CoverTN Implements Plans for Expanded Benefits and Eligibility

Friday, January 30, 2009 | 10:34am

NASHVILLE – With the new year, members of CoverTN now have access to expanded health benefits with no premium increase from the 2008 rates. In addition, applicants to the program for the state’s working uninsured can now earn up to $55,000 per year, an increase from last year’s $43,000 limit.

The state-administered program provides basic health coverage for small businesses, the self-employed, individuals who work but do not have insurance and the recently unemployed. Recent changes to CoverTN make the program more accessible to Tennesseans who lack health coverage, while also offering a stronger benefit plan that covers the services people need most.

“As CoverTN enrollment continues to grow, the needs of its members and of Tennesseans are also growing and changing,” Governor Phil Bredesen said. “It’s ciritcal that we continue to make responsible decisions and allow this program to evolve in a way that serves the needs of our state’s uninsured. I’m proud of what we’re doing with CoverTN.”
 
As part of the benefit expansion, members now have access to 12 primary care physician visits per year, in addition to five or six specialist visits, depending on an individual’s plan choice. Under the new benefit plan, diabetic supplies and insulin are no longer subject to quarterly limits for prescriptions and co-pays for these items have been reduced from $25 to $10.
 
As one of the qualifiers for program eligibility, 2009 also marks the increase of the maximum income for CoverTN from $43,000 to $55,000 annually. For the self-employed, this limit is based on annual adjusted gross income, thereby allowing for business expenses and other expenditures which affect take-home pay.
 
As part of CoverTN’s design, the state contributes one-third of the monthly premium of all Tennesseans who enroll in the program. Monthly premiums are based on a person’s age, weight and tobacco usage and are split equally between the state, employer and employee, with an individual third averaging $56. For individuals, including the self-employed and the recently unemployed, the member assumes responsibility for two-thirds of the premium.
 
“CoverTN is an affordable option for quality health coverage, which provides a great deal of security and peace of mind in these otherwise uncertain times,” Bredesen said.
 
The program launched in April 2007 to serve the needs of uninsured small businesses and self-employed individuals, and later expanded eligibility to include those workers who do not have health coverage through their employer but meet other eligibility criteria, including income limits and being uninsured for six months.
 
CoverTN, which currently serves more than 18,000 members, is a program of Cover Tennessee, Governor Phil Bredesen’s initiative to address the health care needs of Tennessee’s uninsured. Cover Tennessee’s offers three other programs, including CoverKids, a free comprehensive health insurance program for qualifying children 18-years-old and younger. CoverRx provides Tennesseans who lack pharmacy benefits with access to affordable prescriptions and AccessTN offers comprehensive health insurance for those who are uninsurable due to pre-existing medical conditions. 
 
For more information about any of the Cover Tennessee programs, visit www.CoverTN.gov or call 1-866-COVERTN.
 
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CoverKids