Covering most health services that most Tennesseans need. 2nd Quarter 2012


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 Schedule of Benefits which is Attachment C of their Member Handbook. They can also 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

Benefit 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 2012.

    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 their dollar and visit limits. 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.

    Call 1-888-887-3224, toll free, Monday-Friday, 8 a.m. to 6 p.m., ET, if you need help or need to speak with someone in another language. TDD/TTY users should call 1-866-591-2908. These services are free to enrollees. We do not allow unfair treatment in CoverTN. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you've been treated unfairly? Do you have more questions or need more help? If you think you've been treated unfairly, call the Office of Non-Discrimination for free at 1-855-286-9085.

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

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