescription drug benefits paid to CVS/Caremark. What should I do?
- 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?
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?
ParTNers for Health Wellness Program
Voluntary Dental
- Does Coordination of Benefits pertain to my dental and/or vision insurance?
- 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?
Voluntary Vision
- 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?
- How can I request that my provider be added to the Davis Vision network?
- How do I print or request additional or replacement ID cards?
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?
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
- May a spouse, who is also a state or higher education employee, enroll as an employee and as a dependent of the other spouse?
- How can I find out who I designated as the beneficiary?
General Questions
- ? What are my premiums for 2018?
- ? Payroll Call Center
- Receiving and responding to encrypted messages
- Secure Email - How to Open Secure Emails
- Do premiums get prorated for effective dates that occur after the first of the month?
- What do I do if I have a question or would like to appeal a payment decision regarding my insurance claims?
Terms and Definitions
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?
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?
- 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?
- What are my premiums for 2018?
- Payroll Call Center