Tenn. Code Ann. § 56-50-106 — TN Code / Title 56 / Chapter 50 / Section 56-50-106
Reporting requirements and privacy
Status: in_force

(a) Each viatical settlement provider shall file with the commissioner on or before March 1 of each year an annual statement containing such information as the commissioner may prescribe by regulation. In addition to any other requirements, the annual statement shall specify the total number, aggregate face amount and life settlement proceeds of policies settled during the immediately preceding calendar year, together with a breakdown of the information by policy issue year. (b) Except as otherwise allowed or required by law, a viatical settlement provider, viatical settlement broker, viatical settlement investment agent, insurance company, insurance producer, information bureau, rating agency or company or any other person with actual knowledge of an insured's identity shall not disclose that identity as an insured or the insured's financial or medical information to any other person unless the disclosure: (1) Is necessary to effect a viatical settlement between the viator and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (2) Is necessary to effect a viatical settlement purchase agreement between the viatical settlement purchaser and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (3) Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of § 56-50-114(c) ; (4) Is a term of or condition to the transfer of a policy by one (1) viatical settlement provider to another viatical settlement provider; (5) Is necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (6) Is necessary to allow the viatical settlement provider or viatical settlement broker or their authorized representatives to make contacts for the purpose of determining health status; or (7) Is required to purchase stop loss coverage or financial guaranty insurance. Acts 2009, ch. 604, § 7.
(a) Each viatical settlement provider shall file with the commissioner on or before March 1 of each year an annual statement containing such information as the commissioner may prescribe by regulation. In addition to any other requirements, the annual statement shall specify the total number, aggregate face amount and life settlement proceeds of policies settled during the immediately preceding calendar year, together with a breakdown of the information by policy issue year.
(b) Except as otherwise allowed or required by law, a viatical settlement provider, viatical settlement broker, viatical settlement investment agent, insurance company, insurance producer, information bureau, rating agency or company or any other person with actual knowledge of an insured's identity shall not disclose that identity as an insured or the insured's financial or medical information to any other person unless the disclosure: (1) Is necessary to effect a viatical settlement between the viator and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (2) Is necessary to effect a viatical settlement purchase agreement between the viatical settlement purchaser and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (3) Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of § 56-50-114(c) ; (4) Is a term of or condition to the transfer of a policy by one (1) viatical settlement provider to another viatical settlement provider; (5) Is necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure; (6) Is necessary to allow the viatical settlement provider or viatical settlement broker or their authorized representatives to make contacts for the purpose of determining health status; or (7) Is required to purchase stop loss coverage or financial guaranty insurance.
(1) Is necessary to effect a viatical settlement between the viator and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(2) Is necessary to effect a viatical settlement purchase agreement between the viatical settlement purchaser and a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(3) Is provided in response to an investigation or examination by the commissioner or any other governmental officer or agency or pursuant to the requirements of § 56-50-114(c) ;
(4) Is a term of or condition to the transfer of a policy by one (1) viatical settlement provider to another viatical settlement provider;
(5) Is necessary to permit a financing entity, related provider trust or special purpose entity to finance the purchase of policies by a viatical settlement provider and the viator and insured have provided prior written consent to the disclosure;
(6) Is necessary to allow the viatical settlement provider or viatical settlement broker or their authorized representatives to make contacts for the purpose of determining health status; or
(7) Is required to purchase stop loss coverage or financial guaranty insurance.
Acts 2009, ch. 604, § 7.
Tenn. Code Ann. § 56-7-1003 — TN Code / Title 56 / Chapter 7 / Section 56-7-1003
Provider-based telemedicine
Status: in_force

(a) As used in this section: (1) "Health insurance entity" has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5; (2) "Healthcare services" has the same meaning as defined in § 56-61-102 ; (3) "Healthcare services provider" means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33; (4) "Healthcare system" means two (2) or more healthcare organizations as defined in § 63-1-150 , that are affiliated through shared ownership or pursuant to a contractual relationship that controls payment terms and service delivery; (5) "Practice group" means two (2) or more healthcare services providers that share a common employer for the purposes of the healthcare services providers' clinical practice; (6) "Provider-based telemedicine": (A) Means the use of Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when: (i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient; (ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and (iii) (a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit; (b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and (c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment; (B) Does not include: (i) An audio-only conversation; (ii) An electronic mail message or phone text message; (iii) A facsimile transmission; (iv) Remote patient monitoring; or (v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and (C) Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of: (i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and (ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable; (7) "Qualified site" means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity; and (8) "Store-and-forward telemedicine services": (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation. (b) Healthcare services provided through a provider-based telemedicine encounter must comply with state licensure requirements promulgated by the appropriate licensure boards. Provider-based telemedicine providers are held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters. (c) A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity's network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity's network. (d) A health insurance entity: (1) Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine; (2) Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient's health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located; (3) Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and (4) Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers. (e) A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located. (f) This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter. (g) (1) This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage. (2) As used in subdivision (g)(1): (A) For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, "medically necessary" means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and (B) For all other healthcare services, "medically necessary" means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are: (i) In accordance with generally accepted standards of medical practice; (ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and (iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease. (3) This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means. (4) This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means. (h) Any provisions not required by this section are governed by the terms and conditions of the health insurance policy or contract. (i) Provider-based telemedicine is subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title. (j) (1) This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011 ), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.), medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies. (2) This section does apply to the basic health plans authorized under title 8, chapter 27, parts 1, 2, 3, and 7. (k) A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall: (1) Confirm and maintain documentation that the patient: (A) Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter; (B) Is at a location where an audio-video encounter cannot take place due to lack of service; or (C) Has a physical disability that inhibits the use of video technology; and (2) Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter. Amended by 2024 Tenn. Acts, ch. 1027,s 1, eff. 5/28/2024. Amended by 2023 Tenn. Acts, ch. 201, s 1, eff. 4/24/2023. Amended by 2022 Tenn. Acts, ch. 807, Secs.s 1, s 2 eff. 4/8/2022. Amended by 2022 Tenn. Acts, ch. 766, s 3, eff. 4/1/2022. Amended by 2021 Tenn. Acts, ch. 191, Secs.s 1, s 2 eff. 4/22/2021. Added by 2020EX2 Tenn. Acts, ch. 4, s 6, eff. 8/20/2020.
(a) As used in this section: (1) "Health insurance entity" has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5; (2) "Healthcare services" has the same meaning as defined in § 56-61-102 ; (3) "Healthcare services provider" means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33; (4) "Healthcare system" means two (2) or more healthcare organizations as defined in § 63-1-150 , that are affiliated through shared ownership or pursuant to a contractual relationship that controls payment terms and service delivery; (5) "Practice group" means two (2) or more healthcare services providers that share a common employer for the purposes of the healthcare services providers' clinical practice; (6) "Provider-based telemedicine": (A) Means the use of Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when: (i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient; (ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and (iii) (a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit; (b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and (c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment; (B) Does not include: (i) An audio-only conversation; (ii) An electronic mail message or phone text message; (iii) A facsimile transmission; (iv) Remote patient monitoring; or (v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and (C) Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of: (i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and (ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable; (7) "Qualified site" means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity; and (8) "Store-and-forward telemedicine services": (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.
(1) "Health insurance entity" has the same meaning as defined in § 56-7-109 and includes managed care organizations participating in the medical assistance program under title 71, chapter 5;
(2) "Healthcare services" has the same meaning as defined in § 56-61-102 ;
(3) "Healthcare services provider" means an individual acting within the scope of a valid license issued pursuant to title 63 or title 68, chapter 24, part 6, or any state-contracted crisis service provider employed by a facility licensed under title 33;
(4) "Healthcare system" means two (2) or more healthcare organizations as defined in § 63-1-150 , that are affiliated through shared ownership or pursuant to a contractual relationship that controls payment terms and service delivery;
(5) "Practice group" means two (2) or more healthcare services providers that share a common employer for the purposes of the healthcare services providers' clinical practice;
(6) "Provider-based telemedicine": (A) Means the use of Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when: (i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient; (ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and (iii) (a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit; (b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and (c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment; (B) Does not include: (i) An audio-only conversation; (ii) An electronic mail message or phone text message; (iii) A facsimile transmission; (iv) Remote patient monitoring; or (v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and (C) Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of: (i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and (ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;
(A) Means the use of Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant real-time, interactive audio, video telecommunications, or electronic technology, or store-and-forward telemedicine services, used over the course of an interactive visit by a healthcare services provider to deliver healthcare services to a patient within the scope of practice of the healthcare services provider when: (i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient; (ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and (iii) (a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit; (b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and (c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;
(i) The healthcare services provider is at a qualified site other than the site where the patient is located and has access to the relevant medical record for that patient;
(ii) The patient is located at a location the patient deems appropriate to receive the healthcare service that is equipped to engage in the telecommunication described in this section; and
(iii) (a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit; (b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and (c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;
(a) The healthcare services provider makes use of HIPAA compliant real-time, interactive audio, video telecommunications or electronic technology, or store-and-forward telemedicine services to deliver healthcare services to a patient within the scope of practice of the healthcare services provider as long as the healthcare services provider, the healthcare services provider's practice group, or the healthcare system has established a provider-patient relationship by submitting to a health insurance entity evidence of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit;
(b) The healthcare services provider, the healthcare services provider's practice group, or the healthcare system is able to render the healthcare services through an in-person encounter; and
(c) The requirement of an in-person encounter between the healthcare services provider, the healthcare services provider's practice group, or the healthcare system and the patient prior to the interactive visit does not apply to a patient who is receiving an initial behavioral health evaluation or assessment;
(B) Does not include: (i) An audio-only conversation; (ii) An electronic mail message or phone text message; (iii) A facsimile transmission; (iv) Remote patient monitoring; or (v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and
(i) An audio-only conversation;
(ii) An electronic mail message or phone text message;
(iii) A facsimile transmission;
(iv) Remote patient monitoring; or
(v) Healthcare services provided pursuant to a contractual relationship between a health insurance entity and an entity that facilitates the delivery of provider-based telemedicine as the substantial portion of the entity's business; and
(C) Notwithstanding subdivisions (a)(6)(A) and (B), includes Health Insurance Portability and Accountability Act (HIPAA) ( 42 U.S.C. § 1320d et seq.) compliant audio-only conversation for the provision of: (i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and (ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;
(i) Behavioral health services when the means described in subdivision (a)(6)(A) are unavailable; and
(ii) Healthcare services when the means described in subdivision (a)(6)(A) are unavailable;
(7) "Qualified site" means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity; and
(8) "Store-and-forward telemedicine services": (A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and (B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.
(A) Means the use of asynchronous computer-based communications between a patient and healthcare services provider at a distant site for the purpose of diagnostic and therapeutic assistance in the care of patients; and
(B) Includes the transferring of medical data from one (1) site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunication to another site for consultation.
(b) Healthcare services provided through a provider-based telemedicine encounter must comply with state licensure requirements promulgated by the appropriate licensure boards. Provider-based telemedicine providers are held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters.
(c) A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity's network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity's network.
(d) A health insurance entity: (1) Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine; (2) Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient's health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located; (3) Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and (4) Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.
(1) Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
(2) Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient's health insurance policy or contract that is provided through provider-based telemedicine without any distinction or consideration of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located;
(3) Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
(4) Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.
(e) A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a provider-based telemedicine encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.
(f) This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.
(g) (1) This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage. (2) As used in subdivision (g)(1): (A) For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, "medically necessary" means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and (B) For all other healthcare services, "medically necessary" means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are: (i) In accordance with generally accepted standards of medical practice; (ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and (iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease. (3) This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means. (4) This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.
(1) This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.
(2) As used in subdivision (g)(1): (A) For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, "medically necessary" means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and (B) For all other healthcare services, "medically necessary" means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are: (i) In accordance with generally accepted standards of medical practice; (ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and (iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease.
(A) For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, "medically necessary" means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5-144; and
(B) For all other healthcare services, "medically necessary" means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are: (i) In accordance with generally accepted standards of medical practice; (ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and (iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease.
(i) In accordance with generally accepted standards of medical practice;
(ii) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; and
(iii) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury, or disease.
(3) This section does not require a health insurance entity to provide coverage for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage for the same healthcare services if delivered by in-person means.
(4) This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.
(h) Any provisions not required by this section are governed by the terms and conditions of the health insurance policy or contract.
(i) Provider-based telemedicine is subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.
(j) (1) This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011 ), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.), medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies. (2) This section does apply to the basic health plans authorized under title 8, chapter 27, parts 1, 2, 3, and 7.
(1) This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011 ), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.), medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.
(2) This section does apply to the basic health plans authorized under title 8, chapter 27, parts 1, 2, 3, and 7.
(k) A healthcare provider, office staff, or party acting on behalf of the healthcare provider submitting for reimbursement of an audio-only encounter under subdivision (a)(6)(C)(ii) shall: (1) Confirm and maintain documentation that the patient: (A) Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter; (B) Is at a location where an audio-video encounter cannot take place due to lack of service; or (C) Has a physical disability that inhibits the use of video technology; and (2) Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.
(1) Confirm and maintain documentation that the patient: (A) Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter; (B) Is at a location where an audio-video encounter cannot take place due to lack of service; or (C) Has a physical disability that inhibits the use of video technology; and
(A) Does not own the video technology necessary to complete an audio-video provider-based telemedicine encounter;
(B) Is at a location where an audio-video encounter cannot take place due to lack of service; or
(C) Has a physical disability that inhibits the use of video technology; and
(2) Notify the patient that the financial responsibility for the audio-only encounter will be consistent with the financial responsibility for other in-person or video encounters, prior to the audio-only telemedicine encounter.
Amended by 2024 Tenn. Acts, ch. 1027,s 1, eff. 5/28/2024.
Amended by 2023 Tenn. Acts, ch. 201, s 1, eff. 4/24/2023.
Amended by 2022 Tenn. Acts, ch. 807, Secs.s 1, s 2 eff. 4/8/2022.
Amended by 2022 Tenn. Acts, ch. 766, s 3, eff. 4/1/2022.
Amended by 2021 Tenn. Acts, ch. 191, Secs.s 1, s 2 eff. 4/22/2021.
Added by 2020EX2 Tenn. Acts, ch. 4, s 6, eff. 8/20/2020.
Tenn. Code Ann. § 56-45-102 — TN Code / Title 56 / Chapter 45 / Section 56-45-102
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Commissioner" means the commissioner of commerce and insurance or the commissioner, director or superintendent of insurance in any other state; (2) "Completed operations liability" means liability arising out of the installation, maintenance, or repair of any product at a site that is not owned or controlled by: (A) Any person who performs that work; or (B) Any person who hires an independent contractor to perform that work, but includes liability for activities that are completed or abandoned before the date of the occurrence giving rise to the liability; (3) "Domicile", for purposes of determining the state in which a purchasing group is domiciled, means: (A) For a corporation, the state in which the purchasing group is incorporated; and (B) For an unincorporated entity, the state of its principal place of business; (4) "Hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able to: (A) Meet obligations to policyholders with respect to known claims and reasonably anticipated claims; or (B) Pay other obligations in the normal course of business; (5) "Insurance" means primary insurance, excess insurance, reinsurance, surplus lines insurance and any other arrangement for shifting and distributing risk that is determined to be insurance under the laws of this state; (6) "Liability": (A) Means legal liability for damages, including costs of defense, legal costs and fees, and other claims expenses, because of injuries to other persons, damage to their property, or other damage or loss to other persons resulting from or arising out of: (i) Any business, whether profit or nonprofit, trade, product, services, including professional services, premises or operations; or (ii) Any activity of any state or local government, or any agency or political subdivision of state or local government; and (B) Does not include personal risk liability and an employer's liability with respect to its employees other than legal liability under the federal Employers' Liability Act ( 45 U.S.C. § 51 et seq.); (7) "Personal risk liability" means liability for damages because of injury to any person, damage to property, or other loss or damage resulting from any personal, familial or household responsibilities or activities, rather than from responsibilities or activities referred to in subdivision (6); (8) "Plan of operation or a feasibility study" means an analysis that presents the expected activities and results of a risk retention group including, at a minimum: (A) Information sufficient to verify that its members are engaged in businesses or activities similar or related with respect to the liability to which the members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations; (B) For each state in which it intends to operate, the coverages, deductibles, coverage limits, rates, and rating classification systems for each line of insurance the group intends to offer; (C) Historical and expected loss experience of the proposed members and national experience of similar exposures to the extent that this experience is reasonably available; (D) Pro forma financial statements and projections; (E) Appropriate opinions by a qualified, independent casualty actuary, including a determination of minimum premium or participation levels required to commence operations and to prevent a hazardous financial condition; (F) Identification of management, underwriting and claims procedures, marketing methods, managerial oversight methods, investment policies or reinsurance agreements; (G) Identification of each state in which the risk retention group has obtained, or sought to obtain, a charter and license, and a description of its status in each such state; and (H) Other matters that may be prescribed by the commissioner of the state in which the risk retention group is chartered for liability insurance companies authorized by the insurance laws of that state; (9) "Product liability" means liability for damages because of any personal injury, death, emotional harm, consequential economic damage, or property damage, including damages resulting from the loss of use of property, arising out of the manufacture, design, importation, distribution, packaging, labeling, lease or sale of a product, but does not include the liability of any person for those damages if the product involved was in the possession of the person when the incident giving rise to the claim occurred; (10) "Purchasing group" means any group that: (A) Has as one (1) of its purposes the purchase of liability insurance on a group basis; (B) Purchases the insurance only for its group members and only to cover the group member's similar or related liability exposure, as described in subdivision (10)(C); (C) Is composed of members whose businesses or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar, or common business, trade, product, services, premises, or operations; and (D) Is domiciled in any state; (11) "Risk retention group" means any corporation or other limited liability association: (A) Whose primary activity consists of assuming and spreading all, or any portion, of the liability exposure of its group members; (B) That is organized for the primary purpose of conducting the activity described under subdivision (11)(A); (C) That: (i) Is chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state; or (ii) Before January l, 1985, was chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before that date, had certified to the insurance commissioner of at least one (1) state that it satisfied the capitalization requirements of that state, except that the group shall be considered to be a risk retention group only if it has been engaged in business continuously since such date, and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability, as the terms were defined in the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before the date of the enactment of the Liability Risk Retention Act of 1986 ( 15 U.S.C. § 3901 et seq.); (D) That does not exclude any person from membership in the group solely to provide for members of the group a competitive advantage over such a person; (E) That has: (i) As its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; or (ii) As its sole owner an organization that has as: (a) Its members only persons who comprise the membership of the risk retention group; and (b) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; (F) Whose members are engaged in businesses or activities similar or related with respect to the liability of which the members are exposed by virtue of any related, similar or common business trade, product, services, premises or operations; (G) Whose activities do not include the provision of insurance other than: (i) Liability insurance for assuming and spreading all or any portion of the liability of its group members; and (ii) Reinsurance with respect to the liability of any other risk retention group, or any members of the other group, that is engaged in businesses or activities so that the group or member meets the requirement described in subdivision (11)(F) from membership in the risk retention group that provides the reinsurance; and (H) The name of which includes the phrase "Risk Retention Group"; and (12) "State" means any state of the United States or the District of Columbia. Acts 1991, ch. 142, § 6.
As used in this chapter, unless the context otherwise requires:
(1) "Commissioner" means the commissioner of commerce and insurance or the commissioner, director or superintendent of insurance in any other state;
(2) "Completed operations liability" means liability arising out of the installation, maintenance, or repair of any product at a site that is not owned or controlled by: (A) Any person who performs that work; or (B) Any person who hires an independent contractor to perform that work, but includes liability for activities that are completed or abandoned before the date of the occurrence giving rise to the liability;
(A) Any person who performs that work; or
(B) Any person who hires an independent contractor to perform that work, but includes liability for activities that are completed or abandoned before the date of the occurrence giving rise to the liability;
(3) "Domicile", for purposes of determining the state in which a purchasing group is domiciled, means: (A) For a corporation, the state in which the purchasing group is incorporated; and (B) For an unincorporated entity, the state of its principal place of business;
(A) For a corporation, the state in which the purchasing group is incorporated; and
(B) For an unincorporated entity, the state of its principal place of business;
(4) "Hazardous financial condition" means that, based on its present or reasonably anticipated financial condition, a risk retention group, although not yet financially impaired or insolvent, is unlikely to be able to: (A) Meet obligations to policyholders with respect to known claims and reasonably anticipated claims; or (B) Pay other obligations in the normal course of business;
(A) Meet obligations to policyholders with respect to known claims and reasonably anticipated claims; or
(B) Pay other obligations in the normal course of business;
(5) "Insurance" means primary insurance, excess insurance, reinsurance, surplus lines insurance and any other arrangement for shifting and distributing risk that is determined to be insurance under the laws of this state;
(6) "Liability": (A) Means legal liability for damages, including costs of defense, legal costs and fees, and other claims expenses, because of injuries to other persons, damage to their property, or other damage or loss to other persons resulting from or arising out of: (i) Any business, whether profit or nonprofit, trade, product, services, including professional services, premises or operations; or (ii) Any activity of any state or local government, or any agency or political subdivision of state or local government; and (B) Does not include personal risk liability and an employer's liability with respect to its employees other than legal liability under the federal Employers' Liability Act ( 45 U.S.C. § 51 et seq.);
(A) Means legal liability for damages, including costs of defense, legal costs and fees, and other claims expenses, because of injuries to other persons, damage to their property, or other damage or loss to other persons resulting from or arising out of: (i) Any business, whether profit or nonprofit, trade, product, services, including professional services, premises or operations; or (ii) Any activity of any state or local government, or any agency or political subdivision of state or local government; and
(i) Any business, whether profit or nonprofit, trade, product, services, including professional services, premises or operations; or
(ii) Any activity of any state or local government, or any agency or political subdivision of state or local government; and
(B) Does not include personal risk liability and an employer's liability with respect to its employees other than legal liability under the federal Employers' Liability Act ( 45 U.S.C. § 51 et seq.);
(7) "Personal risk liability" means liability for damages because of injury to any person, damage to property, or other loss or damage resulting from any personal, familial or household responsibilities or activities, rather than from responsibilities or activities referred to in subdivision (6);
(8) "Plan of operation or a feasibility study" means an analysis that presents the expected activities and results of a risk retention group including, at a minimum: (A) Information sufficient to verify that its members are engaged in businesses or activities similar or related with respect to the liability to which the members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations; (B) For each state in which it intends to operate, the coverages, deductibles, coverage limits, rates, and rating classification systems for each line of insurance the group intends to offer; (C) Historical and expected loss experience of the proposed members and national experience of similar exposures to the extent that this experience is reasonably available; (D) Pro forma financial statements and projections; (E) Appropriate opinions by a qualified, independent casualty actuary, including a determination of minimum premium or participation levels required to commence operations and to prevent a hazardous financial condition; (F) Identification of management, underwriting and claims procedures, marketing methods, managerial oversight methods, investment policies or reinsurance agreements; (G) Identification of each state in which the risk retention group has obtained, or sought to obtain, a charter and license, and a description of its status in each such state; and (H) Other matters that may be prescribed by the commissioner of the state in which the risk retention group is chartered for liability insurance companies authorized by the insurance laws of that state;
(A) Information sufficient to verify that its members are engaged in businesses or activities similar or related with respect to the liability to which the members are exposed by virtue of any related, similar or common business, trade, product, services, premises or operations;
(B) For each state in which it intends to operate, the coverages, deductibles, coverage limits, rates, and rating classification systems for each line of insurance the group intends to offer;
(C) Historical and expected loss experience of the proposed members and national experience of similar exposures to the extent that this experience is reasonably available;
(D) Pro forma financial statements and projections;
(E) Appropriate opinions by a qualified, independent casualty actuary, including a determination of minimum premium or participation levels required to commence operations and to prevent a hazardous financial condition;
(F) Identification of management, underwriting and claims procedures, marketing methods, managerial oversight methods, investment policies or reinsurance agreements;
(G) Identification of each state in which the risk retention group has obtained, or sought to obtain, a charter and license, and a description of its status in each such state; and
(H) Other matters that may be prescribed by the commissioner of the state in which the risk retention group is chartered for liability insurance companies authorized by the insurance laws of that state;
(9) "Product liability" means liability for damages because of any personal injury, death, emotional harm, consequential economic damage, or property damage, including damages resulting from the loss of use of property, arising out of the manufacture, design, importation, distribution, packaging, labeling, lease or sale of a product, but does not include the liability of any person for those damages if the product involved was in the possession of the person when the incident giving rise to the claim occurred;
(10) "Purchasing group" means any group that: (A) Has as one (1) of its purposes the purchase of liability insurance on a group basis; (B) Purchases the insurance only for its group members and only to cover the group member's similar or related liability exposure, as described in subdivision (10)(C); (C) Is composed of members whose businesses or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar, or common business, trade, product, services, premises, or operations; and (D) Is domiciled in any state;
(A) Has as one (1) of its purposes the purchase of liability insurance on a group basis;
(B) Purchases the insurance only for its group members and only to cover the group member's similar or related liability exposure, as described in subdivision (10)(C);
(C) Is composed of members whose businesses or activities are similar or related with respect to the liability to which members are exposed by virtue of any related, similar, or common business, trade, product, services, premises, or operations; and
(D) Is domiciled in any state;
(11) "Risk retention group" means any corporation or other limited liability association: (A) Whose primary activity consists of assuming and spreading all, or any portion, of the liability exposure of its group members; (B) That is organized for the primary purpose of conducting the activity described under subdivision (11)(A); (C) That: (i) Is chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state; or (ii) Before January l, 1985, was chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before that date, had certified to the insurance commissioner of at least one (1) state that it satisfied the capitalization requirements of that state, except that the group shall be considered to be a risk retention group only if it has been engaged in business continuously since such date, and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability, as the terms were defined in the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before the date of the enactment of the Liability Risk Retention Act of 1986 ( 15 U.S.C. § 3901 et seq.); (D) That does not exclude any person from membership in the group solely to provide for members of the group a competitive advantage over such a person; (E) That has: (i) As its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; or (ii) As its sole owner an organization that has as: (a) Its members only persons who comprise the membership of the risk retention group; and (b) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; (F) Whose members are engaged in businesses or activities similar or related with respect to the liability of which the members are exposed by virtue of any related, similar or common business trade, product, services, premises or operations; (G) Whose activities do not include the provision of insurance other than: (i) Liability insurance for assuming and spreading all or any portion of the liability of its group members; and (ii) Reinsurance with respect to the liability of any other risk retention group, or any members of the other group, that is engaged in businesses or activities so that the group or member meets the requirement described in subdivision (11)(F) from membership in the risk retention group that provides the reinsurance; and (H) The name of which includes the phrase "Risk Retention Group"; and
(A) Whose primary activity consists of assuming and spreading all, or any portion, of the liability exposure of its group members;
(B) That is organized for the primary purpose of conducting the activity described under subdivision (11)(A);
(C) That: (i) Is chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state; or (ii) Before January l, 1985, was chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before that date, had certified to the insurance commissioner of at least one (1) state that it satisfied the capitalization requirements of that state, except that the group shall be considered to be a risk retention group only if it has been engaged in business continuously since such date, and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability, as the terms were defined in the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before the date of the enactment of the Liability Risk Retention Act of 1986 ( 15 U.S.C. § 3901 et seq.);
(i) Is chartered and licensed as a liability insurance company and authorized to engage in the business of insurance under the laws of any state; or
(ii) Before January l, 1985, was chartered or licensed and authorized to engage in the business of insurance under the laws of Bermuda or the Cayman Islands and, before that date, had certified to the insurance commissioner of at least one (1) state that it satisfied the capitalization requirements of that state, except that the group shall be considered to be a risk retention group only if it has been engaged in business continuously since such date, and only for the purpose of continuing to provide insurance to cover product liability or completed operations liability, as the terms were defined in the Product Liability Risk Retention Act of 1981 ( 15 U.S.C. § 3901 et seq.), before the date of the enactment of the Liability Risk Retention Act of 1986 ( 15 U.S.C. § 3901 et seq.);
(D) That does not exclude any person from membership in the group solely to provide for members of the group a competitive advantage over such a person;
(E) That has: (i) As its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; or (ii) As its sole owner an organization that has as: (a) Its members only persons who comprise the membership of the risk retention group; and (b) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group;
(i) As its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group; or
(ii) As its sole owner an organization that has as: (a) Its members only persons who comprise the membership of the risk retention group; and (b) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group;
(a) Its members only persons who comprise the membership of the risk retention group; and
(b) Its owners only persons who comprise the membership of the risk retention group and who are provided insurance by the group;
(F) Whose members are engaged in businesses or activities similar or related with respect to the liability of which the members are exposed by virtue of any related, similar or common business trade, product, services, premises or operations;
(G) Whose activities do not include the provision of insurance other than: (i) Liability insurance for assuming and spreading all or any portion of the liability of its group members; and (ii) Reinsurance with respect to the liability of any other risk retention group, or any members of the other group, that is engaged in businesses or activities so that the group or member meets the requirement described in subdivision (11)(F) from membership in the risk retention group that provides the reinsurance; and
(i) Liability insurance for assuming and spreading all or any portion of the liability of its group members; and
(ii) Reinsurance with respect to the liability of any other risk retention group, or any members of the other group, that is engaged in businesses or activities so that the group or member meets the requirement described in subdivision (11)(F) from membership in the risk retention group that provides the reinsurance; and
(H) The name of which includes the phrase "Risk Retention Group"; and
(12) "State" means any state of the United States or the District of Columbia.
Acts 1991, ch. 142, § 6.
Tenn. Code Ann. § 56-6-914 — TN Code / Title 56 / Chapter 6 / Section 56-6-914
Written contracts - Required terms - Payment by insurer of policy limit of the insurance policy - Written disclosure of financial interest of adjuster - Prohibited contract terms - Disclosure document regarding the claim process - Insured's copy or the original of the contract - Notification letter to insurer - Insured's right to rescind - Adjuster as payee on checks
Status: in_force

(a) Public adjusters shall ensure that all contracts for their services are in writing and contain the following terms: (1) Legible full name of the adjuster signing the contract, as reflected in the records on file with the commissioner; (2) Permanent home state business address and phone number; (3) Tennessee public adjuster license number; (4) Title of "Public Adjuster Contract" or its substantial equivalent; (5) The insured's full name, street address, insurance company name and policy number, if known; (6) A description of the loss and its location, if applicable; (7) Description of services to be provided to the insured; (8) Signatures of the public adjuster and the insured; (9) Date contract was signed by the public adjuster and date the contract was signed by the insured; (10) Attestation language stating that the public adjuster is fully bonded pursuant to this part; and (11) (A) Full salary, fee, commission, compensation or other considerations the public adjuster is to receive for services. If the compensation is based on a share of the insurance settlement, the exact percentage shall be specified. Initial expenses to be reimbursed to a public adjuster from the proceeds of the claim payment shall be specified by type, with dollar estimates set forth in the contract and with any additional expenses to first be approved by the insured; (B) Compensation provisions in a public adjusting contract shall not be redacted in any copy of the contract provided to the commissioner. (b) If the insurer, not later than seventy-two (72) hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay to the insured the policy limit of the insurance policy, the public adjuster shall: (1) Not receive a commission consisting of a percentage of the total amount paid by an insurer to resolve a claim; (2) Inform the insured that the amount of any recovery amount might not be increased; and (3) Be entitled only to reasonable compensation from the insured for services provided by the public adjuster on behalf of the insured, based on the time spent on a claim and expenses incurred by the public adjuster, until the claim is paid or the insured receives a written commitment to pay from the insurer. (c) A public adjuster shall provide the insured a written disclosure concerning any direct or indirect financial interest that the public adjuster has with any other party who is involved in any aspect of the claim, other than the salary, fee, commission or other consideration established in the written contract with the insured, including, but not limited to, any ownership, other than as a minority stockholder, in a publicly traded entity, or any compensation expected to be received from any construction firm, building appraisal firm, motor vehicle repair shop, or any other firm that provides estimates for work, or that performs any work, in conjunction with damages caused by the insured's loss on which the public adjuster is engaged. "Firm" includes any corporation, partnership, association, joint-stock company or person. (d) A public adjuster contract may not contain any contract term that: (1) Allows the public adjuster's percentage fee to be collected when money is due from an insurance company but not paid, or that allows a public adjuster to collect the entire fee from the first check issued by an insurance company, rather than as percentage of each check issued by an insurance company; (2) Requires or requests the public adjuster's name on the issuance of the check; (3) Imposes collection costs or late fees in violation of Tennessee law; or (4) Precludes an insured from pursuing civil remedies. (e) Prior to the signing of the contract, the public adjuster shall provide the insured with a separate disclosure document regarding the claim process that states: (1) An insured is obligated to present the insured's claim to an insurance company in the manner set forth in the insurance contract as required by law. The insured and the insurer shall act in good faith toward the other as required by law. There are three (3) types of adjusters that could be involved in that process. The definitions of the three (3) types are as follows: (A) "Company adjuster" means the insurance adjusters that are employees of an insurance company. The adjusters are paid by the insurance company and will not charge the insured a fee; (B) "Independent adjuster" means the insurance adjusters that are hired on a contract basis by an insurance company in the settlement of the claim. The adjusters are paid by the insured's insurance company and will not charge the insured a fee; and (C) "Public adjuster" means the insurance adjusters that do not work for any insurance company. The adjusters work for the insured in connection with the insured's claim against the insured's insurance carrier. The insured hires the adjusters by signing a contract agreeing to pay the adjusters a fee or commission based on a percentage of the settlement, or other method of compensation; (2) The insured is not required to hire a public adjuster to help the insured meet the insured's obligations under the policy, but has a right to do so; (3) The insured has the right to initiate direct communications with the insured's attorney, the insurer, the insurer's adjuster, and the insurer's attorney, or any other person regarding the settlement of the insured's claim; (4) The public adjuster is not a representative or employee of the insurer; (5) The salary, fee, commission or other consideration is the obligation of the insured, not the insurer; and (6) An insurance company has the right to communicate with its insured, even if the insured has hired a public adjuster; but, if requested by the insured, the insurance company will make a concerted effort to include the public adjuster in communications with the insured. (f) The insured shall be given a copy or the original of the contract with the public adjuster. The public adjuster's original contract, or a copy, shall be available at all times for inspection, without notice, by the commissioner. (g) The public adjuster shall provide the insurer a notification letter, which has been signed by the insured, authorizing the public adjuster to represent the insured's interest. (h) The insured has the right to rescind the contract within three (3) business days after the date the contract was signed. The rescission shall be in writing and mailed or delivered to the public adjuster at the public adjuster's address in the contract within the three-business-day period. (i) If the insured exercises the right to rescind the contract, anything of value given by the insured to the public adjuster under the contract shall be returned to the insured within three (3) business days following the receipt by the public adjuster of the cancellation notice. (j) Nothing in this part shall prevent a public adjuster from requesting an insured to request the insurer to include the public adjuster's name as a payee on any check. Acts 2006, ch. 997, § 15.
(a) Public adjusters shall ensure that all contracts for their services are in writing and contain the following terms: (1) Legible full name of the adjuster signing the contract, as reflected in the records on file with the commissioner; (2) Permanent home state business address and phone number; (3) Tennessee public adjuster license number; (4) Title of "Public Adjuster Contract" or its substantial equivalent; (5) The insured's full name, street address, insurance company name and policy number, if known; (6) A description of the loss and its location, if applicable; (7) Description of services to be provided to the insured; (8) Signatures of the public adjuster and the insured; (9) Date contract was signed by the public adjuster and date the contract was signed by the insured; (10) Attestation language stating that the public adjuster is fully bonded pursuant to this part; and (11) (A) Full salary, fee, commission, compensation or other considerations the public adjuster is to receive for services. If the compensation is based on a share of the insurance settlement, the exact percentage shall be specified. Initial expenses to be reimbursed to a public adjuster from the proceeds of the claim payment shall be specified by type, with dollar estimates set forth in the contract and with any additional expenses to first be approved by the insured; (B) Compensation provisions in a public adjusting contract shall not be redacted in any copy of the contract provided to the commissioner.
(1) Legible full name of the adjuster signing the contract, as reflected in the records on file with the commissioner;
(2) Permanent home state business address and phone number;
(3) Tennessee public adjuster license number;
(4) Title of "Public Adjuster Contract" or its substantial equivalent;
(5) The insured's full name, street address, insurance company name and policy number, if known;
(6) A description of the loss and its location, if applicable;
(7) Description of services to be provided to the insured;
(8) Signatures of the public adjuster and the insured;
(9) Date contract was signed by the public adjuster and date the contract was signed by the insured;
(10) Attestation language stating that the public adjuster is fully bonded pursuant to this part; and
(11) (A) Full salary, fee, commission, compensation or other considerations the public adjuster is to receive for services. If the compensation is based on a share of the insurance settlement, the exact percentage shall be specified. Initial expenses to be reimbursed to a public adjuster from the proceeds of the claim payment shall be specified by type, with dollar estimates set forth in the contract and with any additional expenses to first be approved by the insured; (B) Compensation provisions in a public adjusting contract shall not be redacted in any copy of the contract provided to the commissioner.
(A) Full salary, fee, commission, compensation or other considerations the public adjuster is to receive for services. If the compensation is based on a share of the insurance settlement, the exact percentage shall be specified. Initial expenses to be reimbursed to a public adjuster from the proceeds of the claim payment shall be specified by type, with dollar estimates set forth in the contract and with any additional expenses to first be approved by the insured;
(B) Compensation provisions in a public adjusting contract shall not be redacted in any copy of the contract provided to the commissioner.
(b) If the insurer, not later than seventy-two (72) hours after the date on which the loss is reported to the insurer, either pays or commits in writing to pay to the insured the policy limit of the insurance policy, the public adjuster shall: (1) Not receive a commission consisting of a percentage of the total amount paid by an insurer to resolve a claim; (2) Inform the insured that the amount of any recovery amount might not be increased; and (3) Be entitled only to reasonable compensation from the insured for services provided by the public adjuster on behalf of the insured, based on the time spent on a claim and expenses incurred by the public adjuster, until the claim is paid or the insured receives a written commitment to pay from the insurer.
(1) Not receive a commission consisting of a percentage of the total amount paid by an insurer to resolve a claim;
(2) Inform the insured that the amount of any recovery amount might not be increased; and
(3) Be entitled only to reasonable compensation from the insured for services provided by the public adjuster on behalf of the insured, based on the time spent on a claim and expenses incurred by the public adjuster, until the claim is paid or the insured receives a written commitment to pay from the insurer.
(c) A public adjuster shall provide the insured a written disclosure concerning any direct or indirect financial interest that the public adjuster has with any other party who is involved in any aspect of the claim, other than the salary, fee, commission or other consideration established in the written contract with the insured, including, but not limited to, any ownership, other than as a minority stockholder, in a publicly traded entity, or any compensation expected to be received from any construction firm, building appraisal firm, motor vehicle repair shop, or any other firm that provides estimates for work, or that performs any work, in conjunction with damages caused by the insured's loss on which the public adjuster is engaged. "Firm" includes any corporation, partnership, association, joint-stock company or person.
(d) A public adjuster contract may not contain any contract term that: (1) Allows the public adjuster's percentage fee to be collected when money is due from an insurance company but not paid, or that allows a public adjuster to collect the entire fee from the first check issued by an insurance company, rather than as percentage of each check issued by an insurance company; (2) Requires or requests the public adjuster's name on the issuance of the check; (3) Imposes collection costs or late fees in violation of Tennessee law; or (4) Precludes an insured from pursuing civil remedies.
(1) Allows the public adjuster's percentage fee to be collected when money is due from an insurance company but not paid, or that allows a public adjuster to collect the entire fee from the first check issued by an insurance company, rather than as percentage of each check issued by an insurance company;
(2) Requires or requests the public adjuster's name on the issuance of the check;
(3) Imposes collection costs or late fees in violation of Tennessee law; or
(4) Precludes an insured from pursuing civil remedies.
(e) Prior to the signing of the contract, the public adjuster shall provide the insured with a separate disclosure document regarding the claim process that states: (1) An insured is obligated to present the insured's claim to an insurance company in the manner set forth in the insurance contract as required by law. The insured and the insurer shall act in good faith toward the other as required by law. There are three (3) types of adjusters that could be involved in that process. The definitions of the three (3) types are as follows: (A) "Company adjuster" means the insurance adjusters that are employees of an insurance company. The adjusters are paid by the insurance company and will not charge the insured a fee; (B) "Independent adjuster" means the insurance adjusters that are hired on a contract basis by an insurance company in the settlement of the claim. The adjusters are paid by the insured's insurance company and will not charge the insured a fee; and (C) "Public adjuster" means the insurance adjusters that do not work for any insurance company. The adjusters work for the insured in connection with the insured's claim against the insured's insurance carrier. The insured hires the adjusters by signing a contract agreeing to pay the adjusters a fee or commission based on a percentage of the settlement, or other method of compensation; (2) The insured is not required to hire a public adjuster to help the insured meet the insured's obligations under the policy, but has a right to do so; (3) The insured has the right to initiate direct communications with the insured's attorney, the insurer, the insurer's adjuster, and the insurer's attorney, or any other person regarding the settlement of the insured's claim; (4) The public adjuster is not a representative or employee of the insurer; (5) The salary, fee, commission or other consideration is the obligation of the insured, not the insurer; and (6) An insurance company has the right to communicate with its insured, even if the insured has hired a public adjuster; but, if requested by the insured, the insurance company will make a concerted effort to include the public adjuster in communications with the insured.
(1) An insured is obligated to present the insured's claim to an insurance company in the manner set forth in the insurance contract as required by law. The insured and the insurer shall act in good faith toward the other as required by law. There are three (3) types of adjusters that could be involved in that process. The definitions of the three (3) types are as follows: (A) "Company adjuster" means the insurance adjusters that are employees of an insurance company. The adjusters are paid by the insurance company and will not charge the insured a fee; (B) "Independent adjuster" means the insurance adjusters that are hired on a contract basis by an insurance company in the settlement of the claim. The adjusters are paid by the insured's insurance company and will not charge the insured a fee; and (C) "Public adjuster" means the insurance adjusters that do not work for any insurance company. The adjusters work for the insured in connection with the insured's claim against the insured's insurance carrier. The insured hires the adjusters by signing a contract agreeing to pay the adjusters a fee or commission based on a percentage of the settlement, or other method of compensation;
(A) "Company adjuster" means the insurance adjusters that are employees of an insurance company. The adjusters are paid by the insurance company and will not charge the insured a fee;
(B) "Independent adjuster" means the insurance adjusters that are hired on a contract basis by an insurance company in the settlement of the claim. The adjusters are paid by the insured's insurance company and will not charge the insured a fee; and
(C) "Public adjuster" means the insurance adjusters that do not work for any insurance company. The adjusters work for the insured in connection with the insured's claim against the insured's insurance carrier. The insured hires the adjusters by signing a contract agreeing to pay the adjusters a fee or commission based on a percentage of the settlement, or other method of compensation;
(2) The insured is not required to hire a public adjuster to help the insured meet the insured's obligations under the policy, but has a right to do so;
(3) The insured has the right to initiate direct communications with the insured's attorney, the insurer, the insurer's adjuster, and the insurer's attorney, or any other person regarding the settlement of the insured's claim;
(4) The public adjuster is not a representative or employee of the insurer;
(5) The salary, fee, commission or other consideration is the obligation of the insured, not the insurer; and
(6) An insurance company has the right to communicate with its insured, even if the insured has hired a public adjuster; but, if requested by the insured, the insurance company will make a concerted effort to include the public adjuster in communications with the insured.
(f) The insured shall be given a copy or the original of the contract with the public adjuster. The public adjuster's original contract, or a copy, shall be available at all times for inspection, without notice, by the commissioner.
(g) The public adjuster shall provide the insurer a notification letter, which has been signed by the insured, authorizing the public adjuster to represent the insured's interest.
(h) The insured has the right to rescind the contract within three (3) business days after the date the contract was signed. The rescission shall be in writing and mailed or delivered to the public adjuster at the public adjuster's address in the contract within the three-business-day period.
(i) If the insured exercises the right to rescind the contract, anything of value given by the insured to the public adjuster under the contract shall be returned to the insured within three (3) business days following the receipt by the public adjuster of the cancellation notice.
(j) Nothing in this part shall prevent a public adjuster from requesting an insured to request the insurer to include the public adjuster's name as a payee on any check.
Acts 2006, ch. 997, § 15.
Tenn. Code Ann. § 56-26-120 — TN Code / Title 56 / Chapter 26 / Section 56-26-120
Acts not constituting waiver of defenses
Status: in_force

The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, the acceptance of the proofs or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy. Acts 1955, ch. 4, § 7; T.C.A., § 56-3320.
The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, the acceptance of the proofs or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy.
Acts 1955, ch. 4, § 7; T.C.A., § 56-3320.
Tenn. Code Ann. § 56-46-104 — TN Code / Title 56 / Chapter 46 / Section 56-46-104
Company Action Level Events
Status: in_force

(a) "Company Action Level Event" means any of the following events: (1) The filing of an RBC Report by an insurer that indicates that: (A) The insurer's Total Adjusted Capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; (B) If a life and/or health insurer, the insurer has Total Adjusted Capital that is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and has a negative trend; or (C) If a property and casualty insurer, the insurer has total adjusted capital that is greater than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Property and Casualty RBC instructions; (2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates an event in subdivision (a)(1); provided the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; or (3) If, pursuant to § 56-46-108 , an insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge. (b) In the event of a Company Action Level Event, the insurer shall prepare and submit to the commissioner an RBC Plan, which shall: (1) Identify the conditions that contribute to the Company Action Level Event; (2) Contain proposals of corrective actions that the insurer intends to take and would be expected to result in the elimination of the Company Action Level Event; (3) Provide projections of the insurer's financial results in the current year and at least the four (4) succeeding years, both in the absence of proposed corrective actions, including projections of statutory operating income, net income, capital and/or surplus. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component; (4) Identify the key assumptions impacting the insurer's projections and the sensitivity of the projections to the assumptions; and (5) Identify the quality of, and problems associated with, the insurer's business including, but not limited to, its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business and use of reinsurance, if any, in each case. (c) The RBC Plan shall be submitted: (1) Within forty-five (45) days of the Company Action Level Event; or (2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 , within forty-five (45) days after notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge. (d) Within sixty (60) days after the submission by an insurer of an RBC Plan to the commissioner, the commissioner shall notify the insurer whether the RBC Plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines the RBC Plan is unsatisfactory, the notification to the insurer shall set forth the reasons for the determination, and may set forth proposed revisions that will render the RBC Plan satisfactory, in the judgment of the commissioner. Upon notification from the commissioner, the insurer shall prepare a Revised RBC Plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the Revised RBC Plan to the commissioner: (1) Within forty-five (45) days after the notification from the commissioner; or (2) If the insurer challenges the notification from the commissioner under § 56-46-108 , within forty-five (45) days after a notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge. (e) In the event of a notification by the commissioner to an insurer that the insurer's RBC Plan or Revised RBC Plan is unsatisfactory, the commissioner may, at the commissioner's discretion, subject to the insurer's right to a hearing under § 56-46-108 , specify in the notification that the notification constitutes a Regulatory Action Level Event. (f) Every domestic insurer that files an RBC Plan or Revised RBC Plan with the commissioner shall file a copy of the RBC Plan or Revised RBC Plan with the insurance commissioner in any state in which the insurer is authorized to do business if: (1) That state has an RBC provision substantially similar to § 56-46-109(a) ; and (2) The insurance commissioner of that state has notified the insurer of its request for the filing in writing, in which case the insurer shall file a copy of the RBC Plan or Revised RBC Plan in that state no later than the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC Plan or Revised RBC Plan with the state; or (B) The date on which the RBC Plan or Revised RBC Plan is filed under subsections (c) and (d). Amended by 2014 Tenn. Acts, ch. 559,s 3, eff. 3/21/2014. Acts 1996, ch. 750, § 5; 2012, ch. 633, §§ 4, 5.
(a) "Company Action Level Event" means any of the following events: (1) The filing of an RBC Report by an insurer that indicates that: (A) The insurer's Total Adjusted Capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; (B) If a life and/or health insurer, the insurer has Total Adjusted Capital that is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and has a negative trend; or (C) If a property and casualty insurer, the insurer has total adjusted capital that is greater than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Property and Casualty RBC instructions; (2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates an event in subdivision (a)(1); provided the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; or (3) If, pursuant to § 56-46-108 , an insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(1) The filing of an RBC Report by an insurer that indicates that: (A) The insurer's Total Adjusted Capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; (B) If a life and/or health insurer, the insurer has Total Adjusted Capital that is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and has a negative trend; or (C) If a property and casualty insurer, the insurer has total adjusted capital that is greater than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Property and Casualty RBC instructions;
(A) The insurer's Total Adjusted Capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC;
(B) If a life and/or health insurer, the insurer has Total Adjusted Capital that is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and has a negative trend; or
(C) If a property and casualty insurer, the insurer has total adjusted capital that is greater than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Property and Casualty RBC instructions;
(2) The notification by the commissioner to the insurer of an Adjusted RBC Report that indicates an event in subdivision (a)(1); provided the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; or
(3) If, pursuant to § 56-46-108 , an insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(b) In the event of a Company Action Level Event, the insurer shall prepare and submit to the commissioner an RBC Plan, which shall: (1) Identify the conditions that contribute to the Company Action Level Event; (2) Contain proposals of corrective actions that the insurer intends to take and would be expected to result in the elimination of the Company Action Level Event; (3) Provide projections of the insurer's financial results in the current year and at least the four (4) succeeding years, both in the absence of proposed corrective actions, including projections of statutory operating income, net income, capital and/or surplus. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component; (4) Identify the key assumptions impacting the insurer's projections and the sensitivity of the projections to the assumptions; and (5) Identify the quality of, and problems associated with, the insurer's business including, but not limited to, its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business and use of reinsurance, if any, in each case.
(1) Identify the conditions that contribute to the Company Action Level Event;
(2) Contain proposals of corrective actions that the insurer intends to take and would be expected to result in the elimination of the Company Action Level Event;
(3) Provide projections of the insurer's financial results in the current year and at least the four (4) succeeding years, both in the absence of proposed corrective actions, including projections of statutory operating income, net income, capital and/or surplus. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component;
(4) Identify the key assumptions impacting the insurer's projections and the sensitivity of the projections to the assumptions; and
(5) Identify the quality of, and problems associated with, the insurer's business including, but not limited to, its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business and use of reinsurance, if any, in each case.
(c) The RBC Plan shall be submitted: (1) Within forty-five (45) days of the Company Action Level Event; or (2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 , within forty-five (45) days after notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(1) Within forty-five (45) days of the Company Action Level Event; or
(2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 , within forty-five (45) days after notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(d) Within sixty (60) days after the submission by an insurer of an RBC Plan to the commissioner, the commissioner shall notify the insurer whether the RBC Plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines the RBC Plan is unsatisfactory, the notification to the insurer shall set forth the reasons for the determination, and may set forth proposed revisions that will render the RBC Plan satisfactory, in the judgment of the commissioner. Upon notification from the commissioner, the insurer shall prepare a Revised RBC Plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the Revised RBC Plan to the commissioner: (1) Within forty-five (45) days after the notification from the commissioner; or (2) If the insurer challenges the notification from the commissioner under § 56-46-108 , within forty-five (45) days after a notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(1) Within forty-five (45) days after the notification from the commissioner; or
(2) If the insurer challenges the notification from the commissioner under § 56-46-108 , within forty-five (45) days after a notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(e) In the event of a notification by the commissioner to an insurer that the insurer's RBC Plan or Revised RBC Plan is unsatisfactory, the commissioner may, at the commissioner's discretion, subject to the insurer's right to a hearing under § 56-46-108 , specify in the notification that the notification constitutes a Regulatory Action Level Event.
(f) Every domestic insurer that files an RBC Plan or Revised RBC Plan with the commissioner shall file a copy of the RBC Plan or Revised RBC Plan with the insurance commissioner in any state in which the insurer is authorized to do business if: (1) That state has an RBC provision substantially similar to § 56-46-109(a) ; and (2) The insurance commissioner of that state has notified the insurer of its request for the filing in writing, in which case the insurer shall file a copy of the RBC Plan or Revised RBC Plan in that state no later than the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC Plan or Revised RBC Plan with the state; or (B) The date on which the RBC Plan or Revised RBC Plan is filed under subsections (c) and (d).
(1) That state has an RBC provision substantially similar to § 56-46-109(a) ; and
(2) The insurance commissioner of that state has notified the insurer of its request for the filing in writing, in which case the insurer shall file a copy of the RBC Plan or Revised RBC Plan in that state no later than the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC Plan or Revised RBC Plan with the state; or (B) The date on which the RBC Plan or Revised RBC Plan is filed under subsections (c) and (d).
(A) Fifteen (15) days after the receipt of notice to file a copy of its RBC Plan or Revised RBC Plan with the state; or
(B) The date on which the RBC Plan or Revised RBC Plan is filed under subsections (c) and (d).
Amended by 2014 Tenn. Acts, ch. 559,s 3, eff. 3/21/2014.
Acts 1996, ch. 750, § 5; 2012, ch. 633, §§ 4, 5.
Tenn. Code Ann. § 56-16-118 — TN Code / Title 56 / Chapter 16 / Section 56-16-118
Judgment against reciprocal - Effect
Status: in_force

Any judgment against a reciprocal based upon legal process duly served as provided in this chapter shall be binding upon the reciprocal and upon each of the reciprocal's subscribers as their respective interests may appear, in an amount not exceeding their respective contingent assessment liabilities. Acts 1990, ch. 728, § 2; T.C.A. § 56-16-218.
Any judgment against a reciprocal based upon legal process duly served as provided in this chapter shall be binding upon the reciprocal and upon each of the reciprocal's subscribers as their respective interests may appear, in an amount not exceeding their respective contingent assessment liabilities.
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-218.
Tenn. Code Ann. § 56-12-204 — TN Code / Title 56 / Chapter 12 / Section 56-12-204
Applicability - Limitations on liability
Status: in_force

(a) (1) This part provides coverage for the policies and contracts specified in subsection (b): (A) To persons who, regardless of where they reside except for nonresident certificate holders under group policies or contracts, are the beneficiaries, assignees, or payees, including healthcare providers rendering services covered under health insurance policies or certificates, of persons covered under subdivision (a)(1)(B); and (B) To persons who are owners of or certificate holders or enrollees under the policies or contracts, other than structured settlement annuities, and who: (i) Are residents; or (ii) Are not residents, but only under all of the following conditions: (a) The member insurer that issued the policies or contracts is domiciled in this state; (b) The states in which the persons reside have associations similar to the association created by this part; and (c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law. (2) For structured settlement annuities specified in subsection (b), subdivisions (a)(1)(A) and (a)(1)(B) do not apply, and this part, except as provided in subdivisions (a)(3) and (a)(4), provides coverage to a person who is a payee under a structured settlement annuity, or beneficiary of a payee if the payee is deceased, if the payee: (A) Is a resident, regardless of where the contract owner resides; or (B) Is not a resident, but only under both of the following conditions: (i) (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and (ii) Neither the payee, the beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides. (3) This part does not provide coverage to the following: (A) A person who is a payee or the beneficiary of a contract owner resident of this state if the payee or beneficiary is afforded any coverage by the association of another state; or (B) A person who acquires rights to receive payments through a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section took effect. (4) This part provides coverage to a person who is a resident of this state and, in special circumstances, to a nonresident. In order to avoid duplicate coverage, if a person who would otherwise receive coverage under this part is provided coverage under the laws of any other state, the person is not provided coverage under this part. In determining the application of this subdivision (a)(4) in situations where a person could be covered by the association of more than one (1) state, whether as an owner, payee, enrollee, beneficiary, or assignee, this part must be construed in conjunction with other state laws to result in coverage by only one (1) association. (b) (1) This part provides coverage to the persons specified in subsection (a) for policies or contracts of direct, non-group life insurance, accident and health insurance, which, for purposes of this part, includes health maintenance organization subscriber contracts and certificates, or annuities, for certificates under direct group policies and contracts, and for supplemental contracts to any of these, in each case issued by member insurers, except as limited by this part. Annuity contracts and certificates under group annuity contracts include allocated funding agreements, structured settlement annuities, and any immediate or deferred annuity contracts. (2) Except as otherwise provided in subdivision (b)(3), this part does not provide coverage for: (A) A portion of a policy or contract not guaranteed by the member insurer, or under which the risk is borne by the policy or contract owner; (B) A policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract; (C) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate, or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value: (i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier; and (ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available; (D) A portion of a policy or contract issued to a plan or program of an employer, association, or other person to provide life, health, or annuity benefits to its employees, members, or others, to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association, or other person under: (i) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1002(40) ; (ii) A minimum premium group insurance plan; (iii) A stop-loss group insurance plan; or (iv) An administrative services only contract; (E) A portion of a policy or contract to the extent that it provides for: (i) Dividends or experience rating credits; (ii) Voting rights; or (iii) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract; (F) A policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state; (G) A portion of a policy or contract to the extent that the assessments required by § 56-12-208 with respect to the policy or contract are preempted by federal or state law; (H) An obligation that does not arise under the express written terms of the policy or contract issued by the member insurer to the enrollee, certificate holder, contract owner, or policy owner, including without limitation: (i) Claims based on marketing materials; (ii) Claims based on side letters, riders, or other documents that were issued by the member insurer without meeting applicable policy or contract form filing or approval requirements; (iii) Misrepresentations of or regarding policy or contract benefits; (iv) Extra-contractual claims; or (v) A claim for penalties or consequential or incidental damages; (I) A contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer; (J) An unallocated annuity contract; (K) A portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but which have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under this subdivision (b)(2)(K), the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture; (L) A policy or contract providing any hospital, medical, prescription drug, or other healthcare benefits pursuant to part C or part D of Subchapter XVIII, Chapter 7 of Title 42 of the United States Code, commonly known as Medicare part C and D, or Subchapter XIX, Chapter 7 of Title 42 of the United States Code, commonly known as Medicaid, or any regulations issued pursuant thereto; or (M) Structured settlement annuity benefits to which a payee, or beneficiary, has transferred his or her rights in a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section became effective. (3) The exclusion from coverage in subdivision (b)(2)(C) does not apply to any portion of a policy or contract, including a rider, that provides long-term care or any other health insurance benefits. (c) The benefits that the association may become obligated to cover must in no event exceed the lesser of: (1) The contractual obligations for which the member insurer is liable or would have been liable if it were not an impaired or insolvent insurer; or (2) (A) With respect to one (1) life, regardless of the number of policies or contracts: (i) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance; (ii) One hundred thousand dollars ($100,000) in health insurance benefits; provided, for policies or contracts issued by a member insurer that becomes insolvent after January 1, 2010, the limits for health insurance benefits are as follows: (a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (c) Five hundred thousand dollars ($500,000) for health benefit plans; and (iii) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or (B) With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any; (C) The association is not obligated to cover more than: (i) An aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one (1) life under subdivisions (c)(2)(A) and (B) except with respect to benefits for health benefit plans under subdivision (c)(2)(A)(ii)(c), in which case the aggregate liability of the association must not exceed five hundred thousand dollars ($500,000) with respect to any one (1) individual; or (ii) With respect to one (1) owner of multiple non-group policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner; (D) The limitations set forth in this subsection (c) are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association's obligations under this part may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights; (E) For purposes of this part, benefits provided by a long-term care rider to a life insurance policy or annuity contract are considered the same type of benefits as the base life insurance policy or annuity contract to which it relates. (d) In performing its obligations to provide coverage under § 56-12-207 , the association is not required to guarantee, assume, reinsure, reissue, or perform, or cause to be guaranteed, assumed, reinsured, reissued, or performed, the contractual obligations of the insolvent or impaired insurer under a covered policy or contract that do not materially affect the economic values or economic benefits of the covered policy or contract. Amended by 2019 Tenn. Acts, ch. 5,s 3, eff. 7/1/2019. Acts 1988, ch. 1032, § 3; 2001, ch. 91, § 2; 2009, ch. 178, § 1; 2010, ch. 713, § 2.
(a) (1) This part provides coverage for the policies and contracts specified in subsection (b): (A) To persons who, regardless of where they reside except for nonresident certificate holders under group policies or contracts, are the beneficiaries, assignees, or payees, including healthcare providers rendering services covered under health insurance policies or certificates, of persons covered under subdivision (a)(1)(B); and (B) To persons who are owners of or certificate holders or enrollees under the policies or contracts, other than structured settlement annuities, and who: (i) Are residents; or (ii) Are not residents, but only under all of the following conditions: (a) The member insurer that issued the policies or contracts is domiciled in this state; (b) The states in which the persons reside have associations similar to the association created by this part; and (c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law. (2) For structured settlement annuities specified in subsection (b), subdivisions (a)(1)(A) and (a)(1)(B) do not apply, and this part, except as provided in subdivisions (a)(3) and (a)(4), provides coverage to a person who is a payee under a structured settlement annuity, or beneficiary of a payee if the payee is deceased, if the payee: (A) Is a resident, regardless of where the contract owner resides; or (B) Is not a resident, but only under both of the following conditions: (i) (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and (ii) Neither the payee, the beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides. (3) This part does not provide coverage to the following: (A) A person who is a payee or the beneficiary of a contract owner resident of this state if the payee or beneficiary is afforded any coverage by the association of another state; or (B) A person who acquires rights to receive payments through a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section took effect. (4) This part provides coverage to a person who is a resident of this state and, in special circumstances, to a nonresident. In order to avoid duplicate coverage, if a person who would otherwise receive coverage under this part is provided coverage under the laws of any other state, the person is not provided coverage under this part. In determining the application of this subdivision (a)(4) in situations where a person could be covered by the association of more than one (1) state, whether as an owner, payee, enrollee, beneficiary, or assignee, this part must be construed in conjunction with other state laws to result in coverage by only one (1) association.
(1) This part provides coverage for the policies and contracts specified in subsection (b): (A) To persons who, regardless of where they reside except for nonresident certificate holders under group policies or contracts, are the beneficiaries, assignees, or payees, including healthcare providers rendering services covered under health insurance policies or certificates, of persons covered under subdivision (a)(1)(B); and (B) To persons who are owners of or certificate holders or enrollees under the policies or contracts, other than structured settlement annuities, and who: (i) Are residents; or (ii) Are not residents, but only under all of the following conditions: (a) The member insurer that issued the policies or contracts is domiciled in this state; (b) The states in which the persons reside have associations similar to the association created by this part; and (c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law.
(A) To persons who, regardless of where they reside except for nonresident certificate holders under group policies or contracts, are the beneficiaries, assignees, or payees, including healthcare providers rendering services covered under health insurance policies or certificates, of persons covered under subdivision (a)(1)(B); and
(B) To persons who are owners of or certificate holders or enrollees under the policies or contracts, other than structured settlement annuities, and who: (i) Are residents; or (ii) Are not residents, but only under all of the following conditions: (a) The member insurer that issued the policies or contracts is domiciled in this state; (b) The states in which the persons reside have associations similar to the association created by this part; and (c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law.
(i) Are residents; or
(ii) Are not residents, but only under all of the following conditions: (a) The member insurer that issued the policies or contracts is domiciled in this state; (b) The states in which the persons reside have associations similar to the association created by this part; and (c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law.
(a) The member insurer that issued the policies or contracts is domiciled in this state;
(b) The states in which the persons reside have associations similar to the association created by this part; and
(c) The persons are not eligible for coverage by an association in any other state due to the fact that the insurer or the health maintenance organization was not licensed in the state at the time specified in the state's guaranty association law.
(2) For structured settlement annuities specified in subsection (b), subdivisions (a)(1)(A) and (a)(1)(B) do not apply, and this part, except as provided in subdivisions (a)(3) and (a)(4), provides coverage to a person who is a payee under a structured settlement annuity, or beneficiary of a payee if the payee is deceased, if the payee: (A) Is a resident, regardless of where the contract owner resides; or (B) Is not a resident, but only under both of the following conditions: (i) (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and (ii) Neither the payee, the beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides.
(A) Is a resident, regardless of where the contract owner resides; or
(B) Is not a resident, but only under both of the following conditions: (i) (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and (ii) Neither the payee, the beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides.
(i) (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and
(a) The contract owner of the structured settlement annuity is a resident; or
(b) The contract owner of the structured settlement annuity is not a resident, but the insurer that issued the structured settlement annuity is domiciled in this state, and the state in which the contract owner resides has an association similar to the association created by this part; and
(ii) Neither the payee, the beneficiary, nor the contract owner is eligible for coverage by the association of the state in which the payee or contract owner resides.
(3) This part does not provide coverage to the following: (A) A person who is a payee or the beneficiary of a contract owner resident of this state if the payee or beneficiary is afforded any coverage by the association of another state; or (B) A person who acquires rights to receive payments through a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section took effect.
(A) A person who is a payee or the beneficiary of a contract owner resident of this state if the payee or beneficiary is afforded any coverage by the association of another state; or
(B) A person who acquires rights to receive payments through a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section took effect.
(4) This part provides coverage to a person who is a resident of this state and, in special circumstances, to a nonresident. In order to avoid duplicate coverage, if a person who would otherwise receive coverage under this part is provided coverage under the laws of any other state, the person is not provided coverage under this part. In determining the application of this subdivision (a)(4) in situations where a person could be covered by the association of more than one (1) state, whether as an owner, payee, enrollee, beneficiary, or assignee, this part must be construed in conjunction with other state laws to result in coverage by only one (1) association.
(b) (1) This part provides coverage to the persons specified in subsection (a) for policies or contracts of direct, non-group life insurance, accident and health insurance, which, for purposes of this part, includes health maintenance organization subscriber contracts and certificates, or annuities, for certificates under direct group policies and contracts, and for supplemental contracts to any of these, in each case issued by member insurers, except as limited by this part. Annuity contracts and certificates under group annuity contracts include allocated funding agreements, structured settlement annuities, and any immediate or deferred annuity contracts. (2) Except as otherwise provided in subdivision (b)(3), this part does not provide coverage for: (A) A portion of a policy or contract not guaranteed by the member insurer, or under which the risk is borne by the policy or contract owner; (B) A policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract; (C) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate, or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value: (i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier; and (ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available; (D) A portion of a policy or contract issued to a plan or program of an employer, association, or other person to provide life, health, or annuity benefits to its employees, members, or others, to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association, or other person under: (i) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1002(40) ; (ii) A minimum premium group insurance plan; (iii) A stop-loss group insurance plan; or (iv) An administrative services only contract; (E) A portion of a policy or contract to the extent that it provides for: (i) Dividends or experience rating credits; (ii) Voting rights; or (iii) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract; (F) A policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state; (G) A portion of a policy or contract to the extent that the assessments required by § 56-12-208 with respect to the policy or contract are preempted by federal or state law; (H) An obligation that does not arise under the express written terms of the policy or contract issued by the member insurer to the enrollee, certificate holder, contract owner, or policy owner, including without limitation: (i) Claims based on marketing materials; (ii) Claims based on side letters, riders, or other documents that were issued by the member insurer without meeting applicable policy or contract form filing or approval requirements; (iii) Misrepresentations of or regarding policy or contract benefits; (iv) Extra-contractual claims; or (v) A claim for penalties or consequential or incidental damages; (I) A contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer; (J) An unallocated annuity contract; (K) A portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but which have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under this subdivision (b)(2)(K), the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture; (L) A policy or contract providing any hospital, medical, prescription drug, or other healthcare benefits pursuant to part C or part D of Subchapter XVIII, Chapter 7 of Title 42 of the United States Code, commonly known as Medicare part C and D, or Subchapter XIX, Chapter 7 of Title 42 of the United States Code, commonly known as Medicaid, or any regulations issued pursuant thereto; or (M) Structured settlement annuity benefits to which a payee, or beneficiary, has transferred his or her rights in a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section became effective. (3) The exclusion from coverage in subdivision (b)(2)(C) does not apply to any portion of a policy or contract, including a rider, that provides long-term care or any other health insurance benefits.
(1) This part provides coverage to the persons specified in subsection (a) for policies or contracts of direct, non-group life insurance, accident and health insurance, which, for purposes of this part, includes health maintenance organization subscriber contracts and certificates, or annuities, for certificates under direct group policies and contracts, and for supplemental contracts to any of these, in each case issued by member insurers, except as limited by this part. Annuity contracts and certificates under group annuity contracts include allocated funding agreements, structured settlement annuities, and any immediate or deferred annuity contracts.
(2) Except as otherwise provided in subdivision (b)(3), this part does not provide coverage for: (A) A portion of a policy or contract not guaranteed by the member insurer, or under which the risk is borne by the policy or contract owner; (B) A policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract; (C) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate, or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value: (i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier; and (ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available; (D) A portion of a policy or contract issued to a plan or program of an employer, association, or other person to provide life, health, or annuity benefits to its employees, members, or others, to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association, or other person under: (i) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1002(40) ; (ii) A minimum premium group insurance plan; (iii) A stop-loss group insurance plan; or (iv) An administrative services only contract; (E) A portion of a policy or contract to the extent that it provides for: (i) Dividends or experience rating credits; (ii) Voting rights; or (iii) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract; (F) A policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state; (G) A portion of a policy or contract to the extent that the assessments required by § 56-12-208 with respect to the policy or contract are preempted by federal or state law; (H) An obligation that does not arise under the express written terms of the policy or contract issued by the member insurer to the enrollee, certificate holder, contract owner, or policy owner, including without limitation: (i) Claims based on marketing materials; (ii) Claims based on side letters, riders, or other documents that were issued by the member insurer without meeting applicable policy or contract form filing or approval requirements; (iii) Misrepresentations of or regarding policy or contract benefits; (iv) Extra-contractual claims; or (v) A claim for penalties or consequential or incidental damages; (I) A contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer; (J) An unallocated annuity contract; (K) A portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but which have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under this subdivision (b)(2)(K), the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture; (L) A policy or contract providing any hospital, medical, prescription drug, or other healthcare benefits pursuant to part C or part D of Subchapter XVIII, Chapter 7 of Title 42 of the United States Code, commonly known as Medicare part C and D, or Subchapter XIX, Chapter 7 of Title 42 of the United States Code, commonly known as Medicaid, or any regulations issued pursuant thereto; or (M) Structured settlement annuity benefits to which a payee, or beneficiary, has transferred his or her rights in a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section became effective.
(A) A portion of a policy or contract not guaranteed by the member insurer, or under which the risk is borne by the policy or contract owner;
(B) A policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract;
(C) A portion of a policy or contract to the extent that the rate of interest on which it is based, or the interest rate, crediting rate, or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value: (i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier; and (ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available;
(i) Averaged over the period of four (4) years prior to the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting two (2) percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four (4) years before the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier; and
(ii) On and after the date on which the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier, exceeds the rate of interest determined by subtracting three (3) percentage points from Moody's Corporate Bond Yield Average as most recently available;
(D) A portion of a policy or contract issued to a plan or program of an employer, association, or other person to provide life, health, or annuity benefits to its employees, members, or others, to the extent that the plan or program is self-funded or uninsured, including, but not limited to, benefits payable by an employer, association, or other person under: (i) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1002(40) ; (ii) A minimum premium group insurance plan; (iii) A stop-loss group insurance plan; or (iv) An administrative services only contract;
(i) A multiple employer welfare arrangement as defined in 29 U.S.C. § 1002(40) ;
(ii) A minimum premium group insurance plan;
(iii) A stop-loss group insurance plan; or
(iv) An administrative services only contract;
(E) A portion of a policy or contract to the extent that it provides for: (i) Dividends or experience rating credits; (ii) Voting rights; or (iii) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract;
(i) Dividends or experience rating credits;
(ii) Voting rights; or
(iii) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract;
(F) A policy or contract issued in this state by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this state;
(G) A portion of a policy or contract to the extent that the assessments required by § 56-12-208 with respect to the policy or contract are preempted by federal or state law;
(H) An obligation that does not arise under the express written terms of the policy or contract issued by the member insurer to the enrollee, certificate holder, contract owner, or policy owner, including without limitation: (i) Claims based on marketing materials; (ii) Claims based on side letters, riders, or other documents that were issued by the member insurer without meeting applicable policy or contract form filing or approval requirements; (iii) Misrepresentations of or regarding policy or contract benefits; (iv) Extra-contractual claims; or (v) A claim for penalties or consequential or incidental damages;
(i) Claims based on marketing materials;
(ii) Claims based on side letters, riders, or other documents that were issued by the member insurer without meeting applicable policy or contract form filing or approval requirements;
(iii) Misrepresentations of or regarding policy or contract benefits;
(iv) Extra-contractual claims; or
(v) A claim for penalties or consequential or incidental damages;
(I) A contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer;
(J) An unallocated annuity contract;
(K) A portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but which have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this part, whichever is earlier. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under this subdivision (b)(2)(K), the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture;
(L) A policy or contract providing any hospital, medical, prescription drug, or other healthcare benefits pursuant to part C or part D of Subchapter XVIII, Chapter 7 of Title 42 of the United States Code, commonly known as Medicare part C and D, or Subchapter XIX, Chapter 7 of Title 42 of the United States Code, commonly known as Medicaid, or any regulations issued pursuant thereto; or
(M) Structured settlement annuity benefits to which a payee, or beneficiary, has transferred his or her rights in a structured settlement factoring transaction as defined in 26 U.S.C. § 5891(c)(3)(A) , regardless of whether the transaction occurred before or after that section became effective.
(3) The exclusion from coverage in subdivision (b)(2)(C) does not apply to any portion of a policy or contract, including a rider, that provides long-term care or any other health insurance benefits.
(c) The benefits that the association may become obligated to cover must in no event exceed the lesser of: (1) The contractual obligations for which the member insurer is liable or would have been liable if it were not an impaired or insolvent insurer; or (2) (A) With respect to one (1) life, regardless of the number of policies or contracts: (i) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance; (ii) One hundred thousand dollars ($100,000) in health insurance benefits; provided, for policies or contracts issued by a member insurer that becomes insolvent after January 1, 2010, the limits for health insurance benefits are as follows: (a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (c) Five hundred thousand dollars ($500,000) for health benefit plans; and (iii) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or (B) With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any; (C) The association is not obligated to cover more than: (i) An aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one (1) life under subdivisions (c)(2)(A) and (B) except with respect to benefits for health benefit plans under subdivision (c)(2)(A)(ii)(c), in which case the aggregate liability of the association must not exceed five hundred thousand dollars ($500,000) with respect to any one (1) individual; or (ii) With respect to one (1) owner of multiple non-group policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner; (D) The limitations set forth in this subsection (c) are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association's obligations under this part may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights; (E) For purposes of this part, benefits provided by a long-term care rider to a life insurance policy or annuity contract are considered the same type of benefits as the base life insurance policy or annuity contract to which it relates.
(1) The contractual obligations for which the member insurer is liable or would have been liable if it were not an impaired or insolvent insurer; or
(2) (A) With respect to one (1) life, regardless of the number of policies or contracts: (i) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance; (ii) One hundred thousand dollars ($100,000) in health insurance benefits; provided, for policies or contracts issued by a member insurer that becomes insolvent after January 1, 2010, the limits for health insurance benefits are as follows: (a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (c) Five hundred thousand dollars ($500,000) for health benefit plans; and (iii) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or (B) With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any; (C) The association is not obligated to cover more than: (i) An aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one (1) life under subdivisions (c)(2)(A) and (B) except with respect to benefits for health benefit plans under subdivision (c)(2)(A)(ii)(c), in which case the aggregate liability of the association must not exceed five hundred thousand dollars ($500,000) with respect to any one (1) individual; or (ii) With respect to one (1) owner of multiple non-group policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner; (D) The limitations set forth in this subsection (c) are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association's obligations under this part may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights; (E) For purposes of this part, benefits provided by a long-term care rider to a life insurance policy or annuity contract are considered the same type of benefits as the base life insurance policy or annuity contract to which it relates.
(A) With respect to one (1) life, regardless of the number of policies or contracts: (i) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance; (ii) One hundred thousand dollars ($100,000) in health insurance benefits; provided, for policies or contracts issued by a member insurer that becomes insolvent after January 1, 2010, the limits for health insurance benefits are as follows: (a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (c) Five hundred thousand dollars ($500,000) for health benefit plans; and (iii) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or
(i) Three hundred thousand dollars ($300,000) in life insurance death benefits, but not more than one hundred thousand dollars ($100,000) in net cash surrender and net cash withdrawal values for life insurance;
(ii) One hundred thousand dollars ($100,000) in health insurance benefits; provided, for policies or contracts issued by a member insurer that becomes insolvent after January 1, 2010, the limits for health insurance benefits are as follows: (a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (c) Five hundred thousand dollars ($500,000) for health benefit plans; and
(a) One hundred thousand dollars ($100,000) for coverages that are not disability income insurance, health benefit plans, or long-term care insurance, including any net cash surrender and net cash withdrawal values;
(b) Three hundred thousand dollars ($300,000) for disability income insurance and three hundred thousand dollars ($300,000) for long-term care insurance;
(c) Five hundred thousand dollars ($500,000) for health benefit plans; and
(iii) Two hundred fifty thousand dollars ($250,000) in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or
(B) With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any;
(C) The association is not obligated to cover more than: (i) An aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one (1) life under subdivisions (c)(2)(A) and (B) except with respect to benefits for health benefit plans under subdivision (c)(2)(A)(ii)(c), in which case the aggregate liability of the association must not exceed five hundred thousand dollars ($500,000) with respect to any one (1) individual; or (ii) With respect to one (1) owner of multiple non-group policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner;
(i) An aggregate of three hundred thousand dollars ($300,000) in benefits with respect to any one (1) life under subdivisions (c)(2)(A) and (B) except with respect to benefits for health benefit plans under subdivision (c)(2)(A)(ii)(c), in which case the aggregate liability of the association must not exceed five hundred thousand dollars ($500,000) with respect to any one (1) individual; or
(ii) With respect to one (1) owner of multiple non-group policies of life insurance, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, more than five million dollars ($5,000,000) in benefits, regardless of the number of policies and contracts held by the owner;
(D) The limitations set forth in this subsection (c) are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association's obligations under this part may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights;
(E) For purposes of this part, benefits provided by a long-term care rider to a life insurance policy or annuity contract are considered the same type of benefits as the base life insurance policy or annuity contract to which it relates.
(d) In performing its obligations to provide coverage under § 56-12-207 , the association is not required to guarantee, assume, reinsure, reissue, or perform, or cause to be guaranteed, assumed, reinsured, reissued, or performed, the contractual obligations of the insolvent or impaired insurer under a covered policy or contract that do not materially affect the economic values or economic benefits of the covered policy or contract.
Amended by 2019 Tenn. Acts, ch. 5,s 3, eff. 7/1/2019.
Acts 1988, ch. 1032, § 3; 2001, ch. 91, § 2; 2009, ch. 178, § 1; 2010, ch. 713, § 2.
Tenn. Code Ann. § 56-25-605 — TN Code / Title 56 / Chapter 25 / Section 56-25-605
Admission of foreign or alien society
Status: in_force

(a) No foreign or alien society shall transact business in this state without a license issued by the commissioner. (b) Any such society desiring admission to this state shall comply substantially with the requirements and limitations of this chapter applicable to domestic societies. Any such society may be licensed to transact business in this state after first having shown to the satisfaction of the commissioner that it has maintained an active bona fide lodge for a period of not less than three (3) years and: (1) Upon filing with the commissioner: (A) A duly certified copy of its articles of incorporation; (B) A copy of its bylaws, certified by its secretary or corresponding officer; (C) A power of attorney to the commissioner as prescribed in § 56-25-701 ; (D) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province or country, satisfactory to the commissioner; (E) Certification from the proper officials of its home state, territory, province or country that the society is legally incorporated and licensed to transact business there; (F) Copies of its certificate forms; and (G) Other information the commissioner may deem necessary; and (2) Upon a showing that its assets are invested in accordance with this chapter. Acts 1990, ch. 703, § 1.
(a) No foreign or alien society shall transact business in this state without a license issued by the commissioner.
(b) Any such society desiring admission to this state shall comply substantially with the requirements and limitations of this chapter applicable to domestic societies. Any such society may be licensed to transact business in this state after first having shown to the satisfaction of the commissioner that it has maintained an active bona fide lodge for a period of not less than three (3) years and: (1) Upon filing with the commissioner: (A) A duly certified copy of its articles of incorporation; (B) A copy of its bylaws, certified by its secretary or corresponding officer; (C) A power of attorney to the commissioner as prescribed in § 56-25-701 ; (D) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province or country, satisfactory to the commissioner; (E) Certification from the proper officials of its home state, territory, province or country that the society is legally incorporated and licensed to transact business there; (F) Copies of its certificate forms; and (G) Other information the commissioner may deem necessary; and (2) Upon a showing that its assets are invested in accordance with this chapter.
(1) Upon filing with the commissioner: (A) A duly certified copy of its articles of incorporation; (B) A copy of its bylaws, certified by its secretary or corresponding officer; (C) A power of attorney to the commissioner as prescribed in § 56-25-701 ; (D) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province or country, satisfactory to the commissioner; (E) Certification from the proper officials of its home state, territory, province or country that the society is legally incorporated and licensed to transact business there; (F) Copies of its certificate forms; and (G) Other information the commissioner may deem necessary; and
(A) A duly certified copy of its articles of incorporation;
(B) A copy of its bylaws, certified by its secretary or corresponding officer;
(C) A power of attorney to the commissioner as prescribed in § 56-25-701 ;
(D) A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the commissioner, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province or country, satisfactory to the commissioner;
(E) Certification from the proper officials of its home state, territory, province or country that the society is legally incorporated and licensed to transact business there;
(F) Copies of its certificate forms; and
(G) Other information the commissioner may deem necessary; and
(2) Upon a showing that its assets are invested in accordance with this chapter.
Acts 1990, ch. 703, § 1.
Tenn. Code Ann. § 56-12-104 — TN Code / Title 56 / Chapter 12 / Section 56-12-104
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Account" means any one (1) of the accounts created by § 56-12-105 ; (2) "Affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with an insolvent insurer on December 31 of the year next preceding the date the insurer becomes an insolvent insurer; (3) "Association" means the Tennessee insurance guaranty association created under § 56-12-105 ; (4) "Claimant" means any insured making a first-party claim or any person instituting a liability claim; provided, that no person who is an affiliate of an insolvent insurer may be a claimant; (5) "Commissioner" means the commissioner of commerce and insurance; (6) "Control" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. "Control" is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing that control does not exist in fact; (7) (A) "Covered claim" means an unpaid claim, including one for unearned premiums, submitted by a claimant, which arises out of and is within the coverage and is subject to the applicable limits of an insurance policy to which this part applies and was issued by an insurer that is insolvent, if the insurer becomes an insolvent insurer after March 31, 1999, and: (i) The claimant or insured is a resident of this state when the insured event occurs; provided, that for an entity other than an individual, the residence of a claimant, insured or policyholder is the state in which its principal place of business is located when the insured event occurs; or (ii) The claim is a first-party claim for damage to property with a permanent location in this state. (B) "Covered claim" does not include: (i) Any amount awarded as punitive or exemplary damages; (ii) Any amount sought as a return of premium under any retrospective rating plan; (iii) Any amount due any reinsurer, insurer, insurance pool, or underwriting association as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No such claim for any amount due any reinsurer, insurer, insurance pool, or underwriting association may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association's obligations and limitations set forth in this part or policy limits of the insured, whichever amount is greater; (iv) Any first party claim by an insured whose net worth exceeds ten million dollars ($10,000,000) on December 31 of the year next preceding the date the insurer becomes an insolvent insurer. An insured's net worth on this date is deemed to include the aggregate net worth of the insured and all of its subsidiaries as calculated on a consolidated basis; and (v) Any first-party claims by an insured that is an affiliate of the insolvent insurer; (8) "Insolvent insurer" means an insurer authorized to transact insurance in this state, either when the policy was issued or when the insured event occurred, and against whom a final order of liquidation has been entered after March 31, 1999, with a finding of insolvency by a court of competent jurisdiction in the insurer's state of domicile; (9) (A) "Member insurer" means any person who: (i) Writes any kind of insurance to which this part applies under § 56-12-103 including the exchange of reciprocal or inter-insurance contracts; and (ii) Is licensed to transact insurance in this state, except county mutual fire insurance companies and nonprofit service corporations. (B) An insurer shall cease to be a member insurer effective on the day after the termination or expiration of its license to transact the kinds of insurance to which this chapter applies; provided, that the insurer shall remain liable as a member insurer for any and all obligations, including obligations for assessments levied before the termination or expiration of the insurer's license and assessments levied after the termination or expiration, which relate to any insurer that became an insolvent insurer before the termination or expiration of the insurer's license; (10) (A) "Net direct written premiums" means direct gross premiums written in this state on insurance policies to which this part applies, less return premiums and dividends paid or credited to policyholders on this direct business; (B) "Net direct written premiums" does not include premiums on contracts between insurers or reinsurers; and (11) "Person" means any individual, corporation, partnership, governmental entity, association, voluntary organization or any other legal entity. Acts 1971, ch. 180, § 4; modified; Acts 1975, ch. 62, § 4; 1977, ch. 203, § 2; T.C.A., § 56-4004; Acts 1989, ch. 316, § 1; 1999, ch. 48, § 2.
As used in this part, unless the context otherwise requires:
(1) "Account" means any one (1) of the accounts created by § 56-12-105 ;
(2) "Affiliate" means a person who directly, or indirectly, through one (1) or more intermediaries, controls, is controlled by, or is under common control with an insolvent insurer on December 31 of the year next preceding the date the insurer becomes an insolvent insurer;
(3) "Association" means the Tennessee insurance guaranty association created under § 56-12-105 ;
(4) "Claimant" means any insured making a first-party claim or any person instituting a liability claim; provided, that no person who is an affiliate of an insolvent insurer may be a claimant;
(5) "Commissioner" means the commissioner of commerce and insurance;
(6) "Control" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. "Control" is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of any other person. This presumption may be rebutted by a showing that control does not exist in fact;
(7) (A) "Covered claim" means an unpaid claim, including one for unearned premiums, submitted by a claimant, which arises out of and is within the coverage and is subject to the applicable limits of an insurance policy to which this part applies and was issued by an insurer that is insolvent, if the insurer becomes an insolvent insurer after March 31, 1999, and: (i) The claimant or insured is a resident of this state when the insured event occurs; provided, that for an entity other than an individual, the residence of a claimant, insured or policyholder is the state in which its principal place of business is located when the insured event occurs; or (ii) The claim is a first-party claim for damage to property with a permanent location in this state. (B) "Covered claim" does not include: (i) Any amount awarded as punitive or exemplary damages; (ii) Any amount sought as a return of premium under any retrospective rating plan; (iii) Any amount due any reinsurer, insurer, insurance pool, or underwriting association as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No such claim for any amount due any reinsurer, insurer, insurance pool, or underwriting association may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association's obligations and limitations set forth in this part or policy limits of the insured, whichever amount is greater; (iv) Any first party claim by an insured whose net worth exceeds ten million dollars ($10,000,000) on December 31 of the year next preceding the date the insurer becomes an insolvent insurer. An insured's net worth on this date is deemed to include the aggregate net worth of the insured and all of its subsidiaries as calculated on a consolidated basis; and (v) Any first-party claims by an insured that is an affiliate of the insolvent insurer;
(A) "Covered claim" means an unpaid claim, including one for unearned premiums, submitted by a claimant, which arises out of and is within the coverage and is subject to the applicable limits of an insurance policy to which this part applies and was issued by an insurer that is insolvent, if the insurer becomes an insolvent insurer after March 31, 1999, and: (i) The claimant or insured is a resident of this state when the insured event occurs; provided, that for an entity other than an individual, the residence of a claimant, insured or policyholder is the state in which its principal place of business is located when the insured event occurs; or (ii) The claim is a first-party claim for damage to property with a permanent location in this state.
(i) The claimant or insured is a resident of this state when the insured event occurs; provided, that for an entity other than an individual, the residence of a claimant, insured or policyholder is the state in which its principal place of business is located when the insured event occurs; or
(ii) The claim is a first-party claim for damage to property with a permanent location in this state.
(B) "Covered claim" does not include: (i) Any amount awarded as punitive or exemplary damages; (ii) Any amount sought as a return of premium under any retrospective rating plan; (iii) Any amount due any reinsurer, insurer, insurance pool, or underwriting association as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No such claim for any amount due any reinsurer, insurer, insurance pool, or underwriting association may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association's obligations and limitations set forth in this part or policy limits of the insured, whichever amount is greater; (iv) Any first party claim by an insured whose net worth exceeds ten million dollars ($10,000,000) on December 31 of the year next preceding the date the insurer becomes an insolvent insurer. An insured's net worth on this date is deemed to include the aggregate net worth of the insured and all of its subsidiaries as calculated on a consolidated basis; and (v) Any first-party claims by an insured that is an affiliate of the insolvent insurer;
(i) Any amount awarded as punitive or exemplary damages;
(ii) Any amount sought as a return of premium under any retrospective rating plan;
(iii) Any amount due any reinsurer, insurer, insurance pool, or underwriting association as subrogation recoveries, reinsurance recoveries, contribution, indemnification or otherwise. No such claim for any amount due any reinsurer, insurer, insurance pool, or underwriting association may be asserted against a person insured under a policy issued by an insolvent insurer other than to the extent the claim exceeds the association's obligations and limitations set forth in this part or policy limits of the insured, whichever amount is greater;
(iv) Any first party claim by an insured whose net worth exceeds ten million dollars ($10,000,000) on December 31 of the year next preceding the date the insurer becomes an insolvent insurer. An insured's net worth on this date is deemed to include the aggregate net worth of the insured and all of its subsidiaries as calculated on a consolidated basis; and
(v) Any first-party claims by an insured that is an affiliate of the insolvent insurer;
(8) "Insolvent insurer" means an insurer authorized to transact insurance in this state, either when the policy was issued or when the insured event occurred, and against whom a final order of liquidation has been entered after March 31, 1999, with a finding of insolvency by a court of competent jurisdiction in the insurer's state of domicile;
(9) (A) "Member insurer" means any person who: (i) Writes any kind of insurance to which this part applies under § 56-12-103 including the exchange of reciprocal or inter-insurance contracts; and (ii) Is licensed to transact insurance in this state, except county mutual fire insurance companies and nonprofit service corporations. (B) An insurer shall cease to be a member insurer effective on the day after the termination or expiration of its license to transact the kinds of insurance to which this chapter applies; provided, that the insurer shall remain liable as a member insurer for any and all obligations, including obligations for assessments levied before the termination or expiration of the insurer's license and assessments levied after the termination or expiration, which relate to any insurer that became an insolvent insurer before the termination or expiration of the insurer's license;
(A) "Member insurer" means any person who: (i) Writes any kind of insurance to which this part applies under § 56-12-103 including the exchange of reciprocal or inter-insurance contracts; and (ii) Is licensed to transact insurance in this state, except county mutual fire insurance companies and nonprofit service corporations.
(i) Writes any kind of insurance to which this part applies under § 56-12-103 including the exchange of reciprocal or inter-insurance contracts; and
(ii) Is licensed to transact insurance in this state, except county mutual fire insurance companies and nonprofit service corporations.
(B) An insurer shall cease to be a member insurer effective on the day after the termination or expiration of its license to transact the kinds of insurance to which this chapter applies; provided, that the insurer shall remain liable as a member insurer for any and all obligations, including obligations for assessments levied before the termination or expiration of the insurer's license and assessments levied after the termination or expiration, which relate to any insurer that became an insolvent insurer before the termination or expiration of the insurer's license;
(10) (A) "Net direct written premiums" means direct gross premiums written in this state on insurance policies to which this part applies, less return premiums and dividends paid or credited to policyholders on this direct business; (B) "Net direct written premiums" does not include premiums on contracts between insurers or reinsurers; and
(A) "Net direct written premiums" means direct gross premiums written in this state on insurance policies to which this part applies, less return premiums and dividends paid or credited to policyholders on this direct business;
(B) "Net direct written premiums" does not include premiums on contracts between insurers or reinsurers; and
(11) "Person" means any individual, corporation, partnership, governmental entity, association, voluntary organization or any other legal entity.
Acts 1971, ch. 180, § 4; modified; Acts 1975, ch. 62, § 4; 1977, ch. 203, § 2; T.C.A., § 56-4004; Acts 1989, ch. 316, § 1; 1999, ch. 48, § 2.
Tenn. Code Ann. § 56-1-907 — TN Code / Title 56 / Chapter 1 / Section 56-1-907
Reserve valuation method - Life insurance and endowment benefits
Status: in_force

(a) Except as otherwise provided in §§ 56-1-908 , 56-1-911 and 56-1-913 , reserves according to the commissioner's reserve valuation method, for the life insurance and endowment benefits of policies providing for a uniform amount of insurance and requiring the payment of uniform premiums, shall be the excess, if any, of the present value, at the date of valuation, of the future guaranteed benefits provided for by those policies, over the then present value of any future modified net premiums therefore. The modified net premiums for a policy shall be the uniform percentage of the respective contract premiums for the benefits such that the present value, at the date of issue of the policy, of all modified net premiums shall be equal to the sum of the then present value of the benefits provided for by the policy and the excess of subdivision (a)(1) over subdivision (a)(2), as follows: (1) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one (1) per annum payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the nineteen-year premium whole life plan for insurance of the same amount at an age one (1) year higher than the age at issue of the policy; (2) A net one-year term premium for the benefits provided for in the first policy year. (b) For a life insurance policy issued on or after January 1, 1986, for which the contract premium in the first policy year exceeds that of the second year and for which no comparable additional benefit is provided in the first year for the excess and which provides an endowment benefit or a cash surrender value or a combination in an amount greater than the excess premium, the reserve according to the commissioner's reserve valuation method as of any policy anniversary occurring on or before the assumed ending date defined in this part as the first policy anniversary on which the sum of any endowment benefit and any cash surrender value then available is greater than the excess premium shall, except as otherwise provided in § 56-1-911 , be the greater of the reserve as of the policy anniversary calculated as described in subsection (a) and the reserve as of the policy anniversary calculated as described in subsection (a), but with: (1) The value defined in subdivision (a)(1) being reduced by fifteen percent (15%) of the amount of such excess first year premium; (2) All present values of benefits and premiums being determined without reference to premiums or benefits provided for by the policy after the assumed ending date; (3) The policy being assumed to mature on that date as an endowment; and (4) The cash surrender value provided on that date being considered as an endowment benefit. (c) In making the comparison the mortality and interest bases in §§ 56-1-904 and 56-1-906 shall be used. (d) Reserves according to the commissioner's reserve valuation method shall be calculated by a method consistent with subsections (a) and (b) for: (1) Life insurance policies providing for a varying amount of insurance or requiring the payment of varying premiums; (2) Group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under § 408 of the Internal Revenue Code ( 26 U.S.C. § 408 ), as amended; (3) Disability and accidental death benefits in all policies and contracts; and (4) All other benefits, except life insurance and endowment benefits in life insurance policies and benefits provided by all other annuity and pure endowment contracts. Added by 2013 Tenn. Acts, ch. 260, s 3, eff. 7/1/2013.
(a) Except as otherwise provided in §§ 56-1-908 , 56-1-911 and 56-1-913 , reserves according to the commissioner's reserve valuation method, for the life insurance and endowment benefits of policies providing for a uniform amount of insurance and requiring the payment of uniform premiums, shall be the excess, if any, of the present value, at the date of valuation, of the future guaranteed benefits provided for by those policies, over the then present value of any future modified net premiums therefore. The modified net premiums for a policy shall be the uniform percentage of the respective contract premiums for the benefits such that the present value, at the date of issue of the policy, of all modified net premiums shall be equal to the sum of the then present value of the benefits provided for by the policy and the excess of subdivision (a)(1) over subdivision (a)(2), as follows: (1) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one (1) per annum payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the nineteen-year premium whole life plan for insurance of the same amount at an age one (1) year higher than the age at issue of the policy; (2) A net one-year term premium for the benefits provided for in the first policy year.
(1) A net level annual premium equal to the present value, at the date of issue, of the benefits provided for after the first policy year, divided by the present value, at the date of issue, of an annuity of one (1) per annum payable on the first and each subsequent anniversary of the policy on which a premium falls due. However, the net level annual premium shall not exceed the net level annual premium on the nineteen-year premium whole life plan for insurance of the same amount at an age one (1) year higher than the age at issue of the policy;
(2) A net one-year term premium for the benefits provided for in the first policy year.
(b) For a life insurance policy issued on or after January 1, 1986, for which the contract premium in the first policy year exceeds that of the second year and for which no comparable additional benefit is provided in the first year for the excess and which provides an endowment benefit or a cash surrender value or a combination in an amount greater than the excess premium, the reserve according to the commissioner's reserve valuation method as of any policy anniversary occurring on or before the assumed ending date defined in this part as the first policy anniversary on which the sum of any endowment benefit and any cash surrender value then available is greater than the excess premium shall, except as otherwise provided in § 56-1-911 , be the greater of the reserve as of the policy anniversary calculated as described in subsection (a) and the reserve as of the policy anniversary calculated as described in subsection (a), but with: (1) The value defined in subdivision (a)(1) being reduced by fifteen percent (15%) of the amount of such excess first year premium; (2) All present values of benefits and premiums being determined without reference to premiums or benefits provided for by the policy after the assumed ending date; (3) The policy being assumed to mature on that date as an endowment; and (4) The cash surrender value provided on that date being considered as an endowment benefit.
(1) The value defined in subdivision (a)(1) being reduced by fifteen percent (15%) of the amount of such excess first year premium;
(2) All present values of benefits and premiums being determined without reference to premiums or benefits provided for by the policy after the assumed ending date;
(3) The policy being assumed to mature on that date as an endowment; and
(4) The cash surrender value provided on that date being considered as an endowment benefit.
(c) In making the comparison the mortality and interest bases in §§ 56-1-904 and 56-1-906 shall be used.
(d) Reserves according to the commissioner's reserve valuation method shall be calculated by a method consistent with subsections (a) and (b) for: (1) Life insurance policies providing for a varying amount of insurance or requiring the payment of varying premiums; (2) Group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under § 408 of the Internal Revenue Code ( 26 U.S.C. § 408 ), as amended; (3) Disability and accidental death benefits in all policies and contracts; and (4) All other benefits, except life insurance and endowment benefits in life insurance policies and benefits provided by all other annuity and pure endowment contracts.
(1) Life insurance policies providing for a varying amount of insurance or requiring the payment of varying premiums;
(2) Group annuity and pure endowment contracts purchased under a retirement plan or plan of deferred compensation, established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under § 408 of the Internal Revenue Code ( 26 U.S.C. § 408 ), as amended;
(3) Disability and accidental death benefits in all policies and contracts; and
(4) All other benefits, except life insurance and endowment benefits in life insurance policies and benefits provided by all other annuity and pure endowment contracts.
Added by 2013 Tenn. Acts, ch. 260, s 3, eff. 7/1/2013.