State of Tennessee Group Insurance Program Annual Enrollment Transfer Period October 1 November 1, 2012

*AgendaAnnual Enrollment Transfer PeriodUsing ESS in Edison Whats Changing for 2013?Health Benefits Overview2013 Partnership PromiseVision, Dental and Additional Benefits Overviewwww.partnersforhealthtn.gov

*Annual Enrollment Transfer PeriodOpen Enrollment: October 1 November 1, 2012No increase to monthly late applicant fee Employees can make the following changes:Switch PPOs (subject to eligibility) Change health insurance carriers Enroll in health insurance with a monthly late applicant fee Cancel health coverageEnroll in optional vision coverageEnroll in, cancel or transfer between dental optionswww.partnersforhealthtn.gov

*Annual Enrollment Transfer PeriodIf you DO NOT want to make changesNo action is required this year If you stay in the Partnership PPO, you (and your covered spouse) are agreeing to fulfill the 2013 Partnership PromiseIf you DO want to make changesYou must use Employee Self Service (ESS) in EdisonBenefits Administration will not accept paper forms

www.partnersforhealthtn.gov

*Annual Enrollment Transfer PeriodChanges take effect on January 1, 2013Selections remain in effect through December 31, 2013A qualifying event or family status change is something that results in a covered person losing coverage or becoming newly eligible for other coverage Contact your agency benefits coordinator (Sherry) if you experience a special qualifying eventwww.partnersforhealthtn.gov

*Using Edison ESSTo make changes to your coverage or add dental or vision insurance, you must use Employee Self Service (ESS) in EdisonTo use ESS, log on to Edison at www.edison.tn.govHigher Education : your User ID and a temporary password will be mailed to your home addressIf you did not receive this or are having trouble logging in, please call Benefits Administration at 1-800-253-9981, option 3 Instructions on how to use ESS are available in the Decision Guide or from your Agency Benefits Coordinator. Computer labs will be reserved to assist those who wish to make changes.

www.partnersforhealthtn.gov

Computer labs will be set up in Gooch 325 on the following dates and times:

Tuesday, October 9, 20123:30-5:00 p.m.Monday, October 15, 20129:00-12:00 a.m.Tuesday, October 16, 20129:00-12:00 a.m.Friday, October 19, 20121:00-3:00 p.m.Wednesday, October 24, 20123:00-4:00 p.m.Tuesday, October 30, 20123:30-5:00 p.m.Wednesday, October 31, 20123:00-4:00 p.m.You MUST bring all documentation needed when attending a lab.

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*Whats Changing for 2013New, optional vision planMember cost sharingPharmacy coverage changes Closing optional universal life insurance to new enrollments (State Plan only)www.partnersforhealthtn.gov

*Whats Changing for 2013Optional Vision Plan Available to employees at participating agenciesChoose from two plans: Basic Plan Expanded PlanBoth plans offer the same services Annual routine eye examFramesEyeglass lensesContact lensesDiscount of Lasik/Refractive surgery

www.partnersforhealthtn.gov

*Optional Vision Plan What you pay for services depends on the plan you chooseExpanded plan: Co-pays AllowancesDiscounted rates Administered by EyeMed Vision Care Members have access to their Select Network Whats Changing for 2013Basic plan: Discounted rates Allowanceswww.partnersforhealthtn.gov

*Optional Vision Plan Employee pay-all option (members pay full premium)Monthly premiums for Active Members

Whats Changing for 2013www.partnersforhealthtn.gov

BasicExpandedEmployee Only$3.27$5.73Employee + Child(ren)$6.54$11.46Employee + Spouse$6.21$10.89Employee + Spouse + Child(ren)$9.61$16.84

*Whats Changing for 2013Member Cost Sharing: Health and Dental PremiumsHealth insurance premiums will increase by the following percentages:State Plan = 2%

Dental insurance premiums will increase by 3% for both planswww.partnersforhealthtn.gov

Prepaid PlanPDO PlanEmployee Only$9.63$20.46Employee + Child(ren)$20.00$47.03Employee + Spouse$17.07$38.69Employee + Spouse + Child(ren)$23.47$75.71

*Whats Changing for 2013Member Cost Sharing: DeductiblesThe deductibles for each PPO will increase in 2013 The amount of the increase depends on your premium tier

www.partnersforhealthtn.gov

Employee Only$100 increaseEmployee + Child(ren)$150 increaseEmployee + Spouse$200 increaseEmployee + Spouse + Child(ren)$250 increase

*Whats Changing for 2013Member Cost Sharing: Out-of-Pocket Maximums The out-of-pocket co-insurance maximums will also increase in 2013The amount of the increase depends on your premium tier

www.partnersforhealthtn.gov

Employee Only$200 increaseEmployee + Child(ren)$300 increaseEmployee + Spouse$400 increaseEmployee + Spouse + Child(ren)$500 increase

*Whats Changing for 2013Member Cost Sharing: Network Differential Depending on where you live, BlueCross BlueShield of Tennessee and Cigna premiums vary because the networks have different costs in each regionIf the State pays less, you will pay less tooIf you select the more expensive carrier in your region, the difference you pay will be more in 2013:Employee-only coverage will cost $20 more Those with family coverage (all levels above employee-only) will pay $40 more

www.partnersforhealthtn.gov

*Member Cost Sharing: Specialist Office Visit Co-PaysThe co-pays for specialist office visits will increase by $5 in 2013 Specialist office visit co-pays for 2013 (including surgery in office setting):Partnership PPO (in-network) = $45Partnership PPO (out-of-network) = $70Standard PPO (in-network) = $50 Standard PPO (out-of-network) = $75 Co-pays will not change for the following:Co-pays for primary care Mental health and substance abuse treatment Allergy injections with a primary care office visit Chiropractic visits (visits 1-20)

Whats Changing for 2013www.partnersforhealthtn.gov

*Whats Changing for 2013Member Cost Sharing: Emergency Room Co-PaysCo-pays for emergency room visits will increase by $45 in 2013Partnership PPO = $125Standard PPO = $145 The emergency room co-pay will still be waived if the member is admitted to the hospital Members will continue to have access to urgent care clinics as an alternative to the emergency roomPartnership PPO = $30 Standard PPO = $35 These rates will not change in 2013

www.partnersforhealthtn.gov

*Whats Changing for 2013Pharmacy: Womens Contraceptives Generic contraceptives and brand name contraceptives without a generic equivalent will be covered at $0 co-pay, including:Oral contraceptivesEmergency contraceptives Implantable devices/vaginal ringCo-pays will still apply to brand contraceptives with generics availableOnce a brand drug in these categories has a generic equivalent on the market, only the generic will be covered at $0 co-pay and the brand drug will require the brand co-pay

www.partnersforhealthtn.gov Contraceptive transdermal patches Barrier methods Injectable contraceptives (limit four per year)

*Whats Changing for 2013www.partnersforhealthtn.govPharmacy: Co-pay changes Prescription drug co-pays will increase by $5 for:Tier 2 (Preferred brand) Tier 3 (Non-preferred brand)The increase does not apply to: Tier 1 (Generic)Drugs in the 90-day maintenance tier Statins AntihypertensivesOral diabetic drugs, insulins and diabetic needles/test strips/lancets

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IMPORTANT - Pharmacy: Dispense as Written PolicyWhen a generic is available and your doctor indicates may substitute but you request the brand name drug from the pharmacy, you will pay the difference between the brand name drug and the generic drug plus the brand co-pay. Whats Changing for 2013www.partnersforhealthtn.gov

*Pharmacy: Preferred Specialty Drug Plan New users of the following must use a preferred specialty drug before the plan will cover other non-preferred specialty drugs in the same drug class Tumor necrosis factor (TNF) inhibitors (for inflammatory and autoimmune diseases)Multiple Sclerosis drugsThis requirement is referred to as step therapy

This policy will not apply to current users of these drugsWhats Changing for 2013www.partnersforhealthtn.gov

Drug ClassCovered MedicationsPreferred TNF inhibitorsEnbrel and HumiraPreferred Multiple Sclerosis drugsAvonex, Copaxone and Betaseron

**Optional Universal Life Insurance State Only The state is closing optional universal life insurance plan to new enrollmentsNo new enrollments will be allowed during this transfer period or after the first of the yearMembers currently enrolled in this coverage can continue the benefit If enrolled, you will receive a letter in the fall with details about continuing your coverage

Whats Changing for 2013www.partnersforhealthtn.gov

*Health BenefitsYour Health Insurance Options Subject to eligibility, you will continue to have the same health insurance options. Preferred Provider Organization (PPO) OptionsPartnership PPOStandard PPOLimited PPO (Local Government only)Four Premium LevelsEmployeeEmployee + child(ren)Employee + spouseEmployee + spouse + childrenTwo Insurance CarriersBlueCross BlueShield of TennesseeCigna

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*Health BenefitsBoth PPOs cover services, treatments and products, such as:In-network preventive care, x-ray, lab and diagnostics at no costPrimary and specialist doctor office visits for a fixed co-pay without having to meet a deductiblePrescription drugs for a fixed co-pay without having to meet a deductibleBoth PPOs offer: Deductibles and co-insurance for certain services Out-of-pocket maximums to limit your co-insurance and physician visit co-pay costsBoth carriers also offer discounts for services not covered. Refer to the carriers member handbooks or websites for more information.

*Health BenefitsFree preventive health services include, but are not limited to:Flu vaccination and pneumococcal vaccinationsAnnual preventive visit (i.e., physical exam)Annual well-woman visitCholesterol testOsteoporosis screening for womenScreenings for colon, breast or cervical cancer or prostate cancerIf other services or related treatments are received during the same visit, an office visit co-pay may applyYou need to visit an in-network provider to receive preventive care services at no cost.

*Health BenefitsEach carrier has its own network Both BlueCross and Cigna have made significant changes to their networks for 2013Be sure to check the networks carefully when making your decision Provider directories are available on the ParTNers for Health website, by calling the carrier or from your ABCBlueCross BlueShield offers Network S CIGNA offers Open Access Plus, OA Plus, Choice Fund OA Plus

www.partnersforhealthtn.gov

*Health BenefitsCarrier costs vary by grand divisionIn East and Middle Tennessee, CIGNA costs $20 more per month for employee only coverage and $40 more per month for all other premium levels In West Tennessee, BlueCross BlueShield costs $20 more per month for employee only coverage and $40 more per month for all other premium levels

www.partnersforhealthtn.gov

*Covered ServicesServices that Require Co-PaysThe following are some of the services that require co-pays:

* Subject to Out-of-Pocket Co-pay Maximumwww.partnersforhealthtn.gov

Primary Care Office Visit * Pharmacy Specialist Office Visit* Emergency Room Visit Urgent Care Urgent Care Allergy Injection (with office visit*) Mental Health and Substance Abuse* Chiropractors

*Covered ServicesServices that Require Co-InsuranceThe following are some of the services that require co-insurance:www.partnersforhealthtn.gov

Hospital/Facility Services Maternity Home Care Equipment and Supplies Ambulance Hospice Care Rehabilitation and Therapy Services Dental Advanced X-Ray, Scans and Imaging Out-of-Country Charges

*2013 Deductibles and Out-of-Pocket Co-insurance Maximumswww.partnersforhealthtn.gov

Partnership PPOStandard PPOIn-NetworkOut-of-NetworkIn-NetworkOut-of-NetworkAnnual DeductibleEmployee only$450$800$800$1,500Employee + Child(ren)$700$1,250$1,250$2,350Employee + Spouse$900$1,600$1,600$3,000Employee + Spouse + Child(ren)$1,150$2,050$2,050$3,850Out-of-Pocket Co-Insurance MaximumEmployee only$1,550$2,900$1,900$3,600Employee + Child(ren)$2,450$4,600$3,100$5,900Employee + Spouse$3,100$5,800$3,800$7,200Employee + Spouse + Child(ren)$4,000$7,500$4,000$9,500

*Premiums for 2013: State and Higher EducationEmployee Share of Monthly Premiums - CignaThe State pays 80% of the total premium cost for active employees. Premiums shown are for the least expensive carrier in the region. A complete chart is available in the Decision Guide and on the ParTNers for Health website.www.partnersforhealthtn.gov

Premium LevelPartnership PPOStandard PPOEmployee Only$108.52$133.52Employee + Child(ren)$162.78$187.78Employee + Spouse$227.89$277.89Employee + Spouse + Child(ren)$282.15 $332.15

Premiums for 2013: State and Higher EducationEmployee Share of Monthly Premiums - Blue Cross/Blue Shield*The State pays 80% of the total premium cost for active employees.

Premium LevelPartnership PPOStandard PPOEmployee Only$128.52$153.52Employee + Child(ren)$202.78$227.78Employee + Spouse$267.89$317.89Employee + Spouse + Child(ren)$322.15 $372.15

*Partnership PromiseIn 2013, members and covered spouses must: Complete the online Healthways Well-Being Assessment (health questionnaire) by March 15 Engage in ONE ParTNers for Health wellness activity by July 15 Keep your contact information current with your employerEngage in tobacco cessation program if you are a tobacco user www.partnersforhealthtn.govA health screening for all members is not required in 2013.

*At-risk members and covered spouses must also: Complete a biometric screening at your health care providers office between July 15 2012, and July 15 2013 Participate in health coaching and/or case management, if identified Partnership PromiseHealthways will manage the Partnership Promise in 2013.

*Partnership PromiseOnline Well-Being Assessment (WBA) Summarizes your overall health and offers steps you can take to improveBy completing the confidential assessment, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-beingBeginning January 1, 2013, visit www.partnersforhealthtn.gov and create a new, online well-being account to access the assessmentwww.partnersforhealthtn.govThe Well-Being Assessment must be completed between January 1 and March 15, 2013.

*Partnership Promisewww.partnersforhealthtn.govWellness Activities Wellness activities are easy actions you can take to work towards better health. You must engage in only ONE of the following wellness activities. Receive an age-appropriate preventive serviceAnnual physicalWell-woman visitFlu and pneumonia shotsScreenings for colon, breast and prostate cancers Complete Your Well-Being Plan and Three Action Items Create plan with recommended focus areas from WBA Complete 3 simple action items Join a ParTNers for Health Wellness Challenge Fun way to develop healthier lifestyle with group supportChoose one of the first two quarterly challengesOffered online

OROR

*Partnership PromiseUpdating Contact Information You must make sure that your phone number, mailing address and email address, if you have one, are current with your employer. If your information changes during the year, you must notify your employer to update your record.Higher Education, Local Education and Local Government employees: Change your contact information yourself in Edison, by contacting your agency benefits coordinator or by calling the Benefits Administration Service Center at 1-800-253-9981 and selecting option 6.

www.partnersforhealthtn.gov

*Partnership PromiseTobacco CessationPartnership PPO members must be tobacco free or agree to participate in the tobacco cessation program and work toward becoming tobacco free Members who use tobacco must answer Yes to the question are you a tobacco user on the required WBAHealthways will reach out to enroll you in a tobacco cessation program You will not be required to stop using tobacco by the end of 2013, but you must complete the tobacco cessation program and make an effort to quitThis requirement applies to both you and your covered spouse www.partnersforhealthtn.gov

*Partnership PromiseAt-Risk MembersMembers who are identified as at risk will be required to take extra steps to manage their current conditions and prevent new health risks from developingComplete a biometric screening with your health care providerParticipate in health coaching or case management during 2013Healthways will determine who is at risk based on medical conditions and behaviors that may cause current or future health issuesYour health risks are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results. www.partnersforhealthtn.gov

*Partnership PromiseBiometric Health ScreeningIf identified, you must get a health screening from your health care provider by July 15, 2013You may use screening results from a doctors visit between July 15, 2012, and July 15, 2013Worksite screenings will not be available in 2013Simply ask your doctor to complete the Physician Screening Form, which will be available online on January 1, 2013, and send the completed form to Healthways by the July 15 deadlinewww.partnersforhealthtn.gov

*Partnership PromiseHealth Coaching Lifestyle management helps you form better health habits. Coaches help with:High blood pressureHigh cholesterolDisease management is for those with chronic conditions such as:DiabetesAsthmaCoronary artery diseaseCase management is administered by BlueCross, Cigna and Magellan Promotes quality and cost-effective coordination of care for those with complicated medical needs, chronic conditions and/or catastrophic illnesses or injuries

Weight managementTobacco useCongestive heart failureChronic obstructive pulmonary disease (COPD)

*Health Coaching A health coach works with you and your provider to help you with self-management skills to make sure that you are taking medicines and getting the right careHealth coaches are trained health care professionalsAll conversations with your health coach are confidentialWhen you participate in coaching, your frequency of calls will be tailored to your individual plan of careYour health coach will communicate with you using telephone calls, mailings and the webPartnership PromiseHealthways hours of operation: Monday Friday 7:30 a.m. 9:30 p.m. Saturday 8:00 a.m. 6:30 p.m. (Central Time)

*Eligible employees can choose between two dental options

During the enrollment period, eligible employees can enroll in or transfer between the two options.If you dont ask to change your current dental carrier or cancel coverage, you will keep your current coverage.Dental BenefitsPrepaid PlanFixed co-paysParticipating dentists onlyPDO PlanAny dentistPay less with network providerswww.partnersforhealthtn.gov

*Dental BenefitsPrepaid Plan Administered by Assurant Employee BenefitsPredetermined co-pay amounts There are no deductibles to meet, no claims to file, no waiting periods for covered members, no annual dollar maximum and pre-existing conditions are covered To receive benefits, you must select a dentist from the Prepaid Plan listPremiums will increase by 3% in 2013 in the prepaid planwww.partnersforhealthtn.gov

*Dental Benefits Preferred Dental Organization (PDO) Administered by Delta DentalUse any dentist in the networkMembers have access to Delta Dentals PPO network You pay co-insurance for covered servicesA deductible applies for out-of-network dental care You or your dentist will file claims for covered services Some services require waiting periods and limitations/exclusions apply Premiums will increase by 3% in 2013 for the PDOwww.partnersforhealthtn.gov

*Dental BenefitsDental services for both the Prepaid Plan and the Dental PDO include:

www.partnersforhealthtn.gov

2013 PremiumsAssurant PrepaidDelta Dental PDOEmployee Only$9.63$20.46Employee + Child(ren)$20.00$47.03Employee + Spouse$17.07$38.69Employee + Spouse + Child(ren)$23.47$75.71

Periodic oral evaluations Routine Cleanings Amalgam fillings Endodontic X-rays Extractions Major restorations Orthodontics Dentures

*Additional Benefits

Basic Term Life and Accidental Death Insurance The State provides $20,000 of basic term life and $40,000 of accidental death and dismemberment insurance If you are enrolled in health insurance as the head of contract, your coverage increases with your salary to a maximum of $50,000 for basic term life insurance and $100,000 for accidental death insurance.Coverage provided by Dearborn National

www.partnersforhealthtn.gov

*Additional Benefits Optional Accidental Death Insurance STATE ONLY Additional accident protection for yourself and your dependents Coverage is available at low group ratesno questions asked Premiums vary by age and salary The maximum benefit available to employees is $60,000 Enrollment form is available on the ParTNers for Health websiteCoverage provided by Dearborn Nationalwww.partnersforhealthtn.gov

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Additional BenefitsOptional Term Life Insurance STATE ONLY Cannot enroll or make changes in optional term life insurance during AETP The state is procuring a new contract for optional term life An open enrollment with the selected carrier is planned during 2013 At that time, individuals interested in enrolling will be provided with guaranteed issue of coverage up to the guaranteed maximum Those currently enrolled will be able to increase or decrease coverage during the spring open enrollment period We will provide details of the new term life insurance later this year

*Additional BenefitsEmployee Assistance Program (EAP) Provides support tools that help you and your family deal with personal issues and situations All services are confidential and available at no cost to members Services can be easily accessed by calling Magellan, 24/7 You and your eligible dependents may get up to five free counseling sessions per problem episodeContact ParTNers EAP:1.855.HERE4TN (1.855.437.3486)www.Here4TN.com www.partnersforhealthtn.gov

*Additional BenefitsLong-Term Care Insurance Your agency must choose to participate (Local Ed and Local Gov)Who is eligible? Qualified employeesEligible dependentsCovers services for individuals who are no longer able to care for themselvesNursing home care Assisted livingHome health careApply for coverage at any time through medical underwriting. RetireesParents and parents-in-lawHome careAdult day care

*Additional BenefitsLong-Term Care InsuranceBenefits available for different daily benefit amounts ($100, $150 or $200) for either three- or five-year coverageAvailable with or without inflation protectionYou pay 100 percent of the premiumPremiums are based on age at the time of enrollmentChoose to have the premium taken from your payroll check or opt for a direct bill arrangement with MedAmericaVisit www.ltc-tn.com or call MedAmerica at 1.866.615.5824

www.partnersforhealthtn.gov

*Additional BenefitsFlexible BenefitsLowers your income taxesUse pre-tax earnings to pay for health or dental insurance premiumsSet aside pre-tax earnings to pay for:Medical expensesDependent care expenses

*Additional BenefitsMedical Expense Reimbursement AccountUse the account to reimburse yourself for eligible medical, dental and vision care expensesContribute up to $2,500 per year Dependent Day Care Reimbursement AccountUse the account to reimburse yourself for eligible dependent day care expensesContribution depends on tax filing status

Sign up for this benefit will be held in November. www.partnersforhealthtn.gov

Take Note!If you do not want to make changes, no action is required If you do want to make changes or add coverage, you must use ESS and meet the enrollment deadline of November 1, 2012You must click submit in ESS to finalize your selections by 11:59 p.m. on November 1, 2012 No changes until the next Annual Enrollment Transfer Periodwww.partnersforhealthtn.gov*

Member Communicationswww.partnersforhealthtn.gov*Current members should have received a copy of the 2013 Decision Guide at their homes in mid-September.

*Who to ContactPrimary point of contact - agency benefits coordinator (ABC) Sherry Shanklin sherrys@utm.edu or 881-7850.Questions about a provider or claim contact your insurance carrierQuestions about eligibility and enrollment call Benefits Administration service center at 1-800-253-9981Our ParTNers for Health website www.partnersforhealthtn.gov Enrollment forms and handbooks www.tn.gov/finance/ins

www.partnersforhealthtn.gov

*Questions?

Thanks for attending our meeting today. Im [presenter name] and today well cover these topics:This years Annual Enrollment Transfer PeriodWhats changing for 2013An overview of your health benefits The new 2013 Partnership PromiseAn overview of vision, dental and other additional benefitsWell also take some time to answer your questions. My colleague [name] is here to capture and help answer any questions that come up.The 2013 transfer period will be an Open Enrollment and it will run from October 1 to November 1, 2012. Employees or their eligible dependents who did not join the health plan when they were initially eligible, or who were previously enrolled and dropped coverage, will be allowed to enroll in benefits during AETP if they agree to pay the monthly late applicant fee in addition to the monthly premium while they are enrolled through December 31, 2013.The monthly late applicant fee will not change in 2013.State: Employee Only = $65, Spouse Only = $72, Employee + Spouse = $137Local Ed: Employee Only = $56, Spouse Only = $53, Employee + Spouse = $109Local Gov: Employee Only = $68, Spouse Only = $78, Employee + Spouse = $145 During Open Enrollment, you can make the following changes: Switch PPOs (subject to eligibility) Members enrolled in the Standard PPO may switch to the Partnership PPO for 2013. Members (and covered spouses) enrolled in the Partnership PPO for 2012 who did not meet the requirements of the Partnership Promise, are not eligible to continue in this option during 2013. They will still have coverage; however, they will be automatically switched to the Standard PPO.Change health insurance carriers (BlueCross BlueShield or Cigna)Enroll in health insurance for yourself or your eligible dependents (if you add coverage during AETP, the monthly late applicant fee will apply for you and your covered spouse)Cancel health coverageEnroll in optional vision coverageEnroll in, cancel or transfer between dental optionsApply for optional life coverage, or to increase or decrease optional life coverage amounts, if eligibleIf you are happy with your current benefit selections and you do not want to make any changes to your coverage, no action is required during the transfer period.Please note: if you are currently enrolled and choose to stay in the Partnership PPO, you (and your covered spouse) are automatically agreeing to fulfill the 2013 Partnership Promise. You will not have to sign the Promise again. If you do want to make changes this year, You must use Employee Self Service (ESS) in Edison when making health, dental and vision benefit selections for 2013. Benefits Administration will no longer accept paper forms for health and dental changes or to enroll in the new optional vision planIts important to know that everyone is not required to make changes online this year or submit an application only those who wish to make changes to their coverage.

Changes made during the transfer period take effect on January 1, 2013, and remain in effect through December 31, 2013, unless you lose eligibility or have a qualifying event or family status change during the year. A qualifying event or family status change is something that results in a covered person becoming newly eligible for other coverage. Examples include birth, a change in marital status and new employment. If you or your covered dependent(s) experience one of these events and need to make changes to your coverage during the year, or you need more information about reasons to cancel coverage and who qualifies, contact you agency benefits coordinator.If you want to make changes in your coverage or add vision insurance, you must do so online using ESS in Edison.State ABCs: Your employees will also use ESS to enroll in Flexible Benefits.For higher education employees, your User ID and a temporary password will be mailed to your home address before October 1 . If you do not receive this or are having trouble logging in, please call Benefits Administration at 800.253.9981, option 3. Documentation includes birth certificates; marriage license; tax forms; For 2013 a few moderate changes to benefits are necessary to keep up with the growing cost of healthcare and prevent larger increases in the future. Changes to benefits for 2013 include: New, optional vision plan available to eligible employeesMember cost sharing Pharmacy coverage changes Closing enrollment in optional universal life insurance (State Plan only)Ill talk about these in more detail on the following slides.

State/UT: Beginning in 2013, optional vision coverage will be available to all state and higher education employees and dependents. You will be able to choose from two plans: Basic Plan Expanded PlanBoth plans offer the same services, including: Annual routine eye examFramesEyeglass lensesContact lensesDiscount of Lasik/Refractive surgery

What you pay for services depends on the plan you choose. With the basic plan, you pay a discounted rate or the plan pays a fixed-dollar allowance for services and materials. The expanded plan provides services with a combination of co-pays, allowances and discounted rates. See the vision benefit grid to compare benefits in both plans ABCs: you may want to provide the vision benefit grid as a handout The basic and expanded plans are both administered by EyeMed Vision Care. You will receive the maximum benefit when visiting a provider in their Select Network. However, out-of-network benefits are also available. As with other optional products, the States vision insurance is an employee pay-all option. This means the State does not pay any part of the premium. Members are responsible for the full premium. Monthly premiums for active members are listed on this slide. Health insurance premiums will increase by:2% for the State PlanYou can see a complete list of 2013 health insurance premiums online at www.partnerforhealthtn.gov. (ABCs: you may also want to give employees a copy of the premium tables as a handout.)

Dental insurance premiums will increase by 3% for the Assurant Prepaid Plan and the Delta Dental PDO (Preferred Dental Organization). The 2013 dental premiums are listed on this slide. The deductibles for each PPO will increase in 2013 The amount of the increase depends on your premium tier

The out-of-pocket co-insurance maximums will also increase in 2013The amount of the increase depends on your premium tier

Depending on where you live, BlueCross BlueShield of Tennessee and Cigna premiums vary because the networks have different costs in each regionIf the State pays less, you will pay less too If you select the more expensive carrier in your region, the difference you pay will be more in 2013:Employee-only coverage will pay $20 more Those with family coverage (all levels above employee-only) will pay $40 more

The co-pays for specialist office visits will increase by $5 in 2013Specialist office visit co-pays for 2013 (including surgery in office setting):Partnership PPO (in-network) = $45Partnership PPO (out-of-network) = $70Standard PPO (in-network) = $50 Standard PPO (out-of-network) = $75Co-pays will not change for the following: Co-pays for primary careMental health and substance abuse treatmentAllergy injections with an office visitChiropractic visits (1-20)

Co-pays for emergency room visits will increase by $45 in 2013. Partnership PPO = $125Standard PPO = $145Its important to note that the emergency room co-pay will still be waived if the member is admitted to the hospital. Members will also continue to have access to urgent care clinics as an alternative to the emergency room. In 2012, co-pays for urgent care clinics were reduced to $30 for Partnership PPO (and Limited PPO) members and $35 for Standard PPO members. These rates will not change in 2013.

In 2013, generic contraceptives and brand name contraceptives that do not have a generic equivalent will be covered at $0 co-pay.

This includes the following drug classes:Oral contraceptivesEmergency contraceptivesInjectable contraceptivesImplantable devices/vaginal ringContraceptive transdermal patchesBarrier methods Brand contraceptives with generics available will continue to cost the brand co-pay.

Once a brand drug in these categories has a generic equivalent on the market, only the generic will be covered at $0 co-pay and the brand drug will require the brand co-pay.

Prescription drug co-pays will increase by $5 for:Tier 2 (Preferred brand) Tier 3 (Non-preferred brand)The increase does not apply to: Tier 1 (Generic)Drugs in the 90-day maintenance tier Statins (e.g., Simvastatin, Crestor, Lipitor, Pravastatin, Lovastatin)Antihypertensives (e.g., Lisinopril, Hydrochlorothiazide, Amlodipine, Atenolol) Oral diabetic drugs, insulins and diabetic needles/test strips/lancetsWhen a generic is available and your doctor indicates may substitute but you request the brand name drug from the pharmacy, you will pay the difference between the brand name drug and the generic drug plus the brand co-pay.

New users of tumor necrosis factor (TNF) inhibitors (used to treat inflammatory and autoimmune diseases such as rheumatoid arthritis) and Multiple Sclerosis drugs will be required to use a preferred specialty drug before the plan will cover other non-preferred specialty drugs within the same drug class. This requirement is referred to as step therapy. Preferred TNF inhibitors are Enbrel or Humira.Preferred Multiple Sclerosis drugs include Avonex, Copaxone and Betaseron.Current users of these drugs (as of 12/31/12) will be grandfathered and this policy will not apply.The state is closing enrollment in the optional universal life insurance coverageNo new enrollments will be allowed during this transfer periodMembers currently enrolled in this coverage can continue the benefitIf enrolled, you will receive a letter in the fall with details about continuing your coverageSubject to eligibility, you will continue to have the same health insurance options. Just like last year, you have two preferred provider organization (PPO) options:Partnership PPOStandard PPOLocal Government agencies have a third option: the Limited PPOYou have the same two insurance carrier options:BlueCross BlueShield of Tennessee CignaThere are four premium levels:Employee onlyEmployee + child(ren)Employee + spouseEmployee + spouse + child(ren)Both PPOs cover the same services, treatments and products, such as:In-network preventive care, x-ray, lab and diagnostics at no cost (note: there is a cost for advanced imaging)Primary and specialist doctor office visits for a fixed co-pay without having to meet a deductiblePrescription drugs for a fixed co-pay without having to meet a deductibleBoth PPOs offer:Deductibles and coinsurance for certain services such as hospitalization, therapy, durable medical equipment, advanced imaging and ambulanceOut-of-pocket maximums to limit your co-insurance and physician visit co-pay costsEach PPO option covers the same services, treatments and products. However, for some procedures, different medical criteria may apply based on the carrier you select.Both carriers also offer discounts for certain value-added benefits not covered by traditional insurance. This could include programs for weight loss, fitness club membership or laser vision care. Refer to the carriers member handbooks or websites for more information.Free preventive health services include, but are not limited to:Flu vaccination and pneumococcal vaccinationsAnnual preventive visit (i.e., physical exam)Annual well-woman visitCholesterol testOsteoporosis screening for womenScreenings for colon, breast or cervical cancer or prostate cancerIf other services or related treatment are received during the same visit, an office visit co-pay may apply.Its important to remember that you need to visit an in-network provider to receive preventive care services at no cost.Each carrier has its own network of preferred doctors, hospitals and other health care providers. Many doctors and hospitals are in more than one network. So, you may find yours listed under both of the insurance carrier options. On the other hand, some doctors and hospitals may be in one network but not the other. Check the networks for each carrier carefully when making your selection. Although it happens rarely, providers can be added or drop out of a network during the year.Provider directories are available on the ParTNers for Health website, by calling the carrier or from your ABC.Although BlueCross BlueShield of Tennessee and CIGNA have PPO networks available throughout Tennessee, you will probably want to choose your insurance carrier based on whether or not your doctor, hospital or lab/facility participates in their network. Depending on where you live, BlueCross BlueShield of Tennessee and CIGNA have slight variations in premiums because the networks have different costs in each region. If youre in East or Middle Tennessee, the Cigna plan costs $20 more per month for employee only coverage and $40 more per month for all other premium levels, and BlueCross is a better value. If youre in West Tennessee, the BlueCross BlueShield of Tennessee plan costs $20 more per month for employee only coverage and $40 more per month for all other premium levels, and Cigna is a better value. Its important to note that each carrier offers statewide and national networks, regardless of the region where you live.

The following are some of the services that require co-pays. Remember that a co-pay is a flat dollar amount. These services are NOT subject to a deductible and costs do NOT apply to the annual out-of-pocket co-insurance maximum: Specialist Office Visit* Primary Care Office Visit *Allergy Injection (with office visit*) Chiropractors Pharmacy Emergency Room VisitUrgent CareMental Health and Substance Abuse*Services marked with an * are subject to the out-of-pocket maximum per individual ($900 Partnership PPO; $1,100 Standard PPO)A list of covered services and co-pay amounts is available in the Decision Guide and on the ParTNers for Health website.

The following are some of the services that require co-insurance. Remember, co-insurance is a percentage of the total cost for a service. So, with co-insurance your share of the cost depends on the total charge.These services ARE subject to a deductible and eligible expenses CAN be applied to the annual out-of-pocket coinsurance maximum:Hospital/Facility ServicesMaternityHome CareRehabilitation and Therapy ServicesAmbulanceHospice CareEquipment and SuppliesDentalAdvanced X-Ray, Scans and ImagingOut-of-Country ChargesA list of covered services is available in the Decision Guide and on the ParTNers for Health website.This chart shows the annual deductible and out-of-pocket co-insurance maximum for each PPO option.The annual deductible is the amount you must pay each year before your PPO pays any hospital or other charges that are covered through co-insurance. You annual deductible will be lower under the Partnership PPO. Its also lower for in-network services. (A lower deductible means that, for charges that require co-insurance, the Partnership PPO starts paying a portion of the cost sooner than the Standard PPO.)The deductible does not apply to primary care visits, prescription drugs or other services or products that require only a co-pay. The PPOs also have out-of-pocket maximums for both in-network and out-of-network services. You can see that the maximums are lower under the Partnership PPO. They are also lower for in-network services.These maximums limit how much co-insurance you would have to pay in any given year if you or a covered family member had a serious illness or injury. If your out-of-pocket spending were to reach, say, the maximum co-insurance level for in-network services, you would not have to pay any co-insurance for additional in-network services for the rest of the year. The maximums provide you and your covered dependents with peace of mind and financial protection against a catastrophic illness or injury.

Here are the premiums for State Plan employees. These costs are effective on January 1, 2013.For active employees, the State contributes 80% of the total premium cost; employees pay only 20%.For retired employees, the State contributes 60% to 80% of the total premium cost. The amount paid depends on the retirees length of service. Retirees pay the balance.

In 2013, members and covered spouses must: Complete the online Healthways Well-Being Assessment (health questionnaire) by March 15 Engage in ONE ParTNers for Health wellness activity by July 15 Keep your contact information current with your employerEngage in tobacco cessation program if you are a tobacco user A health screening for all members is not required in 2013. Members must agree to the terms of the Partnership Promise each year, but will only sign the Promise when first enrolling in the Partnership PPO. Both you and your covered spouse must meet the 2013 Partnership Promise requirements to remain eligible for the Partnership PPO in 2014. All members enrolled in the Partnership PPO must fulfill the Partnership Promise even if the Partnership PPO is not the primary insurance plan. Just like in 2012, children do not have to meet the requirements of the Partnership Promise. At-risk members and covered spouses must also: Complete a biometric screening at your health care providers office between July 15 2012, and July 15 2013 Participate in health coaching and/or case management, if identified

If it is unreasonably difficult because of a medical or mental health condition for you to achieve the standards to fulfill the Partnership Promise, or if it is medically inadvisable for you to attempt to fulfill the Partnership Promise, call our ParTNers for Health Wellness Program at 1.888.741.3390, and they will work with you to develop an alternate way to fulfill the Promise.

The online Well-Being Assessment (WBA) summarizes your overall health and offers steps you can take to improve. By completing the confidential, online assessment, you will learn more about your physical, emotional and social health and how your lifestyle habits affect your overall well-being. Beginning January 1, 2013, visit www.partnersforhealthtn.gov and create a new, online well-being account to access the assessment. The Well-Being Assessment must be completed between January 1 and March 15, 2013.Wellness activities are easy actions you can take to work towards better health. You must engage in only ONE of the following wellness activities. Receive an age-appropriate preventive serviceIncluding: annual physical, well-woman visit, flu and pneumonia shots and screenings for colon, breast and prostate cancersWe encourage you to receive the recommended preventive services you need, but only one is required. You may use an age-appropriate preventive service received between July 15, 2012, and July 15, 2013, to fulfill the Partnership Promise. OR 2. Join a ParTNers for Health wellness challenge. Challenges offer fun ways to help members develop healthier lifestyles while providing group support. To meet the July 15 deadline, you must complete one of the first two quarterly challenges, which are offered online. The challenges focus on topics such as fitness, nutrition, weight management and tobacco cessation. OR 3. Complete Your Well-Being Plan. The plan is a personalized tool that helps you reach your healthy best.After you complete your online Well-Being Assessment, you can view your results as well as recommended Focus Areas, like healthy eating, stress management and tobacco cessation. You can use these recommendations to create your online Well-Being Plan with suggested action items. You will be required to complete three action items. Action items can include tracking your exercise, completing a journal entry or reading an article in the Resources Center, to name a few.You have from January 1 to July 15, 2013, to complete ONE wellness activity. You and your covered spouse can choose the same or a different wellness activity from the list. More information about wellness activities, including a complete list of covered preventive services, is available on the ParTNers for Health website.

You must make sure that your phone number, mailing address and email address, if you have one, are current with your employer. If your information changes during the year, you must notify your employer to update your record.Higher Education employees: Change your contact information yourself in EdisonBy contacting your agency benefits coordinator By calling the Benefits Administration Service Center at 1.800.253.9981 and selecting option 6.All members enrolled in the Partnership PPO must be tobacco free or agree to participate in the tobacco cessation program and work toward becoming tobacco free. Members who use tobacco products must answer Yes to the question are you a tobacco user when completing the required online Well-Being Assessment.A tobacco user is someone who uses any tobacco product, including cigarettes, cigars or smokeless tobacco. Someone who smokes an occasional cigar (up to one a month) will not be considered a tobacco user. (Based on similar guidelines from life insurance companies that allow for occasional cigar use.)When you confirm that you are a tobacco user, Healthways will reach out to you to enroll you in a tobacco cessation program. You will not be required to stop using tobacco by the end of 2013, but you must complete the tobacco cessation program and make an effort to quit. This requirement applies to both you and your covered spouse. Members who are identified as at risk will be required to take extra steps to manage their current conditions and prevent new health risks from developing. If the ParTNers for Health Wellness Program identifies you as being at risk, you must complete a health screening with your health care provider and participate in health coaching or case management during 2013. The ParTNers for Health wellness staff at Healthways will determine who is at risk based on medical conditions and behaviors that may cause current or future health issues. These are determined using information from health insurance claims, your Well-Being Assessment results and past health screening results.Biometric Health ScreeningIf identified, you must get a health screening from your health care provider by July 15, 2013. A biometric screening includes height, weight, blood sugar, blood pressure and cholesterol level. You may use screening results from a doctors visit between July 15, 2012, and July 15, 2013. Worksite screenings will not be available in 2013. Simply ask your doctor to complete the Physician Screening Form, which will be available online January 1, 2013, and send the completed form to Healthways by the July 15 deadline.Health CoachingAt-risk members will be asked to participate in health coaching during 2013. Health coaching programs include lifestyle management, disease management and case management programs.Lifestyle management programs help you form better health habits. Coaches can help if you have issues such as:High blood pressureHigh cholesterolWeight managementTobacco useDisease management programs are for people with chronic conditions such as:DiabetesAsthmaCongestive heart failure Chronic obstructive pulmonary disease (COPD)Coronary artery diseaseCase management is a program administered by BlueCross, Cigna and Magellan that promotes quality and cost effective coordination of care for those with complicated medical needs, chronic conditions and/or catastrophic illnesses or injuries.The requirement to participate in case management is new this year. If BCBST, Cigna or Magellan contacts you for case management in 2014, you must participate to continue to be eligible for the Partnership PPO in 2014. A health coach works with you and your provider to help you with self-management skills to make sure that you are taking medicines and getting the right care. Health coaches are trained health care professionals. They include registered nurses, licensed dieticians, clinical social workers, certified health educators and those with degrees in physiology, exercise science and health promotion. All conversations with your health coach are confidential and cannot be shared with the state. When you participate in coaching, your frequency of calls will be tailored to your individual plan of care. Your health coach will assess your individual health risks, as well as the level of support you need to improve your overall health and well-being. When working with your health coach he or she will communicate with you using multiple methods, including telephone calls, mailings and the web. Healthways hours of operation are Monday through Friday 7:30 a.m. 9:30 p.m. and Saturday 8 a.m. 6:30 p.m. (Central Time).

If youre eligible, you can choose between two dental plans a Prepaid Plan and a Preferred Dental Option (PDO). The Prepaid Plan provides dental services at predetermined co-pay amounts from a limited network of participating dentists and specialistsUnder the PDO, you can choose any dentist; however, you receive maximum benefits when you use a network providerDuring the enrollment period, eligible employees can enroll in or transfer between the two options. As with health insurance, you pay premiums up front for dental coverage regardless of whether or not you use any services. If you dont ask to change your current dental carrier or cancel coverage, you will keep your current coverage.

The Prepaid plan is administered by Assurant Employee Benefits.It provides dental services at predetermined co-pay amounts. These co-pays are reduced fees for dental treatments from your selected participating general dentist or from any participating specialist. There are no deductibles to meet, no claims to file, no waiting periods for covered members, no annual dollar maximum and pre-existing conditions are covered. Referrals are not required. To receive benefits, you must select a dentist from the Prepaid Plan list, complete a dentist selection form and return it to Assurant. The form is located on the back of the prepaid dental handbook which is available on our website or you can get a copy from your agency benefits coordinator. Premiums will increase by 3% in 2013 in the prepaid plan

The PDO is administered by Delta Dental.With the PDO, you can choose any dentist; however, you receive maximum benefits when visiting an in-network provider. Members have access to Delta Dentals PPO network. You pay co-insurance for covered services, which is a percentage of the maximum allowable charge, or MAC. In addition, a deductible applies for out-of-network dental care, but not for in-network services. No referrals are required with the PDO, and you or your dentist will file claims for covered services. Some services require waiting periods and limitations and exclusions apply. Premiums will increase by 3% in 2013 for the PDOThese are the dental premiums effective January 1, 2013. This chart includes the 3% increase for both plans. Dental services for both the Assurant Prepaid Plan and the Delta Dental PDO include:Periodic oral evaluationsRoutine CleaningsAmalgam fillingsEndodonticX-raysExtractionsMajor restorationsOrthodonticsDenturesA list of covered services and costs is included in the Decision Guide. You may also refer to the ParTNers for Health website for more information about dental coverage.The State provides a basic level of term life insurance ($20,000) and accidental death and dismemberment insurance ($40,000) to all state and higher education employees. If you are enrolled in health insurance as the head of contract, your coverage increases with your salary to a maximum of $50,000 for basic term life insurance and $100,000 for accidental death insurance.This coverage is provided by Dearborn National.

If you would like additional accident protection, you may enroll in Optional Accidental Death and Dismemberment insurance for yourself and your dependents. Coverage is available at low group ratesno questions asked. Premiums vary by age and salary. The maximum benefit available to employees is $60,000. The enrollment form is available on the ParTNers for Health website under Enrollment materials.This coverage is provided by Dearborn National. During this annual transfer period, you cannot enroll or make any changes in optional term life insurance. The state is conducting a procurement to award a new contract for optional term life. An open enrollment with the selected carrier is planned during 2013. At that time, individuals interested in enrolling will be provided with guaranteed issue of coverage up to the guaranteed maximum. Those currently enrolled will be able to increase or decrease coverage during the spring open enrollment period. We will provide details of the new term life insurance later this year.

The Employee Assistance Program (EAP) provides support tools that help you and your family deal with personal issues and situations.All services are confidential and available at no cost to membersYou can easily access services by calling Magellan available 24 hours a day, 365 days a yearYou and your eligible dependents may get up to five counseling sessions per problem episode, per year, at no cost to you

Eligibility: State and Higher Ed all employees and dependents eligible for health insurance, regardless of whether they are enrolled in the states health plan.

Long-term care insurance is available to local education and local government participants, if your agency chooses to participate. State and Higher Education employees already have access to this insurance product.Qualified employees, their eligible dependents (spouse and children ages 18 through 25), retirees, parents and parents-in-law are eligible to enroll.This insurance covers certain services required by individuals who are no longer able to care for themselves without the assistance of others. Natural aging, a serious illness or an accident may bring on this need.Services covered include nursing home care, assisted living, home health care, home care and adult day care. You and your eligible family members may apply for long-term care coverage at any time, but will be subject to medical underwriting review for approval to enroll. Call MedAmerica or refer to their website to obtain enrollment information.

Benefits are available through different options based on a daily benefit amount ($100, $150 or $200) for either a three-year or five-year coverage period. The benefits are also available with or without inflation protection. The inflation benefit protects the value of the coverage you buy today to offset future increases in the costs for long-term care. If purchased, your benefits will increase at 5 percent compounded annually.You must pay 100 percent of the premium if you choose this coverage. Premiums are based on age at the time of enrollment. So the younger you are when you apply, the lower your monthly premium will be. You may choose to have the premium taken from your payroll check, or may opt for a direct bill arrangement with MedAmerica. Direct billing or payment by bank draft or credit card can be set up on a quarterly, semi-annual or annual basis.To enroll, by visiting www.ltc-tn.com or calling MedAmerica at 1.866.615.5824.

The flexible benefits program helps you reduce taxes by allowing you to be reimbursed for certain expenses from your pretax rather than your after-tax income.The program also offers you the opportunity to pay medical expenses, dependent care expenses and parking and transportation expenses. Enrollment in these additional options is not automatic and you must apply to participate.

With a medical reimbursement account, you can set aside money to pay for eligible medical expenses with your pre-tax contributions. The IRS has set the limit for 2013 to $2,500. Over-the-counter medications are not a reimbursable expense unless your doctor writes a prescription. The amount you can set aside for a dependent day care reimbursement account depends on your tax filing status.If you are interested in participating in either a medical or dependent day care account, you must sign up each year during the enrollment period. Selections made for medical and dependent day care in previous years do not continue automatically.

The amount you can contribute to a flex benefits account is set by the IRS and the limits are subject to change yearly. Please visit www.IRS.gov for more information and to determine contribution limits for 2013.

Remember this years transfer period is different from last years. If you do not want to make changes to your coverage, no action is required. You will keep the same benefits for another year.If you do want to make changes for add coverage, you must use ESS by the November 1 deadline.You must click submit in ESS to finalize your selections by 11:59 p.m. on November 1, 2012 Consider your benefit choices and fill out the enrollment form carefully and completely. Unless you have a qualifying event, you will not be able to change until the next falls Annual Enrollment Transfer Period.

Members will receive a copy of the 2013 Decision Guide at their homes in mid-September. Much like last year, this guide will explain your benefits and whats changing for 2013. The guide as well as other related information is available on the ParTNers for Health website. Your primary point of contact is your agency benefits coordinator (ABC)If you have questions about a provider or insurance claim, contact your insurance carrier directly at the number listed on the inside cover of the Decision Guide or use the number on the back of your ID card. If you have questions about eligibility and enrollment, call the Benefits Administration service center at 1-800-253-9981. Our ParTNers for Health website (www.partnersforhealthtn.gov) has information about all the benefits described in this presentationplus definitions of insurance terms that may be unfamiliar and answers to common questions from members. All enrollment forms and handbooks referenced in this presentation are located on the Benefits Administration website (www.tn.gov/finance/ins) or ask your ABC for a copy.