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For Retirement

Retiree 2018 Annual Enrollment is October 1-26

for State, Higher Education, Local Education and Local Government Retirees

This is your chance to make benefit changes that will be effective Jan. 1, 2019. This year for Annual Enrollment, if you want to make changes, you can submit a paper application or may be able to make changes online in Edison ESS.


If eligible, during Annual Enrollment you can:

  • Change your health insurance option
  • Change your health insurance carrier and network
  • Enroll in or cancel health insurance for your eligible dependents (retiree must be enrolled on the health insurance plan to add a dependent to coverage)
  • Enroll in, cancel or transfer between retiree dental options (if you are a TCRS or higher education ORP retiree)
  • Enroll in, cancel or transfer between retiree vision options (if you are enrolled on the retiree group health plan and you are a TCRS or higher education ORP retiree)

*Limited PPO is available to local education and local government retirees only. If enrolled in a CDHP/HSA, retirees and COBRA participants do not qualify for state HSA funds.

Networks and benefits may change and impact you. Even if you don’t make changes during Annual Enrollment, it’s good to review your enrollment each year. If you don’t want to make any changes in enrollment, NO ACTION if needed on your part.

Important for 2019

  • Health premiums are changing for retirees.
    • State and higher education retirees will increase by 3.5%
    • Local education will increase 2.5%
    • Local government will increase 2.0%
  • Health options and network options are not changing.
  • Copays, coinsurance and deductibles are staying the same for all health plans, except for the Limited PPO (local education and local government retirees only) and the deductibles and out-of-pocket maximum will increase.
    • With the Limited PPO, there will no longer be a $100 pharmacy deductible.
  • Voluntary products premiums:
    • MetLife DPPO dental plan will increase 2%.
    • Cigna DHMO (prepaid) dental plan will stay the same.
    • Davis Vision plans will stay the same.

Benefit Improvements

  • Physical therapy benefit: PPO members no longer have to meet their deductible first for physical therapy, occupational therapy and speech therapy that is in-network and outpatient. They will only have to pay coinsurance. CDHP/HSA members must meet the deductible first and pay coinsurance.
  • Cardiac rehab benefit: PPO members will not pay any costs for in-network, outpatient cardiac rehab. CDHP/HSA members must meet the deductible first before the coinsurance is waived.
  • Bone anchored hearing devices: Will be covered when deemed medically necessary (subject to plan benefits).
  • Certain medications used to treat opioid dependency: Members won’t have to pay for some of these medications. Find more information on the Pharmacy page.
  • Members can work with their pharmacists to coordinate refills for maintenance medications so that multiple medications are filled on the same day. For PPO members, the medications being filled to get you “synced” will have pro-rated copays. This applies to statins for high cholesterol, high blood pressure, coronary artery disease, congestive heart failure, diabetes, depression and asthma/COPD medications.

Want to Learn More?

  • You’ll find your Annual Enrollment newsletter and more on the Enrollment Materials page.
  • On the Videos page, you can learn more about PPOs, CDHP/HSA, dental and vision. If you need help with Edison, scroll down this page to see step-by-step instructional videos made specifically for retirees. You will find help with logging in to Edison for the first time, resetting your Edison password, getting your Access ID and how to select and enroll in your benefits.
  • You can ask our help desk Questions? There is a button on the home page.
  • Call our Benefits Administration service center at 800.253.9981 and press option “2” for a retirement representative.

How to Make Changes

If you want to make changes, fill out the annual enrollment application and submit it to Benefits Administration.

  • Mailed applications must be postmarked no later than Oct. 26, 2018.
  • Submit by fax at 615.741.8196 by Oct. 26, 2018, at 11:59 p.m. Central time.  OR …

This year, if you would like to, you may also be able to make changes online in ESS in Edison at instead of using the paper Annual Enrollment application!

  • When using Edison ESS, Internet Explorer 11 is the preferred browser. You may not be able to enroll if you use another browser, a mobile device or a tablet.
  • In Edison, you will need to set up an account with a password.
  • Important! You may already have an old work email address in ESS in Edison. If you try to reset your password to enroll, the password reset email may go to this old email account. If you do not receive an email after trying to set up your account, you can make changes by submitting a paper application, or call our customer service center for help.
  • Click here for Edison Retiree Self Service Instructions.
  • Instructional step-by-step Edison videos for Retirees:

Retrieve your Access ID

Log in to Edison for the first time

Reset your Edison password

Enroll in Edison

Enrolling new Dependents (if eligible)

We need documents to prove their relationship to you. A list of required documents is found on the Enrollment Materials page.

  • You can upload your documents in Edison or fax to 615.741.8196.
  • The dependent documents deadline is Oct. 26 at 4:30 p.m. Central.
Caremark ID Sample

ID Cards

  • Members who change or transfer plans will receive new ID cards. Current members who don’t make plan changes will use their same ID cards.
  • For 2019, Limited PPO members will receive new pharmacy cards due to the change in the pharmacy deductible.
  • Because there are no changes to dental and vision coverage, current members who continue their coverage can use the same ID cards.
  • CDHP/HSA members who continue coverage will use the same debit card. If you are a new CDHP/HSA enrollee, you will receive a new debit card from PayFlex.
  • Members can always request additional cards by contacting their carrier network or vendor(s).

All eligible retirees who have some level of group health coverage for either themselves or covered dependents are sent general information on available healthcare options, premiums, a listing of benefit changes and service areas for the upcoming year.

The options you choose during the enrollment period take effect the following January 1. After annual enrollment, in most cases you can only add or cancel coverage if 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, marriage, divorce and new employment. If you or your covered dependent(s) experience one of these events and need to make changes to your coverage, or you need more information about reasons to cancel coverage and who qualifies, contact Benefits Administration.