Frequently Asked Questions

•  State of Tennessee Health Plan  (4 Questions)

1.  What's new for 2015?

Limited PPO Option, Vision Plan, Pharmacy Out-of-Pocket Maximum

Partners for Health

-Members of the Local Education Plan can now enroll in the Limited PPO during the fall enrollment period

-In the Limited PPO, there is not longer a co-pay out-of-pocket maximum; however, co-pays (with the exception
 of pharmacy) will apply to the co-insurance out-of-pocket maximum

-To provide additional financial protection for our members, co-pays for emergency room, chiropractic, and urgent
 care in-network visits will now count toward the out-of-pocket maximum in the Partnership and Standard PPOs

-A pharmacy out-of-pocket co-pay maximum of $2,500 per individual will apply in-network for Partnership

-Every Partnership PPO member must complete the online Well-Being Assessment and get a biometric screening at
 their doctor's office or at a worksite visit

-Completing a wellness activity as a part of the Partnership Promise has been removed

 

 

2.  What is required for the 2015 Partnership Promise?

Healthways

-Members and covered spouses must do the following:

  • Complete the online Healthways Well-Being Assessment™ (health questionnaire) by March 15, 2015.
  • Complete a biometric screening at your doctor's office or at a worksite event by July 15, 2015.
  • Participate in health coaching and/or case management if identified by Healthways.
  • Update your contact information with your employer if it changes. (Retirees must keep their contact
    information up to date with Benefits Administration).
  • A wellness activity is NO longer required.

-New employees are required to complete the online Well-Being Assessment and screening within 120 days of their insurance coverage effective date.

*Note: The benefits of the Partnership Promise are open to all plan members. If you think you might be unable to fulfill the Partnership Promise, call our ParTNers for Health Wellness Program at 888.741.3390, and they will work with you and/or your physician, if you wish, to find an alternative way for you to meet the Promise.

 

 

3.  What is the Limited PPO?

Minimum essential coverage to comply with the new health care laws

-The Limited PPO offers the same services, treatments, and products as the other PPO plans. The Limited PPO has low monthly premiums, but higher deductibles and out-of-pocket maximums. Be sure to look at the benefit grid found in your 2015 Decision Guide for additional information including cost structure, co-pays, and deductible amounts. Please note: the in-network deductibles, out-of-network deductibles, and out-of-pocket maximums for all tiers (employee only, employee + children, employee + spouse, and employee + spouse + children).

-The Limited PPO no longer has a co-pay out-of-pocket maximum; however, co-pays (with the exception of pharmacy) will apply to the medical out-of-pocket maximum.

 

 

4.  Can children under age 26 be covered as dependents on their parents' plan if they are eligible for their own coverage?

Yes

Partners for Health logo

-Yes, access to other coverage is not a factor.

 

 

•  The Affordable Care Act  (4 Questions)

1.  What is required of me in 2014?

January 1, 2014 everyone must have minimum essential coverage

Partners for Health logo

-Starting January 1, 2014, if someone does not have a health plan that qualifies as minimum essential coverage, he or she may have to pay a fee.  Employer sponsored coverage (such as the State GroupHealth Insurance Program) is considered minimum essential coverage.

 

 

2.  What if I already have coverage through my spouse's employer?

As long as you have "minimum essential coverage" by 1/1/2014

-As long as you have minimum essential coverage beginning January 1, 2014, (through the State Group Insurance Program or elsewhere) you have satisfied the requirements of the health care law

 

 

3.  What is the Health Insurance Marketplace?

"One-Stop Shopping" to find and compare private health insurance options

-The Marketplace offers "one-stop shopping" to find and compare private health insurance options.  By October 1, 2013, you will recieve a letter from your employer with information about the Marketplace.

 

 

4.  Can I get health insurance through the Marketplace?

Marketplace logo

-If you purchase health coverage through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. In addition, this employer contribution, as well as your employee contribution to employer-offered coverage is often excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.

-If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan.

-For more information on the ACA, visit Healthcare.gov.

 

 

•  Delta Dental of Tennessee  (2 Questions)

1.  How do I get a new ID card?

Consumer Toolkit

-You may print and ID card using out Consumer Toolkit or you may request an ID card via phone 1-(800)-223-3104

 

 

2.  How do I submit a claim for reimbursement?

Delta Dental logo

-When visiting a participating Delta Dental provider, your claims will be filed for you. If your dentist is a non-participating provider, you may need to submit the claim yourself. Download a claim form here
 Either you or your dentist may complete the form and attach a copy of your bill. Completed forms may be faxed to (615) 244-8108 or submitted via mail to:

Delta Dental of Tennessee
240 Venture Circle
Nashville, TN 37228

                         
 

•  EyeMed Vision Care  (4 Questions)

1.  Can I view my EyeMed benefits online?

-Yes, you can view your benefits and do a lot more on our secure website. Members can also print an ID card, check the status of a claim, locate a provider and download an Explanation of Benefits. You can even do all of
 these things from your smartphone because our member site is mobile-optimized.

 

 

2.  Will I get an ID card?

EyeMed logo

-Yes, we provide an ID card to each employee who enrolls in the plan, but you aren’t required to have it at the time of service.  If you lose your card or need extras for your family, you can call our Customer
 Care Center or print cards online, once you register for an account at eyemed.com

 

 

3.  How do I submit a claim?

EyeMed logo

-When you visit one of our in-network providers, we take care of all of the paperwork.  If you see an
 out-of-network provider, you’ll need to pay at the time of service and complete a claim form to send
 to us for reimbursement.

 

 

4.  Who can I call for help?

EyeMed Customer Care Center

-Our Customer Care Center is available to help with whatever you need, 362 days a year. Just call
 1-866-4EyeMed during these hours:

Mon-Sat: 7:30AM to 11:00PM EST

Sun: 11:00AM to 8:000PM EST