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Tennessee Health Insurance
Health coverage is plays a pivotal role in to securing your future against large medical bills and ensuing financial worries. Indeed, purchasing health coverage is costly and requires an assessment of all potential risks and its impact on your financial health. In the U.S., nearly 47 million people are uninsured, among whom most of them are working families. These families, especially children, suffer financially on account of lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.
According to United Health Foundation’s 2008 Health Rankings, Tennessee holds the 47th position when it comes to the state’s health system. Tennessee has maintained its spot in the bottom five least healthy states list since last two years as it stood at 46th and 47th position in 2007 and 2006 respectively. Several factors contributed to the poor healthcare system in the state including high infant mortality rate, high crime rate, and high prevalence of smoking and higher percentage of children in poverty. The state of Tennessee, with more than six million citizens, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide economical health coverage to the uninsurable citizens of Tennessee who meet specific eligibility requirements of age and income.
The Tennessee Department of Commerce and Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, approximately 14.1% of the state population is still uninsured as the state government strives to provide better health care to its residents. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 33.8% of uninsured residents come under the above 200% FPL category.
Overall, Tennessee lawmakers and the citizens need to work together to build a stronger health system and provide accessible health insurance to everyone. Buying health insurance is a tedious task, but with the guidance of a licensed health insurance agent/broker, you can choose a suitable health insurance policy for your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Tennessee. These regulations apply to all insurance companies offering individual or family health insurance in Tennessee:
Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 24 months |
Look Back Period | No Limit |
Look Back Standard | No definition |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, osteoporosis screening, eating disorder parity |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Tennessee. These regulations apply to all insurance companies offering small group health insurance in Tennessee:
Small Group Size | 2-50 |
Employee Qualifications | Owner can be counted as an employee |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 35% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Tennessee. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 3 months |
Extension of Benefits Period - Disabled | 3 months |
Maximum Premium Increase | 100% |
State Legislation Reference | |
Additional Notes | Request for continuation of coverage must be given withinin31 days. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Tennessee to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Tennessee is summarized in the chart below:
Plan Name | AccessTN |
Website | |
Phone Number | 866-636-0080 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Blue Cross Blue Shield of Tennessee |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Currently Open to New Enrollment |
Premium Limits | Between 150% to 200% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | To be eligible for the risk pool, you must be a Tennessee resident for six months and U.S. citizen and legal qualified alien, you should not have access to employer insurance, except CoverTN and you should have no health insurance for previous three months (special rules may apply to those finishing COBRA, TennCare of CoverKids policies) |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Tennessee provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
Program Name | CoverKids |
Website | |
Phone Number | 866-620-8864 |
Apply Online | Yes |
Age Limits | Under 18 |
Insurance Carrier | Blue Cross Blue Shield of Tennessee |
Length of Coverage | 12 months |
Residency Requirements | Tennessee resident, U.S. citizen, qualified legal alien |
Other Eligibility Requirements | To qualify, your child should be uninsured for at least three months prior to application; should not eligible for TennCare; should not have access to state employee health insurance. Household income should be up to 250% of FPL |
Pre-Existing Condition Exclusions | None |
Cost | Family must pay their share of monthly premiums and co-pays. Current premiums are approximately $239 per month per child. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Tennessee:
Governing Agency | Tennessee Department of Finance and Administration |
Website | |
Phone Number | 800-342-3145 |
Residency Requirements | Tennessee resident, U.S. citizen |
Federal Poverty Line Income Limits | Pregnant women & infants: 185% FPL; |
Additional Resources
Tennessee Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Tennessee’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Tennessee: At-A-Glance
Provides all-inclusive health data of Tennessee. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
