Coordination of Benefits
- Do I have to drop my other coverage?
- Where can I find the Coordination of Benefits (COB) letter?
- Where can I find Coordination of Benefits (COB) examples?
- Where can I find more information about Coordination of Benefits (COB)?
- I have more than one policy (dual coverage or double coverage). How does Coordination of Benefits (COB) work?
- Employee Benefits Orientation Video
ParTNers For Health Wellness 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?
- How do I set up my online account to access the ActiveHealth member website?
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
- 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?
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 coverage 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
- What is the CDHP/HSA (or Local CDHP/HSA) insurance plan?
- Does the CDHP cover preventive care?
- Why might I choose the consumer-driven health plan (CDHP) option?
- How is the CDHP similar to the Premier, Standard and Limited PPOs
- How is the CDHP different from the Premier, Standard and Limited PPOs?
- 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?
Flexible Spending Account (FSA)
- What is a flexible spending account (FSA)?
- What is the benefit of a medical flexible spending account (medical FSA)?
- Can I disenroll from the FSA, limited purpose FSA or dependent care FSA during the plan year?
- Am I allowed to enroll in both a medical flexible savings account (medical FSA) and a limited purpose flexible savings account (L-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)?
Pharmacy
- 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)
- 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, 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?
- 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
- 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?
- Do I need to file a claim?
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 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 (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 do I do when I get a "bad request" error in Edison?
- What are my premiums?
- Payroll Call Center
- Replace an Insurance ID card
- Divorce
- Where can I find information about COVID-19 (coronavirus)
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?