What is 250% of the federal poverty level?
2009 FPL guidelines effective 3/1. Subject to change annually.
Persons in Family Unit
|| 250% FPL
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 are currently available to children in CoverKids. We hope to add dental benefits early in 2008.
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.
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 at www.CoverTN.gov or by calling 1-866-CoverTN.