Tennessee has a high risk pool, called AccessTN, to provide coverage for people who are unable to buy private health insurance because of their health status.
WHEN CAN I GET COVERAGE FROM ACCESSTN?
- You can buy coverage from AccessTN if you meet certain qualifications. You must have lived in Tennessee for at least 6 months, been uninsured for the past 6 months, and have exhausted COBRA or state continuation coverage. In addition, you must be able to demonstrate proof of medical eligibility. There are 3 ways you can show eligibility:
- o You have been turned down for coverage by 2 insurance companies;
- o You have been diagnosed with one of 55 specified health conditions, including cancer and AIDS.
- o You have gone though AccessTN underwriting and have been found to be medically eligible.
- If you were offered COBRA or state continuation coverage within the past year and you did not elect it, you will not be eligible for AccessTN for 12 months.
- AccessTN only offers individual coverage. If you need to purchase family coverage, each member of your family needs to qualify on his or her own for an AccessTN policy.
WHAT WILL ACCESSTN COVER?
- You can choose from 3 plan options under AccessTN. Covered benefits are the same under all 3 plans, but the deductible and cost sharing varies. You will have a choice of PPO plans with deductibles of $1,000, $2,500, and $5,000.
- Most services are covered at 80% for in-network and 60% for out-of-network.
Covered benefits include hospital and physician care, prescription drugs, chemotherapy and radiation treatment, and mental health and substance abuse services. There is a $1 million lifetime limit on covered benefits.
WHAT ABOUT COVERAGE FOR MY PRE-EXISTING CONDITION?
- You may have a 3 month pre-existing condition exclusion period when you first enroll in AccessTN. When you enroll, AccessTN will look back 6 months to see if you had a condition for which you actually receive - or for which most people would have sought - a diagnosis, medical advice, or treatment. This is called the prudent person rule. Pregnancy can be considered a pre-existing.
WHAT CAN I BE CHARGED FROM ACCESSTN COVERAGE?
- Premiums will vary based on your age, weight, smoking, and what plan you choose. For example the monthly premium for a 24-year-old range from $273 to $494, depending on the coverage option selected. The monthly premium for a 64-year-old range from $539 to $979.
HOW LONG DOES ACCESSTN COVERAGE LAST?
- AccessTN policies are renewable as long as you pay your premiums, and meet other eligibility requirements.
