ABC Guide Benefits Administration administers the state of Tennessee-sponsored insurance benefits for 300,000 state, higher education, local education and local government employees, dependents and retirees.

CONTENTS

reminders

  • Annual HIPAA training must be completed within 30 days of gaining access to Edison.
  • New ABC training must be completed within 60 days of gaining access to Edison.

Memorandum of Understanding

Local Education Plan MOU

The MOU details the expectations of the roles and responsibilities of the Local Education Agency in partnership with the State of Tennessee.

Contact Info/Hours of Operation

Frequently Used forms

Enrollment Change Application

Employees can use this form to select and/or make changes to their benefits, but it can be utilized in multiple ways such as:

  • Electing new hire coverage within 30 days, allowing you, as the ABC, to enter the information through the Benefit eForm in Edison.
  • If an employee wants to edit their new hire elections within their 30-day eligibility period and is not using Employee Self-Service, this form can be submitted to Benefits Administration through Zendesk.
  • SQE events including but not limited to marriage, divorce, birth, adoption, etc.
Insurance Cancel Request Application

This form is used when an employee and/or their dependents want to voluntarily/involuntarily cancel insurance. You must certify the form after the employee completes and signs the form. Return the form and supporting documents to Benefits Administration by uploading the document in Zendesk.

Note: Canceling is only permitted outside of Annual Enrollment due to one of the specified qualifying events listed on the form.

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Corrections and Appeals

If an ABC finds mistakes, missed deadlines, or claim problems in an employee’s record, they should take the necessary steps to help resolve the issue. Below are the available options for fixing errors and filing appeals.

Making Corrections

ABCs should use the Corrections and Clarifications Form to correct errors in an employee's Edison record.

What ABCs Can Request:

The form can be used to ask Benefits Administration to:

  • Terminate an employee’s coverage before it begins.
  • Fix termination dates.
  • Correct hire dates.
  • Update dependent information, such as name, date of birth, or Social Security number.

How to Submit a Correction Request:

  1. By Email: Fill out the form and email it to benefits.administration@tn.gov.
  2. Through Zendesk (No Form Needed):
  • Go to Zendesk and select Submit a Request.
  • From the dropdown menu, choose Corrections and Clarifications Form.
  • Enter the employee’s details and the correction you need.
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Medical Claims Appeals

If there are problems with medical claims or disagreements about how claims are processed, employees must contact the vendor directly. Benefits Administration does not handle these appeals. For help filing a claim appeal, visit the Partners for Health website under Health and scroll to the bottom of the page for the “Medical Service Appeals” section.

Administrative Error Form

If an ABC or employee misses a policy deadline because of an error, they can request an exception using an Administrative Error Form.

Use the Administrative Error Form to explain:

  • What the mistake was and how it happened.
  • The employee’s efforts to follow the rules on time.
  • The agency’s responsibility for the mistake.
  • Include signatures from both the ABC and their immediate supervisor. If no immediate supervisor is available, explain why the second signature is missing.
Important Note: Submitting an error request does not guarantee approval. Management will review the request and decide whether to grant or deny the exception.

Appealing Denied Requests to BART

If a request is denied, the ABC or employee can appeal to the Benefits Administration Review Team (BART).

How to File an Appeal with BART

Write a request and include:

  • The employee’s name.
  • Employee ID or Social Security number.
  • Contact information (phone or email).
  • A clear explanation of the issue.
  • Why you think the decision should be reviewed.
  • Any supporting documents.

You can send appeals multiple ways via:

What Happens Next?

  • The appeals team reviews the case and collects additional information if needed.
  • If it’s an administrative error, the team sends it to operations for approval without needing a BART review.
  • If not, the case is anonymized and presented to BART for a fair, unbiased decision.

How Long Does It Take?

  • Administrative Error Decisions: You’ll usually hear back in 10–12 business days. It may take longer during busy times, like Annual Enrollment. ABCs will get an email through Zendesk with the decision.
  • BART Appeal Results: Most appeals take about three weeks, but this can vary based on volume or if additional information is required.
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Entering Dates in Edison

For New Hires

Agencies will have two options for eligibility and benefits begin dates. You must use the same process for all newly hired employees. In Edison, ABCs can enter either the effective date or coverage begin date for new hires. Edison will auto populate the other box.

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Pro Tip
Time and Date Calculator

When hiring an employee, use this Time and Date Calculator to help determine eligibility dates to use in Edison. Please subtract one day from the results.

For Terminations

When an employee terminates, ABCs can enter either the coverage end date or the last day of the month before the coverage should end. In both cases, the other box will populate with the corresponding termination date to match their entry.

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Onboarding new employees

When an employee is hired at your agency or an existing employee becomes eligible due to a status change, follow this step-by-step process to enroll them in benefits.

Employee Checklist

For New Employees

Benefits Orientation

To view the Partners for Health Benefits Orientation video, click the Benefits Orientation button or visit the New Employee page on the Partners for Health website.

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Zendesk

Zendesk is a ticketing-based system that serves as your primary form of communication with Benefits Administration.

By signing into your account, you can check the status of a pending request.

BA strives to resolve reported issues within 48 business hours. Documents submitted are processed within 2-5 business days or less.

How to Submit a Zendesk Ticket

To avoid duplicate Zendesk tickets, be sure to respond or add additional attachments to the existing ticket. There is no need to create multiple tickets for the same issue with an employee.

PRO TIP
Add your phone number to your Zendesk profile to ensure that tickets associated with your number are added to your profile.
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insurance cards

Members can get additional cards by contacting their insurance carrier or logging in to their BCBS or Cigna account.

Members can also access digital cards using the carrier’s mobile app.

BlueCross BlueShield

BCBS: 1-800-558-6213 – Up to two ID cards, both with member’s name, sent automatically (may be used by any covered dependent).

Cigna

Cigna: 1-800-997-1617 – Separate ID cards for each insured family member – with the participant’s name (up to four in each mailing).

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Staying up-to-date

WEEKLY EMAILS – This is how we share important information with you and your employees. Weekly emails are sent every Friday.

CONFERENCE CALLS – Calls are held on the second Tuesday of each month. During Annual Enrollment, conference calls will occur more frequently.

You can access these webinar instructions if you need help logging in to these meetings.

Attending the monthly conference calls and reading each email update is essential.
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THE PLAN DOCUMENT

The plan document is the legal publication that defines eligibility, enrollment, benefits and administrative rules of the State Group Insurance Program.

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Special Qualifying Events

If an employee or their dependent loses coverage under any other group insurance plan, or if a new dependent is acquired during the plan year, the special events may provide additional opportunities for the member and eligible dependents to enroll in health coverage outside of annual enrollment.

Employee Covered Under Family Member’s Plan

Sometimes employees decide to waive the state group insurance program’s coverage options and, instead, are enrolled as a dependent on another family member’s coverage.

  • Voluntary removal is not a qualifying event:

If the family member voluntarily removes the employee from their plan during open enrollment, it is not considered a qualifying event to enroll mid-year. The employee would need to wait for the annual enrollment period to obtain coverage.

  • Involuntary loss of coverage is a qualifying event:

If the family member's coverage is lost due to circumstances like job loss, it qualifies as a "special qualifying event," making the employee eligible to enroll mid-year.

Important Reminders

  • The employee can switch to a different carrier or plan if enrolling due to a loss of coverage or for adding a new dependent.
  • Premiums are not prorated. If approved, you must pay premium for the entire month in which the effective date occurs.
  • The employee or eligible dependents may also be eligible to enroll in dental and vision coverage if they meet the requirements stated in the dental or vision certificates of coverage.

SQE eForm Tool Tutorial

ABCs now have access to an SQE eForm Tool Tutorial to learn how to submit SQE changes directly to Edison. ABCs can submit supporting documents, add and provide dependent verification, and input insurance elections. The SQE eForm will go through the service center for review to recycle, approve, or deny the SQE event.

SQE eForm Tool Tutorial
Loss of Coverage

Remember: 60 days

If an employee loses coverage, they will have 60 days from the end of their previous coverage to apply for our insurance plan.

Adding Coverage

Birth, Adoption, or Placement for Adoption

Retroactive Coverage: Employees should enroll their newly acquired child within 30 days to avoid a coverage gap. They have 30 days to apply for coverage that will allow them to have retroactive coverage back to the date of birth, adoption, or placement for adoption.

Prospective Coverage: If the employee misses the 30-day deadline, they can still enroll within the 31–60-day window to avoid the new child being without coverage until the next annual enrollment period. Coverage will begin at the start of the month following the receipt of the SQE application and all required documentation by Benefits Administration.

Important:For dental and vision, the employee has 60 days to enroll. Coverage can only be prospective and will not go back to the date of birth, adoption, or placement for adoption.

Marriage or Order of Guardianship

Employees have 60 days to apply for new dependent coverage from the date of marriage or guardianship order. If enrolled within this timeframe, coverage will begin at the start of the month following the receipt of the SQE application by Benefits Administration.

Important: When an employee acquires a new dependent through a legal guardianship order, only the employee and the new dependent may enroll under special enrollment provisions for insurance coverage.

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the QUERY TOOL

ABCs have access to a Query Tool to find specific queries (also called reports) that run in Edison.

There are numerous queries available including those for address changes, dependent children turning 26, demographics and elections.

Need help using the Query Tool? Check out this video for How to Use Query Tool on the Partners for Health Website.

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Acronyms

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VIDEO TUTORIALS

"Edison" How-Tos

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Helpful Links

Comparison Charts
Carrier Information
Edison
Health Options
Other Benefits
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Partners for Health homepage https://tn.gov/partnersforhealth

Credits:

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