Blue Cross Blue Shield of Tennessee

Humana

 

In Tennessee medical underwriting is allowed without restriction. For those with HIPAA rights, no preexisting conditions may be considered. Otherwise there is no look back and exclusionary period limit for preexisting conditions.

 

In Tennessee, those able to utilize their HIPAA rights may obtain health coverage from any individual carrier in the state. Tennessee offers TennCare to those who are otherwise medically uninsurable. You may be eligible for TennCare if you are under 21, pregnant, a single parent or caretaker, in a two-parent family where one parent has lost a job or has a medical condition expected to last at least 30 days, a woman with breast or cervical cancer, receiving a Social Security Income check, you used to get a Social Security Income check, or living in a nursing home and have a monthly income of less than $1809. 

 

Coverage under TennCare includes chiropractic care, convalescent care, dental services, durable medical equipment, ambulance, home health services, hospice care, inpatient hospital care, lab and x-ray services, medical supplies, occupational therapy, organ transplant, outpatient hospital care, pharmacy, physical exams, renal dialysis service, speech therapy, vision services, mental health and substance abuse services.

High Risk Pool

AccessTN provides comprehensive health insurance for Tennesseans who are uninsurable due to pre-existing medical conditions. Three different plans are available with varying deductibles and participants can select the plan that is best for their situation.

To be eligible, you must meet each of the following criteria:

• No income limits, no asset test
• Tennessee resident for 6 months
• U.S. Citizen or qualified legal alien
• Age 19 or older
• Medically uninsurable as demonsrated by one of the following:
  • A doctor's statement that applicant has one of more than 50 medical conditions pre-approved for presumptive eligibility
  • Denial by two unaffiliated insurance carriers for individual coverage due to a health-related condition
  • Qualification through medical underwriting using the health history information in the application
• No access to employer health insurance, except CoverTN
• No health insurance for previous 3 months

The only factor that determines eligibility for Tennessee small business health insurance is that the group or small business must be 2-50 employees including the owner.

Tennessee offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce. 

 

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Children

Children (ages 1-5)-133% of the Federal Poverty Level
Children (Ages 6-19)-100% of the Federal Poverty Level

 

Pregnant Women and Infants

Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-185% of the Federal Poverty Level

 

Parents

Non Working Parents- 100% of the Federal Poverty Level Working Parents- 100% of the Federal Poverty Level

 

Other populations

Medically Needy Individual- 34% of the Federal Poverty Level

Medically Needy Couple- 27% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal

Poverty Level

 

Inpatient and outpatient hospital services, pharmacy services, chiropractic, durable medical equipment, ambulance services, home health services, hospice, laboratory and x-rays, medical supplies, organ transplants, physical therapy, renal dialysis services, speech therapy, vision care, and mental health and substance abuse services.

 

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

 

Tennessee offers the TennCare CHIP program for children up to the age of 19 whose family income is up to 100% of the Federal Poverty Level. Individuals must be residents of Tennessee and U.S. citizens. Please visit the TennCare website for more detailed information at http://www.state.tn.us/tenncare/.