Common Questions and Answers

  • Who has been involved in planning the redesign of the health insurance program?
 
  • The University of Tennessee participates in the State and Higher Education health insurance plan offered by the State of Tennessee.  This is the same plan offered to State of Tennessee employees and Tennessee Board of Regents employees.  The State and Higher Education Insurance Committee is responsible by law for any changes to benefits and has been working on the redesign since May of 2008.  Higher Education does have a representative on the committee.
  • Why are the benefits changing?
 
  • The state insurance plan is self funded.  When combined with contributions by the state and deductions from other state employees, funds contributed by the University and funds deducted from your paycheck must be able to pay for the expenses of the plan.  Currently, the costs of the plan are higher than the premiums coming in.  In fact, the plan expenses have doubled over the last eight years.
  • Who can join the Partnership PPO?
 
  • Anyone eligible for health insurance can join the Partnership PPO.  You do not have to be young, healthy, or fit.  You can have high blood pressure or any other chronic condition.  You can be overweight or a smoker.   You will need to complete the health questionnaire, complete the health screening, and commit to recommended follow up care to remain on the Partnership PPO for 2012.  If you do not complete the questionnaire or get the health screening by June 30, 2011, you will not be allowed to enroll in the Partnership PPO again for 2012.  All of your 2011 claims will be paid and you will continue membership in the Partnership PPO for the remainder of the calendar year.
  • What is on the health questionnaire?
  • The questions are not much different from what you would expect to be asked on the medical history form you complete for your doctor.  It includes a series of questions about your age, what you eat, how much you exercise, and whether you use tobacco or alcohol.  The State of Tennessee will not make the questionnaire available until January.
  • What does the health screening involve and when does it have to be done?
  • The health screening will include your height, weight, blood sugar, blood pressure, and cholesterol levels.  This information can be provided based on any tests or screenings conducted after July 1, 2010.  If you have already had a physical or screening, your doctor can use those results to complete the screening form.  After the screening form becomes available in January, you can just take the form to the doctor's office with you.  The screening will have to be completed by June 30, 2011.  Remember that annual physicals will not require a co-pay in 2011 and will be free to plan members.
  • Who has to complete the health questionnaire and get a health screening?
  • For employee only coverage, the employee must complete the health questionnaire and get the health screening.  For employee + spouse and employee + family coverage, both the employee and spouse must complete  the health questionnaire and get the health screening.  Dependent children do not have to complete the questionnaire or get the health screening.
  • What happens if my doctor disagrees with the recommendations of APS Healthcare?
  • The orders of the primary care physician will control the members healthcare.  The APS Healthcare coach's role is to provide information and support - not a prescriptive plan that a member must follow.  The member can choose the health risk(s) on which they want to focus and work with both their health care coach and primary care provider to develop a plan that is clinically appropriate.
  • Will my current health care providers be in both PPO networks?
  • Can I change my choices after the October 15th deadline?
  • You cannot change your mind after the October 15th deadline.  Unless you have a Qualifying Event (marriage, birth, drop of spouse's insurance coverage at other job), you will not be allowed to change your selection until the next annual enrollment period.  Additionally, you will not be allowed to enroll at a later date without a Qualifying event.  The medical underwriting alternative no longer exists.
  • What if I am currently enrolled in health insurance and I don't do anything during the enrollment period?
  • You will automatically be enrolled in the Standard PPO with the lowest cost carrier in your region (Cigna in West and BlueCross in East and Middle).  As a result, you will have no choice in reviewing your provider network and will not be rewarded for taking an active role in your health management.  This selection cannot be changed until the enrollment period for next year.

Insurance Continuation

 

Contact

Robert C. Chance

Director

P115 Andy Holt Tower

Knoxville, TN 37996

865-974-5251 Phone

865-974-3530 Fax