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CoverTN participants hope more hospitals join insurance program

Rick Wagner • Apr 27, 2007 at 12:09 PM

KINGSPORT - Elizabethton area resident Robin Nelson says she is glad her employer has decided to participate in the CoverTN health insurance program.

However, Nelson is concerned that none of the hospitals in the area where she lives are participating in the Tennessee program for small businesses that otherwise have no health insurance.

"I'm going to have to drive 45 minutes to get to a hospital or more possibly call an ambulance," Nelson, human resources manager of Technipak in Gray, said during a "town meeting" on CoverTN Thursday.

The meeting, held at the Kingsport Area Chamber of Commerce and sponsored by the Tennessee branch of the National Federation of Independent Businesses, drew about 20 people - mostly business officials and a few insurance agents.

"At least this way our employees have coverage," Nelson said. "I went without for four years."

CoverTN statistics as of Thursday indicated that 1,086 employers were participating and 1,650 employees were enrolled.

In the eight counties of Northeast Tennessee, 80 employees are on CoverTN rolls, program spokeswoman Emily Richard said from Nashville. Among those, Sullivan County had 27, Washington County 11 and Hawkins County five.

The nearest hospital to Nelson is Sycamore Shoals Hospital, and the nearest larger hospital is Johnson City Medical Center. Both are part of the Mountain States Health Alliance, which is not participating in CoverTN.

Wellmont Health System participates, but its nearest hospitals are Bristol Regional Medical Center and Holston Valley Medical Center in Kingsport.

Gary Selvy, Tennessee director of the NFIB, said after the meeting the program is a good start toward addressing the No. 1 issue with most small businesses: affordable health insurance. He said concerns at similar meetings across the state included a lack of participating providers.

"I don't think it's the answer to everything, nor does he (Gov. Phil Bredesen)," said Selvy, whose group represents about 10,000 members in Tennessee and more than 300,000 nationwide. "It's a beginning."

Selvy pointed out the program is the opposite of some proposals in other states that have high deductibles and are geared more toward catastrophic coverage rather than the basic health care of CoverTN.

Stephanie Ryan, executive director of CoverTN, at the meeting said the program is for Tennessee businesses with 25 or fewer full-time employees, although next year that ceiling will jump to 50.

In addition, 50 percent of the work force must earn $41,000 or less. Also, no employer-sponsored health insurance can have been offered for six months, or if offered, the business has not paid 50 percent of employee premiums. Selvy said that requirement also draws concern from some small businesses.

Employees must live in Tennessee, although those who are from other states and work in Tennessee can participate if they pay the state's one-third share. They also must be a U.S. citizen or qualified legal alien and not have voluntarily stopped any health insurance in the past six months.

Individuals' share of premiums range from $34.33 a month for a younger, healthy non-tobacco user to $99.33 a month for older, obese tobacco users. The state pays one-third of the premium, the employee one-third and the employer one-third, although the employer can opt to pay the employee's one-third share. Spousal coverage is also available. (Dependent children younger than 19 can apply for coverage under CoverKids.)

Employees can choose from two different plans - one that has lower co-pays on doctor's visits and an annual $10,000 limit on inpatient hospital visits, and another that has higher co-pays and a $15,000 annual inpatient hospital limit.

Both cover ambulance services, vision, hospice, diabetic supplies and durable medical equipment.

To enroll or for more information go to www.covertn.gov or www.bcbst.com, call (866)268-3786, or contact an insurance agent.

"Agents are allowed to sell this product," Ryan said..

To find participating physicians go to the Web sites and look for Network V participants.

"Just about anything you need to know is on the Web site," Nelson said.

Selvy said he would like to have similar town meetings in Elizabethton, Johnson City, Bristol and other Northeast Tennessee towns.

To request a meeting contact the state NFIB at (615)874-5267 or through www.nfib.com.

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