Care Management

Do you or your child have a serious health problem? Then our care managers are in your corner. They will:

• Explain medical terms in plain language.
• Coordinate doctor appointments.
• Provide the care team with medical records.

Your care manager will stay with you or your child throughout the medical journey. He or she will:

• Think beyond immediate medical needs.
• Make sure there is support at home.

Care Coordinator

Our members' safety at home is our priority. That is why we conduct home visits for those needing extra help to stay at home.

During this visit, we:

• Understand your personal needs.
• See if your home needs minor modifications, such as ramps and bathroom safety devices.
• Set up emergency monitoring.
• Arrange for personal care attendants.

Choice of Birth Center

Where you have your baby is an important choice. That’s why you can pick from hospitals all across Tennessee.

We encourage you to tour the hospital’s birthing center. This way you will be familiar with it. And you’ll be more relaxed when you have your baby.

Chore Services

If you are having difficulty performing day-to-day household activities, chore services can step in. They can take on the routine tasks that may be hard for you to do on your own.

Services will vary by the member's coverage type and may include:

• Running errands.
• Cleaning the house.
• Doing laundry.
• Preparing meals.

Dental Care

Cleanings, checkups and dental work are covered up to age 21.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, we’ll fix it as well.

Equipment and Supplies

The health and safety of our members at home are important.

Your health and safety at home are important.

Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:

• Hospital beds.
• Oxygen tanks.
• Walkers or wheelchairs.

Health Education

Free classes to help improve your health or address a condition.

Our plan includes classes on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you.

Hearing Care

Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect the hearing of members to age 21.

We cover:

• Exams, therapy and tests.
• Hearing aids.

Healthy First Steps®

Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up. 

We will help you:

• Choose a pregnancy provider and a pediatrician (child’s doctor).
• Schedule visits and exams and arrange rides to your visits.
• Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
• Get supplies, including breast pumps for nursing moms.
• Connect with community resources such as Women, Infants and Children (WIC) services.

Home Meal Delivery

Good nutrition is essential to good health. Yet you may not be able to safely fix meals for yourself at home. So we’ll arrange for home meal delivery if you qualify.

Hospitalization

This plan pays for expenses related to a hospital stay, so you can rest and heal.

This includes:

• Nursing care.
• Room and board.
• Supplies and equipment.
• Treatment and therapies.
• Diagnostic tests and exams.

And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.

In-Home Care

After surgery or a serious illness you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:

• In-home medical visit.
• Medical equipment like hospital beds, walkers or wheelchairs.
• Disposable medical supplies
• Help with personal care or housekeeping.

Interpreters

Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.

We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language.

Lab and X-rays

Knowing what's wrong and finding it early can make all the difference. Our plan covers:

• Labs and testing.
• X-rays, scans and other imaging.

We’ll help you get the information needed to improve your health or be at your best.

Language Help

You can receive information in your preferred language. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language.

Member Services

Understanding your health care options can be confusing. We can answer your questions simply and completely.

We help you find:

• Doctors.
• Pharmacies.
• Hospitals or other health facilities.
• Local resources.

Mental Health

Mental health is as important as physical health. That’s why we have the same coverage for both.

Required care is 100% covered with no copay. This includes:

• Mental health therapy.
• Substance abuse treatment.
• Medications.

No Copays

Members have no copayments for:

• Preventive care.
• Annual checkups.

Nurse Visits

Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:

• Provide medical care for you.
• Answer your questions and concerns.

NurseLine℠

Medical questions and situations can sometimes come at inconvenient times. When you have questions about your health or your child’s health, you can call a trained nurse 24/7.

Our NurseLine nurses will: 

• Listen to the symptoms.
• Guide you on self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help for:

• Dressing.
• Bathing.
• Eating.

Prenatal Visits

A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.

All of your recommended prenatal clinical visits and tests are covered.

At these visits, the clinic will:

• Make sure you and your baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Primary Care Provider

You get a primary care physician (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.

Your PCP is your main doctor for:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Quitting Tobacco

You know the bad health effects of smoking.

You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.

Respite Care

Do you have family members or friends who care for you at home?

If so, we want to support their hard work too. That's why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.

Shots and Vaccines

Routine shots help keep you healthy. So, our plan covers:

• Recommended shots and vaccines.
• Influenza shots.

Transportation

Our plan provides round trip rides to and from health care locations when necessary.

Vision Care

Regular eye exams and glasses, if needed, can help you see more clearly.

Members up to age 21 receive:

• Regular exams.
• Frames.
• Prescription lenses. 

TennCare CHOICES members get glasses or contacts after cataracts surgery.

Weight Control

Our plan encourages a healthy approach to eating and living. To help our members be their best, we cover:

• Screening for obesity.
• Support for healthy diet and exercise choices.
• Health coaching.

Well Visits

Well visits with your doctor can help keep you healthy. These visits can help catch health problems early so they can be treated. Preventive services include:

• Checkups for adults and children.
• Well-baby care.
• Care for women expecting a baby.
• Routine shots and tests.
• Mammograms.

You will not have a copayment for preventive care.