By Gayle Robb
TSEA Comp and Benefits Manager
The State Group Insurance committee met Thursday, June 30th in Nashville. Items discussed during the meeting were approval of contract to offer Short Term/Long Term Disability insurance options to state and higher education employees for 2017. The plan design and more detailed information will be available soon.
The Equal Employment Opportunity Commission (EEOC) recently released rules regarding wellness plans that will require changes to bring the state’s Partnership PPO and Wellness HealthSavings CDHP into compliance. Plans can no longer deny health care coverage or limit benefits or options under the plan if an employee refuses to answer a disability-related inquiry or take a medical examination, including those inquiries or examinations that are part of a health risk assessment or biometric screening. For this reason, there will be an added premium level for employees who do not wish to participate in the required examination. The category will be different than the Standard PPO.
For 2017 members will have an additional network to choose from through Cigna. This network will be in addition to the current BCBST Network S and Cigna Local Plus network. OAP is Cigna’s broad network and they have agreed to add providers and facilities at the state’s request. BA recommends a monthly employees surcharge for those members who choose to enroll in this network option.
BA recommended for the 2017 Partnership Promise employees will be required to complete the annual Well-Being Assessment (WBA) and biometric health screening as well as keep their contact information up to date. Those identified for disease management and case management coaching must also participate in the coaching program, if contacted. Lifestyle management (LM) coaching will be voluntary.
Compensation and Benefits staff will have additional information in the next few weeks and will share this information as soon as we are certain of the changes in premiums and out of pocket categories.
Benefits Administration’s proposed benefit option changes for 2017
• Deductibles and maximum out of pocket limits
• Pharmacy co-pay adjustments
• Specialty Pharmacy Tier added to the plan
• Emergency Room co-pay increase
• Co-insurance for labs, ex-ray and diagnostics
(preventive services still covered at 100%)
• Combining medical and pharmacy maximum out-of-
• Including brand obesity medications for weight loss
• Reduction in Telehealth co-pay