Health Insurance

For 2018, members can choose from Preferred Provider Organization (PPO) options or a Consumer Driven Health Plan (CDHP) option.

The following health insurance options are available (if you qualify):

  • Premier PPO
  • Standard PPO
  • Limited PPO  (local education and local government members only)
  • CDHP/HSA 
  • Local CDHP/HSA (local education and local government members only)

Members may also choose from the following three health insurance carrier networks:

  • BlueCross BlueShield Network S
  • Cigna LocalPlus
  • Cigna Open Access Plus (monthly surcharge applies)

All three  networks have providers available across Tennessee. Doctors and facilities in the networks can change. Check the networks carefully for your preferred doctor or hospital when making your selection.

Health Insurance Carrier Information »

There are specific guidelines regarding the time-frame in which you and your eligible dependents must enroll. Please see the eligibility and enrollment guides for specific information. To review a comparison of some common benefit categories for the healthcare options, please see the insurance comparison charts. For specific information about benefits, refer to the appropriate member handbook and provider directory. All referenced materials are available on the Publications and Forms sections or can also be obtained through your agency benefits coordinator.

All options cover the same services and treatments, but medical necessity decisions may vary by carrier. Free in-network preventive health services are covered by each option. 

Below is information about costs and how plan options work. Refer to the comparison chart or member handbooks for the plans' deductibles, copays, coinsurance and out-of-pocket maximum amounts.

Annual Deductible All options include an annual deductible. You pay this amount out of pocket before the plan pays for services that require coinsurance.
Coinsurance Some services require that you pay coinsurance after you meet a deductible. Coinsurance is a percentage of the total cost.
Copays Some services require that you pay a copay (instead of a deductible and coinsurance). A copay is a flat dollar amount, like $25 for a doctor's visit.
Out-of-Pocket Maximum The out-of-pocket maximum is the most you will pay for your copays and coinsurance each year. Once you reach your out-of-pocket maximum, the plan pays 100% of covered medical expenses.
In-Network vs. Out-of-Network Providers You can see any doctor or go to any healthcare facility you want. However, if you use an "in-network" provider, you will always pay less. That's because an in-network provider agrees to provide services to our members at discounted rates. Broad networks of doctors and hospitals are available.

Additional Enrollment Information

Please see the Publications section of this website to view a comparison of covered services and detailed member handbooks. Enrollment applications are available on the Forms Page.

Medical Service Appeals

If you are a plan member in disagreement with a decision or the way a claim has been paid or processed, you or your authorized representative should first call member service to discuss the issue:  BlueCross BlueShield of Tennessee 800-558-6213 or Cigna 800-997-1617.

First Level Appeal — If the issue cannot be resolved through member service, you or your authorized representative may file a formal request for internal review or member grievance by completing the appropriate form or as otherwise instructed. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgement letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of your case from an independent review organization (IRO).

Second Level Appeal — If the first level appeal is denied, you or your authorized representative may file a second formal request for internal review or member grievance by completing the appropriate form or as otherwise instructed. All requests must be filed within the specified timeframes. When your request for review or member grievance is received, you will get an acknowledgement letter advising you what to expect regarding the processing of your grievance. Once a determination is made, you will be notified in writing and advised of any further appeal options including information about how to request an external review of your case from an independent review organization (IRO).

External Review — If your first and/or second level internal appeal is denied, you or your authorized representative may choose to request that an IRO review the case and make a final determination. The IRO will communicate their decision to you. This decision will be final and binding on you, the plan and the carrier. The IRO will communicate their decision to you. This decision will be final and binding on you, the plan and the carrier.

The appeals/grievance form can be found at www.bcbst.com/members/tn_state  or www.cigna.com/sites/stateoftn/index.html. Members will have 180 days to initiate an internal appeal following notice of an adverse determination. Notification of decisions will be made within the following time frames and all decision notices shall advise of any further appeal options:

  • No later than 72 hours after receipt of the claim for urgent care
  • 30 days for denials of non-urgent care not yet received
  • 60 days for denials of services already received