The TBA Association Group Health Insurance Plan
Frequently Asked Questions
What is the name of the Insurance Carrier?
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;
- 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 these facilities (Nashville – Vanderbilt; Memphis – Methodist; Knoxville – Tennova; Chattanooga – Memorial), which are out-of-network. The Humana ChoiceCare 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?
Are there limitations on pre-existing conditions?
Are 1099 independent contractors allowed on the plan?
Are non-attorney employees of Participating Employers eligible under the plan?
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?
January 1st through December 31st each year.
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 www.Humana.com 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.
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?
Open enrollment begins October 1, 2019, and runs through Decemeber 1, 2019. Coverage becomes effective January 1, 2020.