2023 Open Enrollment - Diocese of Knoxville
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2023 Open Enrollment
2023 OPEN ENROLLMENT PERIOD:
OCTOBER 31 – NOVEMBER 4, 2022
This document is meant to provide basic benefit plan information. For additional details and specific information, please
contact the carrier or review the Summary Plan Description (SPD) for each plan. SPD’s are available on the Human
Resources page of the Diocese of Knoxville website
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2023 Open Enrollment GuideElecting Coverage
This year is an active enrollment. That means if you do not actively enroll for coverage during annual enrollment, you
will not have coverage during the 2023 plan year.
2023 Annual Enrollment will be completed by filling out an enrollment form and returning the completed form to your
bookkeeper or HR representative. Completed forms will be accepted from Monday, October 31st thru Friday, November
4th at 5pm EST.
If you have questions regarding benefits, please contact Jennifer Mills (jmills@dioknox.org) or Maura Lentz
(mlentz@dioknox.org). Representatives are available to assist you Monday through Friday, 9am to 4pm (EST).
What’s New for 2023
Medical
• CIGNA will be replacing UHC as our medical insurance provider
• An increased one time employer contribution to an HSA for eligible participants who choose the HDHP option.
• Per IRS Guidelines, HDHP individual deductible increased by $200 and out of pocket maximum stayed the same
as 2022 and remains compliant.
• New ID cards will be mailed to employee homes for employees electing coverage or making changes.
Prescription
• No changes to the prescription insurance
Dental
• CIGNA will be replacing UHC as our dental insurance provider
• An increased annual benefit maximum from $2,000 to $3,000
• A wellness incentive program now available (see page 7)
• An increased maximum orthodontia benefit from $2,000 to $4,000
• Adult orthodontia now available
Vision
• No changes to vision insurance
Health Savings Accounts
• HSA Bank will replace Optum Bank as our HSA Provider
• If you choose to elect the HDHP health plan option, the diocese will make a one-time contribution (see page 9)
Plan Designs and Costs
2023 summary plan designs for Medical, Dental, Vision and Health Savings Account are shown on the following pages.
Monthly benefit deductions for all plans are shown on the last page of this document.
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2023 Open Enrollment GuideMedical
Medical coverage is provided by CIGNA. Employees can access the Cigna website at www.CIGNA.com to find network
providers, view claims, or access wellness tools and resources. Contact number for CIGNA is 800-Cigna24 or 800-244-
6224. Prescription drug coverage is provided by CVS Caremark. Employees can access the CVS Caremark website at
www.caremark.com. Contact number for CVS Caremark is 800-841-5550.
CIGNA HIGH DEDUCTIBLE HEALTH PLAN
CIGNA PPO PLAN
BENEFIT PLANS (HDHP)
IN-NETWORK OUT-OF-NETWORK IN-NETWORK OUT-OF-NETWORK
ANNUAL DEDUCTIBLE
Individual $750 $1,500 $3,000 $4,000
Employee + 1 $1,500 $2,500 $3,700 $6,000
Family $2,250 $4,000 $4,700 $8,000
OUT OF POCKET MAXIMUM
Individual $2,200 $4,200 $5,600 $8,000
Employee + 1 $3,400 $6,400 $7,400 $12,000
Family $4,600 $8,600 $9,400 $16,000
MEDICAL CARE
Preventive Care $0 co-pay Not Covered $0 co-pay Not Covered
Office Visit (Primary Care) $20 co-pay 30% after deductible 20% after deductible 50% after deductible
Office Visit (Specialist) $30 co-pay 30% after deductible 20% after deductible 50% after deductible
Injections at Office Visit $20 co-pay 30% after deductible 20% after deductible 50% after deductible
Virtual Visit $20 co-pay N/A 20% after deductible N/A
Urgent Care $75 co-pay 30% after deductible 20% after deductible 50% after deductible
Emergency Room $125 co-pay $125 co-pay 20% after deductible 20% after deductible
Mental Health Services
Inpatient 10% after deductible 30% after deductible 20% after deductible 50% after deductible
Outpatient $20 co-pay 20% after deductible 50% after deductible
Substance Abuse Rehab
Inpatient 10% after deductible 30% after deductible 20% after deductible 50% after deductible
Outpatient $20 co-pay 20% after deductible 50% after deductible
PRESCRIPTION DRUGS (THROUGH CVS/CAREMARK)
Retail Mail Order Retail Mail Order
$10 co-pay after $10 co-pay after
Generic $15 co-pay $45
deductible deductible
$50 co-pay after $150 co-pay after
Brand-Formulary $40 co-pay $120
deductible deductible
$100 co-pay after $300 co-pay after
Brand-Non Formulary $70 co-pay $210
deductible deductible
NOTE: ALL DEDUCTIBLES, COINSURANCE, AND CO-PAYS APPLY TO THE ABOVE STATED OUT-OF-POCKET MAXIMUMS
3
2023 Open Enrollment GuideMedical Plan Offerings Q&A
1. May I go to any doctor I want and still receive plan benefits?
Yes, but you will pay less out-of-pocket when you access providers who participate in the CIGNA Open Access
Plus (OAP) Network.
2. Is there a deductible?
Yes, the deductibles are different depending on the plan you select. For the PPO Plan, the In-Network
deductible is $750 Individual, $1500 Employee + 1, and $2,250 Family. If you select the High Deductible Health
Plan, the In-Network deductible is $3,000 Individual, $3,700 Employee +1, and $4,700 Family.
3. Will I need to choose a Primary Care Physician (PCP)?
No, but you are encouraged to select a Primary Care Physician to coordinate your care.
4. Do I need a referral to see a specialist?
No.
5. Is preventative care (well-child checkups, annual physicals, etc.) covered?
Yes. In-network preventive care physician visits are covered at 100% with no out of pocket costs in both the
PPO and HDHP Plans.
6. What payments are not subject to the out-of-pocket maximum?
All deductible, co-insurance and co-payments you make will count towards your out-of-pocket maximum.
However, out-of-network balance billed charges will not apply.
7. Can I use any pharmacy to fill my prescriptions?
Yes, you may use your coverage at most pharmacies.
8. Must I use mail order for drugs I use regularly?
9. No, while mail order is encouraged, you may also choose to receive a 3-month supply of your maintenance
medicines at any retail pharmacy. The cost is the same whether you use mail order or a retail pharmacy when
ordering a 90 day supply. However, a 90 day supply at either retail or mail-order will be the same cost to you.
10. Will I be receiving new ID cards?
Yes, all employees who elect medical coverage will receive new ID cards from CIGNA and CVS/Caremark.
11. After I submit my enrollment form, when will I receive m new ID cards?
You should receive your ID cards by January 1, 2023. The cards are mailed directly to your home address.
12. What do I do if I lose my ID card?
You can print new ID cards by logging into myCIGNA.com or caremark.com. You can also contact the carrier
directly.
13. What is the CVS Minute Clinic?
The CVS Minute Clinic is a fast and convenient alternative for acute care needs. The clinics are located inside
some CVS locations. You can schedule online appointments when your need to be seen at the Minute Clinic,
which saves you the time of waiting in an urgent care center. You will need to use your CIGNA Medical Card
when visiting a CVS Minute Clinic. The PPO Minute Clinic copay will be $20 effective January 1, 2020. HDHP
Minute Clinic charges are subject to the deductible and co-insurance limits.
14. What types of care are available at the CVS Minute Clinic?
The Minute Clinic staff can diagnose conditions and prescribe medications for common injuries, illnesses and
infections. Minute Clinics cannot perform diagnostic testing such as X-rays or MRI’s and should not be used in
cases of extreme emergency which may necessitate a higher level of emergency care.
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2023 Open Enrollment GuideWellness Benefits
Wellness benefits are covered at 100% and available with the deductible waived and NO COPAY to enrolled employees
when using In-Network providers. These wellness benefits are available in both of our health plans. We encourage you
to look through this list and familiarize yourself with these new benefits.
Catholic Conscious Preventive Screenings and Counseling:
• Obesity screening and counseling
• Diet counseling for adults at higher risk for chronic disease
• Tobacco use screening and cessation interventions
• Alcohol misuse screening and counseling
• Depression screening
• Immunization vaccines for adults
• Refer to the High Deductible Health Plan Generics Only Preventive Therapy Drug List for medications that will not be
subject to the deductible under the HDHP option
Services for Children:
• Alcohol and drug use assessments for adolescents
• Autism screening for children 18 and 24 months
• Depression screening for adolescents
• Developmental screening for children under age 3
• Fluoride supplements for children without fluoride in their water source
• Hearing screening for newborns
• Hypothyroidism screening for newborns
• Immunization vaccines for children from birth to age 18 (doses, recommended ages, and recommended populations
vary)
• Iron supplements for children 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Obesity screening and counseling
• Oral health risk assessment for young children
• Tuberculin testing for children at higher risk of tuberculosis
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2023 Open Enrollment GuideWellness Updates – Women’s Benefits
Services for Pregnant Women or Women Who May Become Pregnant:
• Anemia screening on a routine basis
• Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies,
for pregnant and nursing women
• Folic acid supplements for women who may become pregnant
• Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational
diabetes
• Expanded tobacco intervention and counseling for pregnant tobacco users
Preventative Services for Women:
• Well-woman visits to get recommended services for women under 65
• Breast cancer genetic test counseling for women at higher risk
• Mammography screenings every 1 to 2 years for women over 40
• Cervical cancer screening
• Domestic and interpersonal violence screening and counseling
• Osteoporosis screening for women over age 60 depending on risk factors
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2023 Open Enrollment GuideDental
Dental coverage is provided by CIGNA. Employees can access the CIGNA website at www.myCIGNA.com to find network
providers or view claims. Contact number for CIGNA Dental is 800-Cigna24 or 800-244-6224.
CIGNA DENTAL
BENEFIT PLAN
IN-NETWORK OUT-OF-NETWORK
ANNUAL DEDUCTIBLE
Employee $25 $25
Employee + 1 $50 $50
Family $75 $75
ANNUAL BENEFIT MAXIMUM*
Per Person $3,000 $3,000
ORTHODONTIA LIFETIME MAXIMUM
Per Person 50% up to $4,000 50% up to $4,000
COVERAGE TYPE
Preventative & Diagnostic Care Covered at 100% Covered at 100%
Basic Coverage Covered at 80% Covered at 80%
Major Coverage Covered at 60% Covered at 60%
*Wellness Benefit Program:
Participating members are able to earn an additional $250 toward the next calendar years annual benefit maximum by
going to at least one preventive dental visit per year. Members are able to earn an up to a total of $750 over 3 years.
Examples:
1. Preventative & Diagnostic Care - Examples of services would include cleanings & periodic oral exam
2. Basic Coverage – Examples of service would include fillings, ER treatment, extractions, endodontics, periodontics, oral surgery
3. Major Coverage – Example of service would include crowns, bridges, dentures, prosthetics
7
2023 Open Enrollment GuideVision
Vision coverage is provided by VSP. Employees can access the VSP website at www.vsp.com to find network providers
or view claims. Contact number for VSP is 800-877-7195. VSP also provides a valuable Hearing Benefit called
TruHearing, which is accessible by calling TruHearing at 877-396-7194. This service offers valuable discounts on both
hearing aids and replacement batteries.
VSP VISION PLAN
BENEFIT PLAN
VSP BENEFITS SUBJECT TO APPLICABLE CO-PAYS
EYE EXAMINATION
Comprehensive WellVision Exam $10 co-pay
Standard Contact Lens Exam $25 co-pay
Routine Retinal Screening $39 co-pay
LENSES
Single Vision $25 co-pay
Lined Bifocal $25 co-pay
Lined Trifocal $25 co-pay
Lenticular $25 co-pay
Standard Progressive $25 co-pay
FRAMES
Retail Frame Allowance Frames covered-in-full after lens co-pay up to the retail $130
Frame allowance is guaranteed by at $50 wholesale allowance at VSP doctors
CONTACT LENSES
In Network Prescription contact lens materials covered-in-full up to $200 retail allowance
Out of Network Up to $130 allowance
Participating Retail Chains
• Costco, Visionworks, Shopko, Cohens Fashion Optical, Pearle Vision, Walmart, Sam’s Club
.
8
2023 Open Enrollment GuideHealth Savings Account (HSA)
If you elect to join the High Deductible Health Plan (HDHP), please note that you will be eligible to set-up a Health
Savings Account (HSA). An HSA is a savings account that allows you to set aside money on a pre-tax basis to pay for
qualified medical expenses if you participate in a qualified HDHP. This process can be done through payroll deduction or
direct contribution.
The Diocese of Knoxville is offering an HSA through HSA Bank. To sign up for an account, employees will elect the
amount they would like to contribute on the benefit election form. Please be aware of the new employer contribution
per election and the maximum annual total contribution. The diocese will cover the fees associate with the sponsored
HSA accounts through HSA Bank. If you are not using HSA Bank, then the employer contribution will not be made.
Facts about an HSA
• HSA’s are portable – individuals can keep their HSA if they change jobs or become unemployed.
• HSA’s are not a “use it or lose it” account – unused contributions roll over each year. The contributions may
earn interest on a tax-free basis.
• There are no income limitations to participate in an HSA.
HSA Limits and Employer Contributions
• The 2023 maximum individual contribution is $3,850; employer will contribute $1,925 of this maximum for full-
Time employees and $960 of this maximum for part-time employees
• The 2023 maximum family contribution is $7,750; employer will contribute $3,875 of this maximum for full-time
employees and $1,930 of this maximum for part-time employees
• Catch-up contributions of an extra $1,000 are allowed for those ages 55 and older
Eligibility Requirements for an HSA
• You must be covered by a compatible health plan such as our High Deductible Health Plan (HDHP)
• You cannot be covered by any other medical plan that is not an HSA compatible health plan. This would include
being enrolled in your Spouse’s plan as secondary coverage.
• You must not be enrolled in Medicare, Tricare or Tricare for life
• You must not be eligible to be claimed as a dependent on another individual’s tax return
• If you are a veteran, you may not have received veterans’ benefits within the last three months
• You must not be active military
What are HSA Eligible Expenses
• An HSA allows you to save on a pre-tax basis for current and future qualifying medical expenses such as doctor
visits and prescriptions. This includes anything you pay towards your High Deductible Health Plan deductible,
and any co-insurance or copay costs associated with your High Deductible Health Plan
• HSA monies can also be used for future healthcare expenses, including certain long-term care expenses and
insurance as well as: prescription drugs, medical co-pays, dental expenses, vision expenses, chiropractic care,
blood work, orthodontia, hospital costs, medical X-rays, durable medical equipment, allergy medication,
9
2023 Open Enrollment Guideambulance and ER services, out-of-network coinsurance, eye exams, vaccinations, laboratory fees, home health
care, skilled nursing care, hospice care, psychiatric care, etc.
Ancillary Benefits
UNUM Employer Paid Life Insurance
The Diocese provides group term life insurance to all employees who are scheduled to work 20 or more hours per week.
The Diocese will continue to offer a life insurance benefit up to $50,000 at no cost to you.
UNUM Long Term Disability Insurance
The Diocese provides employer paid long term disability insurance to all employees who are scheduled to work 20 or
more hours per week. The Diocese will continue to offer employer paid long term disability insurance that will cover
60% of your pre-disability income up to a monthly maximum of $3,500 at no cost to you. This type of insurance will
provide you with coverage in the event of a permanent or temporary disability greater than 90 days due to injury or
illness.
UNUM (EAP)
An Employee Assistance Program (EAP) is available to all employees who are scheduled to work 20 or more hours per
week. Take advantage of your EAP for support and information on parenting and children’s health, tips on elder issues,
assistance to help you deal with legal matters, resource referrals on budgeting and money management, and more. The
EAP is confidential and voluntary. It offers professional assessment, up to 3 (no cost) in-person visits with a licensed
professional counselor, and a referral service for you and your eligible household family members 24 hours a day, 7 days
a week. Just call 1-800-854-1446 or you can also access information online at www.unum.com/lifebalance.
Worldwide Travel Assistance by AXA
This unique benefit for employees offers pre-tip assistance and emergency travel support services for you, your spouse,
and dependent children under the age of 18. It can be used whenever you travel more than 100 miles from home.
Before your trip, you can use this benefit for information regarding passports, documentation needs, inoculation
requirements, and more. During your trip, you can get assistance with document replacement, translation services, and
legal services. The service also includes a valuable medical assistance benefit, and baggage assistance for lost or stolen
luggage.
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2023 Open Enrollment GuideMonthly Benefit Deductions
FULL-TIME MONTHLY MEDICAL DEDUCTIONS
CIGNA PPO CIGNA HDHP
Employee Only $250.00 $10.00
Employee + One $575.00 $140.00
Family $600.00 $150.00
PART-TIME MONTHLY MEDICAL DEDUCTIONS
CIGNA PPO CIGNA HDHP
Employee Only $812.00 $572.00
Employee + One $1,403.00 $968.00
Family $1,453.00 $975.00
FULL –TIME MONTHLY DENTAL DEDUCTIONS
CIGNA DENTAL
Employee Only $5.85
Employee + One $11.71
Family $15.80
PART-TIME MONTHLY DENTAL DEDUCTIONS
CIGNA DENTAL
Employee Only $39.02
Employee + One $78.03
Family $105.83
MONTHLY VISION DEDUCTIONS
VSP VISION PLAN
Employee Only $7.65
Employee + One $15.30
Family $24.63
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2023 Open Enrollment GuideYou can also read
