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
800.997.1617
24/7
cigna.com/stateoftn

2026 Benefits Changes

Most member health plan cost sharing, such as deductibles and coinsurance, will stay the same except for the following changes:

For 2026, pharmacy costs are increasing mainly due to weight loss and specialty medications. Here are the 2026 pharmacy cost-sharing changes:

  • Members will pay 25% coinsurance for medications prescribed for weight loss for all plans.
  • Members will pay 30% coinsurance for in-network specialty medications for all plans.
  • A separate maximum out-of-pocket amount will be added for specialty drugs obtained through the pharmacy benefit. The amount varies based on employee tier and plan selected.

Personalized exercise therapy benefits are changing for 2026! All Partners for Health PPO and CDHP members enrolled with BlueCross BlueShield or Cigna will have access to Hinge Health for personalized exercise therapy at no additional cost.

 

ID Cards

Newly enrolled members or members who made changes to their health plan options for 2025 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.

Find all  premiums

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.

Find the 2026 benefit comparison for state and higher education[JW1] Find the 2025 benefit comparison chart 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 your 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.

Find the 2026 benefit comparison for local education and local government.[JW1] Find the 2025 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 and coinsurance.

All health care options cover the same services and treatments, but medical necessity decisions may vary by carrier. Eligible care billed as preventive is free if you use an in-network provider. Ask your doctor about your recommended preventive services.  

 

Vaccinations

Vaccines authorized by the FDA are covered in accordance with CDC recommendations. Members may get recommended preventive vaccines at no cost through their doctor’s office.  (Note: if you are at your doctor’s office for another reason or illness when you get your shot, the doctor may charge for an office visit.) Members can also use their medical benefits at an in-network immunizing pharmacy or retail convenient care clinic by following the instructions below. For additional information about your Partners for Health coverage for vaccinations, visit the Pharmacy webpage.

 

BlueCross BlueShield members – Go to bcbst.com and click on Find Care

  1. Log in to autofill your information or choose either BlueCross BlueShield Network S or BlueCross BlueShield Network P for Tennessee providers or BlueCard PPO (outside Tennessee) for out-of-state providers.
  2. Enter your location if you need to, then type either Immunizing Pharmacist or Retail Convenient Care Clinic in the search bar and select it from the dropdown.

 

Cigna members

  1. Major participating pharmacies in your network that offer vaccines include: Kroger, Publix, Rite Aid, Food Lion, Costco, Sam’s Club, Walgreens and Walmart which includes their family of pharmacies. You can ask your local pharmacy if they can bill Cigna and if so, present your Cigna ID card.
  2. You can also search your Local Plus or Open Access Plus network at Cigna.com for Convenience Care (Retail/Pharmacy) Clinics in your area.

 

For more information, visit the following resources:

 

Receiving 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 Health. Go to the behavioral health page to learn more.

Medical Service Appeals

If you’re 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 due to medical necessity, you or your authorized representative may request that an independent review organization review the case. The IRO will make a final decision, and  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 https://www.bcbst.com/members/tn_state/resources/ or https://stateoftn.cigna.com/. 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