Tenn. Code Ann. § 56-7-1001 — TN Code / Title 56 / Chapter 7 / Section 56-7-1001
Credentialing and contracting of health care providers by health insurance entities
Status: in_force

(a) (1) A health insurance entity, as defined in § 56-7-109 , regardless of status as a participating organization of the Council on Affordable Quality Healthcare (CAQH) or its successor, shall notify the health care provider of the results of the provider's clean CAQH credentialing application and shall notify the health care provider as to whether or not the health insurance entity is willing to contract with that provider within ninety (90) calendar days after receipt of the completed application. (2) A clean CAQH application means an application that has no defect, misstatement of facts, improprieties, including a lack of any required substantiating documentation, or particular circumstance requiring special treatment that impedes prompt credentialing. (b) Unless otherwise required by a national accrediting body, a health insurance entity shall accept and begin processing a completed credentialing application, whether a CAQH or the health insurance entity's application, as early as ninety (90) calendar days before the anticipated employment start date of the health care provider. (c) Unless otherwise required by a national health insurance entity accrediting body, a health insurance entity shall not mandate, in order to process a credentialing application, whether a CAQH or the health insurance entity's application, that a health care provider have an active health care liability insurance policy and bear the unnecessary costs of the premiums before the provider's employment start date. (d) No health insurance entity shall reflect, in either written material sent to its members or on a web site available to its members, that a health care provider is an in-network provider or that the provider's credentialing application is pending approval until such time as a contract is signed by both the provider and the health insurance entity and the provider is eligible to be reimbursed as an in-network provider. (e) (1) Nothing in this section requires a health insurance entity to contract with a provider if the health insurance entity and the provider do not agree on the terms and conditions of the provider contract. (2) Nothing in this section creates a private cause of action against a health insurance entity. (f) (1) A health insurance entity shall provide to any medical group practice with which the entity has an existing contract a list of all information and supporting documentation required for a credentialing application of a new provider applicant to be considered complete pursuant to this subsection (f). (2) (A) A health insurance entity shall notify a new provider applicant in writing of the status of a credentialing application no later than five (5) business days of receipt of the application. The notice shall indicate if the application is complete or incomplete, and, if the application is incomplete, the notice shall indicate the information or documentation that is needed to complete the application. (B) If the application is incomplete and the new provider applicant submits additional information or documentation to complete the application, the health insurance entity shall comply with the requirements of subdivision (f)(2)(A) upon receipt of the additional information or documentation. (C) A health insurance entity shall notify a new provider applicant of the results of the new provider applicant's credentialing application within ninety (90) calendar days after notification from the health insurance entity that the application is complete. (D) If a new provider applicant fails to submit a complete credentialing application to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the application is deemed incomplete and credentialing is discontinued. If a new provider applicant fails to submit a complete network participation enrollment form, including signature evidencing intent to participate with the group and any other required documentation, to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the new provider applicant is ineligible to receive the payment set out in (f)(3)(A). (3) (A) A new provider applicant shall not submit any claims for covered services provided by the new provider applicant to the health insurance entity for reimbursement while the credentialing application is pending. If claims are submitted while the credentialing application is pending, the health insurance entity may deny the claims. Upon notification pursuant to subdivision (f)(2)(C), the new provider applicant shall submit all held claims to the health insurance entity, and the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between receipt of a complete credentialing application pursuant to subdivision (f)(2)(A) and notification pursuant to subdivision (f)(2)(C). In the event that a new provider applicant or medical group practice has specified a network start date for the new provider applicant that is later than the time of receipt of a complete credentialing application pursuant to subdivision (f)(2)(A), the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between the specified network start date and notification pursuant to subdivision (f)(2)(C). (B) A health insurance entity's reimbursement obligation under subdivision (f)(3)(A) applies only to medical services provided in the name of the medical group practice by a new provider applicant that is billing for professional services under the existing group contract. (4) (A) Nothing in this section requires a health insurance entity to pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant if the new provider applicant's credentialing application is not approved or the health insurance entity is otherwise not willing to contract with the new provider applicant. (B) A medical group practice may be required to refund any reimbursement monies paid by the health insurance entity for services provided by a new provider applicant whose credentialing approval was obtained by fraud. (C) A medical group practice shall not collect from a health insurance beneficiary any amount for services provided if the new provider applicant's credentialing application is not approved or any amount refunded to a health insurance entity under subdivision (f)(4)(B). (5) As used in this subsection (f): (A) "Existing group contract" means a participating provider agreement between a medical group practice and a health insurance entity, under which physicians and other providers of the medical group bill for services provided to patients covered by health insurance provided by the health insurance entity, and under which a new provider applicant who is a member of the medical group practice will become a participating provider upon successful completion of the credentialing process; (B) "Health insurance entity" has the same meaning provided in § 56-7-109(a) ; and (C) "New provider applicant" means a physician or other licensed provider of medical services who has submitted a completed credentialing application to a health insurance entity. (6) Nothing in this subsection (f) shall apply to the TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in title 56, chapter 7, part 29; any other plan managed by the health care finance and administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27. (g) (1) A health insurance entity shall not require the disclosure of a physician's participation in a physician wellness program, as defined in § 63-1-173 , as a condition of credentialing, contracting, or network participation with the health insurance entity. (2) A health insurance entity that is unable to assess a physician's risk of future impairment due to disclosures prohibited by subdivision (g)(1) is immune from civil liability, a civil cause of action, or an administrative sanction or other proceeding related to harm caused by the physician. (h) An individual or entity that provides, discloses, or receives information related to career fatigue as part of a physician wellness program is, with respect to the information provided, disclosed, or received, immune from: (1) Civil liability or a civil cause of action; and (2) An administrative sanction or other proceeding. (i) This section does not: (1) Authorize a physician to withhold information requested in accordance with contractual terms between a health insurance entity and a statewide advocacy organization or information requested in an application used by a health insurance entity for credentialing or contracting purposes, including a Council for Affordable Quality Healthcare application; (2) Waive a physician's obligation to disclose information regarding: (A) A substance use disorder; (B) A mental health condition; or (C) Another condition that impairs the physician's judgment or adversely affects the physician's ability to practice medicine in a competent, ethical, and professional manner; or (3) Authorize a statewide advocacy organization to withhold information in accordance with contractual terms between the statewide advocacy organization and a health insurance entity. Amended by 2024 Tenn. Acts, ch. 924,s 3, eff. 1/1/2025. Amended by 2015 Tenn. Acts, ch. 386, s 1, eff. 1/1/2016. Acts 2007 , ch. 365, § 1; 2012 , ch. 798, § 21.
(a) (1) A health insurance entity, as defined in § 56-7-109 , regardless of status as a participating organization of the Council on Affordable Quality Healthcare (CAQH) or its successor, shall notify the health care provider of the results of the provider's clean CAQH credentialing application and shall notify the health care provider as to whether or not the health insurance entity is willing to contract with that provider within ninety (90) calendar days after receipt of the completed application. (2) A clean CAQH application means an application that has no defect, misstatement of facts, improprieties, including a lack of any required substantiating documentation, or particular circumstance requiring special treatment that impedes prompt credentialing.
(1) A health insurance entity, as defined in § 56-7-109 , regardless of status as a participating organization of the Council on Affordable Quality Healthcare (CAQH) or its successor, shall notify the health care provider of the results of the provider's clean CAQH credentialing application and shall notify the health care provider as to whether or not the health insurance entity is willing to contract with that provider within ninety (90) calendar days after receipt of the completed application.
(2) A clean CAQH application means an application that has no defect, misstatement of facts, improprieties, including a lack of any required substantiating documentation, or particular circumstance requiring special treatment that impedes prompt credentialing.
(b) Unless otherwise required by a national accrediting body, a health insurance entity shall accept and begin processing a completed credentialing application, whether a CAQH or the health insurance entity's application, as early as ninety (90) calendar days before the anticipated employment start date of the health care provider.
(c) Unless otherwise required by a national health insurance entity accrediting body, a health insurance entity shall not mandate, in order to process a credentialing application, whether a CAQH or the health insurance entity's application, that a health care provider have an active health care liability insurance policy and bear the unnecessary costs of the premiums before the provider's employment start date.
(d) No health insurance entity shall reflect, in either written material sent to its members or on a web site available to its members, that a health care provider is an in-network provider or that the provider's credentialing application is pending approval until such time as a contract is signed by both the provider and the health insurance entity and the provider is eligible to be reimbursed as an in-network provider.
(e) (1) Nothing in this section requires a health insurance entity to contract with a provider if the health insurance entity and the provider do not agree on the terms and conditions of the provider contract. (2) Nothing in this section creates a private cause of action against a health insurance entity.
(1) Nothing in this section requires a health insurance entity to contract with a provider if the health insurance entity and the provider do not agree on the terms and conditions of the provider contract.
(2) Nothing in this section creates a private cause of action against a health insurance entity.
(f) (1) A health insurance entity shall provide to any medical group practice with which the entity has an existing contract a list of all information and supporting documentation required for a credentialing application of a new provider applicant to be considered complete pursuant to this subsection (f). (2) (A) A health insurance entity shall notify a new provider applicant in writing of the status of a credentialing application no later than five (5) business days of receipt of the application. The notice shall indicate if the application is complete or incomplete, and, if the application is incomplete, the notice shall indicate the information or documentation that is needed to complete the application. (B) If the application is incomplete and the new provider applicant submits additional information or documentation to complete the application, the health insurance entity shall comply with the requirements of subdivision (f)(2)(A) upon receipt of the additional information or documentation. (C) A health insurance entity shall notify a new provider applicant of the results of the new provider applicant's credentialing application within ninety (90) calendar days after notification from the health insurance entity that the application is complete. (D) If a new provider applicant fails to submit a complete credentialing application to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the application is deemed incomplete and credentialing is discontinued. If a new provider applicant fails to submit a complete network participation enrollment form, including signature evidencing intent to participate with the group and any other required documentation, to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the new provider applicant is ineligible to receive the payment set out in (f)(3)(A). (3) (A) A new provider applicant shall not submit any claims for covered services provided by the new provider applicant to the health insurance entity for reimbursement while the credentialing application is pending. If claims are submitted while the credentialing application is pending, the health insurance entity may deny the claims. Upon notification pursuant to subdivision (f)(2)(C), the new provider applicant shall submit all held claims to the health insurance entity, and the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between receipt of a complete credentialing application pursuant to subdivision (f)(2)(A) and notification pursuant to subdivision (f)(2)(C). In the event that a new provider applicant or medical group practice has specified a network start date for the new provider applicant that is later than the time of receipt of a complete credentialing application pursuant to subdivision (f)(2)(A), the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between the specified network start date and notification pursuant to subdivision (f)(2)(C). (B) A health insurance entity's reimbursement obligation under subdivision (f)(3)(A) applies only to medical services provided in the name of the medical group practice by a new provider applicant that is billing for professional services under the existing group contract. (4) (A) Nothing in this section requires a health insurance entity to pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant if the new provider applicant's credentialing application is not approved or the health insurance entity is otherwise not willing to contract with the new provider applicant. (B) A medical group practice may be required to refund any reimbursement monies paid by the health insurance entity for services provided by a new provider applicant whose credentialing approval was obtained by fraud. (C) A medical group practice shall not collect from a health insurance beneficiary any amount for services provided if the new provider applicant's credentialing application is not approved or any amount refunded to a health insurance entity under subdivision (f)(4)(B). (5) As used in this subsection (f): (A) "Existing group contract" means a participating provider agreement between a medical group practice and a health insurance entity, under which physicians and other providers of the medical group bill for services provided to patients covered by health insurance provided by the health insurance entity, and under which a new provider applicant who is a member of the medical group practice will become a participating provider upon successful completion of the credentialing process; (B) "Health insurance entity" has the same meaning provided in § 56-7-109(a) ; and (C) "New provider applicant" means a physician or other licensed provider of medical services who has submitted a completed credentialing application to a health insurance entity. (6) Nothing in this subsection (f) shall apply to the TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in title 56, chapter 7, part 29; any other plan managed by the health care finance and administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27.
(1) A health insurance entity shall provide to any medical group practice with which the entity has an existing contract a list of all information and supporting documentation required for a credentialing application of a new provider applicant to be considered complete pursuant to this subsection (f).
(2) (A) A health insurance entity shall notify a new provider applicant in writing of the status of a credentialing application no later than five (5) business days of receipt of the application. The notice shall indicate if the application is complete or incomplete, and, if the application is incomplete, the notice shall indicate the information or documentation that is needed to complete the application. (B) If the application is incomplete and the new provider applicant submits additional information or documentation to complete the application, the health insurance entity shall comply with the requirements of subdivision (f)(2)(A) upon receipt of the additional information or documentation. (C) A health insurance entity shall notify a new provider applicant of the results of the new provider applicant's credentialing application within ninety (90) calendar days after notification from the health insurance entity that the application is complete. (D) If a new provider applicant fails to submit a complete credentialing application to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the application is deemed incomplete and credentialing is discontinued. If a new provider applicant fails to submit a complete network participation enrollment form, including signature evidencing intent to participate with the group and any other required documentation, to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the new provider applicant is ineligible to receive the payment set out in (f)(3)(A).
(A) A health insurance entity shall notify a new provider applicant in writing of the status of a credentialing application no later than five (5) business days of receipt of the application. The notice shall indicate if the application is complete or incomplete, and, if the application is incomplete, the notice shall indicate the information or documentation that is needed to complete the application.
(B) If the application is incomplete and the new provider applicant submits additional information or documentation to complete the application, the health insurance entity shall comply with the requirements of subdivision (f)(2)(A) upon receipt of the additional information or documentation.
(C) A health insurance entity shall notify a new provider applicant of the results of the new provider applicant's credentialing application within ninety (90) calendar days after notification from the health insurance entity that the application is complete.
(D) If a new provider applicant fails to submit a complete credentialing application to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the application is deemed incomplete and credentialing is discontinued. If a new provider applicant fails to submit a complete network participation enrollment form, including signature evidencing intent to participate with the group and any other required documentation, to a health insurance entity within thirty (30) calendar days of notice of an incomplete application, then the new provider applicant is ineligible to receive the payment set out in (f)(3)(A).
(3) (A) A new provider applicant shall not submit any claims for covered services provided by the new provider applicant to the health insurance entity for reimbursement while the credentialing application is pending. If claims are submitted while the credentialing application is pending, the health insurance entity may deny the claims. Upon notification pursuant to subdivision (f)(2)(C), the new provider applicant shall submit all held claims to the health insurance entity, and the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between receipt of a complete credentialing application pursuant to subdivision (f)(2)(A) and notification pursuant to subdivision (f)(2)(C). In the event that a new provider applicant or medical group practice has specified a network start date for the new provider applicant that is later than the time of receipt of a complete credentialing application pursuant to subdivision (f)(2)(A), the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between the specified network start date and notification pursuant to subdivision (f)(2)(C). (B) A health insurance entity's reimbursement obligation under subdivision (f)(3)(A) applies only to medical services provided in the name of the medical group practice by a new provider applicant that is billing for professional services under the existing group contract.
(A) A new provider applicant shall not submit any claims for covered services provided by the new provider applicant to the health insurance entity for reimbursement while the credentialing application is pending. If claims are submitted while the credentialing application is pending, the health insurance entity may deny the claims. Upon notification pursuant to subdivision (f)(2)(C), the new provider applicant shall submit all held claims to the health insurance entity, and the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between receipt of a complete credentialing application pursuant to subdivision (f)(2)(A) and notification pursuant to subdivision (f)(2)(C). In the event that a new provider applicant or medical group practice has specified a network start date for the new provider applicant that is later than the time of receipt of a complete credentialing application pursuant to subdivision (f)(2)(A), the health insurance entity shall pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant during the time between the specified network start date and notification pursuant to subdivision (f)(2)(C).
(B) A health insurance entity's reimbursement obligation under subdivision (f)(3)(A) applies only to medical services provided in the name of the medical group practice by a new provider applicant that is billing for professional services under the existing group contract.
(4) (A) Nothing in this section requires a health insurance entity to pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant if the new provider applicant's credentialing application is not approved or the health insurance entity is otherwise not willing to contract with the new provider applicant. (B) A medical group practice may be required to refund any reimbursement monies paid by the health insurance entity for services provided by a new provider applicant whose credentialing approval was obtained by fraud. (C) A medical group practice shall not collect from a health insurance beneficiary any amount for services provided if the new provider applicant's credentialing application is not approved or any amount refunded to a health insurance entity under subdivision (f)(4)(B).
(A) Nothing in this section requires a health insurance entity to pay reimbursement at the contracted in-network rate for any covered medical services provided by the new provider applicant if the new provider applicant's credentialing application is not approved or the health insurance entity is otherwise not willing to contract with the new provider applicant.
(B) A medical group practice may be required to refund any reimbursement monies paid by the health insurance entity for services provided by a new provider applicant whose credentialing approval was obtained by fraud.
(C) A medical group practice shall not collect from a health insurance beneficiary any amount for services provided if the new provider applicant's credentialing application is not approved or any amount refunded to a health insurance entity under subdivision (f)(4)(B).
(5) As used in this subsection (f): (A) "Existing group contract" means a participating provider agreement between a medical group practice and a health insurance entity, under which physicians and other providers of the medical group bill for services provided to patients covered by health insurance provided by the health insurance entity, and under which a new provider applicant who is a member of the medical group practice will become a participating provider upon successful completion of the credentialing process; (B) "Health insurance entity" has the same meaning provided in § 56-7-109(a) ; and (C) "New provider applicant" means a physician or other licensed provider of medical services who has submitted a completed credentialing application to a health insurance entity.
(A) "Existing group contract" means a participating provider agreement between a medical group practice and a health insurance entity, under which physicians and other providers of the medical group bill for services provided to patients covered by health insurance provided by the health insurance entity, and under which a new provider applicant who is a member of the medical group practice will become a participating provider upon successful completion of the credentialing process;
(B) "Health insurance entity" has the same meaning provided in § 56-7-109(a) ; and
(C) "New provider applicant" means a physician or other licensed provider of medical services who has submitted a completed credentialing application to a health insurance entity.
(6) Nothing in this subsection (f) shall apply to the TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in title 56, chapter 7, part 29; any other plan managed by the health care finance and administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27.
(g) (1) A health insurance entity shall not require the disclosure of a physician's participation in a physician wellness program, as defined in § 63-1-173 , as a condition of credentialing, contracting, or network participation with the health insurance entity. (2) A health insurance entity that is unable to assess a physician's risk of future impairment due to disclosures prohibited by subdivision (g)(1) is immune from civil liability, a civil cause of action, or an administrative sanction or other proceeding related to harm caused by the physician.
(1) A health insurance entity shall not require the disclosure of a physician's participation in a physician wellness program, as defined in § 63-1-173 , as a condition of credentialing, contracting, or network participation with the health insurance entity.
(2) A health insurance entity that is unable to assess a physician's risk of future impairment due to disclosures prohibited by subdivision (g)(1) is immune from civil liability, a civil cause of action, or an administrative sanction or other proceeding related to harm caused by the physician.
(h) An individual or entity that provides, discloses, or receives information related to career fatigue as part of a physician wellness program is, with respect to the information provided, disclosed, or received, immune from: (1) Civil liability or a civil cause of action; and (2) An administrative sanction or other proceeding.
(1) Civil liability or a civil cause of action; and
(2) An administrative sanction or other proceeding.
(i) This section does not: (1) Authorize a physician to withhold information requested in accordance with contractual terms between a health insurance entity and a statewide advocacy organization or information requested in an application used by a health insurance entity for credentialing or contracting purposes, including a Council for Affordable Quality Healthcare application; (2) Waive a physician's obligation to disclose information regarding: (A) A substance use disorder; (B) A mental health condition; or (C) Another condition that impairs the physician's judgment or adversely affects the physician's ability to practice medicine in a competent, ethical, and professional manner; or (3) Authorize a statewide advocacy organization to withhold information in accordance with contractual terms between the statewide advocacy organization and a health insurance entity.
(1) Authorize a physician to withhold information requested in accordance with contractual terms between a health insurance entity and a statewide advocacy organization or information requested in an application used by a health insurance entity for credentialing or contracting purposes, including a Council for Affordable Quality Healthcare application;
(2) Waive a physician's obligation to disclose information regarding: (A) A substance use disorder; (B) A mental health condition; or (C) Another condition that impairs the physician's judgment or adversely affects the physician's ability to practice medicine in a competent, ethical, and professional manner; or
(A) A substance use disorder;
(B) A mental health condition; or
(C) Another condition that impairs the physician's judgment or adversely affects the physician's ability to practice medicine in a competent, ethical, and professional manner; or
(3) Authorize a statewide advocacy organization to withhold information in accordance with contractual terms between the statewide advocacy organization and a health insurance entity.
Amended by 2024 Tenn. Acts, ch. 924,s 3, eff. 1/1/2025.
Amended by 2015 Tenn. Acts, ch. 386, s 1, eff. 1/1/2016.
Acts 2007 , ch. 365, § 1; 2012 , ch. 798, § 21.
Tenn. Code Ann. § 56-33-102 — TN Code / Title 56 / Chapter 33 / Section 56-33-102
Chapter definitions
Status: in_force

As used in this chapter: (1) "Aggregator site" means a website that provides access to information regarding insurance products from more than one (1) insurer, including product and insurer information, for use in comparison shopping; (2) "Blanket travel insurance" means a policy of travel insurance issued to an eligible group providing coverage for specific classes of persons defined in the policy with coverage provided to all members of the eligible group without a separate charge to individual members of the eligible group; (3) "Cancellation fee waiver" means a contractual agreement between a supplier of travel services and its customer to waive some or all of the non-refundable cancellation fee provisions of the supplier's underlying travel contract with or without regard to the reason for the cancellation or form of reimbursement; (4) "Commissioner" means the commissioner of commerce and insurance, or the commissioner's designee; (5) "Eligible group" means two (2) or more persons who are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, including: (A) A person engaged in the business of providing travel or travel services, including: (i) Tour operators; (ii) Lodging providers; (iii) Vacation property owners; (iv) Hotels; (v) Resorts; (vi) Travel clubs; (vii) Travel agencies; (viii) Property managers; (ix) Cultural exchange programs; or (x) Common carriers or the operator, owner, or lessor of a means of transportation of passengers, including airlines, cruise lines, railroads, steamship companies, or public bus carriers, where with regard to a particular travel or type of travel or type of traveler or travelers, all members or customers of the group have a common exposure to risk attendant to that travel; (B) An institute of higher education, school, or other institution of learning, covering students, teachers, employees, or volunteers; (C) An employer covering a group of employees, volunteers, contractors, board of directors, dependents, or guests; (D) A sports team, camp, or sponsor thereof, covering participants, members, campers, employees, officials, supervisors, or volunteers; (E) A religious, charitable, recreational, educational, or civic organization, or branch thereof, covering a group of members, participants, or volunteers; (F) A financial institution or financial institution vendor, or parent holding company, trustee, or agent of or designated by one (1) or more financial institutions or financial institution vendors, including accountholders, credit card holders, debtors, guarantors, or purchasers; (G) An incorporated or unincorporated association, including labor unions, with a common interest, constitution and bylaws, and organized and maintained in good faith for purposes other than obtaining insurance for members or participants of the association covering its members; (H) A trust or the trustees of a fund established, created, or maintained for the benefit of and covering members, employees, or customers, subject to: (i) The commissioner permitting the use of a trust; and (ii) The state's premium tax provisions in § 56-4-205 of one (1) or more associations meeting the requirements of subdivision (5)(G); (I) An entertainment production company covering a group of participants, volunteers, audience members, contestants, or workers; (J) A volunteer fire department, ambulance, rescue, police, court, or a first aid, civil defense, or another volunteer group; (K) A preschool, daycare institution for children or adults, or a senior citizen club; (L) An automobile or truck rental or leasing company: (i) Covering a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles; and (ii) For whom the common carrier, operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company, is the policyholder under a policy to which this chapter applies; or (M) Another group where the commissioner has determined that the members are engaged in a common enterprise or have an economic, educational, or social affinity or relationship, and that issuance of the policy would not be contrary to the public interest; (6) "Employer" means a person that employs one (1) or more employees within this state; (7) "Fulfillment materials" means documentation sent to the purchaser of a travel protection plan confirming the purchase and providing the travel protection plan's coverage and assistance details; (8) "Group travel insurance" means travel insurance issued to an eligible group; (9) "Person" means a business entity or a natural person; (10) "Travel assistance services": (A) Means services for which the consumer is not indemnified based on a fortuitous event, and where providing the service does not result in transfer or shifting of risk that would constitute the business of insurance; and (B) Include: (i) Security advisories; (ii) Destination information; (iii) Vaccination and immunization information services; (iv) Travel reservation services; (v) Entertainment; (vi) Activity and event planning; (vii) Translation assistance; (viii) Emergency messaging; (ix) International legal and medical referrals; (x) Medical case monitoring; (xi) Coordination of transportation arrangements; (xii) Emergency cash transfer assistance; (xiii) Medical prescription replacement assistance; (xiv) Passport and travel document replacement assistance; (xv) Lost luggage assistance; (xvi) Concierge services; or (xvii) Another service that is furnished in connection with planned travel; and (11) "Travel protection plans" means plans that provide at least one (1) of the following: (A) Travel insurance; (B) Travel assistance services; or (C) Cancellation fee waivers. Acts 2022, ch. 703, § 6.
As used in this chapter:
(1) "Aggregator site" means a website that provides access to information regarding insurance products from more than one (1) insurer, including product and insurer information, for use in comparison shopping;
(2) "Blanket travel insurance" means a policy of travel insurance issued to an eligible group providing coverage for specific classes of persons defined in the policy with coverage provided to all members of the eligible group without a separate charge to individual members of the eligible group;
(3) "Cancellation fee waiver" means a contractual agreement between a supplier of travel services and its customer to waive some or all of the non-refundable cancellation fee provisions of the supplier's underlying travel contract with or without regard to the reason for the cancellation or form of reimbursement;
(4) "Commissioner" means the commissioner of commerce and insurance, or the commissioner's designee;
(5) "Eligible group" means two (2) or more persons who are engaged in a common enterprise, or have an economic, educational, or social affinity or relationship, including: (A) A person engaged in the business of providing travel or travel services, including: (i) Tour operators; (ii) Lodging providers; (iii) Vacation property owners; (iv) Hotels; (v) Resorts; (vi) Travel clubs; (vii) Travel agencies; (viii) Property managers; (ix) Cultural exchange programs; or (x) Common carriers or the operator, owner, or lessor of a means of transportation of passengers, including airlines, cruise lines, railroads, steamship companies, or public bus carriers, where with regard to a particular travel or type of travel or type of traveler or travelers, all members or customers of the group have a common exposure to risk attendant to that travel; (B) An institute of higher education, school, or other institution of learning, covering students, teachers, employees, or volunteers; (C) An employer covering a group of employees, volunteers, contractors, board of directors, dependents, or guests; (D) A sports team, camp, or sponsor thereof, covering participants, members, campers, employees, officials, supervisors, or volunteers; (E) A religious, charitable, recreational, educational, or civic organization, or branch thereof, covering a group of members, participants, or volunteers; (F) A financial institution or financial institution vendor, or parent holding company, trustee, or agent of or designated by one (1) or more financial institutions or financial institution vendors, including accountholders, credit card holders, debtors, guarantors, or purchasers; (G) An incorporated or unincorporated association, including labor unions, with a common interest, constitution and bylaws, and organized and maintained in good faith for purposes other than obtaining insurance for members or participants of the association covering its members; (H) A trust or the trustees of a fund established, created, or maintained for the benefit of and covering members, employees, or customers, subject to: (i) The commissioner permitting the use of a trust; and (ii) The state's premium tax provisions in § 56-4-205 of one (1) or more associations meeting the requirements of subdivision (5)(G); (I) An entertainment production company covering a group of participants, volunteers, audience members, contestants, or workers; (J) A volunteer fire department, ambulance, rescue, police, court, or a first aid, civil defense, or another volunteer group; (K) A preschool, daycare institution for children or adults, or a senior citizen club; (L) An automobile or truck rental or leasing company: (i) Covering a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles; and (ii) For whom the common carrier, operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company, is the policyholder under a policy to which this chapter applies; or (M) Another group where the commissioner has determined that the members are engaged in a common enterprise or have an economic, educational, or social affinity or relationship, and that issuance of the policy would not be contrary to the public interest;
(A) A person engaged in the business of providing travel or travel services, including: (i) Tour operators; (ii) Lodging providers; (iii) Vacation property owners; (iv) Hotels; (v) Resorts; (vi) Travel clubs; (vii) Travel agencies; (viii) Property managers; (ix) Cultural exchange programs; or (x) Common carriers or the operator, owner, or lessor of a means of transportation of passengers, including airlines, cruise lines, railroads, steamship companies, or public bus carriers, where with regard to a particular travel or type of travel or type of traveler or travelers, all members or customers of the group have a common exposure to risk attendant to that travel;
(i) Tour operators;
(ii) Lodging providers;
(iii) Vacation property owners;
(iv) Hotels;
(v) Resorts;
(vi) Travel clubs;
(vii) Travel agencies;
(viii) Property managers;
(ix) Cultural exchange programs; or
(x) Common carriers or the operator, owner, or lessor of a means of transportation of passengers, including airlines, cruise lines, railroads, steamship companies, or public bus carriers, where with regard to a particular travel or type of travel or type of traveler or travelers, all members or customers of the group have a common exposure to risk attendant to that travel;
(B) An institute of higher education, school, or other institution of learning, covering students, teachers, employees, or volunteers;
(C) An employer covering a group of employees, volunteers, contractors, board of directors, dependents, or guests;
(D) A sports team, camp, or sponsor thereof, covering participants, members, campers, employees, officials, supervisors, or volunteers;
(E) A religious, charitable, recreational, educational, or civic organization, or branch thereof, covering a group of members, participants, or volunteers;
(F) A financial institution or financial institution vendor, or parent holding company, trustee, or agent of or designated by one (1) or more financial institutions or financial institution vendors, including accountholders, credit card holders, debtors, guarantors, or purchasers;
(G) An incorporated or unincorporated association, including labor unions, with a common interest, constitution and bylaws, and organized and maintained in good faith for purposes other than obtaining insurance for members or participants of the association covering its members;
(H) A trust or the trustees of a fund established, created, or maintained for the benefit of and covering members, employees, or customers, subject to: (i) The commissioner permitting the use of a trust; and (ii) The state's premium tax provisions in § 56-4-205 of one (1) or more associations meeting the requirements of subdivision (5)(G);
(i) The commissioner permitting the use of a trust; and
(ii) The state's premium tax provisions in § 56-4-205 of one (1) or more associations meeting the requirements of subdivision (5)(G);
(I) An entertainment production company covering a group of participants, volunteers, audience members, contestants, or workers;
(J) A volunteer fire department, ambulance, rescue, police, court, or a first aid, civil defense, or another volunteer group;
(K) A preschool, daycare institution for children or adults, or a senior citizen club;
(L) An automobile or truck rental or leasing company: (i) Covering a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles; and (ii) For whom the common carrier, operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company, is the policyholder under a policy to which this chapter applies; or
(i) Covering a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles; and
(ii) For whom the common carrier, operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company, is the policyholder under a policy to which this chapter applies; or
(M) Another group where the commissioner has determined that the members are engaged in a common enterprise or have an economic, educational, or social affinity or relationship, and that issuance of the policy would not be contrary to the public interest;
(6) "Employer" means a person that employs one (1) or more employees within this state;
(7) "Fulfillment materials" means documentation sent to the purchaser of a travel protection plan confirming the purchase and providing the travel protection plan's coverage and assistance details;
(8) "Group travel insurance" means travel insurance issued to an eligible group;
(9) "Person" means a business entity or a natural person;
(10) "Travel assistance services": (A) Means services for which the consumer is not indemnified based on a fortuitous event, and where providing the service does not result in transfer or shifting of risk that would constitute the business of insurance; and (B) Include: (i) Security advisories; (ii) Destination information; (iii) Vaccination and immunization information services; (iv) Travel reservation services; (v) Entertainment; (vi) Activity and event planning; (vii) Translation assistance; (viii) Emergency messaging; (ix) International legal and medical referrals; (x) Medical case monitoring; (xi) Coordination of transportation arrangements; (xii) Emergency cash transfer assistance; (xiii) Medical prescription replacement assistance; (xiv) Passport and travel document replacement assistance; (xv) Lost luggage assistance; (xvi) Concierge services; or (xvii) Another service that is furnished in connection with planned travel; and
(A) Means services for which the consumer is not indemnified based on a fortuitous event, and where providing the service does not result in transfer or shifting of risk that would constitute the business of insurance; and
(B) Include: (i) Security advisories; (ii) Destination information; (iii) Vaccination and immunization information services; (iv) Travel reservation services; (v) Entertainment; (vi) Activity and event planning; (vii) Translation assistance; (viii) Emergency messaging; (ix) International legal and medical referrals; (x) Medical case monitoring; (xi) Coordination of transportation arrangements; (xii) Emergency cash transfer assistance; (xiii) Medical prescription replacement assistance; (xiv) Passport and travel document replacement assistance; (xv) Lost luggage assistance; (xvi) Concierge services; or (xvii) Another service that is furnished in connection with planned travel; and
(i) Security advisories;
(ii) Destination information;
(iii) Vaccination and immunization information services;
(iv) Travel reservation services;
(v) Entertainment;
(vi) Activity and event planning;
(vii) Translation assistance;
(viii) Emergency messaging;
(ix) International legal and medical referrals;
(x) Medical case monitoring;
(xi) Coordination of transportation arrangements;
(xii) Emergency cash transfer assistance;
(xiii) Medical prescription replacement assistance;
(xiv) Passport and travel document replacement assistance;
(xv) Lost luggage assistance;
(xvi) Concierge services; or
(xvii) Another service that is furnished in connection with planned travel; and
(11) "Travel protection plans" means plans that provide at least one (1) of the following: (A) Travel insurance; (B) Travel assistance services; or (C) Cancellation fee waivers.
(A) Travel insurance;
(B) Travel assistance services; or
(C) Cancellation fee waivers.
Acts 2022, ch. 703, § 6.
Tenn. Code Ann. § 56-7-1107 — TN Code / Title 56 / Chapter 7 / Section 56-7-1107
Accident prevention course for older drivers - Reductions in premiums
Status: in_force

(a) The rates and premiums for every policy of automobile insurance shall include a provision for appropriate reductions, as determined by the insurer to be actuarially justified, for any motor vehicle when the regular operators are over fifty-five (55) years of age and have successfully completed a motor vehicle accident prevention course approved by the commissioner of safety; however, there shall be no reduction in premiums for a self-instructed course. For purposes of this section, "self-instructed course" shall not include an online course that is approved by the commissioner pursuant to subsection (c). (b) (1) The premium reduction shall remain in effect for the qualifying insured for a period of three (3) years from the date of successful completion of the accident prevention course, except that the insurer may elect to apply the premium reduction beginning at the next renewal date of the policy and continuing for a three-year period. (2) The period of premium reduction for an operator who has repeated the accident prevention course shall be based only upon the last course the operator has successfully completed. (c) Any accident prevention course approved under this section shall be taught by an instructor approved by the commissioner, and the course shall consist of at least eight (8) hours of classroom instruction or an online course that is approved by the commissioner. Each operator who successfully completes an approved motor vehicle accident prevention course shall be issued a certificate by the course's sponsoring agency. Records of completion shall be maintained in a manner acceptable to the commissioner and shall be the basis of qualification for the premium discount. (d) Any person claiming eligibility for a rate or premium reduction shall be responsible for providing to the person's insurance company the information necessary to determine eligibility. (e) This section does not apply to: (1) Any motor vehicle that is a part of a fleet or is used for commercial purposes unless there is a regularly assigned principal operator; (2) Any motor vehicle subject to a higher rate or premium because of an operator's previous motor vehicle claims experience, or to any motor vehicle whose operator has been convicted or forfeited bond for the violation of any of the motor vehicle laws of this state, until that operator shall have maintained a driving record free of at-fault accidents or violations for a continuous period of three (3) years; (3) Any motor vehicle whose operator has had an operator's license revoked or suspended for any reason within the previous three (3) years; or (4) Any motor vehicle whose operator is required by any court to take a defensive driver training course. (f) The department of safety is authorized to promulgate rules and regulations to effectuate the purposes of this section. The rules and regulations shall include establishing the criteria for the motor vehicle accident prevention course and providing a means of certification for instructors of the motor vehicle accident prevention course and certification of an online motor vehicle accident prevention course. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Acts 1983, ch. 13, §§ 1-5, 7; 1990, ch. 880, § 1; 2010, ch. 617, §§ 1 - 3.
(a) The rates and premiums for every policy of automobile insurance shall include a provision for appropriate reductions, as determined by the insurer to be actuarially justified, for any motor vehicle when the regular operators are over fifty-five (55) years of age and have successfully completed a motor vehicle accident prevention course approved by the commissioner of safety; however, there shall be no reduction in premiums for a self-instructed course. For purposes of this section, "self-instructed course" shall not include an online course that is approved by the commissioner pursuant to subsection (c).
(b) (1) The premium reduction shall remain in effect for the qualifying insured for a period of three (3) years from the date of successful completion of the accident prevention course, except that the insurer may elect to apply the premium reduction beginning at the next renewal date of the policy and continuing for a three-year period. (2) The period of premium reduction for an operator who has repeated the accident prevention course shall be based only upon the last course the operator has successfully completed.
(1) The premium reduction shall remain in effect for the qualifying insured for a period of three (3) years from the date of successful completion of the accident prevention course, except that the insurer may elect to apply the premium reduction beginning at the next renewal date of the policy and continuing for a three-year period.
(2) The period of premium reduction for an operator who has repeated the accident prevention course shall be based only upon the last course the operator has successfully completed.
(c) Any accident prevention course approved under this section shall be taught by an instructor approved by the commissioner, and the course shall consist of at least eight (8) hours of classroom instruction or an online course that is approved by the commissioner. Each operator who successfully completes an approved motor vehicle accident prevention course shall be issued a certificate by the course's sponsoring agency. Records of completion shall be maintained in a manner acceptable to the commissioner and shall be the basis of qualification for the premium discount.
(d) Any person claiming eligibility for a rate or premium reduction shall be responsible for providing to the person's insurance company the information necessary to determine eligibility.
(e) This section does not apply to: (1) Any motor vehicle that is a part of a fleet or is used for commercial purposes unless there is a regularly assigned principal operator; (2) Any motor vehicle subject to a higher rate or premium because of an operator's previous motor vehicle claims experience, or to any motor vehicle whose operator has been convicted or forfeited bond for the violation of any of the motor vehicle laws of this state, until that operator shall have maintained a driving record free of at-fault accidents or violations for a continuous period of three (3) years; (3) Any motor vehicle whose operator has had an operator's license revoked or suspended for any reason within the previous three (3) years; or (4) Any motor vehicle whose operator is required by any court to take a defensive driver training course.
(1) Any motor vehicle that is a part of a fleet or is used for commercial purposes unless there is a regularly assigned principal operator;
(2) Any motor vehicle subject to a higher rate or premium because of an operator's previous motor vehicle claims experience, or to any motor vehicle whose operator has been convicted or forfeited bond for the violation of any of the motor vehicle laws of this state, until that operator shall have maintained a driving record free of at-fault accidents or violations for a continuous period of three (3) years;
(3) Any motor vehicle whose operator has had an operator's license revoked or suspended for any reason within the previous three (3) years; or
(4) Any motor vehicle whose operator is required by any court to take a defensive driver training course.
(f) The department of safety is authorized to promulgate rules and regulations to effectuate the purposes of this section. The rules and regulations shall include establishing the criteria for the motor vehicle accident prevention course and providing a means of certification for instructors of the motor vehicle accident prevention course and certification of an online motor vehicle accident prevention course. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1983, ch. 13, §§ 1-5, 7; 1990, ch. 880, § 1; 2010, ch. 617, §§ 1 - 3.
Tenn. Code Ann. § 56-61-120 — TN Code / Title 56 / Chapter 61 / Section 56-61-120
Approval of external review organizations
Status: in_force

(a) The commissioner shall approve external review organizations eligible to conduct external reviews under this chapter. (b) In order to be eligible for approval by the commissioner to conduct external reviews under this chapter, an external review organization: (1) Except as otherwise provided in this section, shall be accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations established under § 56-61-121 ; and (2) Shall submit an application for approval in accordance with subsection (d). (c) The commissioner shall develop an application form for initially approving and for reapproving external review organizations to conduct external reviews. (d) Any external review organization wishing to be approved to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the external review organization satisfies the minimum qualifications established under § 56-61-121 . (e) Subject to subsection (b), an external review organization is eligible for approval under this section only if it is accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations under § 56-61-121 . (f) The commissioner may approve external review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing external review organization accreditation. (g) The commissioner may charge an application fee that external review organizations shall submit to the commissioner with an application for approval and reapproval. (h) An approval is effective for two (2) years, unless the commissioner determines before its expiration that the external review organization is not satisfying the minimum qualifications established under § 56-61-121 . Whenever the commissioner determines that an external review organization has lost its accreditation or no longer satisfies the minimum requirements established under § 56-61-121 , the commissioner shall terminate the approval of the external review organization and remove the external review organization from the list of external review organizations approved to conduct external reviews under this chapter that is maintained by the commissioner pursuant to subsection (i). (i) The commissioner shall maintain and periodically update a list of approved external review organizations. (j) The commissioner may promulgate rules and regulations to carry out this section. Acts 2010, ch. 980, § 21.
(a) The commissioner shall approve external review organizations eligible to conduct external reviews under this chapter.
(b) In order to be eligible for approval by the commissioner to conduct external reviews under this chapter, an external review organization: (1) Except as otherwise provided in this section, shall be accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations established under § 56-61-121 ; and (2) Shall submit an application for approval in accordance with subsection (d).
(1) Except as otherwise provided in this section, shall be accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations established under § 56-61-121 ; and
(2) Shall submit an application for approval in accordance with subsection (d).
(c) The commissioner shall develop an application form for initially approving and for reapproving external review organizations to conduct external reviews.
(d) Any external review organization wishing to be approved to conduct external reviews under this chapter shall submit the application form and include with the form all documentation and information necessary for the commissioner to determine if the external review organization satisfies the minimum qualifications established under § 56-61-121 .
(e) Subject to subsection (b), an external review organization is eligible for approval under this section only if it is accredited by a nationally recognized private accrediting entity that the commissioner has determined has external review organization accreditation standards that are equivalent to or exceed the minimum qualifications for external review organizations under § 56-61-121 .
(f) The commissioner may approve external review organizations that are not accredited by a nationally recognized private accrediting entity if there are no acceptable nationally recognized private accrediting entities providing external review organization accreditation.
(g) The commissioner may charge an application fee that external review organizations shall submit to the commissioner with an application for approval and reapproval.
(h) An approval is effective for two (2) years, unless the commissioner determines before its expiration that the external review organization is not satisfying the minimum qualifications established under § 56-61-121 . Whenever the commissioner determines that an external review organization has lost its accreditation or no longer satisfies the minimum requirements established under § 56-61-121 , the commissioner shall terminate the approval of the external review organization and remove the external review organization from the list of external review organizations approved to conduct external reviews under this chapter that is maintained by the commissioner pursuant to subsection (i).
(i) The commissioner shall maintain and periodically update a list of approved external review organizations.
(j) The commissioner may promulgate rules and regulations to carry out this section.
Acts 2010, ch. 980, § 21.
Tenn. Code Ann. § 56-6-704 — TN Code / Title 56 / Chapter 6 / Section 56-6-704
Utilization review agents
Status: in_force

(a) Utilization review agents shall adhere to the minimum standards set forth in § 56-6-705 . Utilization review programs for the mental health and chemical dependency care must comply with the most recent requirements of nationally recognized utilization review accrediting bodies, i.e., the utilization review accreditation commission (URAC) and the national committee for quality assurance (NCQA), if the agent is accredited and with all final security and privacy rules on protected health information as defined in the Health Insurance Portability and Accountability Act (HIPAA). However, nothing in this part shall be construed to require compliance with the final security and privacy rules of HIPAA prior to the compliance dates set by the secretary of health and human services. (b) (1) A utilization review agent may not conduct utilization review in this state unless the utilization review agent has certified to the commissioner in writing that the agent is in compliance with § 56-6-705 . Certification shall be made annually on or before July 1 of each calendar year. In addition, a utilization review agent shall file the following information: (A) The name, address, telephone number, and normal business hours of the utilization review agent; (B) The name and telephone number of a person for the commissioner to contact; (C) A description of the appeal procedures for utilization review determinations; and (D) Utilization review programs for mental health and chemical dependency care shall make available to a provider submitting patient utilization review information a description of utilization review standards and procedures applicable to that provider. (2) Any material changes in the information filed in accordance with this section shall be filed with the commissioner within thirty (30) days of the change. (c) Upon filing the certification, each utilization review agent shall pay an annual fee in the amount of one thousand dollars ($1,000) to the department. The commissioner shall exempt from payment of the annual fee any utilization review agent that has received accreditation by URAC or NCQA. All fees paid to the department under this part shall be held by the commissioner as expendable receipts for the purpose of administering this part. Acts 1992, ch. 812, § 5; 1993, ch. 482, § 1; 2002, ch. 799, §§ 2, 3; 2009, ch. 611, §§ 1, 2.
(a) Utilization review agents shall adhere to the minimum standards set forth in § 56-6-705 . Utilization review programs for the mental health and chemical dependency care must comply with the most recent requirements of nationally recognized utilization review accrediting bodies, i.e., the utilization review accreditation commission (URAC) and the national committee for quality assurance (NCQA), if the agent is accredited and with all final security and privacy rules on protected health information as defined in the Health Insurance Portability and Accountability Act (HIPAA). However, nothing in this part shall be construed to require compliance with the final security and privacy rules of HIPAA prior to the compliance dates set by the secretary of health and human services.
(b) (1) A utilization review agent may not conduct utilization review in this state unless the utilization review agent has certified to the commissioner in writing that the agent is in compliance with § 56-6-705 . Certification shall be made annually on or before July 1 of each calendar year. In addition, a utilization review agent shall file the following information: (A) The name, address, telephone number, and normal business hours of the utilization review agent; (B) The name and telephone number of a person for the commissioner to contact; (C) A description of the appeal procedures for utilization review determinations; and (D) Utilization review programs for mental health and chemical dependency care shall make available to a provider submitting patient utilization review information a description of utilization review standards and procedures applicable to that provider. (2) Any material changes in the information filed in accordance with this section shall be filed with the commissioner within thirty (30) days of the change.
(1) A utilization review agent may not conduct utilization review in this state unless the utilization review agent has certified to the commissioner in writing that the agent is in compliance with § 56-6-705 . Certification shall be made annually on or before July 1 of each calendar year. In addition, a utilization review agent shall file the following information: (A) The name, address, telephone number, and normal business hours of the utilization review agent; (B) The name and telephone number of a person for the commissioner to contact; (C) A description of the appeal procedures for utilization review determinations; and (D) Utilization review programs for mental health and chemical dependency care shall make available to a provider submitting patient utilization review information a description of utilization review standards and procedures applicable to that provider.
(A) The name, address, telephone number, and normal business hours of the utilization review agent;
(B) The name and telephone number of a person for the commissioner to contact;
(C) A description of the appeal procedures for utilization review determinations; and
(D) Utilization review programs for mental health and chemical dependency care shall make available to a provider submitting patient utilization review information a description of utilization review standards and procedures applicable to that provider.
(2) Any material changes in the information filed in accordance with this section shall be filed with the commissioner within thirty (30) days of the change.
(c) Upon filing the certification, each utilization review agent shall pay an annual fee in the amount of one thousand dollars ($1,000) to the department. The commissioner shall exempt from payment of the annual fee any utilization review agent that has received accreditation by URAC or NCQA. All fees paid to the department under this part shall be held by the commissioner as expendable receipts for the purpose of administering this part.
Acts 1992, ch. 812, § 5; 1993, ch. 482, § 1; 2002, ch. 799, §§ 2, 3; 2009, ch. 611, §§ 1, 2.
Tenn. Code Ann. § 56-3-405 — TN Code / Title 56 / Chapter 3 / Section 56-3-405
Acquisition and conveyance of real property
Status: in_force

Domestic insurance companies may acquire, hold and convey real property only for the following purposes and in the following manner: (1) The land and the building on the land in which it has its principal office and other real property that is requisite for its convenient accommodations in the transaction of its insurance business, the amount not to exceed ten percent (10%) of its admitted assets, subject, however, to the limitations of § 56-3-406 ; (2) Real property that has been mortgaged to it in good faith by way of security for loans previously contracted or for moneys due; (3) Real property that has been conveyed to it in satisfaction of debts previously contracted in the course of its dealings; (4) Real property that has been purchased at sales on judgments, decrees, or mortgages obtained or made for those debts; (5) Real property that has been acquired for investment purposes; provided, that: (A) No real property may be acquired or held under the authority of this section unless at the time of acquisition it is already improved and income-producing or unless it is improved with due diligence after acquisition so as to produce an income; (B) The company shall not at any one (1) time have more than two percent (2%) of its admitted assets invested in a single piece or adjoining pieces of real property acquired or held under the authority of this section; and (C) No investments under the authority of this section shall be made in hotels, club houses, garages, schools, factories erected and designed for special purposes or agricultural properties, without specific approval in advance by the commissioner; and (6) In no event shall the aggregate of all of a company's holdings and investments, under the authority of §§ 56-3-401 - 56-3-404, this section and §§ 56-3-406 and 56-3-407 , exceed ten percent (10%) of the company's admitted assets; provided, that nothing in this section shall prevent the acquisition by the company of any property under subdivisions (2)-(4), but properties so acquired shall be held under § 56-3-406 , and the company shall list the book value of the properties as assets not admitted, to the extent the aggregate of the book value of real estate exceeds ten percent (10%) of the company's admitted assets. Acts 1979, ch. 305, § 5; T.C.A., § 56-365.
Domestic insurance companies may acquire, hold and convey real property only for the following purposes and in the following manner:
(1) The land and the building on the land in which it has its principal office and other real property that is requisite for its convenient accommodations in the transaction of its insurance business, the amount not to exceed ten percent (10%) of its admitted assets, subject, however, to the limitations of § 56-3-406 ;
(2) Real property that has been mortgaged to it in good faith by way of security for loans previously contracted or for moneys due;
(3) Real property that has been conveyed to it in satisfaction of debts previously contracted in the course of its dealings;
(4) Real property that has been purchased at sales on judgments, decrees, or mortgages obtained or made for those debts;
(5) Real property that has been acquired for investment purposes; provided, that: (A) No real property may be acquired or held under the authority of this section unless at the time of acquisition it is already improved and income-producing or unless it is improved with due diligence after acquisition so as to produce an income; (B) The company shall not at any one (1) time have more than two percent (2%) of its admitted assets invested in a single piece or adjoining pieces of real property acquired or held under the authority of this section; and (C) No investments under the authority of this section shall be made in hotels, club houses, garages, schools, factories erected and designed for special purposes or agricultural properties, without specific approval in advance by the commissioner; and
(A) No real property may be acquired or held under the authority of this section unless at the time of acquisition it is already improved and income-producing or unless it is improved with due diligence after acquisition so as to produce an income;
(B) The company shall not at any one (1) time have more than two percent (2%) of its admitted assets invested in a single piece or adjoining pieces of real property acquired or held under the authority of this section; and
(C) No investments under the authority of this section shall be made in hotels, club houses, garages, schools, factories erected and designed for special purposes or agricultural properties, without specific approval in advance by the commissioner; and
(6) In no event shall the aggregate of all of a company's holdings and investments, under the authority of §§ 56-3-401 - 56-3-404, this section and §§ 56-3-406 and 56-3-407 , exceed ten percent (10%) of the company's admitted assets; provided, that nothing in this section shall prevent the acquisition by the company of any property under subdivisions (2)-(4), but properties so acquired shall be held under § 56-3-406 , and the company shall list the book value of the properties as assets not admitted, to the extent the aggregate of the book value of real estate exceeds ten percent (10%) of the company's admitted assets.
Acts 1979, ch. 305, § 5; T.C.A., § 56-365.
Tenn. Code Ann. § 56-55-109 — TN Code / Title 56 / Chapter 55 / Section 56-55-109
Restrictions on use of deceptive language - False or misleading statements - Fraud
Status: in_force

(a) Unless licensed as an insurance company, a vehicle protection product warrantor shall not use in its name, contracts, or literature the words "insurance," "casualty," "surety," "mutual," or any other word that is descriptive of the insurance, casualty, or surety business or that is deceptively similar to the name or description of any insurance or surety corporation or any other vehicle protection product warrantor. A warrantor may use the term "guaranty" or a similar word in the warrantor's name. (b) A vehicle protection product warrantor shall not make, permit, or cause any false or misleading statements, either oral or written, in connection with the sale, offer to sell, or advertisement of a vehicle protection product. (c) A vehicle protection product warrantor shall not permit or cause the omission of any material statement in connection with the sale, offer to sell, or advertisement of a vehicle protection product, that, under the circumstances, should have been made, in order to make the statements that were made not misleading. (d) A vehicle protection product warrantor shall not make, permit, or cause any false or misleading statements, either oral or written, about the performance required or payments that may be available under the vehicle protection product warranty. (e) A vehicle protection product warrantor shall not make, permit, or cause any statement or practice that has the effect of creating or maintaining a fraud. (f) A vehicle protection product seller or warrantor may not require, as a condition of sale or financing, that a retail purchaser of a motor vehicle purchase a vehicle protection product that is not installed on the motor vehicle at the time of sale. Acts 2005, ch. 244, § 10.
(a) Unless licensed as an insurance company, a vehicle protection product warrantor shall not use in its name, contracts, or literature the words "insurance," "casualty," "surety," "mutual," or any other word that is descriptive of the insurance, casualty, or surety business or that is deceptively similar to the name or description of any insurance or surety corporation or any other vehicle protection product warrantor. A warrantor may use the term "guaranty" or a similar word in the warrantor's name.
(b) A vehicle protection product warrantor shall not make, permit, or cause any false or misleading statements, either oral or written, in connection with the sale, offer to sell, or advertisement of a vehicle protection product.
(c) A vehicle protection product warrantor shall not permit or cause the omission of any material statement in connection with the sale, offer to sell, or advertisement of a vehicle protection product, that, under the circumstances, should have been made, in order to make the statements that were made not misleading.
(d) A vehicle protection product warrantor shall not make, permit, or cause any false or misleading statements, either oral or written, about the performance required or payments that may be available under the vehicle protection product warranty.
(e) A vehicle protection product warrantor shall not make, permit, or cause any statement or practice that has the effect of creating or maintaining a fraud.
(f) A vehicle protection product seller or warrantor may not require, as a condition of sale or financing, that a retail purchaser of a motor vehicle purchase a vehicle protection product that is not installed on the motor vehicle at the time of sale.
Acts 2005, ch. 244, § 10.
Tenn. Code Ann. § 56-10-302 — TN Code / Title 56 / Chapter 10 / Section 56-10-302
Acquisitions and dispositions
Status: in_force

(a) No acquisitions or dispositions of assets need be reported pursuant to § 56-10-301 if the acquisitions or dispositions are not material. For purposes of this part, a material acquisition, or the aggregate of any series of related acquisitions during any thirty-day period, or disposition, or the aggregate of any series of related dispositions during a thirty-day period, is one that is non-recurring and not in the ordinary course of business and involves more than five percent (5%) of the reporting insurer's total admitted assets as reported in its most recent statutory statement filed with the insurance department of the insurer's state of domicile. (b) (1) Asset acquisitions subject to this part include every purchase, lease, exchange, merger, consolidation, succession or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for such purpose. (2) Asset dispositions subject to this part include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment, whether for the benefit of creditors or otherwise, abandonment, destruction or other disposition. (c) (1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets: (A) Date of the transaction; (B) Manner of acquisition or disposition; (C) Description of the assets involved; (D) Nature and amount of the consideration given or received; (E) Purpose of, or reason for, the transaction; (F) Manner by which the amount of consideration was determined; (G) Gain or loss recognized or realized as a result of the transaction; and (H) Name or names of the person or persons from whom the assets were acquired or to whom they were disposed. (2) Insurers are required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurer's reserves, and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement, and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurer's capital and surplus. Acts 1995, ch. 363, § 4.
(a) No acquisitions or dispositions of assets need be reported pursuant to § 56-10-301 if the acquisitions or dispositions are not material. For purposes of this part, a material acquisition, or the aggregate of any series of related acquisitions during any thirty-day period, or disposition, or the aggregate of any series of related dispositions during a thirty-day period, is one that is non-recurring and not in the ordinary course of business and involves more than five percent (5%) of the reporting insurer's total admitted assets as reported in its most recent statutory statement filed with the insurance department of the insurer's state of domicile.
(b) (1) Asset acquisitions subject to this part include every purchase, lease, exchange, merger, consolidation, succession or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for such purpose. (2) Asset dispositions subject to this part include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment, whether for the benefit of creditors or otherwise, abandonment, destruction or other disposition.
(1) Asset acquisitions subject to this part include every purchase, lease, exchange, merger, consolidation, succession or other acquisition other than the construction or development of real property by or for the reporting insurer or the acquisition of materials for such purpose.
(2) Asset dispositions subject to this part include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, assignment, whether for the benefit of creditors or otherwise, abandonment, destruction or other disposition.
(c) (1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets: (A) Date of the transaction; (B) Manner of acquisition or disposition; (C) Description of the assets involved; (D) Nature and amount of the consideration given or received; (E) Purpose of, or reason for, the transaction; (F) Manner by which the amount of consideration was determined; (G) Gain or loss recognized or realized as a result of the transaction; and (H) Name or names of the person or persons from whom the assets were acquired or to whom they were disposed. (2) Insurers are required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurer's reserves, and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement, and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurer's capital and surplus.
(1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets: (A) Date of the transaction; (B) Manner of acquisition or disposition; (C) Description of the assets involved; (D) Nature and amount of the consideration given or received; (E) Purpose of, or reason for, the transaction; (F) Manner by which the amount of consideration was determined; (G) Gain or loss recognized or realized as a result of the transaction; and (H) Name or names of the person or persons from whom the assets were acquired or to whom they were disposed.
(A) Date of the transaction;
(B) Manner of acquisition or disposition;
(C) Description of the assets involved;
(D) Nature and amount of the consideration given or received;
(E) Purpose of, or reason for, the transaction;
(F) Manner by which the amount of consideration was determined;
(G) Gain or loss recognized or realized as a result of the transaction; and
(H) Name or names of the person or persons from whom the assets were acquired or to whom they were disposed.
(2) Insurers are required to report material acquisitions and dispositions on a non-consolidated basis unless the insurer is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent (100%) reinsurance agreement that affects the solvency and integrity of the insurer's reserves, and the insurer ceded substantially all of its direct and assumed business to the pool. An insurer is deemed to have ceded substantially all of its direct and assumed business to a pool if the insurer has less than one million dollars ($1,000,000) total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement, and the net income of the business not subject to the pooling arrangement represents less than five percent (5%) of the insurer's capital and surplus.
Acts 1995, ch. 363, § 4.
Tenn. Code Ann. § 56-10-206 — TN Code / Title 56 / Chapter 10 / Section 56-10-206
Rules and regulations - Enforcement by commissioner
Status: in_force

(a) The commissioner is hereby granted authority to issue rules, regulations and orders as may be necessary to properly administer this part. (b) The commissioner may enforce this part and any rule, regulation or order made hereunder by appropriate application for equitable relief to the chancery court for Davidson County, which court is hereby vested with exclusive jurisdiction over such proceedings. Acts 1969, ch. 271, § 6; T.C.A., § 56-3617.
(a) The commissioner is hereby granted authority to issue rules, regulations and orders as may be necessary to properly administer this part.
(b) The commissioner may enforce this part and any rule, regulation or order made hereunder by appropriate application for equitable relief to the chancery court for Davidson County, which court is hereby vested with exclusive jurisdiction over such proceedings.
Acts 1969, ch. 271, § 6; T.C.A., § 56-3617.
Tenn. Code Ann. § 56-48-102 — TN Code / Title 56 / Chapter 48 / Section 56-48-102
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Commissioner" means the commissioner of commerce and insurance; (2) "Health care services" means a health or medical care procedure or service rendered by a health care provider that: (A) Provides testing, diagnosis or treatment of a human disease or dysfunction; or (B) Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction; (3) "HHS" means the United States department of health and human services; (4) "Medicare+Choice program" means the criteria developed by United States Public Law 105-33, The Balanced Budget Act of 1997 (BBA), whereby risk-bearing organizations are permitted to offer health insurance or health benefits coverage to Medicare-eligible enrollees through a Medicare+Choice plan; (5) "Provider" means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services; and (6) "Provider-sponsored organization" or "PSO" means a public or private entity that: (A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers; (B) Provides a substantial proportion, as defined by rule or regulation promulgated by HHS, of the health care items and services under the Medicare+Choice program directly through the provider or affiliated group of providers; and (C) (i) With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity; (ii) As used in subdivision (6)(C)(i), a provider is "affiliated" with another provider if, through contract, ownership or otherwise: (a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other; (b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563; (c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or (d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414. Acts 1998, ch. 896, § 3.
As used in this chapter, unless the context otherwise requires:
(1) "Commissioner" means the commissioner of commerce and insurance;
(2) "Health care services" means a health or medical care procedure or service rendered by a health care provider that: (A) Provides testing, diagnosis or treatment of a human disease or dysfunction; or (B) Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction;
(A) Provides testing, diagnosis or treatment of a human disease or dysfunction; or
(B) Dispenses drugs, medical devices, medical appliances, or medical goods for the treatment of a human disease or dysfunction;
(3) "HHS" means the United States department of health and human services;
(4) "Medicare+Choice program" means the criteria developed by United States Public Law 105-33, The Balanced Budget Act of 1997 (BBA), whereby risk-bearing organizations are permitted to offer health insurance or health benefits coverage to Medicare-eligible enrollees through a Medicare+Choice plan;
(5) "Provider" means any person, including a physician or hospital that is licensed or otherwise authorized in this state to provide health care services; and
(6) "Provider-sponsored organization" or "PSO" means a public or private entity that: (A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers; (B) Provides a substantial proportion, as defined by rule or regulation promulgated by HHS, of the health care items and services under the Medicare+Choice program directly through the provider or affiliated group of providers; and (C) (i) With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity; (ii) As used in subdivision (6)(C)(i), a provider is "affiliated" with another provider if, through contract, ownership or otherwise: (a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other; (b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563; (c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or (d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
(A) Is established or organized, and operated, by a health care provider, or group of affiliated health care providers;
(B) Provides a substantial proportion, as defined by rule or regulation promulgated by HHS, of the health care items and services under the Medicare+Choice program directly through the provider or affiliated group of providers; and
(C) (i) With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity; (ii) As used in subdivision (6)(C)(i), a provider is "affiliated" with another provider if, through contract, ownership or otherwise: (a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other; (b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563; (c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or (d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
(i) With respect to which the affiliated providers share, directly or indirectly, substantial financial risk with respect to the provision of such items and services and have at least a majority financial interest in the entity;
(ii) As used in subdivision (6)(C)(i), a provider is "affiliated" with another provider if, through contract, ownership or otherwise: (a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other; (b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563; (c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or (d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
(a) One (1) provider, directly or indirectly, controls, is controlled by, or is under common control with the other;
(b) The providers are part of a controlled group of corporations under the Internal Revenue Code of 1986, § 1563;
(c) Each provider is a participant in a lawful combination under which each provider shares substantial financial risk in connection with the organization's operations; or
(d) The providers are part of an affiliated service group under the Internal Revenue Code of 1986, § 414.
Acts 1998, ch. 896, § 3.
Tenn. Code Ann. § 56-35-112 — TN Code / Title 56 / Chapter 35 / Section 56-35-112
Paid-up capital stock - Surplus account - Deposits with commissioner
Status: in_force

(a) Every corporation now organized, or which may be organized, under the laws of this state, or any foreign corporation now or in the future doing business in this state, insuring title to real estate, or insuring owners, mortgagees, lessees or others against loss by reason of defective title to real estate, or encumbrances thereon, before engaging in the business, shall have a paid-up capital stock of not less than one hundred thousand dollars ($100,000) and shall deposit with the commissioner as provided in this section, the sum of one hundred thousand dollars ($100,000) in cash or securities of kind and character as provided in this section, out of either capital or surplus, which fund shall be known as "Title Insurance Fund"; and the insurer may, at any time, and from time to time, for the purpose of qualifying itself to do business in any other state or states, or for any other purpose, voluntarily increase the amount of the fund; provided, that the increase or increases, when made, shall become and remain a part of the fund in the same manner as if the sum to which the fund is so increased was the amount required by this chapter, until the purpose for which the additional deposit was made shall cease to exist, whereupon the insurer shall have the right to withdraw the additional sums so deposited upon submission to the commissioner of satisfactory evidence that the insurer is no longer required to maintain the same. In addition to the paid up capital stock set out in this subsection (a), the corporation shall establish and maintain a surplus account to the extent that the capital stock and surplus account is in the aggregate amount of not less than five hundred thousand dollars ($500,000); provided, that the surplus shall not be required of those corporations chartered by the secretary of state on or before January 1, 1980. (b) A foreign title insurance company that satisfies the commissioner that it has on deposit with the proper officer of some other state cash or securities of the kind and character required by this chapter for the protection of all policyholders and creditors of the insurer in the whole of the United States shall be relieved from the requirement of making deposits for such purpose in this state to the extent that it has the funds so deposited for such purposes in another state; provided, that the foreign insurance company shall file with the commissioner, in proper form, the current certificate of the proper officer with whom the cash or securities are deposited, stating the amount of the cash and the time and amount of each security so deposited, and the minimum worth which the officer is satisfied that the total deposit has and certifying that the deposit is being maintained in public custody and control pursuant to law in such state for the protection of the insurer's policyholders and creditors in the whole of the United States. Acts 1955, ch. 173, § 8; 1959, ch. 88, § 1; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3412; Acts 1980, ch. 857, § 3.
(a) Every corporation now organized, or which may be organized, under the laws of this state, or any foreign corporation now or in the future doing business in this state, insuring title to real estate, or insuring owners, mortgagees, lessees or others against loss by reason of defective title to real estate, or encumbrances thereon, before engaging in the business, shall have a paid-up capital stock of not less than one hundred thousand dollars ($100,000) and shall deposit with the commissioner as provided in this section, the sum of one hundred thousand dollars ($100,000) in cash or securities of kind and character as provided in this section, out of either capital or surplus, which fund shall be known as "Title Insurance Fund"; and the insurer may, at any time, and from time to time, for the purpose of qualifying itself to do business in any other state or states, or for any other purpose, voluntarily increase the amount of the fund; provided, that the increase or increases, when made, shall become and remain a part of the fund in the same manner as if the sum to which the fund is so increased was the amount required by this chapter, until the purpose for which the additional deposit was made shall cease to exist, whereupon the insurer shall have the right to withdraw the additional sums so deposited upon submission to the commissioner of satisfactory evidence that the insurer is no longer required to maintain the same. In addition to the paid up capital stock set out in this subsection (a), the corporation shall establish and maintain a surplus account to the extent that the capital stock and surplus account is in the aggregate amount of not less than five hundred thousand dollars ($500,000); provided, that the surplus shall not be required of those corporations chartered by the secretary of state on or before January 1, 1980.
(b) A foreign title insurance company that satisfies the commissioner that it has on deposit with the proper officer of some other state cash or securities of the kind and character required by this chapter for the protection of all policyholders and creditors of the insurer in the whole of the United States shall be relieved from the requirement of making deposits for such purpose in this state to the extent that it has the funds so deposited for such purposes in another state; provided, that the foreign insurance company shall file with the commissioner, in proper form, the current certificate of the proper officer with whom the cash or securities are deposited, stating the amount of the cash and the time and amount of each security so deposited, and the minimum worth which the officer is satisfied that the total deposit has and certifying that the deposit is being maintained in public custody and control pursuant to law in such state for the protection of the insurer's policyholders and creditors in the whole of the United States.
Acts 1955, ch. 173, § 8; 1959, ch. 88, § 1; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3412; Acts 1980, ch. 857, § 3.
Tenn. Code Ann. § 56-7-2409 — TN Code / Title 56 / Chapter 7 / Section 56-7-2409
Employer-based plans to offer at least one plan option providing copayment amounts for office visits with chiropractic physicians, physical or occupational therapists no greater than those for primary care physician visits
Status: in_force

(a) As used in this section: (1) "Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan; (2) "Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan; (3) "Covered person" has the same meaning as set forth in § 56-7-110(a) ; and (4) "Health insurance entity" has the same meaning as set forth in § 56-7-109 , but does not include government insurance plans created by title 8, chapter 27. (b) A health insurance entity offering employer-based plans must offer to employers no less than one (1) plan option in which the copayment and coinsurance amounts for services rendered during an office visit to a chiropractic physician licensed under title 63, chapter 4, or to a physical therapist or occupational therapist licensed under title 63, chapter 13, are no greater than the copayment and coinsurance amounts for the services rendered during an office visit to a primary care physician licensed under title 63, chapter 6 or title 63, chapter 9. (c) Compliance with this section shall not be required with respect to a particular insurance plan if it is determined that compliance would cause that plan to lose its status as a grandfathered health plan within the meaning of § 1251 of the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended, and § 2301 of the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152, as amended, both compiled in 42 U.S.C. § 18011 . (d) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies, and any employer plan exempt from regulation under this title due to § 514 of the federal Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1144 ). Amended by 2014 Tenn. Acts, ch. 862, s 1, eff. 1/1/2015.
(a) As used in this section: (1) "Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan; (2) "Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan; (3) "Covered person" has the same meaning as set forth in § 56-7-110(a) ; and (4) "Health insurance entity" has the same meaning as set forth in § 56-7-109 , but does not include government insurance plans created by title 8, chapter 27.
(1) "Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan;
(2) "Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan;
(3) "Covered person" has the same meaning as set forth in § 56-7-110(a) ; and
(4) "Health insurance entity" has the same meaning as set forth in § 56-7-109 , but does not include government insurance plans created by title 8, chapter 27.
(b) A health insurance entity offering employer-based plans must offer to employers no less than one (1) plan option in which the copayment and coinsurance amounts for services rendered during an office visit to a chiropractic physician licensed under title 63, chapter 4, or to a physical therapist or occupational therapist licensed under title 63, chapter 13, are no greater than the copayment and coinsurance amounts for the services rendered during an office visit to a primary care physician licensed under title 63, chapter 6 or title 63, chapter 9.
(c) Compliance with this section shall not be required with respect to a particular insurance plan if it is determined that compliance would cause that plan to lose its status as a grandfathered health plan within the meaning of § 1251 of the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended, and § 2301 of the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152, as amended, both compiled in 42 U.S.C. § 18011 .
(d) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies, and any employer plan exempt from regulation under this title due to § 514 of the federal Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1144 ).
Amended by 2014 Tenn. Acts, ch. 862, s 1, eff. 1/1/2015.
Tenn. Code Ann. § 56-3-505 — TN Code / Title 56 / Chapter 3 / Section 56-3-505
Amounts allocated to be company owned
Status: in_force

Amounts allocated to a separate account in the exercise of the power granted by this part shall be owned by the company. Acts 1967, ch. 353, § 5; T.C.A., § 56-262; Acts 1968, ch. 450, § 2; T.C.A., § 56-316.
Amounts allocated to a separate account in the exercise of the power granted by this part shall be owned by the company.
Acts 1967, ch. 353, § 5; T.C.A., § 56-262; Acts 1968, ch. 450, § 2; T.C.A., § 56-316.
Tenn. Code Ann. § 56-60-107 — TN Code / Title 56 / Chapter 60 / Section 56-60-107
Requirements for granting a third party access to the contracting entity's provider network - Refusal to accept contractual discount
Status: in_force

(a) No contracting entity shall grant a third party access to the contracting entity's provider network contract by lease, rent or by any other means unless the third party accessing the provider network contract is: (1) A payer of claims or a third party administrator or other entity that administers or processes claims on behalf of the payer; (2) A preferred provider organization or preferred provider network including a physician organization or physician hospital organization; or (3) An entity engaged in the electronic claims transport between the contracting entity and the payer if the entity does not provide access to the provider's services and contractual discounts to any other third party. (b) (1) A provider may refuse the discount taken on the remittance advice (RA) or explanation of payment (EOP) if the discount is taken without a contractual basis or if the provider cannot obtain information relative to the discount because of a violation of § 56-60-105(b)(2) or § 56-60-106(c) . The provider shall notify in writing the contracting entity or third party of the provider's refusal to accept the contractual discount. (2) The provider may require payment of the charge with no discount applied unless the contracting entity or third party within thirty (30) calendar days of receipt of notice of the apparent violation of the requirements of this section: (A) Notifies the provider that the apparent violation resulted from an administrative oversight or other unintentional error and advises the provider of steps taken to remedy and avoid recurrence of the error; and (B) Submits to the provider a corrected RA or EOP with documentation demonstrating eligibility for any discount applied. Acts 2009, ch. 466, § 8.
(a) No contracting entity shall grant a third party access to the contracting entity's provider network contract by lease, rent or by any other means unless the third party accessing the provider network contract is: (1) A payer of claims or a third party administrator or other entity that administers or processes claims on behalf of the payer; (2) A preferred provider organization or preferred provider network including a physician organization or physician hospital organization; or (3) An entity engaged in the electronic claims transport between the contracting entity and the payer if the entity does not provide access to the provider's services and contractual discounts to any other third party.
(1) A payer of claims or a third party administrator or other entity that administers or processes claims on behalf of the payer;
(2) A preferred provider organization or preferred provider network including a physician organization or physician hospital organization; or
(3) An entity engaged in the electronic claims transport between the contracting entity and the payer if the entity does not provide access to the provider's services and contractual discounts to any other third party.
(b) (1) A provider may refuse the discount taken on the remittance advice (RA) or explanation of payment (EOP) if the discount is taken without a contractual basis or if the provider cannot obtain information relative to the discount because of a violation of § 56-60-105(b)(2) or § 56-60-106(c) . The provider shall notify in writing the contracting entity or third party of the provider's refusal to accept the contractual discount. (2) The provider may require payment of the charge with no discount applied unless the contracting entity or third party within thirty (30) calendar days of receipt of notice of the apparent violation of the requirements of this section: (A) Notifies the provider that the apparent violation resulted from an administrative oversight or other unintentional error and advises the provider of steps taken to remedy and avoid recurrence of the error; and (B) Submits to the provider a corrected RA or EOP with documentation demonstrating eligibility for any discount applied.
(1) A provider may refuse the discount taken on the remittance advice (RA) or explanation of payment (EOP) if the discount is taken without a contractual basis or if the provider cannot obtain information relative to the discount because of a violation of § 56-60-105(b)(2) or § 56-60-106(c) . The provider shall notify in writing the contracting entity or third party of the provider's refusal to accept the contractual discount.
(2) The provider may require payment of the charge with no discount applied unless the contracting entity or third party within thirty (30) calendar days of receipt of notice of the apparent violation of the requirements of this section: (A) Notifies the provider that the apparent violation resulted from an administrative oversight or other unintentional error and advises the provider of steps taken to remedy and avoid recurrence of the error; and (B) Submits to the provider a corrected RA or EOP with documentation demonstrating eligibility for any discount applied.
(A) Notifies the provider that the apparent violation resulted from an administrative oversight or other unintentional error and advises the provider of steps taken to remedy and avoid recurrence of the error; and
(B) Submits to the provider a corrected RA or EOP with documentation demonstrating eligibility for any discount applied.
Acts 2009, ch. 466, § 8.
Tenn. Code Ann. § 56-8-110 — TN Code / Title 56 / Chapter 8 / Section 56-8-110
Promulgation of rules and orders - Review
Status: in_force

The commissioner is authorized, after notice and hearing, to promulgate reasonable rules and orders as are necessary or proper to carry out and effectuate this part. The rules shall be subject to review in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Acts 2008, ch. 1079, §§ 1, 11.
The commissioner is authorized, after notice and hearing, to promulgate reasonable rules and orders as are necessary or proper to carry out and effectuate this part. The rules shall be subject to review in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2008, ch. 1079, §§ 1, 11.
Tenn. Code Ann. § 56-17-106 — TN Code / Title 56 / Chapter 17 / Section 56-17-106
Violations - Penalties
Status: in_force

(a) As part of an examination or investigation, the commissioner may request, and the operator or marketer shall provide, copies of materials that are distributed to prospective members. (b) After notice and hearing, the commissioner may levy an administrative penalty, in an amount up to ten thousand dollars ($10,000), for each violation of this chapter. Each day of a continuing violation constitutes a separate violation for purposes of this chapter. Acts 2021, ch. 372, § 1.
(a) As part of an examination or investigation, the commissioner may request, and the operator or marketer shall provide, copies of materials that are distributed to prospective members.
(b) After notice and hearing, the commissioner may levy an administrative penalty, in an amount up to ten thousand dollars ($10,000), for each violation of this chapter. Each day of a continuing violation constitutes a separate violation for purposes of this chapter.
Acts 2021, ch. 372, § 1.
Tenn. Code Ann. § 56-7-3717 — TN Code / Title 56 / Chapter 7 / Section 56-7-3717
Statistics
Status: in_force

A health carrier or utilization review organization requiring prior authorization shall make de-identified aggregate statistics available by service code regarding prior authorization approvals and denials on its website in a readily accessible format. The commissioner shall determine the information required in order to comply with this section and in accordance with applicable state and federal privacy laws. Such statistics include, but are not limited to: (1) The number of initial prior authorization requests that were approved or denied during the previous benefit plan year by the health carrier or utilization review organization; (2) The number of prior authorization requests that were appealed; (3) The number of appeals overturned and the number granted; (4) The time between submission of an initial prior authorization request and response; (5) The top five (5) reasons for denial; (6) The average time between submission and response for an initial prior authorization request; (7) The average time between submission and response for an appeal of a prior authorization denial; and (8) Any other information that the commissioner determines appropriate. Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
A health carrier or utilization review organization requiring prior authorization shall make de-identified aggregate statistics available by service code regarding prior authorization approvals and denials on its website in a readily accessible format. The commissioner shall determine the information required in order to comply with this section and in accordance with applicable state and federal privacy laws. Such statistics include, but are not limited to:
(1) The number of initial prior authorization requests that were approved or denied during the previous benefit plan year by the health carrier or utilization review organization;
(2) The number of prior authorization requests that were appealed;
(3) The number of appeals overturned and the number granted;
(4) The time between submission of an initial prior authorization request and response;
(5) The top five (5) reasons for denial;
(6) The average time between submission and response for an initial prior authorization request;
(7) The average time between submission and response for an appeal of a prior authorization denial; and
(8) Any other information that the commissioner determines appropriate.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
Tenn. Code Ann. § 56-8-102 — TN Code / Title 56 / Chapter 8 / Section 56-8-102
Part definitions - Preemption
Status: in_force

(a) For the purposes of this part: (1) "Adjuster" means any person that is adjusting claims; (2) "Affiliate of a depository institution" means any company that controls, is controlled by, or is under common control with a depository institution; (3) (A) "Claim" means: (i) An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and (ii) Is sufficient to reasonably establish contractual liability for payment on the part of an insurer; (B) For the purposes of § 56-8-105 , a "claim" does not mean an inquiry by an insured as to the existence of coverage or how a potential claim may affect future premiums or renewability of coverage; (4) "Commissioner" means the commissioner of commerce and insurance; (5) "Customer," for purposes of § 56-8-106 , means an individual who purchases, applies to purchase or is solicited to purchase insurance products; (6) "Depository institution" means a bank or savings association. "Depository institution" does not include an insurance company; (7) "Fictitious grouping" means any grouping by way of membership, nonmembership, license, franchise, employment, contract, agreement or any other method or means; (8) "Insured" means the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy; (9) "Insurer" means any person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance. "Insurer" shall also mean medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, hospital medical service corporations, dental, optometric and other similar health service plans. For purposes of this part, these entities shall be deemed to be engaged in the business of insurance; (10) "Person" means a natural or artificial entity, including, but not limited to, individuals, partnerships, associations, trusts, corporations, insurance producers, adjusters, any employer to the extent that the employer self-insures its workers' compensation liabilities pursuant to § 50-6-405(b) or a group of employers qualifying as self-insurers pursuant to § 50-6-405(c) , or third party administrators; (11) "Policy" or "certificate" means a contract of insurance, indemnity, medical, health or hospital service, suretyship, or annuity issued, proposed for issuance or intended for issuance by any insurer; (12) "Producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance under chapter 6, part 1 of this title; and (13) "Third party administrator" means any person that collects charges or premiums from, or who adjusts or settles claims on, residents of this state on behalf of an insurer, and shall include any person currently defined as an administrator by § 56-6-401 , any person currently defined as an administrator by Tenn. Comp. R. & Regs. 0780-1-54, or any person currently defined as a third-party administrator by Tenn. Comp. R. & Regs. 0780-1-81. (b) The Federal Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 ), preempts certain entities and some activities of those entities from the application of state laws. The purpose of the definitions in subsection (a) is to include within this part and rules promulgated pursuant to this part, all entities and activities to the extent not preempted by ERISA. Acts 2008, ch. 1079, §§ 1, 3.
(a) For the purposes of this part: (1) "Adjuster" means any person that is adjusting claims; (2) "Affiliate of a depository institution" means any company that controls, is controlled by, or is under common control with a depository institution; (3) (A) "Claim" means: (i) An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and (ii) Is sufficient to reasonably establish contractual liability for payment on the part of an insurer; (B) For the purposes of § 56-8-105 , a "claim" does not mean an inquiry by an insured as to the existence of coverage or how a potential claim may affect future premiums or renewability of coverage; (4) "Commissioner" means the commissioner of commerce and insurance; (5) "Customer," for purposes of § 56-8-106 , means an individual who purchases, applies to purchase or is solicited to purchase insurance products; (6) "Depository institution" means a bank or savings association. "Depository institution" does not include an insurance company; (7) "Fictitious grouping" means any grouping by way of membership, nonmembership, license, franchise, employment, contract, agreement or any other method or means; (8) "Insured" means the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy; (9) "Insurer" means any person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance. "Insurer" shall also mean medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, hospital medical service corporations, dental, optometric and other similar health service plans. For purposes of this part, these entities shall be deemed to be engaged in the business of insurance; (10) "Person" means a natural or artificial entity, including, but not limited to, individuals, partnerships, associations, trusts, corporations, insurance producers, adjusters, any employer to the extent that the employer self-insures its workers' compensation liabilities pursuant to § 50-6-405(b) or a group of employers qualifying as self-insurers pursuant to § 50-6-405(c) , or third party administrators; (11) "Policy" or "certificate" means a contract of insurance, indemnity, medical, health or hospital service, suretyship, or annuity issued, proposed for issuance or intended for issuance by any insurer; (12) "Producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance under chapter 6, part 1 of this title; and (13) "Third party administrator" means any person that collects charges or premiums from, or who adjusts or settles claims on, residents of this state on behalf of an insurer, and shall include any person currently defined as an administrator by § 56-6-401 , any person currently defined as an administrator by Tenn. Comp. R. & Regs. 0780-1-54, or any person currently defined as a third-party administrator by Tenn. Comp. R. & Regs. 0780-1-81.
(1) "Adjuster" means any person that is adjusting claims;
(2) "Affiliate of a depository institution" means any company that controls, is controlled by, or is under common control with a depository institution;
(3) (A) "Claim" means: (i) An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and (ii) Is sufficient to reasonably establish contractual liability for payment on the part of an insurer; (B) For the purposes of § 56-8-105 , a "claim" does not mean an inquiry by an insured as to the existence of coverage or how a potential claim may affect future premiums or renewability of coverage;
(A) "Claim" means: (i) An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and (ii) Is sufficient to reasonably establish contractual liability for payment on the part of an insurer;
(i) An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and
(ii) Is sufficient to reasonably establish contractual liability for payment on the part of an insurer;
(B) For the purposes of § 56-8-105 , a "claim" does not mean an inquiry by an insured as to the existence of coverage or how a potential claim may affect future premiums or renewability of coverage;
(4) "Commissioner" means the commissioner of commerce and insurance;
(5) "Customer," for purposes of § 56-8-106 , means an individual who purchases, applies to purchase or is solicited to purchase insurance products;
(6) "Depository institution" means a bank or savings association. "Depository institution" does not include an insurance company;
(7) "Fictitious grouping" means any grouping by way of membership, nonmembership, license, franchise, employment, contract, agreement or any other method or means;
(8) "Insured" means the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy;
(9) "Insurer" means any person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance. "Insurer" shall also mean medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, hospital medical service corporations, dental, optometric and other similar health service plans. For purposes of this part, these entities shall be deemed to be engaged in the business of insurance;
(10) "Person" means a natural or artificial entity, including, but not limited to, individuals, partnerships, associations, trusts, corporations, insurance producers, adjusters, any employer to the extent that the employer self-insures its workers' compensation liabilities pursuant to § 50-6-405(b) or a group of employers qualifying as self-insurers pursuant to § 50-6-405(c) , or third party administrators;
(11) "Policy" or "certificate" means a contract of insurance, indemnity, medical, health or hospital service, suretyship, or annuity issued, proposed for issuance or intended for issuance by any insurer;
(12) "Producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance under chapter 6, part 1 of this title; and
(13) "Third party administrator" means any person that collects charges or premiums from, or who adjusts or settles claims on, residents of this state on behalf of an insurer, and shall include any person currently defined as an administrator by § 56-6-401 , any person currently defined as an administrator by Tenn. Comp. R. & Regs. 0780-1-54, or any person currently defined as a third-party administrator by Tenn. Comp. R. & Regs. 0780-1-81.
(b) The Federal Employee Retirement Income Security Act (ERISA) ( 29 U.S.C. § 1001 ), preempts certain entities and some activities of those entities from the application of state laws. The purpose of the definitions in subsection (a) is to include within this part and rules promulgated pursuant to this part, all entities and activities to the extent not preempted by ERISA.
Acts 2008, ch. 1079, §§ 1, 3.
Tenn. Code Ann. § 56-7-3503 — TN Code / Title 56 / Chapter 7 / Section 56-7-3503
Rulemaking
Status: in_force

The commissioner of commerce and insurance shall promulgate rules to effectuate this part. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Added by 2022 Tenn. Acts, ch. 1020, s 1, eff. 1/1/2023.
The commissioner of commerce and insurance shall promulgate rules to effectuate this part. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Added by 2022 Tenn. Acts, ch. 1020, s 1, eff. 1/1/2023.
Tenn. Code Ann. § 56-7-3712 — TN Code / Title 56 / Chapter 7 / Section 56-7-3712
Changing prior authorization requirements
Status: in_force

(a) A utilization review organization shall provide notice to healthcare providers in its network of each new prior authorization requirement, or restriction or amendment to an existing prior authorization requirement, at least sixty (60) days prior to the effective date of the change. (b) A utilization review organization shall provide notice to healthcare providers in its network of each new prior authorization requirement, or restriction or amendment to an existing prior authorization requirement, for a prescription drug at least forty-five (45) days prior to the effective date of the change unless any of the following apply: (1) The United States food and drug administration has: (A) Issued a statement that calls into question the clinical safety of the drug; (B) Required the manufacturers to conduct post-market safety studies and clinical trials after the approval of the drug; (C) Issued any drug safety-related labeling changes; or (D) Required the manufacturers to implement special risk management programs; (2) The drug receives a new approval from the United States food and drug administration and has become available; or (3) The United States food and drug administration has approved expanded use of the drug. (c) Notice required by this section must be distributed through: (1) The utilization review organization's website or the healthcare provider's portal; and (2) Written communication sent to a dedicated email address and regular mailing address for the healthcare provider or as stipulated in the contract between the healthcare provider and the utilization review organization. The healthcare provider may be required to submit a dedicated email address and regular mailing address to receive the notices required by this subsection (c). Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
(a) A utilization review organization shall provide notice to healthcare providers in its network of each new prior authorization requirement, or restriction or amendment to an existing prior authorization requirement, at least sixty (60) days prior to the effective date of the change.
(b) A utilization review organization shall provide notice to healthcare providers in its network of each new prior authorization requirement, or restriction or amendment to an existing prior authorization requirement, for a prescription drug at least forty-five (45) days prior to the effective date of the change unless any of the following apply: (1) The United States food and drug administration has: (A) Issued a statement that calls into question the clinical safety of the drug; (B) Required the manufacturers to conduct post-market safety studies and clinical trials after the approval of the drug; (C) Issued any drug safety-related labeling changes; or (D) Required the manufacturers to implement special risk management programs; (2) The drug receives a new approval from the United States food and drug administration and has become available; or (3) The United States food and drug administration has approved expanded use of the drug.
(1) The United States food and drug administration has: (A) Issued a statement that calls into question the clinical safety of the drug; (B) Required the manufacturers to conduct post-market safety studies and clinical trials after the approval of the drug; (C) Issued any drug safety-related labeling changes; or (D) Required the manufacturers to implement special risk management programs;
(A) Issued a statement that calls into question the clinical safety of the drug;
(B) Required the manufacturers to conduct post-market safety studies and clinical trials after the approval of the drug;
(C) Issued any drug safety-related labeling changes; or
(D) Required the manufacturers to implement special risk management programs;
(2) The drug receives a new approval from the United States food and drug administration and has become available; or
(3) The United States food and drug administration has approved expanded use of the drug.
(c) Notice required by this section must be distributed through: (1) The utilization review organization's website or the healthcare provider's portal; and (2) Written communication sent to a dedicated email address and regular mailing address for the healthcare provider or as stipulated in the contract between the healthcare provider and the utilization review organization. The healthcare provider may be required to submit a dedicated email address and regular mailing address to receive the notices required by this subsection (c).
(1) The utilization review organization's website or the healthcare provider's portal; and
(2) Written communication sent to a dedicated email address and regular mailing address for the healthcare provider or as stipulated in the contract between the healthcare provider and the utilization review organization. The healthcare provider may be required to submit a dedicated email address and regular mailing address to receive the notices required by this subsection (c).
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
Tenn. Code Ann. § 56-7-207 — TN Code / Title 56 / Chapter 7 / Section 56-7-207
Refusal for sickle cell trait or hemoglobin C trait prohibited
Status: in_force

(a) No insurance company that has been qualified and authorized to do business in this state, pursuant to chapter 2 of this title, shall refuse to issue or deliver any policy of life insurance authorized under chapter 2 of this title, solely by reason of the fact that the person to be insured possesses sickle cell trait or hemoglobin C trait. (b) As used in this section: (1) "Hemoglobin C trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin C as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin C or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests; and (2) "Sickle cell trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin S (sickle hemoglobin) as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin S or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests. Acts 1988, ch. 488, § 1.
(a) No insurance company that has been qualified and authorized to do business in this state, pursuant to chapter 2 of this title, shall refuse to issue or deliver any policy of life insurance authorized under chapter 2 of this title, solely by reason of the fact that the person to be insured possesses sickle cell trait or hemoglobin C trait.
(b) As used in this section: (1) "Hemoglobin C trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin C as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin C or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests; and (2) "Sickle cell trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin S (sickle hemoglobin) as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin S or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests.
(1) "Hemoglobin C trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin C as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin C or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests; and
(2) "Sickle cell trait" means the condition wherein the major natural hemoglobin components present in the blood of the individual are hemoglobin A (normal) and hemoglobin S (sickle hemoglobin) as defined by standard chemical and physical analytic techniques, including electrophoresis; and the proportion of hemoglobin A is greater than the proportion of hemoglobin S or one (1) natural parent of the individual is shown to have only normal hemoglobin components (hemoglobin A, hemoglobin A2, hemoglobin F) in the normal proportions by standard chemical and physical analytic tests.
Acts 1988, ch. 488, § 1.
Tenn. Code Ann. § 56-7-3208 — TN Code / Title 56 / Chapter 7 / Section 56-7-3208
Request for cost, benefit, and coverage data
Status: in_force

(a) (1) A covered entity shall, upon request of an enrollee, enrollee's healthcare provider, or authorized third party, furnish the cost, benefit, and coverage data described in subsection (b) to the enrollee, the enrollee's healthcare provider, or an authorized third party, and shall ensure that the data is: (A) Accurate as of the most recent change to the data that was made prior to the date of request; (B) Provided in real time; and (C) Provided in the same format in which the request is made. (2) (A) A request for coverage data must be in a format that uses established industry content and transport standards as published by the following: (i) A standard developing organization that is accredited by the American National Standards Institute, including, but not limited to, the National Council for Prescription Drug Programs, ASC X12, and Health Level 7; or (ii) A relevant governing entity of this state or the federal government, including, but not limited to, the federal centers for medicare and medicaid services and the office of national coordinator for health information technology. (B) The following are not acceptable formats for requests for coverage data under this section: (i) A facsimile; or (ii) Use of a proprietary payor or patient portal or other electronic form. (b) A covered entity that receives a request for data that complies with subsection (a) shall provide the following data for each drug covered under the enrollee's health plan: (1) The enrollee's eligibility information for the drug; (2) A list of any clinically appropriate alternatives to drugs covered under the enrollee's health plan; (3) Cost-sharing information for the drugs and the clinically appropriate alternatives; and (4) Applicable utilization management requirements for the drugs or clinically appropriate alternatives, including prior authorization, step therapy, quantity limits, and site-of-service restrictions. (c) A covered entity that furnishes data as provided in subsection (b) shall not: (1) Restrict, prohibit, or otherwise hinder a healthcare provider from communicating or sharing with the enrollee or enrollee's authorized representative: (A) The data set forth in subsection (b); (B) Additional information on lower-cost or clinically appropriate alternative drugs, whether or not the drugs are covered under the enrollee's plan; or (C) Additional payment or cost-sharing information that may reduce the patient's out-of-pocket costs, such as cash price or patient assistance, and support programs sponsored by a manufacturer, foundation, or other entity; (2) Except as may be required by law, interfere with, prevent, or materially discourage access to, exchange of, or the use of the data set forth in subsection (b), including: (A) Charging fees; (B) Failing to respond to a request at the time made when such a response is reasonably possible; (C) Implementing technology in nonstandard ways; or (D) Instituting requirements, processes, policies, procedures, or renewals that are likely to substantially increase the complexity or burden of accessing, exchanging, or using the data; or (3) Penalize a healthcare provider for: (A) Disclosing the information described in subdivision (c)(1) to an enrollee; or (B) Prescribing, administering, or ordering a clinically appropriate or lower-cost alternative drug. Added by 2021 Tenn. Acts, ch. 569,s 5, eff. 7/1/2022.
(a) (1) A covered entity shall, upon request of an enrollee, enrollee's healthcare provider, or authorized third party, furnish the cost, benefit, and coverage data described in subsection (b) to the enrollee, the enrollee's healthcare provider, or an authorized third party, and shall ensure that the data is: (A) Accurate as of the most recent change to the data that was made prior to the date of request; (B) Provided in real time; and (C) Provided in the same format in which the request is made. (2) (A) A request for coverage data must be in a format that uses established industry content and transport standards as published by the following: (i) A standard developing organization that is accredited by the American National Standards Institute, including, but not limited to, the National Council for Prescription Drug Programs, ASC X12, and Health Level 7; or (ii) A relevant governing entity of this state or the federal government, including, but not limited to, the federal centers for medicare and medicaid services and the office of national coordinator for health information technology. (B) The following are not acceptable formats for requests for coverage data under this section: (i) A facsimile; or (ii) Use of a proprietary payor or patient portal or other electronic form.
(1) A covered entity shall, upon request of an enrollee, enrollee's healthcare provider, or authorized third party, furnish the cost, benefit, and coverage data described in subsection (b) to the enrollee, the enrollee's healthcare provider, or an authorized third party, and shall ensure that the data is: (A) Accurate as of the most recent change to the data that was made prior to the date of request; (B) Provided in real time; and (C) Provided in the same format in which the request is made.
(A) Accurate as of the most recent change to the data that was made prior to the date of request;
(B) Provided in real time; and
(C) Provided in the same format in which the request is made.
(2) (A) A request for coverage data must be in a format that uses established industry content and transport standards as published by the following: (i) A standard developing organization that is accredited by the American National Standards Institute, including, but not limited to, the National Council for Prescription Drug Programs, ASC X12, and Health Level 7; or (ii) A relevant governing entity of this state or the federal government, including, but not limited to, the federal centers for medicare and medicaid services and the office of national coordinator for health information technology. (B) The following are not acceptable formats for requests for coverage data under this section: (i) A facsimile; or (ii) Use of a proprietary payor or patient portal or other electronic form.
(A) A request for coverage data must be in a format that uses established industry content and transport standards as published by the following: (i) A standard developing organization that is accredited by the American National Standards Institute, including, but not limited to, the National Council for Prescription Drug Programs, ASC X12, and Health Level 7; or (ii) A relevant governing entity of this state or the federal government, including, but not limited to, the federal centers for medicare and medicaid services and the office of national coordinator for health information technology.
(i) A standard developing organization that is accredited by the American National Standards Institute, including, but not limited to, the National Council for Prescription Drug Programs, ASC X12, and Health Level 7; or
(ii) A relevant governing entity of this state or the federal government, including, but not limited to, the federal centers for medicare and medicaid services and the office of national coordinator for health information technology.
(B) The following are not acceptable formats for requests for coverage data under this section: (i) A facsimile; or (ii) Use of a proprietary payor or patient portal or other electronic form.
(i) A facsimile; or
(ii) Use of a proprietary payor or patient portal or other electronic form.
(b) A covered entity that receives a request for data that complies with subsection (a) shall provide the following data for each drug covered under the enrollee's health plan: (1) The enrollee's eligibility information for the drug; (2) A list of any clinically appropriate alternatives to drugs covered under the enrollee's health plan; (3) Cost-sharing information for the drugs and the clinically appropriate alternatives; and (4) Applicable utilization management requirements for the drugs or clinically appropriate alternatives, including prior authorization, step therapy, quantity limits, and site-of-service restrictions.
(1) The enrollee's eligibility information for the drug;
(2) A list of any clinically appropriate alternatives to drugs covered under the enrollee's health plan;
(3) Cost-sharing information for the drugs and the clinically appropriate alternatives; and
(4) Applicable utilization management requirements for the drugs or clinically appropriate alternatives, including prior authorization, step therapy, quantity limits, and site-of-service restrictions.
(c) A covered entity that furnishes data as provided in subsection (b) shall not: (1) Restrict, prohibit, or otherwise hinder a healthcare provider from communicating or sharing with the enrollee or enrollee's authorized representative: (A) The data set forth in subsection (b); (B) Additional information on lower-cost or clinically appropriate alternative drugs, whether or not the drugs are covered under the enrollee's plan; or (C) Additional payment or cost-sharing information that may reduce the patient's out-of-pocket costs, such as cash price or patient assistance, and support programs sponsored by a manufacturer, foundation, or other entity; (2) Except as may be required by law, interfere with, prevent, or materially discourage access to, exchange of, or the use of the data set forth in subsection (b), including: (A) Charging fees; (B) Failing to respond to a request at the time made when such a response is reasonably possible; (C) Implementing technology in nonstandard ways; or (D) Instituting requirements, processes, policies, procedures, or renewals that are likely to substantially increase the complexity or burden of accessing, exchanging, or using the data; or (3) Penalize a healthcare provider for: (A) Disclosing the information described in subdivision (c)(1) to an enrollee; or (B) Prescribing, administering, or ordering a clinically appropriate or lower-cost alternative drug.
(1) Restrict, prohibit, or otherwise hinder a healthcare provider from communicating or sharing with the enrollee or enrollee's authorized representative: (A) The data set forth in subsection (b); (B) Additional information on lower-cost or clinically appropriate alternative drugs, whether or not the drugs are covered under the enrollee's plan; or (C) Additional payment or cost-sharing information that may reduce the patient's out-of-pocket costs, such as cash price or patient assistance, and support programs sponsored by a manufacturer, foundation, or other entity;
(A) The data set forth in subsection (b);
(B) Additional information on lower-cost or clinically appropriate alternative drugs, whether or not the drugs are covered under the enrollee's plan; or
(C) Additional payment or cost-sharing information that may reduce the patient's out-of-pocket costs, such as cash price or patient assistance, and support programs sponsored by a manufacturer, foundation, or other entity;
(2) Except as may be required by law, interfere with, prevent, or materially discourage access to, exchange of, or the use of the data set forth in subsection (b), including: (A) Charging fees; (B) Failing to respond to a request at the time made when such a response is reasonably possible; (C) Implementing technology in nonstandard ways; or (D) Instituting requirements, processes, policies, procedures, or renewals that are likely to substantially increase the complexity or burden of accessing, exchanging, or using the data; or
(A) Charging fees;
(B) Failing to respond to a request at the time made when such a response is reasonably possible;
(C) Implementing technology in nonstandard ways; or
(D) Instituting requirements, processes, policies, procedures, or renewals that are likely to substantially increase the complexity or burden of accessing, exchanging, or using the data; or
(3) Penalize a healthcare provider for: (A) Disclosing the information described in subdivision (c)(1) to an enrollee; or (B) Prescribing, administering, or ordering a clinically appropriate or lower-cost alternative drug.
(A) Disclosing the information described in subdivision (c)(1) to an enrollee; or
(B) Prescribing, administering, or ordering a clinically appropriate or lower-cost alternative drug.
Added by 2021 Tenn. Acts, ch. 569,s 5, eff. 7/1/2022.
Tenn. Code Ann. § 56-9-104 — TN Code / Title 56 / Chapter 9 / Section 56-9-104
Delinquency proceeding - Commencement - Jurisdiction
Status: in_force

(a) No delinquency proceeding shall be commenced under this chapter by anyone other than the commissioner and no court has jurisdiction to entertain, hear or determine any proceeding commenced by any other person. (b) No court of this state has jurisdiction to entertain, hear or determine any complaint praying for the dissolution, liquidation, rehabilitation, sequestration, conservation or receivership of any insurer, or praying for an injunction or restraining order or other relief preliminary to, incidental to or relating to the proceedings other than in accordance with this chapter. (c) In addition to other grounds for jurisdiction provided by the law of this state, a court of this state having jurisdiction of the subject matter has jurisdiction over a person served pursuant to the Tennessee Rules of Civil Procedure or other applicable law in an action brought by the receiver of a domestic insurer or an alien insurer domiciled in this state if: (1) The person served is an agent, broker or other person who has at any time written policies of insurance for or has acted in any manner whatsoever on behalf of an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer; (2) The person served is a reinsurer who has at any time entered into a contract of reinsurance with an insurer against which a delinquency proceeding has been instituted, or is an agent or broker of or for the reinsurer, in any action on or incident to the reinsurance contract; (3) The person served is or has been an officer, director, manager, trustee, organizer, promoter or other person in a position of comparable authority or influence over an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer; (4) The person served is, or was at the time of the institution of the delinquency proceeding against the insurer, holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; or (5) The person served is obligated to the insurer in any way whatsoever, in any action on, or incident to, the obligation. (d) If the court on motion of any party finds that any action should as a matter of substantial justice be tried in a forum outside this state, the court may enter an appropriate order to stay further proceedings on the action in this state. (e) All actions authorized in this section shall be brought in the chancery court of Davidson County. Acts 1991, ch. 142, § 4.
(a) No delinquency proceeding shall be commenced under this chapter by anyone other than the commissioner and no court has jurisdiction to entertain, hear or determine any proceeding commenced by any other person.
(b) No court of this state has jurisdiction to entertain, hear or determine any complaint praying for the dissolution, liquidation, rehabilitation, sequestration, conservation or receivership of any insurer, or praying for an injunction or restraining order or other relief preliminary to, incidental to or relating to the proceedings other than in accordance with this chapter.
(c) In addition to other grounds for jurisdiction provided by the law of this state, a court of this state having jurisdiction of the subject matter has jurisdiction over a person served pursuant to the Tennessee Rules of Civil Procedure or other applicable law in an action brought by the receiver of a domestic insurer or an alien insurer domiciled in this state if: (1) The person served is an agent, broker or other person who has at any time written policies of insurance for or has acted in any manner whatsoever on behalf of an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer; (2) The person served is a reinsurer who has at any time entered into a contract of reinsurance with an insurer against which a delinquency proceeding has been instituted, or is an agent or broker of or for the reinsurer, in any action on or incident to the reinsurance contract; (3) The person served is or has been an officer, director, manager, trustee, organizer, promoter or other person in a position of comparable authority or influence over an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer; (4) The person served is, or was at the time of the institution of the delinquency proceeding against the insurer, holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; or (5) The person served is obligated to the insurer in any way whatsoever, in any action on, or incident to, the obligation.
(1) The person served is an agent, broker or other person who has at any time written policies of insurance for or has acted in any manner whatsoever on behalf of an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer;
(2) The person served is a reinsurer who has at any time entered into a contract of reinsurance with an insurer against which a delinquency proceeding has been instituted, or is an agent or broker of or for the reinsurer, in any action on or incident to the reinsurance contract;
(3) The person served is or has been an officer, director, manager, trustee, organizer, promoter or other person in a position of comparable authority or influence over an insurer against which a delinquency proceeding has been instituted, in any action resulting from or incident to such a relationship with the insurer;
(4) The person served is, or was at the time of the institution of the delinquency proceeding against the insurer, holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; or
(5) The person served is obligated to the insurer in any way whatsoever, in any action on, or incident to, the obligation.
(d) If the court on motion of any party finds that any action should as a matter of substantial justice be tried in a forum outside this state, the court may enter an appropriate order to stay further proceedings on the action in this state.
(e) All actions authorized in this section shall be brought in the chancery court of Davidson County.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-52-103 — TN Code / Title 56 / Chapter 52 / Section 56-52-103
Certificate of authority - Application - Fees - Exemption
Status: in_force

(a) A charitable organization shall not receive any transfer of property, conditioned upon its agreement to pay an annuity to the donor or other annuitant unless and until it has obtained from the commissioner a certificate of authority to issue charitable gift annuities. (b) A charitable organization shall file with the commissioner its application for a certificate of authority. The application shall be on a form prescribed and furnished by the commissioner and shall be verified by two (2) of the applicant's officers. The application shall include or be accompanied by such proof as the commissioner may reasonably require that the applicant is qualified under this chapter. At filing of the application the applicant shall pay to the commissioner the applicable filing fees as specified in § 56-4-101(1) . (c) If after such investigation or examination as the commissioner deems advisable, the commissioner finds that the applicant is in sound financial condition and is otherwise qualified, the commissioner shall issue to the applicant a certificate of authority. If the commissioner does not so find, the commissioner shall deny issuance of the certificate of authority and notify the applicant in writing stating the reasons. (d) The certificate of authority of a charitable organization issued under this chapter shall continue until suspended or revoked by the commissioner or terminated by the organization, subject to continuance each year by payment on or before March 1 of the continuance fee of one hundred dollars ($100) and filing of the annual report required under § 56-52-106 . (e) A person acting on behalf of a charitable organization to solicit the transfers of property in exchange for annuity payments as authorized under this chapter shall not be required to be licensed. (f) The commissioner shall be authorized to exempt from this section any charitable organizations or classes of organizations that the commissioner finds inappropriate to include to effectuate the purposes of this chapter. Acts 2008, ch. 831, §§ 1, 4.
(a) A charitable organization shall not receive any transfer of property, conditioned upon its agreement to pay an annuity to the donor or other annuitant unless and until it has obtained from the commissioner a certificate of authority to issue charitable gift annuities.
(b) A charitable organization shall file with the commissioner its application for a certificate of authority. The application shall be on a form prescribed and furnished by the commissioner and shall be verified by two (2) of the applicant's officers. The application shall include or be accompanied by such proof as the commissioner may reasonably require that the applicant is qualified under this chapter. At filing of the application the applicant shall pay to the commissioner the applicable filing fees as specified in § 56-4-101(1) .
(c) If after such investigation or examination as the commissioner deems advisable, the commissioner finds that the applicant is in sound financial condition and is otherwise qualified, the commissioner shall issue to the applicant a certificate of authority. If the commissioner does not so find, the commissioner shall deny issuance of the certificate of authority and notify the applicant in writing stating the reasons.
(d) The certificate of authority of a charitable organization issued under this chapter shall continue until suspended or revoked by the commissioner or terminated by the organization, subject to continuance each year by payment on or before March 1 of the continuance fee of one hundred dollars ($100) and filing of the annual report required under § 56-52-106 .
(e) A person acting on behalf of a charitable organization to solicit the transfers of property in exchange for annuity payments as authorized under this chapter shall not be required to be licensed.
(f) The commissioner shall be authorized to exempt from this section any charitable organizations or classes of organizations that the commissioner finds inappropriate to include to effectuate the purposes of this chapter.
Acts 2008, ch. 831, §§ 1, 4.
Tenn. Code Ann. § 56-30-101 — TN Code / Title 56 / Chapter 30 / Section 56-30-101
Short title
Status: in_force

This chapter shall be known and may be cited as the "Dental Service Plan Law, 1961." Acts 1961, ch. 340, § 1; T.C.A., § 56-3501.
This chapter shall be known and may be cited as the "Dental Service Plan Law, 1961."
Acts 1961, ch. 340, § 1; T.C.A., § 56-3501.
Tenn. Code Ann. § 56-1-917 — TN Code / Title 56 / Chapter 1 / Section 56-1-917
Confidentiality
Status: in_force

(a) For purposes of this section, "confidential information" means: (1) A memorandum in support of an opinion submitted under § 56-1-903 and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such memorandum; (2) All documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of an examination made under § 56-1-914(f) ; provided, however, that if an examination report or other material prepared in connection with an examination made under § 56-1-411 is not held as private and confidential information under § 56-1-411 , an examination report or other material prepared in connection with an examination made under § 56-1-914(f) shall not be confidential information to the same extent as if such examination report or other material had been prepared under § 56-1-411 ; (3) Any reports, documents, materials and other information developed by a company in support of, or in connection with, an annual certification by the company under § 56-1-915(b)(2) evaluating the effectiveness of the company's internal controls with respect to a principle-based valuation and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such reports, documents, materials and other information; (4) Any principle-based valuation report developed under § 56-1-915(b)(3) and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such report; and (5) Any documents, materials, data and other information submitted by a company under § 56-1-916 , collectively, experience data, and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created or produced in connection with such experience data, in each case that include any potentially company-identifying or personally identifiable information, that is provided to or obtained by the commissioner (together with any experience data, the experience materials) and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such experience materials. (b) For privilege for, and confidentiality of, confidential information: (1) Except as provided in this section, a company's confidential information is confidential by law and privileged, and shall not be subject to § 10-7-503 or § 56-1-602 , shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action; provided, however, that the commissioner is authorized to use the confidential information in the furtherance of any regulatory or legal action brought against the company as a part of the commissioner's official duties; (2) Neither the commissioner nor any person who received confidential information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential information; (3) In order to assist in the performance of the commissioner's duties, the commissioner may share confidential information: (A) With other state, federal and international regulatory agencies and with the NAIC and its affiliates and subsidiaries; (B) In the case of confidential information specified in subdivisions (a)(1) and (4) only, with the Actuarial Board for Counseling and Discipline or its successor upon request stating that the confidential information is required for the purpose of professional disciplinary proceedings and with state, federal and international law enforcement officials; and (C) Provided that such recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of such documents, materials, data and other information in the same manner and to the same extent as required for the commissioner; (4) The commissioner may receive documents, materials, data and other information, including otherwise confidential and privileged documents, materials, data or information, from the NAIC and its affiliates and subsidiaries, from regulatory or law enforcement officials of other foreign or domestic jurisdictions and from the Actuarial Board for Counseling and Discipline or its successor and shall maintain as confidential or privileged any document, material, data or other information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or other information; (5) The commissioner may enter into agreements governing sharing and use of information consistent with this subsection (b); (6) No waiver of any applicable privilege or claim of confidentiality in the confidential information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (b)(3); (7) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subsection (b) shall be available and enforced in any proceeding in, and in any court of, this state; (8) In this section, "regulatory agency," "law enforcement agency" and "NAIC" include, but are not limited to, their employees, agents, consultants and contractors. (c) Notwithstanding subsection (b), any confidential information specified in subdivisions (a)(1) and (4): (1) May be subject to subpoena for the purpose of defending an action seeking damages from the appointed actuary submitting the related memorandum in support of an opinion submitted under § 56-1-903 or principle-based valuation report developed under § 56-1-915(b)(3) by reason of an action required pursuant to this part or by regulations promulgated by the commissioner; (2) May otherwise be released by the commissioner with the written consent of the company; and (3) Once any portion of a memorandum in support of an opinion submitted under § 56-1-903 or a principle-based valuation report developed under § 56-1-915(b)(3) is cited by the company in its marketing or is publicly volunteered to or before a governmental agency other than a state insurance department or is released by the company to the news media, all portions of such memorandum or report shall no longer be confidential. Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
(a) For purposes of this section, "confidential information" means: (1) A memorandum in support of an opinion submitted under § 56-1-903 and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such memorandum; (2) All documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of an examination made under § 56-1-914(f) ; provided, however, that if an examination report or other material prepared in connection with an examination made under § 56-1-411 is not held as private and confidential information under § 56-1-411 , an examination report or other material prepared in connection with an examination made under § 56-1-914(f) shall not be confidential information to the same extent as if such examination report or other material had been prepared under § 56-1-411 ; (3) Any reports, documents, materials and other information developed by a company in support of, or in connection with, an annual certification by the company under § 56-1-915(b)(2) evaluating the effectiveness of the company's internal controls with respect to a principle-based valuation and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such reports, documents, materials and other information; (4) Any principle-based valuation report developed under § 56-1-915(b)(3) and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such report; and (5) Any documents, materials, data and other information submitted by a company under § 56-1-916 , collectively, experience data, and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created or produced in connection with such experience data, in each case that include any potentially company-identifying or personally identifiable information, that is provided to or obtained by the commissioner (together with any experience data, the experience materials) and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such experience materials.
(1) A memorandum in support of an opinion submitted under § 56-1-903 and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such memorandum;
(2) All documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in the course of an examination made under § 56-1-914(f) ; provided, however, that if an examination report or other material prepared in connection with an examination made under § 56-1-411 is not held as private and confidential information under § 56-1-411 , an examination report or other material prepared in connection with an examination made under § 56-1-914(f) shall not be confidential information to the same extent as if such examination report or other material had been prepared under § 56-1-411 ;
(3) Any reports, documents, materials and other information developed by a company in support of, or in connection with, an annual certification by the company under § 56-1-915(b)(2) evaluating the effectiveness of the company's internal controls with respect to a principle-based valuation and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such reports, documents, materials and other information;
(4) Any principle-based valuation report developed under § 56-1-915(b)(3) and any other documents, materials and other information, including, but not limited to, all working papers and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such report; and
(5) Any documents, materials, data and other information submitted by a company under § 56-1-916 , collectively, experience data, and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created or produced in connection with such experience data, in each case that include any potentially company-identifying or personally identifiable information, that is provided to or obtained by the commissioner (together with any experience data, the experience materials) and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the commissioner or any other person in connection with such experience materials.
(b) For privilege for, and confidentiality of, confidential information: (1) Except as provided in this section, a company's confidential information is confidential by law and privileged, and shall not be subject to § 10-7-503 or § 56-1-602 , shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action; provided, however, that the commissioner is authorized to use the confidential information in the furtherance of any regulatory or legal action brought against the company as a part of the commissioner's official duties; (2) Neither the commissioner nor any person who received confidential information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential information; (3) In order to assist in the performance of the commissioner's duties, the commissioner may share confidential information: (A) With other state, federal and international regulatory agencies and with the NAIC and its affiliates and subsidiaries; (B) In the case of confidential information specified in subdivisions (a)(1) and (4) only, with the Actuarial Board for Counseling and Discipline or its successor upon request stating that the confidential information is required for the purpose of professional disciplinary proceedings and with state, federal and international law enforcement officials; and (C) Provided that such recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of such documents, materials, data and other information in the same manner and to the same extent as required for the commissioner; (4) The commissioner may receive documents, materials, data and other information, including otherwise confidential and privileged documents, materials, data or information, from the NAIC and its affiliates and subsidiaries, from regulatory or law enforcement officials of other foreign or domestic jurisdictions and from the Actuarial Board for Counseling and Discipline or its successor and shall maintain as confidential or privileged any document, material, data or other information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or other information; (5) The commissioner may enter into agreements governing sharing and use of information consistent with this subsection (b); (6) No waiver of any applicable privilege or claim of confidentiality in the confidential information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (b)(3); (7) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subsection (b) shall be available and enforced in any proceeding in, and in any court of, this state; (8) In this section, "regulatory agency," "law enforcement agency" and "NAIC" include, but are not limited to, their employees, agents, consultants and contractors.
(1) Except as provided in this section, a company's confidential information is confidential by law and privileged, and shall not be subject to § 10-7-503 or § 56-1-602 , shall not be subject to subpoena and shall not be subject to discovery or admissible in evidence in any private civil action; provided, however, that the commissioner is authorized to use the confidential information in the furtherance of any regulatory or legal action brought against the company as a part of the commissioner's official duties;
(2) Neither the commissioner nor any person who received confidential information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential information;
(3) In order to assist in the performance of the commissioner's duties, the commissioner may share confidential information: (A) With other state, federal and international regulatory agencies and with the NAIC and its affiliates and subsidiaries; (B) In the case of confidential information specified in subdivisions (a)(1) and (4) only, with the Actuarial Board for Counseling and Discipline or its successor upon request stating that the confidential information is required for the purpose of professional disciplinary proceedings and with state, federal and international law enforcement officials; and (C) Provided that such recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of such documents, materials, data and other information in the same manner and to the same extent as required for the commissioner;
(A) With other state, federal and international regulatory agencies and with the NAIC and its affiliates and subsidiaries;
(B) In the case of confidential information specified in subdivisions (a)(1) and (4) only, with the Actuarial Board for Counseling and Discipline or its successor upon request stating that the confidential information is required for the purpose of professional disciplinary proceedings and with state, federal and international law enforcement officials; and
(C) Provided that such recipient agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of such documents, materials, data and other information in the same manner and to the same extent as required for the commissioner;
(4) The commissioner may receive documents, materials, data and other information, including otherwise confidential and privileged documents, materials, data or information, from the NAIC and its affiliates and subsidiaries, from regulatory or law enforcement officials of other foreign or domestic jurisdictions and from the Actuarial Board for Counseling and Discipline or its successor and shall maintain as confidential or privileged any document, material, data or other information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or other information;
(5) The commissioner may enter into agreements governing sharing and use of information consistent with this subsection (b);
(6) No waiver of any applicable privilege or claim of confidentiality in the confidential information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (b)(3);
(7) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subsection (b) shall be available and enforced in any proceeding in, and in any court of, this state;
(8) In this section, "regulatory agency," "law enforcement agency" and "NAIC" include, but are not limited to, their employees, agents, consultants and contractors.
(c) Notwithstanding subsection (b), any confidential information specified in subdivisions (a)(1) and (4): (1) May be subject to subpoena for the purpose of defending an action seeking damages from the appointed actuary submitting the related memorandum in support of an opinion submitted under § 56-1-903 or principle-based valuation report developed under § 56-1-915(b)(3) by reason of an action required pursuant to this part or by regulations promulgated by the commissioner; (2) May otherwise be released by the commissioner with the written consent of the company; and (3) Once any portion of a memorandum in support of an opinion submitted under § 56-1-903 or a principle-based valuation report developed under § 56-1-915(b)(3) is cited by the company in its marketing or is publicly volunteered to or before a governmental agency other than a state insurance department or is released by the company to the news media, all portions of such memorandum or report shall no longer be confidential.
(1) May be subject to subpoena for the purpose of defending an action seeking damages from the appointed actuary submitting the related memorandum in support of an opinion submitted under § 56-1-903 or principle-based valuation report developed under § 56-1-915(b)(3) by reason of an action required pursuant to this part or by regulations promulgated by the commissioner;
(2) May otherwise be released by the commissioner with the written consent of the company; and
(3) Once any portion of a memorandum in support of an opinion submitted under § 56-1-903 or a principle-based valuation report developed under § 56-1-915(b)(3) is cited by the company in its marketing or is publicly volunteered to or before a governmental agency other than a state insurance department or is released by the company to the news media, all portions of such memorandum or report shall no longer be confidential.
Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Tenn. Code Ann. § 56-13-122 — TN Code / Title 56 / Chapter 13 / Section 56-13-122
Audit by the comptroller of the treasury - Annual reports
Status: in_force

(a) The regulation of captive insurance companies as authorized by this chapter is subject to audit by the comptroller of the treasury as otherwise provided by state law. Information submitted to the department by captive insurance companies subject to this chapter shall, without written request, be open to inspection by, or disclosure to, the comptroller of the treasury or the comptroller's designated representative for purposes of audit. (b) The commissioner shall annually report to the commerce and labor committee of the senate, and the insurance committee of the house of representatives regarding the captive insurance company program. Such report shall include, but not be limited to, the number and types of captive insurance companies authorized by the commissioner to conduct business in this state, the amount of premium tax and fee revenues generated pursuant to the program, and any recommendations for legislative action to improve the captive insurance company program. Amended by 2019 Tenn. Acts, ch. 345,s 128, eff. 5/10/2019. Amended by 2013 Tenn. Acts, ch. 236,s 19, eff. 4/19/2013. Acts 2011, ch. 468, § 1.
(a) The regulation of captive insurance companies as authorized by this chapter is subject to audit by the comptroller of the treasury as otherwise provided by state law. Information submitted to the department by captive insurance companies subject to this chapter shall, without written request, be open to inspection by, or disclosure to, the comptroller of the treasury or the comptroller's designated representative for purposes of audit.
(b) The commissioner shall annually report to the commerce and labor committee of the senate, and the insurance committee of the house of representatives regarding the captive insurance company program. Such report shall include, but not be limited to, the number and types of captive insurance companies authorized by the commissioner to conduct business in this state, the amount of premium tax and fee revenues generated pursuant to the program, and any recommendations for legislative action to improve the captive insurance company program.
Amended by 2019 Tenn. Acts, ch. 345,s 128, eff. 5/10/2019.
Amended by 2013 Tenn. Acts, ch. 236,s 19, eff. 4/19/2013.
Acts 2011, ch. 468, § 1.