Texas Residents! Compare thousands of Texas health insurance plans.

Get instant Texas health insurance quotes online now!

Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Tennessee. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do — or do not — protect you as a Tennessee resident.

How am I protected?
In Tennessee, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All group health plans in Tennessee must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new group health plan will begin to pay for care for that condition. Generally, if you join a new group plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your health insurance cannot be canceled because you get sick. Most health insurance is guaranteed renewable.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you are leaving a fully insured group health plan and you meet other qualifications, you can buy individual health insurance through a group conversion provision. You will not face a new pre-existing condition exclusion period. There are no limits on what you can be charged for a conversion policy.

• If you are federally eligible, you are guaranteed the right to buy an individual health plan from any insurance company that sells such plans in Tennessee. Insurance companies must offer you a choice of at least two plans. However, they may charge you higher premiums due to your health status, age, or other factors.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is called guaranteed issue.

• If you are a small employer buying a group health plan and have 3-25 employees, there are limits on what you can be charged because of the health status, age, or other characteristics of those in your group.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. TennCare offers free or subsidized health coverage for pregnant women, families with children, elderly and disabled individuals with very low incomes, dislocated workers, and people who cannot obtain private health insurance because of their health condition.