PERSONNEL
Personnel
Insurance (6.21)
PURPOSE
The purpose of this policy is to highlight the benefits of the
State Group Insurance Program, and other optional benefits approved
by the Tennessee Board of Regents (TBR) and the State Insurance
Committee.
POLICY
Regular, full-time Tennessee State University employees who are
scheduled to work at least 30 hours a week are eligible to participate
in all State and TBR sponsored insurance programs. Part-time employees
(as defined under Chapter 1004 of Public Acts of 1990) may be
eligible to participate under the 1450 rule: The employee must
have a total of 24 months of service and be scheduled to
work 1450 hours or more during the fiscal year. Employees
whose status changes so that they meet the eligibility requirements
as outlined may be insured if the necessary enrollment form(s)
is completed within thirty-one (31) days of the status change.
Participating employees will be provided at least thirty (30)
days notice when changes to insurance programs take effect (i.e.,
premium increase or decrease, reduction to or addition of benefits,
and other modifications to current provisions). More information
may be obtained in the State of Tennessee Group Insurance Program
Employee Handbook "Insurance Benefits Summary," or reference
to the Insurance Officer's Plan Document.
Available programs include:
State Sponsored Programs: TBR Programs:PROCEDURE
Basic Medical/Life and Accident Insurance TIAA Long Term Disability
Health Maintenance Organizations Provident Long Term Disability
Dental Plan Other State/TBR Programs:
Optional Special Accident Insurance Optometry Vision Care Plan
Optional Term Life Prescription Discount Program
Optional Universal Life Flexible Benefits Plan
Employee Assistance Program
ENROLLMENT/ELIGIBILITY PERIOD
The enrollment period for a new employee to join all of
the insurance plans is from the first day of employment until
the last day of the full calendar month of employment. The employee
must complete one full calendar month of active
service in order to be eligible to participate in the State and
TBR insurance plans. For example, if an employee begins work on
March l, the enrollment period ends March 31. If employment begins
after the first working day of the month, such as March l5, the
enrollment period ends April 30.
If you choose not to enroll during the initial enrollment period,
you must sign the refusal section of the enrollment form. If
you do not enroll during the initial enrollment period, you will
be considered a "late applicant." As a late applicant,
you must prove insurability by means of a physical examination
at your expense.
New employees who are eligible for insurance are initially informed
of the insurance programs during scheduled employee orientations
(conducted within the first two (2) weeks of employment). Employees
are provided appropriate booklets, brochures, and enrollment forms
and are presented an insurance video in the orientation session.
The Insurance Officer must have your completed enrollment form(s);
the correct premium must be deducted from your paycheck in advance
of the effective date (for most plans); and you must be actively
at work on the date that coverage becomes effective or the effective
date becomes the date you return to work. In order to insure eligible
dependents, they must be listed on the form(s) with the required
information: Social Security Number, name, date of birth, relationship
to you, acquire date, and student status, if applicable. In the
event the dependent is hospitalized on the effective date, the
coverage becomes effective on the day after being discharged from
the hospital. Benefits are not provided for dependents who are
not listed on the appropriate enrollment form(s), such as new
born, new spouse, adopted dependents, or dependents acquired through
marriage.
The employee selects one of the following types of coverage:
*If an employee's spouse is also employed by the State, both are
eligible for single coverage as individual employees. If there
are eligible dependent children, one State employee elects split
contract coverage to cover himself/herself and the dependent children,
and the spouse elects single coverage.
A. EFFECTIVE DATE OF COVERAGE
MEDICAL/BASIC TERM INSURANCE, BASIC ACCIDENT INSURANCE, AND
DENTAL INSURANCE: The effective date of the medical, basic
life and dental insurance would be the first day following completion
of one full calendar month of services.
OPTIONAL SPECIAL ACCIDENT INSURANCE also would be effective
on the first day of the month following completion of one full
calendar month of employment as outlined above.
OPTIONAL TERM LIFE AND OPTIONAL UNIVERSAL LIFE are effective
two months after the medical insurance becomes effective. For
example, if an employee reports to work on May lst, optional life
coverage would be effective August lst. If the employee reports
to work on May l5, coverage would be effective September lst.
B. LATE APPLICANT PROCESS
If an employee does not elect coverage for himself or dependent
during the enrollment period (as a new employee or when first
acquiring a dependent) employee and dependent are considered "late
applicants." All late applicants (i.e., employee and dependents
requesting insurance under the State Plan) must provide satisfactory
evidence of insurability by means of physical examinations. These
examinations must be paid for by the employee. The appropriate
forms may be obtained from the Personnel Office. The Insurance
Officer will be notified if coverage is approved and when it will
become effective. Late applicant procedures also apply to the
employee if he/she cancels coverage and later wishes to re-enroll.
Please note that even though you and/or your dependents have
correctly followed all steps of the late applicant process that
approval for coverage is not guaranteed. You are encouraged
to apply for coverage when you and your dependents are first eligible
rather than risk the possibility of being unable to obtain coverage
as a late applicant.
C. WAIVER OF LATE APPLICANT REQUIREMENTS
The late applicant procedures described above are waived when
an employee and/or dependents lose health insurance coverage through
the spouse's employer due to the death, divorce, or non-voluntary
termination of employment of the spouse. The employee must apply
in writing for this waiver within 60 days of the loss of
the spouse's coverage. Certain guidelines must be followed and
specific information must be submitted to apply for this waiver.
D. REINSTATEMENT OF COVERAGE
If an employee does not wish to continue his or her medical insurance
while on leave, the employee must terminate that coverage IN
WRITING BEFORE the date the leave of absence is to begin.
Coverage terminates on the last day of the month in which the
request was made.
Upon reinstating coverage for an employee that has been laid-off
or on an approved leave of absence, the employee must request
this reinstatement within thirty-one (31) days of his/her return
to work.
--If the employee returns within thirty-one (31) days of termination,
the employee may continue his insurance, if all other eligibility
requirements are met. The employee does not have to prove
insurability or satisfy a six-month, pre-existing condition.
--If the employee returns from leave within six (6) months of
the leave of absence, coverage will be reinstated on the first
day of the calendar month coinciding with or following the date
the employee returns to work without having to prove insurability
or satisfy a six-month, pre-existing condition (eligibility requirements
must also be met).
--If the employee returns to employment later that six (6) months
of termination, the employee will have the applicable waiting
period as a new employee and will be subject to the six-month,
pre-existing conditions (eligibility requirements must also be
met).
TBR PROGRAMS:
TIAA Long Term Disability: This plan assures that the employee
continues to receive income once he or she is no longer receiving
a paycheck. The effective date would be the first day following
completion of one full calendar month of service. Benefits, if
approved, are scheduled to begin on the 91st day of the disability.
(For Administrative/Professional employees and faculty only.)
Provident Long Term Disability Plan: The effective date
would be the first day following completion of one full calendar
month of service. Benefits, if approved, begin on the 9lst day
of the disability. (For all regular, full-time employees who are
scheduled to work at least 30 hours a week.)
OTHER STATE PROGRAMS:
OPTOMETRY VISION CARE PLAN
Under provisions of the OVC Plan, TSU employees and dependents
receive an eighteen (18) percent discount on both professional
services (annual eye examinations), materials (eyeglasses/contact
lenses), and medical treatment of common eye problems. This discount
applies only to payments in full and appointments with participating
doctors, presentation of a higher education identification card,
and your request for the entitled discount from the total fee.
PRESCRIPTION DISCOUNT PROGRAM
This program (under the Rx Care Network), reduces pricing on most
prescription medications for Basic Medical Plan participants and
their eligible dependents. To receive the best price available:
The pharmacist will electronically file the claim with the insurance
carrier. If you have met your medical plan deductible, you will
receive an Explanation of Benefits Statement and the appropriate
reimbursement within ten (10) days.
FLEXIBLE BENEFITS PLAN
Medical insurance premiums will automatically be paid with tax-free
salary affording the employee higher net pay. The employee must,
however, complete an enrollment form for other eligible benefits
each plan year as listed.
The plan is effective on the effective date of the medical and/or
dental insurance for new employees and January 1 for the new plan
year.
Employees electing not to participate must complete the "waiver"
for Medical Premiums Section of the enrollment form.
EMPLOYEE ASSISTANCE PROGRAM (EAP)
This program Combines employee assistance, mental health and substance
abuse benefits for employees covered under the Basic Medical Plan.
Employees not covered by the Basic Medical Plan can utilize the
program for access to a network of EAP specialists who are experienced
in dealing with marital, family, emotional, financial, and legal
issues.
All employees and dependents can receive six (6) free EAP counseling
sessions per problem. The EAP network also includes community-based
resources which may be free or available at special discounted
rates.
ANNUAL OPEN ENROLLMENT/TRANSFER PERIOD:
Each year, October 1 through November 15th, employees may enroll
in:
Transfer: from the Basic Medical Plan to an HMO, or from
an HMO to the Basic Medical Plan; to another Dental Plan Option;
and
Apply: for Optional Term Life and Universal Life Insurance
All transfers and enrollments become effective January 1 of the
ensuing year. Applications for participation in the optional life
plans, if approved for coverage, are effected in accordance with
the insurance carrier's designation.
For further information regarding Insurance Programs contact the
Personnel Department.
REFERENCES
State of Tennessee Group Insurance Program Employee Handbook "Insurance
Benefits Summary"
Insurance Officer's Plan Document