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Posted by on Sep 30, 2013 in Tennessee | 0 comments

The Tennessee Health Insurance Exchange

Tennessee’s Federally Facilitated Marketplace

What website will Tennessee consumers use to apply for subsidies, compare plan options, and enroll in health insurance?

On December 10, 2012, Governor Bill Haslam announced Tennessee would default to a federally-facilitated health insurance exchange. Come October 1, consumers in Tennessee can use the federal website, HealthCare.gov, to apply for coverage, compare plan options, and enroll in health insurance.

Will coverage and premiums be the same statewide?

Insurance companies do not have to offer coverage statewide. In Tennessee, only BlueCross BlueShield of Tennessee will be offering coverage statewide. Cigna Health & Life Insurance Company, Community Health Alliance Mutual Insurance Company, and Humana Insurance Company will only be offering coverage in specific regions of the state.

On February 7, 2013, the Tennessee Commissioner of Insurance, Julie Mix McPeak, sent a letter to Secretary Kathleen Sebelius seeking to establish eight geographic rating areas for the state of Tennessee. Each of these regions may have different health care costs; insurers may charge different premiums in the different rating areas in which they participate. The eight geographic rating areas are detailed below:

AREA AREA NAME COUNTIES
1 East Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi, Washington
2 Greater Knoxville Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Know, Loudon, Monroe, Morgan, Roane, Scott, Sevier, Union
3 Greater Chattanooga Bledsoe, Bradley, Franklin, Grundy, Hamilton, Marion, McMinn, Meigs, Polk, Rhea, Sequatchie
4 Greater Nashville Cheatham, Davidson, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, Wilson
5 West Benton, Carroll, Chester, Crockett, Decatur, Dyer, Gibson, Hardeman, Hardin, Henderson, Henry, Lake, Madison, McNairy, Obion, Weakley
6 Greater Memphis Fayette, Haywood, Lauderdale, Shelby, Tipton
7 East Central Cannon, Clay, Cumberland, DeKalb, Fentress, Jackson, Macon, Overton, Pickett, Putnam, Smith, Van Buren, Warren, White
8 West Central Bedford, Coffee, Dickson, Giles, Hickman, Houston, Humphreys, Lawrence, Lewis, Lincoln, Marshall, Maury, Moore, Perry, Stewart, Wayne

What will the health insurance exchange options in Tennessee look like?

Four carriers will be offering individual medical exchange plans, two carriers will be offering small group medical exchange plans, and four carriers will be offering stand alone dental products.

Medical Carriers

BlueCross BlueShield of Tennessee was approved to offer plans statewide. Individual PPO plans will be available at the platinum, gold, silver, and bronze metal levels. Small group plans will be offered at the gold and silver metal levels. Anthem also submitted a multi-state plan to be offered through the exchange.

Cigna Health & Life Insurance Company will be offering the LocalPlus product, which was introduced in January of 2013 as a new suite of health care plans with a narrow network of providers. The company’s  LocalPlus myCigna Health individual PPO products will be offered at the gold, silver, and bronze metal levels in Rating Areas 3, 4, and 6, (click to view a map showing the rating areas) which includes the Greater Chattanooga, Greater Nashville, and Greater Memphis areas. Cigna will also be offering individual dental plans through the exchange.

Community Health Alliance Mutual Insurance Company, CHA, is Tennessee’s new nonprofit CO-OP. On May 22, 2013, CHA announced that it received its Certificate of Authority from the Tennessee Department of Commerce and Insurance and was officially licensed as a health insurance company. CHA will offer individual and small group exchange plans in Rating Areas 2, 4, 5, 6, and 8. Individual products will be offered at the gold, silver, and bronze metal levels. Small group products will be available at the platinum, gold, silver, and bronze metal levels. CHA intends to have two networks, a primary/direct network with direct contracts and a secondary wrap network from a third-party vendor. Members will have access to both networks; there will be no benefit differences based on point of service. In developing a network, CHA has entered into partnerships with: Houston County Community Hospital, Saint Francis Healthcare, TriStar Health, The Jackson Clinic, Covenant Health, Tennova Healthcare, Decatur County General Hospital, Baptist Memorial Health Care, and Summit Medical Group.

Humana Insurance Company will be offering individual plans in Rating Areas 2, 4, and 6. Standard and Humana Preferred individual plans will both be offered at the platinum, gold, and silver metal levels. Humana will also offer standalone pediatric and adult dental plans.

Coventry Health & Life Insurance Co., which was recently acquired by Aetna, submitted filings for individual products, but has subsequently withdrawn from participating in the state’s health insurance exchange.

Stand Alone Dental Carriers

BEST Life and Health Insurance Company will be offering BESTOne individual products and BESTDental employer group products. Both individual and group products will use the DenteMax Network.

Delta Dental will be offering individual Stand Alone Exchange Certified Pediatric Dental Plans and small group Stand Alone Exchange Certified Pediatric Dental Plan

Dentegra Insurance Company will be offering individual Dentegra Dental PPO plans using the Dentegra Dental Network. Dentegra will also be offering small group dental plans.

Guardian Life Insurance will be offering small group PPO dental plans.

 

New information is being released every day. Follow this blog to receive updates as new information is released in Tennessee.

Jillian Carlile
Research Analyst & Health Exchange know-it-all
Strenuus
jcarlile@strenuus.com

About Strenuus

Strenuus® is the industry leader in delivering network competitive intelligence services. We are the largest collector of managed care data in the country. With a singular focus on the managed care industry, we provide services to support payors, brokers, consultants and healthcare IT companies. Whether you represent employer-based coverage, Medicare, Medicaid, dental, work comp or specialty networks, we have the data and insights you need.

Learn more at www.strenuus.com.

 

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