Tennessee (TN)
Individual Health Insurance Regulations

Learn more about Tennessee Individual Health Insurance

Health insurance is necessary to protect your family’s health against sickness or injury. Before opting for health coverage, you need to assess through your family’s medical needs and your budget. Being a Tennessee resident, you can choose from various health insurance alternatives. The Tennessee Department of Commerce and Insurance (TDCI) supervise the regulations under which the Tennessee health insurers can sell private health insurance to individuals and families.

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, an insurance company may exclude pre-existing medical conditions for 24 months. There are no restrictions as to the length of time for the look-back period.

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

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. Under special circumstances, dependents and permanently disabled persons may remain on COBRA for up to 36 months.

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 enacted through Chapter 7 of Title 56 – Tennessee Cobra Regulations. Election of COBRA benefits must be made within 31 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. 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.