Blue Cross/Blue Shield of TN
Customer Service 1-800-558-6213, 8:00 am - 5:00 pm EST, Monday through Friday.
Pharmacy benefits are administered by CVS
Caremark. Phone toll-free at 1-877-522-TNRX (8679).
Did you receive your insurance cards?
Blue Cross/Blue Shield issues two ID cards per household; however, additional cards are available upon request. The cards
list the name of the head of contract, so family members use the same card for
coverage. Members may request additional cards by phoning 1-800-558-6213
or by logging onto the Blue Cross/Blue Shield website and printing a temporary card.
CVS Caremark is the pharmacy benefits manager. Call the CVS Caremark Call Center, open 24/7, at 1-877-522-8679 to order a replacement card and for instructions on how to print a temporary card from the Caremark Website. You will be able to use your temporary card until your new card arrives.
Partnership PPO and Standard PPO
In many ways, the Partnership PPO and Standard PPO are identical. They cover
the same types of services, treatments and products. However, there's an
important difference between the two options: If you choose the Partnership PPO,
you must commit to a partnership promise, and the state will reward you with
lower monthly premiums; lower annual deductible; lower pharmacy copays; lower coinsurance; lower out-of-pocket maximum.
- Member Home Page
- 2012 Monthly Premiums (select East and Middle TN)
- 2012 Member Handbook - Partnership PPO
- 2012 Member Handbook - Standard PPO
- Provider Search (select Blue Network S)
You can see any doctor or go to any healthcare facility you want. However, if you use an "in-network" provider, you will always pay less. That's because an in-network provider agrees to provide services to members at discounted rates.
- Blue Access (order replacement ID cards, check claim status, verify your benefits)
- Forms
- Group Insurance Enrollment
- Basic Life Insurance Beneficiary must also be submitted
- Using your Health Insurance while Traveling
- What's New for 2012
- Reduced copay for convenience care or urgent facility visits ($30 copay)
- New, separate out-of-pocket copay maximum for primary and specialist office visits ($900 for Partnership PPO and $1,100 for Standard PPO)
- Decrease in deductible and out-of-pocket maximums for those enrolled in the Employee + Child(ren) premium tier in both the Partnership and Standard PPO.
- New lower copay for certain drugs when obtaining a 90-day supply. Read MORE...
Services requiring Copays (a flat dollar amount)
Services in this table are not subject to a deductible and costs do not apply to the annual out-of-pocket coinsurance maximum.
| Partnership PPO | Partnership PPO | Standard PPO | Standard PPO | |
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
Preventive Care |
No charge | $45 copay | No charge | $50 copay |
| Primary Care Office Visit * | $25 copay | $45 copay | $30 copay | $50 copay |
| Specialist Office Visit* | $40 copay | $65 copay | $45 copay | $70 copay |
| Convenience Clinics/Urgent Care Facilities | $30 copay | $30 copay | $35 copay | $35 copay |
| ER Visit (waived if admitted) | $80 copay | $80 copay | $100 copay | $100 copay |
| X-Ray and Lab | 100% covered after office copay | 100% covered after office copay up to MAC | 100% covered after office copay | 100% covered after office copay up to MAC |
| Chiropractor Visits | Visits 1-20: $25 Visits 21 and up: $40 |
Visits 1-20: $45 Visits 21 and up: $65 |
Visits 1-20: $30 Visits 21 and up: $45 |
Visits 1-20: $50 Visits 21 and up: $70 |
| Mental Health (Outpatient, including psychiatry and substance abuse)* | $25 copay | $45 copay | $30 copay | $50 copay |
| Pharmacy: 30-day supply from pharmacy in the 30-day network** | $5 copay for generic; $30 copay for preferred brand; $80 copay for non-preferred brand. | Copay plus amount exceeding MAC. | $10 copay for generic; $40 copay for preferred brand; $90 copay for non-preferred brand. | Copay plus amount exceeding MAC. |
| Pharmacy: 90-day supply available from 90-day network pharmacy or mail order*** | $10 copay for generic; $60 copay for preferred brand; $160 copay for non-preferred brand. | Copay plus amount exceeding MAC. | $20 copay for generic; $80 copay for preferred brand; $180 copay for non-preferred brand. | Copay plus amount exceeding MAC. |
| Pharmacy: 90 day supply for certain maintenance medications from 90-day network pharmacy or mail order*** | $5 copay generic; $30 copay preferred brand; $160 copay non-preferred. | Copay plus amount exceeding MAC. | $10 copay generic; $10 copay preferred brand; $180 copay non-preferred. | Copay plus amount exceeding MAC. |
* Out-of-pocket maximum, per individual, applies to in-network office visits for primary care, specialist care and mental health and substance abuse treatment: $900 Partnership PPO, $1,100 Standard PPO
** 30-day supply
from pharmacy in 30-day network
Use a network
pharmacy when filling prescriptions with up to a 30-day supply. The network
includes more than 1,600 pharmacies across the state and chain
pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and
Walmart. Many local, independent pharmacies are also in the network.
*** 90-day supply from pharmacy in 90-day network or mail order
Use the CVS
Caremark Mail Service Pharmacy to fill your 90-day supply prescription or receive a 90-day supply
from a participating
retail pharmacy store. The mail-at-retail network will be different from the 30-day
retail network.
Coinsurance (a percentage of the total cost)
For the following services, you must meet your deductible before the plan will begin to pay benefits. These costs apply to your annual out-of-pocket coinsurance maximum.
| Partnership PPO | Partnership PPO | Standard PPO | Standard PPO | |
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Hospital/Facility Services Inpatient Care; Outpatient Surgery |
10% coinsurance | 40% coinsurance | 20% coinsurance | 40% coinsurance |
| Home Care | 10% coinsurance | 40% coinsurance | 20% coinsurance | 40% coinsurance |
| Ambulance (air and ground) | 10% coinsurance | 10% coinsurance | 20% coinsurance | 20% coinsurance |
| Advanced X-ray, Scans, Imaging | 10% coinsurance | 40% coinsurance | 20% coinsurance | 40% coinsurance |
| Rehabilitation and Therapy Services | 10% coinsurance | 40% coinsurance | 20% coinsurance | 40% coinsurance |
Annual Deductible (The amount you pay out of your pocket before the plan pays for hospital charges and other services that require coinsurance. It does not apply to services with a copay.) Payments toward the deductible count toward the annual out-of-pocket maximum.
| Partnership PPO | Partnership PPO | Standard PPO | Standard PPO | |
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Employee Only | $350 | $700 | $700 | $1,400 |
| Employee+Child(ren) | $550 | $1,100 | $1,100 | $2,200 |
| Employee+Spouse | $700 | $1,400 | $1,400 | $2,800 |
| Employee+Spouse+Child(ren) | $900 | $1,800 | $1,800 | $3,600 |
Annual Out-of-Pocket Coinsurance Maximum (The most you will pay for your deductible and coinsurance each year. It does not include your copays. Once you reach your out-of-pocket maximum, the play pays 100 percent of covered medical expenses.)
| Partnership PPO | Partnership PPO | Standard PPO | Standard PPO | |
| In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Employee Only | $1,350 | $2,700 | $1,700 | $3,400 |
| Employee+Child(ren) | $2,150 | $4,300 | $2,800 | $5,600 |
| Employee+Spouse | $2,700 | $5,400 | $3,400 | $6,800 |
| Employee+Spouse+Child(ren) | $3,500 | $7,000 | $4,500 | $9,000 |
