Human Resources: Employee Benefits

Questions and Answers

GENERAL

Q. Will I need to enroll in benefits this year?
A. Metro encourages you to review all of your Metro benefits information carefully and then make an active enrollment election during this year's Annual Enrollment. If you are currently in one of the HMOs, and you do not enroll in a different plan during Annual Enrollment, you will automatically be enrolled in the BCBS PPO. Enrollment materials will be mailed to your home this fall with more details on how to enroll.
Q. Will I receive more information about the benefits changes?
A. Metro is committed to keeping you informed about the upcoming benefits changes. In addition to the informational meetings scheduled for August and September, you can look for more information:
  • In the Take Charge of Your Health newsletter, which will be posted on the Human Resources homepage on www.nashville.gov
  • In information provided to you by CIGNA at your home and during informational meetings
  • At Ask & Enroll Days scheduled this fall
  • In your enrollment materials, mailed to your home this fall
  • Through online access to benefits carriers' websites
Q. What is an annual deductible?
A. A deductible is the portion you must pay out-of-pocket for medical expenses before the plan begins to pay benefits.
Q. What is coinsurance?
A. Agreement by which the Plan and you share, in a specified ratio, payment for eligible services covered by the Plan after you meet your deductible.

CIGNA CHOICE FUND®

Q. What is a Health Reimbursement Arrangement (HRA)?
A. An HRA is a health fund established by Metro under the CIGNA Choice Fund to help you pay for covered medical and pharmacy expenses. Medical services include doctor visits, and lab, hospital and pharmacy fees. Any balance in the HRA will roll over for use in future years.
Q. What is the difference between out-of-pocket and out-of-pocket maximum?
A. Out-of-pocket expenses are medical expenses you pay, which include cost-sharing amounts such as copayments, deductibles or coinsurance, as well as medical expenses not covered by insurance.

Out-of-pocket maximum is the maximum amount of coinsurance you pay for covered medical expenses in any single calendar year. Once you have paid the out-of-pocket maximum, the Plan pays 100% of expenses.
Q. Will I pay a copayment for prescriptions under the CIGNA Choice Fund?
A. There are no copayments to pay under CIGNA Choice Fund. Prescription drug expenses are paid through the Health Reimbursement Arrangement fund. Once the fund is spent, you pay for prescription expenses out-of-pocket until you reach your share of the annual deductible. Once the deductible is met, you pay 10% for generic drugs and 30% for brand name drugs.
Q.Does it matter if I go to an in-network pharmacy vs. an out-of- network pharmacy when enrolled in CIGNA Choice Fund?
A. In-network pharmacies will have access to CIGNA's system and will know at time of purchase any HRA funds you have available. In-network pharmacies will also know if you have met your deductible and out-of-pocket maximum. Out-of-network pharmacies will not have access to CIGNA's systems. You must pay for the cost of prescriptions and submit a direct reimbursement form to be reimbursed when using an out-of-network pharmacy.