AccessTN is the state high-risk pool, which reopened two years ago to provide comprehensive health insurance to uninsurable Tennessee residents. If you have a pre-existing condition and have been declined coverage, rated up, or issued exclusions on certain benefits by a Tennessee health insurance company, AccessTN is an alternative health plan. In order to qualify, you must be uninsured for at least three months prior to application, and have proof of your condition. Those who qualify for AccessTN may also qualify for the temporary federal high-risk pool, PCIP. Both health plans are now temporary because of the health care law eliminating discrimination for conditions.
AccessTN provides health insurance for individuals and families for a monthly premium. These premiums cannot exceed twice the amount of market rates in Tennessee, and tend to range between $284 and $1,225 per month. Premiums vary based on the age, weight, tobacco use, and plan type of the applicant. Coverage through AccessTN is a full range of hospital, physician, pharmacy, and other medical services. Benefits will not be excluded based on your medical history or condition, and your rates will also not increase because of your health. Plans are available in three deductible options, one of which can be paired with a Health Savings Account. Each plan covers preventive care in full, and offer 80 percent coverage after deductible on covered services, and 50 percent coverage for pre-existing conditions.
The high-risk pool program in Tennessee accepts individuals with any income, as they have no income or asset tests. As long as the applicant has been a Tennessee resident for six months or longer (though some exceptions apply), and are a U.S. citizen or legal immigrant under age 65, they may be able to qualify. Of course, you must also be deemed medically uninsurable, supported by documentation. You may provide a statement from a doctor, which identifies you has having one of 55 pre-approved conditions for presumptive eligibility, or a notice of denial from an individual health insurance company.
You must also not have any employer health benefits available, except for CoverTN, and be uninsured for at least three months. For those who are finishing COBRA, TennCare, or CoverKids policies, there may be special exceptions.
Premiums are determined by the age of the plan member, as well as their tobacco use, and their weight. The target weight is a BMI of 30, which is the standard acceptable weight for private health insurance plans. A maximum BMI of 30 is shown in the height to weight table below, and any weight up to that limit is acceptable. Those who are over the target weight will have a higher premium, as their risk increases.
Plan One – $1,000 deductible
Plan Two – $3,000 deductible (HSA compatible)
Plan Three – $5,000 deductible
Regardless of your deductible, most of the same benefits are covered with every AccessTN plan. Working similarly to a private individual health plan, AccessTN plans feature a lower cost for in-network covered services (80/20 coinsurance), and the option of using out-of-network for a higher amount (60/40 coinsurance). AccessTN plans are available for both Regular and Portability eligibility. Portability has no waiting periods for conditions, while Regular has a 6 month reduced benefit period for condition-related services. Each plan has a lifetime benefit maximum of $1 million. The following health services are covered for all members of AccessTN:
- Preventive care
- Physician care
- Specialist visits
- Diagnostic services, laboratory, and X-ray
- Office surgery
- Pre-existing conditions
- Maternity care
- Chiropractic care
- Emergency room visits
- Emergency services
- Home health care
- Skilled nursing facility
- Substance abuse treatment
- Inpatient hospital stays
- Outpatient hospital care
- Durable medical equipment
- Supplemental organ transplant (Plans One & Three only)
BlueCross BlueShield of Tennesse is responsible for administering the AccessTN program. Through BCBST, you have access to their Preferred Provider Organization, unlike a regular public health plan. This plan allows you to choose your own doctors, hospitals, and other providers from their contracted network or outside of the BCBST provider network. In-network providers cost much less to use, as these providers have agreed not to exceed the company’s Maximum Allowable Charge (MAC). This health plan also allows you to use out-of-state providers for a discounted rate, as your PPO card will give you access to any Blue Cross and Blue Shield Association independent licensee in another state who accepts the card.
AccessTN vs. PCIP
If you are eligible for AccessTN, you may also qualify for the Pre-Existing Condition Insurance Plan (PCIP). The key difference is you personal preference and the length of time you have been uninsured. Eligibility criteria is similar for PCIP, except for the requirement to be without insurance is at least six months, rather than just three, and there are several other variations in PCIP requirements for acceptance. Premiums are also considerably lower in PCIP, and there is no annual or lifetime limit. Keep in mind that both plans will only last for another year. Below is a comparison of the two plans below.
How to Apply
You may apply for a health plan with AccessTN by completing an application form, cover letter, and attending physician’s statement if proof of uninsurability is necessary. These documents are provided through the Cover Tennessee website. When you have completed these forms, mail them to the AccessTN program at BCBST.
c/o BlueCross BlueShield of Tennessee, Inc.
1 Cameron Hill Circle
Chattanooga, TN 37402
866-636-0080 (M-F, 8 AM to 6 PM EST)
1. Cover Tennessee. “AccessTN”. http://www.covertn.gov/web/access_tn.html.
2. BCBST. “Access TN”. http://www.bcbst.com/health-plans/cover-tennessee/accesstn/.