Understanding CoverTN’s Benefit Limits
It's important that your enrolled employees remember the rules and limits of their CoverTN health plan. The chart below highlights some of them. For a complete listing, members should review their Summary of Benefits that they received in their welcome packet. They can find this information at bcbst.com. Just go to the Plan Options tab at the top of the page. Then choose Cover Tennessee from the drop-down menu. Or, they may call Member Services toll-free at 1-888-877-3224 (TDD/TTY 1-866-591-2908) for details.
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office visit – primary care doctors* |
12 visits per year
• $15 copay |
12 visits per year
• $20 copay |
office visit – specialists |
5 visits per year
• $15 copay |
6 visits per year
• $20 copay |
Non-surgical outpatient visit (does not include annual preventive Mammogram) |
3 visits per year |
3 visits per year |
surgical outpatient visits |
2 visits per year |
2 visits per year |
inpatient facility charges |
$10,000 maximum per year
• $100 copay |
$15,000 maximum per year
• $100 copay |
*Must see a Primary Care Physician (PCP) – A Primary Care Physician includes: Internal Medicine, OB/GYN, Family Practice, General Practice, and Nurse Practitioner.
Please note: “Annual” or “per year” is calendar year, January – December.
Monthly Claims Statement
Remind your enrolled employees that they can check the status of their limits on their Monthly Claims Statement (MCS). This explains what was paid, to whom and for what. It also includes a section showing their status in meeting deductibles and reaching out-of-pocket maximums. A statement will only be sent if a member has claims activity in the 28-day period that the statement covers. If they have no claims activity, no statement will be mailed.
Members still enjoy discounts if benefits run out
If members exhaust their benefits, CoverTN can still be of great benefit to them. Why? Keeping coverage will allow them to:
- Continue getting the contractual discounted rate for services from Network V providers.
- Continue receiving discounts for brand and generic drugs through a nationwide pharmacy network.
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