Covering most health services that most Tennesseans need. 4th 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 bcbst.com. Go to the Plan Options tab at the top of the page and 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.

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. 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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Do you need help in these languages: arabic symbol(Arabic); Bosanski (Bosnian); Kurdish-B (Kurdish-Badinani); Kurdish-S (Kurdish- Sorani); Soomaali (Somali); Español (Spanish); Nguoi Việt (Vietnamese)? CoverTN language and member services are free at 1-888-887-3224, Monday-Friday, 8 a.m. to 6 p.m. ET. For TDD/ TTY help call 1-866-591-2908. Federal and State laws protect your rights. They do not allow anyone to be treated in a different way because of: race, language, sex, age, color, birthplace, or disability. Need help? Call the Office of Non-Discrimination Compliance for free at 1-855-286-9085 or TTY: (877) 779-3103. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association

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

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