Key Takeaways
- Tennessee Department of Commerce and Insurance (TDCI) regulates health insurance
- Tennessee uses the federally-facilitated exchange (HealthCare.gov)
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Essential health benefits are required in individual and small group markets
- CoverKids provides children's health coverage
Last updated: January 2026
Tennessee Health Insurance Policy Requirements
Tennessee has health insurance regulations under Title 56 of the Tennessee Code Annotated.
Regulatory Structure
Tennessee health coverage is regulated by:
| Agency | Responsibility |
|---|---|
| Tennessee Department of Commerce and Insurance (TDCI) | Regulates all insurance |
| Insurance Division | Oversees health insurance |
| HealthCare.gov | Federal marketplace for individual enrollment |
TDCI Role
The TDCI:
- Reviews and approves policy forms and rates
- Licenses insurance producers and companies
- Handles consumer complaints
- Enforces insurance laws and regulations
Health Insurance Marketplace
Tennessee uses the federally-facilitated exchange (HealthCare.gov):
Key Features
- Federal marketplace for individual health insurance
- Premium tax credits available for qualifying applicants
- Qualified Health Plans (QHPs) certified by federal government
- Multiple private insurers participate
Enrollment Periods
- Annual open enrollment each fall
- Special enrollment for qualifying life events
- Financial assistance based on income
State Health Programs
Tennessee has several state health programs:
TennCare
Tennessee's Medicaid program:
- Covers low-income residents
- Covers children and pregnant women
- Managed care delivery system
CoverKids
Children's health insurance program:
- Covers uninsured children
- Income-based eligibility
- Comprehensive benefits
Required Coverage
Tennessee ACA-compliant plans must cover Essential Health Benefits:
Essential Health Benefits
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited |
Guaranteed Issue and Renewal
ACA requirements provide:
Guaranteed Issue
- Insurers must accept all applicants during open enrollment
- Cannot deny coverage based on health status
Guaranteed Renewal
- Cannot cancel coverage except for non-payment or fraud
- Plan discontinuation requires advance notice
Mental Health Parity
Tennessee and federal mental health parity requirements apply:
- Mental health benefits must equal medical benefits
- Same copays, deductibles, and limits
- Coverage for substance use disorders required
Test Your Knowledge
Which marketplace does Tennessee use for individual health insurance enrollment?
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Test Your Knowledge
What is the name of Tennessee's Medicaid program?
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D