Tenn. Code Ann. § 56-7-113 — TN Code / Title 56 / Chapter 7 / Section 56-7-113
Inquiry by homeowner's insurance policyholder not grounds for premium increase or cancellation of policy - Communications necessitating investigation - Violation constitutes unfair trade practice
Status: in_force

(a) For purposes of this section: (1) "Cancel" means to terminate a homeowner's insurance policy prior to the expiration of the policy period; (2) "Claim": (A) Means an oral, written, or electronic submission for payment filed by an insured, on behalf of the insured, or by a third party whereby an insurance company accepts the submission for payment in accordance with the insurance company's reasonable submission standards; and (B) Does not mean an inquiry by an insured or by an insurance producer on behalf of an insured; (3) "Inquiry" means any communication to an insurance company by an insured, or by an insurance producer on behalf of an insured, regarding general terms and conditions of a homeowner's insurance policy, including a communication concerning whether a homeowner's insurance policy provides coverage for a type of event or the process for filing a claim; and (4) "Insurance company" has the same meaning as defined in § 56-1-102 . (b) No insurance company shall increase a premium or cancel a homeowner's insurance policy solely on the basis of an inquiry or inquiries by an insured regarding the insured's homeowner's insurance policy or a loss under the policy. (c) Notwithstanding the foregoing, if a communication by an insured to an insurance company necessitates an investigation by the insurance company which results in a written finding that there has been a change in a known condition or use of the premises or a fraudulent act by the consumer, then the insurance company may consider the communication to be either a claim or an inquiry. (d) A violation of this section shall be considered an unfair trade practice under the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8, part 1 of this title. Added by 2014 Tenn. Acts, ch. 975,s 1, eff. 7/1/2014.
(a) For purposes of this section: (1) "Cancel" means to terminate a homeowner's insurance policy prior to the expiration of the policy period; (2) "Claim": (A) Means an oral, written, or electronic submission for payment filed by an insured, on behalf of the insured, or by a third party whereby an insurance company accepts the submission for payment in accordance with the insurance company's reasonable submission standards; and (B) Does not mean an inquiry by an insured or by an insurance producer on behalf of an insured; (3) "Inquiry" means any communication to an insurance company by an insured, or by an insurance producer on behalf of an insured, regarding general terms and conditions of a homeowner's insurance policy, including a communication concerning whether a homeowner's insurance policy provides coverage for a type of event or the process for filing a claim; and (4) "Insurance company" has the same meaning as defined in § 56-1-102 .
(1) "Cancel" means to terminate a homeowner's insurance policy prior to the expiration of the policy period;
(2) "Claim": (A) Means an oral, written, or electronic submission for payment filed by an insured, on behalf of the insured, or by a third party whereby an insurance company accepts the submission for payment in accordance with the insurance company's reasonable submission standards; and (B) Does not mean an inquiry by an insured or by an insurance producer on behalf of an insured;
(A) Means an oral, written, or electronic submission for payment filed by an insured, on behalf of the insured, or by a third party whereby an insurance company accepts the submission for payment in accordance with the insurance company's reasonable submission standards; and
(B) Does not mean an inquiry by an insured or by an insurance producer on behalf of an insured;
(3) "Inquiry" means any communication to an insurance company by an insured, or by an insurance producer on behalf of an insured, regarding general terms and conditions of a homeowner's insurance policy, including a communication concerning whether a homeowner's insurance policy provides coverage for a type of event or the process for filing a claim; and
(4) "Insurance company" has the same meaning as defined in § 56-1-102 .
(b) No insurance company shall increase a premium or cancel a homeowner's insurance policy solely on the basis of an inquiry or inquiries by an insured regarding the insured's homeowner's insurance policy or a loss under the policy.
(c) Notwithstanding the foregoing, if a communication by an insured to an insurance company necessitates an investigation by the insurance company which results in a written finding that there has been a change in a known condition or use of the premises or a fraudulent act by the consumer, then the insurance company may consider the communication to be either a claim or an inquiry.
(d) A violation of this section shall be considered an unfair trade practice under the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8, part 1 of this title.
Added by 2014 Tenn. Acts, ch. 975,s 1, eff. 7/1/2014.
Tenn. Code Ann. § 56-26-202 — TN Code / Title 56 / Chapter 26 / Section 56-26-202
Filing and approval of policies - Required provisions
Status: in_force

(a) Except as otherwise required by § 56-26-102 , no policy of group accident and sickness insurance shall be delivered or issued for delivery in this state, unless the policy form and rates have been filed with and approved by the commissioner; provided, that in the case of experience-rated group insurance, premium rates and classifications of risk need not be filed, but shall be maintained by the insurance company and made available for review by the commissioner upon the commissioner's request; nor shall any such policy, endorsement, rider or application be issued until the earlier of the expiration of thirty (30) days after the form or rates have been filed or the commissioner giving the commissioner's written approval. The commissioner is authorized to promulgate rules necessary to implement the standards set out in this subsection (a). (b) The policy must contain, in substance, the following provisions: (1) A provision that the policy, the application of the employer, or executive officer or trustee of any association or labor union, and the individual applications, if any, of the employees, members or employees of members insured shall constitute the entire contract between the parties, and that all statements made in the applications shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless it is contained in a written application; (2) A provision that the insurer will issue to the policyholder for delivering to the persons insured under the policy, an individual certificate setting forth the benefits and the exceptions thereunder and referring to the master policy under which the coverage is provided; and (3) A provision that to the group or class thereof originally insured there shall be added from time to time all persons becoming newly eligible for and applying for insurance in the group or class. Acts 1976, ch. 397, § 7; 1978, ch. 514, § 2; T.C.A., § 56-3331; Acts 2011, ch. 344, § 14.
(a) Except as otherwise required by § 56-26-102 , no policy of group accident and sickness insurance shall be delivered or issued for delivery in this state, unless the policy form and rates have been filed with and approved by the commissioner; provided, that in the case of experience-rated group insurance, premium rates and classifications of risk need not be filed, but shall be maintained by the insurance company and made available for review by the commissioner upon the commissioner's request; nor shall any such policy, endorsement, rider or application be issued until the earlier of the expiration of thirty (30) days after the form or rates have been filed or the commissioner giving the commissioner's written approval. The commissioner is authorized to promulgate rules necessary to implement the standards set out in this subsection (a).
(b) The policy must contain, in substance, the following provisions: (1) A provision that the policy, the application of the employer, or executive officer or trustee of any association or labor union, and the individual applications, if any, of the employees, members or employees of members insured shall constitute the entire contract between the parties, and that all statements made in the applications shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless it is contained in a written application; (2) A provision that the insurer will issue to the policyholder for delivering to the persons insured under the policy, an individual certificate setting forth the benefits and the exceptions thereunder and referring to the master policy under which the coverage is provided; and (3) A provision that to the group or class thereof originally insured there shall be added from time to time all persons becoming newly eligible for and applying for insurance in the group or class.
(1) A provision that the policy, the application of the employer, or executive officer or trustee of any association or labor union, and the individual applications, if any, of the employees, members or employees of members insured shall constitute the entire contract between the parties, and that all statements made in the applications shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless it is contained in a written application;
(2) A provision that the insurer will issue to the policyholder for delivering to the persons insured under the policy, an individual certificate setting forth the benefits and the exceptions thereunder and referring to the master policy under which the coverage is provided; and
(3) A provision that to the group or class thereof originally insured there shall be added from time to time all persons becoming newly eligible for and applying for insurance in the group or class.
Acts 1976, ch. 397, § 7; 1978, ch. 514, § 2; T.C.A., § 56-3331; Acts 2011, ch. 344, § 14.
Tenn. Code Ann. § 56-16-112 — TN Code / Title 56 / Chapter 16 / Section 56-16-112
Contingent assessment liability of subscriber
Status: in_force

(a) Each subscriber insured under an assessable policy shall have a contingent assessment liability for payment of actual losses and expenses incurred while the subscriber's policy was in force. This shall be in the amount provided for in the power of attorney or subscriber's agreement. (b) The contingent assessment liability on any one (1) policy in any one (1) calendar year shall equal the premiums earned on the policy for that year multiplied by not less than one (1) nor more than ten (10). (c) The contingent assessment liability shall not be joint, but shall be individual and several. (d) Each assessable policy issued by the insurer shall plainly set forth a statement of the contingent assessment liability on the front of the policy in capital letters in no less than ten-point type. Acts 1990, ch. 728, § 2; T.C.A. § 56-16-212.
(a) Each subscriber insured under an assessable policy shall have a contingent assessment liability for payment of actual losses and expenses incurred while the subscriber's policy was in force. This shall be in the amount provided for in the power of attorney or subscriber's agreement.
(b) The contingent assessment liability on any one (1) policy in any one (1) calendar year shall equal the premiums earned on the policy for that year multiplied by not less than one (1) nor more than ten (10).
(c) The contingent assessment liability shall not be joint, but shall be individual and several.
(d) Each assessable policy issued by the insurer shall plainly set forth a statement of the contingent assessment liability on the front of the policy in capital letters in no less than ten-point type.
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-212.
Tenn. Code Ann. § 56-60-108 — TN Code / Title 56 / Chapter 60 / Section 56-60-108
Enforcement - Rules
Status: in_force

(a) The department shall enforce this chapter. (b) The department is authorized to promulgate rules to effectuate this chapter in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The initial rules promulgated by the department may be designated as emergency rules if the department finds that it cannot implement the rules by January 1, 2010, exercising the rulemaking procedures for the promulgation of permanent rules and if the department complies with § 4-5-208 . Acts 2009, ch. 466, § 9.
(a) The department shall enforce this chapter.
(b) The department is authorized to promulgate rules to effectuate this chapter in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The initial rules promulgated by the department may be designated as emergency rules if the department finds that it cannot implement the rules by January 1, 2010, exercising the rulemaking procedures for the promulgation of permanent rules and if the department complies with § 4-5-208 .
Acts 2009, ch. 466, § 9.
Tenn. Code Ann. § 56-19-108 — TN Code / Title 56 / Chapter 19 / Section 56-19-108
Powers of company - Insurance contracts - Kinds of insurance - Reinsurance
Status: in_force

Any company organized under this chapter is empowered to make contracts of insurance or to reinsure or accept reinsurance or any portion thereof, to the extent specified in its articles of incorporation, for insurance: (1) Against loss or damage to property and loss of use and occupancy by fire, lightning, hail, tempest, flood, earthquake, frost or snow, explosion, fire ensuing and explosion, no fire ensuing, except explosion by steam boilers or flywheels; against loss or damage by water caused by the breakage or leakage of sprinklers, pumps or other apparatus, waterpipes, plumbing or their fixtures, erected for extinguishing fires, and against accidental injury to the sprinklers, pumps or other apparatus, waterpipes, plumbing or fixtures; against the risks of inland transportation and navigation; upon automobiles, whether stationary or operated under their own power, against loss or damage by any of the causes or risks specified in this subdivision (1), including also transportation, collision liability for damage to property resulting from owning, maintaining or using automobiles, and including burglary and theft, but not including loss or damage by reason of bodily injury to the person; (2) Against loss, expense or liability by reason of bodily injury or death by accident, disability, sickness or disease suffered by others for which the insured may be liable or have assumed liability, including workers' compensation; (3) Against bodily injury or death by accident and disability by sickness; (4) Against any or all loss, expense and liability resulting from the ownership, maintenance, or use of any automobile or other vehicle; provided, that no policies shall be issued under this subdivision (4) against the hazard of fire alone; (5) Against loss or liability to persons or property resulting from explosions or accidents to boilers, containers, pipes, engines, flywheels, elevators and machinery in connection therewith, and against loss of use and occupancy caused thereby, and to make inspections and issue certificates of inspection of the machinery; (6) Against loss from interruption of trade or business that may be the result of any accident or casualty; and (7) Against loss or damage by any hazard upon any risk not provided for in this section that is not prohibited by statute or at common law from being the subject of insurance, excepting life insurance. Acts 1919, ch. 108, § 6; Shan. Supp., § 3369a58b12; Code 1932, § 6324; T.C.A. (orig. ed.), § 56-1708.
Any company organized under this chapter is empowered to make contracts of insurance or to reinsure or accept reinsurance or any portion thereof, to the extent specified in its articles of incorporation, for insurance:
(1) Against loss or damage to property and loss of use and occupancy by fire, lightning, hail, tempest, flood, earthquake, frost or snow, explosion, fire ensuing and explosion, no fire ensuing, except explosion by steam boilers or flywheels; against loss or damage by water caused by the breakage or leakage of sprinklers, pumps or other apparatus, waterpipes, plumbing or their fixtures, erected for extinguishing fires, and against accidental injury to the sprinklers, pumps or other apparatus, waterpipes, plumbing or fixtures; against the risks of inland transportation and navigation; upon automobiles, whether stationary or operated under their own power, against loss or damage by any of the causes or risks specified in this subdivision (1), including also transportation, collision liability for damage to property resulting from owning, maintaining or using automobiles, and including burglary and theft, but not including loss or damage by reason of bodily injury to the person;
(2) Against loss, expense or liability by reason of bodily injury or death by accident, disability, sickness or disease suffered by others for which the insured may be liable or have assumed liability, including workers' compensation;
(3) Against bodily injury or death by accident and disability by sickness;
(4) Against any or all loss, expense and liability resulting from the ownership, maintenance, or use of any automobile or other vehicle; provided, that no policies shall be issued under this subdivision (4) against the hazard of fire alone;
(5) Against loss or liability to persons or property resulting from explosions or accidents to boilers, containers, pipes, engines, flywheels, elevators and machinery in connection therewith, and against loss of use and occupancy caused thereby, and to make inspections and issue certificates of inspection of the machinery;
(6) Against loss from interruption of trade or business that may be the result of any accident or casualty; and
(7) Against loss or damage by any hazard upon any risk not provided for in this section that is not prohibited by statute or at common law from being the subject of insurance, excepting life insurance.
Acts 1919, ch. 108, § 6; Shan. Supp., § 3369a58b12; Code 1932, § 6324; T.C.A. (orig. ed.), § 56-1708.
Tenn. Code Ann. § 56-46-204 — TN Code / Title 56 / Chapter 46 / Section 56-46-204
Regulatory Action Level Events
Status: in_force

(a) "Regulatory Action Level Event" means, with respect to a health organization, any of the following events: (1) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC; (2) Notification by the commissioner to a health organization of an adjusted RBC report that indicates the event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ; (3) If, pursuant to § 56-46-207 , the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge; (4) The failure of the health organization to file an RBC report by the filing date, unless the health organization has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date; (5) The failure of the health organization to submit an RBC plan to the commissioner within the time period set forth in § 56-46-203(c) ; (6) Notification by the commissioner to the health organization that: (A) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and (B) Notification constitutes a Regulatory Action Level Event with respect to the health organization; provided, that the health organization has not challenged the determination under § 56-46-207 ; (7) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(6), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge; (8) Notification by the commissioner to the health organization that the health organization has failed to adhere to its RBC plan or revised RBC plan, but only if the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event in accordance with its RBC plan or revised RBC plan and the commissioner has so stated in the notification, provided the health organization has not challenged the determination under § 56-46-207 ; or (9) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(8), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge. (b) In the event of a Regulatory Action Level Event the commissioner shall: (1) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan; (2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the health organization including a review of its RBC plan or revised RBC plan; and (3) Subsequent to the examination or analysis, issue an order specifying such corrective actions as the commissioner shall determine are required (a "corrective order"). (c) In determining corrective actions, the commissioner may take into account factors the commissioner deems relevant with respect to the health organization based upon the commissioner's examination or analysis of the assets, liabilities and operations of the health organization, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC instructions. The RBC plan or revised RBC plan shall be submitted: (1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event; (2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge; or (3) If the health organization challenges a revised RBC plan pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge. (d) The commissioner may retain actuaries, investment experts, and other consultants as may be necessary in the judgment of the commissioner to review the health organization's RBC plan or revised RBC plan, examine or analyze the assets, liabilities and operations (including contractual relationships) of the health organization, and formulate the corrective order with respect to the health organization. The fees, costs and expenses relating to consultants shall be borne by the affected health organization or such other party as directed by the commissioner. Acts 2014, ch. 559, § 7.
(a) "Regulatory Action Level Event" means, with respect to a health organization, any of the following events: (1) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC; (2) Notification by the commissioner to a health organization of an adjusted RBC report that indicates the event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ; (3) If, pursuant to § 56-46-207 , the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge; (4) The failure of the health organization to file an RBC report by the filing date, unless the health organization has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date; (5) The failure of the health organization to submit an RBC plan to the commissioner within the time period set forth in § 56-46-203(c) ; (6) Notification by the commissioner to the health organization that: (A) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and (B) Notification constitutes a Regulatory Action Level Event with respect to the health organization; provided, that the health organization has not challenged the determination under § 56-46-207 ; (7) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(6), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge; (8) Notification by the commissioner to the health organization that the health organization has failed to adhere to its RBC plan or revised RBC plan, but only if the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event in accordance with its RBC plan or revised RBC plan and the commissioner has so stated in the notification, provided the health organization has not challenged the determination under § 56-46-207 ; or (9) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(8), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge.
(1) The filing of an RBC report by the health organization that indicates that the health organization's total adjusted capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC;
(2) Notification by the commissioner to a health organization of an adjusted RBC report that indicates the event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ;
(3) If, pursuant to § 56-46-207 , the health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge;
(4) The failure of the health organization to file an RBC report by the filing date, unless the health organization has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date;
(5) The failure of the health organization to submit an RBC plan to the commissioner within the time period set forth in § 56-46-203(c) ;
(6) Notification by the commissioner to the health organization that: (A) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and (B) Notification constitutes a Regulatory Action Level Event with respect to the health organization; provided, that the health organization has not challenged the determination under § 56-46-207 ;
(A) The RBC plan or revised RBC plan submitted by the health organization is, in the judgment of the commissioner, unsatisfactory; and
(B) Notification constitutes a Regulatory Action Level Event with respect to the health organization; provided, that the health organization has not challenged the determination under § 56-46-207 ;
(7) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(6), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge;
(8) Notification by the commissioner to the health organization that the health organization has failed to adhere to its RBC plan or revised RBC plan, but only if the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event in accordance with its RBC plan or revised RBC plan and the commissioner has so stated in the notification, provided the health organization has not challenged the determination under § 56-46-207 ; or
(9) If, pursuant to § 56-46-207 , the health organization challenges a determination by the commissioner under subdivision (a)(8), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the challenge.
(b) In the event of a Regulatory Action Level Event the commissioner shall: (1) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan; (2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the health organization including a review of its RBC plan or revised RBC plan; and (3) Subsequent to the examination or analysis, issue an order specifying such corrective actions as the commissioner shall determine are required (a "corrective order").
(1) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan;
(2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the health organization including a review of its RBC plan or revised RBC plan; and
(3) Subsequent to the examination or analysis, issue an order specifying such corrective actions as the commissioner shall determine are required (a "corrective order").
(c) In determining corrective actions, the commissioner may take into account factors the commissioner deems relevant with respect to the health organization based upon the commissioner's examination or analysis of the assets, liabilities and operations of the health organization, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC instructions. The RBC plan or revised RBC plan shall be submitted: (1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event; (2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge; or (3) If the health organization challenges a revised RBC plan pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event;
(2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge; or
(3) If the health organization challenges a revised RBC plan pursuant to § 56-46-207 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(d) The commissioner may retain actuaries, investment experts, and other consultants as may be necessary in the judgment of the commissioner to review the health organization's RBC plan or revised RBC plan, examine or analyze the assets, liabilities and operations (including contractual relationships) of the health organization, and formulate the corrective order with respect to the health organization. The fees, costs and expenses relating to consultants shall be borne by the affected health organization or such other party as directed by the commissioner.
Acts 2014, ch. 559, § 7.
Tenn. Code Ann. § 56-55-111 — TN Code / Title 56 / Chapter 55 / Section 56-55-111
Examination of accounts, books, and records for compliance - Costs and fees of examination - Enforcement - Violations - Hearings - Penalties
Status: in_force

(a) (1) The commissioner may conduct examinations of warrantors, administrators, or other persons to enforce this chapter, and to protect warranty holders in this state. Upon request of the commissioner, a warrantor shall make available to the commissioner all accounts, books, and records concerning vehicle protection products sold by the warrantor that are necessary to enable the commissioner to reasonably determine compliance or noncompliance with this chapter. (2) Any person or entity examined shall pay any and all appropriate and reasonable costs incurred by the commissioner during the examination, including, but not limited to, the compensation of experts, actuaries, examiners, or other persons that may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the examination. The compensation shall be fixed at a reasonable amount, commensurate with usual compensation for like services, and shall be contracted for in accordance with applicable state contracting procedures, if applicable. (b) The commissioner may take action that is necessary or appropriate to enforce this chapter and the commissioner's rules and orders, and to protect warranty holders in this state. If a person or entity violates this chapter and the commissioner reasonably believes the violation threatens to cause irreparable loss or injury to the property or business of any person or company located in this state, the commissioner may: (1) Issue an order directed to the warrantor to cease and desist from engaging in further acts, practices, or transactions that are causing the conduct; (2) Issue an order prohibiting the warrantor from selling, or offering for sale, vehicle protection products in violation of this chapter; (3) Issue an order imposing a civil penalty on the warrantor; or (4) Issue any combination of subdivisions (b)(1)-(3), as applicable. (c) At any hearing under this chapter, the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, shall apply. (d) The commissioner may bring an action in any court of competent jurisdiction, for an injunction or other appropriate relief, to enjoin threatened or existing violations of this chapter, or of the commissioner's orders or rules. An action filed under this section may also seek restitution on behalf of persons aggrieved by a violation of this chapter, or orders or rules of the commissioner. (e) A person or entity that is found to have violated this chapter or orders or rules of the commissioner may be ordered to pay to the commissioner a civil penalty in an amount determined by the commissioner, not to exceed five thousand dollars ($5,000) per violation. Acts 2005, ch. 244, § 12.
(a) (1) The commissioner may conduct examinations of warrantors, administrators, or other persons to enforce this chapter, and to protect warranty holders in this state. Upon request of the commissioner, a warrantor shall make available to the commissioner all accounts, books, and records concerning vehicle protection products sold by the warrantor that are necessary to enable the commissioner to reasonably determine compliance or noncompliance with this chapter. (2) Any person or entity examined shall pay any and all appropriate and reasonable costs incurred by the commissioner during the examination, including, but not limited to, the compensation of experts, actuaries, examiners, or other persons that may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the examination. The compensation shall be fixed at a reasonable amount, commensurate with usual compensation for like services, and shall be contracted for in accordance with applicable state contracting procedures, if applicable.
(1) The commissioner may conduct examinations of warrantors, administrators, or other persons to enforce this chapter, and to protect warranty holders in this state. Upon request of the commissioner, a warrantor shall make available to the commissioner all accounts, books, and records concerning vehicle protection products sold by the warrantor that are necessary to enable the commissioner to reasonably determine compliance or noncompliance with this chapter.
(2) Any person or entity examined shall pay any and all appropriate and reasonable costs incurred by the commissioner during the examination, including, but not limited to, the compensation of experts, actuaries, examiners, or other persons that may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the examination. The compensation shall be fixed at a reasonable amount, commensurate with usual compensation for like services, and shall be contracted for in accordance with applicable state contracting procedures, if applicable.
(b) The commissioner may take action that is necessary or appropriate to enforce this chapter and the commissioner's rules and orders, and to protect warranty holders in this state. If a person or entity violates this chapter and the commissioner reasonably believes the violation threatens to cause irreparable loss or injury to the property or business of any person or company located in this state, the commissioner may: (1) Issue an order directed to the warrantor to cease and desist from engaging in further acts, practices, or transactions that are causing the conduct; (2) Issue an order prohibiting the warrantor from selling, or offering for sale, vehicle protection products in violation of this chapter; (3) Issue an order imposing a civil penalty on the warrantor; or (4) Issue any combination of subdivisions (b)(1)-(3), as applicable.
(1) Issue an order directed to the warrantor to cease and desist from engaging in further acts, practices, or transactions that are causing the conduct;
(2) Issue an order prohibiting the warrantor from selling, or offering for sale, vehicle protection products in violation of this chapter;
(3) Issue an order imposing a civil penalty on the warrantor; or
(4) Issue any combination of subdivisions (b)(1)-(3), as applicable.
(c) At any hearing under this chapter, the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, shall apply.
(d) The commissioner may bring an action in any court of competent jurisdiction, for an injunction or other appropriate relief, to enjoin threatened or existing violations of this chapter, or of the commissioner's orders or rules. An action filed under this section may also seek restitution on behalf of persons aggrieved by a violation of this chapter, or orders or rules of the commissioner.
(e) A person or entity that is found to have violated this chapter or orders or rules of the commissioner may be ordered to pay to the commissioner a civil penalty in an amount determined by the commissioner, not to exceed five thousand dollars ($5,000) per violation.
Acts 2005, ch. 244, § 12.
Tenn. Code Ann. § 56-2-1009 — TN Code / Title 56 / Chapter 2 / Section 56-2-1009
Exceptions
Status: in_force

(a) (1) This part does not apply to: (A) A licensee who employs less than twenty-five (25) individuals, regardless of whether the individuals are employees or independent contractors; (B) A licensee with less than five million dollars ($5,000,000) in gross annual revenue; or (C) A licensee with less than ten million dollars ($10,000,000) in year-end total assets. (2) A licensee subject to and governed by the privacy, security, and breach notification rules issued by the United States department of health and human services, 45 CFR Parts 160 and 164, established pursuant to the federal Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. § 1320d et seq.), and the federal Health Information Technology for Economic and Clinical Health (HITECH) Act ( 42 U.S.C. § 300jj et seq. and 42 U.S.C. § 17901 et seq.), and that maintains nonpublic information in the same manner as protected health information meets the requirements of §§ 56-2-1004 and 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health. (3) A licensee subject to Title V of the federal Gramm-Leach-Bliley Act of 1999 ( 15 U.S.C. §§ 6801 - 6809 and 6821 - 6827 ) that meets the requirements of § 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, Title V of the federal Gramm-Leach-Bliley Act of 1999. (4) An employee, agent, representative, or designee of a licensee, who is also a licensee, is exempt from § 56-2-1004 if the activities of the employee, agent, representative, or designee are covered by the other licensee's information security program. (b) If a licensee ceases to qualify for an exception under subsection (a), then the licensee has one hundred eighty (180) days from the time the licensee no longer qualifies for the exception to comply with this part. Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
(a) (1) This part does not apply to: (A) A licensee who employs less than twenty-five (25) individuals, regardless of whether the individuals are employees or independent contractors; (B) A licensee with less than five million dollars ($5,000,000) in gross annual revenue; or (C) A licensee with less than ten million dollars ($10,000,000) in year-end total assets. (2) A licensee subject to and governed by the privacy, security, and breach notification rules issued by the United States department of health and human services, 45 CFR Parts 160 and 164, established pursuant to the federal Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. § 1320d et seq.), and the federal Health Information Technology for Economic and Clinical Health (HITECH) Act ( 42 U.S.C. § 300jj et seq. and 42 U.S.C. § 17901 et seq.), and that maintains nonpublic information in the same manner as protected health information meets the requirements of §§ 56-2-1004 and 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health. (3) A licensee subject to Title V of the federal Gramm-Leach-Bliley Act of 1999 ( 15 U.S.C. §§ 6801 - 6809 and 6821 - 6827 ) that meets the requirements of § 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, Title V of the federal Gramm-Leach-Bliley Act of 1999. (4) An employee, agent, representative, or designee of a licensee, who is also a licensee, is exempt from § 56-2-1004 if the activities of the employee, agent, representative, or designee are covered by the other licensee's information security program.
(1) This part does not apply to: (A) A licensee who employs less than twenty-five (25) individuals, regardless of whether the individuals are employees or independent contractors; (B) A licensee with less than five million dollars ($5,000,000) in gross annual revenue; or (C) A licensee with less than ten million dollars ($10,000,000) in year-end total assets.
(A) A licensee who employs less than twenty-five (25) individuals, regardless of whether the individuals are employees or independent contractors;
(B) A licensee with less than five million dollars ($5,000,000) in gross annual revenue; or
(C) A licensee with less than ten million dollars ($10,000,000) in year-end total assets.
(2) A licensee subject to and governed by the privacy, security, and breach notification rules issued by the United States department of health and human services, 45 CFR Parts 160 and 164, established pursuant to the federal Health Insurance Portability and Accountability Act of 1996 ( 42 U.S.C. § 1320d et seq.), and the federal Health Information Technology for Economic and Clinical Health (HITECH) Act ( 42 U.S.C. § 300jj et seq. and 42 U.S.C. § 17901 et seq.), and that maintains nonpublic information in the same manner as protected health information meets the requirements of §§ 56-2-1004 and 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, the federal Health Insurance Portability and Accountability Act of 1996 and the federal Health Information Technology for Economic and Clinical Health.
(3) A licensee subject to Title V of the federal Gramm-Leach-Bliley Act of 1999 ( 15 U.S.C. §§ 6801 - 6809 and 6821 - 6827 ) that meets the requirements of § 56-2-1006(c) if the licensee is compliant with, and submits a written statement certifying its compliance with, Title V of the federal Gramm-Leach-Bliley Act of 1999.
(4) An employee, agent, representative, or designee of a licensee, who is also a licensee, is exempt from § 56-2-1004 if the activities of the employee, agent, representative, or designee are covered by the other licensee's information security program.
(b) If a licensee ceases to qualify for an exception under subsection (a), then the licensee has one hundred eighty (180) days from the time the licensee no longer qualifies for the exception to comply with this part.
Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
Tenn. Code Ann. § 56-51-130 — TN Code / Title 56 / Chapter 51 / Section 56-51-130
Contract providers
Status: in_force

A prepaid limited health service organization that subcontracts with another entity to obtain a network of providers to furnish services to members or enrollees shall guarantee and assure the payment of all contracted amounts agreed to be paid to such providers by that entity or that entity's agent. This section does not preclude the prepaid limited health service organization from seeking reimbursement from the subcontractor for any amounts paid pursuant to this section. Nor does this section prevent the prepaid limited health service organization from asserting any legal defenses to the payment of a provider's claim that were available to the subcontractor. This section shall be effective for all provider claims for services delivered after January 1, 2001. Acts 2000, ch. 948, § 30.
A prepaid limited health service organization that subcontracts with another entity to obtain a network of providers to furnish services to members or enrollees shall guarantee and assure the payment of all contracted amounts agreed to be paid to such providers by that entity or that entity's agent. This section does not preclude the prepaid limited health service organization from seeking reimbursement from the subcontractor for any amounts paid pursuant to this section. Nor does this section prevent the prepaid limited health service organization from asserting any legal defenses to the payment of a provider's claim that were available to the subcontractor. This section shall be effective for all provider claims for services delivered after January 1, 2001.
Acts 2000, ch. 948, § 30.
Tenn. Code Ann. § 56-41-104 — TN Code / Title 56 / Chapter 41 / Section 56-41-104
Board of directors of association
Status: in_force

(a) The administrative powers of the association are vested in a board of directors, approved by the commissioner, consisting of seven (7) members who shall be elected and votes shall be cast and counted on a weighted basis in accordance with the premiums written of each member insurer. In addition, there shall be appointed by the commissioner two (2) members who shall be licensed agents or a representative of an agent's association. (b) Members of the board of directors may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors and for reasonable and equitable compensation as may be prescribed by the terms of the plan of operation. (c) The board of directors shall submit to the commissioner a plan of operation for the association and make suitable or necessary amendments to the plan to assure the fair, reasonable and equitable administration of the association. The plan of operation shall become effective upon the commissioner's approval in writing. The commissioner has the authority to modify or amend the plan. (d) If the association fails to submit a plan of operation within a reasonable period of time, or if at any time thereafter the association fails to submit amendments to the plan of operation, the commissioner, after a public hearing, may promulgate a plan of operation that is, in the commissioner's discretion, necessary or advisable to effectuate this title. Acts 1987, ch. 439, § 3.
(a) The administrative powers of the association are vested in a board of directors, approved by the commissioner, consisting of seven (7) members who shall be elected and votes shall be cast and counted on a weighted basis in accordance with the premiums written of each member insurer. In addition, there shall be appointed by the commissioner two (2) members who shall be licensed agents or a representative of an agent's association.
(b) Members of the board of directors may be reimbursed from the assets of the association for expenses incurred by them as members of the board of directors and for reasonable and equitable compensation as may be prescribed by the terms of the plan of operation.
(c) The board of directors shall submit to the commissioner a plan of operation for the association and make suitable or necessary amendments to the plan to assure the fair, reasonable and equitable administration of the association. The plan of operation shall become effective upon the commissioner's approval in writing. The commissioner has the authority to modify or amend the plan.
(d) If the association fails to submit a plan of operation within a reasonable period of time, or if at any time thereafter the association fails to submit amendments to the plan of operation, the commissioner, after a public hearing, may promulgate a plan of operation that is, in the commissioner's discretion, necessary or advisable to effectuate this title.
Acts 1987, ch. 439, § 3.
Tenn. Code Ann. § 56-31-102 — TN Code / Title 56 / Chapter 31 / Section 56-31-102
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Beneficiary" means a person designated in the subscription certificate referred to in subdivision (8) as entitled to the vision services referred to in subdivision (8); (2) "Commissioner" means the commissioner of commerce and insurance; (3) "Covered dependent" means the spouse and adult dependent or child of a subscriber who is named in the subscription certificate issued to the subscriber, and with respect to whom appropriate premium is specified in the certificate; (4) "Nonprofit vision service corporation" means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining and operating a nonprofit vision service plan; (5) "Nonprofit vision service plan" means a plan whereby specified vision service is provided by a nonprofit vision service corporation to subscribers to the plan; (6) "Participating optometrist" means an optometrist duly licensed to practice optometry in this state who contracts in writing with a vision service plan corporation to perform the vision services specified in the subscription certificates issued by the corporation, and at rates of compensation determined by the board of directors of the corporation, and who agrees to abide by the bylaws, rules and regulations of the corporation applicable to participating optometrists; (7) "Person" includes a natural person, a corporation, an association, a common-law trust or corporation; (8) "Subscriber" means a person to whom a subscription certificate is issued by a vision care service plan corporation, which sets forth the beneficiaries and the kind and extent of vision service for which the corporation is liable to make payment; and (9) "Vision service" means the usual and general professional services rendered by persons duly licensed under the laws of this state to practice optometry. Acts 1969, ch. 118, § 2; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3702.
As used in this chapter, unless the context otherwise requires:
(1) "Beneficiary" means a person designated in the subscription certificate referred to in subdivision (8) as entitled to the vision services referred to in subdivision (8);
(2) "Commissioner" means the commissioner of commerce and insurance;
(3) "Covered dependent" means the spouse and adult dependent or child of a subscriber who is named in the subscription certificate issued to the subscriber, and with respect to whom appropriate premium is specified in the certificate;
(4) "Nonprofit vision service corporation" means any corporation organized pursuant to this chapter for the purpose of establishing, maintaining and operating a nonprofit vision service plan;
(5) "Nonprofit vision service plan" means a plan whereby specified vision service is provided by a nonprofit vision service corporation to subscribers to the plan;
(6) "Participating optometrist" means an optometrist duly licensed to practice optometry in this state who contracts in writing with a vision service plan corporation to perform the vision services specified in the subscription certificates issued by the corporation, and at rates of compensation determined by the board of directors of the corporation, and who agrees to abide by the bylaws, rules and regulations of the corporation applicable to participating optometrists;
(7) "Person" includes a natural person, a corporation, an association, a common-law trust or corporation;
(8) "Subscriber" means a person to whom a subscription certificate is issued by a vision care service plan corporation, which sets forth the beneficiaries and the kind and extent of vision service for which the corporation is liable to make payment; and
(9) "Vision service" means the usual and general professional services rendered by persons duly licensed under the laws of this state to practice optometry.
Acts 1969, ch. 118, § 2; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3702.
Tenn. Code Ann. § 56-3-114 — TN Code / Title 56 / Chapter 3 / Section 56-3-114
Valuation of securities
Status: in_force

(a) Securities, other than those referred to in § 56-3-113 , held by an insurer shall be valued, in the discretion of the department, at their market value, at their appraised value, or at prices determined by it as representing their fair market value. Nothing in this section applies to loans secured by mortgages upon improved real property or upon leasehold estates in improved real property, which shall continue to be valued on the basis of amortization to maturity. (b) Preferred or guaranteed stocks or shares, while paying full dividends, may be carried at a fixed value in lieu of market value, at the discretion of the department and in accordance with the method of valuation it approves. (c) Stock of a subsidiary corporation of an insurer shall not be valued at an amount in excess of the net value of the stock as based upon those assets only of the subsidiary that would be eligible under this chapter for investment of the funds of the insurer directly. (d) No valuations under this section shall be inconsistent with any applicable valuation or method then currently formulated or approved by the National Association of Insurance Commissioners or its successor organization. (e) Before the commissioner takes any action pursuant to this section, the commissioner shall give written notice to the insurer involved, stating specifically the nature of the alleged violation, and fixing a time and place, at least ten (10) days thereafter, when a hearing on the matter shall be held. The burden of proof shall be on the commissioner to show the lack of statutory criteria by the preponderance of the evidence. After the hearing, or upon failure of the accused to appear at the hearing, the commissioner, if the commissioner finds a violation, may enter an appropriate order under this section as the commissioner deems advisable. (f) When the commissioner takes action in any or all of the ways set out in this section, the party aggrieved may appeal from the action to the chancery court of Davidson County. Acts 1991, ch. 142, § 2.
(a) Securities, other than those referred to in § 56-3-113 , held by an insurer shall be valued, in the discretion of the department, at their market value, at their appraised value, or at prices determined by it as representing their fair market value. Nothing in this section applies to loans secured by mortgages upon improved real property or upon leasehold estates in improved real property, which shall continue to be valued on the basis of amortization to maturity.
(b) Preferred or guaranteed stocks or shares, while paying full dividends, may be carried at a fixed value in lieu of market value, at the discretion of the department and in accordance with the method of valuation it approves.
(c) Stock of a subsidiary corporation of an insurer shall not be valued at an amount in excess of the net value of the stock as based upon those assets only of the subsidiary that would be eligible under this chapter for investment of the funds of the insurer directly.
(d) No valuations under this section shall be inconsistent with any applicable valuation or method then currently formulated or approved by the National Association of Insurance Commissioners or its successor organization.
(e) Before the commissioner takes any action pursuant to this section, the commissioner shall give written notice to the insurer involved, stating specifically the nature of the alleged violation, and fixing a time and place, at least ten (10) days thereafter, when a hearing on the matter shall be held. The burden of proof shall be on the commissioner to show the lack of statutory criteria by the preponderance of the evidence. After the hearing, or upon failure of the accused to appear at the hearing, the commissioner, if the commissioner finds a violation, may enter an appropriate order under this section as the commissioner deems advisable.
(f) When the commissioner takes action in any or all of the ways set out in this section, the party aggrieved may appeal from the action to the chancery court of Davidson County.
Acts 1991, ch. 142, § 2.
Tenn. Code Ann. § 56-6-508 — TN Code / Title 56 / Chapter 6 / Section 56-6-508
Commissioner - Authority to promulgate rules and regulations
Status: in_force

The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this part. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Acts 1991, ch. 142, § 7.
The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this part. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1991, ch. 142, § 7.
Tenn. Code Ann. § 56-8-109 — TN Code / Title 56 / Chapter 8 / Section 56-8-109
Violations of part or rules
Status: in_force

Whenever it appears to the commissioner that any person has violated or is about to violate this part or any rule promulgated under this part, the commissioner may, in the commissioner's discretion, bring an action in the chancery court of Davidson County to enjoin the violation and to enforce compliance with this part, any rule under this part or any order lawfully entered pursuant to this section. The court shall not require the commissioner to post a bond. Acts 2008, ch. 1079, §§ 1, 10.
Whenever it appears to the commissioner that any person has violated or is about to violate this part or any rule promulgated under this part, the commissioner may, in the commissioner's discretion, bring an action in the chancery court of Davidson County to enjoin the violation and to enforce compliance with this part, any rule under this part or any order lawfully entered pursuant to this section. The court shall not require the commissioner to post a bond.
Acts 2008, ch. 1079, §§ 1, 10.
Tenn. Code Ann. § 56-16-201 — TN Code / Title 56 / Chapter 16 / Section 56-16-201
Statements of subscribers - Filing - Contents
Status: in_force

Subscribers contracting among themselves pursuant to part 1 of this chapter shall, through their attorney, file with the commissioner a declaration verified by the oath of the attorney, setting forth: (1) The name or title of the office at which the subscribers propose to exchange the indemnity contracts. The name or title shall not be so similar to any other name or title previously adopted by a similar organization, or by any insurance corporation or association as in the opinion of the commissioner is calculated to result in confusion or deception. The office or offices through which the indemnity contracts shall be exchanged shall be classified as reciprocal or interinsurance exchanges; (2) The kind or kinds of insurance to be effected or exchanged; (3) A copy of the form of policy contract or agreement under or by which the insurance is to be effected or exchanged; (4) A copy of the form of the subscriber's agreement and power of attorney or other authority of the attorney under which the insurance is to be effected or exchanged; (5) The location of the office or offices from which the contracts or agreements are to be issued; (6) That applications have been made for indemnity upon at least twenty-five (25) separate risks aggregating not less than one million five hundred thousand dollars ($1,500,000) as represented by executed contracts or bona fide applications to become concurrently effective, or, in the case of liability or compensation insurance, covering a total payroll of not less than one million five hundred thousand dollars ($1,500,000); and (7) That there is on deposit with the attorney and available for the payment of losses a sum of not less than twenty-five thousand dollars ($25,000). Acts 1990, ch. 728, § 2; T.C.A. § 56-16-301.
Subscribers contracting among themselves pursuant to part 1 of this chapter shall, through their attorney, file with the commissioner a declaration verified by the oath of the attorney, setting forth:
(1) The name or title of the office at which the subscribers propose to exchange the indemnity contracts. The name or title shall not be so similar to any other name or title previously adopted by a similar organization, or by any insurance corporation or association as in the opinion of the commissioner is calculated to result in confusion or deception. The office or offices through which the indemnity contracts shall be exchanged shall be classified as reciprocal or interinsurance exchanges;
(2) The kind or kinds of insurance to be effected or exchanged;
(3) A copy of the form of policy contract or agreement under or by which the insurance is to be effected or exchanged;
(4) A copy of the form of the subscriber's agreement and power of attorney or other authority of the attorney under which the insurance is to be effected or exchanged;
(5) The location of the office or offices from which the contracts or agreements are to be issued;
(6) That applications have been made for indemnity upon at least twenty-five (25) separate risks aggregating not less than one million five hundred thousand dollars ($1,500,000) as represented by executed contracts or bona fide applications to become concurrently effective, or, in the case of liability or compensation insurance, covering a total payroll of not less than one million five hundred thousand dollars ($1,500,000); and
(7) That there is on deposit with the attorney and available for the payment of losses a sum of not less than twenty-five thousand dollars ($25,000).
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-301.
Tenn. Code Ann. § 56-4-221 — TN Code / Title 56 / Chapter 4 / Section 56-4-221
In-state insurance companies - Reinsurance agreements with insurance company affiliates
Status: in_force

(a) An in-state insurance company that has an insurance company affiliate may enter into reinsurance agreements with the affiliate, pursuant to which the tax imposed on gross premiums under § 56-4-205 is allocated from the ceding company to the reinsuring company. The reinsurance agreements shall be effective to enable the reinsuring company to use the premium tax liability so allocated as a credit under § 56-4-217 ; provided, that the ceding company may not use as a credit under § 56-4-217 any tax liability allocated by the ceding company to the reinsuring company. No allocation of premium tax liability as described in this section shall relieve the ceding company from responsibility for payment of the full premium tax on insurance business written in this state and for the filing of sworn returns in accordance with this section. Nothing in this section shall result in a reduction of the premium tax and franchise and excise tax liability of the ceding company from that which would have been imposed in the absence of this section. (b) As used in this section: (1) "In-state insurance company" means an insurance company: (A) Having its principal place of business in this state; and (B) That does not transact insurance business in any other state; and (2) "Insurance company affiliate" means a corporation: (A) Authorized to conduct insurance business in this state after March 19, 1991; (B) That does not transact insurance business in any other state; and (C) Fifty percent (50%) or more of the voting stock of which is directly or indirectly controlled by, or under common control with, an in-state insurance company. Acts 1991, ch. 39, § 1.
(a) An in-state insurance company that has an insurance company affiliate may enter into reinsurance agreements with the affiliate, pursuant to which the tax imposed on gross premiums under § 56-4-205 is allocated from the ceding company to the reinsuring company. The reinsurance agreements shall be effective to enable the reinsuring company to use the premium tax liability so allocated as a credit under § 56-4-217 ; provided, that the ceding company may not use as a credit under § 56-4-217 any tax liability allocated by the ceding company to the reinsuring company. No allocation of premium tax liability as described in this section shall relieve the ceding company from responsibility for payment of the full premium tax on insurance business written in this state and for the filing of sworn returns in accordance with this section. Nothing in this section shall result in a reduction of the premium tax and franchise and excise tax liability of the ceding company from that which would have been imposed in the absence of this section.
(b) As used in this section: (1) "In-state insurance company" means an insurance company: (A) Having its principal place of business in this state; and (B) That does not transact insurance business in any other state; and (2) "Insurance company affiliate" means a corporation: (A) Authorized to conduct insurance business in this state after March 19, 1991; (B) That does not transact insurance business in any other state; and (C) Fifty percent (50%) or more of the voting stock of which is directly or indirectly controlled by, or under common control with, an in-state insurance company.
(1) "In-state insurance company" means an insurance company: (A) Having its principal place of business in this state; and (B) That does not transact insurance business in any other state; and
(A) Having its principal place of business in this state; and
(B) That does not transact insurance business in any other state; and
(2) "Insurance company affiliate" means a corporation: (A) Authorized to conduct insurance business in this state after March 19, 1991; (B) That does not transact insurance business in any other state; and (C) Fifty percent (50%) or more of the voting stock of which is directly or indirectly controlled by, or under common control with, an in-state insurance company.
(A) Authorized to conduct insurance business in this state after March 19, 1991;
(B) That does not transact insurance business in any other state; and
(C) Fifty percent (50%) or more of the voting stock of which is directly or indirectly controlled by, or under common control with, an in-state insurance company.
Acts 1991, ch. 39, § 1.
Tenn. Code Ann. § 56-23-106 — TN Code / Title 56 / Chapter 23 / Section 56-23-106
Annual reports of companies - Contents - Financial condition - Filing fee
Status: in_force

Every company subject to this chapter shall make an annual report to the commissioner, by March 1 of each year as of December 31 of the preceding year, on blank forms prepared and furnished by the commissioner for that purpose, setting forth the transactions of the company during the previous year, showing its condition at the close of the year, and shall pay to the commissioner a fee of fifty dollars ($50.00) therefor at the time of filing the statement. Acts 1973, ch. 293, § 6; T.C.A., § 56-4206.
Every company subject to this chapter shall make an annual report to the commissioner, by March 1 of each year as of December 31 of the preceding year, on blank forms prepared and furnished by the commissioner for that purpose, setting forth the transactions of the company during the previous year, showing its condition at the close of the year, and shall pay to the commissioner a fee of fifty dollars ($50.00) therefor at the time of filing the statement.
Acts 1973, ch. 293, § 6; T.C.A., § 56-4206.
Tenn. Code Ann. § 56-26-115 — TN Code / Title 56 / Chapter 26 / Section 56-26-115
Policy provisions not specifically covered
Status: in_force

No policy provision that is not subject to §§ 56-26-108 - 56-26-114 shall make a policy or any portion thereof less favorable in any respect to the insured or the beneficiary than the provisions that are subject to this chapter. Acts 1955, ch. 4, § 5; T.C.A., § 56-3315.
No policy provision that is not subject to §§ 56-26-108 - 56-26-114 shall make a policy or any portion thereof less favorable in any respect to the insured or the beneficiary than the provisions that are subject to this chapter.
Acts 1955, ch. 4, § 5; T.C.A., § 56-3315.
Tenn. Code Ann. § 56-6-706 — TN Code / Title 56 / Chapter 6 / Section 56-6-706
Violations
Status: in_force

(a) Whenever the commissioner has reason to believe that a utilization review agent subject to this part has been or is engaged in conduct that violates this part, the commissioner shall notify the utilization review agent of the alleged violation. The utilization review agent has thirty (30) days from the date the notice is received to respond to the alleged violation. (b) If the commissioner believes the utilization review agent has violated this part, or is not satisfied that the alleged violation has been corrected, the commissioner may conduct a contested case hearing on the alleged violation in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (c) If, after the hearing, the commissioner determines that the utilization review agent has engaged in violations of this part, the commissioner shall reduce the findings to writing and shall issue and cause to be served upon the utilization review agent a copy of the findings and an order requiring the utilization review agent to cease and desist from engaging in the violations. The commissioner may also, at the commissioner's discretion, order: (1) Payment of a penalty of not more than ten thousand dollars ($10,000) in the aggregate for a violation that occurred with such frequency as to indicate a general business pattern or practice; or (2) Suspension or revocation of the authority to do business in this state as a utilization review agent if the utilization review agent knew the act was in violation of this chapter and repeated the act with such frequency as to indicate a general business pattern or practice. Acts 1992, ch. 812, § 7.
(a) Whenever the commissioner has reason to believe that a utilization review agent subject to this part has been or is engaged in conduct that violates this part, the commissioner shall notify the utilization review agent of the alleged violation. The utilization review agent has thirty (30) days from the date the notice is received to respond to the alleged violation.
(b) If the commissioner believes the utilization review agent has violated this part, or is not satisfied that the alleged violation has been corrected, the commissioner may conduct a contested case hearing on the alleged violation in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(c) If, after the hearing, the commissioner determines that the utilization review agent has engaged in violations of this part, the commissioner shall reduce the findings to writing and shall issue and cause to be served upon the utilization review agent a copy of the findings and an order requiring the utilization review agent to cease and desist from engaging in the violations. The commissioner may also, at the commissioner's discretion, order: (1) Payment of a penalty of not more than ten thousand dollars ($10,000) in the aggregate for a violation that occurred with such frequency as to indicate a general business pattern or practice; or (2) Suspension or revocation of the authority to do business in this state as a utilization review agent if the utilization review agent knew the act was in violation of this chapter and repeated the act with such frequency as to indicate a general business pattern or practice.
(1) Payment of a penalty of not more than ten thousand dollars ($10,000) in the aggregate for a violation that occurred with such frequency as to indicate a general business pattern or practice; or
(2) Suspension or revocation of the authority to do business in this state as a utilization review agent if the utilization review agent knew the act was in violation of this chapter and repeated the act with such frequency as to indicate a general business pattern or practice.
Acts 1992, ch. 812, § 7.
Tenn. Code Ann. § 56-7-1603 — TN Code / Title 56 / Chapter 7 / Section 56-7-1603
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Company" or "insurer" means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations; and (2) "Policy" or "policy form" means: (A) Any policy, contract, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this part; (B) Any certificate, contract or policy issued by a fraternal benefit society; and (C) Any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state. Acts 1981, ch. 415, § 4.
As used in this part, unless the context otherwise requires:
(1) "Company" or "insurer" means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations; and
(2) "Policy" or "policy form" means: (A) Any policy, contract, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this part; (B) Any certificate, contract or policy issued by a fraternal benefit society; and (C) Any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state.
(A) Any policy, contract, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this part;
(B) Any certificate, contract or policy issued by a fraternal benefit society; and
(C) Any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state.
Acts 1981, ch. 415, § 4.
Tenn. Code Ann. § 56-7-2307 — TN Code / Title 56 / Chapter 7 / Section 56-7-2307
Provisions and conditions required in life insurance policies
Status: in_force

No policy of life insurance shall be issued in this state or be issued by a life insurance company organized under the laws of this state unless the policy contains the following: (1) Payment of Premiums. A provision that all premiums after the first shall be payable in advance either at the home office of the company or to an agent of the company, upon delivery of a receipt signed by one (1) or more of the officers who shall be designated in the policy, when a receipt is requested by the policyholder; (2) Grace for Payment of Premiums; Interest; Deduction for Death. A provision for a grace of one (1) month for the payment of every premium after the first year, which may be subject to an interest charge, during which month the insurance shall continue in force, which provision may contain a stipulation that if the insured dies during the month of grace, the overdue premium will be deducted in any settlement under the policy; (3) Policy is Entire Contract; Incontestability; Exceptions. A provision that the policy shall constitute the entire contract between the parties, and shall be incontestable after it has been in force during the lifetime of the insured for a specified period, not more than two (2) years from its date, except for nonpayment of premiums and except for violations of the conditions of the policy relating to naval and military services in time of war; (4) Statements Are Representations and Not Warranties in Absence of Fraud; Written Application Made Part of Policy. A provision, except in industrial policies, that all statements made by the insured shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall void the policy unless it is contained in a written application, and a copy of the application is endorsed upon or attached to the policy when issued; (5) Amount Payable Where Age Understated. A provision that if the age of the insured is understated, the amount payable under the policy shall be that which the premium would have purchased at the correct age; (6) Participation in Surplus. In a case of participating policy, a provision that the policy shall participate annually in the divisible surplus of the company beginning not later than the end of the third policy year, and any policy containing provision for annual participation at the end of the first policy year may also provide that the dividend be paid, subject to the payment of the full premium for the second policy year. The insured under any annual dividend policy shall have the right each year to have the dividend arising from the participation either paid in cash or applied in reduction of premiums, or applied to the purchase of paid-up additional insurance, or left to accumulate to the credit of the policy with interest at a rate determined from time to time by the company, but not less than a guaranteed minimum rate specified in the policy; and payable at the maturity of the policy but withdrawable at any time. If the insured fails to notify the company in writing of the election within the period of grace allowed for the payment of premium, the policy shall provide which of the options are effective; provided, that this sentence does not apply to any policy issued to any plan or trust having qualified status under subchapter D, part I, subtitle A of the Internal Revenue Code of 1954 ( 26 U.S.C. § 401 et seq.), nor under § 501(a) of the Internal Revenue Code of 1954 ( 26 U.S.C. § 501(a) ). This subdivision (6), however, shall not require any individual participating term insurance policy to contain a dividend option under which the dividend may be applied to the purchase of paid-up additional insurance; (7) Loans on Policies; Exception. A provision that after three (3) full years' premiums have been paid, the company, at any time while the policy is in force, will advance on proper assignment of the policy and on the sole security of the policy, at a specified rate of interest, a sum equal to, or at the option of the owner of the policy, less than the amount required by § 56-7-2309 under the conditions specified by § 56-7-2309 ; and that the company will deduct from the loan value any existing indebtedness on the policy and any unpaid balance of the premium for the current policy year, and may collect interest in advance on the loan to the end of the current policy year. It shall be further stipulated in the policy that failure to repay any advance or to pay interest shall not void the policy unless the total indebtedness on the policy to the company equals or exceeds the loan value at the time of the failure, nor until one (1) month after notice has been mailed by the company to the last known address of the insured and of the assignee, if any. No condition other than as provided in this subdivision (7) or in § 56-7-2309 shall be exacted as a prerequisite to the advance. This provision shall not be required in term insurance; (8) Nonforfeiture Benefits; Cash Surrender Value. A provision for nonforfeiture benefits and cash surrender values in accordance with the requirements of § 56-7-312 or § 56-7-401 ; (9) Table Showing Loan Values and Options. A table showing in figures the loan values and the options available under the policies each year upon default in premium payments during at least the first twenty (20) years of the policy; (10) Value of Policy to Be Applied for Other Insurance; Reinstatement Within Three (3) Years After Default. A provision that if, in event of default in premium payments, the value of the policy shall be applied to the purchase of other insurance; and if the insurance shall be in force and the original policy shall not have been surrendered to the company and cancelled, the policy may be reinstated within three (3) years from the default upon evidence of insurability satisfactory to the company and payment of arrears of premiums, with interest; (11) Settlement Upon Proof of Death. A provision that when a policy becomes a claim by the death of the insured, settlement shall be made upon receipt of due proof of death, or not later than two (2) months after receipt of the proof; (12) Table to Show Installment Payments of Policy. A table showing the amounts of installments in which the policy may provide its proceeds may be payable; (13) Provisions Not Applicable to Single Premium Policies Need Not Be Incorporated in Single Premium Policies. Any of subdivisions (1)-(12) or portions of subdivisions (1)-(12) relating to premiums not applicable to single premium policies shall to that extent not be incorporated in the single premium policies. Acts 1907, ch. 457, § 1; Shan., § 3348a8; mod. Code 1932, § 6179; Acts 1945, ch. 56, § 3; C. Supp. 1950, § 6179; Acts 1953, ch. 181, § 1; 1973, ch. 124, § 1; 1976, ch. 417, §§ 1-3; 1977, ch. 86, § 1; T.C.A. (orig. ed.), § 56-1111; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-301.
No policy of life insurance shall be issued in this state or be issued by a life insurance company organized under the laws of this state unless the policy contains the following:
(1) Payment of Premiums. A provision that all premiums after the first shall be payable in advance either at the home office of the company or to an agent of the company, upon delivery of a receipt signed by one (1) or more of the officers who shall be designated in the policy, when a receipt is requested by the policyholder;
(2) Grace for Payment of Premiums; Interest; Deduction for Death. A provision for a grace of one (1) month for the payment of every premium after the first year, which may be subject to an interest charge, during which month the insurance shall continue in force, which provision may contain a stipulation that if the insured dies during the month of grace, the overdue premium will be deducted in any settlement under the policy;
(3) Policy is Entire Contract; Incontestability; Exceptions. A provision that the policy shall constitute the entire contract between the parties, and shall be incontestable after it has been in force during the lifetime of the insured for a specified period, not more than two (2) years from its date, except for nonpayment of premiums and except for violations of the conditions of the policy relating to naval and military services in time of war;
(4) Statements Are Representations and Not Warranties in Absence of Fraud; Written Application Made Part of Policy. A provision, except in industrial policies, that all statements made by the insured shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall void the policy unless it is contained in a written application, and a copy of the application is endorsed upon or attached to the policy when issued;
(5) Amount Payable Where Age Understated. A provision that if the age of the insured is understated, the amount payable under the policy shall be that which the premium would have purchased at the correct age;
(6) Participation in Surplus. In a case of participating policy, a provision that the policy shall participate annually in the divisible surplus of the company beginning not later than the end of the third policy year, and any policy containing provision for annual participation at the end of the first policy year may also provide that the dividend be paid, subject to the payment of the full premium for the second policy year. The insured under any annual dividend policy shall have the right each year to have the dividend arising from the participation either paid in cash or applied in reduction of premiums, or applied to the purchase of paid-up additional insurance, or left to accumulate to the credit of the policy with interest at a rate determined from time to time by the company, but not less than a guaranteed minimum rate specified in the policy; and payable at the maturity of the policy but withdrawable at any time. If the insured fails to notify the company in writing of the election within the period of grace allowed for the payment of premium, the policy shall provide which of the options are effective; provided, that this sentence does not apply to any policy issued to any plan or trust having qualified status under subchapter D, part I, subtitle A of the Internal Revenue Code of 1954 ( 26 U.S.C. § 401 et seq.), nor under § 501(a) of the Internal Revenue Code of 1954 ( 26 U.S.C. § 501(a) ). This subdivision (6), however, shall not require any individual participating term insurance policy to contain a dividend option under which the dividend may be applied to the purchase of paid-up additional insurance;
(7) Loans on Policies; Exception. A provision that after three (3) full years' premiums have been paid, the company, at any time while the policy is in force, will advance on proper assignment of the policy and on the sole security of the policy, at a specified rate of interest, a sum equal to, or at the option of the owner of the policy, less than the amount required by § 56-7-2309 under the conditions specified by § 56-7-2309 ; and that the company will deduct from the loan value any existing indebtedness on the policy and any unpaid balance of the premium for the current policy year, and may collect interest in advance on the loan to the end of the current policy year. It shall be further stipulated in the policy that failure to repay any advance or to pay interest shall not void the policy unless the total indebtedness on the policy to the company equals or exceeds the loan value at the time of the failure, nor until one (1) month after notice has been mailed by the company to the last known address of the insured and of the assignee, if any. No condition other than as provided in this subdivision (7) or in § 56-7-2309 shall be exacted as a prerequisite to the advance. This provision shall not be required in term insurance;
(8) Nonforfeiture Benefits; Cash Surrender Value. A provision for nonforfeiture benefits and cash surrender values in accordance with the requirements of § 56-7-312 or § 56-7-401 ;
(9) Table Showing Loan Values and Options. A table showing in figures the loan values and the options available under the policies each year upon default in premium payments during at least the first twenty (20) years of the policy;
(10) Value of Policy to Be Applied for Other Insurance; Reinstatement Within Three (3) Years After Default. A provision that if, in event of default in premium payments, the value of the policy shall be applied to the purchase of other insurance; and if the insurance shall be in force and the original policy shall not have been surrendered to the company and cancelled, the policy may be reinstated within three (3) years from the default upon evidence of insurability satisfactory to the company and payment of arrears of premiums, with interest;
(11) Settlement Upon Proof of Death. A provision that when a policy becomes a claim by the death of the insured, settlement shall be made upon receipt of due proof of death, or not later than two (2) months after receipt of the proof;
(12) Table to Show Installment Payments of Policy. A table showing the amounts of installments in which the policy may provide its proceeds may be payable;
(13) Provisions Not Applicable to Single Premium Policies Need Not Be Incorporated in Single Premium Policies. Any of subdivisions (1)-(12) or portions of subdivisions (1)-(12) relating to premiums not applicable to single premium policies shall to that extent not be incorporated in the single premium policies.
Acts 1907, ch. 457, § 1; Shan., § 3348a8; mod. Code 1932, § 6179; Acts 1945, ch. 56, § 3; C. Supp. 1950, § 6179; Acts 1953, ch. 181, § 1; 1973, ch. 124, § 1; 1976, ch. 417, §§ 1-3; 1977, ch. 86, § 1; T.C.A. (orig. ed.), § 56-1111; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-301.
Tenn. Code Ann. § 56-1-701 — TN Code / Title 56 / Chapter 1 / Section 56-1-701
[Repealed]
Status: repealed

Repealed by 2018 Tenn. Acts, ch. 873, s 3, eff. 5/3/2018. Acts 1970, ch. 503, § 1; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-141.
Repealed by 2018 Tenn. Acts, ch. 873, s 3, eff. 5/3/2018.
Acts 1970, ch. 503, § 1; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-141.
Tenn. Code Ann. § 56-7-1112 — TN Code / Title 56 / Chapter 7 / Section 56-7-1112
Coverage of foreign exchange student
Status: in_force

For the purposes of motor vehicle coverage under this part for policies issued on or after July 1, 1997, a foreign exchange student shall be considered for coverage as a natural child of the adult under whose policy the child would be covered, if the adult provides the insurer with name, date of birth, and driver license number of the student. Acts 1997, ch. 196, § 1.
For the purposes of motor vehicle coverage under this part for policies issued on or after July 1, 1997, a foreign exchange student shall be considered for coverage as a natural child of the adult under whose policy the child would be covered, if the adult provides the insurer with name, date of birth, and driver license number of the student.
Acts 1997, ch. 196, § 1.
Tenn. Code Ann. § 56-9-511 — TN Code / Title 56 / Chapter 9 / Section 56-9-511
Costs of administrative supervision
Status: in_force

(a) The commissioner shall have the discretion to require any insurer placed under administrative supervision, as authorized by this part, to pay any and all appropriate and reasonable costs incurred during the supervision, including, but not limited to: (1) The expenses of the commissioner or the commissioner's designated appointee; and (2) The compensation of the experts, actuaries and examiners as may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the supervision. The compensation shall be fixed at a reasonable amount commensurate with usual compensation for like services and shall not exceed one hundred fifty percent (150%) of the compensation and per diem allowances set forth in the guidelines adopted by the National Association of Insurance Commissioners. (b) The costs of an administrative supervision incurred by the commissioner shall be paid into the department for its use and benefit in meeting the expenses and compensation for the persons engaged in the supervision. Acts 2004, ch. 604, § 1.
(a) The commissioner shall have the discretion to require any insurer placed under administrative supervision, as authorized by this part, to pay any and all appropriate and reasonable costs incurred during the supervision, including, but not limited to: (1) The expenses of the commissioner or the commissioner's designated appointee; and (2) The compensation of the experts, actuaries and examiners as may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the supervision. The compensation shall be fixed at a reasonable amount commensurate with usual compensation for like services and shall not exceed one hundred fifty percent (150%) of the compensation and per diem allowances set forth in the guidelines adopted by the National Association of Insurance Commissioners.
(1) The expenses of the commissioner or the commissioner's designated appointee; and
(2) The compensation of the experts, actuaries and examiners as may be contracted for by the commissioner or the commissioner's designated appointee for the purpose of assisting in the supervision. The compensation shall be fixed at a reasonable amount commensurate with usual compensation for like services and shall not exceed one hundred fifty percent (150%) of the compensation and per diem allowances set forth in the guidelines adopted by the National Association of Insurance Commissioners.
(b) The costs of an administrative supervision incurred by the commissioner shall be paid into the department for its use and benefit in meeting the expenses and compensation for the persons engaged in the supervision.
Acts 2004, ch. 604, § 1.
Tenn. Code Ann. § 56-7-1203 — TN Code / Title 56 / Chapter 7 / Section 56-7-1203
Insolvency protection limitation - More favorable protection not precluded
Status: in_force

An insurer's insolvency protection shall be applicable only to accidents occurring during a policy period in which its insured's uninsured motorist coverage is in effect where the liability insurer of the tortfeasor becomes insolvent within one (1) year after the accident. Nothing in this section shall be construed to prevent any insurer from affording insolvency protection under terms and conditions more favorable to its insureds than is provided in this section. Acts 1967, ch. 371, § 3; T.C.A., § 56-1150.
An insurer's insolvency protection shall be applicable only to accidents occurring during a policy period in which its insured's uninsured motorist coverage is in effect where the liability insurer of the tortfeasor becomes insolvent within one (1) year after the accident. Nothing in this section shall be construed to prevent any insurer from affording insolvency protection under terms and conditions more favorable to its insureds than is provided in this section.
Acts 1967, ch. 371, § 3; T.C.A., § 56-1150.
Tenn. Code Ann. § 56-61-109 — TN Code / Title 56 / Chapter 61 / Section 56-61-109
Establishment of written procedures for expedited review of urgent care requests of grievances involving adverse determination
Status: in_force

(a) A health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination. (b) In addition to subsection (a), a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review of urgent care requests involving an admission, availability of care, continued stay or healthcare service for a covered person who has received emergency services, but has not been discharged from a facility. (c) The procedures shall allow an aggrieved person to request an expedited review under this section orally, in writing or electronically. (d) A health carrier shall appoint an appropriate clinical peer, or peers as would typically manage the case being reviewed, to review the adverse determination. The clinical peer or peers shall not have been involved in rendering the initial adverse determination. (e) In an expedited review, the health carrier shall provide or transmit all necessary documents and information considered when making the adverse determination to the aggrieved person participating in the expedited review process electronically or by telephone, facsimile or any other expeditious method available. (f) (1) An expedited review decision shall be rendered and the aggrieved person shall be notified of the decision in accordance with subsection (h) as expeditiously as the covered person's medical condition requires, but in no event more than seventy-two (72) hours after the receipt of the request for the expedited review. (2) If the expedited review is of a grievance involving an adverse determination with respect to a concurrent review of an urgent care request, the service shall be continued until the covered person or covered person's authorized representative has been notified of the determination or until the healthcare provider determines that the urgent care is no longer appropriate or necessary. (g) For purposes of calculating the time periods within which a decision is required to be rendered under subsection (f), the time period within which the decision is required to be rendered shall begin on the date that the request is filed with the health carrier in accordance with the health carrier's procedures established pursuant to § 56-61-107 ; without regard to whether all the information necessary to make the determination accompanies the filing. (h) (1) A notification of a decision under this section shall, in a manner calculated to be understood by the aggrieved person, set forth: (A) The titles and qualifying credentials of the person or persons participating in the expedited review process; (B) A statement of the reviewers' understanding of the grievance; (C) The reviewers' decision in clear terms and the contract basis or medical rationale in sufficient detail for the aggrieved person to respond further to the health carrier's position; (D) A reference to the evidence or documentation used as the basis for the decision; and (E) If the decision involves an adverse determination, the notice shall provide: (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary for the covered person to complete the request, including an explanation of why the material or information is necessary to complete the request; (iv) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion, effective at the time of service, to make the adverse determination, either the specific rule, guideline, protocol or other similar criterion or a statement that a specific rule, guideline, protocol or other similar criterion was relied upon to make the adverse determination and a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request; (v) If the adverse determination is based on medical necessity, an explanation of the criteria for making the determination, applying the terms of the health benefit plan to the covered person's medical circumstances or a statement that an explanation will be provided to the aggrieved person free of charge upon request; (vi) If applicable, instructions for requesting: (a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or (b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and (vii) A statement describing the procedures for obtaining an external review of the adverse determination pursuant to this chapter. (2) (A) A health carrier may provide the notice required under this section orally, in writing or electronically. (B) If notice of the adverse determination is provided orally, the health carrier shall provide written or electronic notice of the adverse determination within three (3) days following such oral notification. Acts 2010, ch. 980, § 10.
(a) A health carrier shall establish written procedures for the expedited review of urgent care requests of grievances involving an adverse determination.
(b) In addition to subsection (a), a health carrier shall provide expedited review of a grievance involving an adverse determination with respect to concurrent review of urgent care requests involving an admission, availability of care, continued stay or healthcare service for a covered person who has received emergency services, but has not been discharged from a facility.
(c) The procedures shall allow an aggrieved person to request an expedited review under this section orally, in writing or electronically.
(d) A health carrier shall appoint an appropriate clinical peer, or peers as would typically manage the case being reviewed, to review the adverse determination. The clinical peer or peers shall not have been involved in rendering the initial adverse determination.
(e) In an expedited review, the health carrier shall provide or transmit all necessary documents and information considered when making the adverse determination to the aggrieved person participating in the expedited review process electronically or by telephone, facsimile or any other expeditious method available.
(f) (1) An expedited review decision shall be rendered and the aggrieved person shall be notified of the decision in accordance with subsection (h) as expeditiously as the covered person's medical condition requires, but in no event more than seventy-two (72) hours after the receipt of the request for the expedited review. (2) If the expedited review is of a grievance involving an adverse determination with respect to a concurrent review of an urgent care request, the service shall be continued until the covered person or covered person's authorized representative has been notified of the determination or until the healthcare provider determines that the urgent care is no longer appropriate or necessary.
(1) An expedited review decision shall be rendered and the aggrieved person shall be notified of the decision in accordance with subsection (h) as expeditiously as the covered person's medical condition requires, but in no event more than seventy-two (72) hours after the receipt of the request for the expedited review.
(2) If the expedited review is of a grievance involving an adverse determination with respect to a concurrent review of an urgent care request, the service shall be continued until the covered person or covered person's authorized representative has been notified of the determination or until the healthcare provider determines that the urgent care is no longer appropriate or necessary.
(g) For purposes of calculating the time periods within which a decision is required to be rendered under subsection (f), the time period within which the decision is required to be rendered shall begin on the date that the request is filed with the health carrier in accordance with the health carrier's procedures established pursuant to § 56-61-107 ; without regard to whether all the information necessary to make the determination accompanies the filing.
(h) (1) A notification of a decision under this section shall, in a manner calculated to be understood by the aggrieved person, set forth: (A) The titles and qualifying credentials of the person or persons participating in the expedited review process; (B) A statement of the reviewers' understanding of the grievance; (C) The reviewers' decision in clear terms and the contract basis or medical rationale in sufficient detail for the aggrieved person to respond further to the health carrier's position; (D) A reference to the evidence or documentation used as the basis for the decision; and (E) If the decision involves an adverse determination, the notice shall provide: (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary for the covered person to complete the request, including an explanation of why the material or information is necessary to complete the request; (iv) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion, effective at the time of service, to make the adverse determination, either the specific rule, guideline, protocol or other similar criterion or a statement that a specific rule, guideline, protocol or other similar criterion was relied upon to make the adverse determination and a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request; (v) If the adverse determination is based on medical necessity, an explanation of the criteria for making the determination, applying the terms of the health benefit plan to the covered person's medical circumstances or a statement that an explanation will be provided to the aggrieved person free of charge upon request; (vi) If applicable, instructions for requesting: (a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or (b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and (vii) A statement describing the procedures for obtaining an external review of the adverse determination pursuant to this chapter. (2) (A) A health carrier may provide the notice required under this section orally, in writing or electronically. (B) If notice of the adverse determination is provided orally, the health carrier shall provide written or electronic notice of the adverse determination within three (3) days following such oral notification.
(1) A notification of a decision under this section shall, in a manner calculated to be understood by the aggrieved person, set forth: (A) The titles and qualifying credentials of the person or persons participating in the expedited review process; (B) A statement of the reviewers' understanding of the grievance; (C) The reviewers' decision in clear terms and the contract basis or medical rationale in sufficient detail for the aggrieved person to respond further to the health carrier's position; (D) A reference to the evidence or documentation used as the basis for the decision; and (E) If the decision involves an adverse determination, the notice shall provide: (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary for the covered person to complete the request, including an explanation of why the material or information is necessary to complete the request; (iv) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion, effective at the time of service, to make the adverse determination, either the specific rule, guideline, protocol or other similar criterion or a statement that a specific rule, guideline, protocol or other similar criterion was relied upon to make the adverse determination and a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request; (v) If the adverse determination is based on medical necessity, an explanation of the criteria for making the determination, applying the terms of the health benefit plan to the covered person's medical circumstances or a statement that an explanation will be provided to the aggrieved person free of charge upon request; (vi) If applicable, instructions for requesting: (a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or (b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and (vii) A statement describing the procedures for obtaining an external review of the adverse determination pursuant to this chapter.
(A) The titles and qualifying credentials of the person or persons participating in the expedited review process;
(B) A statement of the reviewers' understanding of the grievance;
(C) The reviewers' decision in clear terms and the contract basis or medical rationale in sufficient detail for the aggrieved person to respond further to the health carrier's position;
(D) A reference to the evidence or documentation used as the basis for the decision; and
(E) If the decision involves an adverse determination, the notice shall provide: (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary for the covered person to complete the request, including an explanation of why the material or information is necessary to complete the request; (iv) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion, effective at the time of service, to make the adverse determination, either the specific rule, guideline, protocol or other similar criterion or a statement that a specific rule, guideline, protocol or other similar criterion was relied upon to make the adverse determination and a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request; (v) If the adverse determination is based on medical necessity, an explanation of the criteria for making the determination, applying the terms of the health benefit plan to the covered person's medical circumstances or a statement that an explanation will be provided to the aggrieved person free of charge upon request; (vi) If applicable, instructions for requesting: (a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or (b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and (vii) A statement describing the procedures for obtaining an external review of the adverse determination pursuant to this chapter.
(i) The specific reason or reasons for the adverse determination;
(ii) Reference to the specific plan provisions on which the determination is based;
(iii) A description of any additional material or information necessary for the covered person to complete the request, including an explanation of why the material or information is necessary to complete the request;
(iv) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion, effective at the time of service, to make the adverse determination, either the specific rule, guideline, protocol or other similar criterion or a statement that a specific rule, guideline, protocol or other similar criterion was relied upon to make the adverse determination and a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request;
(v) If the adverse determination is based on medical necessity, an explanation of the criteria for making the determination, applying the terms of the health benefit plan to the covered person's medical circumstances or a statement that an explanation will be provided to the aggrieved person free of charge upon request;
(vi) If applicable, instructions for requesting: (a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or (b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and
(a) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination in accordance with subdivision (h)(1)(E)(iv); or
(b) The written statement of the criteria for the adverse determination in accordance with subdivision (h)(1)(E)(v); and
(vii) A statement describing the procedures for obtaining an external review of the adverse determination pursuant to this chapter.
(2) (A) A health carrier may provide the notice required under this section orally, in writing or electronically. (B) If notice of the adverse determination is provided orally, the health carrier shall provide written or electronic notice of the adverse determination within three (3) days following such oral notification.
(A) A health carrier may provide the notice required under this section orally, in writing or electronically.
(B) If notice of the adverse determination is provided orally, the health carrier shall provide written or electronic notice of the adverse determination within three (3) days following such oral notification.
Acts 2010, ch. 980, § 10.
Tenn. Code Ann. § 56-7-3703 — TN Code / Title 56 / Chapter 7 / Section 56-7-3703
Requirements for initial adverse determinations
Status: in_force

(a) If a utilization review organization makes an adverse determination for a prior authorization of a healthcare service, then the carrier or organization shall include the following in the notification to the enrollee and the enrollee's healthcare provider requesting the prior authorization on the enrollee's behalf: (1) The reasons for the adverse determination and, if applicable, related evidence-based criteria, including a description of missing or insufficient documentation or lack of coverage of the enrollee for the healthcare service; (2) The right to appeal the adverse determination; (3) Instructions on how to file the appeal; and (4) Additional documentation necessary to support the appeal. (b) An adverse determination regarding a request for prior authorization for a healthcare service must be made by a licensed physician or a healthcare professional with the same or a similar specialty as the healthcare professional requesting the prior authorization. (c) This section does not apply to an initial adverse determination for prescription drugs that are covered under an enrollee's benefit plan. Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
(a) If a utilization review organization makes an adverse determination for a prior authorization of a healthcare service, then the carrier or organization shall include the following in the notification to the enrollee and the enrollee's healthcare provider requesting the prior authorization on the enrollee's behalf: (1) The reasons for the adverse determination and, if applicable, related evidence-based criteria, including a description of missing or insufficient documentation or lack of coverage of the enrollee for the healthcare service; (2) The right to appeal the adverse determination; (3) Instructions on how to file the appeal; and (4) Additional documentation necessary to support the appeal.
(1) The reasons for the adverse determination and, if applicable, related evidence-based criteria, including a description of missing or insufficient documentation or lack of coverage of the enrollee for the healthcare service;
(2) The right to appeal the adverse determination;
(3) Instructions on how to file the appeal; and
(4) Additional documentation necessary to support the appeal.
(b) An adverse determination regarding a request for prior authorization for a healthcare service must be made by a licensed physician or a healthcare professional with the same or a similar specialty as the healthcare professional requesting the prior authorization.
(c) This section does not apply to an initial adverse determination for prescription drugs that are covered under an enrollee's benefit plan.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
Tenn. Code Ann. § 56-16-207 — TN Code / Title 56 / Chapter 16 / Section 56-16-207
Assessments - Power to levy - Computation
Status: in_force

(a) Assessments may be levied upon the subscribers of a domestic reciprocal by the attorney in accordance with § 56-16-112 . The assessments shall be approved in advance by the board of directors and the department. (b) Each domestic reciprocal subscriber's share of a deficiency for which an assessment is made shall be computed by multiplying the premiums earned on the subscriber's policies during the period to be covered by the assessment by the ratio of the total deficiency to the total premiums earned during the period upon all policies subject to the assessment. However, no assessment shall exceed the aggregate contingent assessment liability computed in accordance with § 56-16-112 . For the purposes of this section, the premiums earned on the subscriber's policies are the gross premiums charged by the reciprocal for the policies, minus any charges not recurring upon the renewal or extension of the policies. No subscriber shall have an offset against any assessment for which the subscriber is liable on account of any claim for unearned premium or losses payable. Acts 1990, ch. 728, § 2; T.C.A. § 56-16-307.
(a) Assessments may be levied upon the subscribers of a domestic reciprocal by the attorney in accordance with § 56-16-112 . The assessments shall be approved in advance by the board of directors and the department.
(b) Each domestic reciprocal subscriber's share of a deficiency for which an assessment is made shall be computed by multiplying the premiums earned on the subscriber's policies during the period to be covered by the assessment by the ratio of the total deficiency to the total premiums earned during the period upon all policies subject to the assessment. However, no assessment shall exceed the aggregate contingent assessment liability computed in accordance with § 56-16-112 . For the purposes of this section, the premiums earned on the subscriber's policies are the gross premiums charged by the reciprocal for the policies, minus any charges not recurring upon the renewal or extension of the policies. No subscriber shall have an offset against any assessment for which the subscriber is liable on account of any claim for unearned premium or losses payable.
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-307.
Tenn. Code Ann. § 56-43-115 — TN Code / Title 56 / Chapter 43 / Section 56-43-115
Fees
Status: in_force

Every person subject to this chapter shall pay to the commissioner the fees required by chapter 4 of this title. Acts 1989, ch. 423, § 16.
Every person subject to this chapter shall pay to the commissioner the fees required by chapter 4 of this title.
Acts 1989, ch. 423, § 16.
Tenn. Code Ann. § 56-46-106 — TN Code / Title 56 / Chapter 46 / Section 56-46-106
Authorized Control Level Events
Status: in_force

(a) "Authorized Control Level Event" means any of the following events: (1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Mandatory Control Level RBC but less than its Authorized Control Level RBC; (2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; (3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; (4) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order; provided, that the insurer has not challenged the corrective order under § 56-46-108 ; or (5) If the insurer has challenged a corrective order under § 56-46-108 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner. (b) In the event of an Authorized Control Level Event with respect to an insurer, the commissioner shall: (1) Take the actions that are required under § 56-46-105 regarding an insurer with respect to which a Regulatory Action Level Event has occurred; or (2) If the commissioner deems it to be in the best interests of the policyholders and creditors of the insurer and of the public, take actions necessary to cause the insurer to be placed under regulatory control pursuant to chapter 9 of this title. In the event the commissioner takes such actions, the Authorized Control Level Event shall be deemed sufficient grounds for the commissioner to take action pursuant to chapter 9 of this title, and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 9 of this title. In the event the commissioner takes actions under this subsection (b) pursuant to an Adjusted RBC Report, the insurer shall be entitled to the protections that are afforded to insurers under chapter 9, part 2 of this title. Acts 1996, ch. 750, § 7.
(a) "Authorized Control Level Event" means any of the following events: (1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Mandatory Control Level RBC but less than its Authorized Control Level RBC; (2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; (3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; (4) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order; provided, that the insurer has not challenged the corrective order under § 56-46-108 ; or (5) If the insurer has challenged a corrective order under § 56-46-108 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
(1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Mandatory Control Level RBC but less than its Authorized Control Level RBC;
(2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ;
(3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge;
(4) The failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order; provided, that the insurer has not challenged the corrective order under § 56-46-108 ; or
(5) If the insurer has challenged a corrective order under § 56-46-108 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
(b) In the event of an Authorized Control Level Event with respect to an insurer, the commissioner shall: (1) Take the actions that are required under § 56-46-105 regarding an insurer with respect to which a Regulatory Action Level Event has occurred; or (2) If the commissioner deems it to be in the best interests of the policyholders and creditors of the insurer and of the public, take actions necessary to cause the insurer to be placed under regulatory control pursuant to chapter 9 of this title. In the event the commissioner takes such actions, the Authorized Control Level Event shall be deemed sufficient grounds for the commissioner to take action pursuant to chapter 9 of this title, and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 9 of this title. In the event the commissioner takes actions under this subsection (b) pursuant to an Adjusted RBC Report, the insurer shall be entitled to the protections that are afforded to insurers under chapter 9, part 2 of this title.
(1) Take the actions that are required under § 56-46-105 regarding an insurer with respect to which a Regulatory Action Level Event has occurred; or
(2) If the commissioner deems it to be in the best interests of the policyholders and creditors of the insurer and of the public, take actions necessary to cause the insurer to be placed under regulatory control pursuant to chapter 9 of this title. In the event the commissioner takes such actions, the Authorized Control Level Event shall be deemed sufficient grounds for the commissioner to take action pursuant to chapter 9 of this title, and the commissioner shall have the rights, powers and duties with respect to the insurer as are set forth in chapter 9 of this title. In the event the commissioner takes actions under this subsection (b) pursuant to an Adjusted RBC Report, the insurer shall be entitled to the protections that are afforded to insurers under chapter 9, part 2 of this title.
Acts 1996, ch. 750, § 7.
Tenn. Code Ann. § 56-1-1002 — TN Code / Title 56 / Chapter 1 / Section 56-1-1002
Electronic opt-out provisions
Status: in_force

(a) The plan sponsor of a health benefit plan may, on behalf of covered persons in the plan, provide consent to the delivery of all communications related to the plan by electronic means, including the electronic delivery of a health insurance identification card. (b) Before consenting on behalf of insureds a plan sponsor shall confirm that the party routinely uses electronic communications during the normal course of employment. (c) Before providing delivery by electronic means, the insurer for the health benefit plan shall: (1) Provide the insured with an opportunity to opt out of delivery by electronic means; and (2) Implement and adhere to a policy that contains the following criteria: (A) If the insurer becomes aware that the insured's email address at which the insured has consented to receive notices or documents is no longer valid, the insurer shall send physical notices or documents to the insured at the insured's mailing address on file with the insurer; (B) The insurer will retain records for five (5) years, including proof of the date of each electronic mailing and the email address to which each mailing was sent. The records must be retrievable for a period of five (5) years after the date of the mailing; (C) The insured may withdraw his or her consent to receive mailings electronically at any time; (D) All conditions have been satisfied to facilitate the electronic mailing of notices and documents, unless existing law requires notices and documents to be delivered by a particular method; (E) All conditions to facilitate the electronic mailing of notices and documents have been satisfied under the federal Electronic Signatures in Global and National Commerce Act ( 15 U.S.C. § 7001 , et seq.); and (F) The insurer will not cancel, refuse to issue, or refuse to renew a policy because the applicant or insured refuses to agree to receive electronic mailings of notices and documents pursuant to this section. (d) This section does not apply to TennCare or any successor program provided for in title 71, chapter 5, or to the CoverKids Act of 2006 or any successor program provided for in title 71, chapter 3, part 11. Added by 2023 Tenn. Acts, ch. 104, s 1, eff. 7/1/2023.
(a) The plan sponsor of a health benefit plan may, on behalf of covered persons in the plan, provide consent to the delivery of all communications related to the plan by electronic means, including the electronic delivery of a health insurance identification card.
(b) Before consenting on behalf of insureds a plan sponsor shall confirm that the party routinely uses electronic communications during the normal course of employment.
(c) Before providing delivery by electronic means, the insurer for the health benefit plan shall: (1) Provide the insured with an opportunity to opt out of delivery by electronic means; and (2) Implement and adhere to a policy that contains the following criteria: (A) If the insurer becomes aware that the insured's email address at which the insured has consented to receive notices or documents is no longer valid, the insurer shall send physical notices or documents to the insured at the insured's mailing address on file with the insurer; (B) The insurer will retain records for five (5) years, including proof of the date of each electronic mailing and the email address to which each mailing was sent. The records must be retrievable for a period of five (5) years after the date of the mailing; (C) The insured may withdraw his or her consent to receive mailings electronically at any time; (D) All conditions have been satisfied to facilitate the electronic mailing of notices and documents, unless existing law requires notices and documents to be delivered by a particular method; (E) All conditions to facilitate the electronic mailing of notices and documents have been satisfied under the federal Electronic Signatures in Global and National Commerce Act ( 15 U.S.C. § 7001 , et seq.); and (F) The insurer will not cancel, refuse to issue, or refuse to renew a policy because the applicant or insured refuses to agree to receive electronic mailings of notices and documents pursuant to this section.
(1) Provide the insured with an opportunity to opt out of delivery by electronic means; and
(2) Implement and adhere to a policy that contains the following criteria: (A) If the insurer becomes aware that the insured's email address at which the insured has consented to receive notices or documents is no longer valid, the insurer shall send physical notices or documents to the insured at the insured's mailing address on file with the insurer; (B) The insurer will retain records for five (5) years, including proof of the date of each electronic mailing and the email address to which each mailing was sent. The records must be retrievable for a period of five (5) years after the date of the mailing; (C) The insured may withdraw his or her consent to receive mailings electronically at any time; (D) All conditions have been satisfied to facilitate the electronic mailing of notices and documents, unless existing law requires notices and documents to be delivered by a particular method; (E) All conditions to facilitate the electronic mailing of notices and documents have been satisfied under the federal Electronic Signatures in Global and National Commerce Act ( 15 U.S.C. § 7001 , et seq.); and (F) The insurer will not cancel, refuse to issue, or refuse to renew a policy because the applicant or insured refuses to agree to receive electronic mailings of notices and documents pursuant to this section.
(A) If the insurer becomes aware that the insured's email address at which the insured has consented to receive notices or documents is no longer valid, the insurer shall send physical notices or documents to the insured at the insured's mailing address on file with the insurer;
(B) The insurer will retain records for five (5) years, including proof of the date of each electronic mailing and the email address to which each mailing was sent. The records must be retrievable for a period of five (5) years after the date of the mailing;
(C) The insured may withdraw his or her consent to receive mailings electronically at any time;
(D) All conditions have been satisfied to facilitate the electronic mailing of notices and documents, unless existing law requires notices and documents to be delivered by a particular method;
(E) All conditions to facilitate the electronic mailing of notices and documents have been satisfied under the federal Electronic Signatures in Global and National Commerce Act ( 15 U.S.C. § 7001 , et seq.); and
(F) The insurer will not cancel, refuse to issue, or refuse to renew a policy because the applicant or insured refuses to agree to receive electronic mailings of notices and documents pursuant to this section.
(d) This section does not apply to TennCare or any successor program provided for in title 71, chapter 5, or to the CoverKids Act of 2006 or any successor program provided for in title 71, chapter 3, part 11.
Added by 2023 Tenn. Acts, ch. 104, s 1, eff. 7/1/2023.
Tenn. Code Ann. § 56-9-102 — TN Code / Title 56 / Chapter 9 / Section 56-9-102
Applicability
Status: in_force

The proceedings authorized by this chapter may be applied to: (1) All insurers who are doing, or have done, an insurance business in this state, and against whom claims arising from that business may exist now or in the future; (2) All insurers who purport to do an insurance business in this state; (3) All insurers who have insureds resident in this state; (4) All other persons organized or in the process of organizing with the intent to do an insurance business in this state; (5) All nonprofit service plans and all fraternal benefit societies and beneficial societies subject to § 56-25-606 ; (6) All title insurance companies subject to chapter 35 of this title; (7) All prepaid health care delivery plans; and (8) All fidelity, bonding or surety companies under chapter 15 of this title, and all annuity companies who do business in this state. Acts 1991, ch. 142, § 4.
The proceedings authorized by this chapter may be applied to:
(1) All insurers who are doing, or have done, an insurance business in this state, and against whom claims arising from that business may exist now or in the future;
(2) All insurers who purport to do an insurance business in this state;
(3) All insurers who have insureds resident in this state;
(4) All other persons organized or in the process of organizing with the intent to do an insurance business in this state;
(5) All nonprofit service plans and all fraternal benefit societies and beneficial societies subject to § 56-25-606 ;
(6) All title insurance companies subject to chapter 35 of this title;
(7) All prepaid health care delivery plans; and
(8) All fidelity, bonding or surety companies under chapter 15 of this title, and all annuity companies who do business in this state.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-22-108 — TN Code / Title 56 / Chapter 22 / Section 56-22-108
Surplus or emergency fund - Investment of assets - Borrowing to cover losses
Status: in_force

(a) In the event that the commissioner determines the existing surplus to be inadequate, a county mutual insurance company shall seek to accumulate a surplus or emergency fund in an amount that might be deemed necessary by the commissioner. (b) A county mutual insurance company may invest its assets in the same manner as an insurance company licensed to write property and casualty lines of insurance as provided for by chapter 3, part 4 of this title. (c) A county mutual insurance company may borrow money for the purpose of paying extraordinary losses. A county mutual insurance company shall conduct its affairs in such a manner as to pay those losses as might normally be expected in the course of doing business and to accumulate a surplus that might be used to pay losses above normal losses. A county mutual insurance company may borrow money only when it incurs substantial, extraordinary losses, and must notify the commissioner of its intent to borrow money to pay losses at least ten (10) business days before borrowing the money. Acts 2006, ch. 689, §§ 3, 11.
(a) In the event that the commissioner determines the existing surplus to be inadequate, a county mutual insurance company shall seek to accumulate a surplus or emergency fund in an amount that might be deemed necessary by the commissioner.
(b) A county mutual insurance company may invest its assets in the same manner as an insurance company licensed to write property and casualty lines of insurance as provided for by chapter 3, part 4 of this title.
(c) A county mutual insurance company may borrow money for the purpose of paying extraordinary losses. A county mutual insurance company shall conduct its affairs in such a manner as to pay those losses as might normally be expected in the course of doing business and to accumulate a surplus that might be used to pay losses above normal losses. A county mutual insurance company may borrow money only when it incurs substantial, extraordinary losses, and must notify the commissioner of its intent to borrow money to pay losses at least ten (10) business days before borrowing the money.
Acts 2006, ch. 689, §§ 3, 11.
Tenn. Code Ann. § 56-9-302 — TN Code / Title 56 / Chapter 9 / Section 56-9-302
Order to rehabilitate business of insurer - Effect
Status: in_force

(a) (1) An order to rehabilitate the business of a domestic insurer, or an alien insurer domiciled in this state, shall appoint the commissioner and the commissioner's successors in office the rehabilitator, and shall direct the rehabilitator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court. (2) The filing or recording of the order with the clerk of the chancery court of Davidson County or recorder of deeds of the county in which the principal business of the company is conducted, or the county in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted. (3) The order to rehabilitate the insurer shall by operation of law vest title to all assets of the insurer in the rehabilitator. (b) Any order issued under this section shall require accountings to the court by the rehabilitator. Accountings shall be at intervals that the court specifies in its order, but no less frequently than semi-annually. Each accounting shall include a report concerning the rehabilitator's opinion as to the likelihood that a plan under § 56-9-303(e) shall be prepared by the rehabilitator and the timetable for doing so. (c) Entry of an order of rehabilitation shall not constitute an anticipatory breach of any contracts of the insurer nor shall it be grounds for retroactive revocation or retroactive cancellation of any contracts of the insurer, unless the revocation or cancellation is done by the rehabilitator pursuant to § 56-9-303 . Acts 1991, ch. 142, § 4.
(a) (1) An order to rehabilitate the business of a domestic insurer, or an alien insurer domiciled in this state, shall appoint the commissioner and the commissioner's successors in office the rehabilitator, and shall direct the rehabilitator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court. (2) The filing or recording of the order with the clerk of the chancery court of Davidson County or recorder of deeds of the county in which the principal business of the company is conducted, or the county in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted. (3) The order to rehabilitate the insurer shall by operation of law vest title to all assets of the insurer in the rehabilitator.
(1) An order to rehabilitate the business of a domestic insurer, or an alien insurer domiciled in this state, shall appoint the commissioner and the commissioner's successors in office the rehabilitator, and shall direct the rehabilitator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court.
(2) The filing or recording of the order with the clerk of the chancery court of Davidson County or recorder of deeds of the county in which the principal business of the company is conducted, or the county in which its principal office or place of business is located, shall impart the same notice as a deed, bill of sale, or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.
(3) The order to rehabilitate the insurer shall by operation of law vest title to all assets of the insurer in the rehabilitator.
(b) Any order issued under this section shall require accountings to the court by the rehabilitator. Accountings shall be at intervals that the court specifies in its order, but no less frequently than semi-annually. Each accounting shall include a report concerning the rehabilitator's opinion as to the likelihood that a plan under § 56-9-303(e) shall be prepared by the rehabilitator and the timetable for doing so.
(c) Entry of an order of rehabilitation shall not constitute an anticipatory breach of any contracts of the insurer nor shall it be grounds for retroactive revocation or retroactive cancellation of any contracts of the insurer, unless the revocation or cancellation is done by the rehabilitator pursuant to § 56-9-303 .
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-16-109 — TN Code / Title 56 / Chapter 16 / Section 56-16-109
Attorney for foreign reciprocal - Residence and principal office
Status: in_force

Nothing in this title regarding the admission and licensing of foreign and alien insurers requires that the attorney of a foreign or alien reciprocal be a resident or domiciled in this state, or that the principal office of the attorney be maintained in this state. The office or offices of the attorney shall be determined by the subscribers through the power of attorney. Acts 1990, ch. 728, § 2; T.C.A. § 56-16-209 .
Nothing in this title regarding the admission and licensing of foreign and alien insurers requires that the attorney of a foreign or alien reciprocal be a resident or domiciled in this state, or that the principal office of the attorney be maintained in this state. The office or offices of the attorney shall be determined by the subscribers through the power of attorney.
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-209 .
Tenn. Code Ann. § 56-21-102 — TN Code / Title 56 / Chapter 21 / Section 56-21-102
Deposit of securities
Status: in_force

Notwithstanding the provisions contained in § 56-2-104 to the contrary, guaranty capital securities, in amounts equal to the requirements of § 56-2-104(a)(4) , must be deposited with the commissioner of commerce and insurance for the protection of the policyholders and creditors of the company in this state. Companies not having guaranty capital securities must deposit securities equal to ten percent (10%) of net written premiums, annually, not to exceed the requirements of § 56-2-104(a)(4) . Acts 1907, ch. 461, § 2; Shan., § 3369a6; Acts 1921, ch. 160, § 2; Code 1932, § 6257; Acts 1945, ch. 105, § 2; C. Supp. 1950, § 6257; Acts 1967, ch. 236, § 1; 1968, ch. 549, § 1; 1975, ch. 62, § 1; 1977, ch. 202, § 1; T.C.A. (orig. ed.), § 56-2004.
Notwithstanding the provisions contained in § 56-2-104 to the contrary, guaranty capital securities, in amounts equal to the requirements of § 56-2-104(a)(4) , must be deposited with the commissioner of commerce and insurance for the protection of the policyholders and creditors of the company in this state. Companies not having guaranty capital securities must deposit securities equal to ten percent (10%) of net written premiums, annually, not to exceed the requirements of § 56-2-104(a)(4) .
Acts 1907, ch. 461, § 2; Shan., § 3369a6; Acts 1921, ch. 160, § 2; Code 1932, § 6257; Acts 1945, ch. 105, § 2; C. Supp. 1950, § 6257; Acts 1967, ch. 236, § 1; 1968, ch. 549, § 1; 1975, ch. 62, § 1; 1977, ch. 202, § 1; T.C.A. (orig. ed.), § 56-2004.
Tenn. Code Ann. § 56-6-509 — TN Code / Title 56 / Chapter 6 / Section 56-6-509
Commissioner - Waiver of applicability of chapter
Status: in_force

The commissioner may waive the application of this chapter to a particular person or arrangement if the application of this chapter is not necessary to carry out the purposes of this chapter. Acts 1991, ch. 142, § 7.
The commissioner may waive the application of this chapter to a particular person or arrangement if the application of this chapter is not necessary to carry out the purposes of this chapter.
Acts 1991, ch. 142, § 7.
Tenn. Code Ann. § 56-9-313 — TN Code / Title 56 / Chapter 9 / Section 56-9-313
Effect of issuance of order appointing liquidator - Statute of limitation and laches - Standing
Status: in_force

(a) (1) Upon issuance of an order appointing a liquidator of a domestic insurer or of an alien insurer domiciled in this state, no action at law or equity or in arbitration shall be brought against the insurer or liquidator, whether in this state or elsewhere, nor shall any such existing actions be maintained or further presented after issuance of the order. (2) The courts of this state shall give full faith and credit to injunctions against the liquidator or the company or the continuation of existing actions against the liquidator or the company, when the injunctions are included in an order to liquidate an insurer issued pursuant to corresponding provisions in other states. (3) Whenever, in the liquidator's judgment, protection of the estate of the insurer necessitates intervention in an action against the insurer that is pending outside this state, the liquidator may intervene in the action. The liquidator may defend any action in which the liquidator intervenes under this section at the expense of the estate of the insurer. (b) (1) The liquidator may, upon or after an order for liquidation, within two (2) years or such other longer time as applicable law may permit, institute an action or proceeding on behalf of the estate of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered. (2) Where, by any agreement, a period of limitation is fixed for instituting a suit or proceeding upon any claim, or for filing any claim, proof of claim, proof of loss, demand, notice, or the like, or where in any proceeding, judicial or otherwise, a period of limitation is fixed, either in the proceeding or by applicable law, for taking any action, filing any claim or pleading, or doing any act, and where in any such case the period had not expired at the date of the filing of the petition, the liquidator may, for the benefit of the estate, take any such action or do any such act, required of or permitted to the insurer, within a period of one hundred eighty (180) days subsequent to the entry of an order for liquidation, or within a further period as is shown to the satisfaction of the court not to be unfairly prejudicial to the other party. (c) No statute of limitation or defense of laches shall run with respect to any action against an insurer between the filing of a petition for liquidation against an insurer and the denial of the petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the petition is denied. (d) Any guaranty association or foreign guaranty association has standing to appear in any court proceeding concerning the liquidation of an insurer if the association is or may become liable to act as a result of the liquidation. Acts 1991, ch. 142, § 4.
(a) (1) Upon issuance of an order appointing a liquidator of a domestic insurer or of an alien insurer domiciled in this state, no action at law or equity or in arbitration shall be brought against the insurer or liquidator, whether in this state or elsewhere, nor shall any such existing actions be maintained or further presented after issuance of the order. (2) The courts of this state shall give full faith and credit to injunctions against the liquidator or the company or the continuation of existing actions against the liquidator or the company, when the injunctions are included in an order to liquidate an insurer issued pursuant to corresponding provisions in other states. (3) Whenever, in the liquidator's judgment, protection of the estate of the insurer necessitates intervention in an action against the insurer that is pending outside this state, the liquidator may intervene in the action. The liquidator may defend any action in which the liquidator intervenes under this section at the expense of the estate of the insurer.
(1) Upon issuance of an order appointing a liquidator of a domestic insurer or of an alien insurer domiciled in this state, no action at law or equity or in arbitration shall be brought against the insurer or liquidator, whether in this state or elsewhere, nor shall any such existing actions be maintained or further presented after issuance of the order.
(2) The courts of this state shall give full faith and credit to injunctions against the liquidator or the company or the continuation of existing actions against the liquidator or the company, when the injunctions are included in an order to liquidate an insurer issued pursuant to corresponding provisions in other states.
(3) Whenever, in the liquidator's judgment, protection of the estate of the insurer necessitates intervention in an action against the insurer that is pending outside this state, the liquidator may intervene in the action. The liquidator may defend any action in which the liquidator intervenes under this section at the expense of the estate of the insurer.
(b) (1) The liquidator may, upon or after an order for liquidation, within two (2) years or such other longer time as applicable law may permit, institute an action or proceeding on behalf of the estate of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered. (2) Where, by any agreement, a period of limitation is fixed for instituting a suit or proceeding upon any claim, or for filing any claim, proof of claim, proof of loss, demand, notice, or the like, or where in any proceeding, judicial or otherwise, a period of limitation is fixed, either in the proceeding or by applicable law, for taking any action, filing any claim or pleading, or doing any act, and where in any such case the period had not expired at the date of the filing of the petition, the liquidator may, for the benefit of the estate, take any such action or do any such act, required of or permitted to the insurer, within a period of one hundred eighty (180) days subsequent to the entry of an order for liquidation, or within a further period as is shown to the satisfaction of the court not to be unfairly prejudicial to the other party.
(1) The liquidator may, upon or after an order for liquidation, within two (2) years or such other longer time as applicable law may permit, institute an action or proceeding on behalf of the estate of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered.
(2) Where, by any agreement, a period of limitation is fixed for instituting a suit or proceeding upon any claim, or for filing any claim, proof of claim, proof of loss, demand, notice, or the like, or where in any proceeding, judicial or otherwise, a period of limitation is fixed, either in the proceeding or by applicable law, for taking any action, filing any claim or pleading, or doing any act, and where in any such case the period had not expired at the date of the filing of the petition, the liquidator may, for the benefit of the estate, take any such action or do any such act, required of or permitted to the insurer, within a period of one hundred eighty (180) days subsequent to the entry of an order for liquidation, or within a further period as is shown to the satisfaction of the court not to be unfairly prejudicial to the other party.
(c) No statute of limitation or defense of laches shall run with respect to any action against an insurer between the filing of a petition for liquidation against an insurer and the denial of the petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the petition is denied.
(d) Any guaranty association or foreign guaranty association has standing to appear in any court proceeding concerning the liquidation of an insurer if the association is or may become liable to act as a result of the liquidation.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-30-134 — TN Code / Title 56 / Chapter 30 / Section 56-30-134
Electronic payments for electronic claims by dental service plan
Status: in_force

Notwithstanding any other law or rule to the contrary, a dental service plan that receives claims from dentists electronically may, at the option of the dental service plan, make payments for such claims electronically. Acts 2011, ch. 114, § 1.
Notwithstanding any other law or rule to the contrary, a dental service plan that receives claims from dentists electronically may, at the option of the dental service plan, make payments for such claims electronically.
Acts 2011, ch. 114, § 1.
Tenn. Code Ann. § 56-32-131 — TN Code / Title 56 / Chapter 32 / Section 56-32-131
Verification of health benefit delivery - Annual review - Survey of persons disenrolled by the TennCare program
Status: in_force

(a) It is the intent of this section to establish a procedure to verify that the HMOs and behavioral health organizations participating by contract in the TennCare program are delivering the health benefits required under their TennCare contracts with the state. This procedure shall also assure that each of these entities have adequate provider networks to ensure the effective and efficient delivery of health care services to TennCare enrollees. (b) The commissioner, with the advice and consent of the office of the comptroller of the treasury, shall contract with an entity independent of the state of Tennessee to conduct annual reviews of organizations contracting with the state in the TennCare program. The contract shall be entered into in accordance with appropriate state procedures. The purpose of this contract shall be to verify, on an annual basis, that each HMO and behavioral health organization contracting with the state of Tennessee in the TennCare program is delivering health care services in conformity with the TennCare contract and applicable statutory authority. This annual review shall include verifying that each of these organizations maintains an adequate network. The standards for network adequacy are defined by the TennCare contract and applicable statutes and regulations. Nothing in this subsection (b) precludes the expansion of the state's current contract with its External Quality Review Organization (EQRO) to include having the EQRO conduct this review. The contractor shall submit all findings for each organization in writing to the commissioner, the comptroller of the treasury and the director of the TennCare bureau. (c) The department of commerce and insurance is authorized to conduct a survey of persons disenrolled by the TennCare program to determine if the persons were able to procure health insurance in the private market, or otherwise had access to healthcare benefits. The survey will not commence until a survey form is developed with the assistance of the TennCare bureau of the department of finance and administration, adopted by the commissioner of commerce and insurance, and approved by the state comptroller of the treasury. The survey will be conducted of persons who were disenrolled during the period from January 1, 2002, to December 31, 2002. Acts 1999, ch. 322, § 1; 2002, ch. 874, § 1; T.C.A. § 56-32-231.
(a) It is the intent of this section to establish a procedure to verify that the HMOs and behavioral health organizations participating by contract in the TennCare program are delivering the health benefits required under their TennCare contracts with the state. This procedure shall also assure that each of these entities have adequate provider networks to ensure the effective and efficient delivery of health care services to TennCare enrollees.
(b) The commissioner, with the advice and consent of the office of the comptroller of the treasury, shall contract with an entity independent of the state of Tennessee to conduct annual reviews of organizations contracting with the state in the TennCare program. The contract shall be entered into in accordance with appropriate state procedures. The purpose of this contract shall be to verify, on an annual basis, that each HMO and behavioral health organization contracting with the state of Tennessee in the TennCare program is delivering health care services in conformity with the TennCare contract and applicable statutory authority. This annual review shall include verifying that each of these organizations maintains an adequate network. The standards for network adequacy are defined by the TennCare contract and applicable statutes and regulations. Nothing in this subsection (b) precludes the expansion of the state's current contract with its External Quality Review Organization (EQRO) to include having the EQRO conduct this review. The contractor shall submit all findings for each organization in writing to the commissioner, the comptroller of the treasury and the director of the TennCare bureau.
(c) The department of commerce and insurance is authorized to conduct a survey of persons disenrolled by the TennCare program to determine if the persons were able to procure health insurance in the private market, or otherwise had access to healthcare benefits. The survey will not commence until a survey form is developed with the assistance of the TennCare bureau of the department of finance and administration, adopted by the commissioner of commerce and insurance, and approved by the state comptroller of the treasury. The survey will be conducted of persons who were disenrolled during the period from January 1, 2002, to December 31, 2002.
Acts 1999, ch. 322, § 1; 2002, ch. 874, § 1; T.C.A. § 56-32-231.
Tenn. Code Ann. § 56-45-110 — TN Code / Title 56 / Chapter 45 / Section 56-45-110
Premium taxes - Rate - Entity responsible for payment
Status: in_force

Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing groups shall be: (1) Imposed at the same rate and subject to the same interest, fines and penalties as applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds; and (2) Paid first by the insurance source, and, if not by the source, by the agent or broker for the purchasing group, and, if not by the agent or broker, then by the purchasing group, and, if not by the purchasing group, then by each of its members. Acts 1991, ch. 142, § 6.
Premium taxes and taxes on premiums paid for coverage of risks resident or located in this state by a purchasing group or any members of the purchasing groups shall be:
(1) Imposed at the same rate and subject to the same interest, fines and penalties as applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insureds; and
(2) Paid first by the insurance source, and, if not by the source, by the agent or broker for the purchasing group, and, if not by the agent or broker, then by the purchasing group, and, if not by the purchasing group, then by each of its members.
Acts 1991, ch. 142, § 6.
Tenn. Code Ann. § 56-53-101 — TN Code / Title 56 / Chapter 53 / Section 56-53-101
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Actual malice" means knowledge that information is false, or reckless disregard of whether it is false; (2) "Conceal" means to take affirmative action to prevent others from discovering information. Mere failure to disclose information does not constitute concealment. Action by the holder of a legal privilege, or one who has a reasonable belief that a privilege exists, to prevent discovery of privileged information, does not constitute concealment; (3) "Insurance policy" means the written instrument in which are set forth the terms of any certificate of insurance, binder of coverage or contract of insurance, including a certificate, binder or contract issued by a state-assigned risk plan, benefit plan, nonprofit hospital service plan, health maintenance organization, motor club service plan, or surety bond, cash bond or any other alternative to insurance authorized by a state's financial responsibility act. "Insurance policy" also means any other instruments authorized or regulated by the department of commerce and insurance; (4) "Insurance professional" means sales agents, managing general agents, brokers, producers, adjusters and third-party administrators; (5) "Insurance transaction" means a transaction by, between or among: (A) An insurer or a person who acts on behalf of an insurer; and (B) An insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner, or any person who acts on behalf of an insured, claimant, applicant for insurance, public adjuster, insurance professional, or practitioner; for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim, or otherwise obtaining insurance, self-insurance, or reinsurance or obtaining the benefits of insurance, self-insurance, or reinsurance or from insurance, self-insurance, or reinsurance; (6) "Insurer" means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event. "Insurer" includes, but is not limited to, an insurance company, self-insurer, reinsurer, reciprocal exchange, interinsurer, risk retention group, Lloyd's insurer, fraternal benefit society, surety, medical service, health maintenance organization, dental, optometric or any other similar health service plan, and any other legal entity engaged or purportedly engaged in the business of insurance, including any person or entity that falls within the definition of "insurer" found within this title; (7) "Pattern or practice" means repeated, routine or generalized in nature, and not merely isolated or sporadic; (8) "Person" means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government and any other entity; (9) "Practitioner" means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of the state or person required to be licensed in the state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds, including, but not limited to, automotive repair shops, building contractors and insurance adjusters, or a licensee similarly licensed in other states and nations or the licensed practitioner of any nonmedical treatment rendered in accordance with a recognized religious method of healing; (10) "Premium" means consideration paid or payable for coverage under an insurance policy. "Premium" includes any payments, whether due within the insurance policy term or otherwise, and deductible payments, whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, any self-insured retention or payments, whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, and any collateral or security to be provided to collateralize obligations to pay any of the above; (11) "Premium finance company" means a person engaged or purporting to engage in the business of advancing money, directly or indirectly, to an insurer or producer at the request of an insured pursuant to the terms of a premium finance agreement, including but not limited to loan contracts, notes, agreements or obligations, wherein the insured has assigned the unearned premiums, accrued dividends, or loss payments as security for the advancement in payment of premiums on insurance policies only, and does not include the financing of insurance premiums purchased in connection with the financing of goods and services; (12) "Premium finance transaction" means a transaction by, between or among an insured, a producer or other party claiming to act on behalf of an insured and a third-party premium finance company, for the purposes of purportedly or actually advancing money directly or indirectly to an insurer or producer at the request of an insured pursuant to the terms of a premium finance agreement, wherein the insured has assigned the unearned premiums, accrued dividends or loan payments as security for the advancement in payment of premiums on insurance policies only, and does not include the financing of insurance premiums purchased in connection with the financing of goods and services; (13) "Reckless" means without reasonable belief of the truth, or, for the purposes of § 56-53-103(a)(3) , with a high degree of awareness of probable insolvency; and (14) "Withhold" means to fail to disclose facts or information that any law, other than this chapter, requires to be disclosed. Mere failure to disclose information does not constitute "withholding" if the one failing to disclose reasonably believes that there is no duty to disclose. Acts 2001, ch. 356, § 2.
As used in this chapter, unless the context otherwise requires:
(1) "Actual malice" means knowledge that information is false, or reckless disregard of whether it is false;
(2) "Conceal" means to take affirmative action to prevent others from discovering information. Mere failure to disclose information does not constitute concealment. Action by the holder of a legal privilege, or one who has a reasonable belief that a privilege exists, to prevent discovery of privileged information, does not constitute concealment;
(3) "Insurance policy" means the written instrument in which are set forth the terms of any certificate of insurance, binder of coverage or contract of insurance, including a certificate, binder or contract issued by a state-assigned risk plan, benefit plan, nonprofit hospital service plan, health maintenance organization, motor club service plan, or surety bond, cash bond or any other alternative to insurance authorized by a state's financial responsibility act. "Insurance policy" also means any other instruments authorized or regulated by the department of commerce and insurance;
(4) "Insurance professional" means sales agents, managing general agents, brokers, producers, adjusters and third-party administrators;
(5) "Insurance transaction" means a transaction by, between or among: (A) An insurer or a person who acts on behalf of an insurer; and (B) An insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner, or any person who acts on behalf of an insured, claimant, applicant for insurance, public adjuster, insurance professional, or practitioner; for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim, or otherwise obtaining insurance, self-insurance, or reinsurance or obtaining the benefits of insurance, self-insurance, or reinsurance or from insurance, self-insurance, or reinsurance;
(A) An insurer or a person who acts on behalf of an insurer; and
(B) An insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner, or any person who acts on behalf of an insured, claimant, applicant for insurance, public adjuster, insurance professional, or practitioner; for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim, or otherwise obtaining insurance, self-insurance, or reinsurance or obtaining the benefits of insurance, self-insurance, or reinsurance or from insurance, self-insurance, or reinsurance;
for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim, or otherwise obtaining insurance, self-insurance, or reinsurance or obtaining the benefits of insurance, self-insurance, or reinsurance or from insurance, self-insurance, or reinsurance;
(6) "Insurer" means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event. "Insurer" includes, but is not limited to, an insurance company, self-insurer, reinsurer, reciprocal exchange, interinsurer, risk retention group, Lloyd's insurer, fraternal benefit society, surety, medical service, health maintenance organization, dental, optometric or any other similar health service plan, and any other legal entity engaged or purportedly engaged in the business of insurance, including any person or entity that falls within the definition of "insurer" found within this title;
(7) "Pattern or practice" means repeated, routine or generalized in nature, and not merely isolated or sporadic;
(8) "Person" means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government and any other entity;
(9) "Practitioner" means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of the state or person required to be licensed in the state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds, including, but not limited to, automotive repair shops, building contractors and insurance adjusters, or a licensee similarly licensed in other states and nations or the licensed practitioner of any nonmedical treatment rendered in accordance with a recognized religious method of healing;
(10) "Premium" means consideration paid or payable for coverage under an insurance policy. "Premium" includes any payments, whether due within the insurance policy term or otherwise, and deductible payments, whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, any self-insured retention or payments, whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, and any collateral or security to be provided to collateralize obligations to pay any of the above;
(11) "Premium finance company" means a person engaged or purporting to engage in the business of advancing money, directly or indirectly, to an insurer or producer at the request of an insured pursuant to the terms of a premium finance agreement, including but not limited to loan contracts, notes, agreements or obligations, wherein the insured has assigned the unearned premiums, accrued dividends, or loss payments as security for the advancement in payment of premiums on insurance policies only, and does not include the financing of insurance premiums purchased in connection with the financing of goods and services;
(12) "Premium finance transaction" means a transaction by, between or among an insured, a producer or other party claiming to act on behalf of an insured and a third-party premium finance company, for the purposes of purportedly or actually advancing money directly or indirectly to an insurer or producer at the request of an insured pursuant to the terms of a premium finance agreement, wherein the insured has assigned the unearned premiums, accrued dividends or loan payments as security for the advancement in payment of premiums on insurance policies only, and does not include the financing of insurance premiums purchased in connection with the financing of goods and services;
(13) "Reckless" means without reasonable belief of the truth, or, for the purposes of § 56-53-103(a)(3) , with a high degree of awareness of probable insolvency; and
(14) "Withhold" means to fail to disclose facts or information that any law, other than this chapter, requires to be disclosed. Mere failure to disclose information does not constitute "withholding" if the one failing to disclose reasonably believes that there is no duty to disclose.
Acts 2001, ch. 356, § 2.
Tenn. Code Ann. § 56-50-111 — TN Code / Title 56 / Chapter 50 / Section 56-50-111
Prohibited practices
Status: in_force

(a) It is a violation of this chapter for any person to enter into a viatical settlement contract at any time prior to the application or issuance of a policy that is the subject of viatical settlement contract or within a period of time established by rule, unless the viator certifies to the viatical settlement provider that one (1) or more of the following conditions have been met within the prescribed period: (1) The policy was issued upon the viator's exercise of conversion rights arising out of a group or individual policy; provided, that the total of the time covered under the conversion policy plus the time covered under the prior policy is at least the prescribed period. The time covered under a group policy shall be calculated without regard to any change in insurance carriers; provided, that the coverage has been continuous and under the same group sponsorship; (2) The viator submits independent evidence to the viatical settlement provider that one (1) or more of the following conditions have been met within the prescribed period: (A) The viator or insured is terminally or chronically ill; (B) The viator's spouse dies; (C) The viator divorces the viator's spouse; (D) The viator retires from full-time employment; (E) The viator becomes physically or mentally disabled and a physician determines that the disability prevents the viator from maintaining full-time employment; or (F) A final order, judgment or decree is entered by a court of competent jurisdiction, on the application of a creditor of the viator, adjudicating the viator bankrupt or insolvent, or approving a petition seeking reorganization of the viator or appointing a receiver, trustee or liquidator to all or a substantial part of the viator's assets; or (3) Such other exemptions as may be prescribed by rule. (b) Copies of the independent evidence described in subdivision (a)(2) and documents required by § 56-50-110(a) shall be submitted to the insurer when the viatical settlement provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the viatical settlement provider that the copies are true and correct copies of the documents received by the viatical settlement provider. (c) If the viatical settlement provider submits to the insurer a copy of the owner or insured's certification described in and the independent evidence required by subdivision (a)(2) when the provider submits a request to the insurer to effect the transfer of the policy or certificate to the viatical settlement provider, the copy shall be deemed to conclusively establish that the viatical settlement contract satisfies the requirements of this section and the insurer shall timely respond to the request. (d) No insurer may, as a condition of responding to a request for verification of coverage or effecting the transfer of a policy pursuant to a viatical settlement contract, require that the viator, insured, viatical settlement provider or viatical settlement broker sign any forms, disclosures, consent or waiver form that has not been expressly approved by the commissioner for use in connection with viatical settlement contracts in this state. (e) Upon receipt of a properly completed request for change of ownership or beneficiary of a policy, the insurer shall respond in writing within thirty (30) calendar days with written acknowledgement confirming that the change has been effected or specifying the reasons why the requested change cannot be processed. The insurer shall not unreasonably delay effecting change of ownership or beneficiary and shall not otherwise seek to interfere with any viatical settlement contract lawfully entered into in this state. Acts 2009, ch. 604, § 12.
(a) It is a violation of this chapter for any person to enter into a viatical settlement contract at any time prior to the application or issuance of a policy that is the subject of viatical settlement contract or within a period of time established by rule, unless the viator certifies to the viatical settlement provider that one (1) or more of the following conditions have been met within the prescribed period: (1) The policy was issued upon the viator's exercise of conversion rights arising out of a group or individual policy; provided, that the total of the time covered under the conversion policy plus the time covered under the prior policy is at least the prescribed period. The time covered under a group policy shall be calculated without regard to any change in insurance carriers; provided, that the coverage has been continuous and under the same group sponsorship; (2) The viator submits independent evidence to the viatical settlement provider that one (1) or more of the following conditions have been met within the prescribed period: (A) The viator or insured is terminally or chronically ill; (B) The viator's spouse dies; (C) The viator divorces the viator's spouse; (D) The viator retires from full-time employment; (E) The viator becomes physically or mentally disabled and a physician determines that the disability prevents the viator from maintaining full-time employment; or (F) A final order, judgment or decree is entered by a court of competent jurisdiction, on the application of a creditor of the viator, adjudicating the viator bankrupt or insolvent, or approving a petition seeking reorganization of the viator or appointing a receiver, trustee or liquidator to all or a substantial part of the viator's assets; or (3) Such other exemptions as may be prescribed by rule.
(1) The policy was issued upon the viator's exercise of conversion rights arising out of a group or individual policy; provided, that the total of the time covered under the conversion policy plus the time covered under the prior policy is at least the prescribed period. The time covered under a group policy shall be calculated without regard to any change in insurance carriers; provided, that the coverage has been continuous and under the same group sponsorship;
(2) The viator submits independent evidence to the viatical settlement provider that one (1) or more of the following conditions have been met within the prescribed period: (A) The viator or insured is terminally or chronically ill; (B) The viator's spouse dies; (C) The viator divorces the viator's spouse; (D) The viator retires from full-time employment; (E) The viator becomes physically or mentally disabled and a physician determines that the disability prevents the viator from maintaining full-time employment; or (F) A final order, judgment or decree is entered by a court of competent jurisdiction, on the application of a creditor of the viator, adjudicating the viator bankrupt or insolvent, or approving a petition seeking reorganization of the viator or appointing a receiver, trustee or liquidator to all or a substantial part of the viator's assets; or
(A) The viator or insured is terminally or chronically ill;
(B) The viator's spouse dies;
(C) The viator divorces the viator's spouse;
(D) The viator retires from full-time employment;
(E) The viator becomes physically or mentally disabled and a physician determines that the disability prevents the viator from maintaining full-time employment; or
(F) A final order, judgment or decree is entered by a court of competent jurisdiction, on the application of a creditor of the viator, adjudicating the viator bankrupt or insolvent, or approving a petition seeking reorganization of the viator or appointing a receiver, trustee or liquidator to all or a substantial part of the viator's assets; or
(3) Such other exemptions as may be prescribed by rule.
(b) Copies of the independent evidence described in subdivision (a)(2) and documents required by § 56-50-110(a) shall be submitted to the insurer when the viatical settlement provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the viatical settlement provider that the copies are true and correct copies of the documents received by the viatical settlement provider.
(c) If the viatical settlement provider submits to the insurer a copy of the owner or insured's certification described in and the independent evidence required by subdivision (a)(2) when the provider submits a request to the insurer to effect the transfer of the policy or certificate to the viatical settlement provider, the copy shall be deemed to conclusively establish that the viatical settlement contract satisfies the requirements of this section and the insurer shall timely respond to the request.
(d) No insurer may, as a condition of responding to a request for verification of coverage or effecting the transfer of a policy pursuant to a viatical settlement contract, require that the viator, insured, viatical settlement provider or viatical settlement broker sign any forms, disclosures, consent or waiver form that has not been expressly approved by the commissioner for use in connection with viatical settlement contracts in this state.
(e) Upon receipt of a properly completed request for change of ownership or beneficiary of a policy, the insurer shall respond in writing within thirty (30) calendar days with written acknowledgement confirming that the change has been effected or specifying the reasons why the requested change cannot be processed. The insurer shall not unreasonably delay effecting change of ownership or beneficiary and shall not otherwise seek to interfere with any viatical settlement contract lawfully entered into in this state.
Acts 2009, ch. 604, § 12.
Tenn. Code Ann. § 56-7-2504 — TN Code / Title 56 / Chapter 7 / Section 56-7-2504
Cancer treatment
Status: in_force

(a) In the event that coverage for the treatment of cancer by dose-intensive chemotherapy/autologous bone marrow transplants or stem cell transplants is provided for patients or enrollees included in the TennCare program, then each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, each corporation providing individual or group accident and sickness subscription contracts, and each health maintenance organization providing a health care plan for health care services shall offer and make available the coverage, in the manner provided in subsection (b), under the policy, contract or plan delivered, issued for delivery or renewed in this state on and after January 1, 1996. (b) The coverage may be offered at an additional cost but the health care service shall not be subject to any greater deductible than any other health care service under the policy, contract or plan. Any required copayment shall not exceed the standard copayment required by the insured's policy, contract or plan for health care services. (c) This section shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration. Acts 1995, ch. 539, § 1.
(a) In the event that coverage for the treatment of cancer by dose-intensive chemotherapy/autologous bone marrow transplants or stem cell transplants is provided for patients or enrollees included in the TennCare program, then each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, each corporation providing individual or group accident and sickness subscription contracts, and each health maintenance organization providing a health care plan for health care services shall offer and make available the coverage, in the manner provided in subsection (b), under the policy, contract or plan delivered, issued for delivery or renewed in this state on and after January 1, 1996.
(b) The coverage may be offered at an additional cost but the health care service shall not be subject to any greater deductible than any other health care service under the policy, contract or plan. Any required copayment shall not exceed the standard copayment required by the insured's policy, contract or plan for health care services.
(c) This section shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration.
Acts 1995, ch. 539, § 1.
Tenn. Code Ann. § 56-7-2328 — TN Code / Title 56 / Chapter 7 / Section 56-7-2328
Section definitions - Provision of twelve-month contraceptive refills - Utilization controls prohibited - Exclusions
Status: in_force

(a) As used in this section: (1) "Contraceptive" means any device, medication, biological product, or procedure that is intended for use in the prevention of pregnancy, whether specifically intended to prevent pregnancy or for other health needs, and that is legally marketed under the federal Food, Drug, and Cosmetic Act ( 21 U.S.C. § 301 et seq.); (2) "Health benefit plan" means a policy or contract for health insurance coverage provided under: (A) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor medicaid program; or (B) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program; (3) "Health insurance entity" means a managed care organization contracting with the state to provide insurance through: (A) The TennCare program administered under the Medical Assistance Act of 1968, or a successor medicaid program; or (B) The CoverKids program administered under the CoverKids Act of 2006, or a successor program; and (4) "Healthcare provider" and "provider" mean a person or entity that provides healthcare services; is registered, certified, or licensed in accordance with title 63; and is regulated under the department of health or the division of health-related boards. (b) A health benefit plan that amends, renews, or delivers a policy of coverage on or after July 1, 2024, and that provides coverage for prescription contraceptives, shall provide coverage for a twelve-month refill of contraceptives obtained at one (1) time by an insured person, unless the insured requests a smaller supply or the prescribing healthcare provider instructs that the insured must receive a smaller supply. A health benefit plan that provides coverage shall allow the insured to receive the contraceptives on-site at the provider's office, if available, and prescribing, dispensing, and administration practices must follow all clinical guidelines to ensure the health of the patient while maximizing access to effective contraceptives. (c) A health benefit plan that provides coverage for hormonal contraceptives, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of contraceptives that may be dispensed or furnished by a provider or pharmacy, or at a location licensed or otherwise authorized to dispense drugs or supplies, to an amount that is less than a twelve-month supply. (d) This section does not require a health benefit plan to cover contraceptives provided by a provider, pharmacy, or at a location authorized to dispense drugs or supplies, that does not participate in the health benefit plan's provider or pharmacy network, as applicable, except as may be otherwise authorized or required by federal or state law or by the plan's policies governing out-of-network coverage. Added by 2024 Tenn. Acts, ch. 732,s 1, eff. 1/1/2025.
(a) As used in this section: (1) "Contraceptive" means any device, medication, biological product, or procedure that is intended for use in the prevention of pregnancy, whether specifically intended to prevent pregnancy or for other health needs, and that is legally marketed under the federal Food, Drug, and Cosmetic Act ( 21 U.S.C. § 301 et seq.); (2) "Health benefit plan" means a policy or contract for health insurance coverage provided under: (A) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor medicaid program; or (B) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program; (3) "Health insurance entity" means a managed care organization contracting with the state to provide insurance through: (A) The TennCare program administered under the Medical Assistance Act of 1968, or a successor medicaid program; or (B) The CoverKids program administered under the CoverKids Act of 2006, or a successor program; and (4) "Healthcare provider" and "provider" mean a person or entity that provides healthcare services; is registered, certified, or licensed in accordance with title 63; and is regulated under the department of health or the division of health-related boards.
(1) "Contraceptive" means any device, medication, biological product, or procedure that is intended for use in the prevention of pregnancy, whether specifically intended to prevent pregnancy or for other health needs, and that is legally marketed under the federal Food, Drug, and Cosmetic Act ( 21 U.S.C. § 301 et seq.);
(2) "Health benefit plan" means a policy or contract for health insurance coverage provided under: (A) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor medicaid program; or (B) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program;
(A) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor medicaid program; or
(B) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program;
(3) "Health insurance entity" means a managed care organization contracting with the state to provide insurance through: (A) The TennCare program administered under the Medical Assistance Act of 1968, or a successor medicaid program; or (B) The CoverKids program administered under the CoverKids Act of 2006, or a successor program; and
(A) The TennCare program administered under the Medical Assistance Act of 1968, or a successor medicaid program; or
(B) The CoverKids program administered under the CoverKids Act of 2006, or a successor program; and
(4) "Healthcare provider" and "provider" mean a person or entity that provides healthcare services; is registered, certified, or licensed in accordance with title 63; and is regulated under the department of health or the division of health-related boards.
(b) A health benefit plan that amends, renews, or delivers a policy of coverage on or after July 1, 2024, and that provides coverage for prescription contraceptives, shall provide coverage for a twelve-month refill of contraceptives obtained at one (1) time by an insured person, unless the insured requests a smaller supply or the prescribing healthcare provider instructs that the insured must receive a smaller supply. A health benefit plan that provides coverage shall allow the insured to receive the contraceptives on-site at the provider's office, if available, and prescribing, dispensing, and administration practices must follow all clinical guidelines to ensure the health of the patient while maximizing access to effective contraceptives.
(c) A health benefit plan that provides coverage for hormonal contraceptives, in the absence of clinical contraindications, shall not impose utilization controls or other forms of medical management limiting the supply of contraceptives that may be dispensed or furnished by a provider or pharmacy, or at a location licensed or otherwise authorized to dispense drugs or supplies, to an amount that is less than a twelve-month supply.
(d) This section does not require a health benefit plan to cover contraceptives provided by a provider, pharmacy, or at a location authorized to dispense drugs or supplies, that does not participate in the health benefit plan's provider or pharmacy network, as applicable, except as may be otherwise authorized or required by federal or state law or by the plan's policies governing out-of-network coverage.
Added by 2024 Tenn. Acts, ch. 732,s 1, eff. 1/1/2025.
Tenn. Code Ann. § 56-7-2211 — TN Code / Title 56 / Chapter 7 / Section 56-7-2211
Contracting with a small employer insurer - Compliance with federal laws
Status: in_force

(a) A health group cooperative shall contract only with a small employer insurer that demonstrates: (1) That the insurer or health maintenance organization is licensed and in good standing with the department; (2) The capacity to administer the group health insurance plans; (3) The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures; (4) The ability to conduct utilization management and applicable procedures and policies; (5) The ability to assure enrollees a sufficient number of health care providers, including specialty providers; and (6) A satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints. (b) A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by federal law and this title or rules promulgated pursuant to this title. Acts 2008, ch. 1036, § 6.
(a) A health group cooperative shall contract only with a small employer insurer that demonstrates: (1) That the insurer or health maintenance organization is licensed and in good standing with the department; (2) The capacity to administer the group health insurance plans; (3) The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures; (4) The ability to conduct utilization management and applicable procedures and policies; (5) The ability to assure enrollees a sufficient number of health care providers, including specialty providers; and (6) A satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints.
(1) That the insurer or health maintenance organization is licensed and in good standing with the department;
(2) The capacity to administer the group health insurance plans;
(3) The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures;
(4) The ability to conduct utilization management and applicable procedures and policies;
(5) The ability to assure enrollees a sufficient number of health care providers, including specialty providers; and
(6) A satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints.
(b) A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by federal law and this title or rules promulgated pursuant to this title.
Acts 2008, ch. 1036, § 6.
Tenn. Code Ann. § 56-25-609 — TN Code / Title 56 / Chapter 25 / Section 56-25-609
Licensing of agents
Status: in_force

Agents of societies shall be licensed in accordance with chapter 6, part 1 of this title regulating the licensing, revocation, suspension or termination of license of resident and nonresident agents. Acts 1990, ch. 703, § 1.
Agents of societies shall be licensed in accordance with chapter 6, part 1 of this title regulating the licensing, revocation, suspension or termination of license of resident and nonresident agents.
Acts 1990, ch. 703, § 1.