State's limited-benefit plan waived from health reform rules

State's limited-benefit plan waived from health reform rules

January 28th, 2011 by Emily Bregel in Healthlocal

BlueCross BlueShield of Tennessee has received a waiver from certain provisions of the health care reform bill to maintain the state's limited-benefit CoverTN plan for the next few years, state officials said.

The state requested the waiver in partnership with BlueCross, which administers the CoverTN plan for the state, said Joe Burchfield, Cover Tennessee spokesman. CoverTN is one component of the state-run health program Cover Tennessee.

Health reform requires health plans to phase out annual limits on benefit coverage, but the U.S. Department of Health and Human Services has allowed temporary waivers from those rules for certain "mini-medical" plans that are "unfortunately the only option that some employers offer," according to the HHS website.

The wavier will allow some limited plans to continue until state-run health insurance exchanges, described under health reform, are up and running in 2014. Those exchanges are envisioned as a marketplace where individuals and small groups can purchase affordable insurance with certain guaranteed essential benefits.


A list of companies and plans receiving waivers from the annual limit requirements is available at:


Federal health reform allows group health plans and insurers to offer some level of annual limits on essential health benefits up until 2014. But the annual limits can't be less than:

* $750,000 for plans beginning on or after Sept. 23, 2010, but before Sept. 23, 2011;

* $1,250,000 for plans beginning on or after Sept. 23, 2011, but before Sept. 23, 2012;

* $2,000,000 for plans beginning on or after Sept. 23, 2012, but before Jan. 1, 2014.

For plans beginning in 2014, the insurer may not impose any annual limit.

Waivers are granted only if they are necessary to "prevent either a large increase in premiums or a significant decrease in access to coverage," the HHS site said.

More than 700 groups have gotten waivers so far, according to the site.

CoverTN, with a $25,000 policy limit, was the only one of Cover Tennessee's plans affected by health reform's regulations requiring a minimum annual benefit limit of $750,000 starting this year, Burchfield said.

"It's of course a limited benefit plan that provides coverage for the common service most people need, most of the time," including 12 visits a year to a primary care doctor, he said. "It has a low limit, but to that end, there are thousands of Tennesseans who have coverage who would otherwise be uninsured without CoverTN. Until there is a fully implemented health reform option ... we certainly wanted to try to keep that coverage in place," he said.

CoverTN insures 20,000 people, said Mary Danielson, spokeswoman for BlueCross.

Under reform, health plans' minimum annual limit will climb each year until 2014, when plans won't be able to impose any annual or lifetime limits on health coverage.

BlueCross's one-year waiver for its CoverTN enrollees will likely be renewed each year until 2014, Burchfield said.