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Health Insurance

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

Cigna
800.997.1617
24/7
cigna.com/stateoftn

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Eligible employees can choose from the following health insurance options.

Each option has different cost sharing—your out-of-pocket costs for copays, deductibles, coinsurance and out-of-pocket maximums. For all options, you won’t pay anything for in-network preventive care.

Premier 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

Local education and local government members only:  Lower premiums than the other PPOs―but you’ll pay more out-of-pocket for deductible, copays and coinsurance compared to the other PPOs.

CDHP/HSA   

State and higher education members only: Lowest premiums―but you pay your deductible first before the plan pays anything for most services, and then you pay coinsurance, not copays.

  • You get a health savings account (HSA) to help you save for your healthcare now and in the future, and it offers tax benefits.  You can use it for qualified healthcare expenses, including your deductible and to save for retirement.
  • State puts $250 employee only/$500 family tiers* in your HSA (if enrolled prior to Sept. 2, 2019). This money applies to your maximum contribution.
  • Take the savings from your lower premium and put them in your HSA to cover your deductible! Your HSA balance carries over each year.
  • Go to the CDHP/HSA page to learn more.

*The state HSA funding will be $250 employee-only/$500 for all other tiers. State contribution is not available for coverage starting Sept. 2, 2019, through the end of 2019.

Local CDHP/HSA 

Local education and local government members only:  Lowest premiums―but you pay your deductible first before the plan pays anything for most services, and then you pay coinsurance, not copays.

  • You get a health savings account (HSA) to help you save for your healthcare now and in the future, and it offers tax benefits.  You can use it for qualified healthcare expenses, including your deductible and to save for retirement.
  • Take the savings from your lower premium and put them in your HSA to cover your deductible! Your HSA balance carries over each year.
  • Go to the CDHP/HSA page to learn more.

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

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

    All healthcare options cover the same services and treatments, but medical necessity decisions may vary by carrier.

    Need information on behavioral health?

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

How plan options work

CDHP
Consumer-driven health plan, a type of medical insurance or plan that generally has a higher deductible and lower monthly premiums. Typically, you take responsibility for covering your health care expenses until your deductible is met. Once you meet your deductible, coinsurance applies up to the out-of-pocket maximum.  
Coinsurance Some services require that you pay coinsurance. Coinsurance is a percentage of the total cost.  
Deductible All options include an annual deductible. You pay this amount out of pocket before the plan pays for most services that require coinsurance.  
Cost Sharing
The share of costs not covered by your insurance that you pay out of your own pocket.  
Copay
Some services require that you pay a copay. A copay is a flat dollar amount, like $25 for a doctor's visit.  
Network A group of doctors, hospitals, facilities and other healthcare providers contracted with a health insurance carrier to provide services to plan members for set fees.  
Out-of-Pocket Maximum The out-of-pocket maximum is the most you will pay for your copays, dedutible and coinsurance each year. Once you reach your out-of-pocket maximum, the plan pays 100% of covered medical expenses.  
In-Network vs. Out-of-Network Providers You can see any doctor or go to any healthcare facility you want. However, if you use an "in-network" provider, you will always pay less. That's because an in-network provider agrees to provide services at discounted rates.   
Plan The State of Tennessee Group Insurance Program, including state-sponsored PPO and CDHP/HSA plan options. The plan provides or pays a portion of the cost of medical care and determines how much you pay in premiums, copays and coinsurance.  
PPO Preferred provider organization, gives plan participants access to a network of doctors and facilities that charge pre-negotiated (and typically discounted) fees for the services they provide to members. The benefit level covered through the plan depends on whether the member visits an in-network or out-of-network provider when seeking care.  

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

BCBST
Cigna

Carrier Network Options

You choose one of the following networks of providers (doctors, hospitals, facilities) when you enroll in a health insurance option:

  • BlueCross BlueShield Network S
  • Cigna LocalPlus
  • Cigna Open Access Plus (monthly surcharge applies)

All three networks have providers available across Tennessee and the country. Doctors and facilities in the networks can change during the year. Check the networks carefully for your preferred doctor or hospital when making your selection.

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 (IRO).

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 (IRO).

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  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