Risk Pool Name / Acronym
Insurance Regulation Establishing Risk Pool
Established in 2006 as part of Governor Bredesen's Cover Tennessee program.
AccessTN provides comprehensive health insurance for Tennesseans who are uninsurable due to pre-existing medical conditions.
Funding for AccessTN comes from federal funding and assessments in insurance carriers operating in the state of Tennessee. Premium payments from plan members are expected to cover 60% of operating costs.
AccessTN will offer one basic comprehensive PPO health plan with three different deductible options. Deductible options will include $1,000, $3,000 â?" to be HSA compatible, and $5,000. A maternity rider will be made available to those seeking maternity coverage.
AccessTN offers a range of In-Network deductibles, including a $1,000, $3,000 HSA compatible and $5,000 deductible. The maximum out-of-pocket limit, which includes the deductible, is $5,000 on the $1,000 deductible plan, $5,800 on the $3,000 deductible HSA compatible plan and $10,000 on the $5,000 deductible plan.
Maximum Benefit Limits
Maximum lifetime benefits for AccessTN is $1 million.
There is no set enrollment period for the AccessTN program. Any person meeting the eligibility requirements may register at anytime. Coverage will become effective on the first day of the month following the date of application.
The determination of monthly premiums for AccessTN will be based upon age, tobacco use, obesity status and plan chosen. Premium payment assistance will be available to persons that have income less than 250% of the federal poverty level.
Premiums for the AccessTN program are capped at 1.5 to 2 times the standard markets rates. Premiums will range from $284 per month to over $1,225 based on age, tobacco use and the plan option selected.
There is a 6-month waiting period on pre-existing medical conditions. The waiting period applies to all members, even those that have prior creditable coverage. The waiting period has been waived for prescription drug coverage.
312 Rosa L. Parks Avenue
Nashville, TN 37243
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