Covering most health services that most Tennesseans need. Fourth Quarter 2011


In this issue

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 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.

CoverTN Rules and Limits


Plan A

Plan B

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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®BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.

*24/7 Nurseline and Health Information Library are independent companies or services of independent companies serving CoverTN members.

The information in this newsletter is not meant to take the place of a doctor's advice.

This document has been classified as public information.

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