CoverKids FAQ

What is CoverKids?
CoverKids offers free health coverage for pregnant women and children who do not have insurance and who do not qualify for TennCare. Children age 18 and under also get dental and vision benefits. Preventive health care is free! Sick visits and medication have very low co-pays. And pregnant women get prenatal, delivery and 60 days postpartum care.

CoverKids receives funding as part of the federally-sponsored Children's Health Insurance Program (CHIP), which provides health insurance to uninsured children in all 50 states and the District of Columbia.
What are the CoverKids requirements for eligibility?
Pregnant women and children can get coverage if:
  • Tennessee resident
  • Under 19 years of age
  • Household income up to $60,625 annually for a family of four
Please note:
  • Enrollees who are Native American/Alaskan Native may be eligible for additional benefits.
  • CoverKids must be your only health plan. To get benefits, you cannot be part of any other plan (special rules apply to pregnant women).
  • Children must also be U.S. citizens or qualified aliens.
Visit http://tn.gov/coverkids/topic/coverkids-eligibility to learn more about eligibility for CoverKids.
What are the income requirements for CoverKids?
Visit http://www.tn.gov/assets/entities/tenncare/attachments/eligibilityrefguide.pdf for a summary of TennCare and CoverKids income limits.
I want to apply for a child under age 19. How do I apply?
Unless the child is pregnant, you should apply at www.healthcare.gov. You can also apply by phone by calling 1-800-318-2596.
Can I get help with my application for my child?
YES! You can get in-person help at the Department of Human Services in your county. Visit http://tn.gov/humanservices/article/office-locator-family-assistance to find a location near you.
I am pregnant. How can I apply?
Starting January 1, 2016, four different CoverKids application options are available to pregnant women.
  • An application may be filed online at www.healthcare.gov or by phone toll-free at 1-800-318-2596, or
  • In-person application assistance is available at local health departments throughout the state. To find a list of local health departments visit http://www.tn.gov/health/topic/localdepartments, or
  • A paper application with a signed cover page may be faxed to CoverKids at 1-866-913-1046, or
  • A paper application with a signed cover page may be mailed to CoverKids at P.O. Box 305230 Nashville, TN 37230-5230.
I am pregnant. Can I get a decision right away?
YES! You can usually get a quick decision if you have a Social Security Number. Just apply at www.healthcare.gov or call 1-800-318-2596. This is the easiest way to apply. If you apply there, you might even get a decision today!

Another way to get a faster decision is by applying at a local health department. They will help you apply in person. A list of local health departments by county is available at http://www.tn.gov/health/topic/localdepartments.
What if I am pregnant – but don’t have a Social Security Number?
You can still go to a local health department. They will help you apply in person. A list of local health departments by county is available at http://www.tn.gov/health/topic/localdepartments.
What do I do when my baby is born?
If you already have CoverKids, call 1-866-620-8864 immediately after your baby is born. We will enroll your baby in coverage. Your baby will either get TennCare or CoverKids. Either way, coverage will start on the day your baby was born.
I am pregnant. Can I get in-person help with my application?
YES! You can get in-person help at local health departments throughout the state. Visit http://www.tn.gov/health/topic/localdepartments to find a location near you.
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 its members.
Who can apply for CoverKids coverage on behalf of a child(ren)?
The custodial parent can submit a CoverKids application for the child(ren). The child(ren) must reside in the household with the custodial parent.
Once a pregnant woman or child is enrolled, how long will the child be covered?
Once a child is enrolled in CoverKids, coverage is for 12 months. After the first year, eligibility for the program will be verified annually.
When will my CoverKids coverage begin?
CoverKids coverage will begin the date of receipt of the completed and signed CoverKids application.
Do I need a statement from my doctor confirming my pregnancy?
No, a provider statement is not needed.
I am pregnant and a non-citizen, do I have to submit any documents?
If you are a pregnant woman, no immigration documents are required.
If a family's income changes during the year, can a child lose coverage?
Once a child is enrolled in CoverKids, he or she will receive 12 months of coverage. CoverKids will not re-examine an enrollee's eligibility during this time.

If your household circumstances change contact our Eligibility Contractor at 1-866-620-8864 within 10 days.
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.
If a child has a trauma and goes to the hospital can they enroll at the hospital?
A family can apply for CoverKids at any time, but the coverage will begin on the date of receipt of the completed and signed CoverKids application.

Families are encouraged to apply for the CoverKids program before children become injured or ill.
What services are covered?
CoverKids provides comprehensive health insurance with an emphasis on preventive health services and includes the following:
  • Vaccinations and well-child visits
  • Physician services
  • Hospitalization
  • Mental health services
  • Physical, speech and occupational therapy
  • Vision
  • Dental
What types of preventive health services are covered?
CoverKids has an emphasis on services children need most, such as well-baby and well-child visits, as well as age-appropriate immunizations according to the schedule and endorsement of the American Academy of Pediatrics.
What mental health benefits are included?
CoverKids covers inpatient and outpatient mental health care and substance abuse treatment for low co-pays without limits. Prior authorization is required for these services.
Are orthodontic services covered?
Yes, for children. Children must have one year of continuous enrollment to be eligible for orthodontic services.
What is the cost associated with CoverKids?
Families who meet the income guidelines will not pay monthly premiums for CoverKids, but will be required to make co-payments for certain services. Co-payments will vary based on income. By federal guidelines, a family's total annual out-of-pocket expenditures cannot exceed five percent of the annual household income.
Are children on CoverKids 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 their children can have continuity and quality of care.
What health care providers participate in the network?
CoverKids is part of BlueCross BlueShield of Tennessee's TennCareSelect network with providers across the state. This network provides access to at least one physician, hospital and pharmacy within 30 miles of any member, which is consistent with the standard guidelines for access to care.
What Language Assistance is available?
A Spanish language version of the application is available online at www.tn.gov/coverkids. Contact us at 1-866-620-8864 for further language assistance.
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 after age 19.

Once ineligible due to age, a member should explore other coverage options such as health insurance through the marketplace at www.healthcare.gov or employer sponsored insurance.
What is the best way to learn more about CoverKids?
Information is available at www.tn.gov/coverkids. For more detailed questions about CoverKids, call 1-866-620-8864.