How to Get Health Care in Tennessee for Uninsured Workers

TennCare was bankrupting the state of Tennessee, hopefully CoverTN, launched this March by Governor Phil Bredesen will be the answer for an affordable, comprehensive health care program for working Tennesseans, who do not have have health insurance. BlueCross BlueShield of Tennessee will administer CoverTN, which creates a partnership between state, small business and employees. It is not a mandated program or an entitlement program-it is another option for people in Tennessee to obtain private, portable insurance, which means the individual owns the insurance, not the state or the company.

Cover Tennessee includes 5 programs:

1. Three Insurance Plans
a) CoverKids
b) AccessTN
c) CoverTN

2. Pharmacy Assistance for the Uninsured
a) CoverRX

3. Prevention, Healthy Lifestyles, and Personal Responsibility
a) ProjectDiabetes
b) Coordinated School Health

Who are the uninsured?
According to a statewide study, 53% of Tennessee's working uninsured work for a company of fewer than 25 employees
58% of uninsured have family incomes below $30,000
83% of working uninsured are in permanent, full-time positions.
80% of those surveyed do not buy health insurance because they can't afford it.
other research indicates that employers nor employees want to pay more than $100 per month.
March 2006 US Census Data indicate:
833,114 uninsured Tennesseans, 705,441 adults and 127,673 children under 18

A quick overview of each of the 5 programs: For all programs, one has to be a US citizen or qualified legal alien and meet FPL (poverty level standards for working Tennesseans) Other eligibilities include one's use of tobacco, weight and age and plan deductibles from $1000, $2500 to $5000 will determine premiums. Premiums range based on the above requirements and plan chosen

CoverKids:

Comprehensive plan based on state employee health plan
Not been insured for 3 months, waived for newborns up to 4 months
Screened first for TennCare
Children 18 and under
Maternity coverage available for pregnant women

AccessTN:

No income determination, no asset test
Age 19 and over
Uninsurable by medical or insurance determination
Not been insured for 6 months
Exhausted continuation coverage, including COBRA
No access to insurance at time of application
For a 60 day period, TENNCARE disenrollees as a result of eligibility reform with Health Insurance Portability Act or HIPAA coverage will not have to go without insurance for 6 months to qualify.
Otherwise, 6 month pre-existing condition waiting period
No wait for preventative care, pharmacy or outpatient therapy
Premiums range from $273 to $1156 depending on plan chosen ( Each plan have different deductibles from $1000, $2500 to $5000)

CoverTN:

Small Businesses located in Tennessee
25 or fewer employees
50% of workforce earning $41,000 or less
Not offered employer-sponsored insurance for 6 months, or if offered, business has not paid 50% or more of employee premiums
Once a small business is enrolled, employees eligible if work 20 hours per week, did not stop health insurance in last 6 months, commits to pay one-third of premium, spouse covered with employer option to contribute one-third of spousal premium.
In year 2, plan expands to include businesses with over 50 or fewer full-time employees and individuals at non-participating employers

CoverRX:

At launch household income below 250% FPL
Tennessee resident for 6 months
Age 19 to 64
Uninsured or without pharmacy coverage
This in NOT an insurance, includes pharmacy discounts
No pre-existing condition clauses
No premiums
Co-pays range from $3 to $25 depending on income level and the medication prescribed

ProjectDiabetes:

Obesity is on the rise and Tennessee ranks high as far as poor health habits. This is a major public health effort to educate people in Tennessee to exercise and change their eating habits. Both are aimed at reducing the incidence of Type 2 Diabetes and obesity. Diabetes is the only major disease that is still rising, up 22 percent since 1990 and is the leading cause of kidney failure, blindness and non-traumatic amputation (NY Times, May 16,2006)

In conclusion, I think the Governor is on the right track to help Tennesseans take personal responsibility of their health care in a comprehensive, preventative care program that is accessible for the children, chronically ill and hard working citizens of Tennessee.