Health Insurance

Carriers

BCBST

 

BlueCross BlueShield of Tennessee
800.558.6213
Monday - Friday, 7 a.m. - 5 p.m. CT
bcbst.com/members/tn_state/

Cigna

Cigna
800.997.1617
24/7
cigna.com/stateoftn

ID Cards

Employees new to coverage, or who change or transfer plans, will receive new ID cards. Members can request additional ID cards by contacting their carrier or by using the carrier’s mobile app.

Health insurance options

Partners for Health offers three health plans for state and higher education members and four health plans for local education and local government members. Use the arrows below to see what health plans are available to you.

Partners for Health offers four networks. For detailed health insurance carrier network information, visit the Carrier Information page.

Health insurance options for:

Premier Preferred Provider Organization, or PPO  

Higher premiums – but lower out-of-pocket costs for your deductible, copays and coinsurance. 

Standard PPO  

Lower premiums than the Premier PPO – but you’ll pay more out-of-pocket for your deductible, copays and coinsurance. 

Consumer-driven Health Plan with a health savings account, or CDHP/HSA   

Lowest premiums – but you pay your deductible first before the plan pays anything for most services, and then you pay coinsurance, not copays. Go to the CDHP/HSA page to learn more.

Click here for a 2022 benefit comparison for state and higher education.

Premier Preferred Provider Organization, or PPO  

Higher premiums – but lower out-of-pocket costs for your deductible, copays and coinsurance. 

Standard PPO  

Lower premiums than the Premier PPO – but you’ll pay more out-of-pocket for your deductible, copays and coinsurance. 

Limited PPO

Lower premiums than the other PPOs – but you’ll pay more out-of-pocket for deductible, copays and coinsurance compared to the other PPOs.

Local Consumer-driven Health Plan with a health savings account, or CDHP/HSA 

Lowest premiums – but you pay your deductible first before the plan pays anything for most services, and then you pay coinsurance, not copays. Go to the CDHP/HSA page to learn more.

Click here for a 2022 benefit comparison for local education and local government.

Each health care option has different cost sharing — cost sharing is your out-of-pocket costs for copays, deductibles, coinsurance and out-of-pocket maximums. 

For all options, preventive care is free if you use an in-network provider (visit the Wellness page for information on preventive care). All health care options cover the same services and treatments, but medical necessity decisions may vary by carrier.

For more detailed information, member handbooks are available on the Publications page.

How do I receive services covered by the “Barry Brady Act”?

If you are a firefighter who qualifies for additional health screenings under the Barry Brady Act and your related claims process with unexpected member cost share call your health insurance carrier’s customer service number and request a reconsideration of your claims.

Need information on behavioral health?

Behavioral health benefits are provided by Optum. Click here to go to the behavioral health page.

 

Medical service appeals

If you are a plan member in disagreement with a decision or the way a claim has been paid or processed, you or your authorized representative should first call member services to discuss the issue:  BlueCross BlueShield of Tennessee 800-558-6213 or Cigna 800-997-1617.

First Level Appeal — If the issue cannot be resolved through member services, you or your authorized representative may file a formal request for internal review or member grievance. All requests must be filed within the stated timeframes. When your request for review or member grievance is received, you will get a letter about what to expect regarding the processing of your grievance. Once a decision is made, you will be notified in writing. You will be advised of any further appeal options including information about how to request an external review of your case from an independent review organization.

Second Level Appeal — If the first level appeal is denied, you or your authorized representative may file a second formal request for internal review or member grievance. All requests must be filed within the stated timeframes. When your request for review or member grievance is received, you will get a letter about what to expect regarding the processing of your grievance. Once a decision is made, you will be notified in writing. You will be advised of any further appeal options including information about how to request an external review of your case from an independent review organization.

External Review — If your first and/or second level internal appeal is denied, you or your authorized representative may choose to request that an IRO review the case. The IRO will make a final decision. The IRO will communicate their decision to you. This decision will be final and binding on you, the plan and the carrier.

The appeals/grievance form can be found at www.bcbst.com/members/tn_state/resources/ or www.cigna.com/sites/stateoftn/index.html. Members will have 180 days to begin an internal appeal after a notice of an adverse decision. Notification of decisions will be made within the following time frames and all decision notices shall advise of any further appeal options:

  • No later than 72 hours after receipt of the appeal for urgently needed services
  • 30 days for denials of non-urgent care not yet received
  • 60 days for denials of services already received