The Tennessee Plan is an employer-sponsored, self-insured plan that is similar to a NAIC Model D Medicare Supplement Plan. This plan is not offered to the general public and is not subject to the federal Medicare open enrollment rules. The state does not offer the opportunity to enroll on the POMCO plan outside of the retiree’s initial eligibility without receiving late applicant approval. Find more information here: https://www.tn.gov/partnersforhealth/other-benefits/tennessee-plan.html
You may apply for The Tennessee Plan if you are enrolled in at least Medicare Part A and receive a monthly Tennessee Consolidated Retirement System (TCRS) pension benefit or you are a higher education Optional Retiree Program (ORP) retiree. You may apply to cover your eligible dependents that are enrolled in Medicare when you enroll in The Tennessee Plan.
The application must be submitted within 60 days of your initial eligibility. The initial eligibility date is: the date of TCRS retirement, the date active state group health coverage terminates, or date of Medicare eligibility, whichever is later. For more information on initial eligibility dates, coverage effective dates and dependent eligibility for this plan, please consult the Guide to Continuing Insurance and the Medicare Supplement Plan document on our website https://www.tn.gov/partnersforhealth/continuing-insurance-at-retirement.html
If you did not apply for the Tennessee Plan when you were initially eligible or under a Special Enrollment Provision, you can apply throughout the year (including during Medicare’s open enrollment period) but your application will be subject to late applicant review. Late applicant review is based on a few health questions of your health history in the last 5 years.
The Claims Administrator will review the answers to the health questions for those submitting late applications and determine if enrollment will be approved or denied.
For approved late applicant enrollment, the effective date of coverage will be on the first day of a month, according to calendar established by the Plan Administrator, following approval of enrollment by the Claims Administrator.