Employees
ParTNers For Health Wellness Program
- Who is the vendor for the new Wellness Program?
- Who is eligible to participate?
- Who is eligible to receive the cash incentive?
- Is participation mandatory?
- Will I be charged extra -- at any time -- for participating in this program?
- Can I opt out of participating in this program?
Annual Enrollment
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- Do I have to make changes during Annual Enrollment?
- I'm a retiree. When and how do I enroll for 2019 benefits?
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 two 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 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?
- 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
- ★ 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?
- ★ 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?
- If I enroll in the CDHP and enter an annual contribution for my HSA, is the full amount available to me upfront?
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
- How long does it take to link my bank account for FSA reimbursements with PayFlex?
- How long does it take to link my bank account for FSA reimbursements with PayFlex?
- How do I change my PayFlex password?
- When you have an HSA account in the current year and then you enroll in an HSA during the next enrollment period for the following year, are you issued a new debit card?
- I received a letter from PayFlex indicating that their PayFlex HSA changed to "Retail" account. Why?
- When will I receive my Form 5498?
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?
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
- 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?
Voluntary Dental
- 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 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
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?
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- Do premiums get prorated for effective dates that occur after the first of the month?
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?