CoverTN is a limited-benefit health plan designed to cover most needed medical services.

BlueCross BlueShield of Tennessee, the company offering CoverTN, allows individuals to choose from two different plans — Plan A and Plan B. Since CoverTN is designed to provide coverage for most needed services, the plans have no deductible. Members need only meet their co-pay requirements to gain immediate access to services.

CoverTN has a 12-month pre-existing condition waiting period. No benefits will be paid for conditions that are present during the immediate six months prior to enrolling in CoverTN for the first 12 months of the policy. After the member has been enrolled in CoverTN for 12 months, CoverTN will begin covering these conditions.

Medical services such as doctor's office visits, emergency room visits and ground ambulance, inpatient and outpatient hospital services, surgery and pharmacy benefits may be accessed with just a co-pay. However, there are service and benefit caps per member per calendar year. Both plans have a maximum annual benefit limit of $25,000 per year. Individuals who reach the annual benefit maximum during the year are responsible for all expenses exceeding $25,000 until the next plan year begins. Members exceeding the $25,000 annual benefit maximum will continue to receive network discounts on their medical services and prescription drugs when they use network providers and pharmacies. Refer to the benefit plan for Plan A and Plan B for more information on covered services.

CoverTN members who become pregnant will remain enrolled in CoverTN but will receive maternity benefits and pregnancy-related services through CoverKids HealthyTNBabies or TennCare. Upon becoming pregnant, CoverTN members will be required to complete a CoverKids HealthyTNBabies application.

To apply for these benefits, members must follow these instructions:

Step 1 — Complete the CoverKids application (HealthyTNBabies questions only)

•	Print the CoverKids application and complete the maternity section, or
•	Call CoverKids toll-free at 1-866-620-8864 and request that an application be mailed to you.

Step 2 — Complete the Pregnant Woman Provider's Statement

•	Print the Pregnant Woman Provider's Statement and take it to the physician's office to be filled out to confirm the pregnancy, or
•	Call CoverKids toll-free at 1-866-620-8864 and request that an application be mailed to you.

Step 3 — Mail both completed forms (CoverKids Application and Pregnant Woman Provider's Statement) to:
     CoverKids
     P.O. Box 2010
     Cleveland, TN 37320-2010

Benefit	Plan A	Plan B
Doctor Visits	$15 copay Up to 5 visits per year	$20 copay Up to 6 visits per year
Prescription Drugs	$10 copay generic $25 copay brand-name (insulin only) Quarterly limit $250	$8 copay generic $25 copay brand-name (insulin only) Quarterly limit $75
Inpatient	$100 copay $10,000 annual maximum	$100 copay $15,000 annual maximum
Emergency	2 visits per year	2 visits per year
Outpatient Surgery	$25 copay; 1 surgical visit per year	$25 copay; 1 surgical visit per year
Outpatient Diagnostic	$25 copay; 2 non-surgical visits per year	$25 copay; 2 non-surgical visits per year
Durable Medical Equipment (prosthetics, medical supplies)	100% $500 annual maximum	Not covered
Preventive	No copay 1 adult physical per year 1 well woman visit per year	No copay 1 adult physical per year 1 well woman visit per year