Tennessee Health Insurance Guide
Tennessee Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
When you live in Tennessee you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Tennessee State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Tennessee is not a guarantee issue state. By law, private insurance companies that sell individual policies must medically underwrite them and are required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health, age and lifestyle habits. In Tennessee, insurers are permitted a 24-month exclusionary period; there is no limit on the look-back period for pre-existing conditions, unless you are exempt under HIPAA. Tennessee also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. If you file a claim during the first two years your policy is in effect, your insurer can review your medical history and deny benefits if it is determined that you should have listed the current situation as a pre-existing condition. Premiums, which are not regulated by the state, can be based on your health, your age and lifestyle factors. Tennessee does not require insurers to offer standardized policies for individuals.
Tennessee is a guarantee issue state for group health plans issued to small businesses. If your Tennessee health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 35% of its index rate if your group has a history of unfavorable health.
Tennessee is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
Tennessee Mandated Health Benefits
Tennessee laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Autism
- Bone Marrow Transplants
- Bone Mass Measurements
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Chemotherapy
- Chlamydia
- Clinical Trials
- Colorectal Cancer Screening
- Diabetic Supplies
- Emergency Services
- Mammography
- Mastectomy Stays
- Maternity Stays
- General and Parity Mental Health
- Off Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- Coverage for newborns under guardian's policy
- Coverage for adopted children under guardian's policy
- Coverage for non-custodial children under guardian's policy
- Coverage for handicapped dependents under under guardian's policy
- Coverage for continuation/dependents under guardian's policy
- Coverage for dependent students under their parent’s or guardian’s policy
- Coverage for conversion to non-group
- Coverage for continuation/employees
Types Health Insurance Plans Available in Tennessee
The following major medical health insurance plans are generally available in Tennessee. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Tennessee
Access TN
This is the state-sponsored high-risk pool that offers health insurance to state residents who have been unable to secure coverage from private insurers because of a pre-existing condition. One comprehensive PPO plan is available, with three different deductible levels ranging from $1,000 to $5,000, with one Health Savings Account option. A maternity rider is also available. Premiums are based on the plan you select, your age, tobacco use and obesity status. Access TN enrollment is open. There is a six-month exclusionary period for pre-existing conditions regardless of prior creditable coverage, but can be waived for prescription drugs.
CoverKids
This program provides comprehensive free or low-cost health care for resident pregnant women and children up to age 19, whose families meet income requirements and other eligibility requirements. One plan is available with assignment based on family income. No premiums are charged but there are modest co-pays and coinsurance for some services including prescription drugs. There may be a waiting period of three months, but it can be waived for newborns up to 4 months. Enrollment is open but is subject to review and renewal every 12 months.
Regulating Agency
The Tennessee Department of Commerce and Insurance is responsible for regulating Tennessee’s health insurance industry.
Get access to Tennessee health insurance quotes from http://www.einsurance.com/health-insurance.
Department of Commerce and Insurance
Insurance Division
500 James Robertson Parkway
Nashville, TN 37243
(615) 741-2176
http://www.state.tn.us/commerce/insurance/whatwedo.shtml
Cover Tennessee
312 Rosa L. Parks Aveue, Suite 2600
Nashville, TN 37243
1 (866) CoverTN
http://www.covertn.gov
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/