The TBA Association Group Health Insurance Plan
Frequently Asked Questions

What is the Humana Association Health Plan Response to COVID-19?
The TBA/Humana Association Health Plan is waiving out-of-pocket costs associated with testing for COVID-19 (where allowed within state and federal law) for patients who meet CDC guidelines at approved laboratory locations. To help reduce the risk of infection and spread of disease, Humana is encouraging members to use telemedicine as the first line of defense for all urgent care needs. Costs will be waived for telemedicine visits for urgent care needs for the next 90 days. Furthermore, for the next 30 days, Humana is allowing early refills on prescription medicines so members can prepare for extended supply needs.

Humana has a specialized group of call center associates to help support members with specific coronavirus questions and concerns, including live assistance with telemedicine. To contact the team, members should call Humana’s toll-free customer support line, which can be found on the back of their member ID card.

Humana has a steadfast commitment to supporting you and will continue to be in regular contact with the CDC, federal agencies, state authorities and provider partners to monitor COVID developments.

How do I get a quote or enroll?
Use our online quoting and enrollment tool (available April 1 – May 31).

Sole proprietors are eligible to enroll if they have at least one W-2 employee working 30+ hours a week.

What is the name of the Insurance Carrier?
Humana

Who is eligible under the plan?
Only the Tennessee-based personnel of Participating Employers are eligible to participate in the plan.

Who is eligible to become a Participating Employer?
Law firm members of the Tennessee Bar Association that meet all of the following qualifications:

• Is a Tennessee duly organized and validly existing professional corporation, limited liability company, professional limited liability company, general partnership, limited partnership, limited liability partnership, sole proprietorship, or other entity that complies with the laws of the State of Tennessee;
• Maintains individual memberships in the TBA for all of its attorneys (please contact Membership Director Mindy Thomas for verification);
• Qualifies as an entity which provides Legal Services;
• Constitutes an employer as defined under ERISA § 3(5);
• Employs in the State of Tennessee at least one common law employee who works a minimum of 30 hours per week.
• Executes the Tennessee Bar Benefit Trust Participation Agreement; and,
• Elects to participate in the Plan.

What are my plan and network options? 
There are three benefits options available:

• The Simplicity Plan: $0 Deductible with office visit copays of $25 for PCP, $40 for specialists and $75 for Urgent Care
• The Deductible + Copay Plan: First dollar coverage with office visit copays of $40 for PCP, $55 for specialists and $100 for Urgent Care. The individual deductible is $5,000
• The High Deductible Plan: Is HSA qualified with a $5,000 deductible 80% / 20% plan

All plans are ACA compliant and include annual well visits covered at 100%.

In Nashville, the CPOS network includes the HCA and Ascension/St. Thomas hospitals. In Memphis, the CPOS network includes the Baptist, St. Francis and Region One hospitals. In Knoxville, the CPOS network includes the Covenant hospitals, as well as UT Medical Center and Blount Memorial Hospital. In Chattanooga, the CPOS network includes Erlanger and the HCA hospitals. Pretty much all major physician groups are in-network unless they are specifically aligned with facilities that are out-of-network (Nashville – Vanderbilt; Memphis – Methodist; Knoxville – Tennova; Chattanooga – Memorial). The Humana ChoiceCare network is the network for all other areas.

What are the eligibility requirements for dental coverage? 
Same as medical, 2+ groups are eligible for coverage.  

Does the plan require eligible employees to enroll in coverage in order for their dependents and spouses to obtain coverage?
Yes

Are there limitations on pre-existing conditions? 
No

Are 1099 independent contractors allowed on the plan?
No

Are non-attorney employees of Participating Employers eligible under the plan?
Yes

Are solo practitioners eligible to become Participating Employers under the plan?
A solo practitioner may be eligible to become a Participating Employer if the solo practitioner employs at least one common law employee in the State of Tennessee and otherwise meets the requirements set for in the plan (see the topic above: Who is eligible to become a Participating Employer?)

If I am a licensed attorney, not engaged in the practice of law, can I qualify for the plan? 
Generally, no. You would only be eligible to participate in the plan if you are employed by a Participating Employer.

If I am a licensed attorney engaged in another business with other licensed attorneys, can we qualify for the plan? 
You would only be eligible to participate in the plan if you are employed by a Participating Employer.

Is it possible for non-attorneys who are in the legal services industry to be covered under this plan? 
Yes, as long as you are employed by a Participating Employer.

What is the plan year?
Open enrollment for summer 2020 starts on April 1, 2020 and ends on May 31, 2020 for a July 1, 2020 through December 31, 2020 coverage period. Those participating in this enrollment period will have the opportunity to revisit their plan in the fall for 2021 coverage. Full year coverage runs January 1 through December 31 each year with enrollment starting in the fall.

How do I determine if I can remain with my current physicians if I use this plan?
Two ways, by checking the Humana network provider finder at humana.com/finder/medical and/or with your physician’s office to confirm they are a provider in the above networks.

Who is the point of contact for any issues with open enrollment or plan administration?
Please contact your TBA Member Insurance Solutions representative at 423-629-2400 x264.

When will I receive my health insurance ID card(s)?
Once your enrollment is finalized, ID card(s) will be issued within 10 business days, and then sent to be mailed to member’s home address. For this reason we encourage everyone to complete and submit your enrollment as early as possible.

What happens to my coverage if I leave my firm or move to a status not otherwise covered under the plan? 
You may have the option to elect COBRA coverage.

What is the membership and health plan coverage timeline?
We are currently running a summer enrollment program that with open enrollment starting on April 1, 2020 and ending on May 31, 2020 for a July 1, 2020 through December 31, 2020 coverage period. Those participating in this enrollment period will have the opportunity to revisit in the fall for 2021 coverage with open enrollment beginning October 1.