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Benefits Administration

Health Insurance

Eligible state, local education and local government employees may enroll in health coverage through the state group insurance program. Available options include the Preferred Provider Organization (PPO) which is available statewide, a Point of Service (POS) also available statewide or a Health Maintenance Organization (HMO) if available in your service area. There are specific guidelines regarding the time frame in which you and your eligible dependents must enroll. Please see the Insurance Handbook for specific information regarding eligibility and enrollment. To review a comparison of some common benefit categories for the healthcare options, please see the Medical Options Comparison. For specific information about benefits, refer to the appropriate Member Handbook and Provider Directory. All referenced materials are available on the Publications & Forms section or can also be obtained through your agency benefits coordinator.

To enroll, you must complete an enrollment/change application. If selecting an HMO option, a physician selection card must also be completed designating your primary care physician. The only time of the year when your healthcare selection may be changed is during the annual enrollment transfer period unless you move out of a designated service area.

Preferred Provider Organization (PPO)
The PPO is available statewide with claims administered by BlueCross BlueShield of Tennessee. Under the PPO, participants choose a network provider or a non-network provider. A network provider accepts a pre-negotiated fee. The participant is responsible for a percentage of the maximum allowable charge and an annual deductible. When a participant utilizes a non-network provider, care is paid at a percentage of the maximum allowable charge and charges above the maximum allowable are the patient's responsibility. Annual out-of-pocket maximums apply.

Point of Service (POS)
The POS is available statewide with claims administered by Cigna HealthCare. Under the POS, participants use in-network providers who have agreed to accept a fixed copayment. Use of out-of-network providers is covered at a percentage of the maximum allowable charge. Charges above the maximum allowable amount are the patient's responsibility. There are no deductibles or out-of-pocket maximums if you use in-network providers.

Health Maintenance Organization (HMO)
The HMO is available in many counties within the state. Under the HMO, all care is coordinated through a primary care physician. No benefits, other than approved emergency or urgent care, are paid apart from the HMO's network. Copayments are paid each time services are received and there are no deductibles or out-of-pocket maximums.