BlueCross BlueShield of Tennessee

Coverage Synopsis:

After you have met your deductible, the Blue Partner plan pays 100% of all covered expenses, up to $5 million per person.  There is also an option for 80% coverage, which pays 100% once a co-insurance limit of $10,000 in covered expenses has been reached.

Benefits paid at 100 percent when you use network providers:

• Routine wellness examinations for adults and children (subject to an office visit copay of $20)
  
• Immunizations
  
• Preventive and well care screenings

Benefits paid after you meet your deductible (subject to coinsurance, if applicable):

• Medically necessary and appropriate services in a physician's or other practitioner's office
  
• Surgical procedures, including invasive diagnostic procedures such as colonoscopies and sigmoidoscopies
  
• Injections
  
• Prescription drugs
  
• Diagnostic services for illness or injury
  
• Inpatient hospitalization, including room and board in a semi-private room, general nursing care, medications, injections, diagnostics, and special care units
  
• Outpatient facility services, including outpatient surgery centers, hospital outpatient centers and outpatient diagnostic centers
  
• Emergency care services
  
• Skilled nursing or rehabilitation facilities (limited to 30 days per calendar year)
  
• Therapeutic services including physical, speech, occupational, and manipulative therapies (20-visit limit per therapy per calendar year); and cardiac and pulmonary rehabilitation therapies (36-visit limit per calendar year).
  
• Home health services (40-visit limit per calendar year)
  
• Durable medical equipment, prosthetics and orthotics
  
• Ambulance services
  
• Organ transplant services
  
• Hospice care

Prescription Drug Coverage - The prescription drug network includes over 1,800 pharmacies statewide including most national chains and select independent pharmacies.  You can also make use of their home delivery pharmacy services.

This plan qualifies as HSA-eligible.  Combining a Health Savings Account with the Blue Partner plan allows you to make tax-deductible contributions, pay medical expenses with pre-tax dollars, and earn tax-deferred interest.  This account works much like an IRA, except you may use your tax-free savings for qualified medical expenses your health plan does not cover, such as your deductible, contact lenses, or most types of alternative medicine (see the qualified medical expenses).  If you do not use these funds, they simply accumulate, with interest, for distribution upon your retirement.

Rate Information:

All deductible options have a 12 month rate guarantee.

Preferred rates are available on our instant quote system.  Rates are based on gender, smoking status, zip code, and health status.

The premium can be paid via quarterly, semi-annual, or annual billing, or a monthly bank draft or credit card.  The bank draft will occur on the premium due date each month.  The initial premium must be paid with a check or credit card at the time of application.

PPO Network:

BlueCross BlueShield of Tennessee's Preferred Provider Organization (PPO) is a select network of health care professionals, including many of the area's most respected doctors and hospitals.  Having access to the PPO network can mean substantial discounts in what you pay for your health care, even before you meet your deductible.  The preferred providers in BlueCross BlueShield of Tennessee's Network have agreed to special pricing for patients with BlueCross BlueShield of Tennessee health coverage - lowering your out-of-pocket costs.  You may use any licensed doctor or hospital in the PPO Network or out, but you receive the benefit of their special negotiated rates only when you use a Blue Network preferred provider.

If you should ever want to consult a doctor or visit a hospital outside the network, you're still covered.  It simply means that the doctor or hospital will be allowed to bill you - and you will be financially responsible for - the difference between BlueCross BlueShield of Tennessee's in-network negotiated payment rate and the amount charged by the out-of-network doctor or hospital.  Plus, your out-of-pocket expenses for non-network providers are applied to a separate, higher out-of-pocket maximum.

Blue Network was built around medical centers in major metropolitan areas and members may be required to travel greater distances to receive in-network care.  For example, Blue Network members who live in rural areas of middle Tennessee may be required to travel to Nashville to receive in-network services.  Or, Blue Network may only include certain highly-specialized providers in one urban center, requiring a member to travel from Chattanooga to Nashville.  So make sure that you are comfortable with Blue Network's providers, as well as the distance you may have to travel to receive in-network care.

You can see if your doctor is a preferred provider by checking the Directory of Participating Providers.

Underwriting:

Underwriting of your application with BlueCross BlueShield of Tennessee normally takes 7-10 working days, though if medical records are ordered it could take longer.

The effective date will be the first day of the month following the date we receive the application if no effective date is requested, or you may request a specific effective date.  The requested date must be noted on the application and must be after the date the application is received by BlueCross BlueShield of Tennessee.

Effective dates will not be moved forward without proof of other insurance coverage.  This information must be received during the 10-day free look period of the policy.

It is standard practice to request a Blood Pressure Inquiry on all applicants who are currently being treated for or who have recently discontinued treatment for high blood pressure.  Certain conditions may be waivered with a temporary rider (usually for one to two years), or an indefinite rider.

Please note, if you are requesting an effective date of less than 21 days from the time you complete the application, you may not receive notification of your approval until after your effective date.  If you have claims during this period, they will be eligible for coverage if submitted after you have been approved.  Also note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved.  This is very good for someone who does not have any present coverage and would like for their benefits to begin right away.  For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either HSA for America or directly from BlueCross BlueShield of Tennessee that your coverage has been approved and is in force.

HSA Administrator:

Your health savings account is totally separate from your health insurance, and you may use any approved bank or trustee as your HSA administrator.  We recommend that you choose one from our HSA administrator page, where you can compare rates and features. 

About BlueCross BlueShield of Tennessee:

BlueCross BlueShield of Tennessee is the largest health benefits company in the state, an independent, not-for-profit organization governed by its own board of directors.  But it is also part of a nationwide association of health care plans - the BlueCross BlueShield Association - which licenses the company to offer certain products and services under the BlueCross and BlueShield names.

Because of this affiliation, which includes more than 40 other member organizations, BlueCross BlueShield customers have access to the same network of doctors and hospitals while traveling or living out of state that they have while in Tennessee.

With more than 2 million members, BlueCross BlueShield of Tennessee is 11th in size when compared to other BlueCross plans. Compared to others financially, the company is one of the strongest in relation to its membership base.

From what we can see, BlueCross BlueShield of Tennessee is committed to remaining an independent, not-for-profit, locally governed health plan company.  This format allows the company to do a good job serving the needs of local businesses, families and individuals throughout Tennessee.

BlueCross BlueShield of Tennessee has been assigned an Standard and Poor's rating of A+ (Strong).

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association.  ® Registered marks of the BlueCross BlueShield Association, an Association of Independent BlueCross BlueShield Plans.

 

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