Frequently Asked Questions
Below are answers to many of your most frequently asked questions. Click the question to reveal/hide the answer.
What qualifies me for health insurance eligibility?
You must be a permanent full-time employee regularly scheduled to work at least 30 hours per week.
Is health insurance coverage automatic?
No, COVERAGE IS NOT AUTOMATIC, you must enroll in this program. This is done by completing an enrollment form. An employee must elect coverage the first 31 days of employment, if coverage is declined at that time, an employee must wait until open enrollment unless there is a life-changing event, which would give the employee 31 days from the event to enroll.
Is enrolling in this health insurance plan MANDATORY?
Is there a cost to have this insurance?
Yes, premiums are based on the coverage elected. The premiums will be deducted from you paycheck based on elections. Montgomery County Government pays 85% of the monthly premium for a full-time employee.
The current coverage options and rates are:
|Preferred Option 1 ||Employee Pays Monthly |
|Individual = $721.78 ||$108.28|
|2-Party = $1,415.60 ||$212.28|
|Family = $1,694.50 ||$254.16|
|Standard Option 2 || |
|Individual = $469.74 || $70.46 |
|2-Party = $921.00 ||$138.16 |
|Family = $1,109.70 ||$172.36 |
|PPO + Bridge Option 3|| |
|Individual = $495.16|
|2-Party = $970.82|
|Family -= $1,162.44|
What is a Pre-tax deduction?
A pre-tax deduction is when your share of your health insurance premium is deducted from your gross wages before taxes are withheld in order to lower your taxes. However, when pre-tax benefits are available you are limited in the types of changes you can make to your plan outside of the annual open enrollment period, with the exception of a qualifying event such as marriage, birth of a child, adoption of a child, you have a change in job status that affects coverage, and death or divorce. When a qualifying event occurs, an employee has 31 days to make changes.
What is the NAME of my health insurance plan?
Clarksville-Montgomery County Employees Insurance Trust
What does my coverage include?
Major medical including hospitalization, surgical and prescription drug coverage.
What is the EFFECTIVE DATE of my insurance coverage?
The first of the month following a 30 day waiting period. Premiums are deducted one month in advance.
Can my dependents be covered on my plan?
Yes, eligible dependents include your spouse, unmarried, natural, legally adopted, or stepchild or children of the employee or employee's spouse. The dependent child limiting age will be to age 26. Dependent coverage will end on the last day of the month after reaching the dependent child limiting age.
Can I enroll or make changes in coverage at anytime?
No, changes are made during open enrollment or within 31 days of a life-changing event.
What is a deductible?
The amount of out of pocket expenses you must pay before your insurance will begin to pay. Currently, our Preferred Plan individual deductible is $350 and family deductible is $875 per calendar year. The Standard Plan individual deductible is $2,0000 and family deductible is $5,000 per calendar year.
What is a participating provider?
Participating providers are independent physicians who have agreed to participate with your plan. These preferred network providers have agreed to special pricing for patients with BlueCross BlueShield of Tennessee, which means lower out-of-pocket expenses for you. Our health plan is in the Blue S Network . Please verify with your physician's office that they are a participating provider in the Blue S Network.
What are MC's wellness benefits?
You can go to www.bcbst.com and register to access My Health and Wellness tab to see discounts to gyms as well as access health management tools and resources to help you reach your wellness goals and point you toward healthier living. You can also access the Alive & Well Program through the Onsite Health and Wellness Clinic.
How do I contact Member Services?
The number to Member Services is 1-800-565-9140 or www.bcbst.com.
What do I do if I need mental health or substance abuse care?
Magellan Health Services can supply information concerning the mental health and substance abuse benefit structure and details concerning available providers for this type care. The number to Magellan Health Services is 1-800-424-4039 or the web address is www.magellanhealth.com. This is also covered under our BCBS Medical Insurance.
What if I am not sure if a service is covered?
If you are unsure about whether a procedure, type of facility, equipment, or any other expenses is covered by our medical plan contact Member Services at 1-800-565-9140.
What is a formulary?
A formulary is a list of prescription medications, which designates products approved for coverage by EpiphanyRx and will be dispensed through participating pharmacies to members. This list is subject to periodic review and modification by EpiphanyRx.
Can I be reimbursed through my medical flexible spending account for any out-of-pocket medical expenses?
Yes, you may set aside pre-taxed money in your medical flexible spending account for reimbursement of qualifying out-of-pocket medical expenses.
How can I tell what my co-pay will be for a specific drug?
Go to www.epiphanyrx.com/resources and look at the Drug Formulary to see the Tier listed for particular medication. EpiphanyRx can be reached at 844-820-3260.
What should I do if I am in an area where our network providers are not available and need health care services?
Call the BlueCard/Blue Card PPO Participating Doctor and Hospital Information Line at 1-800-810-BLUE (2583); you will be helped in locating the nearest BlueCard/BlueCard PPO Participating Physician or Hospital. Your benefits will be covered as in-network benefits.
What should I do if I travel out of the United States?
Through the BlueCard Worldwide Program, you have access to participating hospital network and referrals to doctors in major travel destinations throughout the world. When you need to locate a hospital or doctor, you can call the BlueCard Worldwide Service Center at 1 (800) 810-BLUE or call collect at 1 (804) 673-1177, 24 hours a day, 7 days a week.
Can I use any local pharmacy?
You will need to verify that the pharmacy is in the EpiphanyRx Network.
What should I do if my health insurance deduction from my paycheck is incorrect or not being deducted at all?
Contact the Human Resources Office right away at 648-5715. Our office is open Monday – Friday 7:30 am to 4:30 pm.
When does my coverage end?
Your coverage will end on the last day of the month in which your employment ends. If you are leaving employment with Montgomery County Government you will receive information from Blue Cross Blue Shield about continuing your coverage under COBRA.
What Dental Coverage do we have?
Our Dental coverage is through Blue Cross Blue Shield's PPO plan known as DentalBlue. We have two plans: Option 1 and Option 2.
Can I visit any dentist or specialist or only certain ones?
With the Blue Cross Blue Shield of Tennessee plan, you and your family members are free to visit any network or non-network dentist or specialist, any time you need care. However, when network dentists are used, you will usually spend less out of pocket. If you select a Dentist, who is not participating in the Preferred Dental Care Plan (an out-of network dentist) they can bill you for any amount not covered by our Dental plan. In addition, if you select an out-of network dentist, you must file the claim yourself. To reduce your out-of-pocket expense you should receive services from a network dentist.
Do all my covered family members have to go to the same network or non-network dentists?
No. In fact, every family member could go to a different network or non-network dentist or specialist, every time care is needed.
What types of dentists are considered specialists and do I need a referral to see one?
Specialists include endodontists, periodontists, prosthodontists, and oral and maxillofacial surgeons. No referral is needed in order to see a specialist. If either a network or non-network general practicing dentist suggests you see a specialist, they may recommend one to you – but you are always free to see any specialist you’d like, or choose one from your Blue Cross Blue Shield of Tennessee dental provider directory.
How can I find a network dentist or specialist near me?
You can locate a dentist by going to www.bcbst.com under Find a Doctor. Select Dental as your Network. What is a plan deductible and/or annual maximum?
A deductible is the dollar amount of covered dental expenses you must pay during the year before Blue Cross Blue Shield of Tennessee pays benefits. An annual maximum is the maximum amount your dental plan will pay in benefits during the year. Both are generally based on the calendar year. Deductibles and annual maximums apply per covered person (3 max per family).
What is co-insurance?
For some service categories, you may share in the cost of your dental expenses. This is represented as a percentage of the negotiated fee for covered services. The percentage of co-insurance usually depends on the type of service received (preventive, basic, or major). Network services are typically reimbursed at a higher co-insurance percentage.
What is a negotiated fee-for-service?
This refers to the set maximum fees for services that have been negotiated with Blue Cross Blue Shield of Tennessee contracted network dentists and specialists.
If I choose to visit a non-network dentist, will I spend more out-of-pocket?
Possibly. That is because when you or family member sees a non-network dentist; your non-network service charges will be paid for only up to the maximum fee level established with our contracted network dentists. Therefore, any amount above the maximum fee level is your responsibility. You may also have to pay a higher co-insurance level for non-network services.
When I visit a dentist, are there any claim forms to fill out?
Network dentists have contracted with Blue Cross Blue Shield of Tennessee to submit claim forms and accept benefits directly from Blue Cross Blue Shield of Tennessee. Some non-network dentists may submit claims directly to Blue Cross Blue Shield of Tennessee. More often, however, non-network dentists will require that you pay for services at the time they are rendered. Afterward, complete a simple claim form and forward it to Blue Cross Blue Shield of Tennessee along with a copy of your payment receipts.
What are the benefits of our dental plans?
|Dental Blue ||Option 1 ||Option 2|| |
|Preventive Services (Coverage A)||100%||100%|| |
|Basic Resorative Services (Coverage B) Fillings, Root Canals, etc.|
|Major Services (Coverage C)Crowns, Bridges, Implants & Dentures|
|Orthodontics (Coverage D) no age restrictions||50%||not covered|| |
|$50 deductible applies to Coverage B & C only Benefit Maximum $1,500 Applies to A, B & C (per calendar year) Orthodontic Maximum $1,500 per lifetime|
| || || |
When will I receive my first paycheck?
Montgomery County pays on a 2 week lag basis; therefore, you will need to complete your first 2 weeks of employment and you will receive your paycheck two weeks after that.
What is deducted from my wages?
All required deductions, such as Federal taxes, any authorized voluntary deductions, such health co-pays, and retirement savings plan contributions, will be withheld automatically from your paychecks.
Why must I have my check direct deposited?
To ensure you receive your paycheck correctly and on a timely basis, Montgomery County Government requires you to have your payroll checks directly deposited into your bank account.
How does direct deposit work?
You will have your check direct deposited to any financial institution that receives and participates in EFT (Electronic Funds Transfer) program. You designate the account(s) you wish to have your paycheck sent to electronically, and the funds are available to you on the morning of payday.
Will my first paycheck be direct deposit?
No, your first check will be a live check and you will need to deposit it into your account. In order to ensure that we have your correct information, we will run a pre-note.
If I use direct deposit, how will I know how much my check is?
You can log on to the Employer Self Service to see or print check stubs.
I did not receive my first check on the date I had expected, what should I do?
There may be several different explanations, you should contact Robyn Iddins in Human Resources at 648-5715 or e-mail [email protected].
When will I receive my final paycheck?
You should receive your final paycheck approximately two weeks after your last day of employment.
Tennessee Retirement System and Supplemental Retirement Options
When am I eligible to join a retirement system?
Those hired prior to January 1, 2017 are in the Legacy Plan. You become eligible to join the Tennessee Consolidated Retirement System, www.treasury.state.tn.us/tcrs following the completion of six months of employment. This is not an optional benefit for you.
Those hired on or after January 1, 2017 are in the HYBRID Plan.
Would I need to make a contribution to this plan?
LEGACY Plan--No, this plan is provided to you at no cost.
HYBRID Plan--Yes, you are required to contribute 5% of your salary in the Defined Benefit (pension) and 2% with an opt-out feature to the Defined Contribution (401-k).
What if I am already a member of a Tennessee Retirement System?
If you are already a member, you will need to let us know at the time of enrollment.
What is a supplemental retirement account?
This is a 401-k/457/b account through RetireReady TN. You can contact RetireReady at 800-922-7772 or www.RetireReadyTN.gov.
Do I make a contribution to this plan?
Yes, this plan is funded by tax-deferred contributions from your paycheck. Those in the HYBRID Plan- the County contributes to 5% to this plan for you. There are no employer contributions made to this type of a tax deferred plan for those in the LEGACY Plan. You may start, stop, or change your contributions at any time.
What do I need to do if I would like additional information or if I would like to participate in this plan?
Further information can be obtained from RetireReaydy TN(www.RetireReadyTN.gov) or the Human Resources Office (931) 648-5715 or e-mail [email protected] or stop by the Human Resources office, Monday – Friday 7:30 a.m.-4 p.m. An application form is required.