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Cover Tennessee expanding coverage

By: Emily Bregel
(Contact)

Included in this article

Tony Garr
Brian Haile

Though the Cover Tennessee health insurance program is expanding benefits, patient advocates said there still is room for improvement in the coverage.

“The state’s got to put more money into the program,” said Tony Garr, executive director for Nashville-based Tennessee Health Care Campaign.

Gov. Phil Bredesen launched Cover Tennessee last year to assist those who don’t qualify for Medicaid but who can’t access commercial insurance. State officials recently announced expanded benefits and new eligibility options to Cover Tennessee programs.

Mr. Garr said the basic coverage provided through CoverTN, the adult insurance component of the program, would do little for an enrollee in the case of any significant medical need.

With a $25,000 annual maximum limit on CoverTN’s coverage, “really, the mantra is still, ‘Don’t get sick,’” he said.

But CoverTN is not intended to offer comprehensive insurance — it’s meant to give basic coverage to those who otherwise would be uninsured, Brian Haile, deputy director for the benefits administration division for Cover Tennessee, said.

“Seventy-five percent of employers (signing up for CoverTN) had nothing before. ... We’ve moved folks from being completely uninsured and vulnerable to insured with coverage that covers most things that most people need. That’s clearly a win,” Mr. Haile said.

Cover TN allowed Steve Nicola, owner of Smart Homes Chattanooga, to provide a health plan for his eight employees, including himself. The company, which installs home automation, home theater, and audio and video systems in homes, signed up with CoverTN when it launched in spring 2007.

CoverTN’s monthly premiums — $25 paid by the employee, $25 paid by the employer and $25 paid by the state — are less than a fourth of what Mr. Nicola and his workers would have been paying for commercial insurance, he said.

The coverage provides little protection in the case of a major medical problem, but for his employees — mainly single men in their 20s — the minimal coverage is adequate, he said.

“It’s so affordable and it provides the basic coverage that my employees need,” he said. “You’re kind of gambling a little ... (but) it’s a good little starter health care (plan).”

ACCESS ISSUES

In addition to raising the maximum limit on Cover TN coverage, Mr. Garr said state officials should ease the application process to Access TN, the program for high-risk individuals with pre-existing conditions. The application requirements are burdensome compared to other states’ high-risk insurance pools, he said.

“It is very much a deterrent,” he said.

Chattanooga transplant Sharon Peker said she spent weeks applying for AccessTN coverage. Several commercial insurers denied her coverage because of pre-existing conditions, including a torn rotator cuff and hypothyroidism. Neither condition was on AccessTN’s list of conditions that guarantee acceptance into the program. Then, one of her two insurance denial letters — another way to gain acceptance into the program — wasn’t on AccessTN’s list of approved carriers, said Ms. Peker, who in January moved from New York with her business making and selling stretch fabric book covers.

Ms. Peker said she’d never been uninsured before moving to Chattanooga.

“The fact that I could walk out of my apartment any day, twist my ankle or fall down and break a leg and it could cause me to go into bankruptcy, I can’t tell you the emotional toll of that,” she said.

Just last week she was approved through a third avenue of access to AccessTN, paying $75 for the program’s underwriters to review her information and determine if she is indeed uninsurable by commercial insurers’ standards.

Mr. Haile said the three ways to get AccessTN coverage are intended to keep the process as simple as possible.

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