Frequently Asked Questions
What is CoverTN?
What are the eligibility categories? Are there exceptions to the requirement for applicants to be uninsured for six months? What is considered an involuntary loss of coverage? Is there a pre-existing condition waiting period for CoverTN? What are the requirements for eligibility? Why must children be uninsured for the previous three months in order to qualify? If a child has access to a parent's employer-sponsored insurance, but the family declined the coverage because it was too expensive, is the child eligible for CoverKids? What services are covered? Is special assistance available for help completing the CoverKids application? What is AccessTN? What are the requirements for eligibility? How does an applicant prove uninsurable status What are the approved medical conditions which qualify someone for AccessTN? Is premium assistance available for low-income participants? What are the requirements for eligibility? What is the cost for participating in CoverRx? How do I apply? Is there a way to get brand name drugs with CoverRx? What prescriptions are covered? CoverTN
What is CoverTN? CoverTN provides a limited-benefit health care option that is affordable, portable and meets the needs of small business owners, the self-employed, working individuals without access to coverage and those between jobs. CoverTN provides low-cost coverage for basic medical services, with a focus on preventive care. What are the eligibility categories? CoverTN is open to four categories of people:
Are there exceptions to the requirement for applicants to be uninsured for six months? If an individual chooses to stop their existing health insurance coverage, they must wait or "go bare" for six months before being able to enroll in CoverTN. If an individual experiences an involuntary loss of coverage, the six-month go bare period does not apply. The only exceptions to the six-month go bare requirement are as follows. For purposes of eligibility for CoverTN, an involuntary loss of coverage is considered the loss of health insurance due to the following:
Is there a pre-existing condition waiting period for CoverTN? Yes. CoverTN has a 12-month pre-existing condition waiting period. No benefits will be paid for conditions present during the immediate six months prior to enrolling in CoverTN. After the member has been enrolled in CoverTN for 12 months, CoverTN will begin covering these conditions. The pre-existing condition waiting period can be shortened or waived for members with prior creditable coverage who apply within 63 days of an involuntary loss of their coverage. [more...] CoverKids
What are the requirements for eligibility?
Why must children be uninsured for the previous three months in order to qualify? CoverKids is designed to provide health insurance for children who have no other option for coverage. The three month requirement prevents the program from being used as an alternative to private commercial insurance. Exceptions to the three month go-bare requirement include:
If a child has access to a parent's employer-sponsored health insurance, but the family declined the coverage because it was too expensive, is the child eligible for CoverKids? Yes. Access to coverage is not a factor in CoverKids eligibility. If all other eligibility criteria are met, it is simply a matter of whether the child is insured or uninsured. One exception is access to state employee insurance. Federal guidelines do not allow children with access to state employee health insurance to participate in CoverKids. What services are covered? CoverKids provides comprehensive health insurance with an emphasis on preventive health services and includes the following:
Is special assistance available for help completing the CoverKids application? Yes. Those who need special assistance completing the CoverKids application may call 1.866.620.8864 and request help with completing their application. [more...] AccessTN
What is AccessTN?
AccessTN is a comprehensive health insurance program for Tennesseans who are uninsurable because of pre-existing medical conditions or health history. AccessTN functions as Tennessee's high-risk insurance pool. What are the requirements for eligibility?
How does an applicant prove uninsurable status? In one of three ways:
What are the approved medical conditions which qualify someone for AccessTN? If, within the previous three years, an applicant has been diagnosed or treated for any of these medical conditions, he or she will qualify for AccessTN as medically uninsurable. (It is important to know that these are not the only ways to qualify for AccessTN.)
Is premium assistance available for low-income participants? Tennessee has allocated more state funding to premium assistance for this kind of high-risk pool than any state in the nation. However, due to enrollment growth in the program, premium assistance funding is being fully used by those already on the program. A waiting list is available for those applicants who cannot afford to pay full premiums. As space becomes available, applicants on the waiting list will receive assistance based on their annual household income. For those who need coverage as soon as possible and must wait for premium assistance, CoverRx may be an option to provide prescription coverage during the waiting period. It is also important to note that anyone may contribute to the cost of premiums, co-pays and deductibles and other out-of-pocket expenses for an AccessTN applicant. There are restrictions on who can contribute to an individual's premium. Health care providers, government sponsored programs and employers are specifically restricted from contributing to the monthly premium. Charitable organizations, family and personal friends are not restricted from offering financial assistance to an AccessTN member. [more...] CoverRx
What are the requirements for eligibility?
What is the cost for participating in CoverRx? Because CoverRx is not insurance, there are no monthly premiums and no cost to join. Members are responsible for affordable, income-based co-pays when they fill prescriptions. Participants will pay a discounted price for any drugs that are not covered. How do I apply? Applications are available for download from this web site or by calling 1.866.CoverTN. Is there a way to get brand name drugs with CoverRx? The program does not pay for medications not on the covered drug list. The CoverRx card can be used as a discount card to purchase brand name drugs. What prescriptions are covered? The list of covered drugs will be included in every welcome packet, but can also be found on this web site. You can request a copy be mailed to you by calling 1.888.560.2649. [more...] Cover Tennessee General Cover Tennessee FAQ |
