CoverTN is a limited-benefit health plan designed to cover most needed medical services. It is a defined contribution health plan, not a defined benefit health plan. The Governor and the General Assembly have set aside a specific budget and some minimum parameters for a benefit package.

BlueCross BlueShield of Tennessee was awarded the CoverTN contract through a competitive bid process. Individuals have two different plans from which to choose — Plan A and Plan B. Since CoverTN is designed to provide coverage for most needed services, the plans have no deductible. Members need only meet their co-pay requirements to gain immediate access to services.

CoverTN has a 12-month pre-existing condition waiting period. No benefits will be paid for conditions that are present during the immediate six months prior to enrolling in CoverTN for the first 12 months of the policy. After the member has been enrolled in CoverTN for 12 months, CoverTN will begin covering these conditions.

Medical services such as doctor's office visits, emergency room visits and ground ambulance, inpatient and outpatient hospital services, surgery and pharmacy benefits may be accessed with just a co-pay. However, there are service and benefit caps per member per calendar year. Both plans have a maximum annual benefit limit of $25,000 per year. Individuals who reach the annual benefit maximum during the year are responsible for all expenses exceeding $25,000 until the next plan year begins. Refer to the benefit plan for Plan A and Plan B for more information on covered services.

CoverTN members who become pregnant will remain enrolled in CoverTN but will receive maternity benefits and pregnancy-related services through CoverKids HealthyTNBabies, the maternity portion of CoverKids. There is no application requirement for maternity benefits through CoverTN — coverage is automatic.