What We Cover

We want to help you get the most from your benefits. Knowing what’s covered is a good place to start. Here are some details that we hope you’ll find useful.

What’s covered depends on your age and assigned benefit level. TennCareSM assigns your benefit level, which is listed on the front of your Member ID card.

Benefits for Adults, Children and Teens

All TennCare members receive medical and behavioral health care and prescription medicines. Behavioral health includes mental health and substance use disorders. Only medically necessary care is covered. Please note that if you’re also on Medicare, your prescription benefits come through Medicare.

Physical and Mental Health Emergency Care is available any time you need it. Emergencies are times when there could be serious danger or damage to your health if you don’t get care right away. If you think you’re having an emergency, go to the nearest emergency room (ER). If you can’t get to the ER, call 911. For a mental health emergency, you can also go to a mental health crisis walk-in center or call the Tennessee Statewide 24/7 Crisis Line at 1-855-274-7471. If you’re not sure if it’s an emergency, you can call your primary care provider (PCP). Your PCP can help you get emergency care if you need it.

Well-care checkups are covered for adults 21 and over. This includes well-woman checkups (pap smears and mammograms). Seeing the provider even when you’re not sick can help spot small problems before they become big. Vaccines you need like flu and pneumonia shots are also covered.

Well-child and well-teen checkups are free until age 21 through a program called TennCare Kids.

Children and young adults under 21 are also covered for dental care. DentaQuest manages dental claims and services for TennCare members. Use your BlueCareSM or TennCareSelect Member ID card for dental care.

Prescription drug coverage and claims are managed by Magellan HealthSM – an independent company that specializes in these services. You can reach them at 1-888-816-1680. You have a Magellan ID Card just for your prescription drugs, so be sure to call them if you have questions or need a new card. TennCare’s website also provides helpful info about prescription coverage.

DentaQuest and Magellan are independent companies that do not provide BlueCare Tennessee branded products and services. Magellan is solely responsible for administering pharmacy benefits. DentaQuest is solely responsible for administering dental benefits.

handbook

See Your Handbook – Limits and restrictions apply to some types of care. Part 2 of your handbook has the details. Choose your health plan – BlueCare or TennCareSelect. icon

Your Providers and Referrals

Your primary care provider (PCP) is the main person to see for your health care. We encourage you to see them for checkups and when you’re sick. Having a provider you see regularly can actually help improve your health. You’ll find your PCP listed on your Member ID card.

Want to change PCPs? You can call the Customer Service number on the back of your card. Or it’s easy login to BlueAccess (top right) to request the change.

You may need care from a specialist who treats a certain disease or part of the body. Your PCP has to make that request. That’s called a referral.

No referral is needed to:

  • See a women’s health provider for well-woman checkups
  • Get treatment for mental health or substance use disorders

Always check to make sure providers are in our network. Otherwise, you could receive an unexpected bill. Search online for network providers at Find A Doctor.

prior authorization

You Need an OK for Some Care
Your benefits cover the most common kinds of care, but certain services require an OK from us. An OK is called a prior authorization, and your provider has to make the request. icon


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Types of Coverage

Want to learn more about TennCareSM, CoverKids or the other programs we offer? Find helpful details, including how to apply.

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