Home » Rights – Laws

Rights – Laws

Tennessee health insurance regulations were strict compared to many states prior to the Affordable Care Act. In most cases, the state’s insurance laws exuded a quality of discrimination on the behalf of insurance companies, leaving many incapable of obtaining coverage. As a red state, Tennessee also had a hand in trying to remove the health reform bill in the Supreme Court. The law was upheld, and requires insurers to cover certain benefits, preventive care, and participate in a health insurance marketplace. Major changes for insurers will result in major changes for a wide

There are a several parts of the Obamacare law that contribute positively to insured Tennesseans, including guaranteed renewal, guaranteed issue, and mandatory benefits. As a health plan shopper or someone who is already insured, awareness of your state laws and of your plan’s provisions are important should a problem arise. Even before applying for health insurance in Tennessee, you should take into account what the insurers can and cannot do.

 

Guaranteed Renewal

Tennessee may not be a guarantee issue state, but they do have a law guaranteeing your plan will be renewed before your plan year has ended. This provision also prevents an insurer from losing their benefits in the event that they become ill during the course of their term. Insurers once would be able to terminate your coverage if you unexpectedly acquired a condition you did not have when you enrolled, and now it is illegal to do so. The only reason your health plan can cancel your benefits would be if there was some sort of fraudulent conduct on your end, or failure to pay your premiums.

As a continually paying, honest customer, you will receive the benefits of the guaranteed renewal provision whether you get sick or simply want to receive continuous coverage. This helps the insurance company stay in business and also helps people stay insured without any coverage gaps, making for a smooth transition from one year to the next.

 

Pre-Existing Conditions

The Affordable Care Act, whether this state enjoys the law or not, has changed the rules for accepting children and teenagers with pre-existing conditions in Tennessee. Regardless of the condition, underwriters must accept children up to age 18 for individual health plans. They may increase their rates, though it is important to keep in mind that an insurer cannot decline them completely. For adults between age 19 and 65, the story is different, as it is completely legal to decline someone for having any number of conditions.

When being considered for an insurance policy, your health since the beginning of time is evaluated based on anything the insurer decides is a pre-existing condition. The definition is open and there is no limit on the state’s look-back period. If an insurer decides to sell you a plan and you have a condition according to their knowledge, there are many possibilities of what can happen next. Firstly, your rates will increase. Then you can get an exclusion period of up to two years, or an elimination rider for as long as the insurer decides. The state is also rigid in not allowing credit for prior coverage if you wanted to use funds from a previous plan to cover excluded benefits for your condition.

 

Mandatory Benefits

If you are fortunate enough to get past the grueling underwriting process in Tennessee, you have access to numerous benefits that are required by the state. Each private health insurer must cover these services when necessary, though it varies from one plan to another. Covered services required by the state include preventive health care benefits, as well as services for those with specific medical needs. The following Tennessee state mandated benefits are included in the majority of private health insurance plans:

 

  • Autism coverage
  • Birth control
  • Bone marrow transplants
  • Cancer clinical trials
  • Cervical cancer and HPV screenings
  • Chemotherapy
  • Chlamydia screening
  • Colorectal cancer exams
  • Coverage for dependent adopted children
  • Coverage for non-custodial children
  • Continuation of dependent children’s coverage
  • Diabetes management and supplies
  • Disabled dependent coverage
  • Emergency care
  • Mammograms
  • Mastectomy and inpatient stays
  • Maternity care including hospital stays
  • Medical foods
  • Mental health care
  • Newborn dependent coverage
  • Prostate cancer screening
  • Substance abuse treatment

 

 

Sources:

 

1. Kaiser State Health Facts. “Tennessee: Protections in Individual Insurance Markets”. http://www.statehealthfacts.org/profileind.jsp?cat=7&sub=87&rgn=44&cmprgn=1.

Top