The Cover Tennessee programs – CoverKids, CoverTN, AccessTN and CoverRX were designed to fill gaps in coverage for Tennesseans who had difficulties accessing health insurance. Starting Oct. 1, 2013, the federal Health Insurance Marketplace will be open for enrollment with coverage starting Jan. 1, 2014. Due to new insurance regulations put in place by the Affordable Care Act (ACA) insurance companies can no longer implement annual or lifetime limits, institute a waiting period for pre-existing conditions, require a "go bare” period, or deny an individual coverage due to a pre-existing condition. Insurance companies must also cover preventative services without any out-of-pocket costs to the member. Because of these changes, some of the Cover Tennessee programs will no longer be needed to continue to fill gaps in coverage and/or will not meet the new requirements of coverage.
Overview: CoverKids is Tennessee Children's Health Insurance Program (CHIP) that is funded by both the state and the federal government. In order to qualify, families must earn less than 250% of the federal poverty level. For a family of four that is $58,875 a year or less. Members do not pay premiums but may pay some co-pays.
ACA-related changes: A small amount of the members in the CoverKids program, specifically children in families with a household income greater than 250% of the federal poverty level, were allowed to obtain coverage by "buying into” the program – meaning they paid the full cost of the premium. Because these individuals will have access to insurance in the federal Marketplace, they have been notified that their CoverKids coverage will end Dec. 31, 2013, and sent information about enrolling for coverage in the Marketplace.
Overview: CoverTN is a limited benefit health insurance plan where the cost of the premium is split among the employee, the employer and the state. This program receives no federal funding. The plan has an annual benefit limit of $25,000. Individuals cannot have had health insurance coverage within the previous six months. New enrollment in the program has been closed since Dec. 2009, however businesses already participating in the program were allowed to continue to enroll new employees.
ACA-related changes: Since it is a limited benefit program, CoverTN will not meet the new insurance requirements that go into effect Jan. 1, 2014. Members have been sent notices informing them that their coverage will end Dec. 31, 2013, and information on the federal health insurance Marketplace. Furthermore, there will no longer be a need for such a program as individuals will have access to coverage through the Marketplace or through their employer in the federally-run SHOP exchange. Maternity coverage for current pregnant membership will continue until 60 days postpartum.
Enrollment changes: CoverTN will accept new applications as well as benefit changes until 10/31/2013. The last effective date for new CoverTN member will be Dec. 1, 2013 meaning you will have ONE MONTH of coverage. You will need to purchase alternative health insurance coverage after December 31, 2013.
Overview: This is the state's high risk pool which offers coverage to individuals who are uninsurable due to pre-existing conditions. Members pay monthly premiums for this comprehensive coverage. At one time, premium assistance was available to help off-set the cost of coverage, however premium assistance for new members ended in Dec. 2010. AccessTN has annual and lifetime spending limits of $250,000 and $1,000,000.
ACA-related changes: Given that individuals should have been able to access lower cost coverage in the federal Health Insurance Marketplace, the AccessTN board previously decided to close the program for members above the federal poverty level and/or not receiving premium assistance. However, recent problems with the implementation of the Health Insurance Marketplace have created difficulties for people attempting to transition to the Marketplace. As a result of these issues, the board has voted to extend coverage to current members who were previously advised that their coverage would end. This extension will allow AccessTN members to keep their current coverage until April 30, 2014, which provides coverage for 30 days following the end of the Marketplace open enrollment period. Existing members with incomes below the federal poverty level AND who currently receive premium assistance have been granted a one-year extension. Notices have been mailed to existing members to inform them when their coverage will end.
Enrollment changes: No new applications will be accepted for the AccessTN program after October 31, 2013. Premium assistance remains closed at this time. The last effective date for a new AccessTN member will be December 1, 2013 meaning you will have ONE MONTH of coverage. You will need to purchase alternative health insurance coverage after December 31, 2013.
Overview: CoverRx is a pharmacy assistance program designed to assist those who have no pharmacy coverage, but have a need for medication. CoverRx is not health insurance and will not cover doctor's visits or hospitalizations. The program has no monthly premiums, just copays which vary with income. Members cannot have other pharmacy coverage and must have a household income below 250% of poverty.
ACA-related changes: CoverRx will close to members above the federal poverty level after December 31, 2013 due to new opportunities through the federal Marketplace. Members will be sent notices to inform them that their coverage will be ending Dec. 31, 2013 and to provide them information about enrolling in the federal Marketplace.