Q1: Will CoverKids cover uninsurable children and children with special health needs?
A1: Yes. CoverKids is a guaranteed issue policy and there are no pre-existing condition exclusions for participants in CoverKids.
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Q2: Why is there a requirement that the child cannot have been insured for the previous 3 months?
A2: CoverKids is designed to provide health insurance options where they do not exist today. The 3-month requirement and other “crowd out” provisions protect the program from being used by people who drop their existing coverage and immediately enroll in CoverKids.

Newborns (up to 4 months of age) will not have a “Go Bare” requirement and will receive presumptive eligibility as of date of application.

Q3: What services are covered?
A3: CoverKids provides comprehensive health insurance and is modeled after the insurance plan that covers state employees and their children. The coverage includes an emphasis on preventive health services and coverage for physician services, hospitals, mental health and more. HealthyTNBabies covers the already pregnant woman from the date of application (assuming she meets all other eligibility requirements, including the 3 month Go Bare requirement) through birth and ending 60 days after the birth. Any medical treatment or physician visit related to the pregnancy or the health of the child will be covered under CoverKids/HealthyTNBabies. Once the child is born, the child can be enrolled for full, comprehensive coverage if otherwise eligible.
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Q4: Does HealthyTNBabies cover services for conditions other than the pregnancy, such as mental health benefits or coverage for accidents?
A4: No, your HealthyTNBabies ID card covers maternity benefits only, including complications of pregnancy.  For example, if you break your leg while covered by HealthyTNBabies, then the broken leg would not be covered under your maternity benefit.  It would be covered under any other medical coverage you may have. 
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Q5: If I am pregnant, and have employer-sponsored health insurance but do not have maternity, am I eligible for maternity coverage under CoverKids?
A5: Yes, HealthyTNBabies will cover pregnant women with employer-sponsored health insurance who are without a maternity benefit, but they must have a household income under 250% of the Federal Poverty Level.
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Q6: 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?
A6: 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.  The exception is state employee insurance. Federal guidelines do not allow children with access to state employee health insurance to participate in CoverKids.
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Q7: If my child has a trauma and goes to the hospital can she enroll in CoverKids at the hospital?
A7: The child can apply at any time, but the coverage will not begin for approximately a month after the application, which is the standard for commercial insurance policies. Children should become enrolled in the CoverKids program before they become injured or ill.

Newborns (up to 4 months of age) will receive presumptive eligibility based on the date of application.

Q8: What type of preventive health services are included?
A8: CoverKids has an emphasis on services children need most, well-baby and well-child visits, as well as age-appropriate immunizations according to the schedule endorsed by the American Academy of Pediatrics.
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Q9: Does CoverKids include mental health benefits?
A9: Yes, up to 52 visits per year on an outpatient basis, and 30 days of inpatient treatment per year.
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Q10: What is the cost?
A10: For CoverKids, participants under 250% of the Federal Poverty Level will not pay monthly premiums but will be required to make co-payments for certain services.  Co-payments will vary based on income.  Total annual out-of-pocket expenditures cannot exceed 5% of the family’s annual household income.

Participants over 250% of the Federal Poverty Level may buy-in to the CoverKids program.  There will be no federal subsidy for those over 250% FPL, so participants would be charged the full premium amount ($208.13 a month for 2007).  Co-payments are required for certain services and there is no out of pocket maximum. 

For HealthTNBabies, there is no premium for CoverTN members (regardless of income) OR for pregnant women with a household income under 250% of the Federal Poverty Level.  Participants will be required to make co-payments for certain services.  Co-payments will vary based on income.  Total annual out-of-pocket expenditures cannot exceed 5% of the family’s annual household income. 

Q11: If an applicant would rather be on CoverKids than on TennCare, can he request this or switch from TennCare?
A11: No. Any child that is eligible for TennCare will be covered by TennCare. In fact, every application for CoverKids will first be screened for TennCare eligibility before enrolling the child in CoverKids.
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Q12: Will a child insured under CoverKids qualify for the “Vaccines for Children” program?
A12: No. Once a child is insured, they no longer qualify for VFC, but the benefit package under CoverKids includes all vaccinations as recommended by the American Academy of Pediatrics.
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Q13: Will a child insured under CoverKids have to follow the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program?
A13: No. EPSDT is a program under Medicaid/TennCare and does not apply to CoverKids. The families will have access to the same preventive health services but will not have to follow EPSDT compliant procedures. CoverKids will follow the well-baby, well-child schedule laid out by the American Academy of Pediatrics (AAP). This includes all age appropriate immunizations that are endorsed by the AAP.
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Q14: Will my child be assigned a physician?
A14: No. Families will have a listing of participating physicians in their area and can select the health care provider they are most comfortable seeing. Families are encouraged to select a physician to be their medical care coordinator so that their children can have optimal continuity and comprehensive care.
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Q15: What health care providers participate in the network?
A15: CoverKids members, including HealthyTNBabies, have access to providers in Blue Network S, which features at least one physician, hospital and pharmacy within 30 miles of participants.  To see which providers participate in Blue Network S, go to the “Find a doctor” tool on the CoverKids page or on the bcbst.com home page, and select Blue Network S.
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Q16: How do I apply?
A16: Eligibility and enrollment for this program is handled by the CoverKids Eligibility Contractor, not BlueCross BlueShield of Tennessee.  For more information, please contact CoverKids Eligibility Contractor at 1-866-620-8864. An application must be completed for each eligible child or pregnant female in the household.
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Q17: What happens when a child is too old to qualify for CoverKids?
A17: CoverKids is specifically intended for children, not adults. As a result, a child is no longer eligible for CoverKids once that individual reaches his or her 19th birthday. At that time the individual would need to purchase other health insurance -- either commercial insurance, employer-sponsored coverage, or other coverage like CoverTN or AccessTN.
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Q18: When will it begin?
A18: CoverKids is available today.  The effective date of this program was 4/1/07.
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