Frequently Asked Questions Cover Tennessee
Why was Cover Tennessee developed?Who are the uninsured in Tennessee? What are the insurance products that are available through Cover Tennessee? What is the difference between Cover Tennessee and CoverTN? Is Cover Tennessee a newer version of TennCare? Where is the money coming from to pay for these programs? What is the total cost of the Cover Tennessee programs? Are there any cost controls built into the programs to keep the premiums affordable? How do I know where to apply for the various programs? What is the best way to learn more about the Cover Tennessee programs? What insurance carrier denials will qualify to determine medical uninsurability? One of the ways to show you are uninsurable is through an AccessTN contracted underwriting process. What does that mean? If I was disenrolled from TennCare when the category for "uninsurable" was categorically disenrolled, am I automatically considered medically uninsurable for purposes of AccessTN eligibility? If I am receiving services from one of the Safety Net programs (i.e. Dialysis, Transplant, Oxygen, etc.) am I eligible for AccessTN or is the Safety Net considered insurance? Is there an income test or an asset test? How do I demonstrate Tennessee residency? Who can pay a premium for an AccessTN participant? Is AccessTN a limited benefit plan like CoverTN? Is there maternity coverage under AccessTN? Can people with HIPAA policies apply for AccessTN? Can people with COBRA coverage apply for AccessTN? Why is there a requirement that someone go without insurance before they can be eligible? Why is there a waiting period before certain conditions are covered? How do I apply? What is the best way to learn more about AccessTN? How does CoverTN differ from traditional health insurance plans? What is a qualified legal alien? Can a county or city government, or a school district participate in CoverTN if they meet eligibility criteria? How should a business count "full-time equivalent" employees? Is the income requirement for the self-employed based on gross or adjusted gross income? As an employer, do I list my employee's income at my business or do I list their household income including other jobs and spouse's income? Are seasonal employees eligible for CoverTN? What about part-time employees? Can they participate through their employer? What if the company's eligibility status changes during the year (e.g. grows to more than 50 employees)? Can the company still participate in CoverTN? Why is there a requirement that the company cannot have offered insurance for the previous six months? What are exceptions to the "go bare" requirement? What is considered "health insurance?" What if my business is located in Tennessee but I have employees that are not Tennessee residents? Can they participate in CoverTN? If my company is interested, how can I sign up to make sure we get enrollment information? What is the difference between Plan A and Plan B? What is I have COBRA? What health care providers participate in the network? How will providers be reimbursed under CoverTN? Can CoverTN premiums be increased? What is the best way to learn more about CoverTN? What is 250% of the federal poverty level? Will CoverKids cover uninsurable children and children with special health needs? Why is there a requirement that the child cannot have been insured for the previous three months? Once my child is enrolled, how long will they be covered? If my family income changes during the year, can my child be taken off CoverKids? For a pregnant woman, what is covered? Are there restrictions on pregnancy eligibility? If I am pregnant, and have employer-sponsored health insurance but do not have maternity, am I eligible for maternity coverage under CoverKids? If a child has access to a parent's employer-sponsored insurance, but the family declined the coverage because it was too expensive, is the child eligible for CoverKids? If my child has a trauma and goes to the hospital can she enroll in CoverKids at the hospital? What services are covered? What type of preventive health services are included? Does CoverKids include mental health benefits? When will CoverKids add dental and vision coverage? What is the cost? How does the buy in work for applicants over 250% of the federal poverty level (FPL)? If an applicant would rather be on CoverKids than on TennCare, can he request this or switch from TennCare? Will a child insured under CoverKids qualify for the "Vaccines for Children" program? Will a child insured under CoverKids have to follow the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program? Will my child be assigned a physician? What health care providers participate in the network? How do I apply? What happens when a child is too old to qualify for CoverKids? What is the best way to learn more about CoverKids? Is there co-pay assistance? How do I apply? Does it matter which pharmacy I go to? Can they go to any pharmacy, or will there be a list of participating pharmacies? If I join this program, can I use other Patient Assistance Programs (PAPs)? Other resources for additional meds or meds that are not on the formulary? Can I join if I have Medicare Part D? Why were these drugs chosen to be covered by CoverRx? Why is there a limit of five prescriptions per month? I take more than five prescriptions each month. Can I appeal the limit? Where's the point of contact for those recipients needing more than five prescriptions per month? I can't take generics. Is there any way to get brands? How do I get the list of covered drugs? How do you access the "restricted" formulary? I never had TennCare. Can I still join? How long will this program last? I am not on any medication right now, but can I join in case I need it in the future? Is mail order available? Will there be a mail order program? Can I get three month supply at one time? Can you help me get a prescription? After I get my five prescriptions at the regular co-pay, can I get more at a discount/larger co-pay? Will members receive a card? How do I get more information? Why was Cover Tennessee developed?
Governor Bredesen’s Cover Tennessee initiative extends health insurance to uninsured residents of Tennessee. Every state is struggling to find ways to provide access to health coverage for those living without insurance. A comprehensive solution can only come from the federal government, but until that time, states must act on their own to address the issue. Cover Tennessee offers access to health insurance for those who want it, but cannot obtain it. Who are the uninsured in Tennessee? A 2005 study of the uninsured in Tennessee found that the uninsured in Tennessee are, for the most part, people who not eligible for programs like TennCare but cannot afford the rising cost of health insurance. For example:
What are the insurance products that are available through Cover Tennessee? There are three insurance products under the umbrella of Cover Tennessee:
What is the difference between Cover Tennessee and CoverTN? Cover Tennessee is the name of the umbrella initiative and includes an array of programs. CoverTN — one of the insurance products that falls under the Cover Tennessee umbrella — provides low-cost insurance to uninsured working Tennesseans. The other insurance products are AccessTN and CoverKids. There is also a pharmacy assistance program called CoverRx. Is Cover Tennessee a newer version of TennCare? No. TennCare is a medical assistance entitlement program regulated by federal Medicaid guidelines. The Cover Tennessee programs have been built specifically to help the Tennesseans who do not qualify for TennCare and have been going without health insurance, and in many cases, without health care. TennCare remains mired in a number of ongoing federal lawsuits that restrict the state’s ability to control the program, but Cover Tennessee is free from these lawsuits and is able to change as the state’s needs and finances change. Also, at its peak, TennCare only covered a small fraction of the uninsured individuals in Tennessee. Cover Tennessee, however, has the potential to cover a far greater percentage of the uninsured. The Cover Tennessee programs are entirely voluntary; no individual or business or insurance company will be required to participate. Unlike TennCare, every participant will be required to contribute to the cost through premiums and co-payments. By operating independently of the federal guidelines and lawsuits of TennCare, Cover Tennessee will extend health insurance to far more people than TennCare ever could, and will cost a fraction of TennCare’s annual cost. Where is the money coming from to pay for these programs? Funding for the Cover Tennessee programs come from a variety of sources, but most of the funds come from several sources:
What is the total cost of the Cover Tennessee programs? The health insurance programs that exist under Cover Tennessee — CoverKids, CoverTN, and AccessTN — will cost the state $251 million over three years. This represents a fraction of what the state would have spent on TennCare over the next three years. More importantly, these funds extend health insurance options to Tennesseans who cannot afford commercial health insurance and would never have qualified for TennCare coverage. See the funding summary for more information. Are there any cost controls built into the programs to keep the programs affordable? Yes. Participants in each of these programs will be required to make co-payments when services are used. CoverTN and AccessTN will include monthly premiums that must be paid by participating individuals. CoverTN also includes a provision to cap the annual cost increases at no more than 10 percent for each of the first three years to ensure the program remains affordable. CoverKids has a federal provision that out-of-pocket spending cannot exceed 5% of the family’s annual income. How do I know where to apply for the various programs? Application forms are available on this website or you can call 1-866-CoverTN. What is the best way to learn more about the Cover Tennessee programs? Information about each of the programs is available on this website or by calling 1-866-CoverTN. AccessTN
What insurance carrier denials will qualify to determine medical uninsurability?
Within the last six months, you were denied individual health insurance coverage by two different companies due to health reasons. Qualification can be based on ANY health condition. You must attach copies of insurance denial letters. A letter from an insurance agent is not sufficient; it must be an official letter from the insurance company. A list of the insurers is located here. One of the ways to show you are uninsurable is through an AccessTN contracted underwriting process. What does that mean? AccessTN has contracted with an insurance reviewer to evaluate the health history of applicants who tell us if their health conditions would disqualify them for individual coverage from Tennessee commercial health insurance. This method provides an alternative for applicants who may not have one of the listed medical conditions or a current relationship with a doctor or who have not applied for commercial health insurance within the last six months. Unless you are a TennCare disenrollee, using this method requires a cashier's check or money order for $75, made payable to Fort Dearborn Life Insurance Company with your application. This fee is non-refundable. If you choose this method to qualify, you may also be responsible for getting additional doctor's records at your own expense, as requested. If I was disenrolled from TennCare when the category for "uninsurable" was categorically disenrolled, am I automatically considered medically uninsurable for purposes of AccessTN eligibility? No. All applicants must demonstrate medical uninsurability according to one of the three criteria set forth by the AccessTN Board of Directors. However, the Board has agreed to temporarily cover the $75 fee for TennCare disenrollees who utilize the AccessTN underwriting process to show uninsurability. The option to go through this process is built into the AccessTN application. If I am receiving services from one of the Safety Net programs (i.e. Dialysis, Transplant, Oxygen, etc.) am I eligible for AccessTN or is the Safety Net considered insurance? Someone receiving Safety Net services is not considered insured, so as long as they meet other eligibility criteria, they would be able to apply for AccessTN. Is there an income test or an asset test? There is no income test or asset test to get into AccessTN. People in all income brackets will be eligible to participate in this coverage. There will be an income test to be eligible for premium assistance. How do I demonstrate Tennessee residency? You will need two types of identification to show residency, consistent with the standards for proving residency for a current Tennessee driver's license. www.state.tn.us/safety/driverlicense/dlproof.htm Who can pay a premium for an AccessTN participant? Anyone can contribute to the cost of co-pays and deductibles and other out-of-pocket expenses for an AccessTN applicant. There are restrictions, however, on who can contribute to an individual's premium. The following organizations are specifically restricted from contributing to AccessTN premiums: health care provider, government sponsored programs, employer. Provided there is no conflict of interest, the following are allowed to contribute to AccessTN premiums: charitable organizations, family and personal friends. Is AccessTN a limited benefit plan like CoverTN? AccessTN is comprehensive health insurance. The benefits are modeled after the insurance plan that is offered to state employees and includes broad coverage of services that are needed by chronically ill adults. See the benefit summary for more information. Is there maternity coverage under AccessTN? Maternity is included as a core benefit under each of the AccessTN plans, but there will be a 12-month waiting period from the date of enrollment before an AccessTN participant can file a claim for maternity services. Can people with HIPAA policies apply for AccessTN? In general, people with HIPAA policies will not be eligible for AccessTN at the program’s launch because of the requirement in the law that a person be without other health insurance for six months. However, applicants who were disenrolled from TennCare as part of reform and who have been on a HIPAA plan will be allowed to apply for AccessTN until the end of July 2007. Rates for these participants will be slightly higher, but will not have any pre-existing condition exclusion. Can people with COBRA coverage apply for AccessTN? An applicant must have exhausted all COBRA coverage available to them in order to be eligible to apply for AccessTN. If he or she exhausts all available COBRA coverage AND applies within 63 days from the end of the coverage, the applicant may apply directly to the Portability category without any "go-bare" and without a pre-existing condition waiting period. Whether there is any gap in coverage will be determined when the application is processed by the plan administrator. So be sure to apply early enough. If an applicant has access to COBRA and does not elect to take it or discontinues COBRA insurance before exhausting the coverage available, that applicant will have a three-month "go bare" requirement from the last date of coverage before the applicant's AccessTN coverage can be effective. Why is there a requirement that someone go without insurance for three months before they can be eligible? This period is required to try to ensure that AccessTN is available to those without other insurance options and to discourage individuals from dropping other commercial coverage to join AccessTN. This is called a "go bare" period and has been reduced from six to three months for 2008 by the AccessTN Board of Directors. The "go bare" requirement does not apply to:
Why is there a waiting period before certain conditions are covered? This is an insurance plan. Health insurance premiums are based upon actuarial estimates of medical claims. A limitation on pre-existing conditions reduces premium rates and helps make the program financially stable for participants in the long-run The AccessTN Board of Directors determined that having no pre-existing conditions waiting period made the premiums too expensive. Initially, the AccessTN board chose a six-month pre-existing waiting period and later found the resources to lower the period to three-months until December 31, 2007. In doing so, Tennessee joins only three other states with a pre-existing conditions period of three months or less, out of the 31 states with high-risk pools like AccessTN. And AccessTN is the only state pool in which members have outpatient drug coverage from the first day that is not subject to either the pre-exiting conditions exclusion or a deductible. The AccessTN board approved this to help participants afford medications for chronic conditions and chemotherapy treatment. How do I apply? Applications are available at www.CoverTN.gov and by calling 1-866-CoverTN. What is the best way to learn more about AccessTN? Information about AccessTN and other Cover Tennessee programs is available on this website or by calling 1-866-CoverTN. This customer service center can help with any of the Cover Tennessee programs. If you have more detailed questions about AccessTN, our customer call center is 1-866-636-0080. CoverTN
How does CoverTN differ from traditional health insurance plans? CoverTN plan benefits are very limited in nature compared to traditional insurance. For instance, these plans do not have an out-of-pocket maximum, and therefore do not protect against the potential of catastrophic medical costs. In other words, there is no limit to the amount of medical bills a member might have to pay for a major illness or injury, such as disease treatment, or injuries sustained in an automobile accident for example. Therefore, CoverTN is not a low-cost alternative to traditional insurance coverage. What is a qualified legal alien? A qualified legal alien is someone who is not a U.S. Citizen, but who does live in the United States legally. To be a qualified alien, a person must meet certain conditions. These conditions are defined by federal law at 8 U.S.C. §1622(b). If a person is not a U.S. Citizen or qualified alien, they cannot enroll in CoverTN. Can a county or city government, or a school district participate in CoverTN if they meet eligibility criteria? Yes. However, they also have access to broader coverage at favorable terms through the State's public sector health insurance programs. The State sponsored Local Government Plan, a pool for counties, municipalities and qualified quasi-governmental agencies. Information is available at www.state.tn.us/finance/ins/. How should a business count "full-time equivalent" employees? One full-time employee is any combinations of employees that total 40 hours per week. For example, one employee that works 40 hours per week counts as one full-time employee equivalent; two part-time employees that each work 20 hours per week also count as one full-time employee equivalent; four part-time employees that each work ten hours per week also count as one full-time employee equivalent. For the business to qualify to offer CoverTN, the business must have 50 or fewer full-time equivalent employees. A participating employer must offer CoverTN to all employees working at least 20 hours per week, on average. Only employees working at least 20 hours per week, on average, will qualify to participate in CoverTN . Is the income requirement for the self-employed based on gross or adjusted gross income? Adjusted gross income (AGI). This is income on which an individual computes federal income tax. AGI is determined by subtracting from gross income any unreimbursed business expenses and other deductions. AGI is the income before itemized deductions for items such as medical expenses, state and local income taxes and real estate taxes. As an employer, do I list my employee's income at my business or do I list their household income including other jobs and spouse's income? The employer should list the employee's gross income at your business. Are seasonal employees eligible for CoverTN? Yes, seasonal employees who work an average of 20 hours per week annually are eligible for CoverTN. What about part-time employees? Can they participate through their employer? If a company is a qualifying small employer, the coverage must be offered to every employee who works an average of 20 hours per week (or more). In order to qualify to participate in CoverTN, an employee must work at least 20 hours per week, on average. What if the company's eligibility status changes during the year (e.g. grows to more than 50 employees, etc.)? Can the company still participate in CoverTN? Yes, the company can still participate. Two of the employer eligibility requirements: 50 or fewer full-time equivalent employees and half of the employees earning $43,000 or less per year are required only upon the business initially qualifying for the program. Why is there a requirement that the company cannot have offered insurance for the previous six months? CoverTN is not intended to replace existing, comprehensive health insurance coverage but is designed to provide health insurance options where they do not exist today. The six month go bare requirement and other "crowd out" provisions protect the program from being used by companies that already offer health insurance. What are exceptions to the "go bare" requirement? If an individual chooses to stop their existing health insurance coverage, they must wait or "go bare" for six months before being able to enroll in CoverTN. The only exceptions to the "go bare" requirement are:
What is considered "health insurance?" The following are considered health insurance policies and, if in force within the past six months, would make a business/individual ineligible for CoverTN.
The following are not considered health insurance and would be permissible to keep with CoverTN in force.
What if my business is located in Tennessee but I have employees that are not Tennessee residents? Can they participate in CoverTN? Employees of qualified employers who happen to work in Tennessee but live in states bordering Tennessee are also eligible for CoverTN coverage. The only difference is that the employer or employee must pay the state's portion of the monthly premium. These employees must visit network providers within the State of Tennessee to receive benefits. If my company is interested, how can I sign up to make sure we get enrollment information? You can complete the online VERIFICATION APPLICATION on our website and qualify your company to participate in CoverTN. What is the difference between Plan A and Plan B? The main difference between the two plans is the number of doctor's office visits, inpatient hospitalization and prescription drug benefits. People with more prescriptions may find Plan A to be a better option for them. People who anticipate an inpatient hospital stay or multiple physician office visits may find Plan B a better choice. What if I have COBRA? Individuals who take COBRA must exhaust the benefits (18 months) before becoming eligible for CoverTN. If you choose not to elect COBRA, you can join CoverTN immediately. What health care providers participate in the network? CoverTN plans feature access to providers who participate in Blue Network V. More information on the provider network is available at www.bcbst.com/health-plans/cover-tennessee/covertn/. How will providers be reimbursed under CoverTN? Just like any other commercial plan, BlueCross BlueShield of Tennessee will contract with providers to participate in the CoverTN network at terms to which they mutually agree. Can CoverTN premiums be increased? The law that governs CoverTN allows, on an annual basis, a premium increase not to exceed 10% per year. What is the best way to learn more about CoverTN? Information about CoverTN and other Cover Tennessee programs is available on this website or by calling 1-866-CoverTN. CoverKids
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What is 250% of the federal poverty level?
Will CoverKids cover uninsurable children and children with special health needs? Yes. CoverKids is a guaranteed issue policy and there are no pre-existing condition exclusions for participants in CoverKids. Why is there a requirement that the child cannot have been insured for the previous three months? CoverKids is designed to provide health insurance options where they do not exist today. The three month requirement and other “crowd out” provisions protect the program from being used by people who drop their existing coverage and immediately enroll in CoverKids. Newborns (up to 4 months of age) will not have a “go bare” requirement and will receive fast track eligibility based on the date of application. Other children exempted from the "go bare" requirement include children who are leaving TennCare because their income no longer qualifies and children moving to Tennessee who have been on another state SCHIP program. Once my child is enrolled, how long will they be covered? Once a child is enrolled in CoverKids, coverage is for 12 months. Thereafter, there will be an annual process of re-verifying eligibility. If my family income changes during the year, can my child be taken off CoverKids? Once a child is enrolled in CoverKids, that child will get 12 months of coverage. CoverKids will not re-examine an enrollee's eligibility during that time frame. However, if parents report a reduction in family income that would make the child eligible for TennCare, by federal regulations, steps would be initiated to get that child coverage in TennCare and disenrolled from CoverKids. For a pregnant woman, what is covered? Once a pregnant woman is approved for CoverKids coverage, she is covered from the date she becomes effective through 60 days after the end of her pregnancy. Any medical treatment or physician visit related to the pregnancy or the health of the child will be covered under CoverKids. Once the child is born, the child can be enrolled for full, comprehensive coverage if otherwise eligible. Are there restrictions on pregnancy eligibility? To promote healthy pregnancies and deliveries of healthy babies, only one presumptive eligibility for pregnancy will be allowed in an 18-month period. This is an opportunity to promote public health by educating the public about the importance of birth spacing. Not enough time between pregnancies can contribute to infant mortality. The infant mortality rate in Tennessee is comparable to that of third world countries. If a woman that is otherwise eligible becomes pregnant again within 18 months, she must apply for regular coverage. A woman who is otherwise eligible for CoverKids maternity coverage who gets pregnant within 18 months of a previous pregnancy on CoverKids can still get coverage, but she will have to wait for the application to process rather than being able to use presumptive eligibility. Women who are enrolled in CoverTN and who are utilizing CoverKids as the maternity benefit under their CoverTN plan will have no interruption in coverage for pregnancy. If I am pregnant, and have employer-sponsored health insurance but do not have maternity, am I eligible for maternity coverage under CoverKids? Yes, if applicant otherwise meets CoverKids eligibility requirements for residency, citizenship, income and period without maternity insurance coverage. At this time, pregnant women over 250% of the federal poverty level are not able to buy into the CoverKids program. If a child has access to a parent’s employer-sponsored insurance, but the family declined the coverage because it was too expensive, is the child eligible for CoverKids? Yes. Access to coverage is not a factor in CoverKids eligibility. If all other eligibility criteria are met, it is simply a matter of whether the child is insured or uninsured. The exception is state employee insurance. Federal guidelines do not allow children with access to state employee health insurance to participate in CoverKids. If my child has a trauma and goes to the hospital can she enroll in CoverKids at the hospital? The child can apply at any time, but the coverage will not begin for approximately one month after the application, which is the standard for commercial insurance policies. Children should become enrolled in the CoverKids program before they become injured or ill. Newborns (up to four months of age) will receive fast track eligibility based on the date of application. If the newborn was not previously enrolled in an insurance plan, the three-month "go bare" is waived. What services are covered? CoverKids provides comprehensive health insurance and is modeled after the insurance plan that covers state employees and their children. The coverage includes an emphasis on preventive health services and coverage for physician services, hospitals, mental health and more. See the benefit summary for more information. What type of preventive health services are included? CoverKids has an emphasis on services children need most, well-baby and well-child visits, as well as age-appropriate immunizations according to the schedule and endorsement of the American Academy of Pediatrics. See the benefit summary for more information. Does CoverKids include mental health benefits? Yes, up to 52 visits per year on an outpatient basis, and 30 days of inpatient treatment per year. See the benefit summary for more information. When will CoverKids add dental and vision coverage? Vision benefits and dental services are currently available to children in CoverKids. See the benefit summary for more information. You can also visit Doral Dental at www.doralusa.com for more information on dental services. What is the cost? Participants under 250% of the Federal Poverty Level enrolled in CoverKids will not pay monthly premiums, but will be required to make co-payments for certain services. Co-payments will vary based on income. Total annual out-of-pocket expenditures cannot exceed 5% of the family’s annual household income. See the benefit summary for more information. How does the buy in work for applicants over 250% of the federal poverty level (FPL)? There will be no federal or state subsidy for those over 250% FPL, so these participants will be charged full premium. The premiums for children over 250% of the FPL are approximately $225 per month per child. If an applicant would rather be on CoverKids than on TennCare, can he request this or switch from TennCare? No. Any child that is eligible for TennCare will be covered by TennCare. In fact, every application for CoverKids will first be screened for TennCare eligibility before enrolling the child in CoverKids. Will a child insured under CoverKids qualify for the “Vaccines for Children” program? No. Once a child is insured, they no longer qualify for VFC, but the benefit package under CoverKids includes all vaccinations as recommended by the American Academy of Pediatrics. Will a child insured under CoverKids have to follow the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Program? No. EPSDT is a program under Medicaid/TennCare and does not apply to CoverKids. The families will have access to the same preventive health services but will not have to follow EPSDT compliant procedures. CoverKids will follow the well-baby, well-child schedule laid out by the American Academy of Pediatrics (AAP). This includes the age appropriate immunizations endorsed by the AAP. Will my child be assigned a physician? No. Families will have a listing of participating physicians in their area and can select the health care provider they are most comfortable seeing. Families are encouraged to select a physician to be their medical care coordinator so that their children can have optimal continuity and comprehensive care. What health care providers participate in the network? Provider networks must be statewide and should provide access to at least one physician, hospital and pharmacy within 30 miles of the participant, which is consistent with the standard guidelines for access to care. To see which providers participate, go to the Find a Doctor tool on the BlueCross BlueShield of Tennessee home page at www.bcbst.com and select Blue Network S. How do I apply? You can apply by calling 1-866-CoverTN or with the application available online. You must apply for each child in the household. Application assistance for CoverKids applications is available at nine Community Service Agencies across the state. To see which Community Service Agency covers your area, check this map. What happens when a child is too old to qualify for CoverKids? CoverKids is specifically intended for children, not adults. As a result, a child is no longer eligible for CoverKids once that individual reaches the 19th birthday. At that time the individual would need to purchase other health insurance — either commercial insurance, employer-sponsored coverage, or other coverage like CoverTN or AccessTN. What is the best way to learn more about CoverKids? Information about CoverKids and other Cover Tennessee programs is available on this website or by calling 1-866-CoverTN. CoverRx
Is there co-pay assistance? No, but co-pays are on a sliding scale based on income. How do I apply? As with all Cover Tennessee programs, you can call 1-866-COVERTN or you can call CoverRx directly at 888-560-2649, or download an application from our website and mail it in. Does it matter which pharmacy I go to? Can they go to any pharmacy, or will there be a list of participating pharmacies? You must use a CoverRx network pharmacy. If I join this program, can I use other Patient Assistance Programs (PAPs)? Yes, other PAP programs are also available and their use is encouraged. Other resources for additional meds or meds that are not on formulary:
Can I join if I have Medicare Part D? No. Medicare Part D is considered prescription drug coverage and to be eligible for CoverRx individuals cannot have prescription drug coverage. Why were these drugs chosen to be covered by CoverRx? CoverRx was built upon the successful model of the Safety Net pharmacy assistance program which included more than 50 generic medications targeting chronic conditions. The CoverRx covered drug list expanded upon this program to include other categories of drugs including medications intended for both maintenance and episodic use. Categories targeting the treatment of mental health conditions and diabetes were also augmented. Why is there a limit of five prescriptions per month? Past experience for Tennessee pharmaceutical assistance to TennCare disenrollees showed that on average, three to five prescriptions covered the pharmaceutical needs of participants. By placing the limit at five, and adding a short list of medications including insulin that do not count against the limit, policymakers tried to err on the high side, and still stretch our funding to cover as much of the need as possible. I take more than five prescriptions each month. Can I appeal the limit? What's the point of contact for those recipients needing more than five prescriptions? There is no appeal process for exceptions to the five prescription limit. The CoverRx card can be used as a discount card for drugs over the five script limit. I can't take generics. Is there any way to get brands? The program does not pay for drugs not on the covered drug list. The CoverRx card can be used as a discount card to purchase brand drugs not on the covered drug list. How do I get the list of covered drugs? The list of covered drugs will be included in every welcome packet. The list is also available at the website www.covertn.gov/web/coverrx_druglist.pdf or you can request that a copy be mailed to you by calling 1-888-560-2649. How do you access the "restricted" drug list? The restricted drug list is available only to Mental Health Safety Net individuals that have been diagnosed as Severely and Persistently Mentally Ill (SPMI). This diagnosis is provided by the Community Mental Health Centers. www.tennessee.gov/mental/safetynet.html I never had TennCare. Can I still join? Yes. How long will this program last? The CoverRx program is designed to be an on-going program, and is funded on a recurring basis. The legislation that authorized the creation of the CoverRx program requires that it be re-evaluated at the end of its third year (June 2009). I am not on any medication right now, but can I join in case I need it in the future? Yes, however, this program is designed to support individuals with serious or immediate pharmacy needs that do not have other options. Is mail order available? Will there be a mail order program? Yes. Can I get a three-month supply at one time? Yes. A 90-day supply is available through mail order and through those local retail pharmacies that have opted to participate in the 90-day program. Check with your local pharmacist to determine if they participate in the 90-day program. Can you help me get a prescription? All prescriptions must be written by your provider. CoverRx does not interface with providers on behalf of enrollees. After I get my five prescriptions at the regular co-pay, can I get more at a discount/larger co-pay? Yes. The CoverRx card acts as a discount card for drugs over the five script limit as well as drugs not on the covered drug list. Will members receive a card? Yes. Anyone determined to be eligible will receive a card along with their welcome packet. How do I get more information? Information about CoverRx and other Cover Tennessee programs is available on this website or by calling 1-866-CoverTN. |
