Tenn. Code Ann. § 56-12-107 — TN Code / Title 56 / Chapter 12 / Section 56-12-107
Powers and duties of association
Status: in_force

(a) The association shall: (1) (A) Be obligated to the extent of the covered claims existing prior to the determination of insolvency and arising within thirty (30) days after the determination of insolvency, or before the policy expiration date if less than thirty (30) days after the determination, or before the insured replaces the policy or on request effects cancellation, if the insured does so within thirty (30) days of the determination, but the obligation shall include only that amount of each covered claim that is in excess of one hundred dollars ($100) and is less than one hundred thousand dollars ($100,000), except that the association shall pay the full amount of any covered claim arising out of a workers' compensation policy. In no event shall the association be obligated to a policyholder or claimant in an amount in excess of the obligation of the insolvent insurer under the policy from which the claim arises; (B) In the case of claims other than workers' compensation arising from bodily injury, sickness, or disease, including death resulting from bodily injury, sickness, or disease, the amount for which the association shall be obligated shall not exceed the claimant's reasonable expenses incurred for necessary medical, surgical, X-ray and dental services, including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services, and any amounts actually lost by reason of claimant's inability to work and earn wages or salary or their equivalent that would otherwise have been earned in the normal course of the injured claimant's employment, to which may be added at the discretion of the association an additional sum as compensation for permanent physical impairment if the payment can be made within the policy limits; (C) (i) Any obligation of the association to defend an insured shall cease upon the association's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the association's covered claim obligation limit or the applicable policy limit; (ii) Notwithstanding any other provisions of this part, except in the case of a claim for benefits under workers' compensation coverage, any obligation of the association to any and all persons shall cease when ten million dollars ($10,000,000) has been paid in the aggregate to or on behalf of any single insured and its affiliates by the association and any one (1) or more associations similar to the association of any other state or states or any property and casualty security fund that obtains contributions from insurers on a pre-insolvency basis, on covered claims or allowed claims arising under the policy or policies of any one (1) insolvent insurer. For the purposes of this section, "affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with another person. If the association determines that there may be more than one (1) claimant having a covered claim or allowed claim against the association or any associations similar to the association or any property and casualty insurance security fund in other states, under the policy or policies of any one (1) insolvent insurer, the association may establish a plan to allocate amounts payable by the association in the manner that the association in its discretion deems equitable; (2) Be deemed the insurer to the extent of its obligation on the covered claims and to this extent shall have all rights, duties, and obligations of the insolvent insurer as if the insurer had not become insolvent including, but not limited to, the right to pursue and retain salvage and subrogation recoverable on paid covered claim obligations. The association shall not be deemed the insolvent insurer for any purpose relating to the issue of whether the association is amenable to the personal jurisdiction of the courts of any other state; (3) Allocate claims paid and expenses incurred among the two (2) accounts separately, and assess member insurers separately for each account amounts necessary to pay the obligations of the association under subdivision (a)(1) subsequent to an insolvency, the expenses of handling covered claims subsequent to an insolvency, and expenses authorized by this part. The assessments of each member insurer shall be in the proportion that the net direct written premiums of the member insurer for the preceding calendar year on the kinds of insurance in the account bears to the net direct written premiums of all member insurers for the preceding calendar year on the kinds of insurance in the account. Each member insurer shall be notified of the assessment not later than thirty (30) days before it is due. No member insurer may be assessed in any year on any account an amount greater than two percent (2%) of that member insurer's net direct written premiums for the preceding calendar year on the kinds of insurance in the account. If the maximum assessment, together with the other assets of the association in any account, does not provide in any one (1) year in any account an amount sufficient to make all necessary payments from that account, the funds available shall be prorated and the unpaid portion shall be paid as soon thereafter as funds become available. The association may exempt or defer, in whole or in part, the assessment of any member insurer, if the assessment would cause the member insurer's financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. Each member insurer may set off against any assessment, authorized payments made on covered claims and expenses incurred in the payment of the claims by the member insurer if they are chargeable to the account for which the assessment is made; (4) Investigate claims brought against the association and adjust, compromise, settle, and pay covered claims to the extent of the association's obligation and deny all other claims and may review settlements, releases and judgments to which the insolvent insurer or its insureds were parties to determine the extent to which the settlements, releases and judgments may be properly contested; (5) Notify any persons as the commissioner directs under § 56-12-109(b)(1) ; (6) Handle claims through its employees or through one (1) or more insurers or other persons designated as servicing facilities. Designation of a servicing facility is subject to the approval of the commissioner, but such designation may be declined by a member insurer; and (7) Reimburse each servicing facility for obligations of the association paid by the facility and for expenses incurred by the facility while handling claims on behalf of the association, and shall pay the other expenses of the association authorized by this part. (b) The association may: (1) Appear in, defend, and appeal any action on a claim brought against the association; (2) Employ or retain such persons as are necessary to handle claims and perform other duties of the association; (3) Borrow funds necessary to effect the purposes of this part in accordance with the plan of operation. In the event of an insolvency resulting in covered claims payable by the association in excess of its capacity to pay from assessments under subdivision (a)(3), the association, in its sole discretion, may by resolution request the local development authority to issue bonds and/or notes pursuant to title 4, chapter 31, part 8, in such amounts as the association may determine necessary to provide funds for the payments of covered claims and expenses related thereto. However, the amount of the bond issuance may be limited by §§ 4-31-804 and 4-31-805 with the local development authority having the final authority to determine the total amount of the bond issuance including issuance costs. When the association and the local development authority agree that bonds or notes shall be issued to pay covered claims in the event of an insolvency, the association shall have the authority to annually assess member insurers for amounts necessary to secure and provide for the repayment of the indebtedness, including, without limitation, the principal, redemption premium, if any, and interest on, and related costs of issuance of such indebtedness including bond investors insurance. Necessary assessments collected pursuant to this authority shall be collected under the same procedures provided in subdivision (a)(3). Assessments collected under this section may be assigned and pledged to or on behalf of the local development authority for the benefit of the holders of such indebtedness, in order to provide for the payment of the principal of, redemption premium, if any, and interest on such indebtedness, the costs of issuance, and the funding of any reserves and any other payments under the documents under which the indebtedness was incurred. In addition to the assessments provided for in this section, the association in its sole discretion may utilize assessments made under subdivision (a)(3), to service such indebtedness, if necessary. The association shall have no obligation to pay covered claims solely from the proceeds of bonds or notes issued under § 4-31-804 ; provided, that if the association may cause assessments to be made hereunder for such covered claims, and assigns and pledges such assessments to or on behalf of the local development authority as issuer of such indebtedness for the benefit of the holders of bonds or notes, the association may administer such covered claims and present valid covered claims for payment; (4) Sue or be sued, and such power to sue includes the power and right to intervene as a party before any court that has jurisdiction over an insolvent insurer as defined by this part; (5) Negotiate and become a party to such contracts as are necessary to carry out the purpose of this part; (6) Perform such other acts as are necessary or proper to effectuate the purpose of this part; and (7) Refund to the member insurers in proportion to the contribution of each member insurer to that account that amount by which the assets of the account exceed the liabilities, if, at the end of any calendar year, the board of directors finds that the assets of the association in any account exceed the liabilities of that account as estimated by the board of directors for the coming year. (c) With respect to any suit involving the association: (1) Any action relating to or arising out of this part against the association shall be brought in a court in this state. Such court shall have exclusive jurisdiction over any action relating to or arising out of this part against the association; and (2) Exclusive venue in any action brought against the association is in the circuit or chancery court in Davidson County; provided, that the association may waive such venue as to a specific action. Acts 1971, ch. 180, § 7; 1975, ch. 62, §§ 5, 6; 1977, ch. 203, § 3; T.C.A., § 56-4007; Acts 1995, ch. 240, § 2; 1999, ch. 48, §§ 3 - 6, 11.
(a) The association shall: (1) (A) Be obligated to the extent of the covered claims existing prior to the determination of insolvency and arising within thirty (30) days after the determination of insolvency, or before the policy expiration date if less than thirty (30) days after the determination, or before the insured replaces the policy or on request effects cancellation, if the insured does so within thirty (30) days of the determination, but the obligation shall include only that amount of each covered claim that is in excess of one hundred dollars ($100) and is less than one hundred thousand dollars ($100,000), except that the association shall pay the full amount of any covered claim arising out of a workers' compensation policy. In no event shall the association be obligated to a policyholder or claimant in an amount in excess of the obligation of the insolvent insurer under the policy from which the claim arises; (B) In the case of claims other than workers' compensation arising from bodily injury, sickness, or disease, including death resulting from bodily injury, sickness, or disease, the amount for which the association shall be obligated shall not exceed the claimant's reasonable expenses incurred for necessary medical, surgical, X-ray and dental services, including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services, and any amounts actually lost by reason of claimant's inability to work and earn wages or salary or their equivalent that would otherwise have been earned in the normal course of the injured claimant's employment, to which may be added at the discretion of the association an additional sum as compensation for permanent physical impairment if the payment can be made within the policy limits; (C) (i) Any obligation of the association to defend an insured shall cease upon the association's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the association's covered claim obligation limit or the applicable policy limit; (ii) Notwithstanding any other provisions of this part, except in the case of a claim for benefits under workers' compensation coverage, any obligation of the association to any and all persons shall cease when ten million dollars ($10,000,000) has been paid in the aggregate to or on behalf of any single insured and its affiliates by the association and any one (1) or more associations similar to the association of any other state or states or any property and casualty security fund that obtains contributions from insurers on a pre-insolvency basis, on covered claims or allowed claims arising under the policy or policies of any one (1) insolvent insurer. For the purposes of this section, "affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with another person. If the association determines that there may be more than one (1) claimant having a covered claim or allowed claim against the association or any associations similar to the association or any property and casualty insurance security fund in other states, under the policy or policies of any one (1) insolvent insurer, the association may establish a plan to allocate amounts payable by the association in the manner that the association in its discretion deems equitable; (2) Be deemed the insurer to the extent of its obligation on the covered claims and to this extent shall have all rights, duties, and obligations of the insolvent insurer as if the insurer had not become insolvent including, but not limited to, the right to pursue and retain salvage and subrogation recoverable on paid covered claim obligations. The association shall not be deemed the insolvent insurer for any purpose relating to the issue of whether the association is amenable to the personal jurisdiction of the courts of any other state; (3) Allocate claims paid and expenses incurred among the two (2) accounts separately, and assess member insurers separately for each account amounts necessary to pay the obligations of the association under subdivision (a)(1) subsequent to an insolvency, the expenses of handling covered claims subsequent to an insolvency, and expenses authorized by this part. The assessments of each member insurer shall be in the proportion that the net direct written premiums of the member insurer for the preceding calendar year on the kinds of insurance in the account bears to the net direct written premiums of all member insurers for the preceding calendar year on the kinds of insurance in the account. Each member insurer shall be notified of the assessment not later than thirty (30) days before it is due. No member insurer may be assessed in any year on any account an amount greater than two percent (2%) of that member insurer's net direct written premiums for the preceding calendar year on the kinds of insurance in the account. If the maximum assessment, together with the other assets of the association in any account, does not provide in any one (1) year in any account an amount sufficient to make all necessary payments from that account, the funds available shall be prorated and the unpaid portion shall be paid as soon thereafter as funds become available. The association may exempt or defer, in whole or in part, the assessment of any member insurer, if the assessment would cause the member insurer's financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. Each member insurer may set off against any assessment, authorized payments made on covered claims and expenses incurred in the payment of the claims by the member insurer if they are chargeable to the account for which the assessment is made; (4) Investigate claims brought against the association and adjust, compromise, settle, and pay covered claims to the extent of the association's obligation and deny all other claims and may review settlements, releases and judgments to which the insolvent insurer or its insureds were parties to determine the extent to which the settlements, releases and judgments may be properly contested; (5) Notify any persons as the commissioner directs under § 56-12-109(b)(1) ; (6) Handle claims through its employees or through one (1) or more insurers or other persons designated as servicing facilities. Designation of a servicing facility is subject to the approval of the commissioner, but such designation may be declined by a member insurer; and (7) Reimburse each servicing facility for obligations of the association paid by the facility and for expenses incurred by the facility while handling claims on behalf of the association, and shall pay the other expenses of the association authorized by this part.
(1) (A) Be obligated to the extent of the covered claims existing prior to the determination of insolvency and arising within thirty (30) days after the determination of insolvency, or before the policy expiration date if less than thirty (30) days after the determination, or before the insured replaces the policy or on request effects cancellation, if the insured does so within thirty (30) days of the determination, but the obligation shall include only that amount of each covered claim that is in excess of one hundred dollars ($100) and is less than one hundred thousand dollars ($100,000), except that the association shall pay the full amount of any covered claim arising out of a workers' compensation policy. In no event shall the association be obligated to a policyholder or claimant in an amount in excess of the obligation of the insolvent insurer under the policy from which the claim arises; (B) In the case of claims other than workers' compensation arising from bodily injury, sickness, or disease, including death resulting from bodily injury, sickness, or disease, the amount for which the association shall be obligated shall not exceed the claimant's reasonable expenses incurred for necessary medical, surgical, X-ray and dental services, including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services, and any amounts actually lost by reason of claimant's inability to work and earn wages or salary or their equivalent that would otherwise have been earned in the normal course of the injured claimant's employment, to which may be added at the discretion of the association an additional sum as compensation for permanent physical impairment if the payment can be made within the policy limits; (C) (i) Any obligation of the association to defend an insured shall cease upon the association's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the association's covered claim obligation limit or the applicable policy limit; (ii) Notwithstanding any other provisions of this part, except in the case of a claim for benefits under workers' compensation coverage, any obligation of the association to any and all persons shall cease when ten million dollars ($10,000,000) has been paid in the aggregate to or on behalf of any single insured and its affiliates by the association and any one (1) or more associations similar to the association of any other state or states or any property and casualty security fund that obtains contributions from insurers on a pre-insolvency basis, on covered claims or allowed claims arising under the policy or policies of any one (1) insolvent insurer. For the purposes of this section, "affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with another person. If the association determines that there may be more than one (1) claimant having a covered claim or allowed claim against the association or any associations similar to the association or any property and casualty insurance security fund in other states, under the policy or policies of any one (1) insolvent insurer, the association may establish a plan to allocate amounts payable by the association in the manner that the association in its discretion deems equitable;
(A) Be obligated to the extent of the covered claims existing prior to the determination of insolvency and arising within thirty (30) days after the determination of insolvency, or before the policy expiration date if less than thirty (30) days after the determination, or before the insured replaces the policy or on request effects cancellation, if the insured does so within thirty (30) days of the determination, but the obligation shall include only that amount of each covered claim that is in excess of one hundred dollars ($100) and is less than one hundred thousand dollars ($100,000), except that the association shall pay the full amount of any covered claim arising out of a workers' compensation policy. In no event shall the association be obligated to a policyholder or claimant in an amount in excess of the obligation of the insolvent insurer under the policy from which the claim arises;
(B) In the case of claims other than workers' compensation arising from bodily injury, sickness, or disease, including death resulting from bodily injury, sickness, or disease, the amount for which the association shall be obligated shall not exceed the claimant's reasonable expenses incurred for necessary medical, surgical, X-ray and dental services, including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services, and any amounts actually lost by reason of claimant's inability to work and earn wages or salary or their equivalent that would otherwise have been earned in the normal course of the injured claimant's employment, to which may be added at the discretion of the association an additional sum as compensation for permanent physical impairment if the payment can be made within the policy limits;
(C) (i) Any obligation of the association to defend an insured shall cease upon the association's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the association's covered claim obligation limit or the applicable policy limit; (ii) Notwithstanding any other provisions of this part, except in the case of a claim for benefits under workers' compensation coverage, any obligation of the association to any and all persons shall cease when ten million dollars ($10,000,000) has been paid in the aggregate to or on behalf of any single insured and its affiliates by the association and any one (1) or more associations similar to the association of any other state or states or any property and casualty security fund that obtains contributions from insurers on a pre-insolvency basis, on covered claims or allowed claims arising under the policy or policies of any one (1) insolvent insurer. For the purposes of this section, "affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with another person. If the association determines that there may be more than one (1) claimant having a covered claim or allowed claim against the association or any associations similar to the association or any property and casualty insurance security fund in other states, under the policy or policies of any one (1) insolvent insurer, the association may establish a plan to allocate amounts payable by the association in the manner that the association in its discretion deems equitable;
(i) Any obligation of the association to defend an insured shall cease upon the association's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the association's covered claim obligation limit or the applicable policy limit;
(ii) Notwithstanding any other provisions of this part, except in the case of a claim for benefits under workers' compensation coverage, any obligation of the association to any and all persons shall cease when ten million dollars ($10,000,000) has been paid in the aggregate to or on behalf of any single insured and its affiliates by the association and any one (1) or more associations similar to the association of any other state or states or any property and casualty security fund that obtains contributions from insurers on a pre-insolvency basis, on covered claims or allowed claims arising under the policy or policies of any one (1) insolvent insurer. For the purposes of this section, "affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with another person. If the association determines that there may be more than one (1) claimant having a covered claim or allowed claim against the association or any associations similar to the association or any property and casualty insurance security fund in other states, under the policy or policies of any one (1) insolvent insurer, the association may establish a plan to allocate amounts payable by the association in the manner that the association in its discretion deems equitable;
(2) Be deemed the insurer to the extent of its obligation on the covered claims and to this extent shall have all rights, duties, and obligations of the insolvent insurer as if the insurer had not become insolvent including, but not limited to, the right to pursue and retain salvage and subrogation recoverable on paid covered claim obligations. The association shall not be deemed the insolvent insurer for any purpose relating to the issue of whether the association is amenable to the personal jurisdiction of the courts of any other state;
(3) Allocate claims paid and expenses incurred among the two (2) accounts separately, and assess member insurers separately for each account amounts necessary to pay the obligations of the association under subdivision (a)(1) subsequent to an insolvency, the expenses of handling covered claims subsequent to an insolvency, and expenses authorized by this part. The assessments of each member insurer shall be in the proportion that the net direct written premiums of the member insurer for the preceding calendar year on the kinds of insurance in the account bears to the net direct written premiums of all member insurers for the preceding calendar year on the kinds of insurance in the account. Each member insurer shall be notified of the assessment not later than thirty (30) days before it is due. No member insurer may be assessed in any year on any account an amount greater than two percent (2%) of that member insurer's net direct written premiums for the preceding calendar year on the kinds of insurance in the account. If the maximum assessment, together with the other assets of the association in any account, does not provide in any one (1) year in any account an amount sufficient to make all necessary payments from that account, the funds available shall be prorated and the unpaid portion shall be paid as soon thereafter as funds become available. The association may exempt or defer, in whole or in part, the assessment of any member insurer, if the assessment would cause the member insurer's financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. Each member insurer may set off against any assessment, authorized payments made on covered claims and expenses incurred in the payment of the claims by the member insurer if they are chargeable to the account for which the assessment is made;
(4) Investigate claims brought against the association and adjust, compromise, settle, and pay covered claims to the extent of the association's obligation and deny all other claims and may review settlements, releases and judgments to which the insolvent insurer or its insureds were parties to determine the extent to which the settlements, releases and judgments may be properly contested;
(5) Notify any persons as the commissioner directs under § 56-12-109(b)(1) ;
(6) Handle claims through its employees or through one (1) or more insurers or other persons designated as servicing facilities. Designation of a servicing facility is subject to the approval of the commissioner, but such designation may be declined by a member insurer; and
(7) Reimburse each servicing facility for obligations of the association paid by the facility and for expenses incurred by the facility while handling claims on behalf of the association, and shall pay the other expenses of the association authorized by this part.
(b) The association may: (1) Appear in, defend, and appeal any action on a claim brought against the association; (2) Employ or retain such persons as are necessary to handle claims and perform other duties of the association; (3) Borrow funds necessary to effect the purposes of this part in accordance with the plan of operation. In the event of an insolvency resulting in covered claims payable by the association in excess of its capacity to pay from assessments under subdivision (a)(3), the association, in its sole discretion, may by resolution request the local development authority to issue bonds and/or notes pursuant to title 4, chapter 31, part 8, in such amounts as the association may determine necessary to provide funds for the payments of covered claims and expenses related thereto. However, the amount of the bond issuance may be limited by §§ 4-31-804 and 4-31-805 with the local development authority having the final authority to determine the total amount of the bond issuance including issuance costs. When the association and the local development authority agree that bonds or notes shall be issued to pay covered claims in the event of an insolvency, the association shall have the authority to annually assess member insurers for amounts necessary to secure and provide for the repayment of the indebtedness, including, without limitation, the principal, redemption premium, if any, and interest on, and related costs of issuance of such indebtedness including bond investors insurance. Necessary assessments collected pursuant to this authority shall be collected under the same procedures provided in subdivision (a)(3). Assessments collected under this section may be assigned and pledged to or on behalf of the local development authority for the benefit of the holders of such indebtedness, in order to provide for the payment of the principal of, redemption premium, if any, and interest on such indebtedness, the costs of issuance, and the funding of any reserves and any other payments under the documents under which the indebtedness was incurred. In addition to the assessments provided for in this section, the association in its sole discretion may utilize assessments made under subdivision (a)(3), to service such indebtedness, if necessary. The association shall have no obligation to pay covered claims solely from the proceeds of bonds or notes issued under § 4-31-804 ; provided, that if the association may cause assessments to be made hereunder for such covered claims, and assigns and pledges such assessments to or on behalf of the local development authority as issuer of such indebtedness for the benefit of the holders of bonds or notes, the association may administer such covered claims and present valid covered claims for payment; (4) Sue or be sued, and such power to sue includes the power and right to intervene as a party before any court that has jurisdiction over an insolvent insurer as defined by this part; (5) Negotiate and become a party to such contracts as are necessary to carry out the purpose of this part; (6) Perform such other acts as are necessary or proper to effectuate the purpose of this part; and (7) Refund to the member insurers in proportion to the contribution of each member insurer to that account that amount by which the assets of the account exceed the liabilities, if, at the end of any calendar year, the board of directors finds that the assets of the association in any account exceed the liabilities of that account as estimated by the board of directors for the coming year.
(1) Appear in, defend, and appeal any action on a claim brought against the association;
(2) Employ or retain such persons as are necessary to handle claims and perform other duties of the association;
(3) Borrow funds necessary to effect the purposes of this part in accordance with the plan of operation. In the event of an insolvency resulting in covered claims payable by the association in excess of its capacity to pay from assessments under subdivision (a)(3), the association, in its sole discretion, may by resolution request the local development authority to issue bonds and/or notes pursuant to title 4, chapter 31, part 8, in such amounts as the association may determine necessary to provide funds for the payments of covered claims and expenses related thereto. However, the amount of the bond issuance may be limited by §§ 4-31-804 and 4-31-805 with the local development authority having the final authority to determine the total amount of the bond issuance including issuance costs. When the association and the local development authority agree that bonds or notes shall be issued to pay covered claims in the event of an insolvency, the association shall have the authority to annually assess member insurers for amounts necessary to secure and provide for the repayment of the indebtedness, including, without limitation, the principal, redemption premium, if any, and interest on, and related costs of issuance of such indebtedness including bond investors insurance. Necessary assessments collected pursuant to this authority shall be collected under the same procedures provided in subdivision (a)(3). Assessments collected under this section may be assigned and pledged to or on behalf of the local development authority for the benefit of the holders of such indebtedness, in order to provide for the payment of the principal of, redemption premium, if any, and interest on such indebtedness, the costs of issuance, and the funding of any reserves and any other payments under the documents under which the indebtedness was incurred. In addition to the assessments provided for in this section, the association in its sole discretion may utilize assessments made under subdivision (a)(3), to service such indebtedness, if necessary. The association shall have no obligation to pay covered claims solely from the proceeds of bonds or notes issued under § 4-31-804 ; provided, that if the association may cause assessments to be made hereunder for such covered claims, and assigns and pledges such assessments to or on behalf of the local development authority as issuer of such indebtedness for the benefit of the holders of bonds or notes, the association may administer such covered claims and present valid covered claims for payment;
(4) Sue or be sued, and such power to sue includes the power and right to intervene as a party before any court that has jurisdiction over an insolvent insurer as defined by this part;
(5) Negotiate and become a party to such contracts as are necessary to carry out the purpose of this part;
(6) Perform such other acts as are necessary or proper to effectuate the purpose of this part; and
(7) Refund to the member insurers in proportion to the contribution of each member insurer to that account that amount by which the assets of the account exceed the liabilities, if, at the end of any calendar year, the board of directors finds that the assets of the association in any account exceed the liabilities of that account as estimated by the board of directors for the coming year.
(c) With respect to any suit involving the association: (1) Any action relating to or arising out of this part against the association shall be brought in a court in this state. Such court shall have exclusive jurisdiction over any action relating to or arising out of this part against the association; and (2) Exclusive venue in any action brought against the association is in the circuit or chancery court in Davidson County; provided, that the association may waive such venue as to a specific action.
(1) Any action relating to or arising out of this part against the association shall be brought in a court in this state. Such court shall have exclusive jurisdiction over any action relating to or arising out of this part against the association; and
(2) Exclusive venue in any action brought against the association is in the circuit or chancery court in Davidson County; provided, that the association may waive such venue as to a specific action.
Acts 1971, ch. 180, § 7; 1975, ch. 62, §§ 5, 6; 1977, ch. 203, § 3; T.C.A., § 56-4007; Acts 1995, ch. 240, § 2; 1999, ch. 48, §§ 3 - 6, 11.
Tenn. Code Ann. § 56-22-112 — TN Code / Title 56 / Chapter 22 / Section 56-22-112
Acquisition or merger
Status: in_force

The acquisition or merger of a county mutual insurance company is subject to the same standards and procedures set forth in § 56-11-103 , and any rules promulgated thereunder. Acts 2006, ch. 689, §§ 3, 15.
The acquisition or merger of a county mutual insurance company is subject to the same standards and procedures set forth in § 56-11-103 , and any rules promulgated thereunder.
Acts 2006, ch. 689, §§ 3, 15.
Tenn. Code Ann. § 56-7-2207 — TN Code / Title 56 / Chapter 7 / Section 56-7-2207
Health benefit plans - Preexisting conditions - Late enrollees - Premiums - Transfers - Place of business - Filings - Documentation
Status: in_force

(a) Health benefit plans covering small employers are subject to the following: (1) Except in the case of a late enrollee, any preexisting conditions provision may not limit or exclude coverage for a period beyond twelve (12) months following the insured's effective date of coverage, and may only relate to conditions manifesting themselves in a manner that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment; for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months immediately before the effective date of coverage, or as to a pregnancy existing on the effective date of coverage; (2) In determining whether a preexisting conditions provision applies to an eligible employee or to a dependent, all health benefit plans shall credit the time the person was covered under a previous group health benefit plan if the previous coverage was continuous to a date not more than thirty (30) days before the effective date of the new coverage, exclusive of any applicable waiting period under the plan; (3) (A) The health benefit plan is renewable with respect to all eligible employees or dependents at the option of the policyholder or contract holder except: (i) For nonpayment of the required premiums by the policyholder or contract holder; (ii) For fraud or misrepresentation of the policyholder or contract holder or, with respect to coverage of individual enrollees, the enrollees or their representatives; (iii) For noncompliance with plan provisions that have been approved by the commissioner; (iv) When the number of enrollees covered under the plan is fewer than the number of insureds or percentage of enrollees required by participation requirements under the plan; (v) When the policyholder or contract holder is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or (vi) When the small employer carrier stops writing new business in the small employer market, if the employer: (a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and (b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part; (B) A small employer carrier that stops writing new business in the small employer market in this state after January 1, 1993, shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the commissioner. In the case of an HMO doing business in the small employer market in one (1) service area of this state, the rules set forth in this subdivision (a)(3) shall apply to the HMO's operations in the service area, unless [former] § 56-7-2208(g) [repealed] applies; (4) Late enrollees may be excluded from coverage for the greater of eighteen (18) months or an eighteen-month preexisting condition exclusion; however, if both a period of exclusion from coverage and a preexisting condition exclusion are applicable to a late enrollee, the combined period shall not exceed eighteen (18) months; and (5) A carrier may continue to enforce reasonable employer participation and contribution requirements on small employers applying for coverage; however, participation and contributions requirements may vary among small employers only by the size of the small group. (b) Premium rates for health benefit plans subject to this part are subject to the following: (1) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than twenty-five percent (25%), adjusted pro rata for any rating period of less than one (1) year; (2) For a class of business, the premium rates charged during a rating period to small employers with similar case characteristics for the same or similar coverage, or the rates that could be charged to those employers under the rating system for that class of business shall not vary from the index rate by more than thirty-five percent (35%) of the index rate, adjusted pro rata for any rating period of less than one (1) year; (3) The percentage increase in the premium rate charged to a small employer for a new rating period, adjusted pro rata for any rating period of less than one (1) year, may not exceed the sum of the following: (A) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period. If a small employer carrier is not issuing any new policies, but is only renewing policies, the carrier shall use the percentage change in the base premium rate; (B) Any adjustment, not to exceed fifteen percent (15%) annually and adjusted pro rata for any rating period of less than one (1) year, due to the claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the small employer carrier's rate manual for the class of business; (C) Any adjustment because of a change in coverage or change in the case characteristics of the small employer as determined from the small employer carrier's rate manual for the class of business; (4) Premium rates for health benefit plans shall comply with the requirements of this section, notwithstanding any reinsurance premiums and assessments paid or payable by small employer carriers in accordance with [former] § 56-7-2221 [repealed]; (5) In any case where a small employer carrier uses industry as a case characteristic in establishing premium rates, the rate factor associated with any industry classification may not vary from the arithmetic average of the rate factors associated with all industry classifications by greater than fifteen percent (15%) of coverage; (6) Small employer carriers shall apply rating factors including case characteristics consistently with respect to all small employers in a class of business. Adjustments in rates for claims experience, health status and duration from issue may not be applied individually. Any such adjustment must be applied uniformly to the rate charged for all participants of the small employer; and (7) Notwithstanding this title to the contrary, neither the definition of case characteristics in § 56-7-2203 , nor this chapter, prohibits a pool created under § 56-26-204 from using case characteristics, claim experience, health status, or duration of coverage since issue in determining initial or adjusted premium rates for employers pooling their liabilities under § 56-26-204 . (c) All premium rates for a small employer carrier shall be subject to the review and approval or disapproval of the commissioner as provided for in § 56-26-102 and any regulations promulgated under the authority of that section. Section 56-26-102 and regulations shall apply to all plans subject to this section in the same manner as to accident and sickness policies subject to § 56-26-102 . (d) A small employer carrier shall not involuntarily transfer a small employer into or out of a class of business. A small employer carrier shall not offer to transfer a small employer into or out of a class of business unless the carrier offers to transfer all small employers in the class of business without regard to case characteristics, claims experience, health status or duration of coverage since issue. (e) In connection with the offering for sale of any health benefit plan to a small employer, each small employer carrier shall make a reasonable disclosure as part of its solicitation and sales materials of: (1) The extent to which premium rates for a specified small employer are established or adjusted in part based upon the actual or expected variation in claims costs, or actual or expected variation in health condition of the eligible employees and dependents of the small employer; (2) Provisions concerning the small employer carrier's right to change premium rates and the factors other than claims experience that affect changes in premium rates; (3) Provisions relating to renewability of policies and contracts; and (4) Provisions affecting any preexisting conditions provision. (f) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles. (g) Each small employer carrier shall file with the commissioner annually, on or before March 15, an actuarial certification certifying that it is in compliance with this part and that its rating methods are actuarially sound. The small employer carrier shall retain a copy of the certification at its principal place of business. (h) A small employer carrier shall make the information and documentation described in subsection (f) available to the commissioner upon request. Except in cases of violations of this part, the information is proprietary and trade secret information and is not subject to disclosure by the commissioner to persons outside the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction. (i) Subdivisions (a)(1), (3) and (5) and subsections (b) and (d)-(h) apply to health benefit plans delivered, issued for delivery, renewed or continued in this state or covering persons residing in this state on or after January 1, 1993. Subdivisions (a)(2) and (4) apply to health benefit plans delivered, issued for delivery, renewed or continued in this state or covering persons residing in this state on or after the date the plan becomes operational, as designated by the commissioner. For purposes of this subsection (i), the date a health benefit plan is continued is the anniversary date of the issuance of the health benefit plan. Amended by 2019 Tenn. Acts, ch. 182, s 1, eff. 4/23/2019. Acts 1992, ch. 808, § 9; 1993, ch. 228, § 1; 2011 , ch. 344, §§ 4 - 6.
(a) Health benefit plans covering small employers are subject to the following: (1) Except in the case of a late enrollee, any preexisting conditions provision may not limit or exclude coverage for a period beyond twelve (12) months following the insured's effective date of coverage, and may only relate to conditions manifesting themselves in a manner that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment; for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months immediately before the effective date of coverage, or as to a pregnancy existing on the effective date of coverage; (2) In determining whether a preexisting conditions provision applies to an eligible employee or to a dependent, all health benefit plans shall credit the time the person was covered under a previous group health benefit plan if the previous coverage was continuous to a date not more than thirty (30) days before the effective date of the new coverage, exclusive of any applicable waiting period under the plan; (3) (A) The health benefit plan is renewable with respect to all eligible employees or dependents at the option of the policyholder or contract holder except: (i) For nonpayment of the required premiums by the policyholder or contract holder; (ii) For fraud or misrepresentation of the policyholder or contract holder or, with respect to coverage of individual enrollees, the enrollees or their representatives; (iii) For noncompliance with plan provisions that have been approved by the commissioner; (iv) When the number of enrollees covered under the plan is fewer than the number of insureds or percentage of enrollees required by participation requirements under the plan; (v) When the policyholder or contract holder is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or (vi) When the small employer carrier stops writing new business in the small employer market, if the employer: (a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and (b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part; (B) A small employer carrier that stops writing new business in the small employer market in this state after January 1, 1993, shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the commissioner. In the case of an HMO doing business in the small employer market in one (1) service area of this state, the rules set forth in this subdivision (a)(3) shall apply to the HMO's operations in the service area, unless [former] § 56-7-2208(g) [repealed] applies; (4) Late enrollees may be excluded from coverage for the greater of eighteen (18) months or an eighteen-month preexisting condition exclusion; however, if both a period of exclusion from coverage and a preexisting condition exclusion are applicable to a late enrollee, the combined period shall not exceed eighteen (18) months; and (5) A carrier may continue to enforce reasonable employer participation and contribution requirements on small employers applying for coverage; however, participation and contributions requirements may vary among small employers only by the size of the small group.
(1) Except in the case of a late enrollee, any preexisting conditions provision may not limit or exclude coverage for a period beyond twelve (12) months following the insured's effective date of coverage, and may only relate to conditions manifesting themselves in a manner that would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment; for which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) months immediately before the effective date of coverage, or as to a pregnancy existing on the effective date of coverage;
(2) In determining whether a preexisting conditions provision applies to an eligible employee or to a dependent, all health benefit plans shall credit the time the person was covered under a previous group health benefit plan if the previous coverage was continuous to a date not more than thirty (30) days before the effective date of the new coverage, exclusive of any applicable waiting period under the plan;
(3) (A) The health benefit plan is renewable with respect to all eligible employees or dependents at the option of the policyholder or contract holder except: (i) For nonpayment of the required premiums by the policyholder or contract holder; (ii) For fraud or misrepresentation of the policyholder or contract holder or, with respect to coverage of individual enrollees, the enrollees or their representatives; (iii) For noncompliance with plan provisions that have been approved by the commissioner; (iv) When the number of enrollees covered under the plan is fewer than the number of insureds or percentage of enrollees required by participation requirements under the plan; (v) When the policyholder or contract holder is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or (vi) When the small employer carrier stops writing new business in the small employer market, if the employer: (a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and (b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part; (B) A small employer carrier that stops writing new business in the small employer market in this state after January 1, 1993, shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the commissioner. In the case of an HMO doing business in the small employer market in one (1) service area of this state, the rules set forth in this subdivision (a)(3) shall apply to the HMO's operations in the service area, unless [former] § 56-7-2208(g) [repealed] applies;
(A) The health benefit plan is renewable with respect to all eligible employees or dependents at the option of the policyholder or contract holder except: (i) For nonpayment of the required premiums by the policyholder or contract holder; (ii) For fraud or misrepresentation of the policyholder or contract holder or, with respect to coverage of individual enrollees, the enrollees or their representatives; (iii) For noncompliance with plan provisions that have been approved by the commissioner; (iv) When the number of enrollees covered under the plan is fewer than the number of insureds or percentage of enrollees required by participation requirements under the plan; (v) When the policyholder or contract holder is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or (vi) When the small employer carrier stops writing new business in the small employer market, if the employer: (a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and (b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part;
(i) For nonpayment of the required premiums by the policyholder or contract holder;
(ii) For fraud or misrepresentation of the policyholder or contract holder or, with respect to coverage of individual enrollees, the enrollees or their representatives;
(iii) For noncompliance with plan provisions that have been approved by the commissioner;
(iv) When the number of enrollees covered under the plan is fewer than the number of insureds or percentage of enrollees required by participation requirements under the plan;
(v) When the policyholder or contract holder is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or
(vi) When the small employer carrier stops writing new business in the small employer market, if the employer: (a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and (b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part;
(a) Provides notice to the department and either to the policyholder, contract holder or employer of its decision to stop writing new business in the small employer market; and
(b) Does not cancel health benefit plans subject to this part for one hundred eighty (180) days after the date of the notice required under subdivision (a)(3)(A)(vi)( a ); and for that business of the carrier that remains in force, the carrier shall continue to be governed by this part with respect to business conducted under this part;
(B) A small employer carrier that stops writing new business in the small employer market in this state after January 1, 1993, shall be prohibited from writing new business in the small employer market in this state for a period of five (5) years from the date of notice to the commissioner. In the case of an HMO doing business in the small employer market in one (1) service area of this state, the rules set forth in this subdivision (a)(3) shall apply to the HMO's operations in the service area, unless [former] § 56-7-2208(g) [repealed] applies;
(4) Late enrollees may be excluded from coverage for the greater of eighteen (18) months or an eighteen-month preexisting condition exclusion; however, if both a period of exclusion from coverage and a preexisting condition exclusion are applicable to a late enrollee, the combined period shall not exceed eighteen (18) months; and
(5) A carrier may continue to enforce reasonable employer participation and contribution requirements on small employers applying for coverage; however, participation and contributions requirements may vary among small employers only by the size of the small group.
(b) Premium rates for health benefit plans subject to this part are subject to the following: (1) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than twenty-five percent (25%), adjusted pro rata for any rating period of less than one (1) year; (2) For a class of business, the premium rates charged during a rating period to small employers with similar case characteristics for the same or similar coverage, or the rates that could be charged to those employers under the rating system for that class of business shall not vary from the index rate by more than thirty-five percent (35%) of the index rate, adjusted pro rata for any rating period of less than one (1) year; (3) The percentage increase in the premium rate charged to a small employer for a new rating period, adjusted pro rata for any rating period of less than one (1) year, may not exceed the sum of the following: (A) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period. If a small employer carrier is not issuing any new policies, but is only renewing policies, the carrier shall use the percentage change in the base premium rate; (B) Any adjustment, not to exceed fifteen percent (15%) annually and adjusted pro rata for any rating period of less than one (1) year, due to the claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the small employer carrier's rate manual for the class of business; (C) Any adjustment because of a change in coverage or change in the case characteristics of the small employer as determined from the small employer carrier's rate manual for the class of business; (4) Premium rates for health benefit plans shall comply with the requirements of this section, notwithstanding any reinsurance premiums and assessments paid or payable by small employer carriers in accordance with [former] § 56-7-2221 [repealed]; (5) In any case where a small employer carrier uses industry as a case characteristic in establishing premium rates, the rate factor associated with any industry classification may not vary from the arithmetic average of the rate factors associated with all industry classifications by greater than fifteen percent (15%) of coverage; (6) Small employer carriers shall apply rating factors including case characteristics consistently with respect to all small employers in a class of business. Adjustments in rates for claims experience, health status and duration from issue may not be applied individually. Any such adjustment must be applied uniformly to the rate charged for all participants of the small employer; and (7) Notwithstanding this title to the contrary, neither the definition of case characteristics in § 56-7-2203 , nor this chapter, prohibits a pool created under § 56-26-204 from using case characteristics, claim experience, health status, or duration of coverage since issue in determining initial or adjusted premium rates for employers pooling their liabilities under § 56-26-204 .
(1) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of business by more than twenty-five percent (25%), adjusted pro rata for any rating period of less than one (1) year;
(2) For a class of business, the premium rates charged during a rating period to small employers with similar case characteristics for the same or similar coverage, or the rates that could be charged to those employers under the rating system for that class of business shall not vary from the index rate by more than thirty-five percent (35%) of the index rate, adjusted pro rata for any rating period of less than one (1) year;
(3) The percentage increase in the premium rate charged to a small employer for a new rating period, adjusted pro rata for any rating period of less than one (1) year, may not exceed the sum of the following: (A) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period. If a small employer carrier is not issuing any new policies, but is only renewing policies, the carrier shall use the percentage change in the base premium rate; (B) Any adjustment, not to exceed fifteen percent (15%) annually and adjusted pro rata for any rating period of less than one (1) year, due to the claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the small employer carrier's rate manual for the class of business; (C) Any adjustment because of a change in coverage or change in the case characteristics of the small employer as determined from the small employer carrier's rate manual for the class of business;
(A) The percentage change in the new business premium rate measured from the first day of the prior rating period to the first day of the new rating period. If a small employer carrier is not issuing any new policies, but is only renewing policies, the carrier shall use the percentage change in the base premium rate;
(B) Any adjustment, not to exceed fifteen percent (15%) annually and adjusted pro rata for any rating period of less than one (1) year, due to the claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the small employer carrier's rate manual for the class of business;
(C) Any adjustment because of a change in coverage or change in the case characteristics of the small employer as determined from the small employer carrier's rate manual for the class of business;
(4) Premium rates for health benefit plans shall comply with the requirements of this section, notwithstanding any reinsurance premiums and assessments paid or payable by small employer carriers in accordance with [former] § 56-7-2221 [repealed];
(5) In any case where a small employer carrier uses industry as a case characteristic in establishing premium rates, the rate factor associated with any industry classification may not vary from the arithmetic average of the rate factors associated with all industry classifications by greater than fifteen percent (15%) of coverage;
(6) Small employer carriers shall apply rating factors including case characteristics consistently with respect to all small employers in a class of business. Adjustments in rates for claims experience, health status and duration from issue may not be applied individually. Any such adjustment must be applied uniformly to the rate charged for all participants of the small employer; and
(7) Notwithstanding this title to the contrary, neither the definition of case characteristics in § 56-7-2203 , nor this chapter, prohibits a pool created under § 56-26-204 from using case characteristics, claim experience, health status, or duration of coverage since issue in determining initial or adjusted premium rates for employers pooling their liabilities under § 56-26-204 .
(c) All premium rates for a small employer carrier shall be subject to the review and approval or disapproval of the commissioner as provided for in § 56-26-102 and any regulations promulgated under the authority of that section. Section 56-26-102 and regulations shall apply to all plans subject to this section in the same manner as to accident and sickness policies subject to § 56-26-102 .
(d) A small employer carrier shall not involuntarily transfer a small employer into or out of a class of business. A small employer carrier shall not offer to transfer a small employer into or out of a class of business unless the carrier offers to transfer all small employers in the class of business without regard to case characteristics, claims experience, health status or duration of coverage since issue.
(e) In connection with the offering for sale of any health benefit plan to a small employer, each small employer carrier shall make a reasonable disclosure as part of its solicitation and sales materials of: (1) The extent to which premium rates for a specified small employer are established or adjusted in part based upon the actual or expected variation in claims costs, or actual or expected variation in health condition of the eligible employees and dependents of the small employer; (2) Provisions concerning the small employer carrier's right to change premium rates and the factors other than claims experience that affect changes in premium rates; (3) Provisions relating to renewability of policies and contracts; and (4) Provisions affecting any preexisting conditions provision.
(1) The extent to which premium rates for a specified small employer are established or adjusted in part based upon the actual or expected variation in claims costs, or actual or expected variation in health condition of the eligible employees and dependents of the small employer;
(2) Provisions concerning the small employer carrier's right to change premium rates and the factors other than claims experience that affect changes in premium rates;
(3) Provisions relating to renewability of policies and contracts; and
(4) Provisions affecting any preexisting conditions provision.
(f) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
(g) Each small employer carrier shall file with the commissioner annually, on or before March 15, an actuarial certification certifying that it is in compliance with this part and that its rating methods are actuarially sound. The small employer carrier shall retain a copy of the certification at its principal place of business.
(h) A small employer carrier shall make the information and documentation described in subsection (f) available to the commissioner upon request. Except in cases of violations of this part, the information is proprietary and trade secret information and is not subject to disclosure by the commissioner to persons outside the department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction.
(i) Subdivisions (a)(1), (3) and (5) and subsections (b) and (d)-(h) apply to health benefit plans delivered, issued for delivery, renewed or continued in this state or covering persons residing in this state on or after January 1, 1993. Subdivisions (a)(2) and (4) apply to health benefit plans delivered, issued for delivery, renewed or continued in this state or covering persons residing in this state on or after the date the plan becomes operational, as designated by the commissioner. For purposes of this subsection (i), the date a health benefit plan is continued is the anniversary date of the issuance of the health benefit plan.
Amended by 2019 Tenn. Acts, ch. 182, s 1, eff. 4/23/2019.
Acts 1992, ch. 808, § 9; 1993, ch. 228, § 1; 2011 , ch. 344, §§ 4 - 6.
Tenn. Code Ann. § 56-6-112 — TN Code / Title 56 / Chapter 6 / Section 56-6-112
License denial, nonrenewal, suspension or revocation
Status: in_force

(a) The commissioner may place on probation, suspend, revoke or refuse to issue or renew a license issued under this part or may levy a civil penalty in accordance with this section or take any combination of those actions, for any one (1) or more of the following causes: (1) Providing incorrect, misleading, incomplete or materially untrue information in the license application; (2) Violating any law, rule, regulation, subpoena or order of the commissioner or of another state's commissioner; (3) Obtaining or attempting to obtain a license through misrepresentation or fraud; (4) Improperly withholding, misappropriating or converting any moneys or properties received in the course of doing insurance business; (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; (6) Having been convicted of a felony; (7) Having admitted or been found to have committed any insurance unfair trade practice or fraud; (8) Using fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere; (9) Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory; (10) Forging another's name to an application for insurance or to any document related to an insurance transaction; (11) Improperly using notes or any other reference material to complete an examination for an insurance license; (12) Knowingly directing any person to submit an application for health care benefits through the TennCare program at a time when the person is covered by a group policy or when the policy is being renewed, and then quoting a rate for a group health insurance policy if the insurance producer knows the person would otherwise have been eligible to participate or continue participation in the group policy; (13) Knowingly accepting insurance business from an individual who is not licensed; (14) Selling, soliciting or negotiating insurance for a company that is not authorized to transact the business of insurance in this state; and (15) Violating the unfair trade practices as enumerated in § 56-6-125 . (b) Any action by the commissioner to put on probation, suspend, revoke or deny the renewal of a license pursuant to this section shall be governed by the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (c) In the event that the action by the commissioner is to deny an application for a license, the commissioner shall notify the applicant and advise, in writing, the applicant of the denial of the applicant's application within thirty (30) days. (d) The license of a business entity may be suspended or revoked if the commissioner finds, after a hearing, that an individual licensee's violation was known or should have been known by one (1) or more of the partners, officers or managers acting on behalf of the partnership or corporation and the violation was neither reported to the commissioner nor corrective action taken. (e) The commissioner shall retain the authority to enforce this part and impose any penalty or remedy authorized by this part and this title against any person who is under investigation for or charged with a violation of this part or this title, even if the person's license has been surrendered or has lapsed by operation of law. (f) The commissioner may serve a notice or order in any action arising under this part by registered or certified mail to the insurance producer or applicant at the address of record in the files of the department. Notwithstanding any law to the contrary, service in the manner set forth in this subsection (f) shall be deemed to constitute actual service on the insurance producer or applicant. (g) If, after providing notice consistent with the process established by § 4-5-320(c) , and providing the opportunity for a contested case hearing held in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the commissioner finds that any person required to be licensed, permitted, or authorized by the division of insurance pursuant to this chapter has violated any statute, rule or order, the commissioner may, at the commissioner's discretion, order: (1) The person to cease and desist from engaging in the act or practice giving rise to the violation; (2) Payment of a monetary penalty of not more than one thousand dollars ($1,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000). This subdivision (g)(2) shall not apply where a statute or rule specifically provides for other civil penalties for the violation. For purposes of this subdivision (g)(2), each day of continued violation shall constitute a separate violation; and (3) The suspension or revocation of the person's license. (h) In determining the amount of penalty to assess under this section, the commissioner shall consider: (1) Whether the person could reasonably have interpreted such person's actions to be in compliance with the obligations required by a statute, rule or order; (2) Whether the amount imposed will be a substantial economic deterrent to the violator; (3) The circumstances leading to the violation; (4) The severity of the violation and the risk of harm to the public; (5) The economic benefits gained by the violator as a result of noncompliance; (6) The interest of the public; and (7) The person's efforts to cure the violation. (i) For purposes of determining whether to issue an insurance producer license to an individual pursuant to this part, the commissioner shall not consider the following offenses if the offense occurred more than ten (10) years before the date upon which an individual submits an application for a license: (1) A misdemeanor; or (2) A Class E felony of which the individual was charged, but not convicted. Amended by 2022 Tenn. Acts, ch. 814, s 1, eff. 4/8/2022. Acts 2002, ch. 798, § 13; 2008 , ch. 1192, §§ 4, 5; 2011 , ch. 90, §§ 4, 5.
(a) The commissioner may place on probation, suspend, revoke or refuse to issue or renew a license issued under this part or may levy a civil penalty in accordance with this section or take any combination of those actions, for any one (1) or more of the following causes: (1) Providing incorrect, misleading, incomplete or materially untrue information in the license application; (2) Violating any law, rule, regulation, subpoena or order of the commissioner or of another state's commissioner; (3) Obtaining or attempting to obtain a license through misrepresentation or fraud; (4) Improperly withholding, misappropriating or converting any moneys or properties received in the course of doing insurance business; (5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; (6) Having been convicted of a felony; (7) Having admitted or been found to have committed any insurance unfair trade practice or fraud; (8) Using fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere; (9) Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory; (10) Forging another's name to an application for insurance or to any document related to an insurance transaction; (11) Improperly using notes or any other reference material to complete an examination for an insurance license; (12) Knowingly directing any person to submit an application for health care benefits through the TennCare program at a time when the person is covered by a group policy or when the policy is being renewed, and then quoting a rate for a group health insurance policy if the insurance producer knows the person would otherwise have been eligible to participate or continue participation in the group policy; (13) Knowingly accepting insurance business from an individual who is not licensed; (14) Selling, soliciting or negotiating insurance for a company that is not authorized to transact the business of insurance in this state; and (15) Violating the unfair trade practices as enumerated in § 56-6-125 .
(1) Providing incorrect, misleading, incomplete or materially untrue information in the license application;
(2) Violating any law, rule, regulation, subpoena or order of the commissioner or of another state's commissioner;
(3) Obtaining or attempting to obtain a license through misrepresentation or fraud;
(4) Improperly withholding, misappropriating or converting any moneys or properties received in the course of doing insurance business;
(5) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance;
(6) Having been convicted of a felony;
(7) Having admitted or been found to have committed any insurance unfair trade practice or fraud;
(8) Using fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this state or elsewhere;
(9) Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory;
(10) Forging another's name to an application for insurance or to any document related to an insurance transaction;
(11) Improperly using notes or any other reference material to complete an examination for an insurance license;
(12) Knowingly directing any person to submit an application for health care benefits through the TennCare program at a time when the person is covered by a group policy or when the policy is being renewed, and then quoting a rate for a group health insurance policy if the insurance producer knows the person would otherwise have been eligible to participate or continue participation in the group policy;
(13) Knowingly accepting insurance business from an individual who is not licensed;
(14) Selling, soliciting or negotiating insurance for a company that is not authorized to transact the business of insurance in this state; and
(15) Violating the unfair trade practices as enumerated in § 56-6-125 .
(b) Any action by the commissioner to put on probation, suspend, revoke or deny the renewal of a license pursuant to this section shall be governed by the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(c) In the event that the action by the commissioner is to deny an application for a license, the commissioner shall notify the applicant and advise, in writing, the applicant of the denial of the applicant's application within thirty (30) days.
(d) The license of a business entity may be suspended or revoked if the commissioner finds, after a hearing, that an individual licensee's violation was known or should have been known by one (1) or more of the partners, officers or managers acting on behalf of the partnership or corporation and the violation was neither reported to the commissioner nor corrective action taken.
(e) The commissioner shall retain the authority to enforce this part and impose any penalty or remedy authorized by this part and this title against any person who is under investigation for or charged with a violation of this part or this title, even if the person's license has been surrendered or has lapsed by operation of law.
(f) The commissioner may serve a notice or order in any action arising under this part by registered or certified mail to the insurance producer or applicant at the address of record in the files of the department. Notwithstanding any law to the contrary, service in the manner set forth in this subsection (f) shall be deemed to constitute actual service on the insurance producer or applicant.
(g) If, after providing notice consistent with the process established by § 4-5-320(c) , and providing the opportunity for a contested case hearing held in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the commissioner finds that any person required to be licensed, permitted, or authorized by the division of insurance pursuant to this chapter has violated any statute, rule or order, the commissioner may, at the commissioner's discretion, order: (1) The person to cease and desist from engaging in the act or practice giving rise to the violation; (2) Payment of a monetary penalty of not more than one thousand dollars ($1,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000). This subdivision (g)(2) shall not apply where a statute or rule specifically provides for other civil penalties for the violation. For purposes of this subdivision (g)(2), each day of continued violation shall constitute a separate violation; and (3) The suspension or revocation of the person's license.
(1) The person to cease and desist from engaging in the act or practice giving rise to the violation;
(2) Payment of a monetary penalty of not more than one thousand dollars ($1,000) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000). This subdivision (g)(2) shall not apply where a statute or rule specifically provides for other civil penalties for the violation. For purposes of this subdivision (g)(2), each day of continued violation shall constitute a separate violation; and
(3) The suspension or revocation of the person's license.
(h) In determining the amount of penalty to assess under this section, the commissioner shall consider: (1) Whether the person could reasonably have interpreted such person's actions to be in compliance with the obligations required by a statute, rule or order; (2) Whether the amount imposed will be a substantial economic deterrent to the violator; (3) The circumstances leading to the violation; (4) The severity of the violation and the risk of harm to the public; (5) The economic benefits gained by the violator as a result of noncompliance; (6) The interest of the public; and (7) The person's efforts to cure the violation.
(1) Whether the person could reasonably have interpreted such person's actions to be in compliance with the obligations required by a statute, rule or order;
(2) Whether the amount imposed will be a substantial economic deterrent to the violator;
(3) The circumstances leading to the violation;
(4) The severity of the violation and the risk of harm to the public;
(5) The economic benefits gained by the violator as a result of noncompliance;
(6) The interest of the public; and
(7) The person's efforts to cure the violation.
(i) For purposes of determining whether to issue an insurance producer license to an individual pursuant to this part, the commissioner shall not consider the following offenses if the offense occurred more than ten (10) years before the date upon which an individual submits an application for a license: (1) A misdemeanor; or (2) A Class E felony of which the individual was charged, but not convicted.
(1) A misdemeanor; or
(2) A Class E felony of which the individual was charged, but not convicted.
Amended by 2022 Tenn. Acts, ch. 814, s 1, eff. 4/8/2022.
Acts 2002, ch. 798, § 13; 2008 , ch. 1192, §§ 4, 5; 2011 , ch. 90, §§ 4, 5.
Tenn. Code Ann. § 56-7-3119 — TN Code / Title 56 / Chapter 7 / Section 56-7-3119
Dealings with 340B entities - Discrimination against 340B entity prohibited
Status: in_force

(a) A health insurance issuer, managed health insurance issuer as defined in § 56-32-128(a) , pharmacy benefits manager, or other third-party payer shall not: (1) Reimburse a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug by national drug code number to pharmacies that are not 340B entities; (2) Assess a fee, chargeback, or adjustment upon a 340B entity that is not equally assessed on non-340B entities; (3) Exclude 340B entities from its network of participating pharmacies based on criteria that is not applied to non-340B entities; or (4) Require a claim for a drug by national drug code number to include a modifier to identify that the drug is a 340B drug. (b) With respect to a patient eligible to receive drugs subject to an agreement under 42 U.S.C. § 256b , a pharmacy benefits manager, or third party that makes payment for those drugs, shall not discriminate against a 340B entity in a manner that violates § 56-7-2359 or otherwise prevents or interferes with the patient's choice to receive those drugs from the 340B entity. (c) Notwithstanding § 56-7-1005 , this section does not apply to: (1) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor Medicaid program; (2) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program; or (3) The prescription drug program described in chapter 57 of this title, or a successor program. (d) As used in this section: (1) "340B entity" means a covered entity participating in the federal 340B drug discount program, as defined in section 340B of the Public Health Service Act, 42 U.S.C. § 256b , including the entity's pharmacy or pharmacies, or any pharmacy or pharmacies under contract with the 340B covered entity to dispense drugs on behalf of the 340B covered entity; and (2) "National drug code number" means the unique national drug code number that identifies a specific approved drug, its manufacturer, and its package presentation. Added by 2021 Tenn. Acts, ch. 569, s 1, eff. 7/1/2021.
(a) A health insurance issuer, managed health insurance issuer as defined in § 56-32-128(a) , pharmacy benefits manager, or other third-party payer shall not: (1) Reimburse a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug by national drug code number to pharmacies that are not 340B entities; (2) Assess a fee, chargeback, or adjustment upon a 340B entity that is not equally assessed on non-340B entities; (3) Exclude 340B entities from its network of participating pharmacies based on criteria that is not applied to non-340B entities; or (4) Require a claim for a drug by national drug code number to include a modifier to identify that the drug is a 340B drug.
(1) Reimburse a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug by national drug code number to pharmacies that are not 340B entities;
(2) Assess a fee, chargeback, or adjustment upon a 340B entity that is not equally assessed on non-340B entities;
(3) Exclude 340B entities from its network of participating pharmacies based on criteria that is not applied to non-340B entities; or
(4) Require a claim for a drug by national drug code number to include a modifier to identify that the drug is a 340B drug.
(b) With respect to a patient eligible to receive drugs subject to an agreement under 42 U.S.C. § 256b , a pharmacy benefits manager, or third party that makes payment for those drugs, shall not discriminate against a 340B entity in a manner that violates § 56-7-2359 or otherwise prevents or interferes with the patient's choice to receive those drugs from the 340B entity.
(c) Notwithstanding § 56-7-1005 , this section does not apply to: (1) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor Medicaid program; (2) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program; or (3) The prescription drug program described in chapter 57 of this title, or a successor program.
(1) The TennCare program administered under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or a successor Medicaid program;
(2) The CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program; or
(3) The prescription drug program described in chapter 57 of this title, or a successor program.
(d) As used in this section: (1) "340B entity" means a covered entity participating in the federal 340B drug discount program, as defined in section 340B of the Public Health Service Act, 42 U.S.C. § 256b , including the entity's pharmacy or pharmacies, or any pharmacy or pharmacies under contract with the 340B covered entity to dispense drugs on behalf of the 340B covered entity; and (2) "National drug code number" means the unique national drug code number that identifies a specific approved drug, its manufacturer, and its package presentation.
(1) "340B entity" means a covered entity participating in the federal 340B drug discount program, as defined in section 340B of the Public Health Service Act, 42 U.S.C. § 256b , including the entity's pharmacy or pharmacies, or any pharmacy or pharmacies under contract with the 340B covered entity to dispense drugs on behalf of the 340B covered entity; and
(2) "National drug code number" means the unique national drug code number that identifies a specific approved drug, its manufacturer, and its package presentation.
Added by 2021 Tenn. Acts, ch. 569, s 1, eff. 7/1/2021.
Tenn. Code Ann. § 56-10-109 — TN Code / Title 56 / Chapter 10 / Section 56-10-109
Effect of merger, consolidation or exchange of stock
Status: in_force

(a) The effect of the merger or consolidation shall be as provided in § 48-21-108 . (b) The plan of exchange and the issuance and exchange of securities provided for therein shall become effective when the agreement of exchange has been recorded by the commissioner, or upon such later date as may be specified in the agreement, which may not be later than thirty (30) days after the recording. Upon the plan of exchange becoming effective, the issuance and exchange of securities provided for therein shall be deemed to have been consummated, each shareholder of the domestic company shall cease to be a shareholder of the company and the ownership of all shares of the issued and outstanding stock of the domestic company shall vest in the acquiring corporation automatically without any physical transfer or deposit of certificates representing the shares. (c) Certificates representing shares of stock of the domestic company prior to the plan of exchange becoming effective shall, after the plan of exchange becomes effective, represent: (1) Shares of the issued and outstanding capital stock or other securities issued by the acquiring corporation; and (2) The right, if any, to receive such cash or other consideration upon such terms as shall be specified in the plan of exchange. The certificates representing shares of stock of the domestic company may, after the plan of exchange becomes effective, be exchanged for shares of stock or other securities issued by the acquiring corporation or cash or other consideration or any combination thereof upon the terms as are specified in the plan of exchange. Acts 1968, ch. 448, § 5; T.C.A., § 56-3609.
(a) The effect of the merger or consolidation shall be as provided in § 48-21-108 .
(b) The plan of exchange and the issuance and exchange of securities provided for therein shall become effective when the agreement of exchange has been recorded by the commissioner, or upon such later date as may be specified in the agreement, which may not be later than thirty (30) days after the recording. Upon the plan of exchange becoming effective, the issuance and exchange of securities provided for therein shall be deemed to have been consummated, each shareholder of the domestic company shall cease to be a shareholder of the company and the ownership of all shares of the issued and outstanding stock of the domestic company shall vest in the acquiring corporation automatically without any physical transfer or deposit of certificates representing the shares.
(c) Certificates representing shares of stock of the domestic company prior to the plan of exchange becoming effective shall, after the plan of exchange becomes effective, represent: (1) Shares of the issued and outstanding capital stock or other securities issued by the acquiring corporation; and (2) The right, if any, to receive such cash or other consideration upon such terms as shall be specified in the plan of exchange. The certificates representing shares of stock of the domestic company may, after the plan of exchange becomes effective, be exchanged for shares of stock or other securities issued by the acquiring corporation or cash or other consideration or any combination thereof upon the terms as are specified in the plan of exchange.
(1) Shares of the issued and outstanding capital stock or other securities issued by the acquiring corporation; and
(2) The right, if any, to receive such cash or other consideration upon such terms as shall be specified in the plan of exchange. The certificates representing shares of stock of the domestic company may, after the plan of exchange becomes effective, be exchanged for shares of stock or other securities issued by the acquiring corporation or cash or other consideration or any combination thereof upon the terms as are specified in the plan of exchange.
Acts 1968, ch. 448, § 5; T.C.A., § 56-3609.
Tenn. Code Ann. § 56-2-1008 — TN Code / Title 56 / Chapter 2 / Section 56-2-1008
Confidentiality
Status: in_force

(a) Documents, materials, or information in the department's control or possession that are furnished by a licensee, or an employee or agent acting on behalf of the licensee, pursuant to § 56-2-1004(9) or § 56-2-1006(b) , or that are obtained by the commissioner in connection with an investigation or examination pursuant to § 56-2-1007 : (1) Are confidential and not open for inspection by members of the public under title 10, chapter 7 or § 56-1-602 ; and (2) Are not subject to subpoena, subject to discovery, or admissible in evidence in a private civil action, except that the commissioner may use the documents, materials, or information in the furtherance of regulatory or legal action by the commissioner. (b) The commissioner, or a person who received documents, materials, or information while acting under the authority of the commissioner, is not permitted or required to testify in a private civil action concerning documents, materials, or information made confidential under subsection (a). (c) Notwithstanding subsection (a), to assist in the commissioner's duties under this part, the commissioner may: (1) Share documents, materials, or information made confidential under subsection (a) with other state, federal, or international regulatory agencies or law enforcement authorities, the national association of insurance commissioners or its affiliates or subsidiaries, or a third-party consultant or vendor of the department, as long as the recipient agrees in writing to maintain the confidential nature of the documents, materials, or information; (2) Receive documents, materials, or information, including otherwise confidential documents, materials, or information, from the national association of insurance commissioners or its affiliates or subsidiaries, or from regulatory or law enforcement officials of other foreign or domestic jurisdictions, and the commissioner must maintain as confidential any document, material, or information received with notice or the understanding that it is confidential under the laws of the source jurisdiction; and (3) Enter into agreements governing sharing and use of documents, materials, or information consistent with this subsection (c). (d) A waiver of an applicable privilege or confidentiality does not occur as a result of the disclosure of documents, materials, or information by or to the commissioner under subsection (c). (e) This part does not prohibit the commissioner from releasing final, adjudicated actions open to public inspection under title 10, chapter 7 or § 56-1-602 to a database or other clearinghouse service maintained by the national association of insurance commissioners or its affiliates or subsidiaries. Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
(a) Documents, materials, or information in the department's control or possession that are furnished by a licensee, or an employee or agent acting on behalf of the licensee, pursuant to § 56-2-1004(9) or § 56-2-1006(b) , or that are obtained by the commissioner in connection with an investigation or examination pursuant to § 56-2-1007 : (1) Are confidential and not open for inspection by members of the public under title 10, chapter 7 or § 56-1-602 ; and (2) Are not subject to subpoena, subject to discovery, or admissible in evidence in a private civil action, except that the commissioner may use the documents, materials, or information in the furtherance of regulatory or legal action by the commissioner.
(1) Are confidential and not open for inspection by members of the public under title 10, chapter 7 or § 56-1-602 ; and
(2) Are not subject to subpoena, subject to discovery, or admissible in evidence in a private civil action, except that the commissioner may use the documents, materials, or information in the furtherance of regulatory or legal action by the commissioner.
(b) The commissioner, or a person who received documents, materials, or information while acting under the authority of the commissioner, is not permitted or required to testify in a private civil action concerning documents, materials, or information made confidential under subsection (a).
(c) Notwithstanding subsection (a), to assist in the commissioner's duties under this part, the commissioner may: (1) Share documents, materials, or information made confidential under subsection (a) with other state, federal, or international regulatory agencies or law enforcement authorities, the national association of insurance commissioners or its affiliates or subsidiaries, or a third-party consultant or vendor of the department, as long as the recipient agrees in writing to maintain the confidential nature of the documents, materials, or information; (2) Receive documents, materials, or information, including otherwise confidential documents, materials, or information, from the national association of insurance commissioners or its affiliates or subsidiaries, or from regulatory or law enforcement officials of other foreign or domestic jurisdictions, and the commissioner must maintain as confidential any document, material, or information received with notice or the understanding that it is confidential under the laws of the source jurisdiction; and (3) Enter into agreements governing sharing and use of documents, materials, or information consistent with this subsection (c).
(1) Share documents, materials, or information made confidential under subsection (a) with other state, federal, or international regulatory agencies or law enforcement authorities, the national association of insurance commissioners or its affiliates or subsidiaries, or a third-party consultant or vendor of the department, as long as the recipient agrees in writing to maintain the confidential nature of the documents, materials, or information;
(2) Receive documents, materials, or information, including otherwise confidential documents, materials, or information, from the national association of insurance commissioners or its affiliates or subsidiaries, or from regulatory or law enforcement officials of other foreign or domestic jurisdictions, and the commissioner must maintain as confidential any document, material, or information received with notice or the understanding that it is confidential under the laws of the source jurisdiction; and
(3) Enter into agreements governing sharing and use of documents, materials, or information consistent with this subsection (c).
(d) A waiver of an applicable privilege or confidentiality does not occur as a result of the disclosure of documents, materials, or information by or to the commissioner under subsection (c).
(e) This part does not prohibit the commissioner from releasing final, adjudicated actions open to public inspection under title 10, chapter 7 or § 56-1-602 to a database or other clearinghouse service maintained by the national association of insurance commissioners or its affiliates or subsidiaries.
Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
Tenn. Code Ann. § 56-7-2808 — TN Code / Title 56 / Chapter 7 / Section 56-7-2808
Applicability - Determination of creditable service
Status: in_force

(a) Except as modified in this section, this part shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997. (b) Determination of creditable coverage. (1) Period of coverage. (A) Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage. (B) The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means. (2) Certifications. (A) Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996. (B) In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997. (C) In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing. (3) Transitional Rule. In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996: (A) The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and (B) A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan's or issuer's crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section. (c) (1) Except as provided in subdivision (b)(2), in the case of a group health plan maintained pursuant to one (1) or more collective bargaining agreements between employee representatives and one (1) or more employers ratified before April 30, 1997, this part shall not apply to plan years beginning before the later of the date on which the last of the collective bargaining agreements relating to the plan terminates, determined without regard to any extension of the collective bargaining agreements agreed to after April 30, 1997, or July 1, 1997. (2) Any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement of this part shall not be treated as a termination of the collective bargaining agreement. Acts 1997, ch. 157, § 9.
(a) Except as modified in this section, this part shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997.
(b) Determination of creditable coverage. (1) Period of coverage. (A) Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage. (B) The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means. (2) Certifications. (A) Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996. (B) In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997. (C) In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing. (3) Transitional Rule. In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996: (A) The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and (B) A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan's or issuer's crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section.
(1) Period of coverage. (A) Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage. (B) The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means.
(A) Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage.
(B) The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means.
(2) Certifications. (A) Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996. (B) In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997. (C) In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing.
(A) Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996.
(B) In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997.
(C) In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing.
(3) Transitional Rule. In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996: (A) The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and (B) A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan's or issuer's crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section.
(A) The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and
(B) A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan's or issuer's crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section.
(c) (1) Except as provided in subdivision (b)(2), in the case of a group health plan maintained pursuant to one (1) or more collective bargaining agreements between employee representatives and one (1) or more employers ratified before April 30, 1997, this part shall not apply to plan years beginning before the later of the date on which the last of the collective bargaining agreements relating to the plan terminates, determined without regard to any extension of the collective bargaining agreements agreed to after April 30, 1997, or July 1, 1997. (2) Any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement of this part shall not be treated as a termination of the collective bargaining agreement.
(1) Except as provided in subdivision (b)(2), in the case of a group health plan maintained pursuant to one (1) or more collective bargaining agreements between employee representatives and one (1) or more employers ratified before April 30, 1997, this part shall not apply to plan years beginning before the later of the date on which the last of the collective bargaining agreements relating to the plan terminates, determined without regard to any extension of the collective bargaining agreements agreed to after April 30, 1997, or July 1, 1997.
(2) Any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement of this part shall not be treated as a termination of the collective bargaining agreement.
Acts 1997, ch. 157, § 9.
Tenn. Code Ann. § 56-7-1120 — TN Code / Title 56 / Chapter 7 / Section 56-7-1120
Insurance coverage for car sharing programs
Status: in_force

(a) As used in this section: (1) "Car sharing delivery period" means the period of time during which a shared vehicle is being delivered to the location of the car sharing start time, if applicable, as documented by the governing car sharing program agreement; (2) "Car sharing period" means the period of time: (A) That commences with the car sharing delivery period and ends at the car sharing termination time; or (B) If there is no car sharing delivery period, that commences with the car sharing start time and ends at the car sharing termination time; (3) "Car sharing program agreement": (A) Means the terms and conditions applicable to a shared vehicle owner and a shared vehicle driver that govern the use of a shared vehicle through a peer-to-peer car sharing program; and (B) Does not mean a rental car agreement with a rental car company; (4) "Car sharing start time" means the time when the shared vehicle becomes subject to the control of the shared vehicle driver at or after the time the reservation of a shared vehicle is scheduled to begin as documented in the records of a peer-to-peer car sharing program; (5) "Car sharing termination time" means the earliest of the following events: (A) The expiration of the agreed upon period of time established for the use of a shared vehicle according to the terms of the car sharing program agreement if the shared vehicle is delivered to the location agreed upon in the car sharing program agreement; (B) When the shared vehicle is returned to a location as alternatively agreed upon by the shared vehicle owner and shared vehicle driver as communicated through a peer-to-peer car sharing program; or (C) When the shared vehicle owner, or the shared vehicle owner's authorized designee, takes possession and control of the shared vehicle; (6) "Peer-to-peer car sharing": (A) Means the authorized use of a vehicle by an individual other than the vehicle's owner through a peer-to-peer car sharing program; and (B) Does not include the services offered by a rental car company; (7) "Peer-to-peer car sharing program": (A) Means a business platform that connects vehicle owners with drivers to enable the sharing of vehicles for financial consideration; and (B) Does not include: (i) The services offered by a rental car company; or (ii) A service provider who is solely providing hardware or software as a service to a person or entity that is not effectuating payment of financial consideration for use of a shared vehicle; (8) "Rental car company" means a business engaged in the rental of motor vehicles that is subject to title 67, chapter 4, part 19, and not a peer-to-peer car sharing program; (9) "Shared vehicle": (A) Means a vehicle that is available for sharing through a peer-to-peer car sharing program; and (B) Does not mean a rental vehicle provided by a rental car company; (10) "Shared vehicle driver" means an individual who has been authorized to drive the shared vehicle by the shared vehicle owner under a car sharing program agreement; and (11) "Shared vehicle owner" means the registered owner, or a person or entity designated by the registered owner, of a vehicle made available for sharing to shared vehicle drivers through a peer-to-peer car sharing program. (b) An authorized insurer that writes motor vehicle liability insurance in the state may exclude any and all coverage and the duty to defend or indemnify for any claim afforded under a shared vehicle owner's motor vehicle liability insurance policy, including, but not limited to: (1) Liability coverage for bodily injury and property damage; (2) Uninsured and underinsured motorist coverage; (3) Medical payments coverage; (4) Comprehensive physical damage coverage; and (5) Collision physical damage coverage. (c) The exclusions in subsection (b) apply notwithstanding any requirement in this title or title 55, chapter 12. This section does not require that a personal automobile insurance policy provide coverage during a car sharing period. (d) Automobile insurers that exclude coverage as described in subsection (b) have no duty to defend or indemnify any claim expressly excluded. This section and title 55, chapter 12, do not invalidate or limit an exclusion contained in the policy, including any policy in use or approved for use in this state prior to January 1, 2021, that excludes coverage for vehicles that are rented or that are engaged in a commercial use. (e) A motor vehicle insurer that defends or indemnifies a claim against a shared vehicle that is excluded or not covered under the terms of its policy may seek contribution from any other motor vehicle insurer providing coverage required by § 55-12-302(d) , except to the extent the shared vehicle is excluded or not covered under the terms of the other policy. (f) In a claims investigation involving a shared vehicle, the insurer of the peer-to-peer car sharing program, the insurer of the shared vehicle owner, and the insurer of the shared vehicle driver shall cooperate with each other to facilitate the exchange of relevant information, including, without limitation, records that the peer-to-peer car sharing program is required to collect under title 55, chapter 12, part 3. The insurer of the peer-to-peer car sharing program, the insurer of the shared vehicle owner, and the insurer of a shared vehicle driver shall disclose to each other a clear description of the coverage, exclusions, and limits provided in their respective policies. (g) (1) Notwithstanding any other law, statute, or rule to the contrary, a peer-to-peer car sharing program has an insurable interest in a shared vehicle during the car sharing period. (2) This section does not create liability on a peer-to-peer car sharing program to maintain insurance coverage beyond the extent mandated by § 55-12-302 . (3) A peer-to-peer car sharing program may own and maintain as the named insured one (1) or more policies of motor vehicle liability insurance that provides coverage for: (A) Liabilities assumed by the peer-to-peer car sharing program under a peer-to-peer car sharing program agreement; (B) Any liability of the shared vehicle owner; or (C) Damage or loss to the shared motor vehicle or any liability of the shared vehicle driver. (h) This section does not preclude an insurer from providing coverage for a peer-to-peer car sharing program or a shared vehicle owner, if it chooses to do so by contract or endorsement. Added by 2020 Tenn. Acts, ch. 796, s 6, eff. 7/15/2020.
(a) As used in this section: (1) "Car sharing delivery period" means the period of time during which a shared vehicle is being delivered to the location of the car sharing start time, if applicable, as documented by the governing car sharing program agreement; (2) "Car sharing period" means the period of time: (A) That commences with the car sharing delivery period and ends at the car sharing termination time; or (B) If there is no car sharing delivery period, that commences with the car sharing start time and ends at the car sharing termination time; (3) "Car sharing program agreement": (A) Means the terms and conditions applicable to a shared vehicle owner and a shared vehicle driver that govern the use of a shared vehicle through a peer-to-peer car sharing program; and (B) Does not mean a rental car agreement with a rental car company; (4) "Car sharing start time" means the time when the shared vehicle becomes subject to the control of the shared vehicle driver at or after the time the reservation of a shared vehicle is scheduled to begin as documented in the records of a peer-to-peer car sharing program; (5) "Car sharing termination time" means the earliest of the following events: (A) The expiration of the agreed upon period of time established for the use of a shared vehicle according to the terms of the car sharing program agreement if the shared vehicle is delivered to the location agreed upon in the car sharing program agreement; (B) When the shared vehicle is returned to a location as alternatively agreed upon by the shared vehicle owner and shared vehicle driver as communicated through a peer-to-peer car sharing program; or (C) When the shared vehicle owner, or the shared vehicle owner's authorized designee, takes possession and control of the shared vehicle; (6) "Peer-to-peer car sharing": (A) Means the authorized use of a vehicle by an individual other than the vehicle's owner through a peer-to-peer car sharing program; and (B) Does not include the services offered by a rental car company; (7) "Peer-to-peer car sharing program": (A) Means a business platform that connects vehicle owners with drivers to enable the sharing of vehicles for financial consideration; and (B) Does not include: (i) The services offered by a rental car company; or (ii) A service provider who is solely providing hardware or software as a service to a person or entity that is not effectuating payment of financial consideration for use of a shared vehicle; (8) "Rental car company" means a business engaged in the rental of motor vehicles that is subject to title 67, chapter 4, part 19, and not a peer-to-peer car sharing program; (9) "Shared vehicle": (A) Means a vehicle that is available for sharing through a peer-to-peer car sharing program; and (B) Does not mean a rental vehicle provided by a rental car company; (10) "Shared vehicle driver" means an individual who has been authorized to drive the shared vehicle by the shared vehicle owner under a car sharing program agreement; and (11) "Shared vehicle owner" means the registered owner, or a person or entity designated by the registered owner, of a vehicle made available for sharing to shared vehicle drivers through a peer-to-peer car sharing program.
(1) "Car sharing delivery period" means the period of time during which a shared vehicle is being delivered to the location of the car sharing start time, if applicable, as documented by the governing car sharing program agreement;
(2) "Car sharing period" means the period of time: (A) That commences with the car sharing delivery period and ends at the car sharing termination time; or (B) If there is no car sharing delivery period, that commences with the car sharing start time and ends at the car sharing termination time;
(A) That commences with the car sharing delivery period and ends at the car sharing termination time; or
(B) If there is no car sharing delivery period, that commences with the car sharing start time and ends at the car sharing termination time;
(3) "Car sharing program agreement": (A) Means the terms and conditions applicable to a shared vehicle owner and a shared vehicle driver that govern the use of a shared vehicle through a peer-to-peer car sharing program; and (B) Does not mean a rental car agreement with a rental car company;
(A) Means the terms and conditions applicable to a shared vehicle owner and a shared vehicle driver that govern the use of a shared vehicle through a peer-to-peer car sharing program; and
(B) Does not mean a rental car agreement with a rental car company;
(4) "Car sharing start time" means the time when the shared vehicle becomes subject to the control of the shared vehicle driver at or after the time the reservation of a shared vehicle is scheduled to begin as documented in the records of a peer-to-peer car sharing program;
(5) "Car sharing termination time" means the earliest of the following events: (A) The expiration of the agreed upon period of time established for the use of a shared vehicle according to the terms of the car sharing program agreement if the shared vehicle is delivered to the location agreed upon in the car sharing program agreement; (B) When the shared vehicle is returned to a location as alternatively agreed upon by the shared vehicle owner and shared vehicle driver as communicated through a peer-to-peer car sharing program; or (C) When the shared vehicle owner, or the shared vehicle owner's authorized designee, takes possession and control of the shared vehicle;
(A) The expiration of the agreed upon period of time established for the use of a shared vehicle according to the terms of the car sharing program agreement if the shared vehicle is delivered to the location agreed upon in the car sharing program agreement;
(B) When the shared vehicle is returned to a location as alternatively agreed upon by the shared vehicle owner and shared vehicle driver as communicated through a peer-to-peer car sharing program; or
(C) When the shared vehicle owner, or the shared vehicle owner's authorized designee, takes possession and control of the shared vehicle;
(6) "Peer-to-peer car sharing": (A) Means the authorized use of a vehicle by an individual other than the vehicle's owner through a peer-to-peer car sharing program; and (B) Does not include the services offered by a rental car company;
(A) Means the authorized use of a vehicle by an individual other than the vehicle's owner through a peer-to-peer car sharing program; and
(B) Does not include the services offered by a rental car company;
(7) "Peer-to-peer car sharing program": (A) Means a business platform that connects vehicle owners with drivers to enable the sharing of vehicles for financial consideration; and (B) Does not include: (i) The services offered by a rental car company; or (ii) A service provider who is solely providing hardware or software as a service to a person or entity that is not effectuating payment of financial consideration for use of a shared vehicle;
(A) Means a business platform that connects vehicle owners with drivers to enable the sharing of vehicles for financial consideration; and
(B) Does not include: (i) The services offered by a rental car company; or (ii) A service provider who is solely providing hardware or software as a service to a person or entity that is not effectuating payment of financial consideration for use of a shared vehicle;
(i) The services offered by a rental car company; or
(ii) A service provider who is solely providing hardware or software as a service to a person or entity that is not effectuating payment of financial consideration for use of a shared vehicle;
(8) "Rental car company" means a business engaged in the rental of motor vehicles that is subject to title 67, chapter 4, part 19, and not a peer-to-peer car sharing program;
(9) "Shared vehicle": (A) Means a vehicle that is available for sharing through a peer-to-peer car sharing program; and (B) Does not mean a rental vehicle provided by a rental car company;
(A) Means a vehicle that is available for sharing through a peer-to-peer car sharing program; and
(B) Does not mean a rental vehicle provided by a rental car company;
(10) "Shared vehicle driver" means an individual who has been authorized to drive the shared vehicle by the shared vehicle owner under a car sharing program agreement; and
(11) "Shared vehicle owner" means the registered owner, or a person or entity designated by the registered owner, of a vehicle made available for sharing to shared vehicle drivers through a peer-to-peer car sharing program.
(b) An authorized insurer that writes motor vehicle liability insurance in the state may exclude any and all coverage and the duty to defend or indemnify for any claim afforded under a shared vehicle owner's motor vehicle liability insurance policy, including, but not limited to: (1) Liability coverage for bodily injury and property damage; (2) Uninsured and underinsured motorist coverage; (3) Medical payments coverage; (4) Comprehensive physical damage coverage; and (5) Collision physical damage coverage.
(1) Liability coverage for bodily injury and property damage;
(2) Uninsured and underinsured motorist coverage;
(3) Medical payments coverage;
(4) Comprehensive physical damage coverage; and
(5) Collision physical damage coverage.
(c) The exclusions in subsection (b) apply notwithstanding any requirement in this title or title 55, chapter 12. This section does not require that a personal automobile insurance policy provide coverage during a car sharing period.
(d) Automobile insurers that exclude coverage as described in subsection (b) have no duty to defend or indemnify any claim expressly excluded. This section and title 55, chapter 12, do not invalidate or limit an exclusion contained in the policy, including any policy in use or approved for use in this state prior to January 1, 2021, that excludes coverage for vehicles that are rented or that are engaged in a commercial use.
(e) A motor vehicle insurer that defends or indemnifies a claim against a shared vehicle that is excluded or not covered under the terms of its policy may seek contribution from any other motor vehicle insurer providing coverage required by § 55-12-302(d) , except to the extent the shared vehicle is excluded or not covered under the terms of the other policy.
(f) In a claims investigation involving a shared vehicle, the insurer of the peer-to-peer car sharing program, the insurer of the shared vehicle owner, and the insurer of the shared vehicle driver shall cooperate with each other to facilitate the exchange of relevant information, including, without limitation, records that the peer-to-peer car sharing program is required to collect under title 55, chapter 12, part 3. The insurer of the peer-to-peer car sharing program, the insurer of the shared vehicle owner, and the insurer of a shared vehicle driver shall disclose to each other a clear description of the coverage, exclusions, and limits provided in their respective policies.
(g) (1) Notwithstanding any other law, statute, or rule to the contrary, a peer-to-peer car sharing program has an insurable interest in a shared vehicle during the car sharing period. (2) This section does not create liability on a peer-to-peer car sharing program to maintain insurance coverage beyond the extent mandated by § 55-12-302 . (3) A peer-to-peer car sharing program may own and maintain as the named insured one (1) or more policies of motor vehicle liability insurance that provides coverage for: (A) Liabilities assumed by the peer-to-peer car sharing program under a peer-to-peer car sharing program agreement; (B) Any liability of the shared vehicle owner; or (C) Damage or loss to the shared motor vehicle or any liability of the shared vehicle driver.
(1) Notwithstanding any other law, statute, or rule to the contrary, a peer-to-peer car sharing program has an insurable interest in a shared vehicle during the car sharing period.
(2) This section does not create liability on a peer-to-peer car sharing program to maintain insurance coverage beyond the extent mandated by § 55-12-302 .
(3) A peer-to-peer car sharing program may own and maintain as the named insured one (1) or more policies of motor vehicle liability insurance that provides coverage for: (A) Liabilities assumed by the peer-to-peer car sharing program under a peer-to-peer car sharing program agreement; (B) Any liability of the shared vehicle owner; or (C) Damage or loss to the shared motor vehicle or any liability of the shared vehicle driver.
(A) Liabilities assumed by the peer-to-peer car sharing program under a peer-to-peer car sharing program agreement;
(B) Any liability of the shared vehicle owner; or
(C) Damage or loss to the shared motor vehicle or any liability of the shared vehicle driver.
(h) This section does not preclude an insurer from providing coverage for a peer-to-peer car sharing program or a shared vehicle owner, if it chooses to do so by contract or endorsement.
Added by 2020 Tenn. Acts, ch. 796, s 6, eff. 7/15/2020.
Tenn. Code Ann. § 56-61-107 — TN Code / Title 56 / Chapter 61 / Section 56-61-107
First level review of adverse determination
Status: in_force

(a) Within one hundred and eighty (180) days after the date of receipt of a notice of an adverse determination, an aggrieved person may file a grievance with the health carrier requesting a first level review of the adverse determination. (b) The health carrier shall provide the aggrieved person with the name and address of the organizational unit or department designated to coordinate the first level review on behalf of the health carrier. (c) (1) (A) An aggrieved person does not have the right to attend, or to have a representative in attendance at the first level review; provided, that the aggrieved person is entitled to: (i) Submit written comments, documents, records and other material relating to the request for benefits for the reviewer or reviewers to consider when conducting the review; and (ii) Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits. (B) For purposes of subdivision (c)(1)(A)(ii), a document, record or other information shall be considered relevant to an aggrieved person's request for benefits if the document, record or other information: (i) Was relied upon in making the benefit determination; (ii) Was submitted, considered or generated in the course of making the adverse determination, without regard to whether the document, record or other information was relied upon in making the benefit determination; (iii) Demonstrates that, in making the benefit determination, the health carrier or its designated representatives applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or (iv) Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied healthcare service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination. (2) The health carrier shall make the provisions of subdivision (c)(1) known to the aggrieved person within five (5) business days after the date of receipt of the grievance; provided, that the request was made to the appropriate organizational unit or department designated by the health carrier. (d) For purposes of calculating the time periods within which a determination is required to be rendered and notice provided under subsection (e), the time period shall begin on the date the grievance requesting the first level review is filed with the health carrier in accordance with the health carrier's procedures established pursuant to this section, without regard to whether all of the information necessary to make the determination accompanies the filing. (e) (1) A health carrier shall notify and issue a decision, in writing or electronically, to the aggrieved person within the timeframes provided in subdivisions (e)(2) and (3). (2) With respect to a grievance requesting a first level review of an adverse determination involving a prospective review request, the health carrier shall notify and issue a decision within a reasonable period of time that is appropriate given the covered person's medical condition, but no later than thirty (30) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a). (3) With respect to a grievance requesting a first level review of an adverse determination involving a retrospective review request, the health carrier shall notify and issue a decision within a reasonable period of time, but no later than sixty (60) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a). (f) The decision issued pursuant to subsection (e) shall set forth, in a manner calculated to be understood by the aggrieved person: (1) The titles and qualifying credentials of the person or persons participating and reviewing in the first level review; (2) A statement of each reviewer's understanding of the grievance; (3) Each reviewer's 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; (4) A reference to the evidence or documentation used as the basis for the decision; (5) For a first level review decision issued pursuant to subsection (e) involving an adverse determination: (A) The specific reason or reasons for the adverse determination; (B) A reference to the specific plan provisions on which the determination is based; (C) A statement that the aggrieved person is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant, as the term "relevant" is defined in subdivision (c)(1)(B), to the covered person's benefit request; (D) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion 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 that a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request and the date such policy was effective; (E) If the adverse determination is based on medical necessity, either 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; and (F) If applicable, instructions for requesting: (i) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination, as provided in subdivision (f)(5)(D); and (ii) The written statement of the criteria for the determination, as provided in subdivision (f)(5)(E); (6) If applicable, a statement indicating: (A) A description of the process to obtain a second level review of the first level review's decision involving an adverse determination, if the aggrieved person wishes to request a second level review pursuant to § 56-61-108 ; (B) The written procedures governing the second level review, including any required timeframe for the review; and (C) A description of the procedures for obtaining an external review of the adverse determination pursuant to this chapter if the aggrieved person decides not to file for a second review of the first level review's decision involving an adverse determination. Acts 2010, ch. 980, § 8.
(a) Within one hundred and eighty (180) days after the date of receipt of a notice of an adverse determination, an aggrieved person may file a grievance with the health carrier requesting a first level review of the adverse determination.
(b) The health carrier shall provide the aggrieved person with the name and address of the organizational unit or department designated to coordinate the first level review on behalf of the health carrier.
(c) (1) (A) An aggrieved person does not have the right to attend, or to have a representative in attendance at the first level review; provided, that the aggrieved person is entitled to: (i) Submit written comments, documents, records and other material relating to the request for benefits for the reviewer or reviewers to consider when conducting the review; and (ii) Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits. (B) For purposes of subdivision (c)(1)(A)(ii), a document, record or other information shall be considered relevant to an aggrieved person's request for benefits if the document, record or other information: (i) Was relied upon in making the benefit determination; (ii) Was submitted, considered or generated in the course of making the adverse determination, without regard to whether the document, record or other information was relied upon in making the benefit determination; (iii) Demonstrates that, in making the benefit determination, the health carrier or its designated representatives applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or (iv) Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied healthcare service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination. (2) The health carrier shall make the provisions of subdivision (c)(1) known to the aggrieved person within five (5) business days after the date of receipt of the grievance; provided, that the request was made to the appropriate organizational unit or department designated by the health carrier.
(1) (A) An aggrieved person does not have the right to attend, or to have a representative in attendance at the first level review; provided, that the aggrieved person is entitled to: (i) Submit written comments, documents, records and other material relating to the request for benefits for the reviewer or reviewers to consider when conducting the review; and (ii) Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits. (B) For purposes of subdivision (c)(1)(A)(ii), a document, record or other information shall be considered relevant to an aggrieved person's request for benefits if the document, record or other information: (i) Was relied upon in making the benefit determination; (ii) Was submitted, considered or generated in the course of making the adverse determination, without regard to whether the document, record or other information was relied upon in making the benefit determination; (iii) Demonstrates that, in making the benefit determination, the health carrier or its designated representatives applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or (iv) Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied healthcare service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination.
(A) An aggrieved person does not have the right to attend, or to have a representative in attendance at the first level review; provided, that the aggrieved person is entitled to: (i) Submit written comments, documents, records and other material relating to the request for benefits for the reviewer or reviewers to consider when conducting the review; and (ii) Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits.
(i) Submit written comments, documents, records and other material relating to the request for benefits for the reviewer or reviewers to consider when conducting the review; and
(ii) Receive from the health carrier, upon request and free of charge, reasonable access to, and copies of all documents, records and other information relevant to the covered person's request for benefits.
(B) For purposes of subdivision (c)(1)(A)(ii), a document, record or other information shall be considered relevant to an aggrieved person's request for benefits if the document, record or other information: (i) Was relied upon in making the benefit determination; (ii) Was submitted, considered or generated in the course of making the adverse determination, without regard to whether the document, record or other information was relied upon in making the benefit determination; (iii) Demonstrates that, in making the benefit determination, the health carrier or its designated representatives applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or (iv) Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied healthcare service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination.
(i) Was relied upon in making the benefit determination;
(ii) Was submitted, considered or generated in the course of making the adverse determination, without regard to whether the document, record or other information was relied upon in making the benefit determination;
(iii) Demonstrates that, in making the benefit determination, the health carrier or its designated representatives applied required administrative procedures and safeguards with respect to the covered person as other similarly situated covered persons; or
(iv) Constitutes a statement of policy or guidance with respect to the health benefit plan concerning the denied healthcare service or treatment for the covered person's diagnosis, without regard to whether the advice or statement was relied upon in making the benefit determination.
(2) The health carrier shall make the provisions of subdivision (c)(1) known to the aggrieved person within five (5) business days after the date of receipt of the grievance; provided, that the request was made to the appropriate organizational unit or department designated by the health carrier.
(d) For purposes of calculating the time periods within which a determination is required to be rendered and notice provided under subsection (e), the time period shall begin on the date the grievance requesting the first level review is filed with the health carrier in accordance with the health carrier's procedures established pursuant to this section, without regard to whether all of the information necessary to make the determination accompanies the filing.
(e) (1) A health carrier shall notify and issue a decision, in writing or electronically, to the aggrieved person within the timeframes provided in subdivisions (e)(2) and (3). (2) With respect to a grievance requesting a first level review of an adverse determination involving a prospective review request, the health carrier shall notify and issue a decision within a reasonable period of time that is appropriate given the covered person's medical condition, but no later than thirty (30) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a). (3) With respect to a grievance requesting a first level review of an adverse determination involving a retrospective review request, the health carrier shall notify and issue a decision within a reasonable period of time, but no later than sixty (60) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a).
(1) A health carrier shall notify and issue a decision, in writing or electronically, to the aggrieved person within the timeframes provided in subdivisions (e)(2) and (3).
(2) With respect to a grievance requesting a first level review of an adverse determination involving a prospective review request, the health carrier shall notify and issue a decision within a reasonable period of time that is appropriate given the covered person's medical condition, but no later than thirty (30) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a).
(3) With respect to a grievance requesting a first level review of an adverse determination involving a retrospective review request, the health carrier shall notify and issue a decision within a reasonable period of time, but no later than sixty (60) days after the date of the health carrier's receipt of the grievance requesting the first level review made pursuant to subsection (a).
(f) The decision issued pursuant to subsection (e) shall set forth, in a manner calculated to be understood by the aggrieved person: (1) The titles and qualifying credentials of the person or persons participating and reviewing in the first level review; (2) A statement of each reviewer's understanding of the grievance; (3) Each reviewer's 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; (4) A reference to the evidence or documentation used as the basis for the decision; (5) For a first level review decision issued pursuant to subsection (e) involving an adverse determination: (A) The specific reason or reasons for the adverse determination; (B) A reference to the specific plan provisions on which the determination is based; (C) A statement that the aggrieved person is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant, as the term "relevant" is defined in subdivision (c)(1)(B), to the covered person's benefit request; (D) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion 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 that a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request and the date such policy was effective; (E) If the adverse determination is based on medical necessity, either 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; and (F) If applicable, instructions for requesting: (i) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination, as provided in subdivision (f)(5)(D); and (ii) The written statement of the criteria for the determination, as provided in subdivision (f)(5)(E); (6) If applicable, a statement indicating: (A) A description of the process to obtain a second level review of the first level review's decision involving an adverse determination, if the aggrieved person wishes to request a second level review pursuant to § 56-61-108 ; (B) The written procedures governing the second level review, including any required timeframe for the review; and (C) A description of the procedures for obtaining an external review of the adverse determination pursuant to this chapter if the aggrieved person decides not to file for a second review of the first level review's decision involving an adverse determination.
(1) The titles and qualifying credentials of the person or persons participating and reviewing in the first level review;
(2) A statement of each reviewer's understanding of the grievance;
(3) Each reviewer's 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;
(4) A reference to the evidence or documentation used as the basis for the decision;
(5) For a first level review decision issued pursuant to subsection (e) involving an adverse determination: (A) The specific reason or reasons for the adverse determination; (B) A reference to the specific plan provisions on which the determination is based; (C) A statement that the aggrieved person is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant, as the term "relevant" is defined in subdivision (c)(1)(B), to the covered person's benefit request; (D) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion 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 that a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request and the date such policy was effective; (E) If the adverse determination is based on medical necessity, either 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; and (F) If applicable, instructions for requesting: (i) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination, as provided in subdivision (f)(5)(D); and (ii) The written statement of the criteria for the determination, as provided in subdivision (f)(5)(E);
(A) The specific reason or reasons for the adverse determination;
(B) A reference to the specific plan provisions on which the determination is based;
(C) A statement that the aggrieved person is entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant, as the term "relevant" is defined in subdivision (c)(1)(B), to the covered person's benefit request;
(D) If the health carrier relied upon an internal rule, guideline, protocol or other similar criterion 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 that a copy of the rule, guideline, protocol or other similar criterion will be provided free of charge to the aggrieved person upon request and the date such policy was effective;
(E) If the adverse determination is based on medical necessity, either 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; and
(F) If applicable, instructions for requesting: (i) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination, as provided in subdivision (f)(5)(D); and (ii) The written statement of the criteria for the determination, as provided in subdivision (f)(5)(E);
(i) A copy of the rule, guideline, protocol or other similar criterion relied upon in making the adverse determination, as provided in subdivision (f)(5)(D); and
(ii) The written statement of the criteria for the determination, as provided in subdivision (f)(5)(E);
(6) If applicable, a statement indicating: (A) A description of the process to obtain a second level review of the first level review's decision involving an adverse determination, if the aggrieved person wishes to request a second level review pursuant to § 56-61-108 ; (B) The written procedures governing the second level review, including any required timeframe for the review; and (C) A description of the procedures for obtaining an external review of the adverse determination pursuant to this chapter if the aggrieved person decides not to file for a second review of the first level review's decision involving an adverse determination.
(A) A description of the process to obtain a second level review of the first level review's decision involving an adverse determination, if the aggrieved person wishes to request a second level review pursuant to § 56-61-108 ;
(B) The written procedures governing the second level review, including any required timeframe for the review; and
(C) A description of the procedures for obtaining an external review of the adverse determination pursuant to this chapter if the aggrieved person decides not to file for a second review of the first level review's decision involving an adverse determination.
Acts 2010, ch. 980, § 8.
Tenn. Code Ann. § 56-25-105 — TN Code / Title 56 / Chapter 25 / Section 56-25-105
Operation for benefit of members - Powers
Status: in_force

(a) A society shall operate for the benefit of members and their beneficiaries by: (1) Providing benefits as specified in § 56-25-1401; and (2) Operating for one (1) or more social, intellectual, educational, charitable, benevolent, moral, fraternal, patriotic or religious purposes for the benefit of its members, which may also be extended to others. The purposes may be carried out directly by the society, or indirectly through subsidiary corporations or affiliated organizations. (b) Every society has the power to adopt laws and rules for the government of the society, the admission of its members, and the management of its affairs. It has the power to change, alter, add to or amend the laws and rules and has such other powers as are necessary and incidental to carrying into effect the objects and purposes of the society. (c) The commissioner may require any society to furnish facts and figures disclosing expenditures made by the society under subdivision (a)(2). Acts 1990, ch. 703, § 1.
(a) A society shall operate for the benefit of members and their beneficiaries by: (1) Providing benefits as specified in § 56-25-1401; and (2) Operating for one (1) or more social, intellectual, educational, charitable, benevolent, moral, fraternal, patriotic or religious purposes for the benefit of its members, which may also be extended to others. The purposes may be carried out directly by the society, or indirectly through subsidiary corporations or affiliated organizations.
(1) Providing benefits as specified in § 56-25-1401; and
(2) Operating for one (1) or more social, intellectual, educational, charitable, benevolent, moral, fraternal, patriotic or religious purposes for the benefit of its members, which may also be extended to others. The purposes may be carried out directly by the society, or indirectly through subsidiary corporations or affiliated organizations.
(b) Every society has the power to adopt laws and rules for the government of the society, the admission of its members, and the management of its affairs. It has the power to change, alter, add to or amend the laws and rules and has such other powers as are necessary and incidental to carrying into effect the objects and purposes of the society.
(c) The commissioner may require any society to furnish facts and figures disclosing expenditures made by the society under subdivision (a)(2).
Acts 1990, ch. 703, § 1.
Tenn. Code Ann. § 56-53-109 — TN Code / Title 56 / Chapter 53 / Section 56-53-109
Cooperation
Status: in_force

(a) When any law enforcement official or authority, any insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority requests information from an insurer or insurance professional for the purpose of detecting, prosecuting or preventing insurance fraud, the insurer or insurance professional shall take all reasonable actions to provide the information requested, subject to any legal privilege protecting the information. (b) Any insurer or insurance professional who has reasonable belief that an act violating § 56-53-102 or § 56-53-103 will be, is being, or has been committed shall furnish and disclose any information in the insurance professional's possession concerning the act to the appropriate law enforcement official or authority, insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority, subject to any legal privilege protecting the information. In no case shall the information be required by subpoena or otherwise to be given to the person alleged to have committed a violation, unless in possession of an insurer and that insurer used the information to deny a claim of the person, in whole or in part. (c) All documents or other information submitted to or generated by a law enforcement, regulatory, licensing or other governmental agency pursuant to subsection (a) or (b) shall not be subject to disclosure pursuant to the public records laws, codified in title 10, chapter 7, and shall be confidential unless disclosed by the law enforcement, regulatory, licensing or other governmental agency at the agency's sole discretion. (d) Any person who has a reasonable belief that an act violating this chapter will be, is being, or has been committed, or any person who collects, reviews or analyzes information concerning insurance fraud may furnish and disclose any information in the person's possession concerning the act to an authorized representative of an insurer who requests the information for the purpose of detecting, prosecuting or preventing insurance fraud. (e) Failure to cooperate with a request for information from an appropriate local, state or federal governmental authority shall bar a person's eligibility for restitution from any proceeds resulting from the governmental investigation and prosecution. This subsection (e) shall not be construed as limiting the ability of any governmental authority from imposing lawful civil discipline upon a person or entity that fails to cooperate with a request for information as delineated in this subsection (e). Acts 2001, ch. 356, § 10.
(a) When any law enforcement official or authority, any insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority requests information from an insurer or insurance professional for the purpose of detecting, prosecuting or preventing insurance fraud, the insurer or insurance professional shall take all reasonable actions to provide the information requested, subject to any legal privilege protecting the information.
(b) Any insurer or insurance professional who has reasonable belief that an act violating § 56-53-102 or § 56-53-103 will be, is being, or has been committed shall furnish and disclose any information in the insurance professional's possession concerning the act to the appropriate law enforcement official or authority, insurance department, state division of insurance fraud, or state or federal regulatory or licensing authority, subject to any legal privilege protecting the information. In no case shall the information be required by subpoena or otherwise to be given to the person alleged to have committed a violation, unless in possession of an insurer and that insurer used the information to deny a claim of the person, in whole or in part.
(c) All documents or other information submitted to or generated by a law enforcement, regulatory, licensing or other governmental agency pursuant to subsection (a) or (b) shall not be subject to disclosure pursuant to the public records laws, codified in title 10, chapter 7, and shall be confidential unless disclosed by the law enforcement, regulatory, licensing or other governmental agency at the agency's sole discretion.
(d) Any person who has a reasonable belief that an act violating this chapter will be, is being, or has been committed, or any person who collects, reviews or analyzes information concerning insurance fraud may furnish and disclose any information in the person's possession concerning the act to an authorized representative of an insurer who requests the information for the purpose of detecting, prosecuting or preventing insurance fraud.
(e) Failure to cooperate with a request for information from an appropriate local, state or federal governmental authority shall bar a person's eligibility for restitution from any proceeds resulting from the governmental investigation and prosecution. This subsection (e) shall not be construed as limiting the ability of any governmental authority from imposing lawful civil discipline upon a person or entity that fails to cooperate with a request for information as delineated in this subsection (e).
Acts 2001, ch. 356, § 10.
Tenn. Code Ann. § 56-7-1901 — TN Code / Title 56 / Chapter 7 / Section 56-7-1901
Notice of intention not to renew
Status: in_force

Except as provided in § 56-7-1304 , if an insurance company does not intend to renew a contract of any kind of personal risk insurance identified in § 56-5-102 , the company shall mail or deliver to the named insured, at the address shown in the policy, notice of its intention not to renew at least thirty (30) days prior to the expiration of the policy. Acts 1989, ch. 157, § 1; 2003, ch. 215, § 4.
Except as provided in § 56-7-1304 , if an insurance company does not intend to renew a contract of any kind of personal risk insurance identified in § 56-5-102 , the company shall mail or deliver to the named insured, at the address shown in the policy, notice of its intention not to renew at least thirty (30) days prior to the expiration of the policy.
Acts 1989, ch. 157, § 1; 2003, ch. 215, § 4.
Tenn. Code Ann. § 56-12-211 — TN Code / Title 56 / Chapter 12 / Section 56-12-211
Detection and prevention of insurer insolvencies and impairments
Status: in_force

(a) To aid in the detection and prevention of insurer insolvencies or impairments, it shall be the duty of the commissioner to: (1) Notify the commissioner of insurance, or other appropriate official, of all the other states, territories of the United States and the District of Columbia, when the commissioner takes any of the following actions against a member insurer: (A) Revocation of license; (B) Suspension of license; or (C) Makes any formal order that such company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policyholders or creditors. Such notice shall be mailed to all such commissioners or other appropriate officials within thirty (30) days following the action taken or the date on which such action occurs; (2) Report to the board of directors when the commissioner has taken any of the actions set forth in subdivision (a)(1), or has received a report from any other commissioner indicating that any such action has been taken in another state. Such report to the board of directors shall contain all significant details of the action taken or the report received from another commissioner or other appropriate official; (3) Report to the board of directors when the commissioner has reasonable cause to believe from any examination, whether completed or in process, of any member company, that such company may be an impaired or insolvent insurer; and (4) Furnish to the board of directors of the National Association of Insurance Commissioners, insurance regulatory information system ratios and listings of companies not included in the ratios developed by the National Association of Insurance Commissioners. The board may then use the information contained therein in carrying out its duties and responsibilities under this section. Such report and the information contained in the report shall be kept confidential by the board of directors, until such time as made public by the commissioner or other lawful authority. (b) The commissioner may seek the advice and recommendations of the board of directors concerning any matter affecting the duties and responsibilities of the commissioner regarding the financial condition of member insurers and companies seeking admission to transact insurance business in this state. (c) The board of directors may, upon majority vote, make reports and recommendations to the commissioner upon any matter relative to the solvency, liquidation, rehabilitation or conservation of any member insurer or relative to the solvency of any company seeking to transact insurance business in this state. Such reports and recommendations shall not be considered public documents. (d) It is the duty of the board of directors, upon majority vote, to notify the commissioner of any information indicating any member insurer may be an impaired or insolvent insurer. (e) (1) The board of directors may, upon majority vote, request that the commissioner order an examination of any member insurer that the board in good faith believes may be an impaired or insolvent insurer. Within thirty (30) days of the receipt of such request, the commissioner shall begin such examination. The examination may be conducted as a National Association of Insurance Commissioners examination or may be conducted by such persons as the commissioner designates. The cost of such examination shall be paid by the association and the examination report shall be treated as are other examination reports. In no event shall such examination report be released to the board of directors prior to its release to the public, but this shall not preclude the commissioner from complying with subsection (a). (2) The commissioner shall notify the board of directors when the examination is completed. The request for an examination shall be kept on file by the commissioner, but it shall not be open to public inspection prior to the release of the examination report to the public. (f) The board of directors may, upon majority vote, make recommendations to the commissioner for the detection and prevention of insurer insolvencies. (g) The board of directors shall, at the conclusion of any insurer insolvency in which the association was obligated to pay covered claims, prepare a report to the commissioner containing such information as it may have in its possession relative to the history and causes of such insolvency. The board shall cooperate with the boards of directors of guaranty associations in other states in preparing a report on the history and causes of insolvency of a particular insurer, and may adopt by reference any report prepared by such other associations. Acts 1988, ch. 1032, § 11.
(a) To aid in the detection and prevention of insurer insolvencies or impairments, it shall be the duty of the commissioner to: (1) Notify the commissioner of insurance, or other appropriate official, of all the other states, territories of the United States and the District of Columbia, when the commissioner takes any of the following actions against a member insurer: (A) Revocation of license; (B) Suspension of license; or (C) Makes any formal order that such company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policyholders or creditors. Such notice shall be mailed to all such commissioners or other appropriate officials within thirty (30) days following the action taken or the date on which such action occurs; (2) Report to the board of directors when the commissioner has taken any of the actions set forth in subdivision (a)(1), or has received a report from any other commissioner indicating that any such action has been taken in another state. Such report to the board of directors shall contain all significant details of the action taken or the report received from another commissioner or other appropriate official; (3) Report to the board of directors when the commissioner has reasonable cause to believe from any examination, whether completed or in process, of any member company, that such company may be an impaired or insolvent insurer; and (4) Furnish to the board of directors of the National Association of Insurance Commissioners, insurance regulatory information system ratios and listings of companies not included in the ratios developed by the National Association of Insurance Commissioners. The board may then use the information contained therein in carrying out its duties and responsibilities under this section. Such report and the information contained in the report shall be kept confidential by the board of directors, until such time as made public by the commissioner or other lawful authority.
(1) Notify the commissioner of insurance, or other appropriate official, of all the other states, territories of the United States and the District of Columbia, when the commissioner takes any of the following actions against a member insurer: (A) Revocation of license; (B) Suspension of license; or (C) Makes any formal order that such company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policyholders or creditors. Such notice shall be mailed to all such commissioners or other appropriate officials within thirty (30) days following the action taken or the date on which such action occurs;
(A) Revocation of license;
(B) Suspension of license; or
(C) Makes any formal order that such company restrict its premium writing, obtain additional contributions to surplus, withdraw from the state, reinsure all or any part of its business, or increase capital, surplus, or any other account for the security of policyholders or creditors. Such notice shall be mailed to all such commissioners or other appropriate officials within thirty (30) days following the action taken or the date on which such action occurs;
Such notice shall be mailed to all such commissioners or other appropriate officials within thirty (30) days following the action taken or the date on which such action occurs;
(2) Report to the board of directors when the commissioner has taken any of the actions set forth in subdivision (a)(1), or has received a report from any other commissioner indicating that any such action has been taken in another state. Such report to the board of directors shall contain all significant details of the action taken or the report received from another commissioner or other appropriate official;
(3) Report to the board of directors when the commissioner has reasonable cause to believe from any examination, whether completed or in process, of any member company, that such company may be an impaired or insolvent insurer; and
(4) Furnish to the board of directors of the National Association of Insurance Commissioners, insurance regulatory information system ratios and listings of companies not included in the ratios developed by the National Association of Insurance Commissioners. The board may then use the information contained therein in carrying out its duties and responsibilities under this section. Such report and the information contained in the report shall be kept confidential by the board of directors, until such time as made public by the commissioner or other lawful authority.
(b) The commissioner may seek the advice and recommendations of the board of directors concerning any matter affecting the duties and responsibilities of the commissioner regarding the financial condition of member insurers and companies seeking admission to transact insurance business in this state.
(c) The board of directors may, upon majority vote, make reports and recommendations to the commissioner upon any matter relative to the solvency, liquidation, rehabilitation or conservation of any member insurer or relative to the solvency of any company seeking to transact insurance business in this state. Such reports and recommendations shall not be considered public documents.
(d) It is the duty of the board of directors, upon majority vote, to notify the commissioner of any information indicating any member insurer may be an impaired or insolvent insurer.
(e) (1) The board of directors may, upon majority vote, request that the commissioner order an examination of any member insurer that the board in good faith believes may be an impaired or insolvent insurer. Within thirty (30) days of the receipt of such request, the commissioner shall begin such examination. The examination may be conducted as a National Association of Insurance Commissioners examination or may be conducted by such persons as the commissioner designates. The cost of such examination shall be paid by the association and the examination report shall be treated as are other examination reports. In no event shall such examination report be released to the board of directors prior to its release to the public, but this shall not preclude the commissioner from complying with subsection (a). (2) The commissioner shall notify the board of directors when the examination is completed. The request for an examination shall be kept on file by the commissioner, but it shall not be open to public inspection prior to the release of the examination report to the public.
(1) The board of directors may, upon majority vote, request that the commissioner order an examination of any member insurer that the board in good faith believes may be an impaired or insolvent insurer. Within thirty (30) days of the receipt of such request, the commissioner shall begin such examination. The examination may be conducted as a National Association of Insurance Commissioners examination or may be conducted by such persons as the commissioner designates. The cost of such examination shall be paid by the association and the examination report shall be treated as are other examination reports. In no event shall such examination report be released to the board of directors prior to its release to the public, but this shall not preclude the commissioner from complying with subsection (a).
(2) The commissioner shall notify the board of directors when the examination is completed. The request for an examination shall be kept on file by the commissioner, but it shall not be open to public inspection prior to the release of the examination report to the public.
(f) The board of directors may, upon majority vote, make recommendations to the commissioner for the detection and prevention of insurer insolvencies.
(g) The board of directors shall, at the conclusion of any insurer insolvency in which the association was obligated to pay covered claims, prepare a report to the commissioner containing such information as it may have in its possession relative to the history and causes of such insolvency. The board shall cooperate with the boards of directors of guaranty associations in other states in preparing a report on the history and causes of insolvency of a particular insurer, and may adopt by reference any report prepared by such other associations.
Acts 1988, ch. 1032, § 11.
Tenn. Code Ann. § 56-45-108 — TN Code / Title 56 / Chapter 45 / Section 56-45-108
Purchasing groups - Requirements for doing business in this state
Status: in_force

(a) A purchasing group that intends to do business in this state shall, prior to doing business, furnish notice to the commissioner, which notice shall: (1) Identify the state in which the group is domiciled; (2) Identify all other states in which the group intends to do business; (3) Specify the lines and classifications of liability insurance that the purchasing group intends to purchase; (4) Identify the insurance company or companies from which the group intends to purchase its insurance and the domicile of the company; (5) Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state; (6) Identify the principal place of business of the group; and (7) Provide other information that may be required by the commissioner to verify that the purchasing group is qualified under § 56-45-102(10) . (b) A purchasing group shall, within ten (10) days, notify the commissioner of any changes in any of the items set forth in subsection (a). (c) The purchasing group shall register with and designate the commissioner, or other appropriate authority, as its agent, solely for the purpose of receiving service of legal documents or process, for which a filing fee shall be determined by the commissioner, except that the requirements do not apply in the case of a purchasing group that only purchases insurance that was authorized under the federal Products Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), and: (1) That in any state of the United States: (A) Was domiciled before April 1, 1986; and (B) Is domiciled on and after October 27, 1986; (2) That: (A) Before October 27, 1986, purchased insurance from an insurance carrier licensed in any state; and (B) Since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state; or (3) That was a purchasing group under the requirements of the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before October 27, 1986. (d) Each purchasing group that is required to give notice pursuant to subsection (a) shall also furnish such information as may be required by the commissioner to: (1) Verify that the entity qualifies as a purchasing group; (2) Determine where the purchasing group is located; and (3) Determine appropriate tax treatment. Acts 1991, ch. 142, § 6.
(a) A purchasing group that intends to do business in this state shall, prior to doing business, furnish notice to the commissioner, which notice shall: (1) Identify the state in which the group is domiciled; (2) Identify all other states in which the group intends to do business; (3) Specify the lines and classifications of liability insurance that the purchasing group intends to purchase; (4) Identify the insurance company or companies from which the group intends to purchase its insurance and the domicile of the company; (5) Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state; (6) Identify the principal place of business of the group; and (7) Provide other information that may be required by the commissioner to verify that the purchasing group is qualified under § 56-45-102(10) .
(1) Identify the state in which the group is domiciled;
(2) Identify all other states in which the group intends to do business;
(3) Specify the lines and classifications of liability insurance that the purchasing group intends to purchase;
(4) Identify the insurance company or companies from which the group intends to purchase its insurance and the domicile of the company;
(5) Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this state;
(6) Identify the principal place of business of the group; and
(7) Provide other information that may be required by the commissioner to verify that the purchasing group is qualified under § 56-45-102(10) .
(b) A purchasing group shall, within ten (10) days, notify the commissioner of any changes in any of the items set forth in subsection (a).
(c) The purchasing group shall register with and designate the commissioner, or other appropriate authority, as its agent, solely for the purpose of receiving service of legal documents or process, for which a filing fee shall be determined by the commissioner, except that the requirements do not apply in the case of a purchasing group that only purchases insurance that was authorized under the federal Products Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), and: (1) That in any state of the United States: (A) Was domiciled before April 1, 1986; and (B) Is domiciled on and after October 27, 1986; (2) That: (A) Before October 27, 1986, purchased insurance from an insurance carrier licensed in any state; and (B) Since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state; or (3) That was a purchasing group under the requirements of the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before October 27, 1986.
(1) That in any state of the United States: (A) Was domiciled before April 1, 1986; and (B) Is domiciled on and after October 27, 1986;
(A) Was domiciled before April 1, 1986; and
(B) Is domiciled on and after October 27, 1986;
(2) That: (A) Before October 27, 1986, purchased insurance from an insurance carrier licensed in any state; and (B) Since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state; or
(A) Before October 27, 1986, purchased insurance from an insurance carrier licensed in any state; and
(B) Since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state; or
(3) That was a purchasing group under the requirements of the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before October 27, 1986.
(d) Each purchasing group that is required to give notice pursuant to subsection (a) shall also furnish such information as may be required by the commissioner to: (1) Verify that the entity qualifies as a purchasing group; (2) Determine where the purchasing group is located; and (3) Determine appropriate tax treatment.
(1) Verify that the entity qualifies as a purchasing group;
(2) Determine where the purchasing group is located; and
(3) Determine appropriate tax treatment.
Acts 1991, ch. 142, § 6.
Tenn. Code Ann. § 56-29-110 — TN Code / Title 56 / Chapter 29 / Section 56-29-110
Acquisition and administrative expenses - Limitation - Approval
Status: in_force

All acquisition and administrative expenses in connection with the hospital service corporations shall at all times be limited after the first year of operation to not exceed twenty-five percent (25%) of the total net premium income of the corporation. All acquisition and administrative expenses shall be subject to the approval of the commissioner. Acts 1949, ch. 234, § 13; C. Supp. 1950, § 4186.55 (Williams, § 4186.58); T.C.A. (orig. ed.), § 56-3110.
All acquisition and administrative expenses in connection with the hospital service corporations shall at all times be limited after the first year of operation to not exceed twenty-five percent (25%) of the total net premium income of the corporation. All acquisition and administrative expenses shall be subject to the approval of the commissioner.
Acts 1949, ch. 234, § 13; C. Supp. 1950, § 4186.55 (Williams, § 4186.58); T.C.A. (orig. ed.), § 56-3110.
Tenn. Code Ann. § 56-6-109 — TN Code / Title 56 / Chapter 6 / Section 56-6-109
Exemption from examination
Status: in_force

(a) An individual who applies for an insurance producer license in this state who was previously licensed for the same lines of authority in another state is not required to complete any examination. This exemption is only available if the person is currently licensed in that state, or if the application is received within ninety (90) days of the cancellation of the applicant's previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state's producer database records, maintained by the NAIC, or its affiliates or subsidiaries, indicate that the producer is or was licensed in good standing for the line of authority requested. (b) A person licensed as an insurance producer in another state who moves to this state shall make application within ninety (90) days of establishing legal residence to become a resident licensee pursuant to § 56-6-106 . An examination is not required of that person to obtain a line of authority previously held in the prior state, except where the commissioner determines otherwise by rule. Amended by 2023 Tenn. Acts, ch. 57, s 3, eff. 3/21/2023. Acts 2002, ch. 798, § 10.
(a) An individual who applies for an insurance producer license in this state who was previously licensed for the same lines of authority in another state is not required to complete any examination. This exemption is only available if the person is currently licensed in that state, or if the application is received within ninety (90) days of the cancellation of the applicant's previous license and if the prior state issues a certification that, at the time of cancellation, the applicant was in good standing in that state or the state's producer database records, maintained by the NAIC, or its affiliates or subsidiaries, indicate that the producer is or was licensed in good standing for the line of authority requested.
(b) A person licensed as an insurance producer in another state who moves to this state shall make application within ninety (90) days of establishing legal residence to become a resident licensee pursuant to § 56-6-106 . An examination is not required of that person to obtain a line of authority previously held in the prior state, except where the commissioner determines otherwise by rule.
Amended by 2023 Tenn. Acts, ch. 57, s 3, eff. 3/21/2023.
Acts 2002, ch. 798, § 10.