By Gwen Tuttle
TSEA Compensation and Benefits Manager
Depending on your perspective, you may be pleasantly surprised to find that the summary of changes below for 2014 do not include many of the costs we have expected. There is a premium increase which doesn’t surprise most of us anymore. But with covered employees partnering together to make their health more of a priority, we are not experiencing increased costs in most of the benefit areas as have been passed on to employees in the past three years in the form of deductibles, co-pays, and out-of-pocket maximums.
Partnership and Standard PPO
• Charges included in the out-of-pocket co-pay maximum will further expand to include ER, chiropractic and urgent care in-network visits. This expansion will provide additional financial protection for members. Already included in the in-network co-pay/out–of-pocket maximum are primary care, specialist care, and substance abuse treatment
A Cigna Local Plus Network Will Be Added in Middle Tennessee
As a pilot program, Cigna will offer an additional network called Cigna Local Plus in the middle region for a two-year period. This is a narrower network than the current Cigna Open Access Plus network. For example:
• The network includes primarily HCA affiliated hospitals and Vanderbilt Medical Center.
• Baptist, St. Thomas, Middle Tennessee Medical, Williamson Medical Center, among others will NOT be included.
• The Cigna Local Plus Network will NOT have a carrier surcharge of $20/$40.
• As such, the Cigna Local Plus network will cost the same as BlueCross in Middle/East Tennessee.
• The current Cigna Open Access Plus network will still be available and the network carrier surcharge will apply.
• Premiums will increase by 5.5% in the Partnership and Standard PPOs. CLICK HERE to download premium charts.
• Step therapy for those taking human growth hormones will begin in 2014. Plan members who are currently taking a non-preferred brand of this prescription medication will NOT be grandfathered. A plan member must first try one of the two preferred brands before the plan will cover one of the non-preferred brands. This change affects a very small number of individuals.
• A pharmacy out-of-pocket co-pay maximum of $3,750 per individual will apply in-network for both the Partnership and Standard PPOs.
In 2014 every Partnership PPO plan member will be required to do two (2) things:
• Complete the online Well-Being Assessment (WBA) by March 15, 2014
• Get a biometric screening at their doctor’s office or at a worksite location between July 15, 2013 and July 15, 2014
In addition, plan members who are contacted by Healthways must participate in wellness coaching.
Plan members will NOT be required to report a preventive service or wellness activity to Healthways in 2014.