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Frequently Asked Questions

CoverTN
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?

CoverKids
What are the requirements for eligibility?
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?

AccessTN
What is AccessTN?
What is the Pre-existing Condition Insurance Plan (PCIP)?
Why is there a six-month waiting period before pre-existing medical conditions are treated the same as other medical conditions?

CoverRx
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?
If I go to the pharmacy but do not have my ID card, how can I get a prescription filled?



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.

Enrollment to new members in CoverTN is closed. Existing members and new employees of participating employees will continue to be eligible for coverage.

What are the eligibility categories?
CoverTN was designed for people in the following categories:
Small business owners and their employees
Self-employed individuals
Individuals who work at least 20 hours per week but cannot afford traditional health insurance
Individuals who, within the previous six months, have lost their job or had work hours reduced to less than 20 hours per week

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:
Separation from employment (voluntary or involuntary)
Cancellation of group or individual health insurance coverage by the insurance carrier for reasons other than non-payment of premium, fraud or misrepresentation
A health insurance carrier's decision to no longer sell small group benefits coverage
Loss of eligibility for TennCare or CoverKids
Active duty in the Armed Forces during the previous six months

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.

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CoverKids

What are the requirements for eligibility?
Tennessee resident
U.S. citizen or qualified legal alien (babies born in the U.S. will be considered citizens)
Age 18 or younger
Household income up to $59,625 annually for a family of four
Children who are Native American/Alaskan Native may be eligible for additional benefits and should include federally-recognized tribal paperwork with the application
CoverKids must be your only health plan. To get benefits, your child cannot be part of any other plan.
A pregnant woman with maternity coverage is not eligible for CoverKids HealthyTNBabies. CoverKids HealthyTNBabies can't be used as a secondary plan.

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:
Vaccinations and well-child visits
Physician services
Hospitalization
Mental health services
Physical, speech and occupational therapy
Vision
Dental

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.

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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 is the Pre-existing Condition Insurance Plan (PCIP)?
Tennesseans who lack health insurance and cannot access private coverage because of pre-existing conditions may be eligible for coverage through the Pre-existing Condition Insurance Plan (PCIP). PCIP is administered by the United States Department of Health and Human Services. The program provides coverage to those who prove a pre-existing medical condition with a denial letter from a private insurer and have been uninsured for at least six months. PCIP offers comprehensive coverage with no pre-existing condition exclusion and no annual or lifetime benefit limit. Like AccessTN, PCIP members are responsible for paying monthly premiums, which vary from $163 to $699 per month, depending on the individual's age.

To learn about PCIP, including how to apply, visit the Health and Human Services website at www.pcip.gov or call 1-866-717-5826.

Why is there a six-month waiting period before pre-existing medical conditions are treated the same as other medical conditions?
Like traditional, commercial individual health insurance plans, a limitation on pre-existing conditions reduces premium rates and helps make an insurance program financially stable for its members. The AccessTN Board of Directors determined that not having a pre-existing condition-waiting period made premiums too expensive and decided on a six-month waiting period.

However, AccessTN will pay a 50 percent benefit for treatment of pre-existing conditions, rather than exclude coverage altogether. Prescription drug coverage is not subject to the pre-existing waiting period. Also, outpatient behavioral health services and outpatient drugs used for the treatment of cancer are not subject to either the pre-existing conditions exclusion or a deductible. The AccessTN Board approved this to help participants afford medications for chronic conditions and chemotherapy or radiation treatment.

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CoverRx

What are the requirements for eligibility?
Tennessee resident (six months)
U.S. citizen or qualified legal alien
Age 19 to 64
Uninsured or insured with no pharmacy coverage
Household income below 2013 federal poverty level ($23,550 per year for a family of four)

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 at www.CoverTN.gov or by calling 1.866.CoverTN or 1-88-560-2649 ext. 361240.

Is there a way to get brand name drugs with CoverRx?
The program does not pay for medications not on the covered drug list. Howver, the CoverRx card can be used as a discount card to purchase brand name drugs.  When available, members are encouraged to use patient assistance programs offered by many drug manufacturers.

What prescriptions are covered?
The list of covered drugs will be included in every welcome packet, but can also be found here. You can request a copy be mailed to you by calling 1-888-560-2649.

If I go to the pharmacy but do not have my ID card, how can I get a prescription filled?
Provide this information to the pharmacist to process your order.
Step 1 Enter Bin 003858
Step 2 Enter Processor Control Number A4
Step 3 Enter Rx Group TCXA
Step 4 Enter Participant's SSN
Step 5 Enter Participant's Date of Birth


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