Tennessee’s Children’s Health Insurance Program (CHIP), CoverKids, is available to residents age 18 and younger who do not have medical insurance, and whose income is over the limit for TennCare Medicaid. Pregnant women living in Tennessee are also eligible for maternity coverage through CoverKids if their income is within a certain range. A full range of health care services is offered through the CoverKids program, including dental, major medical, and preventative care. Those who are covered for the duration of their pregnancy have access to regular medical care in addition to prenantal, postnatal, and delivery services.
To qualify for CoverKids, children under 19 must be Tennessee residents whose household income is less than or equal to 250 percent of the federal poverty level (FPL), which is $57,625 per year for a family of four. Pregnant women must also be residents of the state, and must meet the income guidelines of up to 250 percent of FPL. All eligible applicants will have been born in the United States or have qualified immigrant status with adequate documentation, and will not have had any insurance coverage for a minimum of 3 months prior to enrollment.
Having any other form of insurance will disqualify an applicant, as CoverKids must be your primary source of coverage. CoverKids HealthyTNBabies for pregnant women is also intended to be a beneficiary’s sole health plan, and they may not have any other health benefits on top of this program. Also, no CoverKids applicant can be eligible for TennCare or have access to state employee health insurance, including local education agencies.
CoverKids Income Guidelines
To determine your family’s total income and the size of your household, add parents or guardians and all children under age 19 living in the same house. Then take into account all combined earnings, and use the table below to decide if you qualify for CoverKids benefits. If your total family earnings are at or below 250 percent of the poverty line according to the number of people in your household, you are eligible for benefits and should fill out an application. Below are the current income regulations for admission into the CoverKids program.
Benefits & Copayments
CoverKids is a comprehensive health insurance plan, offering a large array of medical services for a small copay, which is based on a member’s income level. Certain types of care are free of charge for all members, such as preventative care, medically necessary ambulance transport, lab work and X-rays. All services are available for immediate use with no waiting periods, except for orthodontic care, which has a 12 month waiting period.
There is a maximum benefit amount of $1,000 that each child can reach per year, and the lifetime maximum per child is $1,250. After reaching those amounts, your CoverKids plan will require members to pay out-of-pocket. However, the out-of-pocket maximum is 5 percent of a family’s total annual income. Below are the two income levels for CoverKids and their corresponding copayments for included benefits.
Blue Cross Blue Shield of Tennessee is the primary managed care organization offering CoverKids and HealthyTNBabies coverage. As this health insurer is available throughout the state, CoverKids members have access to care through their participating CoverKids provider network. Dental benefits are provided through DentaQuest to all CoverKids and HealthyTNBabies members.
Children receiving benefits through CoverKids in Group One, which indicates having a family income below 250 percent of the FPL, are not required to pay a premium. Children in Group Two, whose family earns more than 250 percent of the FPL will be charged $268 to $341 per month for each child covered. Pregnant women on HealthyTNBabies coverage who have an income under 250 percent of the FPL are also not required to pay a monthly premium.
Contact CoverKids: 866-620-8864
c/o BlueCross BlueShield of Tennessee
1 Cameron Hill Circle
Chattanooga, TN 37402