CoverTN is the product for Tennessee Governor Phil Bredesen’s Cover Tennessee program. This plan design is not intended to be a low-cost alternative to traditional insurance, but an affordable option for those who otherwise couldn’t afford coverage at all. Therefore, these plans have eligibility requirements that were established by State legislation that must be met in order to obtain this limited benefit coverage.

State eligibility guidelines

Because CoverTN is part of the Cover Tennessee initiative, you must meet certain criteria established by the state to be eligible for the limited-benefit coverage.

A small business owner must:

• Have fewer than 50 full-time equivalent (FTE) employees
• Have a workforce in which at least half of the employees earn $55,000 or less per year
• Be located and operate in Tennessee as its principal place of business
• Not have offered coverage in the past 6 months, unless you only offered it to certain classes of employees (carve-out)
• Agree to abide by the program guidelines, including paying one-third of the employee’s premium
• Limit coverage to employees who are U.S. citizens or qualified aliens

A self-employed individual must:

• Be 19 years old or older
• Be a U.S. citizen or qualified alien
• Live in Tennessee (6 months)
• Work at least 20 hours a week on average (Must be able to show income from the business equal to at least 20 hours per week at minimum wage, or about $6,800 per year)
• Earn $55,000 or less per year in adjusted gross income
• Not have existing health coverage (individual or group)
• Have been without health coverage for 6 months or more*
• Agree to be directly billed for two-thirds of the premium

An employee of a participating employer must:

• Be 19 years old or older
• Be a U.S. citizen or qualified alien
• Live in Tennessee (6 months) or a bordering state
• Work at least 20 hours a week on average
• Pay one-third of the premium, unless the employer agrees to pick up the employee’s third
• Not have existing health coverage (individual or group)
• Have been without health coverage for 6 months or more*

An employee of a non-participating employer must:

• Be 19 years old or older
• Be a U.S. citizen or qualified alien
• Live in Tennessee (6 months)
• Work at least 20 hours a week on average
• Earn $55,000 or less per year
• Not have existing health coverage (individual or group)
• Have been without health coverage for 6 months or more*
• Agree to be directly billed for two-thirds of the premium

An employee who has had his or her hours reduced must:

• Be 19 years old or older
• Be a U.S. citizen or qualified alien
• Live in Tennessee (6 months)
• Have worked at least one 20-hour week in the last 6 months
• Earn $55,000 or less per year
• Not have existing health coverage (individual or group)
• Not have access to employer-sponsored coverage
• Agree to be directly billed for two-thirds of the premium

An individual between jobs (lost his or her job and benefits) must:

• Be a U.S. citizen or qualified alien (see pg. 11, FAQ #2)
• Live in Tennessee (6 months)
• Have worked at least one 20-hour week in the past 6 months
• Not have been unemployed longer than 6 months
• Earn $55,000 or less per year
• Not have existing health coverage (individual or group)
• Agree to be directly billed for two-thirds of the premium

Spouses of CoverTN participants are eligible, too.
If you are eligible for CoverTN, your spouse is also eligible, as long as he or she:

• Is 19 years old or older
• Is a U.S. citizen or qualified alien
• Lives in Tennessee (6 months)
• Does not have existing health coverage (individual or group)
• Has been without health coverage for 6 months or more*
• Agrees to be directly billed for two-thirds of the premium