Tennessee Health Insurance (TN)

Tennessee (TN)
Individual Health Insurance Regulations

Learn more about Tennessee Individual Health Insurance

Insurance regulations for the State of Tennessee provide for individual health insurance policies to be medically underwritten. This process provides the health insurance carrier an opportunity to medically evaluate your past and present health status and determine whether coverage should be offered or denied. If medical insurance coverage is offered, the health insurance carrier is allowed to modify the terms of coverage based upon the applicants past health history. The policy may be modified by placing an elimination rider or an exclusionary period on the terms of coverage. An elimination rider or provision for exclusionary period may, temporarily or permanently, eliminate coverage of specific medical conditions. The applicant must be made aware of any elimination riders or exclusionary period prior to the policy becoming effective. Premium rates for individual health insurance policies may vary and are based on age, gender, family size, health status and other contributing factors. Unless the insured member is exempt under federal HIPAA, there are no restrictions as to the length of time that an insurance company may exclude pre-existing medical conditions.

Tennessee (TN)
Small Group Health Insurance Regulations

For purposes of obtaining small group health insurance, Tennessee insurance regulations define a small group as 2 – 50 employees. Medical coverage under small group regulations is written on a guarantee issue basis, which provides that neither the group nor any individual employee may be declined coverage based upon past or present medical conditions. Small group applicants lacking prior creditable coverage may be subject to a 6 month look back period and a maximum 12 month exclusionary period limit on pre-existing medical conditions. Tennessee insurance regulations require that credit for prior creditable coverage must be given as long as there is no more than a 63 day break in coverage. Small group health insurance rates may be determined by the process of medical underwriting. Under this process, rates may vary plus or minus 35 percent of the indexed rate based on certain variables, including the overall health of the employees to be included on the group plan.

Tennessee COBRA and Continuation Coverage

COBRA is a continuation of coverage under the group health plan. For employers with less than 20 employees, any employee with at least 3 months of prior coverage under the group plan and their dependents are eligible to receive COBRA benefits. Election of COBRA benefits must be made within 30 days of termination of coverage. Exercising this option will provide the COBRA beneficiary with up to 3 months of continuation coverage under the employer-sponsored health plan. All premiums under COBRA are the responsibility of the recipient of benefits. Larger groups of 20 or more are subject to federal COBRA laws that provide 18 months of continuation coverage under the employer's group health plan. Conversion plans are also available that will allow a person leaving their group plan to convert their coverage to an individual policy with the same insurance carrier.

Additional Tennessee Resources

• AccessTN
  AccessTN is the state-sponsored high risk pool for the medically uninsurable and covers individuals starting at age 19. Eligibility is based on a number of factors including proof of inability to get insurance.
• Tennessee Coverkids
  Tennessee Coverkids is a state sponsored health care plan offered to uninsured children through the age of 18. To be eligible, family income must not exceed 250% of the federal poverty level.
• Tennessee Department of Health
  A state government agency provided with the responsibility of looking out for the health of all Tennessee residents. This site offers helpful consumer information as well as links to many informative health related sites.
• Department of Human Services
  The Tennessee Department of Human Services administers the state-sponsored Medicaid and TennCare programs which provide medical benefits to eligible individuals who have no access to health care benefits or inadequate health care coverage.

TN Medical Insurance Statistics

Total Population: 5,867,000
With Health Insurance: 5,031,000 / 85.8%
Without Health Insurance: 836,000 / 14.2%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Tennessee residents without health insurance has increased .1% since 2004.

Tennessee Department of Commerce & Insurance
Phone: 615-741-2241
State run agency which regulates the insurance industry throughout the State of Tennessee while protecting the interest of consumers.

* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.