Medical Insurance and Wellness Benefits

 

What is the difference between Network S and Network P for medical insurance?

 

Network P and Network S are two network options through BlueCross BlueShield of Tennessee (BCBST).  Physicians and hospitals may be included in one or both networks depending upon the agreements that they make with BCBST.  Network P is more comprehensive, but Network S includes almost all the same physicians and hospitals as Network P.  The main difference for hospitals is that Memorial Hospital is not in Network S. 

 

What Chattanooga hospitals are not in Network S?

 

The Erlanger Hospital system and the Parkridge Hospital / Parkridge East systems are in Network S.  Memorial Hospital is not in Network S.  This also means that a number of physicians associated with Memorial Hospital are not in Network S. 

                       

What is the best way to find out if my provider is in Network S?

 

• Log on to the website www.bcbst.com and look for the “Find care” button. In your search select the Network S and the zip code or area that you wish to search. A list of the doctors in that specified area will be provided.  If you wish to search a different area, you can make that change and submit the search again. 

• You can also call (800) 565-9140 to speak with BCBST Member services to determine if a specific doctor is in the Network S. 

• And you can directly ask a specific provider through the provider's billing office.

 

Is Network S just a Chattanooga area Network?

 

Network S is a regional network and exists throughout the state of Tennessee.  Those enrolled must use Network S providers throughout the state to have in-Network coverage.  The one exception is in the event of an emergency.

                       

What if I have a child on my medical plan that lives outside TN?

 

Outside the TN regions, Network S works just like Network P.  To have in-Network coverage, the provider only has to be in the "Blue Network", that is, the national network of Blue providers. The one exception is in case of an emergency.

                       

What happens if I have a medical emergency while traveling outside of TN?

 

In case of an emergency you may not have your choice of providers.  You should receive treatment in accordance with the emergency, keep your records of the treatment from the provider or the facility and file the claims. If the provider happens to be in the “Blue Network”, then your claim will most likely be filed at the time of service.  In other cases the provider may be able provide information to your insurer or file your claim for you.

           

What do I do when I have a qualifying life event and how does it affect my premium?

 

First you can call the Benefits Office to confirm that you have had a life event that is a qualifying life event for adjusting your health insurance coverage.

 

If you have a qualifying life event, you have 31 days from the effective date of the qualifying event in order to make the change to your coverage.  This rule is communicated at orientation, in the Employee Benefits Guide, and in the emails and other communications surrounding open enrollment.  If you wait 32 or more days, you have missed the opportunity to make the qualifying change and you must wait to the next open enrollment to make your change.

 

The change to your coverage will be effective on the date of the qualifying event, regardless of the number of days you wait to make the change to your coverage.  Your premium will be adjusted based on the effective date of the qualifying event and may require collection of additional premium in the payroll deduction. For example, adding a newborn child and changing from employee and spouse coverage to family coverage will require that you pay the difference in premium from the date the child was born in order to cover the child.

 

What are the rules for making a change due to a qualifying life event?

 

A qualifying life event is a change in your personal life circumstances that may impact your eligibility or your dependent’s eligibility for benefits.

 

Each year at open enrollment, you have the opportunity to make changes to your coverage as you plan for known events in the coming year.  Open enrollment is the ideal time to make changes to your coverage.  The choices you make during open enrollment are in effect from the first day of the plan year for the full plan year.

 

However, sometimes unexpected life events occur or the timing of an expected life event may change.  Some examples of qualifying life events are:  change in legal marital status (marriage, death of spouse, divorce, legal separation, or annulment); change in number of dependents (birth, death, adoption or placement for adoption); change in employment status; dependent ceases to qualify (age, student status, marital status, or other circumstance).

 

If such a life event occurs, you have 31 days from the date of the life event to make the change to your coverage or your dependent’s coverage.  The coverage change will affect the premium rate for the coverage from the date of the life event.  If no action is taken within the 31 day window, you must wait until the next open enrollment opportunity to make the change to your coverage. 

 

Where can I find out whether my doctor is in the health insurance network?

 

For medical, contact BlueCross BlueShield to determine if a doctor or pharmacy is in the network.  You can call (800) 565-9140 or log on to the website to check the directory. The website is www.bcbst.com/members/chattanooga/.

           

For dental, contact Cigna to determine if your dentist is in the network.  The best network level for dental benefits is the ‘Advantage’ level.  You can call (800) 244-6224 or log on to the website to check the directory.  The website is www.mycigna.com.  You will look for a ‘green’ indicator for the Advantage network level.

 

For vision, contact BlueCross BlueShield to determine if your eye care provider is in the network.  You can call (877) 342-0737 or log on to the website to check the directory. The website is www.bcbst.com/members/chattanooga/.

 

 

What is the definition of certain basic health insurance terms – copay, deductible, coinsurance, out of pocket maximum?

 

Copay – A fixed amount you pay for a covered health care service at the time of service.  The amount can be different for a different service.

 

Deductible – The amount you owe for health care services covered by your health insurance plan before the health insurance plan begins to pay.  The deductible may not apply to all services covered by the plan.  As an example, if the deductible is $1,000, your plan will not pay anything for covered services subject to the deductible until you have paid $1,000 for the covered services.

 

Coinsurance – Your share of the costs of covered health care services, after you have met your deductible, expressed as a percentage of the allowed amount of the services.  The health insurance plan pays the rest of the allowed amount.  (The “allowed amount” is the maximum amount on which the health plan payment is based for covered health care services.  It may be called “eligible expense”, “payment allowance”, or “negotiated rate”.)

 

Out-of-Pocket Maximum – This is the most you will pay during a plan year before your health insurance begins to pay 100% of the allowed amount. 

• You will still pay your premium. 

• If you are balance billed for any covered health care services, you are responsible for paying those amounts. 

• If you receive care for a service that is not covered by the health care plan, you will be responsible for paying those charges. 

 

Your Explanation of Benefits provided by BlueCross BlueShield of Tennessee will keep up with your progress during the plan year toward your deductible and out of pocket maximum.  If you have questions about any portion of the summary, you must contact BlueCross BlueShield of Tennessee.

           

Disability Insurance

 

I am enrolled in Short-Term Disability and now I need to make a claim. What do I do?

 

You will need to contact Symetra to initiate your short-term disability claim. The phone number is 1-800-426-7784.

 

What is the Long-Term Disability (LTD) benefit?

 

The City, along with the General Pension Plan, offers a Long-Term Disability benefit to members of the General Pension Plan. The plan protects a full-time employee from loss of income in the event that he or she is unable to work due to illness, injury, or accident for a long period of time. This benefit will replace lost income after the member has fulfilled the six (6) month elimination period and is determined by the insurer to be totally disabled from his/her own occupation.  The plan pays 60% of the pre-disability earnings rate but not more than $5,000 per month. The plan benefit will not be less than $100 per month.

 

Other things to note about the benefits:

 

1. If the injury or accident occurs on the job, then you will first need to apply for Injured on Duty (IOD) benefits.

2. You do not have to be vested in the pension plan to apply for Long-Term Disability benefits.  You are eligible for benefits once you have completed a six (6) month employment period from the date of hire.  And you must fulfill the six (6) month elimination period to qualify for benefits.

3. You may have enrolled in short-term disability which will provide income replacement during the six (6) month elimination period for the long-term disability.

4. Long-term disability benefits protect you from loss of income if you are unable to work for a long period of time.  If you continue to be totally disabled after the first two years of your long term disability, payments may continue while you are totally disabled until you have reached your social security normal retirement age.

5. Your long-term disability benefits will be taxable for income tax purposes since you did not pay the premium for the benefits. 

6. You may be required by the insurer to file for social security disability benefits.  It is important to comply with this requirement in order to continue to receive your LTD benefits whether you qualify for social security disability benefits or not. 

 

How do I apply for Long-Term Disability (LTD)?

 

You will need to contact Symetra to initiate your long-term disability claim. The phone number is 1-800-426-7784.If you are currently on a short-term disability claim that may become a long-term disability claim, you can have that conversation during the course of your short-term disability claim.

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Life Insurance

 

How do I change my beneficiary designation?

 

• Basic Life and AD&D - Beneficiary designations for the City Basic Life and ADD are made through the Oracle system shortly after orientation is completed or when the employee initially enrolls in benefits.  If the employee enrolls in Supplemental Term Life insurance, the beneficiary designation for that coverage is made at the time of enrollment.

  • If a change in beneficiary designation is desired for these benefits, the employee will need to log in to Employee Self Service and navigate to the appropriate page to make the change online. 

• General Pension Plan - Beneficiary designations for the General Pension Plan (Plan) are made shortly after orientation is complete.  A beneficiary designation form is included in the orientation packet.  Since contributions are mandatory, the employee needs to complete the beneficiary designation so that the contributions can be refunded to the beneficiary if the employee dies before vesting in the Plan. 

  • The beneficiary designation can be changed as necessary to reflect changes in life or family circumstances. Contact the plan administrator to obtain a beneficiary designation form.  The most recently dated form will be used to establish the beneficiary for payment of benefits should the employee die prior to retirement.

  • At retirement, the employee has the opportunity to establish the beneficiary for the retirement benefits by continuing the existing designation or completing a new form.

  • Beneficiary designations for Wages Payable at Death are made shortly after orientation is complete.  If an employee dies in service, any remaining unpaid wages will be paid to the beneficiary designated on this form.  The beneficiary designation can be changed to reflect changes in life or family circumstances. Contact the Human Resources Records Coordinator to obtain the beneficiary designation form.

 

If I separate from service with the City, is the life insurance benefit portable?

 

• The Basic Life and ADD coverage may be retained after separation as term life insurance coverage or converted to permanent coverage.  A form is provided by the carrier at the time of separation for the employee to make the appropriate choice.  The employee does not have to keep the coverage, but if he/she chooses to do so, the premiums are paid directly to the carrier.

• The Supplemental Term Life insurance purchased by the employee is portable after separation from service and, if the employee chooses to port the coverage, the premiums are paid directly to the carrier.

• The Whole Life insurance purchased by the employee through Unum is completely portable because the contract is with Unum and the policy is fully owned by the employee.  At the time of separation, the employee merely pays Unum directly for the policy.

 

The City provides Basic Life & ADD coverage for each employee based on salary and also offers Supplemental Term Life insurance.  What is the difference and how does each plan work?

 

The Basic Life & ADD Insurance provided by the City is limited to one times your salary up to $50,000.  The amount of insurance for each employee is based on the current salary but set at the next whole thousand.  (For example, if the salary is $34,582, the coverage is $35,000).  The coverage cannot exceed $50,000.

 

The Supplemental Term Life insurance offered to a newly hired employee and at open enrollment is additional term life insurance that an employee can purchase.  The rules for a new hire who is enrolling when first eligible are different than for those who are enrolling for the first time at open enrollment or adding to existing coverage. 

 

There is a guaranteed issue amount for the employee and for the spouse where the coverage will be issued without any health related questions asked.  Any amounts applied for above the guaranteed issue limit will require that the employee or spouse answer health related questions to establish the current health status.  Based on the answers to those questions, the insurer may issue all or only a portion of the requested amount.

 

An employee who has a child or children can purchase the child coverage in an amount up to $10,000. When purchasing child coverage, each child that is designated at the time of enrollment will be covered under the single policy. 

 

Deferred Compensation (Supplemental Retirement Plans)

 

How do I enroll in a Deferred Compensation (457) Plan?

 

To enroll in one of the Deferred Compensation plans, contact Lindsay Lacy in the Finance Department. Her phone number is (423) 643-7382 and her email is llacy@chattanooga.gov.

 

Representatives of certain of the Deferred Compensation plans come to Chattanooga periodically.  You may attend one of those meetings to learn about the program and initiate your enrollment.

           

 

How can I change my contribution to my 457 plan?

 

Contact Lindsay Lacy in the Finance Department.  Her phone number is (423) 643-7382 and her email is llacy@chattanooga.gov.  She will send you the form you need to complete for your plan.  Your change in contribution will be reflected in your payroll deductions once the form is processed.

 

           

What happens to my 457 plan when I retire?

 

You may continue to maintain your 457 plan after you retire.  Any changes or withdrawals you wish to make will be administered by representatives of your plan. 

 

If you wish to terminate your account or withdraw some or all of your funds from the 457 plan, you must consider the tax consequences.  The IRS requires an automatic 20% withholding on withdrawals from these plans.  A better choice may be a rollover/transfer to another qualified plan.  “Another qualified plan” includes an IRA you may set up at your financial institution.

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