- Who has been involved
in planning the redesign of the health
insurance program?
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- 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.
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- Why are the benefits
changing?
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- 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.
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- Who can join the
Partnership PPO?
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- 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.
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- What is on the health
questionnaire?
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- 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.
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- What does the health
screening involve and when does it have to
be done?
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- 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.
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- Who has to complete
the health questionnaire and get a health
screening?
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- 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.
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- What happens if my
doctor disagrees with the recommendations of
APS Healthcare?
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- 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.
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- Will my current
health care providers be in both PPO
networks?
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- Can I change my
choices after the October 15th deadline?
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- 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.
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- What if I am
currently enrolled in health insurance and I
don't do anything during the enrollment
period?
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- 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.
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