Tennessee Medical Insurance

Medical insurance is the most important financial product you can buy for your family. It provides protection and peace of mind when it comes to your health and your finances. When looking into buying individual medical insurance you will need to evaluate the type of insurance your family needs and what your budget can handle. In the state of Tennessee, as in many parts of the country, there are many options when it comes to health insurance. The governing body that oversees insurers in the state is the Tennessee Department of Commerce and Insurance or the TDCI. Almost 86% of the more than 6 million people residing in Tennessee have medical insurance.

Regulations For Individual Medical Insurance

As in many other states, policies in Tennessee can be medically underwritten, according to state regulations. This allows an insurer to take your past and present health into account in order to decide whether or not you are qualified for coverage. Even if you are approved for coverage, an insurer can still make changes to the policy terms because of pre-existing conditions. A rider on the policy can permanently or temporarily exclude certain types of claims. The insured must be informed of such exclusions before the policy commences. There are a number of things that are taken into consideration when rates are set. Amongst them are any pre-existing conditions that are in your medical history in the past 2 years, unless you are exempt according to federal HIPAA laws. An insurer can go back in your medical history as far as possible in order to gather information.

Tennessee Medical Insurance for Small Groups

In Tennessee small groups are considered those with 2 to 50 employees for the purpose of health insurance. Policies for such groups are guarantee issue, which means that no member of the group can be refused coverage due to his or her personal health status. If an individual lacks 6 months of creditable prior coverage, the insurer can look back 6 months in the medical history of that person and put a 1 year exclusion on the policy for pre-existing conditions. The State of Tennessee requires coverage to be counted as creditable unless the gap is more than 63 days in length. Medical underwriting is typically used to set rates for each group and can be no more than 35% above or below the indexed rate. Factors such as the health of the group as a whole are taken into consideration when setting the rate.

Continuation Coverage and COBRA

COBRA laws, which are federally mandated, provide for the continuation of group medical insurance for terminated employees who are members of a group of 20 or more employees. The continuation is typically for up to 18 months, but in specific circumstances may last as long as 36 months.

The state of Tennessee has put in place a system to provide continuation of group benefits for members of smaller groups. If an employer has under 20 employees, the terminated employee qualifies for the Tennessee COBRA Regulations if they have been a member of the health insurance plan for a minimum of 3 months. Terminated employees have only 31 days to activate the continuation coverage and their group insurance will be continued for only 3 months. The employee is solely responsible for all premiums due following termination. Such employees can also opt for a conversion plan which lets them transfer their group plan to an individual one with the same insurer.