PLANS & PROGRAMS

BlueCare provides coverage for:

• Children under age 21
• Pregnant women
• Parents or caretaker relatives of a minor child (child must live with you and be a close relative)
• Women who need treatment for breast or cervical cancer
• People who live in a nursing home with a monthly income of less than $2,205 or get other long-term care services that TennCare pays for

You can learn more about BlueCare benefits below.

TennCareSelect is a statewide health plan that provides care for specific groups of people like:

• Children under age 21 who receive Supplemental Security Income (SSI)
• Children under age 21 receiving long-term services and supports
• TennCare members living in areas with fewer health care providers
• TennCare members temporarily living out-of-state
• Foster children (including those age 18-20) in state care. Plus children who have left state custody for six months as long as they remain eligible. This program is called SelectKids.
• TennCare members with intellectual and developmental differences. This program is called SelectCommunity.

You can learn more about TennCareSelect benefits below.

Yes. Here are some reasons your plan could end:

• You feel we treat you differently or don’t cover the services you need because of your religion.
• You can’t get all the related services you need in our provider network. (For example, a cesarean section and a tubal ligation.) And your doctor says getting the services at different times would hurt your health.
• You’d have to change one of your support providers because they leave our provider network. This could cause a disruption in where you live or work. (This is only for LTSS members.)
• You have problems with your care, such as:
  • You’re not getting high quality care.
  • You can’t get services TennCare covers.
  • You don’t have access to providers who can meet your needs.
• You choose another managed care organization (MCO). You can choose one during the 90-day change period after you enroll or during the annual choice period.
• TennCare lets you change MCOs because you meet certain requirements.
• You win your TennCare appeal to change MCOs due to hardship, and you’re enrolled in another MCO.
• TennCare assigns you to us by mistake, and you’re enrolled in another MCO.
• You move outside our service area and change to another MCO.
• You’re a CHOICES/Employment and Community First CHOICES member and you ask to change MCOs because you meet the guidelines in TennCare Rule. (This is for all MCOs except TennCareSelect)
• TennCare decides it’s in the best interest of you and them.
• You aren’t eligible for or are removed from TennCare.
• You choose to leave our plan, and you’re enrolled in another MCO.
• We don’t take part in TennCare anymore.

Your plan will not end for the following reasons:

• Adverse changes in the enrollee’s health.
• Pre-exisiting medical or behavioral health conditions.
• High cost medial or behavioral health bills.
• Failure or refusal to pay applicable TennCare cost sharing responsibilities; except when this results in loss of eligibility for TennCare.
• Enrollees utilization of medical or behavioral health services.
• Enrollee’s diminished mental capacity.
• Enrollee’s uncooperative or disruptive behavior resulting from his or her special needs (except when his or her continued enrollment in the MCO seriously impairs the entity’s ability to furnish services to either this particular enrollee or other enrollees).

We’ll only ask you to leave our plan if staying enrolled with us makes it harder for us to serve you or other members.

When you apply for TennCare, they give you a health plan. But you can also ask to change it. If you’re new to TennCare, you have 90 days to ask for a change. After 90 days, call the number on the back of your Member ID card, and we’ll help you. Or call TennCare Member Medical Appeals at 1-800-878-3192. To learn more, go to the How Do I Change My Health Plan webpage.