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State New Hire Documentation for ABCs
Documentation
Agency Benefits Coordinators (ABCs)
HSA/CDHP Questions
- 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?
- If an employee selects the CDHP during annual enrollment, how can an employer determine if an employee still has funds in FSA prior to setting up a new HSA if an employee selects the CDHP?
Frequently Asked Questions (FAQ)
- ? What is a Proof of Joint Ownership document?
- 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?
- I entered the wrong begin date in Edison/on the form and need to change it. How do I do that?
- I have submitted an enrollment request. How do I know it has been entered?
- How do I run a collections applied report?
COBRA
Frequently Asked Questions (FAQ)
- 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?
- What are COBRA Qualifying Events for Dependents?
- How do I qualify for a COBRA Disability Extension?
- What is a COBRA Disability Extension?
- How long does COBRA last?
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 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?
- I am enrolled in the Hybrid 401k plan, but I should be enrolled in regular 401k. How can this be corrected?
Flexible Benefits
- 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?
- I elected Flex Parking but meant to enroll in Flex Medical, can I switch accounts?
- I am quitting my job and my last day will be December 2, so I will only receive a paycheck for two days of work. Can I terminate my flex account so that it doesn’t come out of that final paycheck?
- I am a Part-Time employee. Am I eligible for 401K and Flexible Benefits?
- I am a 120-day retiree. Am I eligible for Flexible Benefits?
Frequently Asked Questions (FAQ)
- ? 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?
- ? Cancel Request Reasons and Documentation Requirements
- There was an error on a recent enrollment/Special Qualifying Event (SQE) request form. How do I make the correction?
- My child/spouse Social Security Number is incorrect in Edison. How do I correct it?
- I am a Local Government employee who is changing employers (i.e., one city government to another etc.), how does that affect my insurance coverage?
General
Flexible Spending Account (FSA)
- What is the significance of the plan year?
- What about termination or change in employment?
- Does a FSA hurt my other benefits?
- How can you use your medical or limited purpose FSA funds?
- Can you have both a HSA account and a FSA account?
- What are some benefits of a limited purpose FSA?
Terms and Definitions
Affordable Care Act (ACA)
- 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 new 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?
Life Insurance - State and Higher Education Only
- 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?
- How can I find out who I designated as the beneficiary?
- Can I decrease the amount of coverage I have?
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 a high medical bill? Will I have to pay coinsurance for the whole amount?
- 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
- 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?
- I have diabetes. Can I use any lancets and test strips?
HealthSavings CDHP
- Can you postpone Medicare enrollment if you are still working in order to sign up for the CDHP plan and contribute to a HSA account?
- If my dependent child is on Medicaid or TennCare, can he or she be covered by the HealthSavings CDHP?
- If my spouse is on Medicare, can I choose the HealthSavings CDHP?
- Can I use the money in my HSA when I am receiving Medicare (Part A, B or D) benefits?
- What if I enroll in the HealthSavings CDHP and then enroll in Medicare Part A later in the plan year?
- Can I enroll in the HealthSavings CDHP if I have Medicare?
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 health 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)?
FAQ
- ? How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?
- Vision Coverage – Eligibility and enrollment
- Dental Coverage – Eligibility and enrollment
- Do premiums get prorated for effective dates that occur after the first of the month?
- What is a Special Qualifying Event?
- Is my grandchild eligible for State sponsored coverage?
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.
Promoted articles
- 2016 New Hire Presentation - ST/HE
- Employee Checklist
- Pre-Enrollment Benefits Information
- What is a Proof of Joint Ownership document?
- 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?
- Cancel Request Reasons and Documentation Requirements
- 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?
- How do I add my new spouse/family to the State Group Health Insurance coverage due to a recent marriage?