CoverKids is the state program designed to help uninsured children up to age 18 in Tennessee with a household income that exceeds the TennCare Medicaid limits. As the state’s Children’s Health Insurance Program, CoverKids offers a subsidized plan for those with a lower income, and a non-subsidized option for those who have income up to three times the federal poverty level. Pregnant woman with income over the Medicaid guidelines may also benefit from the CoverKids program specifically for maternity coverage, HealthyTNBabies. For children, CoverKids is a comprhenesive health plan with the same benefits received through TennCare Medicaid. These include physicians services, preventive care, and hospital services, as well.
Coverage for eligible residents of Tennessee is either free for those with an income up to 250 of FPL, or offered for a monthly premium for those over the limit. Many services are free, or covered for a small copayment at the time of your appointment. Those who qualify must meet the income requirements and not be eligible for TennCare. Additionally, children and pregnant women who qualify must be without health insurance for at least the past three months prior to application. As with Medicaid, legal documentation of citizenship or being a U.S. native is also a requirement.
The CoverKids program accepts children with absolutely no access to health insurance coverage, and will be the main source of coverage once a child is enrolled. Pregnant women will only have coverage during the course of their pregnancy, delivery and several months postpartum, though it also serves as the only plan an eligible woman can receive. An individual with access to state employee health benefits, short term coverage, COBRA, or group insurance will be disqualified for CoverKids. Individuals with income between Medicaid limits and 250 percent of the current federal poverty level will be eligible for the regular CoverKids program. The table below indicates the household incomes based on family size accepted for coverage through CoverKids.
Benefits of CoverKids include all of the preventive services, doctor’s office visits, diagnostic work, hospital care, and maternity care, each for a modest copayment. All services with the exception of orthodontic care are available for use as soon as your plan starts. Orthodontic services are covered after a 12 month waiting period. Copayments are slightly higher for families with income over 150 percent of poverty, though certain types of care such as lab and X-ray and preventive care are free for every CoverKids member.
CoverKids Buy-In Premiums
If you would like to get insured through CoverKids, yet have an income over 250 percent of FPL, there is a monthly premium of $268 to $341 per month per child. Comparatively, it would be a fraction of the cost to sign your child up for an individual health plan in Tennessee.
The HealthyTNBabies program covers pregnancies and complications of pregnancies for women with a specified income in Tennessee. Once you have been approved for coverage, the eligibility worker overseeing your case will decide the start date of your benefits. Sixty days after you have delivered your child and been receiving postpartum care, HealthyTNBabies insurance will no longer be active. The program pays for the cost of prenatal care, labor, delivery, hospital stays, pharmacy benefits, and postpartum office visits.
Your newborn may be eligible for TennCare or CoverKids once they are born, and it is especially important to remember to attempt to enroll your baby as soon as possible after their birth. Most children are automatically eligible, and a phone call to CoverKids or TennCare will begin the child’s benefits from their date of birth. After CoverKids runs out for pregnant woman, it is necessary to find another source of coverage.
There is only one health plan in the state administering coverage for CoverKids and HealthyTNBabies, which is BlueCross BlueShield of Tennessee. Members will select a primary care physician to organize their health care services and maintain a knowledgeable patient-doctor relationship. All medical care is provided through BCBST and dental services are provided by DentaQuest for recipients of CoverKids.
c/o BlueCross BlueShield of Tennessee
1 Cameron Hill Circle
Chattanooga, TN 37402
1. Cover Tennessee. “CoverKids”. http://www.covertn.gov/web/cover_kids.html.
2. BCBST. “CoverKids & HealthyTNBabies”. http://www.bcbst.com/health-plans/cover-tennessee/coverkids/