Frequently Asked Questions

(FAQs)

Frequently Asked Questions2020-08-28T08:20:05+00:00
Why is the TDCBT transitioning from Allied/PHCS to Aetna?2020-08-20T18:44:38+00:00

This decision is part of our ongoing customer-focused efforts to improve the cost and quality of services for our members. We heard from our members and prospects that the current reference-based pricing model for facility services was a negative and that they would prefer a more traditional model for coverage. Based on this, we chose to offer a PPO model through Aetna that offers a robust network of providers and facilities.

Does the transition need to be approved by the Tennessee Department of Commerce and Insurance?2020-08-20T18:47:37+00:00

Any material changes that the TDCBT makes must be filed with Tennessee Department of Commerce & Insurance (TDCI) for review and/or approval. Initial notification has been sent to TDCI notifying them of this change and we don’t anticipate issues with obtaining approval.

Will the TD Consortium Benefits Trust still be referred to as the TD Consortium Benefits Trust?2020-08-20T18:48:38+00:00

Yes. TDCBT will be transitioning over to be a client of Aetna and continue under the plan name TD Consortium Benefits Trust.

Does Aetna own the TDCBT health plan now?2020-08-20T18:48:57+00:00

No. The TD Consortium Benefits Trust is not owned by any entity. The TDCBT is a self-insured, member-owned Tennessee MEWA health plan.

When will the transition to the new platform take place?2020-08-20T18:49:20+00:00

For existing groups, the transition to the new platform will take place at the time of your renewal which is January 1, 2021. All new business with an effective date of October 1 and thereafter will enroll on the new Aetna platform.

Will we have the option to remain on the Allied TPA platform?2020-08-20T18:52:25+00:00

No. All TDCBT members will transition upon renewal of January 1, 2021.

What services are changing because of the transition?2020-08-20T18:50:04+00:00

In order to provide our members with this new and improved coverage, Medical and Pharmacy coverage will be changing. For both Medical and Pharmacy coverage, the customer service, claims processing, medical management and provider networks will be transitioned from Allied/PHCS to Aetna.

Your existing medical coverage through Allied, using the PHCS network, will now be changing to a much stronger network through Aetna. You will also have access to superior concierge level customer service through Aetna’s A1A program. They will service all your medical and pharmacy needs.

While you had coverage with CVS Caremark previously, you will be covered under a direct arrangement for pharmacy benefits with CVS Aetna Pharmacy and your coverage may be changing as outlined in question 8.

Will benefits change during this transition?2020-08-20T19:30:59+00:00

Some benefits are changing as a result of this transition and we are also adding some new plan options that we feel will be beneficial to our membership. The changes are outlined below:

• We have greatly enhanced all of our plans to accommodate the change from reference-based pricing to a traditional network PPO model. These changes consisted of adding a network for facility services (there was previously no network and all services were considered out-of-network and were paid accordingly). All plans will now have a robust network of facilities for access to. These Aetna network facilities will be applied to a new in-network benefit and all other facilities that do not participate with Aetna will be applied to the out-of-network benefit. More details on these benefits can be found in the new benefit summaries.

• We have also made enhancements to most of our plans in network copays, coinsurance and out-of-pocket maximums, including the Classic 500 Plan, Classic 1000 Plan, Classic 2000 Plan, Classic 3500 Plan and HSA 5000 Plan.  More details on these benefits can be found in the new benefit summaries.

• We are eliminating the Value 1000 Plan, the Value 3000 Plan and the HSA 3000 Plan – there is little to no membership in these plans.  However, if you are enrolled or have employees in these plans, we will be reaching out to you to advise how we will be handling your enrollment.

• We have also added 3 new plan options and more information will be provided to you at renewal on these plans so you can make an informed decision on your plan options:

Pharmacy Plans are changing as well to offer you more choices to fit your needs. The current 4 pharmacy plans are being consolidated into 3 plans – 2 copay plans and one HSA-compatible deductible plan as outlined above.  The great news is that all 3 prescription options can now be selected with any medical plan to give you more flexibility and choice.  Note that copay plans are not eligible with HSA plans as they would make the plan non-HSA compatible.  More details on the pharmacy benefits can be found in the new benefit summaries.

You will be given the choice at renewal to keep your existing coverage or change to any of the new or existing Medical and Prescription Plans being offered and the TDA Insurance team and your Broker will help you navigate these decisions.

Do the employer or employees need to complete new paperwork at time of transition?2020-08-20T19:32:28+00:00

Because you are transitioning during your renewal period, you will be required to complete your normal renewal paperwork.  If you are making plan changes at time of renewal, you will be required to complete the required paperwork.

Can my group transition to the new platform earlier than my renewal?2020-08-20T19:32:54+00:00

Yes.  However, you will only be able to transition beginning October 1, 2020.  A group will be required to terminate and enroll as a new group.  The group will be required to submit a termination form, receive a new rate quote based on new underwriting and then submit new group paperwork to be enrolled.

Will the transition impact my rates?2020-08-20T19:33:14+00:00

This transition is providing our members with enhanced benefits and services, but even with these enhancements, rates are not being impacted.  The expectation is that the TDCBT will benefit by utilizing the comprehensive Aetna network, the dedicated member advocate concierge program, integrated medical & RX clinical programs, as well as other value-based programs.  You may still experience a rate increase through your normal renewal process due to trend and demographic changes within your group (such as increased aging) but the overall transition to Aetna is providing additional benefits at little to no additional cost.

How will my day-to-day processes change because of this transition?2020-08-20T19:33:35+00:00

Your day-to-day process should not be impacted. You will continue to utilize your Broker and/or TDA

Insurance’s current Client Service Team to assist with your day-to-day changes and questions.  Your members will continue to call Allied prior to their transition dates and will then call Aetna after their transition date for claims, customer service, medical management authorizations, pharmacy questions, etc.

Will I be receiving a new ID card?2020-08-20T19:34:06+00:00

All members will receive a new combined medical and prescription ID card when transitioning to Aetna.

Will the role of TDA Insurance change in this transition?2020-08-20T19:34:25+00:00

No, TDA Insurance is and will remain the Plan’s Managing General Agency.  Employers and Brokers will now have access to the Aetna 1 Advocate (A1A) team of experts.

Will there be new contact information?2020-08-20T19:34:43+00:00

Phone number and addresses will change.  Members will receive a new ID card after their transition that will include a new phone number for the Aetna One Advocate (A1A) Member Services.

Are there any changes to the billing or payment remittance process?2020-08-20T19:35:02+00:00

Effective January 1, 2021, your monthly health care fee invoice will no longer come from Allied.  Invoices will initially be mailed and in the future, you will be able to log into a new employer website to access your monthly invoice and manage your employee eligibility online.  The monthly ACH payment will continue to be automatically withdrawn from the bank account on file.  There is nothing additional you need to do as this will be transitioned automatically.  If you have billing or payment questions, please note that the updated phone number is 423-629-2400, ext. 264.

Will the transition to the new platform have any impact to the Health Plans underwriting guidelines or eligibility?2020-08-20T19:35:19+00:00

No.  Currently, the underwriting and eligibility guidelines will not be changing because of the transition to the new platform.

Do I still need to join one of the sponsoring associations to be eligible for a health plan?2020-08-20T19:35:55+00:00

Yes.  Membership with the Tennessee Dental Association is a requirement of the plans underwriting guidelines.  To join the TDA, click here.

Will the TDCBT now be able to offer coverage to groups headquartered outside of Tennessee?2020-08-20T19:36:52+00:00

No.  The eligibility and underwriting guidelines will not change as it relates to the transition.  All employers must be domiciled in Tennessee.

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