Tenn. Code Ann. § 56-7-2911 — TN Code / Title 56 / Chapter 7 / Section 56-7-2911
[For postponed repeal effective 6/30/2025, see T.C.A. 56-7-2916] Funding
Status: in_force

(a) The program shall be funded in the manner set forth as follows: (1) Premiums. (A) The board shall establish premium rates for program coverage as provided in subdivision (1)(B). Separate schedules of premium rates based on age, tobacco use and weight may apply for individual risks. Premium rates and schedules shall be submitted to the commissioner for approval prior to use. (B) The board, with the assistance of the commissioner, shall determine a standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques, and shall reflect anticipated experience and expenses for the coverage. Initial rates for program coverage shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subject to the limits provided in this subdivision (a)(1)(B), subsequent rates shall be established to provide fully for the expected costs of claims, including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other cost factors subject to the limitations described herein. In no event shall program rates exceed two hundred percent (200%) of rates applicable to individual standard risks. (C) Following the close of each fiscal year, the commissioner shall prepare a report analyzing the program's projected revenues and expenditures and funding requirements. The commissioner shall present this report, together with the board's comments, to the governor with a recommendation for the funding of the program. (2) Sources of Additional Revenue. (A) The deficit incurred by the program, reported by the insurer or administrator pursuant to § 56-7-2909(g) , shall be funded through state appropriations and an assessment on insurers, insurance arrangements and third party administrators. (B) The board is authorized to determine the amount and allocation of any assessments and advance interim assessments on insurers, insurance arrangements and third party administrators in accordance with this section and subject to approval by the commissioner. The commissioner shall have the authority to assess insurers, insurance arrangements, and third party administrators, and to make advance interim assessments as may be reasonable and necessary for the program's organizational and interim operating expenses. Any interim assessments are to be credited as offsets against any regular assessments due following the close of the fiscal year. The assessments must be presented to the department of commerce and insurance to advise whether the assessment will create a hazardous operational or financial condition for the insurer, insurance arrangement, or third party administrator. (C) The assessment for each individual insurer, insurance arrangement and third party administrator shall be determined by multiplying the total assessment of all insurers, insurance arrangements and third party administrators as determined in subdivision (a)(2)(B) by a fraction, the numerator of which equals the number of individuals in Tennessee covered by each individual insurer, insurance arrangement and third party administrator, and the denominator of which equals the total number of all individuals in Tennessee covered by insurers, insurance arrangements and third party administrators, all determined as of the end of the prior calendar year. (D) The board shall make reasonable efforts designed to ensure that each individual covered by insurers, insurance arrangements and third party administrators is counted only once with respect to any assessment. For that purpose, the board shall: (i) Require each insurer and insurance arrangement that obtains excess or stop loss insurance to include in its count of insured individuals all individuals whose coverage is reinsured, including by way of excess or stop loss coverage, in whole or part; (ii) Require each insurer and insurance arrangement that contracts with a third party administrator to include in its count of insured individuals all individuals whose coverage is administered in whole or part by a third party administrator; (iii) Require each insurer that is an excess or stop loss insurer to include in its count of insured individuals all individuals covered through an insurance arrangement; (iv) Require each third party administrator to include in its count of insured individuals all individuals covered through an insurance arrangement; (v) Permit an insurer who is an excess or stop loss insurer to exclude from its number of insured individuals those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subdivision (a)(2); (vi) Permit a third party administrator to exclude from its number of insured individuals those who have been counted by an insurer; and (vii) Permit an insurance arrangement to exclude from its number of insured individuals those who have been counted by an excess or stop loss insurer or third party administrator. (E) The amount of the assessment of each insurer, insurance arrangement or third party administrator shall be determined by the board based on annual statements and other reports deemed to be necessary by the board and filed by the participating insurer with the board or through other reporting mechanisms established by the department of commerce and insurance. The board may use any reasonable method of estimating the number of individuals covered by an insurer or insurance arrangement if the specific number is unknown. With respect to insurers that are reinsurers or excess or stop loss insurers, the board may use any reasonable method of estimating the number of persons insured by each reinsurer or excess or stop loss insurer. The commissioner shall approve and may make modifications to the board's determination of amounts and allocations of the assessments, and shall have the authority to issue and collect the assessments. (F) An insurer, insurance arrangement or third party administrator may petition the commissioner for an abatement or deferment of all or part of an assessment imposed pursuant to this section. The commissioner, in consultation with the commissioner of commerce and insurance, may abate or defer, in whole or in part, the assessment if, in the opinion of the commissioner, payments of the assessment would endanger the ability of the insurer, insurance arrangement or third party administrator to fulfill its contractual obligations. In the event an assessment against an insurer, insurance arrangement or third party administrator is abated or deferred in whole or in part, the amount by which the assessment is abated or deferred may be assessed against the other insurers, insurance arrangements and third party administrators in a manner consistent with the basis for assessments set forth in this subsection (a). The insurer, insurance arrangement or third party administrator receiving the abatement or deferment shall remain liable to the program for the deficiency for four (4) years. (b) The board shall operate the program in a manner so that the estimated cost of providing health insurance coverage during any fiscal year will not exceed total income the program expects to receive from policy premiums, assessments, funds appropriated by the state legislature, and moneys received under subsection (c). After determining the amount of funds appropriated to it for a fiscal year, the board shall estimate the number of new policies it believes the program has the financial capacity to insure during that year so that costs do not exceed income. The board shall take steps necessary to assure that program enrollment does not exceed the number of residents it has estimated it has the financial capacity to insure. (c) The board may make application for any federal grants or other federal sources under which the program may be eligible to receive moneys. (d) Program Fund. (1) The Access Tennessee health insurance program fund shall be established as a separate account in the state treasury. (2) Moneys in the fund, including interest earned on the moneys, shall be invested by the state treasurer, pursuant to §§ 9-4-602 and 9-4-603 for the sole benefit of the fund. (3) Any moneys remaining in the fund at the end of the fiscal year shall not revert to the general fund, but shall be brought forward to the next fiscal year for the exclusive benefit of the fund's payment of future expenses. (4) The fund shall be subject to audit by the comptroller of the treasury. Amended by 2015 Tenn. Acts, ch. 185, s 9, eff. 4/22/2015. Acts 2006, ch. 867, §§ 3, 14.
(a) The program shall be funded in the manner set forth as follows: (1) Premiums. (A) The board shall establish premium rates for program coverage as provided in subdivision (1)(B). Separate schedules of premium rates based on age, tobacco use and weight may apply for individual risks. Premium rates and schedules shall be submitted to the commissioner for approval prior to use. (B) The board, with the assistance of the commissioner, shall determine a standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques, and shall reflect anticipated experience and expenses for the coverage. Initial rates for program coverage shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subject to the limits provided in this subdivision (a)(1)(B), subsequent rates shall be established to provide fully for the expected costs of claims, including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other cost factors subject to the limitations described herein. In no event shall program rates exceed two hundred percent (200%) of rates applicable to individual standard risks. (C) Following the close of each fiscal year, the commissioner shall prepare a report analyzing the program's projected revenues and expenditures and funding requirements. The commissioner shall present this report, together with the board's comments, to the governor with a recommendation for the funding of the program. (2) Sources of Additional Revenue. (A) The deficit incurred by the program, reported by the insurer or administrator pursuant to § 56-7-2909(g) , shall be funded through state appropriations and an assessment on insurers, insurance arrangements and third party administrators. (B) The board is authorized to determine the amount and allocation of any assessments and advance interim assessments on insurers, insurance arrangements and third party administrators in accordance with this section and subject to approval by the commissioner. The commissioner shall have the authority to assess insurers, insurance arrangements, and third party administrators, and to make advance interim assessments as may be reasonable and necessary for the program's organizational and interim operating expenses. Any interim assessments are to be credited as offsets against any regular assessments due following the close of the fiscal year. The assessments must be presented to the department of commerce and insurance to advise whether the assessment will create a hazardous operational or financial condition for the insurer, insurance arrangement, or third party administrator. (C) The assessment for each individual insurer, insurance arrangement and third party administrator shall be determined by multiplying the total assessment of all insurers, insurance arrangements and third party administrators as determined in subdivision (a)(2)(B) by a fraction, the numerator of which equals the number of individuals in Tennessee covered by each individual insurer, insurance arrangement and third party administrator, and the denominator of which equals the total number of all individuals in Tennessee covered by insurers, insurance arrangements and third party administrators, all determined as of the end of the prior calendar year. (D) The board shall make reasonable efforts designed to ensure that each individual covered by insurers, insurance arrangements and third party administrators is counted only once with respect to any assessment. For that purpose, the board shall: (i) Require each insurer and insurance arrangement that obtains excess or stop loss insurance to include in its count of insured individuals all individuals whose coverage is reinsured, including by way of excess or stop loss coverage, in whole or part; (ii) Require each insurer and insurance arrangement that contracts with a third party administrator to include in its count of insured individuals all individuals whose coverage is administered in whole or part by a third party administrator; (iii) Require each insurer that is an excess or stop loss insurer to include in its count of insured individuals all individuals covered through an insurance arrangement; (iv) Require each third party administrator to include in its count of insured individuals all individuals covered through an insurance arrangement; (v) Permit an insurer who is an excess or stop loss insurer to exclude from its number of insured individuals those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subdivision (a)(2); (vi) Permit a third party administrator to exclude from its number of insured individuals those who have been counted by an insurer; and (vii) Permit an insurance arrangement to exclude from its number of insured individuals those who have been counted by an excess or stop loss insurer or third party administrator. (E) The amount of the assessment of each insurer, insurance arrangement or third party administrator shall be determined by the board based on annual statements and other reports deemed to be necessary by the board and filed by the participating insurer with the board or through other reporting mechanisms established by the department of commerce and insurance. The board may use any reasonable method of estimating the number of individuals covered by an insurer or insurance arrangement if the specific number is unknown. With respect to insurers that are reinsurers or excess or stop loss insurers, the board may use any reasonable method of estimating the number of persons insured by each reinsurer or excess or stop loss insurer. The commissioner shall approve and may make modifications to the board's determination of amounts and allocations of the assessments, and shall have the authority to issue and collect the assessments. (F) An insurer, insurance arrangement or third party administrator may petition the commissioner for an abatement or deferment of all or part of an assessment imposed pursuant to this section. The commissioner, in consultation with the commissioner of commerce and insurance, may abate or defer, in whole or in part, the assessment if, in the opinion of the commissioner, payments of the assessment would endanger the ability of the insurer, insurance arrangement or third party administrator to fulfill its contractual obligations. In the event an assessment against an insurer, insurance arrangement or third party administrator is abated or deferred in whole or in part, the amount by which the assessment is abated or deferred may be assessed against the other insurers, insurance arrangements and third party administrators in a manner consistent with the basis for assessments set forth in this subsection (a). The insurer, insurance arrangement or third party administrator receiving the abatement or deferment shall remain liable to the program for the deficiency for four (4) years.
(1) Premiums. (A) The board shall establish premium rates for program coverage as provided in subdivision (1)(B). Separate schedules of premium rates based on age, tobacco use and weight may apply for individual risks. Premium rates and schedules shall be submitted to the commissioner for approval prior to use. (B) The board, with the assistance of the commissioner, shall determine a standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques, and shall reflect anticipated experience and expenses for the coverage. Initial rates for program coverage shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subject to the limits provided in this subdivision (a)(1)(B), subsequent rates shall be established to provide fully for the expected costs of claims, including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other cost factors subject to the limitations described herein. In no event shall program rates exceed two hundred percent (200%) of rates applicable to individual standard risks. (C) Following the close of each fiscal year, the commissioner shall prepare a report analyzing the program's projected revenues and expenditures and funding requirements. The commissioner shall present this report, together with the board's comments, to the governor with a recommendation for the funding of the program.
(A) The board shall establish premium rates for program coverage as provided in subdivision (1)(B). Separate schedules of premium rates based on age, tobacco use and weight may apply for individual risks. Premium rates and schedules shall be submitted to the commissioner for approval prior to use.
(B) The board, with the assistance of the commissioner, shall determine a standard risk rate by considering the premium rates charged by other insurers offering health insurance coverage to individuals. The standard risk rate shall be established using reasonable actuarial techniques, and shall reflect anticipated experience and expenses for the coverage. Initial rates for program coverage shall not be less than one hundred fifty percent (150%) of rates established as applicable for individual standard risks. Subject to the limits provided in this subdivision (a)(1)(B), subsequent rates shall be established to provide fully for the expected costs of claims, including recovery of prior losses, expenses of operation, investment income of claim reserves, and any other cost factors subject to the limitations described herein. In no event shall program rates exceed two hundred percent (200%) of rates applicable to individual standard risks.
(C) Following the close of each fiscal year, the commissioner shall prepare a report analyzing the program's projected revenues and expenditures and funding requirements. The commissioner shall present this report, together with the board's comments, to the governor with a recommendation for the funding of the program.
(2) Sources of Additional Revenue. (A) The deficit incurred by the program, reported by the insurer or administrator pursuant to § 56-7-2909(g) , shall be funded through state appropriations and an assessment on insurers, insurance arrangements and third party administrators. (B) The board is authorized to determine the amount and allocation of any assessments and advance interim assessments on insurers, insurance arrangements and third party administrators in accordance with this section and subject to approval by the commissioner. The commissioner shall have the authority to assess insurers, insurance arrangements, and third party administrators, and to make advance interim assessments as may be reasonable and necessary for the program's organizational and interim operating expenses. Any interim assessments are to be credited as offsets against any regular assessments due following the close of the fiscal year. The assessments must be presented to the department of commerce and insurance to advise whether the assessment will create a hazardous operational or financial condition for the insurer, insurance arrangement, or third party administrator. (C) The assessment for each individual insurer, insurance arrangement and third party administrator shall be determined by multiplying the total assessment of all insurers, insurance arrangements and third party administrators as determined in subdivision (a)(2)(B) by a fraction, the numerator of which equals the number of individuals in Tennessee covered by each individual insurer, insurance arrangement and third party administrator, and the denominator of which equals the total number of all individuals in Tennessee covered by insurers, insurance arrangements and third party administrators, all determined as of the end of the prior calendar year. (D) The board shall make reasonable efforts designed to ensure that each individual covered by insurers, insurance arrangements and third party administrators is counted only once with respect to any assessment. For that purpose, the board shall: (i) Require each insurer and insurance arrangement that obtains excess or stop loss insurance to include in its count of insured individuals all individuals whose coverage is reinsured, including by way of excess or stop loss coverage, in whole or part; (ii) Require each insurer and insurance arrangement that contracts with a third party administrator to include in its count of insured individuals all individuals whose coverage is administered in whole or part by a third party administrator; (iii) Require each insurer that is an excess or stop loss insurer to include in its count of insured individuals all individuals covered through an insurance arrangement; (iv) Require each third party administrator to include in its count of insured individuals all individuals covered through an insurance arrangement; (v) Permit an insurer who is an excess or stop loss insurer to exclude from its number of insured individuals those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subdivision (a)(2); (vi) Permit a third party administrator to exclude from its number of insured individuals those who have been counted by an insurer; and (vii) Permit an insurance arrangement to exclude from its number of insured individuals those who have been counted by an excess or stop loss insurer or third party administrator. (E) The amount of the assessment of each insurer, insurance arrangement or third party administrator shall be determined by the board based on annual statements and other reports deemed to be necessary by the board and filed by the participating insurer with the board or through other reporting mechanisms established by the department of commerce and insurance. The board may use any reasonable method of estimating the number of individuals covered by an insurer or insurance arrangement if the specific number is unknown. With respect to insurers that are reinsurers or excess or stop loss insurers, the board may use any reasonable method of estimating the number of persons insured by each reinsurer or excess or stop loss insurer. The commissioner shall approve and may make modifications to the board's determination of amounts and allocations of the assessments, and shall have the authority to issue and collect the assessments. (F) An insurer, insurance arrangement or third party administrator may petition the commissioner for an abatement or deferment of all or part of an assessment imposed pursuant to this section. The commissioner, in consultation with the commissioner of commerce and insurance, may abate or defer, in whole or in part, the assessment if, in the opinion of the commissioner, payments of the assessment would endanger the ability of the insurer, insurance arrangement or third party administrator to fulfill its contractual obligations. In the event an assessment against an insurer, insurance arrangement or third party administrator is abated or deferred in whole or in part, the amount by which the assessment is abated or deferred may be assessed against the other insurers, insurance arrangements and third party administrators in a manner consistent with the basis for assessments set forth in this subsection (a). The insurer, insurance arrangement or third party administrator receiving the abatement or deferment shall remain liable to the program for the deficiency for four (4) years.
(A) The deficit incurred by the program, reported by the insurer or administrator pursuant to § 56-7-2909(g) , shall be funded through state appropriations and an assessment on insurers, insurance arrangements and third party administrators.
(B) The board is authorized to determine the amount and allocation of any assessments and advance interim assessments on insurers, insurance arrangements and third party administrators in accordance with this section and subject to approval by the commissioner. The commissioner shall have the authority to assess insurers, insurance arrangements, and third party administrators, and to make advance interim assessments as may be reasonable and necessary for the program's organizational and interim operating expenses. Any interim assessments are to be credited as offsets against any regular assessments due following the close of the fiscal year. The assessments must be presented to the department of commerce and insurance to advise whether the assessment will create a hazardous operational or financial condition for the insurer, insurance arrangement, or third party administrator.
(C) The assessment for each individual insurer, insurance arrangement and third party administrator shall be determined by multiplying the total assessment of all insurers, insurance arrangements and third party administrators as determined in subdivision (a)(2)(B) by a fraction, the numerator of which equals the number of individuals in Tennessee covered by each individual insurer, insurance arrangement and third party administrator, and the denominator of which equals the total number of all individuals in Tennessee covered by insurers, insurance arrangements and third party administrators, all determined as of the end of the prior calendar year.
(D) The board shall make reasonable efforts designed to ensure that each individual covered by insurers, insurance arrangements and third party administrators is counted only once with respect to any assessment. For that purpose, the board shall: (i) Require each insurer and insurance arrangement that obtains excess or stop loss insurance to include in its count of insured individuals all individuals whose coverage is reinsured, including by way of excess or stop loss coverage, in whole or part; (ii) Require each insurer and insurance arrangement that contracts with a third party administrator to include in its count of insured individuals all individuals whose coverage is administered in whole or part by a third party administrator; (iii) Require each insurer that is an excess or stop loss insurer to include in its count of insured individuals all individuals covered through an insurance arrangement; (iv) Require each third party administrator to include in its count of insured individuals all individuals covered through an insurance arrangement; (v) Permit an insurer who is an excess or stop loss insurer to exclude from its number of insured individuals those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subdivision (a)(2); (vi) Permit a third party administrator to exclude from its number of insured individuals those who have been counted by an insurer; and (vii) Permit an insurance arrangement to exclude from its number of insured individuals those who have been counted by an excess or stop loss insurer or third party administrator.
(i) Require each insurer and insurance arrangement that obtains excess or stop loss insurance to include in its count of insured individuals all individuals whose coverage is reinsured, including by way of excess or stop loss coverage, in whole or part;
(ii) Require each insurer and insurance arrangement that contracts with a third party administrator to include in its count of insured individuals all individuals whose coverage is administered in whole or part by a third party administrator;
(iii) Require each insurer that is an excess or stop loss insurer to include in its count of insured individuals all individuals covered through an insurance arrangement;
(iv) Require each third party administrator to include in its count of insured individuals all individuals covered through an insurance arrangement;
(v) Permit an insurer who is an excess or stop loss insurer to exclude from its number of insured individuals those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subdivision (a)(2);
(vi) Permit a third party administrator to exclude from its number of insured individuals those who have been counted by an insurer; and
(vii) Permit an insurance arrangement to exclude from its number of insured individuals those who have been counted by an excess or stop loss insurer or third party administrator.
(E) The amount of the assessment of each insurer, insurance arrangement or third party administrator shall be determined by the board based on annual statements and other reports deemed to be necessary by the board and filed by the participating insurer with the board or through other reporting mechanisms established by the department of commerce and insurance. The board may use any reasonable method of estimating the number of individuals covered by an insurer or insurance arrangement if the specific number is unknown. With respect to insurers that are reinsurers or excess or stop loss insurers, the board may use any reasonable method of estimating the number of persons insured by each reinsurer or excess or stop loss insurer. The commissioner shall approve and may make modifications to the board's determination of amounts and allocations of the assessments, and shall have the authority to issue and collect the assessments.
(F) An insurer, insurance arrangement or third party administrator may petition the commissioner for an abatement or deferment of all or part of an assessment imposed pursuant to this section. The commissioner, in consultation with the commissioner of commerce and insurance, may abate or defer, in whole or in part, the assessment if, in the opinion of the commissioner, payments of the assessment would endanger the ability of the insurer, insurance arrangement or third party administrator to fulfill its contractual obligations. In the event an assessment against an insurer, insurance arrangement or third party administrator is abated or deferred in whole or in part, the amount by which the assessment is abated or deferred may be assessed against the other insurers, insurance arrangements and third party administrators in a manner consistent with the basis for assessments set forth in this subsection (a). The insurer, insurance arrangement or third party administrator receiving the abatement or deferment shall remain liable to the program for the deficiency for four (4) years.
(b) The board shall operate the program in a manner so that the estimated cost of providing health insurance coverage during any fiscal year will not exceed total income the program expects to receive from policy premiums, assessments, funds appropriated by the state legislature, and moneys received under subsection (c). After determining the amount of funds appropriated to it for a fiscal year, the board shall estimate the number of new policies it believes the program has the financial capacity to insure during that year so that costs do not exceed income. The board shall take steps necessary to assure that program enrollment does not exceed the number of residents it has estimated it has the financial capacity to insure.
(c) The board may make application for any federal grants or other federal sources under which the program may be eligible to receive moneys.
(d) Program Fund. (1) The Access Tennessee health insurance program fund shall be established as a separate account in the state treasury. (2) Moneys in the fund, including interest earned on the moneys, shall be invested by the state treasurer, pursuant to §§ 9-4-602 and 9-4-603 for the sole benefit of the fund. (3) Any moneys remaining in the fund at the end of the fiscal year shall not revert to the general fund, but shall be brought forward to the next fiscal year for the exclusive benefit of the fund's payment of future expenses. (4) The fund shall be subject to audit by the comptroller of the treasury.
(1) The Access Tennessee health insurance program fund shall be established as a separate account in the state treasury.
(2) Moneys in the fund, including interest earned on the moneys, shall be invested by the state treasurer, pursuant to §§ 9-4-602 and 9-4-603 for the sole benefit of the fund.
(3) Any moneys remaining in the fund at the end of the fiscal year shall not revert to the general fund, but shall be brought forward to the next fiscal year for the exclusive benefit of the fund's payment of future expenses.
(4) The fund shall be subject to audit by the comptroller of the treasury.
Amended by 2015 Tenn. Acts, ch. 185, s 9, eff. 4/22/2015.
Acts 2006, ch. 867, §§ 3, 14.
Tenn. Code Ann. § 56-7-3401 — TN Code / Title 56 / Chapter 7 / Section 56-7-3401
Short title
Status: in_force

This part shall be known as the "Unclaimed Life Insurance Benefits Act". Added by 2014 Tenn. Acts, ch. 974,s 1, eff. 7/1/2015.
This part shall be known as the "Unclaimed Life Insurance Benefits Act".
Added by 2014 Tenn. Acts, ch. 974,s 1, eff. 7/1/2015.
Tenn. Code Ann. § 56-6-1007 — TN Code / Title 56 / Chapter 6 / Section 56-6-1007
Expertise of adjuster sufficient to undertake adjustment of claim
Status: in_force

A crop insurance adjuster shall not undertake the adjustment of any claim, if the crop insurance adjuster is not sufficiently competent and knowledgeable as to the terms and conditions of the insurance coverage so as to properly discharge the duties of a crop insurance adjuster, or that otherwise exceeds the crop insurance adjuster's current expertise. Acts 2009, ch. 476, § 8.
A crop insurance adjuster shall not undertake the adjustment of any claim, if the crop insurance adjuster is not sufficiently competent and knowledgeable as to the terms and conditions of the insurance coverage so as to properly discharge the duties of a crop insurance adjuster, or that otherwise exceeds the crop insurance adjuster's current expertise.
Acts 2009, ch. 476, § 8.
Tenn. Code Ann. § 56-7-903 — TN Code / Title 56 / Chapter 7 / Section 56-7-903
Applicability of credit life insurance provisions
Status: in_force

All life insurance policies and certificates issued in connection with loans or credit transactions for a duration of fifteen (15) years or less shall be subject to § 56-7-902 - 56-7-912, except in connection with a loan or other credit transaction where the period of coverage on the debtor determined at date of issuance of the coverage is of more than ten (10) years' duration. Insurance shall not be subject to § 56-7-902 - 56-7-912 where the issuance of the insurance is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor. Acts 1985, ch. 107, § 3; 1988, ch. 709, § 2.
All life insurance policies and certificates issued in connection with loans or credit transactions for a duration of fifteen (15) years or less shall be subject to § 56-7-902 - 56-7-912, except in connection with a loan or other credit transaction where the period of coverage on the debtor determined at date of issuance of the coverage is of more than ten (10) years' duration. Insurance shall not be subject to § 56-7-902 - 56-7-912 where the issuance of the insurance is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor.
Acts 1985, ch. 107, § 3; 1988, ch. 709, § 2.
Tenn. Code Ann. § 56-2-110 — TN Code / Title 56 / Chapter 2 / Section 56-2-110
Injunction to prevent violation of Section 56-2-105
Status: in_force

(a) Whenever the commissioner believes, from evidence satisfactory to the commissioner, that any foreign or alien company is violating or is about to violate § 56-2-105 , the commissioner may, through the attorney general and reporter, cause a bill to be filed in the chancery court of Davidson County to enjoin and restrain the company from continuing the violation, engaging in the violation or doing any act in furtherance of the violation. (b) The court shall have jurisdiction of the proceeding and shall have the power to make and enter an order or decree awarding the preliminary or final injunctive relief as in its judgment is proper. Acts 1968, ch. 536, § 5; T.C.A., § 56-210.
(a) Whenever the commissioner believes, from evidence satisfactory to the commissioner, that any foreign or alien company is violating or is about to violate § 56-2-105 , the commissioner may, through the attorney general and reporter, cause a bill to be filed in the chancery court of Davidson County to enjoin and restrain the company from continuing the violation, engaging in the violation or doing any act in furtherance of the violation.
(b) The court shall have jurisdiction of the proceeding and shall have the power to make and enter an order or decree awarding the preliminary or final injunctive relief as in its judgment is proper.
Acts 1968, ch. 536, § 5; T.C.A., § 56-210.
Tenn. Code Ann. § 56-13-412 — TN Code / Title 56 / Chapter 13 / Section 56-13-412
Reinsurance
Status: in_force

(a) An SPFC may reinsure only the risks of a ceding insurer, pursuant to a reinsurance contract. No SPFC shall issue a contract of insurance or a contract for assumption of risk or indemnification of loss other than such reinsurance contract. (b) Unless otherwise approved in advance by the commissioner, no SPFC shall assume or retain exposure to insurance or reinsurance losses for its own account that are not funded by: (1) Proceeds from an insurance securitization or letters of credit or other assets described in § 56-13-402 ; (2) Premium and other amounts payable by the ceding insurer to the SPFC pursuant to the reinsurance contract; and (3) Any return on investment of the items described in subdivisions (b)(1) and (2). (c) The reinsurance contract shall contain all provisions reasonably required or approved by the commissioner, which requirements shall take into account the laws applicable to the ceding insurer regarding the ceding insurer taking credit for the reinsurance provided under such reinsurance contract. (d) An SPFC may cede risks assumed through a reinsurance contract to one (1) or more reinsurers through the purchase of reinsurance, subject to the prior approval of the commissioner. (e) An SPFC may enter into contracts and conduct other commercial activities related or incidental to and necessary to fulfill the purposes of the reinsurance contract, the insurance securitization, and this part, provided such contracts and activities are included in the SPFC's plan of operation or are otherwise approved in advance by the commissioner. Such contracts and activities may include but are not limited to: (1) Entering into SPFC contracts; (2) Issuing SPFC securities in accordance with applicable securities law; (3) Complying with the terms of such contracts or securities; (4) Entering into trust, guaranteed investment contract, letter of credit, swap, tax, administration, reimbursement, or fiscal agent transactions; and (5) Complying with trust indenture, reinsurance, or retrocession; and other agreements necessary or incidental to effectuate an insurance securitization in compliance with this part or the plan of operation approved by the commissioner. (f) Unless otherwise approved in advance by the commissioner, a reinsurance contract shall not contain any provision for payment by the SPFC in discharge of its obligations under the reinsurance contract to any person other than the ceding insurer or any receiver of the ceding insurer. (g) An SPFC shall notify the commissioner immediately of any action by a ceding insurer or any other person to foreclose on or otherwise take possession of collateral provided by the SPFC to secure any obligation of the SPFC. (h) In the SPFC insurance securitization, the contracts or other relating documentation shall contain provisions identifying the SPFC. (i) Unless otherwise approved by the commissioner, no SPFC shall enter into an SPFC contract with a person that is not licensed or otherwise authorized to transact the business of insurance or reinsurance in at least its state or country of domicile. (j) No SPFC shall: (1) Have any direct obligation to the policyholders or reinsureds of the counterparty; or (2) Lend or otherwise invest, or place in custody, trust, or under management any of its assets with, or to borrow money or receive a loan from, other than by issuance of the securities pursuant to an insurance securitization, or advance from, anyone convicted of a felony, anyone who is untrustworthy or of known bad character, or anyone convicted of a criminal offense involving the conversion or misappropriation of fiduciary funds or insurance accounts, theft, deceit, fraud, misrepresentation, or corruption. Acts 2011, ch. 468, § 1.
(a) An SPFC may reinsure only the risks of a ceding insurer, pursuant to a reinsurance contract. No SPFC shall issue a contract of insurance or a contract for assumption of risk or indemnification of loss other than such reinsurance contract.
(b) Unless otherwise approved in advance by the commissioner, no SPFC shall assume or retain exposure to insurance or reinsurance losses for its own account that are not funded by: (1) Proceeds from an insurance securitization or letters of credit or other assets described in § 56-13-402 ; (2) Premium and other amounts payable by the ceding insurer to the SPFC pursuant to the reinsurance contract; and (3) Any return on investment of the items described in subdivisions (b)(1) and (2).
(1) Proceeds from an insurance securitization or letters of credit or other assets described in § 56-13-402 ;
(2) Premium and other amounts payable by the ceding insurer to the SPFC pursuant to the reinsurance contract; and
(3) Any return on investment of the items described in subdivisions (b)(1) and (2).
(c) The reinsurance contract shall contain all provisions reasonably required or approved by the commissioner, which requirements shall take into account the laws applicable to the ceding insurer regarding the ceding insurer taking credit for the reinsurance provided under such reinsurance contract.
(d) An SPFC may cede risks assumed through a reinsurance contract to one (1) or more reinsurers through the purchase of reinsurance, subject to the prior approval of the commissioner.
(e) An SPFC may enter into contracts and conduct other commercial activities related or incidental to and necessary to fulfill the purposes of the reinsurance contract, the insurance securitization, and this part, provided such contracts and activities are included in the SPFC's plan of operation or are otherwise approved in advance by the commissioner. Such contracts and activities may include but are not limited to: (1) Entering into SPFC contracts; (2) Issuing SPFC securities in accordance with applicable securities law; (3) Complying with the terms of such contracts or securities; (4) Entering into trust, guaranteed investment contract, letter of credit, swap, tax, administration, reimbursement, or fiscal agent transactions; and (5) Complying with trust indenture, reinsurance, or retrocession; and other agreements necessary or incidental to effectuate an insurance securitization in compliance with this part or the plan of operation approved by the commissioner.
(1) Entering into SPFC contracts;
(2) Issuing SPFC securities in accordance with applicable securities law;
(3) Complying with the terms of such contracts or securities;
(4) Entering into trust, guaranteed investment contract, letter of credit, swap, tax, administration, reimbursement, or fiscal agent transactions; and
(5) Complying with trust indenture, reinsurance, or retrocession; and other agreements necessary or incidental to effectuate an insurance securitization in compliance with this part or the plan of operation approved by the commissioner.
(f) Unless otherwise approved in advance by the commissioner, a reinsurance contract shall not contain any provision for payment by the SPFC in discharge of its obligations under the reinsurance contract to any person other than the ceding insurer or any receiver of the ceding insurer.
(g) An SPFC shall notify the commissioner immediately of any action by a ceding insurer or any other person to foreclose on or otherwise take possession of collateral provided by the SPFC to secure any obligation of the SPFC.
(h) In the SPFC insurance securitization, the contracts or other relating documentation shall contain provisions identifying the SPFC.
(i) Unless otherwise approved by the commissioner, no SPFC shall enter into an SPFC contract with a person that is not licensed or otherwise authorized to transact the business of insurance or reinsurance in at least its state or country of domicile.
(j) No SPFC shall: (1) Have any direct obligation to the policyholders or reinsureds of the counterparty; or (2) Lend or otherwise invest, or place in custody, trust, or under management any of its assets with, or to borrow money or receive a loan from, other than by issuance of the securities pursuant to an insurance securitization, or advance from, anyone convicted of a felony, anyone who is untrustworthy or of known bad character, or anyone convicted of a criminal offense involving the conversion or misappropriation of fiduciary funds or insurance accounts, theft, deceit, fraud, misrepresentation, or corruption.
(1) Have any direct obligation to the policyholders or reinsureds of the counterparty; or
(2) Lend or otherwise invest, or place in custody, trust, or under management any of its assets with, or to borrow money or receive a loan from, other than by issuance of the securities pursuant to an insurance securitization, or advance from, anyone convicted of a felony, anyone who is untrustworthy or of known bad character, or anyone convicted of a criminal offense involving the conversion or misappropriation of fiduciary funds or insurance accounts, theft, deceit, fraud, misrepresentation, or corruption.
Acts 2011, ch. 468, § 1.
Tenn. Code Ann. § 56-11-107 — TN Code / Title 56 / Chapter 11 / Section 56-11-107
Financial condition of insurer or health maintenance organization
Status: in_force

(a) Power of Commissioner. Subject to the limitation contained in this section, and in addition to the powers that the commissioner has under chapters 1 and 32 of this title, relating to the examination of insurers or health maintenance organizations, the commissioner also has the power to examine any insurer or health maintenance organization registered under § 56-11-105 and its affiliates to ascertain the financial condition of the insurer or health maintenance organization, including the enterprise risk to the insurer by the ultimate controlling party, or by any entity or combination of entities within the insurance or health maintenance organization holding company system, or by the insurance or health maintenance organization holding company system on a consolidated basis. (b) Access to Books and Records. (1) The commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce any records, books, or other information papers in the possession of the insurer or health maintenance organization or its affiliates that are reasonably necessary to determine compliance with this title. (2) To determine compliance with this title, the commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce information not in the possession of the insurer or health maintenance organization if the insurer or health maintenance organization can obtain access to such information pursuant to contractual relationships, statutory obligations, or other methods. In the event the insurer or health maintenance organization cannot obtain the information requested by the commissioner, the insurer or health maintenance organization shall provide the commissioner a detailed explanation of the reason that the insurer or health maintenance organization cannot obtain the information and the identity of the holder of information. Whenever it appears to the commissioner that the detailed explanation is without merit, the commissioner may require, after notice and hearing, the insurer or health maintenance organization to pay a penalty of one hundred dollars ($100) for each day's delay, or may suspend or revoke the insurer's license. (c) Use of Consultants. The commissioner may retain, at the registered insurer or health maintenance organization's expense, attorneys, actuaries, accountants and other experts, not otherwise a part of the commissioner's staff, that shall be reasonably necessary to assist in the conduct of the examination under subsection (a). Any persons so retained shall be under the direction and control of the commissioner and shall act in a purely advisory capacity. (d) Expenses. Each registered insurer or health maintenance organization producing for examination records, books and papers pursuant to subsection (a) shall be liable for and shall pay the expense of the examination in accordance with chapters 1 and 32 of this title. (e) Compelling Production. In the event the insurer fails to comply with an order, the commissioner shall have the power to examine the affiliates to obtain the information. The commissioner shall also have the power to issue subpoenas, to administer oaths, and to examine under oath any person for purposes of determining compliance with this section. Upon the failure or refusal of any person to obey a subpoena, the commissioner may petition a court of competent jurisdiction, and upon proper showing, the court may enter an order compelling the witness to appear and testify or produce documentary evidence. Failure to obey the court order shall be punishable as contempt of court. Every person shall be obliged to attend as a witness at the place specified in the subpoena, when subpoenaed, anywhere within the state. Such person shall be entitled to the same fees and mileage, if claimed, as a witness in courts of this state, which fees, mileage, and actual expense, if any, necessarily incurred in securing the attendance of witnesses, and their testimony, shall be itemized and charged against, and be paid by, the company being examined. Amended by 2014 Tenn. Acts, ch. 583,s 15, eff. 3/28/2014. Acts 1986, ch. 572, § 7; 2000, ch. 708, § 3f; T.C.A. § 56-11-207 .
(a) Power of Commissioner. Subject to the limitation contained in this section, and in addition to the powers that the commissioner has under chapters 1 and 32 of this title, relating to the examination of insurers or health maintenance organizations, the commissioner also has the power to examine any insurer or health maintenance organization registered under § 56-11-105 and its affiliates to ascertain the financial condition of the insurer or health maintenance organization, including the enterprise risk to the insurer by the ultimate controlling party, or by any entity or combination of entities within the insurance or health maintenance organization holding company system, or by the insurance or health maintenance organization holding company system on a consolidated basis.
(b) Access to Books and Records. (1) The commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce any records, books, or other information papers in the possession of the insurer or health maintenance organization or its affiliates that are reasonably necessary to determine compliance with this title. (2) To determine compliance with this title, the commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce information not in the possession of the insurer or health maintenance organization if the insurer or health maintenance organization can obtain access to such information pursuant to contractual relationships, statutory obligations, or other methods. In the event the insurer or health maintenance organization cannot obtain the information requested by the commissioner, the insurer or health maintenance organization shall provide the commissioner a detailed explanation of the reason that the insurer or health maintenance organization cannot obtain the information and the identity of the holder of information. Whenever it appears to the commissioner that the detailed explanation is without merit, the commissioner may require, after notice and hearing, the insurer or health maintenance organization to pay a penalty of one hundred dollars ($100) for each day's delay, or may suspend or revoke the insurer's license.
(1) The commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce any records, books, or other information papers in the possession of the insurer or health maintenance organization or its affiliates that are reasonably necessary to determine compliance with this title.
(2) To determine compliance with this title, the commissioner may order any insurer or health maintenance organization registered under § 56-11-105 to produce information not in the possession of the insurer or health maintenance organization if the insurer or health maintenance organization can obtain access to such information pursuant to contractual relationships, statutory obligations, or other methods. In the event the insurer or health maintenance organization cannot obtain the information requested by the commissioner, the insurer or health maintenance organization shall provide the commissioner a detailed explanation of the reason that the insurer or health maintenance organization cannot obtain the information and the identity of the holder of information. Whenever it appears to the commissioner that the detailed explanation is without merit, the commissioner may require, after notice and hearing, the insurer or health maintenance organization to pay a penalty of one hundred dollars ($100) for each day's delay, or may suspend or revoke the insurer's license.
(c) Use of Consultants. The commissioner may retain, at the registered insurer or health maintenance organization's expense, attorneys, actuaries, accountants and other experts, not otherwise a part of the commissioner's staff, that shall be reasonably necessary to assist in the conduct of the examination under subsection (a). Any persons so retained shall be under the direction and control of the commissioner and shall act in a purely advisory capacity.
(d) Expenses. Each registered insurer or health maintenance organization producing for examination records, books and papers pursuant to subsection (a) shall be liable for and shall pay the expense of the examination in accordance with chapters 1 and 32 of this title.
(e) Compelling Production. In the event the insurer fails to comply with an order, the commissioner shall have the power to examine the affiliates to obtain the information. The commissioner shall also have the power to issue subpoenas, to administer oaths, and to examine under oath any person for purposes of determining compliance with this section. Upon the failure or refusal of any person to obey a subpoena, the commissioner may petition a court of competent jurisdiction, and upon proper showing, the court may enter an order compelling the witness to appear and testify or produce documentary evidence. Failure to obey the court order shall be punishable as contempt of court. Every person shall be obliged to attend as a witness at the place specified in the subpoena, when subpoenaed, anywhere within the state. Such person shall be entitled to the same fees and mileage, if claimed, as a witness in courts of this state, which fees, mileage, and actual expense, if any, necessarily incurred in securing the attendance of witnesses, and their testimony, shall be itemized and charged against, and be paid by, the company being examined.
Amended by 2014 Tenn. Acts, ch. 583,s 15, eff. 3/28/2014.
Acts 1986, ch. 572, § 7; 2000, ch. 708, § 3f; T.C.A. § 56-11-207 .
Tenn. Code Ann. § 56-7-109 — TN Code / Title 56 / Chapter 7 / Section 56-7-109
Definitions - Timely reimbursement of health insurance claims
Status: in_force

(a) Definitions. As used in this section: (1) (A) "Clean claim" means a claim received by a health insurance entity for adjudication that requires no further information, adjustment or alteration by the provider of the services in order to be processed and paid by the health insurer. A claim is clean if it has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this section; (B) "Clean claim" does not include a duplicate claim; (C) "Clean claim" does not include any claim submitted more than ninety (90) days after the date of service; and (D) "Clean claim" includes resubmitted paper claims with previously identified deficiencies corrected; (2) "Duplicate claim" means an original claim and its duplicate, when the duplicate is filed within thirty (30) days of the original claim; (3) "Health insurance coverage" means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate or agreement offered by a health insurance entity; provided, that health insurance coverage does not include policies or certificates covering only accident, credit, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, other limited benefit health insurance, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that are statutorily required to be contained in any liability insurance policy or equivalent self-insurance; (4) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation; (5) "Pay" means that the health insurance entity shall either send the provider cash or a cash equivalent in full satisfaction of the allowed portion of the claim, or give the provider a credit against any outstanding balance owed by that provider to the health insurance entity. Payment shall occur on the date when the cash, cash equivalent or notice of credit is mailed or otherwise sent to the provider; and (6) "Submitted" means that the provider either mails or otherwise sends a claim to the health insurance entity. Submission shall occur on the date the claim is mailed or otherwise sent to the health insurance entity. (b) Prompt Payment Standards. (1) (A) Not later than thirty (30) calendar days after the date that a health insurance entity actually receives a claim submitted on paper from a provider, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider in writing why the remaining portion of the claim will not be paid; or (iii) Notify the provider in writing of all reasons why the claim is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. (B) Not later than twenty-one (21) calendar days after receiving a claim by electronic submission, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or (iii) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim. (2) No paper claim may be denied upon resubmission for lack of substantiating documentation or information that has been previously provided by the health care provider. (3) Health insurance entities shall timely provide contracted providers with all necessary information to properly submit a claim. (4) Any health insurance entity that does not comply with subdivision (b)(1) shall pay one percent (1%) interest per month, accruing from the day after the payment was due, on that amount of the claim that remains unpaid. (c) Regulatory Oversight. (1) The commissioner shall ensure, as part of the department's ongoing regulatory oversight of health insurance entities, that health insurance entities properly process and pay claims in accordance with this section. (2) If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay ninety-five percent (95%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty up to ten thousand dollars ($10,000). If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay eighty-five percent (85%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than ten thousand dollars ($10,000) nor more than one hundred thousand dollars ($100,000), if reasonable notice in writing is given of the intent to levy the penalty. If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay sixty percent (60%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than one hundred thousand dollars ($100,000) nor more than two hundred thousand dollars ($200,000). In determining the amount of any fine, the commissioner shall take into account whether the failure to achieve the standards in this section is due to circumstances beyond the health insurance entity's control and whether the health insurance entity has been in the business of processing claims for two (2) years or less. The health insurance entity may request an administrative hearing contesting the assessment of any administrative penalty imposed by the commissioner within thirty (30) days after receipt of the notice of the assessment. (3) The commissioner may issue an order directing a health insurance entity or a representative of a health insurance entity to cease and desist from engaging in any act or practice in violation of this section. Within fifteen (15) days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of this act have occurred. (4) All hearings under this part shall be conducted pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (5) In the case of any violations of this section, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued by the commissioner, the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in the chancery court of Davidson County. (6) Examinations to determine compliance with this section may be conducted by the commissioner's staff. The commissioner may, if necessary, contract with qualified impartial outside sources to assist in examinations to determine compliance with this section. The expenses of the examinations shall be assessed against health maintenance organizations in accordance with § 56-32-115 . For other health insurance entities, the commissioner shall bill the expenses of the examinations to those entities in accordance with § 56-1-413 . (d) Rules and regulations. The commissioner shall adopt rules and regulations to ensure effective compliance with this section. Acts 2000, ch. 890, § 2.
(a) Definitions. As used in this section: (1) (A) "Clean claim" means a claim received by a health insurance entity for adjudication that requires no further information, adjustment or alteration by the provider of the services in order to be processed and paid by the health insurer. A claim is clean if it has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this section; (B) "Clean claim" does not include a duplicate claim; (C) "Clean claim" does not include any claim submitted more than ninety (90) days after the date of service; and (D) "Clean claim" includes resubmitted paper claims with previously identified deficiencies corrected; (2) "Duplicate claim" means an original claim and its duplicate, when the duplicate is filed within thirty (30) days of the original claim; (3) "Health insurance coverage" means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate or agreement offered by a health insurance entity; provided, that health insurance coverage does not include policies or certificates covering only accident, credit, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, other limited benefit health insurance, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that are statutorily required to be contained in any liability insurance policy or equivalent self-insurance; (4) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation; (5) "Pay" means that the health insurance entity shall either send the provider cash or a cash equivalent in full satisfaction of the allowed portion of the claim, or give the provider a credit against any outstanding balance owed by that provider to the health insurance entity. Payment shall occur on the date when the cash, cash equivalent or notice of credit is mailed or otherwise sent to the provider; and (6) "Submitted" means that the provider either mails or otherwise sends a claim to the health insurance entity. Submission shall occur on the date the claim is mailed or otherwise sent to the health insurance entity.
(1) (A) "Clean claim" means a claim received by a health insurance entity for adjudication that requires no further information, adjustment or alteration by the provider of the services in order to be processed and paid by the health insurer. A claim is clean if it has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this section; (B) "Clean claim" does not include a duplicate claim; (C) "Clean claim" does not include any claim submitted more than ninety (90) days after the date of service; and (D) "Clean claim" includes resubmitted paper claims with previously identified deficiencies corrected;
(A) "Clean claim" means a claim received by a health insurance entity for adjudication that requires no further information, adjustment or alteration by the provider of the services in order to be processed and paid by the health insurer. A claim is clean if it has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this section;
(B) "Clean claim" does not include a duplicate claim;
(C) "Clean claim" does not include any claim submitted more than ninety (90) days after the date of service; and
(D) "Clean claim" includes resubmitted paper claims with previously identified deficiencies corrected;
(2) "Duplicate claim" means an original claim and its duplicate, when the duplicate is filed within thirty (30) days of the original claim;
(3) "Health insurance coverage" means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate or agreement offered by a health insurance entity; provided, that health insurance coverage does not include policies or certificates covering only accident, credit, disability income, long-term care, hospital indemnity, medicare supplement as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, other limited benefit health insurance, automobile medical payment insurance, or insurance under which benefits are payable with or without regard to fault and that are statutorily required to be contained in any liability insurance policy or equivalent self-insurance;
(4) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation;
(5) "Pay" means that the health insurance entity shall either send the provider cash or a cash equivalent in full satisfaction of the allowed portion of the claim, or give the provider a credit against any outstanding balance owed by that provider to the health insurance entity. Payment shall occur on the date when the cash, cash equivalent or notice of credit is mailed or otherwise sent to the provider; and
(6) "Submitted" means that the provider either mails or otherwise sends a claim to the health insurance entity. Submission shall occur on the date the claim is mailed or otherwise sent to the health insurance entity.
(b) Prompt Payment Standards. (1) (A) Not later than thirty (30) calendar days after the date that a health insurance entity actually receives a claim submitted on paper from a provider, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider in writing why the remaining portion of the claim will not be paid; or (iii) Notify the provider in writing of all reasons why the claim is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. (B) Not later than twenty-one (21) calendar days after receiving a claim by electronic submission, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or (iii) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim. (2) No paper claim may be denied upon resubmission for lack of substantiating documentation or information that has been previously provided by the health care provider. (3) Health insurance entities shall timely provide contracted providers with all necessary information to properly submit a claim. (4) Any health insurance entity that does not comply with subdivision (b)(1) shall pay one percent (1%) interest per month, accruing from the day after the payment was due, on that amount of the claim that remains unpaid.
(1) (A) Not later than thirty (30) calendar days after the date that a health insurance entity actually receives a claim submitted on paper from a provider, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider in writing why the remaining portion of the claim will not be paid; or (iii) Notify the provider in writing of all reasons why the claim is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean. (B) Not later than twenty-one (21) calendar days after receiving a claim by electronic submission, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or (iii) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim.
(A) Not later than thirty (30) calendar days after the date that a health insurance entity actually receives a claim submitted on paper from a provider, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider in writing why the remaining portion of the claim will not be paid; or (iii) Notify the provider in writing of all reasons why the claim is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean.
(i) If the claim is clean, pay the total covered amount of the claim;
(ii) Pay the portion of the claim that is clean and not in dispute and notify the provider in writing why the remaining portion of the claim will not be paid; or
(iii) Notify the provider in writing of all reasons why the claim is not clean and will not be paid and what substantiating documentation and information is required to adjudicate the claim as clean.
(B) Not later than twenty-one (21) calendar days after receiving a claim by electronic submission, a health insurance entity shall: (i) If the claim is clean, pay the total covered amount of the claim; (ii) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or (iii) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim.
(i) If the claim is clean, pay the total covered amount of the claim;
(ii) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or
(iii) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim.
(2) No paper claim may be denied upon resubmission for lack of substantiating documentation or information that has been previously provided by the health care provider.
(3) Health insurance entities shall timely provide contracted providers with all necessary information to properly submit a claim.
(4) Any health insurance entity that does not comply with subdivision (b)(1) shall pay one percent (1%) interest per month, accruing from the day after the payment was due, on that amount of the claim that remains unpaid.
(c) Regulatory Oversight. (1) The commissioner shall ensure, as part of the department's ongoing regulatory oversight of health insurance entities, that health insurance entities properly process and pay claims in accordance with this section. (2) If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay ninety-five percent (95%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty up to ten thousand dollars ($10,000). If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay eighty-five percent (85%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than ten thousand dollars ($10,000) nor more than one hundred thousand dollars ($100,000), if reasonable notice in writing is given of the intent to levy the penalty. If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay sixty percent (60%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than one hundred thousand dollars ($100,000) nor more than two hundred thousand dollars ($200,000). In determining the amount of any fine, the commissioner shall take into account whether the failure to achieve the standards in this section is due to circumstances beyond the health insurance entity's control and whether the health insurance entity has been in the business of processing claims for two (2) years or less. The health insurance entity may request an administrative hearing contesting the assessment of any administrative penalty imposed by the commissioner within thirty (30) days after receipt of the notice of the assessment. (3) The commissioner may issue an order directing a health insurance entity or a representative of a health insurance entity to cease and desist from engaging in any act or practice in violation of this section. Within fifteen (15) days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of this act have occurred. (4) All hearings under this part shall be conducted pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (5) In the case of any violations of this section, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued by the commissioner, the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in the chancery court of Davidson County. (6) Examinations to determine compliance with this section may be conducted by the commissioner's staff. The commissioner may, if necessary, contract with qualified impartial outside sources to assist in examinations to determine compliance with this section. The expenses of the examinations shall be assessed against health maintenance organizations in accordance with § 56-32-115 . For other health insurance entities, the commissioner shall bill the expenses of the examinations to those entities in accordance with § 56-1-413 .
(1) The commissioner shall ensure, as part of the department's ongoing regulatory oversight of health insurance entities, that health insurance entities properly process and pay claims in accordance with this section.
(2) If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay ninety-five percent (95%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty up to ten thousand dollars ($10,000). If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay eighty-five percent (85%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than ten thousand dollars ($10,000) nor more than one hundred thousand dollars ($100,000), if reasonable notice in writing is given of the intent to levy the penalty. If the commissioner finds a health insurance entity has failed during any calendar year to properly process and pay sixty percent (60%) of all clean claims received from all providers during that year in accordance with this section, the commissioner may levy an aggregate penalty in an amount of not less than one hundred thousand dollars ($100,000) nor more than two hundred thousand dollars ($200,000). In determining the amount of any fine, the commissioner shall take into account whether the failure to achieve the standards in this section is due to circumstances beyond the health insurance entity's control and whether the health insurance entity has been in the business of processing claims for two (2) years or less. The health insurance entity may request an administrative hearing contesting the assessment of any administrative penalty imposed by the commissioner within thirty (30) days after receipt of the notice of the assessment.
(3) The commissioner may issue an order directing a health insurance entity or a representative of a health insurance entity to cease and desist from engaging in any act or practice in violation of this section. Within fifteen (15) days after service of the cease and desist order, the respondent may request a hearing on the question of whether acts or practices in violation of this act have occurred.
(4) All hearings under this part shall be conducted pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(5) In the case of any violations of this section, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued by the commissioner, the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in the chancery court of Davidson County.
(6) Examinations to determine compliance with this section may be conducted by the commissioner's staff. The commissioner may, if necessary, contract with qualified impartial outside sources to assist in examinations to determine compliance with this section. The expenses of the examinations shall be assessed against health maintenance organizations in accordance with § 56-32-115 . For other health insurance entities, the commissioner shall bill the expenses of the examinations to those entities in accordance with § 56-1-413 .
(d) Rules and regulations. The commissioner shall adopt rules and regulations to ensure effective compliance with this section.
Acts 2000, ch. 890, § 2.
Tenn. Code Ann. § 56-35-113 — TN Code / Title 56 / Chapter 35 / Section 56-35-113
Use of income from deposits
Status: in_force

The commissioner shall permit any title insurance company, its agents, attorneys, representatives or assigns, to collect, receive and use the income and any and all remittances of any of the income received by the commissioner, from all securities so deposited, and the commissioner shall deliver, or cause to be delivered to them or any of them, any and all coupons or other evidences of the income to which they may be entitled. Acts 1955, ch. 173, § 8; T.C.A., § 56-3413.
The commissioner shall permit any title insurance company, its agents, attorneys, representatives or assigns, to collect, receive and use the income and any and all remittances of any of the income received by the commissioner, from all securities so deposited, and the commissioner shall deliver, or cause to be delivered to them or any of them, any and all coupons or other evidences of the income to which they may be entitled.
Acts 1955, ch. 173, § 8; T.C.A., § 56-3413.
Tenn. Code Ann. § 56-13-402 — TN Code / Title 56 / Chapter 13 / Section 56-13-402
Part definitions
Status: in_force

For purposes of this part: (1) "Affiliated company" means a company in the same corporate system as a parent, by virtue of common ownership, control, operation, or management; (2) "Control", "controlling", "controlled by", and "under common control with" mean the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or non-management services, or otherwise; provided, that such power is not the result of an official position with or corporate office held by the person. Control shall be presumed to exist if a person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of another person. This presumption may be rebutted by a showing that control does not exist. Notwithstanding this subdivision (2), for purposes of this part, the fact that an SPFC exclusively provides reinsurance to a ceding insurer under an SPFC contract is not by itself sufficient grounds for a finding that the SPFC and ceding insurer are under common control; (3) "Counterparty" means an SPFC's parent or affiliated company, a ceding insurer to the SPFC contract, or subject to the prior approval of the commissioner, a non-affiliated company; (4) "Fair value" means: (A) As to cash, the amount of the cash; and (B) As to an asset other than cash: (i) The quoted mid-market price for the asset in active markets shall be used if available; or (ii) If the quoted mid-market price is not available: (a) A value determined using the best information available considering values of similar assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets, or comparison to values of other asset classes, the value of which have been historically related to the subject asset; or (b) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties; (5) "Insolvency" or "insolvent" means that the SPFC or one (1) or more of its protected cells is unable to pay its obligations when they are due, unless those obligations are the subject of a bona fide dispute, or the commissioner previously has established by order other criteria for determining the solvency of the SPFC or one (1) or more of its protected cells, in which case the SPFC is insolvent if it fails to meet that criteria; (6) "Insurance securitization" and "securitization" mean a transaction or a group of related transactions, which: (A) Include capital market offerings, that are effected through related risk transfer instruments and facilitating administrative agreements where all or part of the result of such transactions is used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer and by which: (i) Proceeds are obtained by a special purpose financial captive insurance company, directly or indirectly, through the issuance of securities by the SPFC or any other person; or (ii) A person provides one (1) or more letters of credit or other assets for the benefit of the SPFC; that the commissioner authorizes the SPFC to treat such letters of credit or other assets as admitted assets for purposes of the SPFC's annual report; and all or any part of such proceeds, letters of credit, or assets, as applicable, are used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer; and (B) Do not include the issuance of a letter of credit for the benefit of the commissioner to satisfy all or part of the SPFC's capital and surplus requirements under § 56-13-406 ; (7) "Management" means the board of directors, managing board, or other individual or individuals vested with overall responsibility for the management of the affairs of the SPFC, including the election and appointment of officers or other of those agents to act on behalf of the SPFC; (8) "Organizational document" means the SPFC's articles of incorporation, articles of charter, articles of organization, bylaws, operating agreement, or other formation documents as required by the secretary of state that establish the SPFC as a legal entity or prescribes its existence; (9) "Parent" means any corporation, limited liability company, partnership, or individual that directly or indirectly owns, controls, or holds with power to vote more than fifty percent (50%) of the outstanding voting securities of an SPFC; (10) "Protected cell" means a separate account established and maintained by an SPFC for one (1) SPFC contract and the accompanying insurance securitization with a counterparty; (11) "Securities" means those different types of debt obligations, equity, surplus certificates, surplus notes, funding agreements, derivatives, and other legal forms of financial instruments; (12) "SPFC" or "special purpose financial captive" means a captive insurance company that has received a certificate of authority from the commissioner for the limited purposes provided for in this part; (13) "SPFC contract" means a contract between the SPFC and the counterparty pursuant to which the SPFC agrees to provide insurance or reinsurance protection to the counterparty for risks associated with the counterparty's insurance or reinsurance business; (14) "SPFC securities" means the securities issued by a SPFC; and (15) "Surplus note" means an unsecured subordinated debt obligation deemed to be a surplus certificate under this title and otherwise possessing characteristics consistent with paragraph 3 of the Statement of Statutory Accounting Principles No. 41, as amended, National Association of Insurance Commissioners (NAIC). Acts 2011, ch. 468, § 1.
For purposes of this part:
(1) "Affiliated company" means a company in the same corporate system as a parent, by virtue of common ownership, control, operation, or management;
(2) "Control", "controlling", "controlled by", and "under common control with" mean the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or non-management services, or otherwise; provided, that such power is not the result of an official position with or corporate office held by the person. Control shall be presumed to exist if a person, directly or indirectly, owns, controls, holds with the power to vote, or holds proxies representing ten percent (10%) or more of the voting securities of another person. This presumption may be rebutted by a showing that control does not exist. Notwithstanding this subdivision (2), for purposes of this part, the fact that an SPFC exclusively provides reinsurance to a ceding insurer under an SPFC contract is not by itself sufficient grounds for a finding that the SPFC and ceding insurer are under common control;
(3) "Counterparty" means an SPFC's parent or affiliated company, a ceding insurer to the SPFC contract, or subject to the prior approval of the commissioner, a non-affiliated company;
(4) "Fair value" means: (A) As to cash, the amount of the cash; and (B) As to an asset other than cash: (i) The quoted mid-market price for the asset in active markets shall be used if available; or (ii) If the quoted mid-market price is not available: (a) A value determined using the best information available considering values of similar assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets, or comparison to values of other asset classes, the value of which have been historically related to the subject asset; or (b) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties;
(A) As to cash, the amount of the cash; and
(B) As to an asset other than cash: (i) The quoted mid-market price for the asset in active markets shall be used if available; or (ii) If the quoted mid-market price is not available: (a) A value determined using the best information available considering values of similar assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets, or comparison to values of other asset classes, the value of which have been historically related to the subject asset; or (b) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties;
(i) The quoted mid-market price for the asset in active markets shall be used if available; or
(ii) If the quoted mid-market price is not available: (a) A value determined using the best information available considering values of similar assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets, or comparison to values of other asset classes, the value of which have been historically related to the subject asset; or (b) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties;
(a) A value determined using the best information available considering values of similar assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets, or comparison to values of other asset classes, the value of which have been historically related to the subject asset; or
(b) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties;
(5) "Insolvency" or "insolvent" means that the SPFC or one (1) or more of its protected cells is unable to pay its obligations when they are due, unless those obligations are the subject of a bona fide dispute, or the commissioner previously has established by order other criteria for determining the solvency of the SPFC or one (1) or more of its protected cells, in which case the SPFC is insolvent if it fails to meet that criteria;
(6) "Insurance securitization" and "securitization" mean a transaction or a group of related transactions, which: (A) Include capital market offerings, that are effected through related risk transfer instruments and facilitating administrative agreements where all or part of the result of such transactions is used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer and by which: (i) Proceeds are obtained by a special purpose financial captive insurance company, directly or indirectly, through the issuance of securities by the SPFC or any other person; or (ii) A person provides one (1) or more letters of credit or other assets for the benefit of the SPFC; that the commissioner authorizes the SPFC to treat such letters of credit or other assets as admitted assets for purposes of the SPFC's annual report; and all or any part of such proceeds, letters of credit, or assets, as applicable, are used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer; and (B) Do not include the issuance of a letter of credit for the benefit of the commissioner to satisfy all or part of the SPFC's capital and surplus requirements under § 56-13-406 ;
(A) Include capital market offerings, that are effected through related risk transfer instruments and facilitating administrative agreements where all or part of the result of such transactions is used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer and by which: (i) Proceeds are obtained by a special purpose financial captive insurance company, directly or indirectly, through the issuance of securities by the SPFC or any other person; or (ii) A person provides one (1) or more letters of credit or other assets for the benefit of the SPFC; that the commissioner authorizes the SPFC to treat such letters of credit or other assets as admitted assets for purposes of the SPFC's annual report; and all or any part of such proceeds, letters of credit, or assets, as applicable, are used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer; and
(i) Proceeds are obtained by a special purpose financial captive insurance company, directly or indirectly, through the issuance of securities by the SPFC or any other person; or
(ii) A person provides one (1) or more letters of credit or other assets for the benefit of the SPFC; that the commissioner authorizes the SPFC to treat such letters of credit or other assets as admitted assets for purposes of the SPFC's annual report; and all or any part of such proceeds, letters of credit, or assets, as applicable, are used to fund the SPFC's obligations under a reinsurance contract with a ceding insurer; and
(B) Do not include the issuance of a letter of credit for the benefit of the commissioner to satisfy all or part of the SPFC's capital and surplus requirements under § 56-13-406 ;
(7) "Management" means the board of directors, managing board, or other individual or individuals vested with overall responsibility for the management of the affairs of the SPFC, including the election and appointment of officers or other of those agents to act on behalf of the SPFC;
(8) "Organizational document" means the SPFC's articles of incorporation, articles of charter, articles of organization, bylaws, operating agreement, or other formation documents as required by the secretary of state that establish the SPFC as a legal entity or prescribes its existence;
(9) "Parent" means any corporation, limited liability company, partnership, or individual that directly or indirectly owns, controls, or holds with power to vote more than fifty percent (50%) of the outstanding voting securities of an SPFC;
(10) "Protected cell" means a separate account established and maintained by an SPFC for one (1) SPFC contract and the accompanying insurance securitization with a counterparty;
(11) "Securities" means those different types of debt obligations, equity, surplus certificates, surplus notes, funding agreements, derivatives, and other legal forms of financial instruments;
(12) "SPFC" or "special purpose financial captive" means a captive insurance company that has received a certificate of authority from the commissioner for the limited purposes provided for in this part;
(13) "SPFC contract" means a contract between the SPFC and the counterparty pursuant to which the SPFC agrees to provide insurance or reinsurance protection to the counterparty for risks associated with the counterparty's insurance or reinsurance business;
(14) "SPFC securities" means the securities issued by a SPFC; and
(15) "Surplus note" means an unsecured subordinated debt obligation deemed to be a surplus certificate under this title and otherwise possessing characteristics consistent with paragraph 3 of the Statement of Statutory Accounting Principles No. 41, as amended, National Association of Insurance Commissioners (NAIC).
Acts 2011, ch. 468, § 1.
Tenn. Code Ann. § 56-7-3205 — TN Code / Title 56 / Chapter 7 / Section 56-7-3205
Calculation of enrollee's contribution to applicable cost sharing requirement
Status: in_force

(a) When calculating an enrollee's contribution to an applicable cost sharing requirement, an insurer shall include cost sharing amounts paid by the enrollee or on behalf of the enrollee by another person. (b) Subsection (a) does not apply to a prescription drug for which there is a generic alternative, unless the enrollee has obtained access to the brand name prescription drug through prior authorization, a step therapy protocol, the insurer's exceptions and appeals process, or as specified in § 53-10-204(a) . Added by 2021 Tenn. Acts, ch. 405, s 2, eff. 7/1/2021.
(a) When calculating an enrollee's contribution to an applicable cost sharing requirement, an insurer shall include cost sharing amounts paid by the enrollee or on behalf of the enrollee by another person.
(b) Subsection (a) does not apply to a prescription drug for which there is a generic alternative, unless the enrollee has obtained access to the brand name prescription drug through prior authorization, a step therapy protocol, the insurer's exceptions and appeals process, or as specified in § 53-10-204(a) .
Added by 2021 Tenn. Acts, ch. 405, s 2, eff. 7/1/2021.
Tenn. Code Ann. § 56-7-2802 — TN Code / Title 56 / Chapter 7 / Section 56-7-2802
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Affiliation period": (A) Means a period that, under the terms of the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective. The organization is not required to provide health care services or benefits during the affiliation period and no premium shall be charged to the participant or beneficiary for any coverage during the period; (B) The period shall begin on the enrollment date; and (C) An affiliation period under a plan shall run concurrently with any waiting period under the plan; (2) "Beneficiary" has the meaning given such term under § 3(8) of ERISA ( 29 U.S.C. § 1002(8) ); (3) "Bona fide association" means an association that satisfies the requirements of § 56-26-204(a) and: (A) Does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee; (B) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members or individuals eligible for coverage through a member; (C) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and (D) Meets additional requirements established by the commissioner; (4) "Church plan" has the meaning given the term under § 3(33) of ERISA ( 29 U.S.C. § 1002(33) ); (5) "COBRA continuation provision" means any of the following: (A) Section 4980B of the Internal Revenue Code of 1986 ( 26 U.S.C. § 4980B ), other than subdivision (f)(1) of that section insofar as it relates to pediatric vaccines; (B) ERISA, Part 6 of Subtitle B of Title I ( 29 U.S.C. § 1161 et seq.), other than § 609 ( 29 U.S.C. § 1169 ); or (C) Title XXII of the Public Health Service Act ( 42 U.S.C. § 300bb-1 et seq.); (6) (A) "Creditable coverage" means, with respect to an individual, coverage of the individual under any of the following: (i) A group health plan; (ii) Health insurance coverage; (iii) Title XVIII, Part A or Part B of the Social Security Act, known as medicare ( 42 U.S.C. § 1395 et seq.); (iv) Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under § 1928 ( 42 U.S.C. § 300x-28 ); (v) United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.); (vi) A medical care program of the Indian Health Service or of a tribal organization; (vii) A state health benefits risk pool; (viii) A health plan offered under United States Code, title 5, ch. 89 ( 5 U.S.C. § 8901 et seq.); (ix) A public health plan; or (x) A health benefit plan under § 5(e) of the Peace Corps Act ( 22 U.S.C. § 2504(e) ); (B) Creditable coverage does not include coverage consisting solely of coverage of excepted benefits; (7) "Employee" has the meaning given the term under § 3(6) of ERISA ( 29 U.S.C. § 1002(6) ); (8) "Employer" has the meaning given the term under § 3(5) of ERISA ( 29 U.S.C. § 1002(5) ), except that the term includes only employers of two (2) or more employees; (9) "Enrollment date" means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment; (10) "Excepted benefits" means benefits under one (1) or more, or any combination, of the following: (A) Benefits not subject to requirements: (i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance; (ii) Coverage issued as a supplement to liability insurance; (iii) Liability insurance, including general liability insurance and automobile liability insurance; (iv) Workers' compensation or similar insurance; (v) Automobile medical payment insurance; (vi) Credit-only insurance; (vii) Coverage for on-site medical clinics; or (viii) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits; (B) Benefits not subject to requirements if offered separately: (i) Limited scope dental or vision benefits; (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of long-term care, nursing home care, home health care and community-based care; and (iii) Other similar, limited benefits specified in regulations; (C) Benefits not subject to the requirements if offered as independent, noncoordinated benefits are coverage only for a specified disease or illness and hospital indemnity or other fixed indemnity insurance; and (D) Benefits not subject to the requirements if offered as a separate insurance policy are medicare supplement insurance, coverage supplemental to the coverage provided under United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.), and similar supplemental coverage provided to coverage under a group health plan; (11) "Federal governmental plan" means a governmental plan established or maintained for its employees by the federal government or by any agency or instrumentality of the federal government; (12) "Governmental plan" has the meaning given the term under ERISA, § 3(32) ( 29 U.S.C. § 1002(32) ), and any federal governmental plan; (13) "Group health insurance coverage" means, in connection with a group health plan, health insurance coverage offered in connection with the plan; (14) "Group health plan" means an employee welfare benefit plan, as defined in ERISA, § 3(1) ( 29 U.S.C. § 1002(1) ), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents, as defined under the terms of the plan, directly or through insurance, reimbursement, or otherwise. A program under which creditable coverage is provided shall be treated as a group health plan for the purposes of applying this part; (15) "Health insurance coverage" means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer; (16) "Health insurance issuer" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. "Health insurance issuer" does not include a group health plan; (17) "Health maintenance organization" means: (A) A federally qualified health maintenance organization, as defined under federal law; or (B) An organization recognized under state law as a health maintenance organization; (18) "Health status-related factor" means any of the following factors: (A) Health status; (B) Medical condition, including both physical and mental illnesses; (C) Claims experience; (D) Receipt of health care; (E) Medical history; (F) Genetic information; (G) Evidence of insurability, including conditions arising out of acts of domestic violence; and (H) Disability; (19) "Individual health insurance coverage" means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance; (20) "Individual market" means the market for health insurance coverage offered to individuals other than in connection with a group health plan. This includes coverage offered in connection with a group health plan that has fewer than two (2) participants as current employees on the first day of the plan year; (21) "Large employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year; (22) "Large group market" means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a large employer; (23) "Late enrollee" means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during: (A) The first period in which the individual is eligible to enroll under the plan; or (B) A special enrollment period; (24) "Medical care" means amounts paid for: (A) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body; (B) Amounts paid for transportation primarily for and essential to medical care referred to in subdivision (24)(A); and (C) Amounts paid for insurance covering medical care referred to in subdivisions (24)(A) and (B); (25) "Network plan" means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer; (26) "Nonfederal governmental plan" means a governmental plan that is not a federal governmental plan; (27) "Participant" has the meaning given the term under ERISA, § 3(7) ( 29 U.S.C. § 1002(7) ); (28) "Placed for adoption," in connection with any placement for adoption of a child with any person, means the assumption and retention by the person of a legal obligation for total or partial support of the child in anticipation of adoption of the child. The child's placement with the person terminates upon the termination of the legal obligation; (29) "Plan sponsor" has the meaning given the term under § 3(16)(B) of ERISA ( 29 U.S.C. § 1002(16)(B) ); (30) "Preexisting condition exclusion" means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information; (31) "Small employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employs an average of at least two (2) but no more than fifty (50) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year; (32) "Small group market" means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a small employer; and (33) "Waiting period" means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. Amended by 2020 Tenn. Acts, ch. 515, s 1, eff. 7/1/2020. Acts 1997 , ch. 157, § 3.
As used in this part, unless the context otherwise requires:
(1) "Affiliation period": (A) Means a period that, under the terms of the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective. The organization is not required to provide health care services or benefits during the affiliation period and no premium shall be charged to the participant or beneficiary for any coverage during the period; (B) The period shall begin on the enrollment date; and (C) An affiliation period under a plan shall run concurrently with any waiting period under the plan;
(A) Means a period that, under the terms of the health insurance coverage offered by the health maintenance organization, must expire before the health insurance coverage becomes effective. The organization is not required to provide health care services or benefits during the affiliation period and no premium shall be charged to the participant or beneficiary for any coverage during the period;
(B) The period shall begin on the enrollment date; and
(C) An affiliation period under a plan shall run concurrently with any waiting period under the plan;
(2) "Beneficiary" has the meaning given such term under § 3(8) of ERISA ( 29 U.S.C. § 1002(8) );
(3) "Bona fide association" means an association that satisfies the requirements of § 56-26-204(a) and: (A) Does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee; (B) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members or individuals eligible for coverage through a member; (C) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and (D) Meets additional requirements established by the commissioner;
(A) Does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee;
(B) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to the members or individuals eligible for coverage through a member;
(C) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
(D) Meets additional requirements established by the commissioner;
(4) "Church plan" has the meaning given the term under § 3(33) of ERISA ( 29 U.S.C. § 1002(33) );
(5) "COBRA continuation provision" means any of the following: (A) Section 4980B of the Internal Revenue Code of 1986 ( 26 U.S.C. § 4980B ), other than subdivision (f)(1) of that section insofar as it relates to pediatric vaccines; (B) ERISA, Part 6 of Subtitle B of Title I ( 29 U.S.C. § 1161 et seq.), other than § 609 ( 29 U.S.C. § 1169 ); or (C) Title XXII of the Public Health Service Act ( 42 U.S.C. § 300bb-1 et seq.);
(A) Section 4980B of the Internal Revenue Code of 1986 ( 26 U.S.C. § 4980B ), other than subdivision (f)(1) of that section insofar as it relates to pediatric vaccines;
(B) ERISA, Part 6 of Subtitle B of Title I ( 29 U.S.C. § 1161 et seq.), other than § 609 ( 29 U.S.C. § 1169 ); or
(C) Title XXII of the Public Health Service Act ( 42 U.S.C. § 300bb-1 et seq.);
(6) (A) "Creditable coverage" means, with respect to an individual, coverage of the individual under any of the following: (i) A group health plan; (ii) Health insurance coverage; (iii) Title XVIII, Part A or Part B of the Social Security Act, known as medicare ( 42 U.S.C. § 1395 et seq.); (iv) Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under § 1928 ( 42 U.S.C. § 300x-28 ); (v) United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.); (vi) A medical care program of the Indian Health Service or of a tribal organization; (vii) A state health benefits risk pool; (viii) A health plan offered under United States Code, title 5, ch. 89 ( 5 U.S.C. § 8901 et seq.); (ix) A public health plan; or (x) A health benefit plan under § 5(e) of the Peace Corps Act ( 22 U.S.C. § 2504(e) ); (B) Creditable coverage does not include coverage consisting solely of coverage of excepted benefits;
(A) "Creditable coverage" means, with respect to an individual, coverage of the individual under any of the following: (i) A group health plan; (ii) Health insurance coverage; (iii) Title XVIII, Part A or Part B of the Social Security Act, known as medicare ( 42 U.S.C. § 1395 et seq.); (iv) Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under § 1928 ( 42 U.S.C. § 300x-28 ); (v) United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.); (vi) A medical care program of the Indian Health Service or of a tribal organization; (vii) A state health benefits risk pool; (viii) A health plan offered under United States Code, title 5, ch. 89 ( 5 U.S.C. § 8901 et seq.); (ix) A public health plan; or (x) A health benefit plan under § 5(e) of the Peace Corps Act ( 22 U.S.C. § 2504(e) );
(i) A group health plan;
(ii) Health insurance coverage;
(iii) Title XVIII, Part A or Part B of the Social Security Act, known as medicare ( 42 U.S.C. § 1395 et seq.);
(iv) Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under § 1928 ( 42 U.S.C. § 300x-28 );
(v) United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.);
(vi) A medical care program of the Indian Health Service or of a tribal organization;
(vii) A state health benefits risk pool;
(viii) A health plan offered under United States Code, title 5, ch. 89 ( 5 U.S.C. § 8901 et seq.);
(ix) A public health plan; or
(x) A health benefit plan under § 5(e) of the Peace Corps Act ( 22 U.S.C. § 2504(e) );
(B) Creditable coverage does not include coverage consisting solely of coverage of excepted benefits;
(7) "Employee" has the meaning given the term under § 3(6) of ERISA ( 29 U.S.C. § 1002(6) );
(8) "Employer" has the meaning given the term under § 3(5) of ERISA ( 29 U.S.C. § 1002(5) ), except that the term includes only employers of two (2) or more employees;
(9) "Enrollment date" means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment;
(10) "Excepted benefits" means benefits under one (1) or more, or any combination, of the following: (A) Benefits not subject to requirements: (i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance; (ii) Coverage issued as a supplement to liability insurance; (iii) Liability insurance, including general liability insurance and automobile liability insurance; (iv) Workers' compensation or similar insurance; (v) Automobile medical payment insurance; (vi) Credit-only insurance; (vii) Coverage for on-site medical clinics; or (viii) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits; (B) Benefits not subject to requirements if offered separately: (i) Limited scope dental or vision benefits; (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of long-term care, nursing home care, home health care and community-based care; and (iii) Other similar, limited benefits specified in regulations; (C) Benefits not subject to the requirements if offered as independent, noncoordinated benefits are coverage only for a specified disease or illness and hospital indemnity or other fixed indemnity insurance; and (D) Benefits not subject to the requirements if offered as a separate insurance policy are medicare supplement insurance, coverage supplemental to the coverage provided under United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.), and similar supplemental coverage provided to coverage under a group health plan;
(A) Benefits not subject to requirements: (i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance; (ii) Coverage issued as a supplement to liability insurance; (iii) Liability insurance, including general liability insurance and automobile liability insurance; (iv) Workers' compensation or similar insurance; (v) Automobile medical payment insurance; (vi) Credit-only insurance; (vii) Coverage for on-site medical clinics; or (viii) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;
(i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance;
(ii) Coverage issued as a supplement to liability insurance;
(iii) Liability insurance, including general liability insurance and automobile liability insurance;
(iv) Workers' compensation or similar insurance;
(v) Automobile medical payment insurance;
(vi) Credit-only insurance;
(vii) Coverage for on-site medical clinics; or
(viii) Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;
(B) Benefits not subject to requirements if offered separately: (i) Limited scope dental or vision benefits; (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of long-term care, nursing home care, home health care and community-based care; and (iii) Other similar, limited benefits specified in regulations;
(i) Limited scope dental or vision benefits;
(ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of long-term care, nursing home care, home health care and community-based care; and
(iii) Other similar, limited benefits specified in regulations;
(C) Benefits not subject to the requirements if offered as independent, noncoordinated benefits are coverage only for a specified disease or illness and hospital indemnity or other fixed indemnity insurance; and
(D) Benefits not subject to the requirements if offered as a separate insurance policy are medicare supplement insurance, coverage supplemental to the coverage provided under United States Code, title 10, ch. 55 ( 10 U.S.C. § 1071 et seq.), and similar supplemental coverage provided to coverage under a group health plan;
(11) "Federal governmental plan" means a governmental plan established or maintained for its employees by the federal government or by any agency or instrumentality of the federal government;
(12) "Governmental plan" has the meaning given the term under ERISA, § 3(32) ( 29 U.S.C. § 1002(32) ), and any federal governmental plan;
(13) "Group health insurance coverage" means, in connection with a group health plan, health insurance coverage offered in connection with the plan;
(14) "Group health plan" means an employee welfare benefit plan, as defined in ERISA, § 3(1) ( 29 U.S.C. § 1002(1) ), to the extent that the plan provides medical care and including items and services paid for as medical care to employees or their dependents, as defined under the terms of the plan, directly or through insurance, reimbursement, or otherwise. A program under which creditable coverage is provided shall be treated as a group health plan for the purposes of applying this part;
(15) "Health insurance coverage" means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer;
(16) "Health insurance issuer" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. "Health insurance issuer" does not include a group health plan;
(17) "Health maintenance organization" means: (A) A federally qualified health maintenance organization, as defined under federal law; or (B) An organization recognized under state law as a health maintenance organization;
(A) A federally qualified health maintenance organization, as defined under federal law; or
(B) An organization recognized under state law as a health maintenance organization;
(18) "Health status-related factor" means any of the following factors: (A) Health status; (B) Medical condition, including both physical and mental illnesses; (C) Claims experience; (D) Receipt of health care; (E) Medical history; (F) Genetic information; (G) Evidence of insurability, including conditions arising out of acts of domestic violence; and (H) Disability;
(A) Health status;
(B) Medical condition, including both physical and mental illnesses;
(C) Claims experience;
(D) Receipt of health care;
(E) Medical history;
(F) Genetic information;
(G) Evidence of insurability, including conditions arising out of acts of domestic violence; and
(H) Disability;
(19) "Individual health insurance coverage" means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance;
(20) "Individual market" means the market for health insurance coverage offered to individuals other than in connection with a group health plan. This includes coverage offered in connection with a group health plan that has fewer than two (2) participants as current employees on the first day of the plan year;
(21) "Large employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year;
(22) "Large group market" means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a large employer;
(23) "Late enrollee" means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during: (A) The first period in which the individual is eligible to enroll under the plan; or (B) A special enrollment period;
(A) The first period in which the individual is eligible to enroll under the plan; or
(B) A special enrollment period;
(24) "Medical care" means amounts paid for: (A) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body; (B) Amounts paid for transportation primarily for and essential to medical care referred to in subdivision (24)(A); and (C) Amounts paid for insurance covering medical care referred to in subdivisions (24)(A) and (B);
(A) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;
(B) Amounts paid for transportation primarily for and essential to medical care referred to in subdivision (24)(A); and
(C) Amounts paid for insurance covering medical care referred to in subdivisions (24)(A) and (B);
(25) "Network plan" means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer;
(26) "Nonfederal governmental plan" means a governmental plan that is not a federal governmental plan;
(27) "Participant" has the meaning given the term under ERISA, § 3(7) ( 29 U.S.C. § 1002(7) );
(28) "Placed for adoption," in connection with any placement for adoption of a child with any person, means the assumption and retention by the person of a legal obligation for total or partial support of the child in anticipation of adoption of the child. The child's placement with the person terminates upon the termination of the legal obligation;
(29) "Plan sponsor" has the meaning given the term under § 3(16)(B) of ERISA ( 29 U.S.C. § 1002(16)(B) );
(30) "Preexisting condition exclusion" means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. Genetic information shall not be treated as a preexisting condition in the absence of a diagnosis of the condition related to such information;
(31) "Small employer" means, in connection with a group health plan with respect to a calendar year and a plan year, an employer who employs an average of at least two (2) but no more than fifty (50) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year;
(32) "Small group market" means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a small employer; and
(33) "Waiting period" means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan.
Amended by 2020 Tenn. Acts, ch. 515, s 1, eff. 7/1/2020.
Acts 1997 , ch. 157, § 3.
Tenn. Code Ann. § 56-25-603 — TN Code / Title 56 / Chapter 25 / Section 56-25-603
License
Status: in_force

Societies that are now authorized to transact business in this state, and all societies hereafter licensed, may continue such business until June 30, 1992. The authority of these societies and all societies hereafter licensed may thereafter be renewed annually, but in all cases to terminate on the succeeding June 30. However, a license so issued shall continue in full force and effect until the new license is issued or specifically refused. For each license or renewal, the society shall pay the commissioner a fee of ten dollars ($10.00). A duly certified copy or duplicate of the license shall be prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter. Acts 1990, ch. 703, § 1.
Societies that are now authorized to transact business in this state, and all societies hereafter licensed, may continue such business until June 30, 1992. The authority of these societies and all societies hereafter licensed may thereafter be renewed annually, but in all cases to terminate on the succeeding June 30. However, a license so issued shall continue in full force and effect until the new license is issued or specifically refused. For each license or renewal, the society shall pay the commissioner a fee of ten dollars ($10.00). A duly certified copy or duplicate of the license shall be prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter.
Acts 1990, ch. 703, § 1.
Tenn. Code Ann. § 56-21-105 — TN Code / Title 56 / Chapter 21 / Section 56-21-105
Impairment of guaranty capital - Effect
Status: in_force

(a) Should the guaranty capital of any mutual fire insurance company at any time become impaired and remain so for sixty (60) days, the company shall cease issuing policies until the impairment is made good by either replacing the funds due the guaranty capital or by reducing the authorized amount of same by written notice to the commissioner by an amount equal to the impairment, but in no event to less than nine hundred fifty thousand dollars ($950,000). The company may continue to collect premiums that are due or become due on policies already in force while the impairment exists and until it is made good. (b) The increase in the minimum amount of guaranty capital provided by the 1969 amendment does not apply to companies qualified and authorized prior to May 7, 1969. Acts 1907, ch. 461, § 4; Shan., § 3369a9; Acts 1921, ch. 160, § 4; Code 1932, § 6260; Acts 1969, ch. 218, §§ 3, 6; T.C.A. (orig. ed.), § 56-2007.
(a) Should the guaranty capital of any mutual fire insurance company at any time become impaired and remain so for sixty (60) days, the company shall cease issuing policies until the impairment is made good by either replacing the funds due the guaranty capital or by reducing the authorized amount of same by written notice to the commissioner by an amount equal to the impairment, but in no event to less than nine hundred fifty thousand dollars ($950,000). The company may continue to collect premiums that are due or become due on policies already in force while the impairment exists and until it is made good.
(b) The increase in the minimum amount of guaranty capital provided by the 1969 amendment does not apply to companies qualified and authorized prior to May 7, 1969.
Acts 1907, ch. 461, § 4; Shan., § 3369a9; Acts 1921, ch. 160, § 4; Code 1932, § 6260; Acts 1969, ch. 218, §§ 3, 6; T.C.A. (orig. ed.), § 56-2007.
Tenn. Code Ann. § 56-7-106 — TN Code / Title 56 / Chapter 7 / Section 56-7-106
Liability of policyholders when action not brought in good faith
Status: in_force

In the event it is made to appear to the court or jury trying the cause that the action of the policyholder in bringing the suit was not in good faith, and recovery under the policy is not had, the policyholder shall be liable to the insurance company, corporation, firm, or person in a sum not exceeding twenty-five percent (25%) of the amount of the loss claimed under the policy; provided, that the liability, within the limits prescribed, shall, in the discretion of the court or jury trying the cause, be measured by the additional expense, loss, or injury inflicted upon the defendant by reason of the suit. Acts 1901, ch. 141, § 2; Shan., § 3369a142; Code 1932, § 6435; T.C.A. (orig. ed.), § 56-1106.
In the event it is made to appear to the court or jury trying the cause that the action of the policyholder in bringing the suit was not in good faith, and recovery under the policy is not had, the policyholder shall be liable to the insurance company, corporation, firm, or person in a sum not exceeding twenty-five percent (25%) of the amount of the loss claimed under the policy; provided, that the liability, within the limits prescribed, shall, in the discretion of the court or jury trying the cause, be measured by the additional expense, loss, or injury inflicted upon the defendant by reason of the suit.
Acts 1901, ch. 141, § 2; Shan., § 3369a142; Code 1932, § 6435; T.C.A. (orig. ed.), § 56-1106.
Tenn. Code Ann. § 56-7-2315 — TN Code / Title 56 / Chapter 7 / Section 56-7-2315
Requests for information from insured persons - Grounds for nonrenewal of policy
Status: in_force

(a) A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of the policy of any person covered under the policy as to whether: (1) The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program; (2) The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or (3) Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law. (b) The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured under the policy for the following reasons only: (1) Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the commissioner, or the converted policyholder fails to provide the requested information; (2) Fraud or material misrepresentation in applying for any benefits under the converted policy; (3) Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or (4) Other reasons approved by the commissioner. Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1504.
(a) A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of the policy of any person covered under the policy as to whether: (1) The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program; (2) The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or (3) Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law.
(1) The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program;
(2) The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(3) Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law.
(b) The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured under the policy for the following reasons only: (1) Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the commissioner, or the converted policyholder fails to provide the requested information; (2) Fraud or material misrepresentation in applying for any benefits under the converted policy; (3) Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or (4) Other reasons approved by the commissioner.
(1) Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the commissioner, or the converted policyholder fails to provide the requested information;
(2) Fraud or material misrepresentation in applying for any benefits under the converted policy;
(3) Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or
(4) Other reasons approved by the commissioner.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1504.
Tenn. Code Ann. § 56-33-101 — TN Code / Title 56 / Chapter 33 / Section 56-33-101
Applicability and scope
Status: in_force

(a) This chapter applies to travel insurance: (1) That covers a resident of this state and is sold, solicited, negotiated, or offered in this state; and (2) Policies and certificates that are delivered or issued for delivery in this state. (b) This chapter does not apply to cancellation fee waivers or travel assistance services, except as expressly provided in this chapter. Acts 2022, ch. 703, § 6.
(a) This chapter applies to travel insurance: (1) That covers a resident of this state and is sold, solicited, negotiated, or offered in this state; and (2) Policies and certificates that are delivered or issued for delivery in this state.
(1) That covers a resident of this state and is sold, solicited, negotiated, or offered in this state; and
(2) Policies and certificates that are delivered or issued for delivery in this state.
(b) This chapter does not apply to cancellation fee waivers or travel assistance services, except as expressly provided in this chapter.
Acts 2022, ch. 703, § 6.
Tenn. Code Ann. § 56-5-114 — TN Code / Title 56 / Chapter 5 / Section 56-5-114
Joint underwriting, pools, residual market mechanisms, and workers' compensation assigned risk plans
Status: in_force

(a) Authorization. Notwithstanding § 56-5-113(a) , insurers participating in joint underwriting, pools or residual market mechanisms may, in connection with the activity, act in cooperation with each other in the making of rates, supplementary rate information, policy forms, underwriting rules, surveys, inspections and investigations, the furnishing of loss and expense statistics or other information, and in the conduct of research. Joint underwriting, pools and residual market mechanisms shall not be deemed rate service or advisory organizations. (b) Regulation. (1) Except to the extent modified by this section, insurers participating in joint underwriting, pool or residual market mechanisms are subject to this part. (2) Every pool shall file with the commissioner: (A) A copy of its constitution, articles of association or incorporation, bylaws, and any other rules or regulations governing its activities; (B) A list of its members; (C) The name and address of a resident of this state upon whom notices or orders of the commissioner or process may be served; and (D) Any changes in the filings under subdivisions (b)(2)(A)-(C). (3) Any residual market mechanism, plan or agreement to implement the mechanism, and any amendments to the mechanism, plan or agreement, shall be submitted in writing to the commissioner for approval, together with such information as the commissioner may reasonably require. (4) If, after a hearing, the commissioner finds that any activity or practice of insurers participating in joint underwriting, pool or residual market mechanisms is unfair, unreasonable or otherwise inconsistent with this part, the commissioner shall issue a written order specifying in what respects the activity or practice is unfair, unreasonable or otherwise inconsistent with this part and require the discontinuance of the activity or practice. (c) (1) The commissioner shall implement a plan as soon as possible for the equitable apportionment among insurers of applicants for workers' compensation insurance who are in good faith entitled to such insurance, but who are unable to procure it through ordinary methods. The plan shall provide reasonable rules governing the equitable distribution of risks by direct assignment, reinsurance, or otherwise, and their assignment to insurers, and shall provide a method whereby applicants for insurance, insured, and insurers may have a hearing on grievances and the right of appeal to the commissioner. (2) Notwithstanding § 56-5-113(a) , every insurer, except those entities under § 50-6-405(a)(2) and (c) that qualify under § 50-6-401 or § 50-6-405 , and those entities under title 50, chapter 6, part 6, undertaking to transact in this state the business of either workers' compensation or employer's liability insurance, or both, and every rating organization that files rates or prospective loss costs for such insurance shall participate in the plan. No insurer shall thereafter issue a policy of workers' compensation or employer's liability insurance or undertake to transact that business in this state unless the insurer participates in the plan. (3) (A) No later than July 1 of each year, the commissioner shall determine whether the membership of the assigned risk pool, created pursuant to this subsection (c), for the prior calendar year exceeds fifteen percent (15%) of the membership of the eligible employer market, as based on premium, excluding self-insured employers and self-insured groups. For any period in which it is determined the membership of the assigned risk pool exceeds fifteen percent (15%) of the membership of the eligible employer market, the commissioner shall issue a report to the advisory council on workers' compensation setting forth the percentage of the eligible employer market insured through the assigned risk pool and the reasons contributing to increased membership of the pool. The report shall include recommendations as to whether: (i) The competitive state workers' compensation insurance fund, established by title 50, chapter 6, part 6, should be activated; (ii) A plan of direct assignment on a randomized basis of all assigned risk plan policies to insurers offering workers' compensation insurance subject to subdivision (c)(4) should be implemented; (iii) Other actions should be taken; or (iv) No action should be taken. (B) The advisory council shall have ninety (90) days to provide written comments to the commissioner regarding the report and recommendations. After receipt of the advisory council's comments and recommendations, the commissioner shall take action deemed appropriate; provided, that the commissioner shall hold a hearing before electing to activate the competitive state workers' compensation insurance fund or to institute a plan of direct assignment. (4) If a direct assignment plan becomes operational, pursuant to this section, then the commissioner shall structure the randomized assignment so that small insurers do not bear a disproportionate share of risk in the market. A plan of direct assignment shall include provisions to provide that insurers who depopulated the assigned risk pool in the preceding five (5) years receive applicable take out credits to be used in determining the appropriate level of policies to be assigned to the insurers. (5) If the commissioner elects to make the competitive state workers' compensation fund operational pursuant to subdivision (c)(3), then the fund shall not be required to meet the reserve requirements for a domestic insurance company for the first seven (7) years of operation as otherwise required by §§ 50-6-601 and 50-6-603 . The commissioner shall promptly notify the governor, and the speakers of the senate and the house of representatives of the election. (6) (A) (i) On and after January 1, 1997, the plan developed under this subsection (c) shall assign an insured in this plan to one (1) of three (3) subplans. Those subplans are: (a) The small employer plan, for insureds not eligible for experience rating; (b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and (c) The safety incentive plan, for all other risks. (ii) The commissioner is authorized to establish increasing levels of premium surcharges for employers with experience modification factors in excess of one and ten hundredths (1.10). The surcharges may not exceed fifty percent (50%) for employers with modification factors in excess of two and zero hundredths (2.00). (B) The advisory prospective loss cost for subdivisions (c)(6)(A)(i)( a ) and ( b ) may not exceed that approved by the commissioner for the voluntary market. The commissioner shall annually establish the multiplier to be applied to the advisory prospective loss cost for the assigned risk plan. In establishing the multiplier, the commissioner shall consider the estimated cost of providing required services pursuant to this subsection (c) and the level of the multipliers in the voluntary market. (7) (A) The commissioner shall not approve a plan pursuant to this subsection (c) that does not provide for the making available of a list of the employers insured under this subsection (c) on request to interested persons for a reasonable fee or to the department. A reasonable fee shall only include the cost of production and mailing the list. (B) As part of the application for insurance coverage, an employer shall elect whether to be excluded from the list provided for by this subsection (c). Every application for the assigned risk plan shall include the following language: THE INSURED ELECTS TO BE EXCLUDED FROM THE LIST OF EMPLOYERS IN THE ASSIGNED RISK PLAN: ____________________ YES ____________________ NO Acts 1983, ch. 66, § 15; 1993, ch. 452, §§ 1, 2; 1995, ch. 448, § 2; 1996, ch. 944, §§ 29, 30; 1997 , ch. 533, §§ 13, 14; 2000, ch. 852, §§ 1, 2; 2001, ch. 192, §§ 6, 7; 2002, ch. 695, § 5.
(a) Authorization. Notwithstanding § 56-5-113(a) , insurers participating in joint underwriting, pools or residual market mechanisms may, in connection with the activity, act in cooperation with each other in the making of rates, supplementary rate information, policy forms, underwriting rules, surveys, inspections and investigations, the furnishing of loss and expense statistics or other information, and in the conduct of research. Joint underwriting, pools and residual market mechanisms shall not be deemed rate service or advisory organizations.
(b) Regulation. (1) Except to the extent modified by this section, insurers participating in joint underwriting, pool or residual market mechanisms are subject to this part. (2) Every pool shall file with the commissioner: (A) A copy of its constitution, articles of association or incorporation, bylaws, and any other rules or regulations governing its activities; (B) A list of its members; (C) The name and address of a resident of this state upon whom notices or orders of the commissioner or process may be served; and (D) Any changes in the filings under subdivisions (b)(2)(A)-(C). (3) Any residual market mechanism, plan or agreement to implement the mechanism, and any amendments to the mechanism, plan or agreement, shall be submitted in writing to the commissioner for approval, together with such information as the commissioner may reasonably require. (4) If, after a hearing, the commissioner finds that any activity or practice of insurers participating in joint underwriting, pool or residual market mechanisms is unfair, unreasonable or otherwise inconsistent with this part, the commissioner shall issue a written order specifying in what respects the activity or practice is unfair, unreasonable or otherwise inconsistent with this part and require the discontinuance of the activity or practice.
(1) Except to the extent modified by this section, insurers participating in joint underwriting, pool or residual market mechanisms are subject to this part.
(2) Every pool shall file with the commissioner: (A) A copy of its constitution, articles of association or incorporation, bylaws, and any other rules or regulations governing its activities; (B) A list of its members; (C) The name and address of a resident of this state upon whom notices or orders of the commissioner or process may be served; and (D) Any changes in the filings under subdivisions (b)(2)(A)-(C).
(A) A copy of its constitution, articles of association or incorporation, bylaws, and any other rules or regulations governing its activities;
(B) A list of its members;
(C) The name and address of a resident of this state upon whom notices or orders of the commissioner or process may be served; and
(D) Any changes in the filings under subdivisions (b)(2)(A)-(C).
(3) Any residual market mechanism, plan or agreement to implement the mechanism, and any amendments to the mechanism, plan or agreement, shall be submitted in writing to the commissioner for approval, together with such information as the commissioner may reasonably require.
(4) If, after a hearing, the commissioner finds that any activity or practice of insurers participating in joint underwriting, pool or residual market mechanisms is unfair, unreasonable or otherwise inconsistent with this part, the commissioner shall issue a written order specifying in what respects the activity or practice is unfair, unreasonable or otherwise inconsistent with this part and require the discontinuance of the activity or practice.
(c) (1) The commissioner shall implement a plan as soon as possible for the equitable apportionment among insurers of applicants for workers' compensation insurance who are in good faith entitled to such insurance, but who are unable to procure it through ordinary methods. The plan shall provide reasonable rules governing the equitable distribution of risks by direct assignment, reinsurance, or otherwise, and their assignment to insurers, and shall provide a method whereby applicants for insurance, insured, and insurers may have a hearing on grievances and the right of appeal to the commissioner. (2) Notwithstanding § 56-5-113(a) , every insurer, except those entities under § 50-6-405(a)(2) and (c) that qualify under § 50-6-401 or § 50-6-405 , and those entities under title 50, chapter 6, part 6, undertaking to transact in this state the business of either workers' compensation or employer's liability insurance, or both, and every rating organization that files rates or prospective loss costs for such insurance shall participate in the plan. No insurer shall thereafter issue a policy of workers' compensation or employer's liability insurance or undertake to transact that business in this state unless the insurer participates in the plan. (3) (A) No later than July 1 of each year, the commissioner shall determine whether the membership of the assigned risk pool, created pursuant to this subsection (c), for the prior calendar year exceeds fifteen percent (15%) of the membership of the eligible employer market, as based on premium, excluding self-insured employers and self-insured groups. For any period in which it is determined the membership of the assigned risk pool exceeds fifteen percent (15%) of the membership of the eligible employer market, the commissioner shall issue a report to the advisory council on workers' compensation setting forth the percentage of the eligible employer market insured through the assigned risk pool and the reasons contributing to increased membership of the pool. The report shall include recommendations as to whether: (i) The competitive state workers' compensation insurance fund, established by title 50, chapter 6, part 6, should be activated; (ii) A plan of direct assignment on a randomized basis of all assigned risk plan policies to insurers offering workers' compensation insurance subject to subdivision (c)(4) should be implemented; (iii) Other actions should be taken; or (iv) No action should be taken. (B) The advisory council shall have ninety (90) days to provide written comments to the commissioner regarding the report and recommendations. After receipt of the advisory council's comments and recommendations, the commissioner shall take action deemed appropriate; provided, that the commissioner shall hold a hearing before electing to activate the competitive state workers' compensation insurance fund or to institute a plan of direct assignment. (4) If a direct assignment plan becomes operational, pursuant to this section, then the commissioner shall structure the randomized assignment so that small insurers do not bear a disproportionate share of risk in the market. A plan of direct assignment shall include provisions to provide that insurers who depopulated the assigned risk pool in the preceding five (5) years receive applicable take out credits to be used in determining the appropriate level of policies to be assigned to the insurers. (5) If the commissioner elects to make the competitive state workers' compensation fund operational pursuant to subdivision (c)(3), then the fund shall not be required to meet the reserve requirements for a domestic insurance company for the first seven (7) years of operation as otherwise required by §§ 50-6-601 and 50-6-603 . The commissioner shall promptly notify the governor, and the speakers of the senate and the house of representatives of the election. (6) (A) (i) On and after January 1, 1997, the plan developed under this subsection (c) shall assign an insured in this plan to one (1) of three (3) subplans. Those subplans are: (a) The small employer plan, for insureds not eligible for experience rating; (b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and (c) The safety incentive plan, for all other risks. (ii) The commissioner is authorized to establish increasing levels of premium surcharges for employers with experience modification factors in excess of one and ten hundredths (1.10). The surcharges may not exceed fifty percent (50%) for employers with modification factors in excess of two and zero hundredths (2.00). (B) The advisory prospective loss cost for subdivisions (c)(6)(A)(i)( a ) and ( b ) may not exceed that approved by the commissioner for the voluntary market. The commissioner shall annually establish the multiplier to be applied to the advisory prospective loss cost for the assigned risk plan. In establishing the multiplier, the commissioner shall consider the estimated cost of providing required services pursuant to this subsection (c) and the level of the multipliers in the voluntary market. (7) (A) The commissioner shall not approve a plan pursuant to this subsection (c) that does not provide for the making available of a list of the employers insured under this subsection (c) on request to interested persons for a reasonable fee or to the department. A reasonable fee shall only include the cost of production and mailing the list. (B) As part of the application for insurance coverage, an employer shall elect whether to be excluded from the list provided for by this subsection (c). Every application for the assigned risk plan shall include the following language: THE INSURED ELECTS TO BE EXCLUDED FROM THE LIST OF EMPLOYERS IN THE ASSIGNED RISK PLAN: ____________________ YES ____________________ NO
(1) The commissioner shall implement a plan as soon as possible for the equitable apportionment among insurers of applicants for workers' compensation insurance who are in good faith entitled to such insurance, but who are unable to procure it through ordinary methods. The plan shall provide reasonable rules governing the equitable distribution of risks by direct assignment, reinsurance, or otherwise, and their assignment to insurers, and shall provide a method whereby applicants for insurance, insured, and insurers may have a hearing on grievances and the right of appeal to the commissioner.
(2) Notwithstanding § 56-5-113(a) , every insurer, except those entities under § 50-6-405(a)(2) and (c) that qualify under § 50-6-401 or § 50-6-405 , and those entities under title 50, chapter 6, part 6, undertaking to transact in this state the business of either workers' compensation or employer's liability insurance, or both, and every rating organization that files rates or prospective loss costs for such insurance shall participate in the plan. No insurer shall thereafter issue a policy of workers' compensation or employer's liability insurance or undertake to transact that business in this state unless the insurer participates in the plan.
(3) (A) No later than July 1 of each year, the commissioner shall determine whether the membership of the assigned risk pool, created pursuant to this subsection (c), for the prior calendar year exceeds fifteen percent (15%) of the membership of the eligible employer market, as based on premium, excluding self-insured employers and self-insured groups. For any period in which it is determined the membership of the assigned risk pool exceeds fifteen percent (15%) of the membership of the eligible employer market, the commissioner shall issue a report to the advisory council on workers' compensation setting forth the percentage of the eligible employer market insured through the assigned risk pool and the reasons contributing to increased membership of the pool. The report shall include recommendations as to whether: (i) The competitive state workers' compensation insurance fund, established by title 50, chapter 6, part 6, should be activated; (ii) A plan of direct assignment on a randomized basis of all assigned risk plan policies to insurers offering workers' compensation insurance subject to subdivision (c)(4) should be implemented; (iii) Other actions should be taken; or (iv) No action should be taken. (B) The advisory council shall have ninety (90) days to provide written comments to the commissioner regarding the report and recommendations. After receipt of the advisory council's comments and recommendations, the commissioner shall take action deemed appropriate; provided, that the commissioner shall hold a hearing before electing to activate the competitive state workers' compensation insurance fund or to institute a plan of direct assignment.
(A) No later than July 1 of each year, the commissioner shall determine whether the membership of the assigned risk pool, created pursuant to this subsection (c), for the prior calendar year exceeds fifteen percent (15%) of the membership of the eligible employer market, as based on premium, excluding self-insured employers and self-insured groups. For any period in which it is determined the membership of the assigned risk pool exceeds fifteen percent (15%) of the membership of the eligible employer market, the commissioner shall issue a report to the advisory council on workers' compensation setting forth the percentage of the eligible employer market insured through the assigned risk pool and the reasons contributing to increased membership of the pool. The report shall include recommendations as to whether: (i) The competitive state workers' compensation insurance fund, established by title 50, chapter 6, part 6, should be activated; (ii) A plan of direct assignment on a randomized basis of all assigned risk plan policies to insurers offering workers' compensation insurance subject to subdivision (c)(4) should be implemented; (iii) Other actions should be taken; or (iv) No action should be taken.
(i) The competitive state workers' compensation insurance fund, established by title 50, chapter 6, part 6, should be activated;
(ii) A plan of direct assignment on a randomized basis of all assigned risk plan policies to insurers offering workers' compensation insurance subject to subdivision (c)(4) should be implemented;
(iii) Other actions should be taken; or
(iv) No action should be taken.
(B) The advisory council shall have ninety (90) days to provide written comments to the commissioner regarding the report and recommendations. After receipt of the advisory council's comments and recommendations, the commissioner shall take action deemed appropriate; provided, that the commissioner shall hold a hearing before electing to activate the competitive state workers' compensation insurance fund or to institute a plan of direct assignment.
(4) If a direct assignment plan becomes operational, pursuant to this section, then the commissioner shall structure the randomized assignment so that small insurers do not bear a disproportionate share of risk in the market. A plan of direct assignment shall include provisions to provide that insurers who depopulated the assigned risk pool in the preceding five (5) years receive applicable take out credits to be used in determining the appropriate level of policies to be assigned to the insurers.
(5) If the commissioner elects to make the competitive state workers' compensation fund operational pursuant to subdivision (c)(3), then the fund shall not be required to meet the reserve requirements for a domestic insurance company for the first seven (7) years of operation as otherwise required by §§ 50-6-601 and 50-6-603 . The commissioner shall promptly notify the governor, and the speakers of the senate and the house of representatives of the election.
(6) (A) (i) On and after January 1, 1997, the plan developed under this subsection (c) shall assign an insured in this plan to one (1) of three (3) subplans. Those subplans are: (a) The small employer plan, for insureds not eligible for experience rating; (b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and (c) The safety incentive plan, for all other risks. (ii) The commissioner is authorized to establish increasing levels of premium surcharges for employers with experience modification factors in excess of one and ten hundredths (1.10). The surcharges may not exceed fifty percent (50%) for employers with modification factors in excess of two and zero hundredths (2.00). (B) The advisory prospective loss cost for subdivisions (c)(6)(A)(i)( a ) and ( b ) may not exceed that approved by the commissioner for the voluntary market. The commissioner shall annually establish the multiplier to be applied to the advisory prospective loss cost for the assigned risk plan. In establishing the multiplier, the commissioner shall consider the estimated cost of providing required services pursuant to this subsection (c) and the level of the multipliers in the voluntary market.
(A) (i) On and after January 1, 1997, the plan developed under this subsection (c) shall assign an insured in this plan to one (1) of three (3) subplans. Those subplans are: (a) The small employer plan, for insureds not eligible for experience rating; (b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and (c) The safety incentive plan, for all other risks. (ii) The commissioner is authorized to establish increasing levels of premium surcharges for employers with experience modification factors in excess of one and ten hundredths (1.10). The surcharges may not exceed fifty percent (50%) for employers with modification factors in excess of two and zero hundredths (2.00).
(i) On and after January 1, 1997, the plan developed under this subsection (c) shall assign an insured in this plan to one (1) of three (3) subplans. Those subplans are: (a) The small employer plan, for insureds not eligible for experience rating; (b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and (c) The safety incentive plan, for all other risks.
(a) The small employer plan, for insureds not eligible for experience rating;
(b) The special risk plan, for insureds that are employers whose experience modifications are one and ten hundredths (1.10) or less; and
(c) The safety incentive plan, for all other risks.
(ii) The commissioner is authorized to establish increasing levels of premium surcharges for employers with experience modification factors in excess of one and ten hundredths (1.10). The surcharges may not exceed fifty percent (50%) for employers with modification factors in excess of two and zero hundredths (2.00).
(B) The advisory prospective loss cost for subdivisions (c)(6)(A)(i)( a ) and ( b ) may not exceed that approved by the commissioner for the voluntary market. The commissioner shall annually establish the multiplier to be applied to the advisory prospective loss cost for the assigned risk plan. In establishing the multiplier, the commissioner shall consider the estimated cost of providing required services pursuant to this subsection (c) and the level of the multipliers in the voluntary market.
(7) (A) The commissioner shall not approve a plan pursuant to this subsection (c) that does not provide for the making available of a list of the employers insured under this subsection (c) on request to interested persons for a reasonable fee or to the department. A reasonable fee shall only include the cost of production and mailing the list. (B) As part of the application for insurance coverage, an employer shall elect whether to be excluded from the list provided for by this subsection (c). Every application for the assigned risk plan shall include the following language: THE INSURED ELECTS TO BE EXCLUDED FROM THE LIST OF EMPLOYERS IN THE ASSIGNED RISK PLAN: ____________________ YES ____________________ NO
(A) The commissioner shall not approve a plan pursuant to this subsection (c) that does not provide for the making available of a list of the employers insured under this subsection (c) on request to interested persons for a reasonable fee or to the department. A reasonable fee shall only include the cost of production and mailing the list.
(B) As part of the application for insurance coverage, an employer shall elect whether to be excluded from the list provided for by this subsection (c). Every application for the assigned risk plan shall include the following language: THE INSURED ELECTS TO BE EXCLUDED FROM THE LIST OF EMPLOYERS IN THE ASSIGNED RISK PLAN: ____________________ YES ____________________ NO
THE INSURED ELECTS TO BE EXCLUDED FROM THE LIST OF EMPLOYERS IN THE ASSIGNED RISK PLAN:
____________________ YES ____________________ NO
Acts 1983, ch. 66, § 15; 1993, ch. 452, §§ 1, 2; 1995, ch. 448, § 2; 1996, ch. 944, §§ 29, 30; 1997 , ch. 533, §§ 13, 14; 2000, ch. 852, §§ 1, 2; 2001, ch. 192, §§ 6, 7; 2002, ch. 695, § 5.
Tenn. Code Ann. § 56-16-117 — TN Code / Title 56 / Chapter 16 / Section 56-16-117
Action by or against reciprocal - Venue - Service of process
Status: in_force

(a) Any reciprocal doing business in this state may sue or be sued in the name or designation under which its insurance contracts are effected. (b) (1) Any action or suit against a reciprocal may be brought in any county where: (A) Its principal office is located; or (B) The cause of action or any part of the cause of action arose. (2) If the action or suit is to recover a loss under a policy of insurance, it may also be brought in the county where the property insured was situated at the date of the policy. (3) Any action or suit against a foreign or alien reciprocal may also be brought in any county of this state in which it has any debts owed to it. (c) In an action or suit against a reciprocal, process against or notice to the reciprocal may be served upon the commissioner. Acts 1990, ch. 728, § 2; T.C.A. § 56-16-217.
(a) Any reciprocal doing business in this state may sue or be sued in the name or designation under which its insurance contracts are effected.
(b) (1) Any action or suit against a reciprocal may be brought in any county where: (A) Its principal office is located; or (B) The cause of action or any part of the cause of action arose. (2) If the action or suit is to recover a loss under a policy of insurance, it may also be brought in the county where the property insured was situated at the date of the policy. (3) Any action or suit against a foreign or alien reciprocal may also be brought in any county of this state in which it has any debts owed to it.
(1) Any action or suit against a reciprocal may be brought in any county where: (A) Its principal office is located; or (B) The cause of action or any part of the cause of action arose.
(A) Its principal office is located; or
(B) The cause of action or any part of the cause of action arose.
(2) If the action or suit is to recover a loss under a policy of insurance, it may also be brought in the county where the property insured was situated at the date of the policy.
(3) Any action or suit against a foreign or alien reciprocal may also be brought in any county of this state in which it has any debts owed to it.
(c) In an action or suit against a reciprocal, process against or notice to the reciprocal may be served upon the commissioner.
Acts 1990, ch. 728, § 2; T.C.A. § 56-16-217.
Tenn. Code Ann. § 56-37-115 — TN Code / Title 56 / Chapter 37 / Section 56-37-115
Reenactment - Short title
Status: in_force

This chapter is reenacted in its entirety as amended by Acts 1981, ch. 414, and shall continue to be entitled the "Premium Finance Company Act of 1980." Acts 1981, ch. 414, § 5.
This chapter is reenacted in its entirety as amended by Acts 1981, ch. 414, and shall continue to be entitled the "Premium Finance Company Act of 1980."
Acts 1981, ch. 414, § 5.
Tenn. Code Ann. § 56-9-304 — TN Code / Title 56 / Chapter 9 / Section 56-9-304
Rehabilitation order - Stay of pending action or proceeding - Tolling of statute of limitations - Laches unavailable - Standing - Federal home loan bank
Status: in_force

(a) Any court in this state before which any action or proceeding in which the insurer is a party, or is obligated to defend a party, is pending when a rehabilitation order against the insurer is entered shall stay the action or proceeding for ninety (90) days and any additional time as is necessary for the rehabilitator to obtain proper representation and prepare for further proceedings. The rehabilitator shall take such action respecting the pending litigation as the rehabilitator deems necessary in the interests of justice and for the protection of creditors, policyholders, and the public. The rehabilitator shall immediately consider all litigation pending outside this state and shall petition the courts having jurisdiction over that litigation for stays whenever necessary to protect the estate of the insurer. (b) No statute of limitations or defense of laches shall run with respect to any action by or against an insurer between the filing of a petition for appointment of a rehabilitator for that insurer and the order granting or denying that petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the order of rehabilitation is entered or the petition is denied. The rehabilitator may, upon an order for rehabilitation, within one (1) year or such other longer time as applicable law may permit, institute an action or proceeding on behalf of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered. (c) Any guaranty association or foreign guaranty association covering life or health insurance or annuities has standing to appear in any court proceeding concerning the rehabilitation of a life or health insurer if the association is or may become liable under this chapter as a result of the rehabilitation. (d) Notwithstanding subsections (a) and (b) and any other provision of this title, a federal home loan bank shall not be stayed, enjoined, or prohibited from exercising or enforcing any right or cause of action regarding collateral pledged under a security agreement or under any pledge agreement, security agreement, collateral agreement, or other similar arrangement or credit enhancement relating to a security agreement to which the federal home loan bank is a party. Amended by 2019 Tenn. Acts, ch. 430,s 3, eff. 5/21/2019. Acts 1991, ch. 142, § 4.
(a) Any court in this state before which any action or proceeding in which the insurer is a party, or is obligated to defend a party, is pending when a rehabilitation order against the insurer is entered shall stay the action or proceeding for ninety (90) days and any additional time as is necessary for the rehabilitator to obtain proper representation and prepare for further proceedings. The rehabilitator shall take such action respecting the pending litigation as the rehabilitator deems necessary in the interests of justice and for the protection of creditors, policyholders, and the public. The rehabilitator shall immediately consider all litigation pending outside this state and shall petition the courts having jurisdiction over that litigation for stays whenever necessary to protect the estate of the insurer.
(b) No statute of limitations or defense of laches shall run with respect to any action by or against an insurer between the filing of a petition for appointment of a rehabilitator for that insurer and the order granting or denying that petition. Any action against the insurer that might have been commenced when the petition was filed may be commenced for at least sixty (60) days after the order of rehabilitation is entered or the petition is denied. The rehabilitator may, upon an order for rehabilitation, within one (1) year or such other longer time as applicable law may permit, institute an action or proceeding on behalf of the insurer upon any cause of action against which the period of limitation fixed by applicable law has not expired at the time of the filing of the petition upon which the order is entered.
(c) Any guaranty association or foreign guaranty association covering life or health insurance or annuities has standing to appear in any court proceeding concerning the rehabilitation of a life or health insurer if the association is or may become liable under this chapter as a result of the rehabilitation.
(d) Notwithstanding subsections (a) and (b) and any other provision of this title, a federal home loan bank shall not be stayed, enjoined, or prohibited from exercising or enforcing any right or cause of action regarding collateral pledged under a security agreement or under any pledge agreement, security agreement, collateral agreement, or other similar arrangement or credit enhancement relating to a security agreement to which the federal home loan bank is a party.
Amended by 2019 Tenn. Acts, ch. 430,s 3, eff. 5/21/2019.
Acts 1991, ch. 142, § 4.