New Federal High Risk Pool Open to Uninsurable Tennesseans

 

NASHVILLE – The United States Department of Health and Human Services today announced the formation of the Pre-Existing Condition Insurance Plan, which will serve as the new, nationwide high risk pool. The addition of PCIP provides an additional option for uninsurable Tennesseans, who already have an option for coverage through AccessTN, the state’s existing high risk pool.

 

While some details about benefits and premiums for PCIP are yet to be finalized, there are some clear differences between the new plan and AccessTN.

 

In order to qualify for AccessTN, an individual must be uninsured for at least three months, though special provisions apply for those finishing COBRA, CoverKids or TennCare policies. PCIP requires applicants to be uninsured for six months.

 

Both AccessTN and PCIP require applicants to be medically unisurable. Those applying for AccessTN can prove uninsurability through either a letter of denial of coverage from a private insurer or a physician’s statement indicating someone has one of 55 pre-existing conditions. For PCIP, applicants can only prove uninsurability through a denial letter from a private insurer.

 

AccessTN offers three plan options with deductibles of $1,000, $3,000 and $5,000. Monthly premiums vary among the three plans and are based on an individual’s age, weight and tobacco use. AccessTN also provides premium assistance of 20, 40 or 60 percent of the total amount to those who qualify.

 

The plan options and premiums for PCIP are not yet available, but premium assistance will not be offered through the federal pool. However, monthly premiums for PCIP will be priced at the standard commercial rate, unlike AccessTN which has premiums at 130 percent of the commercial rate, though many AccessTN members pay less than the commercial rate as a result of premium assistance.

 

Current members of AccessTN will not be impacted by the addition of PCIP and enrollment in Tennessee’s plan will continue.

 

The following chart provides a basic comparison between AccessTN and PCIP. 

 

	AccessTN	Pre-Existing Condition Insurance Plan
Offered by	AccessTN for the State of Tennessee	Federal Government, by the U.S. Dept. of Health and Human Services (HHS) for Tennessee and other states
Plan administrator	BlueCross BlueShield of Tennessee (BCBST)	Government Employees Health Association (GEHA)
Eligibility	Tennessee residents who are U.S. citizens; Qualified aliens meeting one of nine listed categories	U.S. citizens; Those lawfully present in the U.S. (including valid Green Card or visa holders)
Medical eligibility	1)   HIPAA-eligible 2)   Denial by insurer 3)   Diagnosed with one of 55 medical conditions	Proof of pre-existing medical condition (method of verification to be determined)
Uninsured period / “Go bare” requirement	Three months	Six months
Exceptions to go-bare requirement	1) Those HIPAA-eligible after COBRA coverage 2) Individuals losing eligibility for CoverKids or TennCare 3) Those with permanent exclusions in current coverage	None
Medical benefits	Comprehensive coverage with three benefit plan choices; annual limit of $300,000	Comprehensive coverage with no annual or lifetime limit (details to be determined)
Deductible	$1,000, $3,000 or $5,000 (depending on plan choice)	To be determined
Coverage of pre-existing medical conditions	50 percent coverage for first six months; full pharmacy benefits from day one	Full coverage; no limitation for pre-existing conditions
Maternity coverage	12 month waiting period	No waiting period
Premiums	$ 284 to $1038 depending on age, weight, tobacco use and plan	Market rate; to be determined
Premium assistance	20, 40 or 60 percent assistance for those with household incomes up to $75,000	None

 

With a current membership of nearly 3,900, AccessTN is a program of Cover Tennessee, Governor Phil Bredesen’s initiative to address the health care needs of Tennessee’s uninsured. 

 

Additional information about AccessTN and PCIP is available online or by phone at:

 

www.CoverTN.gov  

1-866-636-0080

 

www.HealthCare.gov  

1-866-717-5826

 

# # #