Coordination of Benefits
ParTNers For Health Wellness Program
- If I am pregnant, can I still participate in a Disease Management program?
- Who is the vendor for the Wellness Program?
- Who is eligible to participate?
- Who is eligible to receive the cash incentive?
- Will I be charged extra at any time for participating in this program?
- Can I opt out of participating in this program?
PPACA (Affordable Care Act)
- Where do I locate tax forms in Edison?
- Why is my Form 1095-C not showing the correct monthly premium amount?
- Can I get insurance through the Marketplace?
- What is the Health Insurance Marketplace?
- Do the ParTNers for Health plans meet the health care reform law’s minimum value requirements?
- What if I already have coverage through my spouse’s employer?
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?
- How Do I Cancel COBRA?
- Is COBRA different than active benefits?
- What is COBRA?
- Who is eligible for COBRA?
- How do I enroll in COBRA?
- How long does COBRA last?
- 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 is paid off, but deductions are still being taken 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
- What dependents are eligible and what required documentation do I need to submit for verification when adding a dependent?
- How do I change my dependent's last name?
- 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?
BlueCross BlueShield and Cigna
- Where can I find more information about the BlueCross BlueShield and Cigna networks?
- 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 annual 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?
CDHP/HSA and Local CDHP/HSA
- What is the CDHP/HSA (or Local CDHP/HSA) insurance plan?
- On what can I spend my health savings account funds?
- On whom can I spend my health savings account funds?
- If I close my health savings account or switch from the Consumer-driven Health Plan or Local CDHP to one of the preferred provider plans, what happens to my HSA balance?
- Why might I choose the Consumer-driven Health Plan option?
- Does enrollment in Medicare impact my HSA eligibility?
Flexible Spending Account (FSA)
- What happens to my flex funds if I quit work or retire in the middle of the plan year?
- Can I change my flexible spending contribution amount during the middle of the plan year?
- If I am a new employee who starts employment with the state of Tennessee or a higher education institution during the year, how do I enroll in flex benefits?
- Can anyone enroll in the flex benefits?
- Why am I being asked to provide evidence of a claim or an EOB from my insurance because I used my FSA or L-FSA debit card?
- What if I need an additional flex debit card?
- My specialty prescription has gone way up in cost. 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?
ParTNers Employee Assistance Program (EAP)
- If two state employees are individually enrolled on the state health plan, or have dependents under one parent, is an individual able to receive five EAP visits for the same issue under each employee?
- I am an employee with health coverage through state-sponsored insurance. I have a dependent who lives at home with me but is not enrolled in my health coverage. They are benefit eligible. Is that dependent able to utilize the EAP/behavioral health?
- Who is eligible for the Employee Assistance Program (EAP)?
- Is preauthorization required for outpatient behavioral health?
- What happens if I utilize all of my available EAP sessions, but I would like to continue seeing my provider?
- How many sessions do I have through the EAP?
- Does coordination of benefits pertain to my dental and/or vision insurance?
- How often are the dental insurance companies selected for the state’s insurance program?
- How can I find out how much a procedure will cost under my Delta Dental DPPO plan?
- What if I am out of the area and need emergency care? Will the Cigna DHMO cover some or all of the services?
- How do I find a Cigna DHMO network dentist?
- Do I have to select a primary dentist in the Cigna DHMO plan? Can I change my dentist?
- 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?
- How can I request that my provider be added to the EyeMed network?
- Do I need to file a claim?
Disability-State and Higher Education Only
- What is Disability Insurance?
- What is Short Term Disability Insurance?
- What is Long Term Disability Insurance?
- Am I Required to Enroll in the Short Term and Long Term Disability Plan?
- 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 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 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?
- What do I do when I get a "bad request" error in Edison?
- What are my premiums?
- How do I contact the Payroll Call Center?
- How do I update my email address in Edison?
- How can I replace an insurance ID card?
- What do I do if I get a divorce?
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 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?