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Blue Cross/Blue Shield of TN


Instructions for CDHP/HSA: HealthSavings Authorization Form
If you enrolled in the Wellness HealthSavings CDHP as your health insurance plan for 2016, in early January, the University of Tennessee will deposit the employer contribution of $500.00 for employees with individual coverage and $1,000 for employees with family coverage into your Health Savings Account.

If you enrolled in the Standard HealthSavings CDHP as your health insurance plan for 2016, and want to add your own monies to the Health Savings Account, please read the instructions below and complete the necessary form.

If you would like to sign up to have additional funds deducted pretax from your payroll checks and deposited into your Health Savings Account, a Health Savings Account Authorization form must be completed whenever you wish to start, stop, or change the amount during the year. Completed forms (keep a copy for your records) may be returned via:

  • US Mail:  University of Tennessee, Payroll Dept, P115 Andy Holt Tower, Knoxville, TN 37996
  • Fax: 1-865-974-3530
  • Deliver: UT Chattanooga, Human Resources, Dept 3603, 615 McCallie Ave, Chattanooga, TN 37403 (5 days prior to deadline below)

For monthly employees, the form will be due in the Payroll Office by the 15th of the month to be included in that month’s payroll.  For biweekly employees, the form will be due in the Payroll Office by the last working day of the pay period to be included on that biweekly payroll.

Please note, if you signed up for the Wellness HealthSavings CDHP, and if you have a 2015 Medical Flexible Benefits Account with a balance on December 31, 2015, the Internal Revenue Service will not allow employer or employee contributions to your account until April 1, 2016.

If you have any questions in reference to UT payroll deductions, please call 1-865-974-5251.  If you have questions about your Health Savings Account, please call Payflex/Healthub 1-800-284-4885.


Network for 2016
The network for 2016 will continue to be Network S. The following local providers are not in the network: Chattanooga Surgery Center, Parkridge Medical Center, Parkridge East Hospital (East Ridge). Parkridge Valley Hospital is NOT affected. Also, not all physician groups housed in Parkridge are affected; please check with BCBST Member Services for inquiries about individual physician and physician groups.

Partnership Promise

If you choose the Partnership PPO or Wellness Health Savings CDHP, you must commit to a Partnership Promise. Both you and your spouse, if enrolled, have to meet the Partnership Promise in order to remain in the selected plan. Children, regardless of age, do not have to fulfill the Partnership Promise. If you cannot fulfill the Partnership Promise because of a physical or mental health condition, your health coach will work with you to come up with a different way to keep your Promise.

Insurance Cards

Blue Cross/Blue Shield issues two ID cards per household; however, additional cards are available upon request. The cards list the name of the head of contract, so family members use the same card for coverage. Members may request additional cards by phoning (800) 558-6213 or by logging onto the Blue Cross/Blue Shield website and printing a temporary card.


CVS Caremark is the pharmacy benefits manager. Call the CVS Caremark Call Center, open 24/7, at (877) 522-8679 to order a replacement card and for instructions on how to print a temporary card from the Caremark Website. You will be able to use your temporary card until your new card arrives.

Filling a prescription
Use a network pharmacy when filling prescriptions with up to a 30-day supply. The network includes more than 1,600 pharmacies across the state and chain pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and Walmart. Many local, independent pharmacies are also in the network.

Use the CVS Caremark Mail Service Pharmacy to fill your 90-day supply prescription or receive a 90-day supply from a participating retail pharmacy store. The mail-at-retail network will be different from the 30-day retail network.

In Network vs. Out of Network Providers

You can see any doctor or go to any health care 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. Non-network health care providers can bill you for any difference between actual charges and the approved amount plus any charges for services deemed not medically necessary or not authorized by BlueCross/BlueShield of Tennessee.



Services requiring copays are not subject to a deductible and do not apply to the annual out-of-pocket coinsurance maximum. Services requiring copays include preventive care (well-baby, well-child visits); adult annual physical; annual well-woman exam; immunizations as recommended by the CDC; primary care and specialist office visits; urgent care facilities; emergency room visit; x-ray and lab; prescriptions. 


Some services require that you pay coinsurance after you meet a deductible. Coinsurance is a percentage of the total cost. Typical coinsurance charges include hospital stays; home care; ambulance services; advanced X-ray, scans, imaging; rehabilitation and therapy services.



A deductible is the amount you pay out of your pocket before the plan pays for hospital charges and other services that require coinsurance. It does not apply to services with a copay. Payments toward the deductible count toward the annual out-of-pocket maximum.


Out-of-Pocket Coinsurance Maximum

An out-of-pocket coinsurance maximum is the most you will pay for your deductible and coinsurance each year. It does not include your copays. Once you reach your out-of-pocket maximum, the plan pays 100 percent of covered medical expenses.