Tenn. Code Ann. § 56-37-116 — TN Code / Title 56 / Chapter 37 / Section 56-37-116
Licensing through multi-state automated licensing system
Status: in_force

(a) In addition to any other powers imposed upon the commissioner by law, the commissioner is authorized to require persons subject to this chapter to be licensed through a multi-state automated licensing system. Pursuant to this authority, the commissioner may: (1) Promulgate any rules reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system; (2) Establish relationships or enter into agreements reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system. The agreements may include, but are not limited to, operating agreements, information sharing agreements, interstate cooperative agreements, and technology licensing agreements; (3) Require that applications for licensing under this chapter and renewals of such licenses be filed with a multi-state automated licensing system; (4) Require that any fees required to be paid under this chapter be paid through a multi-state automated licensing system; (5) Establish deadlines for transitioning licenses to a multi-state automated licensing system. The commissioner may deny any applications or renewal applications not filed with a multi-state automated licensing system after the deadlines have passed, notwithstanding any other deadlines established in this chapter. The commissioner shall provide reasonable notice of any transition deadlines to licensees; and (6) Take such further actions as are reasonably necessary to give effect to this section. (b) Nothing in this section authorizes the commissioner to require a person who is not subject to this chapter to submit information to, or participate in, a multi-state automated licensing system. (c) Notwithstanding any other provision of this section, the commissioner retains full authority and discretion to license persons under this chapter and to enforce this chapter. Nothing in this section reduces or derogates that authority and discretion. (d) Applicants for and holders of licenses issued under this chapter must pay all costs associated with submitting an application or transitioning a license to a multi-state automated licensing system, as well as all costs associated with maintaining and renewing any license issued by the commissioner on a multi-state automated licensing system. Added by 2017 Tenn. Acts, ch. 122, s 14, eff. 7/1/2018.
(a) In addition to any other powers imposed upon the commissioner by law, the commissioner is authorized to require persons subject to this chapter to be licensed through a multi-state automated licensing system. Pursuant to this authority, the commissioner may: (1) Promulgate any rules reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system; (2) Establish relationships or enter into agreements reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system. The agreements may include, but are not limited to, operating agreements, information sharing agreements, interstate cooperative agreements, and technology licensing agreements; (3) Require that applications for licensing under this chapter and renewals of such licenses be filed with a multi-state automated licensing system; (4) Require that any fees required to be paid under this chapter be paid through a multi-state automated licensing system; (5) Establish deadlines for transitioning licenses to a multi-state automated licensing system. The commissioner may deny any applications or renewal applications not filed with a multi-state automated licensing system after the deadlines have passed, notwithstanding any other deadlines established in this chapter. The commissioner shall provide reasonable notice of any transition deadlines to licensees; and (6) Take such further actions as are reasonably necessary to give effect to this section.
(1) Promulgate any rules reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system;
(2) Establish relationships or enter into agreements reasonably necessary for participation in, transition to, or operation of a multi-state automated licensing system. The agreements may include, but are not limited to, operating agreements, information sharing agreements, interstate cooperative agreements, and technology licensing agreements;
(3) Require that applications for licensing under this chapter and renewals of such licenses be filed with a multi-state automated licensing system;
(4) Require that any fees required to be paid under this chapter be paid through a multi-state automated licensing system;
(5) Establish deadlines for transitioning licenses to a multi-state automated licensing system. The commissioner may deny any applications or renewal applications not filed with a multi-state automated licensing system after the deadlines have passed, notwithstanding any other deadlines established in this chapter. The commissioner shall provide reasonable notice of any transition deadlines to licensees; and
(6) Take such further actions as are reasonably necessary to give effect to this section.
(b) Nothing in this section authorizes the commissioner to require a person who is not subject to this chapter to submit information to, or participate in, a multi-state automated licensing system.
(c) Notwithstanding any other provision of this section, the commissioner retains full authority and discretion to license persons under this chapter and to enforce this chapter. Nothing in this section reduces or derogates that authority and discretion.
(d) Applicants for and holders of licenses issued under this chapter must pay all costs associated with submitting an application or transitioning a license to a multi-state automated licensing system, as well as all costs associated with maintaining and renewing any license issued by the commissioner on a multi-state automated licensing system.
Added by 2017 Tenn. Acts, ch. 122, s 14, eff. 7/1/2018.
Tenn. Code Ann. § 56-51-150 — TN Code / Title 56 / Chapter 51 / Section 56-51-150
Confidentiality
Status: in_force

(a) Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from § 10-7-503 , and shall only be available pursuant to specific written consent of the enrollee, or as otherwise provided by law. With respect to any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant, a prepaid limited health service organization is entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the prepaid limited health service organization is entitled to claim. (b) Any proprietary financial information contained in contracts entered into with providers by prepaid limited health service organizations is confidential and exempt from § 10-7-503 . (c) Any information obtained or produced by the department pursuant to an examination or investigation is confidential and exempt from § 10-7-503 until the examination report has been filed and adopted by the commissioner or until the time, if ever, the information is used in litigation by the commissioner or in a contested case. Except for active criminal intelligence or criminal investigative information; personal financial and medical information; information that would defame or cause unwarranted damage to the good name or reputation of an individual; information that would impair the safety and financial soundness of the licensee or affiliated party; proprietary financial information; or information that would reveal the identity of a confidential source, all information obtained by the department pursuant to an examination shall be available after the examination report has been filed. Acts 2000, ch. 948, § 50.
(a) Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from § 10-7-503 , and shall only be available pursuant to specific written consent of the enrollee, or as otherwise provided by law. With respect to any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant, a prepaid limited health service organization is entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the prepaid limited health service organization is entitled to claim.
(b) Any proprietary financial information contained in contracts entered into with providers by prepaid limited health service organizations is confidential and exempt from § 10-7-503 .
(c) Any information obtained or produced by the department pursuant to an examination or investigation is confidential and exempt from § 10-7-503 until the examination report has been filed and adopted by the commissioner or until the time, if ever, the information is used in litigation by the commissioner or in a contested case. Except for active criminal intelligence or criminal investigative information; personal financial and medical information; information that would defame or cause unwarranted damage to the good name or reputation of an individual; information that would impair the safety and financial soundness of the licensee or affiliated party; proprietary financial information; or information that would reveal the identity of a confidential source, all information obtained by the department pursuant to an examination shall be available after the examination report has been filed.
Acts 2000, ch. 948, § 50.
Tenn. Code Ann. § 56-7-1006 — TN Code / Title 56 / Chapter 7 / Section 56-7-1006
Prohibition against denial of reimbursement to or discrimination against physician based on maintenance of certification or licensure
Status: in_force

(a) As used in this section: (1) "Continuing medical education" means board of medical examiners or board of osteopathic examination required continued postgraduate medical education intended to provide medical professionals with knowledge of new developments in the professional's field; (2) "Maintenance of certification" means any process requiring periodic recertification examinations or other activities to maintain specialty medical board certification; (3) "Maintenance of licensure" means the proprietary framework for physician license renewal established through the Federation of State Medical Boards or its successor organization, which includes additional periodic testing or requirements other than continuing medical education; and (4) "Specialty medical board certification" means certification by a board that specializes in one (1) particular area of medicine and typically requires additional examinations other than the requirements of the board of medical examiners or board of osteopathic examination to practice medicine. (b) A health insurance entity, as defined in § 56-7-109 , shall not deny reimbursement to or prevent a physician licensed pursuant to title 63, chapter 6 or 9 from participating in any of the insurance entity's provider networks based solely on a physician's decision not to participate in any form of maintenance of licensure or maintenance of certification, including basing a physician's network participation on any form of maintenance of licensure tied to maintenance of certification. (c) A health insurance entity, as defined in § 56-7-109 , shall not discriminate with respect to reimbursement levels based solely on a physician's decision not to participate in any form of maintenance of licensure or maintenance of certification, including basing a physician's reimbursement level on any form of maintenance of licensure tied to maintenance of certification. Acts 2018, ch. 694, § 2.
(a) As used in this section: (1) "Continuing medical education" means board of medical examiners or board of osteopathic examination required continued postgraduate medical education intended to provide medical professionals with knowledge of new developments in the professional's field; (2) "Maintenance of certification" means any process requiring periodic recertification examinations or other activities to maintain specialty medical board certification; (3) "Maintenance of licensure" means the proprietary framework for physician license renewal established through the Federation of State Medical Boards or its successor organization, which includes additional periodic testing or requirements other than continuing medical education; and (4) "Specialty medical board certification" means certification by a board that specializes in one (1) particular area of medicine and typically requires additional examinations other than the requirements of the board of medical examiners or board of osteopathic examination to practice medicine.
(1) "Continuing medical education" means board of medical examiners or board of osteopathic examination required continued postgraduate medical education intended to provide medical professionals with knowledge of new developments in the professional's field;
(2) "Maintenance of certification" means any process requiring periodic recertification examinations or other activities to maintain specialty medical board certification;
(3) "Maintenance of licensure" means the proprietary framework for physician license renewal established through the Federation of State Medical Boards or its successor organization, which includes additional periodic testing or requirements other than continuing medical education; and
(4) "Specialty medical board certification" means certification by a board that specializes in one (1) particular area of medicine and typically requires additional examinations other than the requirements of the board of medical examiners or board of osteopathic examination to practice medicine.
(b) A health insurance entity, as defined in § 56-7-109 , shall not deny reimbursement to or prevent a physician licensed pursuant to title 63, chapter 6 or 9 from participating in any of the insurance entity's provider networks based solely on a physician's decision not to participate in any form of maintenance of licensure or maintenance of certification, including basing a physician's network participation on any form of maintenance of licensure tied to maintenance of certification.
(c) A health insurance entity, as defined in § 56-7-109 , shall not discriminate with respect to reimbursement levels based solely on a physician's decision not to participate in any form of maintenance of licensure or maintenance of certification, including basing a physician's reimbursement level on any form of maintenance of licensure tied to maintenance of certification.
Acts 2018, ch. 694, § 2.
Tenn. Code Ann. § 56-55-112 — TN Code / Title 56 / Chapter 55 / Section 56-55-112
Commissioner or secretary of state as attorney for service of process
Status: in_force

(a) Any warrantor doing business in this state in accordance with this chapter shall be deemed to have appointed the commissioner its true and lawful attorney upon whom may be served all lawful process in any action or proceeding against it. (b) Any warrantor doing business in this state unauthorized by this chapter shall be deemed to have appointed the secretary of state to be its true and lawful attorney upon whom may be served all lawful process in any action or proceeding against it. Acts 2005, ch. 244, § 13.
(a) Any warrantor doing business in this state in accordance with this chapter shall be deemed to have appointed the commissioner its true and lawful attorney upon whom may be served all lawful process in any action or proceeding against it.
(b) Any warrantor doing business in this state unauthorized by this chapter shall be deemed to have appointed the secretary of state to be its true and lawful attorney upon whom may be served all lawful process in any action or proceeding against it.
Acts 2005, ch. 244, § 13.
Tenn. Code Ann. § 56-47-102 — TN Code / Title 56 / Chapter 47 / Section 56-47-102
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Actual malice" means the knowledge that information is false, or reckless disregard of whether it is false; (2) "Conceal" means to take affirmative action to prevent others from discovering information. Mere failure to disclose information does not constitute concealment. Action by the holder of a legal privilege, or one who has a reasonable belief that a privilege exists, to prevent discovery of privileged information does not constitute concealment; (3) "Insurance policy" means the written instrument in which are set forth the terms of any binder of coverage or contract of insurance, including a binder or contract issued by a state-assigned risk plan, or other forms of workers' compensation insurance; (4) "Insurance professional" means sales agents, managing general agents, brokers, producers, adjusters and third party administrators; (5) "Insurance transaction" means a transaction by, between or among an: (A) Insurer or a person who acts on behalf of an insurer; and (B) Insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner or any person who acts on behalf of any of the insureds, claimants, applicants for insurance, public adjusters, insurance professionals and practitioners, for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim or otherwise obtaining insurance, self-insurance or reinsurance or obtaining the benefits of or from insurance, self-insurance or reinsurance; (6) "Insurer" means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event related to causes arising under title 50, chapter 6; (7) "Pattern or practice" means repeated, routine or generalized in nature, and not merely isolated or sporadic; (8) "Person" means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government or any other entity; (9) "Practitioner" means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of state or person required to be licensed in this state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds; (10) "Premium" means consideration paid or payable for coverage under an insurance policy. "Premium" includes any payments, whether due within the insurance policy term or otherwise, and deductible payments whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, any self-insured retention or payments, whether advanced by the insurer or insurance professionals and subject to reimbursement by the insured or otherwise, and any collateral or security to be provided to collateralize obligations to pay any of the above; (11) "Premium avoidance" means any intentional material misrepresentation by an employer of any or all of the four (4) premium determinants. The determinants are employee job classifications, amount of payroll in each classification, geographic location of insured operations, and history of past losses. Intentional misrepresentation of each of these items can affect the total premium charged by an insurer to a workers' compensation risk; (12) "Reckless" means without reasonable belief of the truth, or, for the purposes of § 56-47-104(a)(3) , with a high degree of awareness of probable insolvency; and (13) "Withhold" means to fail to disclose facts or information that any law other than this chapter requires to be disclosed. Mere failure to disclose information does not constitute "withholding" if the one failing to disclose reasonably believes that there is no duty to disclose. Acts 1996, ch. 944, § 48; 1998, ch. 1024, § 11.
As used in this chapter, unless the context otherwise requires:
(1) "Actual malice" means the knowledge that information is false, or reckless disregard of whether it is false;
(2) "Conceal" means to take affirmative action to prevent others from discovering information. Mere failure to disclose information does not constitute concealment. Action by the holder of a legal privilege, or one who has a reasonable belief that a privilege exists, to prevent discovery of privileged information does not constitute concealment;
(3) "Insurance policy" means the written instrument in which are set forth the terms of any binder of coverage or contract of insurance, including a binder or contract issued by a state-assigned risk plan, or other forms of workers' compensation insurance;
(4) "Insurance professional" means sales agents, managing general agents, brokers, producers, adjusters and third party administrators;
(5) "Insurance transaction" means a transaction by, between or among an: (A) Insurer or a person who acts on behalf of an insurer; and (B) Insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner or any person who acts on behalf of any of the insureds, claimants, applicants for insurance, public adjusters, insurance professionals and practitioners, for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim or otherwise obtaining insurance, self-insurance or reinsurance or obtaining the benefits of or from insurance, self-insurance or reinsurance;
(A) Insurer or a person who acts on behalf of an insurer; and
(B) Insured, claimant, applicant for insurance, public adjuster, insurance professional, practitioner or any person who acts on behalf of any of the insureds, claimants, applicants for insurance, public adjusters, insurance professionals and practitioners, for the purpose of obtaining insurance or reinsurance, calculating insurance premiums, submitting a claim, negotiating or adjusting a claim or otherwise obtaining insurance, self-insurance or reinsurance or obtaining the benefits of or from insurance, self-insurance or reinsurance;
(6) "Insurer" means any person purporting to engage in the business of insurance or authorized to do business in this state or subject to regulation by the state, who undertakes to indemnify another against loss, damage or liability arising from a contingent or unknown event related to causes arising under title 50, chapter 6;
(7) "Pattern or practice" means repeated, routine or generalized in nature, and not merely isolated or sporadic;
(8) "Person" means a natural person, company, corporation, unincorporated association, partnership, professional corporation, agency of government or any other entity;
(9) "Practitioner" means a licensee of this state authorized to practice medicine and surgery, psychology, chiropractic or law or any other licensee of state or person required to be licensed in this state whose services are compensated either in whole or in part, directly or indirectly, by insurance proceeds;
(10) "Premium" means consideration paid or payable for coverage under an insurance policy. "Premium" includes any payments, whether due within the insurance policy term or otherwise, and deductible payments whether advanced by the insurer or insurance professional and subject to reimbursement by the insured or otherwise, any self-insured retention or payments, whether advanced by the insurer or insurance professionals and subject to reimbursement by the insured or otherwise, and any collateral or security to be provided to collateralize obligations to pay any of the above;
(11) "Premium avoidance" means any intentional material misrepresentation by an employer of any or all of the four (4) premium determinants. The determinants are employee job classifications, amount of payroll in each classification, geographic location of insured operations, and history of past losses. Intentional misrepresentation of each of these items can affect the total premium charged by an insurer to a workers' compensation risk;
(12) "Reckless" means without reasonable belief of the truth, or, for the purposes of § 56-47-104(a)(3) , with a high degree of awareness of probable insolvency; and
(13) "Withhold" means to fail to disclose facts or information that any law other than this chapter requires to be disclosed. Mere failure to disclose information does not constitute "withholding" if the one failing to disclose reasonably believes that there is no duty to disclose.
Acts 1996, ch. 944, § 48; 1998, ch. 1024, § 11.
Tenn. Code Ann. § 56-6-1301 — TN Code / Title 56 / Chapter 6 / Section 56-6-1301
Part definitions
Status: in_force

For purposes of this part: (1) "Commissioner" means the commissioner of commerce and insurance; (2) "Exchange" means any health benefit exchange established or operating in this state, including any exchange established or operated by the United States department of health and human services; and (3) "Navigator" means any person, other than an insurance producer, or a hospital licensed in this state under title 68 or title 33, who: (A) Receives any funding, directly or indirectly, from an exchange, this state or the federal government to perform any of the activities and duties identified in 42 U.S.C. § 18031(i) ; (B) Facilitates enrollment of individuals or employers in health plans or public insurance programs offered through an exchange; (C) Conducts public education or consumer assistance activities for, or on behalf of, an exchange; or (D) Is described or designated by an exchange, this state or the United States department of health and human services, or could reasonably be described or designated as, a navigator, an in-person assister, enrollment assister, application assister or application counselor. Amended by 2014 Tenn. Acts, ch. 660,s 1, eff. 4/10/2014. Added by 2013 Tenn. Acts, ch. 377,s 1, eff. 7/1/2013.
For purposes of this part:
(1) "Commissioner" means the commissioner of commerce and insurance;
(2) "Exchange" means any health benefit exchange established or operating in this state, including any exchange established or operated by the United States department of health and human services; and
(3) "Navigator" means any person, other than an insurance producer, or a hospital licensed in this state under title 68 or title 33, who: (A) Receives any funding, directly or indirectly, from an exchange, this state or the federal government to perform any of the activities and duties identified in 42 U.S.C. § 18031(i) ; (B) Facilitates enrollment of individuals or employers in health plans or public insurance programs offered through an exchange; (C) Conducts public education or consumer assistance activities for, or on behalf of, an exchange; or (D) Is described or designated by an exchange, this state or the United States department of health and human services, or could reasonably be described or designated as, a navigator, an in-person assister, enrollment assister, application assister or application counselor.
(A) Receives any funding, directly or indirectly, from an exchange, this state or the federal government to perform any of the activities and duties identified in 42 U.S.C. § 18031(i) ;
(B) Facilitates enrollment of individuals or employers in health plans or public insurance programs offered through an exchange;
(C) Conducts public education or consumer assistance activities for, or on behalf of, an exchange; or
(D) Is described or designated by an exchange, this state or the United States department of health and human services, or could reasonably be described or designated as, a navigator, an in-person assister, enrollment assister, application assister or application counselor.
Amended by 2014 Tenn. Acts, ch. 660,s 1, eff. 4/10/2014.
Added by 2013 Tenn. Acts, ch. 377,s 1, eff. 7/1/2013.
Tenn. Code Ann. § 56-19-109 — TN Code / Title 56 / Chapter 19 / Section 56-19-109
License - Conditions precedent
Status: in_force

No such company shall issue policies or transact any business of insurance, unless it holds a license from the commissioner authorizing the transaction of the business, which license shall not be issued until and unless the company complies with the following conditions: (1) It shall hold bona fide applications for insurance upon which it shall issue simultaneously, or it shall have in force, at least twenty (20) policies to at least twenty (20) members for the same kind of insurance upon not less than two hundred (200) separate risks, each within the maximum single risk described in subdivision (2); (2) The "maximum single risk" shall not exceed twenty percent (20%) of the admitted assets or three (3) times the average risk of one percent (1%) of the insurance in force, whichever is the greater, any reinsurance taking effect simultaneously with the policy being deducted in determining the maximum single risk; (3) It shall have collected a premium upon each application, which premiums shall be held in cash or securities in which insurance companies are authorized to invest and shall be equal, in case of fire insurance to not less than twice the maximum single risk assumed subject to one (1) fire nor less than ten thousand dollars ($10,000), and in any other kind of insurance to not less than five (5) times the maximum single risk assumed, and in case of workers' compensation insurance to not less than fifty thousand dollars ($50,000); (4) For the purpose of transacting employer's liability and workers' compensation insurance, the applications shall cover not less than one thousand five hundred (1,500) employees, each such employee being considered a separate risk for determining the maximum single risk; and (5) Satisfy the commissioner that its financial condition, methods of operation and manner of doing business are adequate to meet its obligations to all policyholders in this state. Acts 1919, ch. 108, § 7; Shan. Supp., § 3369a58b13; Code 1932, § 6325; T.C.A. (orig. ed.), § 56-1709.
No such company shall issue policies or transact any business of insurance, unless it holds a license from the commissioner authorizing the transaction of the business, which license shall not be issued until and unless the company complies with the following conditions:
(1) It shall hold bona fide applications for insurance upon which it shall issue simultaneously, or it shall have in force, at least twenty (20) policies to at least twenty (20) members for the same kind of insurance upon not less than two hundred (200) separate risks, each within the maximum single risk described in subdivision (2);
(2) The "maximum single risk" shall not exceed twenty percent (20%) of the admitted assets or three (3) times the average risk of one percent (1%) of the insurance in force, whichever is the greater, any reinsurance taking effect simultaneously with the policy being deducted in determining the maximum single risk;
(3) It shall have collected a premium upon each application, which premiums shall be held in cash or securities in which insurance companies are authorized to invest and shall be equal, in case of fire insurance to not less than twice the maximum single risk assumed subject to one (1) fire nor less than ten thousand dollars ($10,000), and in any other kind of insurance to not less than five (5) times the maximum single risk assumed, and in case of workers' compensation insurance to not less than fifty thousand dollars ($50,000);
(4) For the purpose of transacting employer's liability and workers' compensation insurance, the applications shall cover not less than one thousand five hundred (1,500) employees, each such employee being considered a separate risk for determining the maximum single risk; and
(5) Satisfy the commissioner that its financial condition, methods of operation and manner of doing business are adequate to meet its obligations to all policyholders in this state.
Acts 1919, ch. 108, § 7; Shan. Supp., § 3369a58b13; Code 1932, § 6325; T.C.A. (orig. ed.), § 56-1709.
Tenn. Code Ann. § 56-49-114 — TN Code / Title 56 / Chapter 49 / Section 56-49-114
Investigations - Hearings and proceedings - Penalties for violations
Status: in_force

(a) The commissioner may conduct investigations or examinations of insurers and agents to ensure compliance with and enforcement of this chapter or any rule, regulation or order under this chapter. The examination or investigation shall be conducted and subject to § 56-1-411 and chapter 8, part 1 of this title. (b) The commissioner may by order, deny, suspend or revoke an insurer's certificate of authority or an agent's license if the commissioner finds that the insurer or agent has violated this chapter. Every hearing or other proceeding, except examinations or investigations conducted pursuant to this chapter, held under this chapter that determines or affects the legal rights, duties, or privileges of an insurer or an agent shall be deemed to be a contested case under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, and shall be conducted as required by that act, unless otherwise noted. (c) If the commissioner has reason to believe that any person or entity is engaging in any activity that would be a violation of this chapter or any rule promulgated under this chapter, the commissioner may issue an order directing that person or entity to cease and desist from committing the violations, impose a civil penalty for the violations, provide an equitable remedy for past violations, or any combination of these. The order may be issued without prior notice if the commissioner makes a finding that the order is necessary for the protection of policyholders and that the public health, safety, and welfare require the order to be issued without prior notice to affected parties. At any hearing or other proceeding conducted as a result of an order to cease and desist, pursuant to this chapter, the person or entity subject to the order shall be required to show cause why the order should be annulled, modified or confirmed. (d) Whenever it appears to the commissioner that any person or entity has engaged or is about to engage in an act or practice constituting a violation of any provision of this chapter or any rule, regulation or order under this chapter, the commissioner may, in the commissioner's discretion, bring an action in chancery court of any county in this state to enjoin the acts or practices and to enforce compliance with this chapter or any rule, regulation or order under this chapter. Upon a proper showing, a permanent or temporary injunction, restraining order, writ of mandamus, disgorgement, or other proper equitable relief shall be granted. (e) Additionally, upon a finding that any person or entity has violated a provision of this chapter, the commissioner may impose a civil penalty of not more than one thousand dollars ($1,000) for each violation, not to exceed in the aggregate one hundred thousand dollars ($100,000), unless the violation was committed flagrantly in conscious disregard of this chapter, in which case the penalty shall not be more than twenty-five thousand dollars ($25,000) for each violation, not to exceed in the aggregate two hundred fifty thousand dollars ($250,000). (f) Any person aggrieved by a final order of the commissioner under this chapter may obtain judicial review of the order in the chancery court of Davidson County by proceedings in accordance with the Uniform Administrative Procedures Act. Acts 1999, ch. 144, § 14.
(a) The commissioner may conduct investigations or examinations of insurers and agents to ensure compliance with and enforcement of this chapter or any rule, regulation or order under this chapter. The examination or investigation shall be conducted and subject to § 56-1-411 and chapter 8, part 1 of this title.
(b) The commissioner may by order, deny, suspend or revoke an insurer's certificate of authority or an agent's license if the commissioner finds that the insurer or agent has violated this chapter. Every hearing or other proceeding, except examinations or investigations conducted pursuant to this chapter, held under this chapter that determines or affects the legal rights, duties, or privileges of an insurer or an agent shall be deemed to be a contested case under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, and shall be conducted as required by that act, unless otherwise noted.
(c) If the commissioner has reason to believe that any person or entity is engaging in any activity that would be a violation of this chapter or any rule promulgated under this chapter, the commissioner may issue an order directing that person or entity to cease and desist from committing the violations, impose a civil penalty for the violations, provide an equitable remedy for past violations, or any combination of these. The order may be issued without prior notice if the commissioner makes a finding that the order is necessary for the protection of policyholders and that the public health, safety, and welfare require the order to be issued without prior notice to affected parties. At any hearing or other proceeding conducted as a result of an order to cease and desist, pursuant to this chapter, the person or entity subject to the order shall be required to show cause why the order should be annulled, modified or confirmed.
(d) Whenever it appears to the commissioner that any person or entity has engaged or is about to engage in an act or practice constituting a violation of any provision of this chapter or any rule, regulation or order under this chapter, the commissioner may, in the commissioner's discretion, bring an action in chancery court of any county in this state to enjoin the acts or practices and to enforce compliance with this chapter or any rule, regulation or order under this chapter. Upon a proper showing, a permanent or temporary injunction, restraining order, writ of mandamus, disgorgement, or other proper equitable relief shall be granted.
(e) Additionally, upon a finding that any person or entity has violated a provision of this chapter, the commissioner may impose a civil penalty of not more than one thousand dollars ($1,000) for each violation, not to exceed in the aggregate one hundred thousand dollars ($100,000), unless the violation was committed flagrantly in conscious disregard of this chapter, in which case the penalty shall not be more than twenty-five thousand dollars ($25,000) for each violation, not to exceed in the aggregate two hundred fifty thousand dollars ($250,000).
(f) Any person aggrieved by a final order of the commissioner under this chapter may obtain judicial review of the order in the chancery court of Davidson County by proceedings in accordance with the Uniform Administrative Procedures Act.
Acts 1999, ch. 144, § 14.
Tenn. Code Ann. § 56-1-919 — TN Code / Title 56 / Chapter 1 / Section 56-1-919
Conflicts with other laws - Applicability date
Status: in_force

To the extent that this part conflicts with or is inconsistent with any law, this part shall control. This part shall apply to policies and contracts issued on or after January 1, 1962. Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
To the extent that this part conflicts with or is inconsistent with any law, this part shall control. This part shall apply to policies and contracts issued on or after January 1, 1962.
Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Tenn. Code Ann. § 56-26-105 — TN Code / Title 56 / Chapter 26 / Section 56-26-105
Review - Certiorari
Status: in_force

Any order or decision of the commissioner under §§ 56-26-102 - 56-26-104 and this section shall be subject to review in the manner provided by title 27, chapter 9, pertaining to the statutory writ of certiorari. Acts 1955, ch. 4, § 2; T.C.A., § 56-3305.
Any order or decision of the commissioner under §§ 56-26-102 - 56-26-104 and this section shall be subject to review in the manner provided by title 27, chapter 9, pertaining to the statutory writ of certiorari.
Acts 1955, ch. 4, § 2; T.C.A., § 56-3305.
Tenn. Code Ann. § 56-51-104 — TN Code / Title 56 / Chapter 51 / Section 56-51-104
Insurance business not authorized
Status: in_force

Nothing in this title or this chapter authorizes any prepaid limited health service organization to transact any insurance business other than that specifically authorized by this chapter, or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by the department under the Tennessee insurance code. Acts 2000, ch. 948, § 4.
Nothing in this title or this chapter authorizes any prepaid limited health service organization to transact any insurance business other than that specifically authorized by this chapter, or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by the department under the Tennessee insurance code.
Acts 2000, ch. 948, § 4.
Tenn. Code Ann. § 56-50-110 — TN Code / Title 56 / Chapter 50 / Section 56-50-110
General rules
Status: in_force

(a) (1) A viatical settlement provider entering into a viatical settlement contract shall first obtain: (A) If the viator is the insured, a written statement from a licensed attending physician that the viator is of sound mind and under no constraint or undue influence to enter into a viatical settlement contract; and (B) A document in which the insured consents to the release of the insured's medical records to a licensed viatical settlement provider, viatical settlement broker and the insurance company that issued the life insurance policy covering the life of the insured. (2) Within twenty (20) days after a viator executes documents necessary to transfer any rights under an insurance policy or within twenty (20) days of entering any agreement, option, promise or any other form of understanding, expressed or implied, to viaticate the policy, the viatical settlement provider shall give written notice to the insurer that issued the insurance policy that the policy has or will become a viaticated policy. The notice shall be accompanied by the documents required by subdivision (a)(3). (3) The viatical provider shall deliver a copy of the medical release required under subdivision (a)(1)(B), a copy of the viator's application for the viatical settlement contract, the notice required under subdivision (a)(2) and a request for verification of coverage to the insurer that issued the life policy that is the subject of the viatical transaction. The National Association of Insurance Commissioners (NAIC) form for verification of coverage shall be used unless another form is developed and approved by the commissioner. (4) The insurer shall respond to a request for verification of coverage submitted on an approved form by a viatical settlement provider or viatical settlement broker within thirty (30) calendar days of the date the request is received and shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract or possible fraud. The insurer shall accept a request for verification of coverage made on a NAIC form or any other form approved by the commissioner. The insurer shall accept an original or facsimile or electronic copy of such request and any accompanying authorization signed by the viator. Failure by the insurer to meet its obligations under this subdivision (a)(4) shall be a violation of §§ 56-50-111(c) and 56-50-116 . (5) Prior to or at the time of execution of the viatical settlement contract, the viatical settlement provider shall obtain a witnessed document in which the viator consents to the viatical settlement contract, represents that the viator has a full and complete understanding of the viatical settlement contract, that the viator has a full and complete understanding of the benefits of the life insurance policy, acknowledges that the viator is entering into the viatical settlement contract freely and voluntarily and, for persons with a terminal or chronic illness or condition, acknowledges that the insured has a terminal or chronic illness and that the terminal or chronic illness or condition was diagnosed after the life insurance policy was issued. (6) If a viatical settlement broker performs any of these activities required of the viatical settlement provider, the provider is deemed to have fulfilled the requirements of this section. (b) All medical information solicited or obtained by any licensee shall be subject to the applicable state laws relating to confidentiality of medical information. (c) The viator has the right to rescind a viatical settlement contract before the earlier of thirty (30) calendar days after the date upon which the viatical settlement contract is executed by all parties or fifteen (15) calendar days after the viatical settlement proceeds have been paid to the viator, as provided in subsection (f). Rescission, if exercised by the viator, is effective only if both notice of the rescission is given, and the viator repays all proceeds and any premiums, loans and loan interest paid on account of the viatical settlement within the rescission period. If the insured dies during the rescission period, the viatical settlement contract shall be deemed to have been rescinded, subject to repayment by the viator or the viator's estate of all viatical settlement proceeds and any premiums, loans and loan interest paid on account of the viatical settlement within sixty (60) days of the insured's death. (d) The purchaser shall have the right to rescind a viatical settlement contract within three (3) days after the disclosures mandated by § 56-50-108(d) and (e) are received by the purchaser. (e) The viatical settlement provider shall instruct the viator to send the executed documents required to effect the change in ownership, assignment or change in beneficiary directly to the independent escrow agent. Within three (3) business days after the date the escrow agent receives the document or from the date the viatical settlement provider receives the documents, if the viator erroneously provides the documents directly to the provider, the provider shall pay or transfer the proceeds of the viatical settlement into an escrow or trust account maintained in a state or federally chartered financial institution whose deposits are insured by the federal deposit insurance corporation (FDIC). Upon payment of the settlement proceeds into the escrow account, the escrow agent shall deliver the original change in ownership, assignment or change in beneficiary forms to the viatical settlement provider or related provider trust or other designated representative of the viatical settlement provider. Upon the escrow agent's receipt of the acknowledgment of the properly completed transfer of ownership, assignment or designation of beneficiary from the insurance company, the escrow agent shall pay the settlement proceeds to the viator. (f) Failure to tender consideration to the viator for the viatical settlement contract within the time set forth in the disclosure pursuant to § 56-50-108(a)(7) renders the viatical settlement contract voidable by the viator for lack of consideration until the time consideration is tendered to and accepted by the viator. Funds shall be deemed sent by a viatical settlement provider to a viator as of the date that the escrow agent either releases funds for wire transfer to the viator or places a check for delivery to the viator via the United States postal service or other nationally recognized delivery service. (g) Contacts with the insured for the purpose of determining the health status of the insured by the viatical settlement provider after the viatical settlement has occurred shall only be made by the viatical settlement provider licensed in this state or its authorized representatives and shall be limited to once every three (3) months for insureds with a life expectancy of more than one (1) year, and to no more than once per month for insureds with a life expectancy of one (1) year or less. The provider shall explain the procedure for these contacts at the time the viatical settlement contract is entered into. The limitations set forth in this subsection (g) shall not apply to any contacts with an insured for reasons other than determining the insured's health status. Viatical settlement providers and viatical settlement brokers shall be responsible for the actions of their authorized representatives. Acts 2009 , ch. 604, § 11.
(a) (1) A viatical settlement provider entering into a viatical settlement contract shall first obtain: (A) If the viator is the insured, a written statement from a licensed attending physician that the viator is of sound mind and under no constraint or undue influence to enter into a viatical settlement contract; and (B) A document in which the insured consents to the release of the insured's medical records to a licensed viatical settlement provider, viatical settlement broker and the insurance company that issued the life insurance policy covering the life of the insured. (2) Within twenty (20) days after a viator executes documents necessary to transfer any rights under an insurance policy or within twenty (20) days of entering any agreement, option, promise or any other form of understanding, expressed or implied, to viaticate the policy, the viatical settlement provider shall give written notice to the insurer that issued the insurance policy that the policy has or will become a viaticated policy. The notice shall be accompanied by the documents required by subdivision (a)(3). (3) The viatical provider shall deliver a copy of the medical release required under subdivision (a)(1)(B), a copy of the viator's application for the viatical settlement contract, the notice required under subdivision (a)(2) and a request for verification of coverage to the insurer that issued the life policy that is the subject of the viatical transaction. The National Association of Insurance Commissioners (NAIC) form for verification of coverage shall be used unless another form is developed and approved by the commissioner. (4) The insurer shall respond to a request for verification of coverage submitted on an approved form by a viatical settlement provider or viatical settlement broker within thirty (30) calendar days of the date the request is received and shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract or possible fraud. The insurer shall accept a request for verification of coverage made on a NAIC form or any other form approved by the commissioner. The insurer shall accept an original or facsimile or electronic copy of such request and any accompanying authorization signed by the viator. Failure by the insurer to meet its obligations under this subdivision (a)(4) shall be a violation of §§ 56-50-111(c) and 56-50-116 . (5) Prior to or at the time of execution of the viatical settlement contract, the viatical settlement provider shall obtain a witnessed document in which the viator consents to the viatical settlement contract, represents that the viator has a full and complete understanding of the viatical settlement contract, that the viator has a full and complete understanding of the benefits of the life insurance policy, acknowledges that the viator is entering into the viatical settlement contract freely and voluntarily and, for persons with a terminal or chronic illness or condition, acknowledges that the insured has a terminal or chronic illness and that the terminal or chronic illness or condition was diagnosed after the life insurance policy was issued. (6) If a viatical settlement broker performs any of these activities required of the viatical settlement provider, the provider is deemed to have fulfilled the requirements of this section.
(1) A viatical settlement provider entering into a viatical settlement contract shall first obtain: (A) If the viator is the insured, a written statement from a licensed attending physician that the viator is of sound mind and under no constraint or undue influence to enter into a viatical settlement contract; and (B) A document in which the insured consents to the release of the insured's medical records to a licensed viatical settlement provider, viatical settlement broker and the insurance company that issued the life insurance policy covering the life of the insured.
(A) If the viator is the insured, a written statement from a licensed attending physician that the viator is of sound mind and under no constraint or undue influence to enter into a viatical settlement contract; and
(B) A document in which the insured consents to the release of the insured's medical records to a licensed viatical settlement provider, viatical settlement broker and the insurance company that issued the life insurance policy covering the life of the insured.
(2) Within twenty (20) days after a viator executes documents necessary to transfer any rights under an insurance policy or within twenty (20) days of entering any agreement, option, promise or any other form of understanding, expressed or implied, to viaticate the policy, the viatical settlement provider shall give written notice to the insurer that issued the insurance policy that the policy has or will become a viaticated policy. The notice shall be accompanied by the documents required by subdivision (a)(3).
(3) The viatical provider shall deliver a copy of the medical release required under subdivision (a)(1)(B), a copy of the viator's application for the viatical settlement contract, the notice required under subdivision (a)(2) and a request for verification of coverage to the insurer that issued the life policy that is the subject of the viatical transaction. The National Association of Insurance Commissioners (NAIC) form for verification of coverage shall be used unless another form is developed and approved by the commissioner.
(4) The insurer shall respond to a request for verification of coverage submitted on an approved form by a viatical settlement provider or viatical settlement broker within thirty (30) calendar days of the date the request is received and shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract or possible fraud. The insurer shall accept a request for verification of coverage made on a NAIC form or any other form approved by the commissioner. The insurer shall accept an original or facsimile or electronic copy of such request and any accompanying authorization signed by the viator. Failure by the insurer to meet its obligations under this subdivision (a)(4) shall be a violation of §§ 56-50-111(c) and 56-50-116 .
(5) Prior to or at the time of execution of the viatical settlement contract, the viatical settlement provider shall obtain a witnessed document in which the viator consents to the viatical settlement contract, represents that the viator has a full and complete understanding of the viatical settlement contract, that the viator has a full and complete understanding of the benefits of the life insurance policy, acknowledges that the viator is entering into the viatical settlement contract freely and voluntarily and, for persons with a terminal or chronic illness or condition, acknowledges that the insured has a terminal or chronic illness and that the terminal or chronic illness or condition was diagnosed after the life insurance policy was issued.
(6) If a viatical settlement broker performs any of these activities required of the viatical settlement provider, the provider is deemed to have fulfilled the requirements of this section.
(b) All medical information solicited or obtained by any licensee shall be subject to the applicable state laws relating to confidentiality of medical information.
(c) The viator has the right to rescind a viatical settlement contract before the earlier of thirty (30) calendar days after the date upon which the viatical settlement contract is executed by all parties or fifteen (15) calendar days after the viatical settlement proceeds have been paid to the viator, as provided in subsection (f). Rescission, if exercised by the viator, is effective only if both notice of the rescission is given, and the viator repays all proceeds and any premiums, loans and loan interest paid on account of the viatical settlement within the rescission period. If the insured dies during the rescission period, the viatical settlement contract shall be deemed to have been rescinded, subject to repayment by the viator or the viator's estate of all viatical settlement proceeds and any premiums, loans and loan interest paid on account of the viatical settlement within sixty (60) days of the insured's death.
(d) The purchaser shall have the right to rescind a viatical settlement contract within three (3) days after the disclosures mandated by § 56-50-108(d) and (e) are received by the purchaser.
(e) The viatical settlement provider shall instruct the viator to send the executed documents required to effect the change in ownership, assignment or change in beneficiary directly to the independent escrow agent. Within three (3) business days after the date the escrow agent receives the document or from the date the viatical settlement provider receives the documents, if the viator erroneously provides the documents directly to the provider, the provider shall pay or transfer the proceeds of the viatical settlement into an escrow or trust account maintained in a state or federally chartered financial institution whose deposits are insured by the federal deposit insurance corporation (FDIC). Upon payment of the settlement proceeds into the escrow account, the escrow agent shall deliver the original change in ownership, assignment or change in beneficiary forms to the viatical settlement provider or related provider trust or other designated representative of the viatical settlement provider. Upon the escrow agent's receipt of the acknowledgment of the properly completed transfer of ownership, assignment or designation of beneficiary from the insurance company, the escrow agent shall pay the settlement proceeds to the viator.
(f) Failure to tender consideration to the viator for the viatical settlement contract within the time set forth in the disclosure pursuant to § 56-50-108(a)(7) renders the viatical settlement contract voidable by the viator for lack of consideration until the time consideration is tendered to and accepted by the viator. Funds shall be deemed sent by a viatical settlement provider to a viator as of the date that the escrow agent either releases funds for wire transfer to the viator or places a check for delivery to the viator via the United States postal service or other nationally recognized delivery service.
(g) Contacts with the insured for the purpose of determining the health status of the insured by the viatical settlement provider after the viatical settlement has occurred shall only be made by the viatical settlement provider licensed in this state or its authorized representatives and shall be limited to once every three (3) months for insureds with a life expectancy of more than one (1) year, and to no more than once per month for insureds with a life expectancy of one (1) year or less. The provider shall explain the procedure for these contacts at the time the viatical settlement contract is entered into. The limitations set forth in this subsection (g) shall not apply to any contacts with an insured for reasons other than determining the insured's health status. Viatical settlement providers and viatical settlement brokers shall be responsible for the actions of their authorized representatives.
Acts 2009 , ch. 604, § 11.
Tenn. Code Ann. § 56-15-112 — TN Code / Title 56 / Chapter 15 / Section 56-15-112
Action against company - Jurisdiction - Venue
Status: in_force

Any surety company doing business under this chapter may be sued in respect to doing business under this chapter in any court that has now, or hereafter may have, jurisdiction of actions or suits upon the recognizance, stipulation, bond, or undertaking in the county in which the recognizance, stipulation, bond, or undertaking was made or guaranteed, or in the county in which the principal office of the company is located; and, for the purposes of this chapter, the recognizance, stipulation, bond, or undertaking shall be treated as made or guaranteed in the county in which the office is located, to which it is returnable or in which it is filed, or in the county in which the principal in the recognizance, stipulation, bond, or undertaking resided when it was made or guaranteed. Acts 1895, ch. 175, § 5; Shan., § 2218; Code 1932, § 3950; T.C.A. (orig. ed.), § 56-1412.
Any surety company doing business under this chapter may be sued in respect to doing business under this chapter in any court that has now, or hereafter may have, jurisdiction of actions or suits upon the recognizance, stipulation, bond, or undertaking in the county in which the recognizance, stipulation, bond, or undertaking was made or guaranteed, or in the county in which the principal office of the company is located; and, for the purposes of this chapter, the recognizance, stipulation, bond, or undertaking shall be treated as made or guaranteed in the county in which the office is located, to which it is returnable or in which it is filed, or in the county in which the principal in the recognizance, stipulation, bond, or undertaking resided when it was made or guaranteed.
Acts 1895, ch. 175, § 5; Shan., § 2218; Code 1932, § 3950; T.C.A. (orig. ed.), § 56-1412.
Tenn. Code Ann. § 56-9-106 — TN Code / Title 56 / Chapter 9 / Section 56-9-106
Obligation to cooperate with commissioner - Obstruction of, or interference with, commissioner - Penalties
Status: in_force

(a) (1) Any officer, manager, director, trustee, owner, employee or agent of any insurer, or any other persons with authority over, or in charge of, any segment of the insurer's affairs, shall cooperate with the commissioner in any proceeding under this chapter or any investigation preliminary to the proceeding. (2) As used in this section: (A) "Person" includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer; and (B) "To cooperate" includes, but is not limited to, the following: (i) To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and (ii) To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control. (b) No person shall obstruct or interfere with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto. (c) This section shall not be construed to abridge otherwise existing legal rights, including the right to resist a petition for liquidation or other delinquency proceedings, or other orders. (d) Any person included within subsection (a) who willfully and wrongfully obstructs or interferes with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto, or who violates any order the commissioner issued validly under this chapter may: (1) Be sentenced by a court of competent jurisdiction to pay a fine not exceeding ten thousand dollars ($10,000) or be punished for a Class E felony, or both; or (2) After a hearing, be subject to the imposition by the commissioner of a civil penalty not to exceed ten thousand dollars ($10,000) and shall be subject further to the revocation or suspension of any insurance licenses issued by the commissioner. Acts 1991, ch. 142, § 4.
(a) (1) Any officer, manager, director, trustee, owner, employee or agent of any insurer, or any other persons with authority over, or in charge of, any segment of the insurer's affairs, shall cooperate with the commissioner in any proceeding under this chapter or any investigation preliminary to the proceeding. (2) As used in this section: (A) "Person" includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer; and (B) "To cooperate" includes, but is not limited to, the following: (i) To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and (ii) To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control.
(1) Any officer, manager, director, trustee, owner, employee or agent of any insurer, or any other persons with authority over, or in charge of, any segment of the insurer's affairs, shall cooperate with the commissioner in any proceeding under this chapter or any investigation preliminary to the proceeding.
(2) As used in this section: (A) "Person" includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer; and (B) "To cooperate" includes, but is not limited to, the following: (i) To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and (ii) To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control.
(A) "Person" includes any person who exercises control directly or indirectly over activities of the insurer through any holding company or other affiliate of the insurer; and
(B) "To cooperate" includes, but is not limited to, the following: (i) To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and (ii) To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control.
(i) To reply promptly in writing to any inquiry from the commissioner requesting such a reply; and
(ii) To make available to the commissioner any books, accounts, documents, or other records or information or property of, or pertaining to, the insurer and in the person's possession, custody or control.
(b) No person shall obstruct or interfere with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto.
(c) This section shall not be construed to abridge otherwise existing legal rights, including the right to resist a petition for liquidation or other delinquency proceedings, or other orders.
(d) Any person included within subsection (a) who willfully and wrongfully obstructs or interferes with the commissioner in the conduct of any delinquency proceeding or any investigation preliminary or incidental thereto, or who violates any order the commissioner issued validly under this chapter may: (1) Be sentenced by a court of competent jurisdiction to pay a fine not exceeding ten thousand dollars ($10,000) or be punished for a Class E felony, or both; or (2) After a hearing, be subject to the imposition by the commissioner of a civil penalty not to exceed ten thousand dollars ($10,000) and shall be subject further to the revocation or suspension of any insurance licenses issued by the commissioner.
(1) Be sentenced by a court of competent jurisdiction to pay a fine not exceeding ten thousand dollars ($10,000) or be punished for a Class E felony, or both; or
(2) After a hearing, be subject to the imposition by the commissioner of a civil penalty not to exceed ten thousand dollars ($10,000) and shall be subject further to the revocation or suspension of any insurance licenses issued by the commissioner.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-7-1304 — TN Code / Title 56 / Chapter 7 / Section 56-7-1304
Notice of intention not to renew
Status: in_force

(a) Nothing in this part applies to nonrenewal, except that in the event the company does not intend to renew the contract, it shall mail or deliver to the named insured, at the address shown in the policy, not less than thirty (30) days' notice of its intention not to renew. Proof of mailing of notice shall be sufficient proof of notice. (b) Unless the nonrenewal notice contains a reason for the nonrenewal action, the notice shall advise the insured that upon written request of the named insured, mailed or delivered to the insurer not later than fifteen (15) days after the effective date of the nonrenewal, the insurer will within twenty (20) days mail to the named insured a written statement specifying a reason for the nonrenewal action. There shall be no liability on the part of and no cause of action of any nature shall arise against any insurer, its authorized representative, its agents, its employees, or against any firm, person or corporation furnishing information to the insurer, as to reason for nonrenewal. Acts 1968, ch. 582, § 4; T.C.A., § 56-1157; Acts 1988, ch. 603, § 1; 1989, ch. 110, § 1.
(a) Nothing in this part applies to nonrenewal, except that in the event the company does not intend to renew the contract, it shall mail or deliver to the named insured, at the address shown in the policy, not less than thirty (30) days' notice of its intention not to renew. Proof of mailing of notice shall be sufficient proof of notice.
(b) Unless the nonrenewal notice contains a reason for the nonrenewal action, the notice shall advise the insured that upon written request of the named insured, mailed or delivered to the insurer not later than fifteen (15) days after the effective date of the nonrenewal, the insurer will within twenty (20) days mail to the named insured a written statement specifying a reason for the nonrenewal action. There shall be no liability on the part of and no cause of action of any nature shall arise against any insurer, its authorized representative, its agents, its employees, or against any firm, person or corporation furnishing information to the insurer, as to reason for nonrenewal.
Acts 1968, ch. 582, § 4; T.C.A., § 56-1157; Acts 1988, ch. 603, § 1; 1989, ch. 110, § 1.
Tenn. Code Ann. § 56-7-1504 — TN Code / Title 56 / Chapter 7 / Section 56-7-1504
Benefits - Minimum standards
Status: in_force

Medicare supplement policies shall return to policyholders benefits that are reasonable in relation to the premium charged. The commissioner shall promulgate reasonable rules and regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices. Every entity providing medicare supplement policies and certificates in this state shall file annually its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this state. All filings of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this part. Acts 1992, ch. 735, § 4.
Medicare supplement policies shall return to policyholders benefits that are reasonable in relation to the premium charged. The commissioner shall promulgate reasonable rules and regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices. Every entity providing medicare supplement policies and certificates in this state shall file annually its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this state. All filings of rates and rating schedules shall demonstrate that the actual and expected losses in relation to premiums comply with the requirements of this part.
Acts 1992, ch. 735, § 4.
Tenn. Code Ann. § 56-3-702 — TN Code / Title 56 / Chapter 3 / Section 56-3-702
Equity securities of domestic stock insurance companies - Statements of beneficial owners, directors and officers
Status: in_force

Every person who is directly or indirectly the beneficial owner of more than ten percent (10%) of any class of any equity security of a domestic stock insurance company, or who is a director or an officer of the company, shall file in the office of the commissioner within ten (10) days after the person becomes the beneficial owner, director, or officer, a statement, in the form the commissioner prescribes, of the amount of all equity securities of the company of which the person is the beneficial owner, and within ten (10) days after the close of each calendar month thereafter, if there has been a change in ownership during that month, shall file in the office of the commissioner a statement, in the form the commissioner prescribes, indicating the ownership at the close of the calendar month and the changes in ownership that have occurred during that calendar month. Acts 1965, ch. 95, § 1; T.C.A., §§ 56-250, 56-332.
Every person who is directly or indirectly the beneficial owner of more than ten percent (10%) of any class of any equity security of a domestic stock insurance company, or who is a director or an officer of the company, shall file in the office of the commissioner within ten (10) days after the person becomes the beneficial owner, director, or officer, a statement, in the form the commissioner prescribes, of the amount of all equity securities of the company of which the person is the beneficial owner, and within ten (10) days after the close of each calendar month thereafter, if there has been a change in ownership during that month, shall file in the office of the commissioner a statement, in the form the commissioner prescribes, indicating the ownership at the close of the calendar month and the changes in ownership that have occurred during that calendar month.
Acts 1965, ch. 95, § 1; T.C.A., §§ 56-250, 56-332.
Tenn. Code Ann. § 56-20-103 — TN Code / Title 56 / Chapter 20 / Section 56-20-103
Obligations of insured - Uniformity
Status: in_force

Every person insured in and by any corporation subject to this chapter shall give an undertaking in the form as the corporation may prescribe, which form shall be uniform between and by all the insured, to pay the person's pro rata share of all losses or damages sustained by any member from any cause specified in the policy of the corporation. The person shall also pay a reasonable sum for expenses as the bylaws may require. Acts 1895, ch. 220, § 4; Shan., § 3357; Code 1932, § 6239; T.C.A. (orig. ed.), § 56-1903.
Every person insured in and by any corporation subject to this chapter shall give an undertaking in the form as the corporation may prescribe, which form shall be uniform between and by all the insured, to pay the person's pro rata share of all losses or damages sustained by any member from any cause specified in the policy of the corporation. The person shall also pay a reasonable sum for expenses as the bylaws may require.
Acts 1895, ch. 220, § 4; Shan., § 3357; Code 1932, § 6239; T.C.A. (orig. ed.), § 56-1903.
Tenn. Code Ann. § 56-45-101 — TN Code / Title 56 / Chapter 45 / Section 56-45-101
Purpose
Status: in_force

The purpose of this chapter is to regulate the formation and/or operation of risk retention groups and purchasing groups in this state formed pursuant to the federal "Liability Risk Retention Act of 1986" ("RRA 1986") ( 15 U.S.C. § 3901 et seq.), to the extent permitted by such law. Acts 1991, ch. 142, § 6.
The purpose of this chapter is to regulate the formation and/or operation of risk retention groups and purchasing groups in this state formed pursuant to the federal "Liability Risk Retention Act of 1986" ("RRA 1986") ( 15 U.S.C. § 3901 et seq.), to the extent permitted by such law.
Acts 1991, ch. 142, § 6.
Tenn. Code Ann. § 56-2-506 — TN Code / Title 56 / Chapter 2 / Section 56-2-506
Method of service - Notice to defendant - Filing with clerk
Status: in_force

(a) Service of process shall be made by delivering and leaving with the secretary of state two (2) copies of the process. (b) The secretary of state shall forthwith mail by registered mail one (1) of the copies of the process to the company at its last known principal place of business, and shall keep a record of all process so served upon the secretary of state. (c) The service shall be sufficient service upon the company; provided, that notice of the service and a copy of the process are, within ten (10) days thereafter, sent by registered mail by or on behalf of the commissioner to the company at its last known principal place of business; and provided, further, that the receipt by the secretary of state and an affidavit of compliance with this section by or on behalf of the commissioner are filed with the clerk of the court in which the action or proceeding is pending on or before the return date of the process or within any further time that the court allows. Acts 1968, ch. 536, § 8; T.C.A., § 56-256.
(a) Service of process shall be made by delivering and leaving with the secretary of state two (2) copies of the process.
(b) The secretary of state shall forthwith mail by registered mail one (1) of the copies of the process to the company at its last known principal place of business, and shall keep a record of all process so served upon the secretary of state.
(c) The service shall be sufficient service upon the company; provided, that notice of the service and a copy of the process are, within ten (10) days thereafter, sent by registered mail by or on behalf of the commissioner to the company at its last known principal place of business; and provided, further, that the receipt by the secretary of state and an affidavit of compliance with this section by or on behalf of the commissioner are filed with the clerk of the court in which the action or proceeding is pending on or before the return date of the process or within any further time that the court allows.
Acts 1968, ch. 536, § 8; T.C.A., § 56-256.
Tenn. Code Ann. § 56-7-2313 — TN Code / Title 56 / Chapter 7 / Section 56-7-2313
Converted policy - Conditions
Status: in_force

Issuance of a converted policy shall be subject to the following conditions: (1) Written application for the converted policy shall be made and the first premium paid to the insurer not later than thirty-one (31) days after the termination under the group policy; (2) The converted policy shall be issued without evidence of insurability; (3) The initial premium for the converted policy for the first twelve (12) months and subsequent renewal premiums shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the converted policy and to the type and amount of insurance provided; (4) The effective date of the converted policy shall be the day following the termination of insurance under the group policy; and (5) The converted policy shall cover the employee or member and the person's dependents who were covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any dependent. Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1502.
Issuance of a converted policy shall be subject to the following conditions:
(1) Written application for the converted policy shall be made and the first premium paid to the insurer not later than thirty-one (31) days after the termination under the group policy;
(2) The converted policy shall be issued without evidence of insurability;
(3) The initial premium for the converted policy for the first twelve (12) months and subsequent renewal premiums shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the converted policy and to the type and amount of insurance provided;
(4) The effective date of the converted policy shall be the day following the termination of insurance under the group policy; and
(5) The converted policy shall cover the employee or member and the person's dependents who were covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any dependent.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1502.
Tenn. Code Ann. § 56-7-2324 — TN Code / Title 56 / Chapter 7 / Section 56-7-2324
Student accident coverage - Benefit reduction restricted
Status: in_force

Under any student accident coverage, regardless of the form of the contract, no provision may be included that reduces the benefits payable on account of the existence of group or individual insurance contracts that provide health insurance coverage on the student; provided, that this section does not apply to any student accident coverage where the school or institution is the policyholder and pays one hundred percent (100%) of the premium for the policy, without receipt of any premium contribution from any individual insured, parent or guardian. Acts 1976, ch. 412, § 2; 1978, ch. 897, § 1; T.C.A., § 56-3333; Acts 1992, ch. 984, § 1; T.C.A., § 56-26-131.
Under any student accident coverage, regardless of the form of the contract, no provision may be included that reduces the benefits payable on account of the existence of group or individual insurance contracts that provide health insurance coverage on the student; provided, that this section does not apply to any student accident coverage where the school or institution is the policyholder and pays one hundred percent (100%) of the premium for the policy, without receipt of any premium contribution from any individual insured, parent or guardian.
Acts 1976, ch. 412, § 2; 1978, ch. 897, § 1; T.C.A., § 56-3333; Acts 1992, ch. 984, § 1; T.C.A., § 56-26-131.
Tenn. Code Ann. § 56-43-117 — TN Code / Title 56 / Chapter 43 / Section 56-43-117
Public documents
Status: in_force

All applications, filings, and reports required under this chapter shall be treated as public documents. Acts 1989, ch. 423, § 18.
All applications, filings, and reports required under this chapter shall be treated as public documents.
Acts 1989, ch. 423, § 18.
Tenn. Code Ann. § 56-19-105 — TN Code / Title 56 / Chapter 19 / Section 56-19-105
Certificate of incorporation
Status: in_force

Upon approval as provided in § 56-19-104 , the commissioner or any other officer that may be charged with the duty in the case of other corporations shall issue to the company a certificate that shall be its authority to begin business. Acts 1919, ch. 108, § 4; Shan. Supp., § 3369a58b9; Code 1932, § 6321; T.C.A. (orig. ed.), § 56-1705.
Upon approval as provided in § 56-19-104 , the commissioner or any other officer that may be charged with the duty in the case of other corporations shall issue to the company a certificate that shall be its authority to begin business.
Acts 1919, ch. 108, § 4; Shan. Supp., § 3369a58b9; Code 1932, § 6321; T.C.A. (orig. ed.), § 56-1705.
Tenn. Code Ann. § 56-42-107 — TN Code / Title 56 / Chapter 42 / Section 56-42-107
Incontestability period
Status: in_force

(a) For a policy or certificate that has been in force for less than six (6) months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. (b) For a policy or certificate that has been in force for at least six (6) months but less than two (2) years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought. (c) After a policy or certificate has been in force for two (2) years, it is not contestable upon the grounds of misrepresentation alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health. (d) (1) A long-term care insurance policy or certificate may be field issued if the compensation to the field issuer is not based on the number of policies or certificates issued. (2) For purposes of subdivision (d)(1), "field issued" means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third party administrator by an insurer and using the insurer's underwriting guidelines. (e) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded. (f) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by § 56-7-2307(3) . In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care. Acts 2008, ch. 1058, § 10.
(a) For a policy or certificate that has been in force for less than six (6) months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
(b) For a policy or certificate that has been in force for at least six (6) months but less than two (2) years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.
(c) After a policy or certificate has been in force for two (2) years, it is not contestable upon the grounds of misrepresentation alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(d) (1) A long-term care insurance policy or certificate may be field issued if the compensation to the field issuer is not based on the number of policies or certificates issued. (2) For purposes of subdivision (d)(1), "field issued" means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third party administrator by an insurer and using the insurer's underwriting guidelines.
(1) A long-term care insurance policy or certificate may be field issued if the compensation to the field issuer is not based on the number of policies or certificates issued.
(2) For purposes of subdivision (d)(1), "field issued" means a policy or certificate issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third party administrator by an insurer and using the insurer's underwriting guidelines.
(e) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(f) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by § 56-7-2307(3) . In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
Acts 2008, ch. 1058, § 10.
Tenn. Code Ann. § 56-53-104 — TN Code / Title 56 / Chapter 53 / Section 56-53-104
Criminal penalties
Status: in_force

A person who violates § 56-53-102 shall be punished and subject to the penalties under § 39-14-133 . Acts 2001, ch. 356, § 5.
A person who violates § 56-53-102 shall be punished and subject to the penalties under § 39-14-133 .
Acts 2001, ch. 356, § 5.
Tenn. Code Ann. § 56-30-112 — TN Code / Title 56 / Chapter 30 / Section 56-30-112
Issuance of license - Prerequisites
Status: in_force

The commissioner shall issue a license upon compliance with this chapter, and other proper requirements of the commissioner, and upon being satisfied that: (1) All items required to be filed are in proper form, as required by this chapter, and meet the approval of the commissioner; (2) The applicant is established as a bona fide dental service plan corporation, and the service rendered by the corporation is not an unnecessary duplication of similar services in the community served, and is desirable for public necessity and convenience, and a fair opportunity has been given to all practicing dentists of standing in the area to be served to become participating dentists; (3) The solicitations of contracts by the corporation and its conditions or methods of operation are fair and reasonable; (4) The rates charged are fair, reasonable, adequate and not unfairly discriminatory, and the benefits to be provided are fair, reasonable, and not unfairly discriminatory. The rates may differ between subscribers in recognized groups and subscribers not in groups, all subject to the approval of the commissioner; (5) The amount of money actually available for working capital is sufficient to carry all acquisition costs and operating expenses for a period of at least six (6) months from the date of the issuance of the certificate, or two thousand five hundred dollars ($2,500), whichever amount is larger; (6) The amount provided as working capital shall only be provided by individuals or groups who have no financial interest in the activities of the dental service corporations, or by the participating dentists. Interest charged for the capital, if any, shall not exceed six percent (6%), and payment of interest, if any, and repayment of the working capital, shall be permitted only after adequate provisions have been made for operating expenses, payments to participating dentists and the establishment of legal reserves and other reserves as may be required by the commissioner; (7) The dental service corporation shall maintain at all times proper reserves, subject to the approval of the commissioner, for unearned subscription fees and unearned premiums, and for unpaid dental service bills, including provision for unreported and undischarged dental cases and other known liabilities. In addition, a contingency reserve shall be accumulated annually at the rate of not less than two and one half percent (2.5%) of net premium income. When the contingency reserves equal seventy-five thousand dollars ($75,000), or fifty-five percent (55%) of the annual premium income, whichever is higher, further accumulations may be discontinued for any length of time not required to meet the requirements of this subdivision (7); (8) In the county or counties or areas in which a corporation proposes to operate, fifty-one percent (51%) or more of the resident dentists have agreed to render the dental services for which the corporation agrees to pay, or that at least twenty-five percent (25%) of the dentists duly licensed to practice in this state under title 63, chapter 5, have agreed to render dental services for corporations organized or to be organized pursuant to this chapter; and (9) A provision has been made in the subscription contract authorizing dental service other than participating dentists, in which case money benefits shall be provided as specified in the subscription contract, and approved as fair by the commissioner. The certificate of authority issued by the commissioner to operate a dental service plan or plans will be limited by the commissioner to the contracts and practices approved by the commissioner, and may be further limited to the county or counties or areas as the commissioner deems in the public interest. Acts 1961, ch. 340, § 11; 1965, ch. 309, § 3; T.C.A., § 56-3512.
The commissioner shall issue a license upon compliance with this chapter, and other proper requirements of the commissioner, and upon being satisfied that:
(1) All items required to be filed are in proper form, as required by this chapter, and meet the approval of the commissioner;
(2) The applicant is established as a bona fide dental service plan corporation, and the service rendered by the corporation is not an unnecessary duplication of similar services in the community served, and is desirable for public necessity and convenience, and a fair opportunity has been given to all practicing dentists of standing in the area to be served to become participating dentists;
(3) The solicitations of contracts by the corporation and its conditions or methods of operation are fair and reasonable;
(4) The rates charged are fair, reasonable, adequate and not unfairly discriminatory, and the benefits to be provided are fair, reasonable, and not unfairly discriminatory. The rates may differ between subscribers in recognized groups and subscribers not in groups, all subject to the approval of the commissioner;
(5) The amount of money actually available for working capital is sufficient to carry all acquisition costs and operating expenses for a period of at least six (6) months from the date of the issuance of the certificate, or two thousand five hundred dollars ($2,500), whichever amount is larger;
(6) The amount provided as working capital shall only be provided by individuals or groups who have no financial interest in the activities of the dental service corporations, or by the participating dentists. Interest charged for the capital, if any, shall not exceed six percent (6%), and payment of interest, if any, and repayment of the working capital, shall be permitted only after adequate provisions have been made for operating expenses, payments to participating dentists and the establishment of legal reserves and other reserves as may be required by the commissioner;
(7) The dental service corporation shall maintain at all times proper reserves, subject to the approval of the commissioner, for unearned subscription fees and unearned premiums, and for unpaid dental service bills, including provision for unreported and undischarged dental cases and other known liabilities. In addition, a contingency reserve shall be accumulated annually at the rate of not less than two and one half percent (2.5%) of net premium income. When the contingency reserves equal seventy-five thousand dollars ($75,000), or fifty-five percent (55%) of the annual premium income, whichever is higher, further accumulations may be discontinued for any length of time not required to meet the requirements of this subdivision (7);
(8) In the county or counties or areas in which a corporation proposes to operate, fifty-one percent (51%) or more of the resident dentists have agreed to render the dental services for which the corporation agrees to pay, or that at least twenty-five percent (25%) of the dentists duly licensed to practice in this state under title 63, chapter 5, have agreed to render dental services for corporations organized or to be organized pursuant to this chapter; and
(9) A provision has been made in the subscription contract authorizing dental service other than participating dentists, in which case money benefits shall be provided as specified in the subscription contract, and approved as fair by the commissioner. The certificate of authority issued by the commissioner to operate a dental service plan or plans will be limited by the commissioner to the contracts and practices approved by the commissioner, and may be further limited to the county or counties or areas as the commissioner deems in the public interest.
Acts 1961, ch. 340, § 11; 1965, ch. 309, § 3; T.C.A., § 56-3512.
Tenn. Code Ann. § 56-2-118 — TN Code / Title 56 / Chapter 2 / Section 56-2-118
Address and phone number of policyholder service office outside state
Status: in_force

(a) Every policy of life insurance, accident and health insurance, property insurance or casualty insurance issued after January 1, 1989, covering risks in this state by a company not maintaining a policyholder service office in this state, shall be accompanied by the complete address and telephone number, toll-free if available, of the policyholder service office of the company issuing the policy. In the event an insurance company that has a policyholder's service office in this state ceases to maintain the office, the company shall provide its policyholders residing in this state with a written notice containing the complete address and telephone number, toll-free if available, of the servicing agent or the nearest policyholder service office of the company. (b) The commissioner may promulgate rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to effectuate the purposes of this section. (c) Failure to include the information required by subsection (a) shall be a deceptive act or practice and the procedures and penalties established by chapter 8, part 1 of this title, shall be applicable. Acts 1988, ch. 721, §§ 1-3.
(a) Every policy of life insurance, accident and health insurance, property insurance or casualty insurance issued after January 1, 1989, covering risks in this state by a company not maintaining a policyholder service office in this state, shall be accompanied by the complete address and telephone number, toll-free if available, of the policyholder service office of the company issuing the policy. In the event an insurance company that has a policyholder's service office in this state ceases to maintain the office, the company shall provide its policyholders residing in this state with a written notice containing the complete address and telephone number, toll-free if available, of the servicing agent or the nearest policyholder service office of the company.
(b) The commissioner may promulgate rules and regulations in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to effectuate the purposes of this section.
(c) Failure to include the information required by subsection (a) shall be a deceptive act or practice and the procedures and penalties established by chapter 8, part 1 of this title, shall be applicable.
Acts 1988, ch. 721, §§ 1-3.
Tenn. Code Ann. § 56-7-708 — TN Code / Title 56 / Chapter 7 / Section 56-7-708
Fraudulent statements in application or claim under industrial or fraternal insurance forbidden
Status: in_force

No person shall knowingly or willfully make or aid in making any false or fraudulent statement of any material fact or thing in any written statement or certificate for the purpose of procuring or attempting to procure the payment of any false or fraudulent claim against any industrial insurance company or fraternal or benefit association, and no person shall make any false or fraudulent statement in any application for insurance, or as to the death or disability of the policy or certificate holder for the purpose of obtaining any money or benefit from the industrial insurance company or fraternal or benefit association licensed to do business in this state. Acts 1917, ch. 7, § 3; Shan., § 3369a153; Code 1932, § 6446; T.C.A. (orig. ed.), § 56-1135; Acts 1989, ch. 591, § 113.
No person shall knowingly or willfully make or aid in making any false or fraudulent statement of any material fact or thing in any written statement or certificate for the purpose of procuring or attempting to procure the payment of any false or fraudulent claim against any industrial insurance company or fraternal or benefit association, and no person shall make any false or fraudulent statement in any application for insurance, or as to the death or disability of the policy or certificate holder for the purpose of obtaining any money or benefit from the industrial insurance company or fraternal or benefit association licensed to do business in this state.
Acts 1917, ch. 7, § 3; Shan., § 3369a153; Code 1932, § 6446; T.C.A. (orig. ed.), § 56-1135; Acts 1989, ch. 591, § 113.
Tenn. Code Ann. § 56-6-807 — TN Code / Title 56 / Chapter 6 / Section 56-6-807
Written contract - Required provisions
Status: in_force

Transactions between an RM and the reinsurer it represents in that capacity shall only be entered into pursuant to a written contract, specifying the responsibilities of each party, which shall be approved by the reinsurer's board of directors. At least thirty (30) days before the reinsurer assumes or cedes business through the producer, a true copy of the approved contract shall be filed with the commissioner for approval. The contract shall, at a minimum, provide that: (1) The reinsurer may terminate the contract for cause upon written notice to the RM. The reinsurer may immediately suspend the authority of the RM to assume or cede business during the pendency of any dispute regarding the cause for termination; (2) The RM will render accounts to the reinsurer accurately detailing all material transactions, including information necessary to support all commissions, charges and other fees received by or owing to the RM, and remit all funds due under the contract to the reinsurer on not less than a monthly basis; (3) All funds collected for the reinsurer's account will be held by the RM in a fiduciary capacity in a bank that is a qualified United States financial institution. The RM may retain no more than three (3) months' estimated claims payments and allocated loss adjustment expenses. The RM shall maintain a separate bank account for each reinsurer that it represents; (4) For at least ten (10) years after expiration of each contract of reinsurance transacted by the RM, the RM will keep a complete record for each transaction showing: (A) The type of contract, limits, underwriting restrictions, classes or risks and territory; (B) Period of coverage, including effective and expiration dates, cancellation provisions and notice required of cancellation, and disposition of outstanding reserves on covered risks; (C) Reporting and settlement requirements of balances; (D) Rate used to compute the reinsurance premium; (E) Names and addresses of reinsurers; (F) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RM; (G) Related correspondence and memoranda; (H) Proof of placement; (I) Details regarding retrocessions handled by the RM, as permitted by § 56-6-808 , including the identity of retrocessionaires and percentage of each contract assumed or ceded; (J) Financial records, including, but not limited to, premium and loss accounts; and (K) When the RM places a reinsurance contract on behalf of a ceding insurer: (i) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or (ii) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative; (5) The reinsurer will have access to and the right to copy all accounts and records maintained by the RM related to its business in a form usable by the reinsurer; (6) The contract cannot be assigned in whole or in part by the RM; (7) The RM will comply with the written underwriting and rating standards established by the insurer for the acceptance, rejection or cession of all risks; (8) The rates, terms and purposes of commissions, charges and other fees that the RM may levy against the reinsurer are set forth; (9) If the contract permits the RM to settle claims on behalf of the reinsurer: (A) All claims will be reported to the reinsurer in a timely manner; (B) A copy of the claim file will be sent to the reinsurer at its request or as soon as it becomes known that the claim: (i) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer; (ii) Involves a coverage dispute; (iii) May exceed the RM's claims settlement authority; (iv) Is open for more than six (6) months; or (v) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer; (C) All claim files will be the joint property of the reinsurer and RM; however, upon an order of liquidation of the reinsurer, the files shall become the sole property of the reinsurer or its estate, and the RM shall have reasonable access to and the right to copy the files on a timely basis; and (D) Any settlement authority granted to the RM may be terminated for cause upon the reinsurer's written notice to the RM or upon the termination of the contract. The reinsurer may suspend the settlement authority during the pendency of the dispute regarding the cause of termination; (10) If the contract provides for a sharing of interim profits by the RM, that the interim profits will not be paid until one (1) year after the end of each underwriting period for property business and five (5) years after the end of each underwriting period for casualty business, or a later period set by the commissioner for specified lines of insurance, and not until the adequacy of reserves on remaining claims has been verified pursuant to § 56-6-809(c) ; (11) The RM will annually provide the reinsurer with a statement of its financial condition prepared by an independent certified accountant; (12) The reinsurer will periodically, at least semi-annually, conduct an on-site review of the underwriting and claims processing operations of the RM; (13) The RM will disclose to the reinsurer any relationship it has with any insurer prior to ceding or assuming any business with the insurer pursuant to this contract; and (14) Within the scope of its actual or apparent authority, the acts of the RM shall be deemed to be the acts of the reinsurer on whose behalf it is acting. Acts 1993, ch. 253, § 9.
Transactions between an RM and the reinsurer it represents in that capacity shall only be entered into pursuant to a written contract, specifying the responsibilities of each party, which shall be approved by the reinsurer's board of directors. At least thirty (30) days before the reinsurer assumes or cedes business through the producer, a true copy of the approved contract shall be filed with the commissioner for approval. The contract shall, at a minimum, provide that:
(1) The reinsurer may terminate the contract for cause upon written notice to the RM. The reinsurer may immediately suspend the authority of the RM to assume or cede business during the pendency of any dispute regarding the cause for termination;
(2) The RM will render accounts to the reinsurer accurately detailing all material transactions, including information necessary to support all commissions, charges and other fees received by or owing to the RM, and remit all funds due under the contract to the reinsurer on not less than a monthly basis;
(3) All funds collected for the reinsurer's account will be held by the RM in a fiduciary capacity in a bank that is a qualified United States financial institution. The RM may retain no more than three (3) months' estimated claims payments and allocated loss adjustment expenses. The RM shall maintain a separate bank account for each reinsurer that it represents;
(4) For at least ten (10) years after expiration of each contract of reinsurance transacted by the RM, the RM will keep a complete record for each transaction showing: (A) The type of contract, limits, underwriting restrictions, classes or risks and territory; (B) Period of coverage, including effective and expiration dates, cancellation provisions and notice required of cancellation, and disposition of outstanding reserves on covered risks; (C) Reporting and settlement requirements of balances; (D) Rate used to compute the reinsurance premium; (E) Names and addresses of reinsurers; (F) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RM; (G) Related correspondence and memoranda; (H) Proof of placement; (I) Details regarding retrocessions handled by the RM, as permitted by § 56-6-808 , including the identity of retrocessionaires and percentage of each contract assumed or ceded; (J) Financial records, including, but not limited to, premium and loss accounts; and (K) When the RM places a reinsurance contract on behalf of a ceding insurer: (i) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or (ii) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative;
(A) The type of contract, limits, underwriting restrictions, classes or risks and territory;
(B) Period of coverage, including effective and expiration dates, cancellation provisions and notice required of cancellation, and disposition of outstanding reserves on covered risks;
(C) Reporting and settlement requirements of balances;
(D) Rate used to compute the reinsurance premium;
(E) Names and addresses of reinsurers;
(F) Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the RM;
(G) Related correspondence and memoranda;
(H) Proof of placement;
(I) Details regarding retrocessions handled by the RM, as permitted by § 56-6-808 , including the identity of retrocessionaires and percentage of each contract assumed or ceded;
(J) Financial records, including, but not limited to, premium and loss accounts; and
(K) When the RM places a reinsurance contract on behalf of a ceding insurer: (i) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or (ii) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative;
(i) Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or
(ii) If placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative;
(5) The reinsurer will have access to and the right to copy all accounts and records maintained by the RM related to its business in a form usable by the reinsurer;
(6) The contract cannot be assigned in whole or in part by the RM;
(7) The RM will comply with the written underwriting and rating standards established by the insurer for the acceptance, rejection or cession of all risks;
(8) The rates, terms and purposes of commissions, charges and other fees that the RM may levy against the reinsurer are set forth;
(9) If the contract permits the RM to settle claims on behalf of the reinsurer: (A) All claims will be reported to the reinsurer in a timely manner; (B) A copy of the claim file will be sent to the reinsurer at its request or as soon as it becomes known that the claim: (i) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer; (ii) Involves a coverage dispute; (iii) May exceed the RM's claims settlement authority; (iv) Is open for more than six (6) months; or (v) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer; (C) All claim files will be the joint property of the reinsurer and RM; however, upon an order of liquidation of the reinsurer, the files shall become the sole property of the reinsurer or its estate, and the RM shall have reasonable access to and the right to copy the files on a timely basis; and (D) Any settlement authority granted to the RM may be terminated for cause upon the reinsurer's written notice to the RM or upon the termination of the contract. The reinsurer may suspend the settlement authority during the pendency of the dispute regarding the cause of termination;
(A) All claims will be reported to the reinsurer in a timely manner;
(B) A copy of the claim file will be sent to the reinsurer at its request or as soon as it becomes known that the claim: (i) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer; (ii) Involves a coverage dispute; (iii) May exceed the RM's claims settlement authority; (iv) Is open for more than six (6) months; or (v) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer;
(i) Has the potential to exceed the lesser of an amount determined by the commissioner or the limit set by the reinsurer;
(ii) Involves a coverage dispute;
(iii) May exceed the RM's claims settlement authority;
(iv) Is open for more than six (6) months; or
(v) Is closed by payment of the lesser of an amount set by the commissioner or an amount set by the reinsurer;
(C) All claim files will be the joint property of the reinsurer and RM; however, upon an order of liquidation of the reinsurer, the files shall become the sole property of the reinsurer or its estate, and the RM shall have reasonable access to and the right to copy the files on a timely basis; and
(D) Any settlement authority granted to the RM may be terminated for cause upon the reinsurer's written notice to the RM or upon the termination of the contract. The reinsurer may suspend the settlement authority during the pendency of the dispute regarding the cause of termination;
(10) If the contract provides for a sharing of interim profits by the RM, that the interim profits will not be paid until one (1) year after the end of each underwriting period for property business and five (5) years after the end of each underwriting period for casualty business, or a later period set by the commissioner for specified lines of insurance, and not until the adequacy of reserves on remaining claims has been verified pursuant to § 56-6-809(c) ;
(11) The RM will annually provide the reinsurer with a statement of its financial condition prepared by an independent certified accountant;
(12) The reinsurer will periodically, at least semi-annually, conduct an on-site review of the underwriting and claims processing operations of the RM;
(13) The RM will disclose to the reinsurer any relationship it has with any insurer prior to ceding or assuming any business with the insurer pursuant to this contract; and
(14) Within the scope of its actual or apparent authority, the acts of the RM shall be deemed to be the acts of the reinsurer on whose behalf it is acting.
Acts 1993, ch. 253, § 9.
Tenn. Code Ann. § 56-7-501 — TN Code / Title 56 / Chapter 7 / Section 56-7-501
Contingent or mortality contracts - Dividing policyholders or members into classes and paying benefits to oldest member of class prohibited - Exceptions
Status: in_force

No life insurance company, fraternal benefit society, order or association authorized to do business in this state shall hereafter be permitted to issue policies, certificates or contracts to policyholders or members providing for the establishment of its policyholders or members into divisions and classes for the purpose of providing for the payment of benefits from special funds created for that purpose to the oldest member of the division and class or to the member of the division and class whose policy has been in force the longest period of time, upon the death of a member in the division and class; provided, that any life insurance company, fraternal benefit society, order or association heretofore issuing policies, certificates, or contracts on this plan in this state may continue so to do on condition that the life insurance company, fraternal benefit society, order or association shall not hereafter establish its policyholders or members into divisions or classes, other than the divisions or classes actually containing subsisting policies or certificates on February 23, 1939. No division of any class shall contain more than twenty-six (26) policyholders. No additional policyholder or policyholders shall ever be added to any of the divisions in this state because of vacancy or vacancies created by lapsed policies, death or otherwise, and no policyholder or policyholders shall be added in this state to any of the divisions under any circumstances. Acts 1939, ch. 31, § 1; mod. C. Supp. 1950, § 6459.1; T.C.A. (orig. ed.), § 56-1125.
No life insurance company, fraternal benefit society, order or association authorized to do business in this state shall hereafter be permitted to issue policies, certificates or contracts to policyholders or members providing for the establishment of its policyholders or members into divisions and classes for the purpose of providing for the payment of benefits from special funds created for that purpose to the oldest member of the division and class or to the member of the division and class whose policy has been in force the longest period of time, upon the death of a member in the division and class; provided, that any life insurance company, fraternal benefit society, order or association heretofore issuing policies, certificates, or contracts on this plan in this state may continue so to do on condition that the life insurance company, fraternal benefit society, order or association shall not hereafter establish its policyholders or members into divisions or classes, other than the divisions or classes actually containing subsisting policies or certificates on February 23, 1939. No division of any class shall contain more than twenty-six (26) policyholders. No additional policyholder or policyholders shall ever be added to any of the divisions in this state because of vacancy or vacancies created by lapsed policies, death or otherwise, and no policyholder or policyholders shall be added in this state to any of the divisions under any circumstances.
Acts 1939, ch. 31, § 1; mod. C. Supp. 1950, § 6459.1; T.C.A. (orig. ed.), § 56-1125.
Tenn. Code Ann. § 56-18-116 — TN Code / Title 56 / Chapter 18 / Section 56-18-116
Abandonment of conversion of stock life insurance company into mutual
Status: in_force

Any time before the mutualization of the corporation is complete, the corporation may abandon a plan of mutualization by the same procedure as was followed in adopting the plan. Upon abandonment, any right of any stockholder to be paid for stock in accordance with the plan shall cease and terminate, and the corporation shall continue to conduct its business as a domestic stock life insurance corporation as though no plan of mutualization had ever been adopted. Acts 1949, ch. 91, § 5; C. Supp. 1950, § 6433.17 (Williams, § 6433.21); T.C.A. (orig. ed.), § 56-1617.
Any time before the mutualization of the corporation is complete, the corporation may abandon a plan of mutualization by the same procedure as was followed in adopting the plan. Upon abandonment, any right of any stockholder to be paid for stock in accordance with the plan shall cease and terminate, and the corporation shall continue to conduct its business as a domestic stock life insurance corporation as though no plan of mutualization had ever been adopted.
Acts 1949, ch. 91, § 5; C. Supp. 1950, § 6433.17 (Williams, § 6433.21); T.C.A. (orig. ed.), § 56-1617.
Tenn. Code Ann. § 56-31-116 — TN Code / Title 56 / Chapter 31 / Section 56-31-116
Annual statement - Form - Filing fee
Status: in_force

Every vision service plan corporation shall annually, on or before March 1, file in the office of the department a statement of its operations for the calendar year, showing financial conditions as of December 31, then next preceding, in such form and content as the commissioner prescribes, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of fifteen dollars ($15.00). Acts 1969, ch. 118, § 17; impl. am. Acts 1971, ch. 137, § 1; T.C.A., § 56-3716.
Every vision service plan corporation shall annually, on or before March 1, file in the office of the department a statement of its operations for the calendar year, showing financial conditions as of December 31, then next preceding, in such form and content as the commissioner prescribes, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of fifteen dollars ($15.00).
Acts 1969, ch. 118, § 17; impl. am. Acts 1971, ch. 137, § 1; T.C.A., § 56-3716.
Tenn. Code Ann. § 56-47-112 — TN Code / Title 56 / Chapter 47 / Section 56-47-112
Workers' compensation on insurance antifraud plans
Status: in_force

(a) (1) Every insurer shall prepare, implement, maintain and submit to the department of commerce and insurance a workers' compensation insurance anti-fraud plan. (2) Each insurer's anti-fraud plan shall outline specific procedures to: (A) Prevent, detect and investigate all forms of insurance fraud, including fraud involving the insurer's employees or agents; fraud resulting from misrepresentations in the application, renewal or rating of insurance policies; claims fraud; and security of the insurer's data processing system; (B) Educate appropriate employees on fraud detection and the insurer's anti-fraud plan; (C) Provide for the hiring of or contracting for fraud investigators; (D) Report insurance fraud to appropriate law enforcement and regulatory authorities in the investigation and prosecution of insurance fraud; and (E) Pursue restitution for financial loss caused by insurance fraud, where appropriate. (3) The commissioner may review each insurer's anti-fraud plan to determine if it complies with the requirements of this section. (4) It is the responsibility of the commissioner to assure insurer compliance with anti-fraud plans submitted to the commissioner. The commissioner may require reasonable modification of the insurer's anti-fraud plan, or may require other reasonable remedial action if the review or examination reveals substantial noncompliance with the terms of the insurer's own anti-fraud plan. (5) The commissioner may require each insurer to file a summary of the insurer's anti-fraud activities and results. The anti-fraud plans and the summary of the insurer's anti-fraud activities and results are not public records and are exempt from title 10, chapter 7, part 5, and shall be proprietary and not subject to public examination, and shall not be discoverable or admissible in civil litigation. (6) This section confers no private rights of action. (b) (1) All printed applications for insurance, and all printed claim forms provided and required by an insurer or required by law as a condition of payment of a claim, shall contain a statement, permanently affixed to the application or claim form, that clearly states in substance the following: "It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of committing fraud. Penalties include imprisonment, fines and denial of insurance benefits." (2) The lack of a statement required in this section does not constitute a defense in any criminal prosecution under § 56-47-103 nor in any civil action under § 56-47-103 or § 56-47-104 . (c) Notwithstanding any other provision of title 56, the following are the exclusive monetary penalties for a violation of this section. Insurers that fail to prepare, implement, maintain and submit to the department of commerce and insurance an insurance anti-fraud plan are subject to a penalty of five hundred dollars ($500) per day, not to exceed twenty-five thousand dollars ($25,000). Acts 1996, ch. 944, § 48.
(a) (1) Every insurer shall prepare, implement, maintain and submit to the department of commerce and insurance a workers' compensation insurance anti-fraud plan. (2) Each insurer's anti-fraud plan shall outline specific procedures to: (A) Prevent, detect and investigate all forms of insurance fraud, including fraud involving the insurer's employees or agents; fraud resulting from misrepresentations in the application, renewal or rating of insurance policies; claims fraud; and security of the insurer's data processing system; (B) Educate appropriate employees on fraud detection and the insurer's anti-fraud plan; (C) Provide for the hiring of or contracting for fraud investigators; (D) Report insurance fraud to appropriate law enforcement and regulatory authorities in the investigation and prosecution of insurance fraud; and (E) Pursue restitution for financial loss caused by insurance fraud, where appropriate. (3) The commissioner may review each insurer's anti-fraud plan to determine if it complies with the requirements of this section. (4) It is the responsibility of the commissioner to assure insurer compliance with anti-fraud plans submitted to the commissioner. The commissioner may require reasonable modification of the insurer's anti-fraud plan, or may require other reasonable remedial action if the review or examination reveals substantial noncompliance with the terms of the insurer's own anti-fraud plan. (5) The commissioner may require each insurer to file a summary of the insurer's anti-fraud activities and results. The anti-fraud plans and the summary of the insurer's anti-fraud activities and results are not public records and are exempt from title 10, chapter 7, part 5, and shall be proprietary and not subject to public examination, and shall not be discoverable or admissible in civil litigation. (6) This section confers no private rights of action.
(1) Every insurer shall prepare, implement, maintain and submit to the department of commerce and insurance a workers' compensation insurance anti-fraud plan.
(2) Each insurer's anti-fraud plan shall outline specific procedures to: (A) Prevent, detect and investigate all forms of insurance fraud, including fraud involving the insurer's employees or agents; fraud resulting from misrepresentations in the application, renewal or rating of insurance policies; claims fraud; and security of the insurer's data processing system; (B) Educate appropriate employees on fraud detection and the insurer's anti-fraud plan; (C) Provide for the hiring of or contracting for fraud investigators; (D) Report insurance fraud to appropriate law enforcement and regulatory authorities in the investigation and prosecution of insurance fraud; and (E) Pursue restitution for financial loss caused by insurance fraud, where appropriate.
(A) Prevent, detect and investigate all forms of insurance fraud, including fraud involving the insurer's employees or agents; fraud resulting from misrepresentations in the application, renewal or rating of insurance policies; claims fraud; and security of the insurer's data processing system;
(B) Educate appropriate employees on fraud detection and the insurer's anti-fraud plan;
(C) Provide for the hiring of or contracting for fraud investigators;
(D) Report insurance fraud to appropriate law enforcement and regulatory authorities in the investigation and prosecution of insurance fraud; and
(E) Pursue restitution for financial loss caused by insurance fraud, where appropriate.
(3) The commissioner may review each insurer's anti-fraud plan to determine if it complies with the requirements of this section.
(4) It is the responsibility of the commissioner to assure insurer compliance with anti-fraud plans submitted to the commissioner. The commissioner may require reasonable modification of the insurer's anti-fraud plan, or may require other reasonable remedial action if the review or examination reveals substantial noncompliance with the terms of the insurer's own anti-fraud plan.
(5) The commissioner may require each insurer to file a summary of the insurer's anti-fraud activities and results. The anti-fraud plans and the summary of the insurer's anti-fraud activities and results are not public records and are exempt from title 10, chapter 7, part 5, and shall be proprietary and not subject to public examination, and shall not be discoverable or admissible in civil litigation.
(6) This section confers no private rights of action.
(b) (1) All printed applications for insurance, and all printed claim forms provided and required by an insurer or required by law as a condition of payment of a claim, shall contain a statement, permanently affixed to the application or claim form, that clearly states in substance the following: "It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of committing fraud. Penalties include imprisonment, fines and denial of insurance benefits." (2) The lack of a statement required in this section does not constitute a defense in any criminal prosecution under § 56-47-103 nor in any civil action under § 56-47-103 or § 56-47-104 .
(1) All printed applications for insurance, and all printed claim forms provided and required by an insurer or required by law as a condition of payment of a claim, shall contain a statement, permanently affixed to the application or claim form, that clearly states in substance the following: "It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of committing fraud. Penalties include imprisonment, fines and denial of insurance benefits."
"It is a crime to knowingly provide false, incomplete or misleading information to any party to a workers' compensation transaction for the purpose of committing fraud. Penalties include imprisonment, fines and denial of insurance benefits."
(2) The lack of a statement required in this section does not constitute a defense in any criminal prosecution under § 56-47-103 nor in any civil action under § 56-47-103 or § 56-47-104 .
(c) Notwithstanding any other provision of title 56, the following are the exclusive monetary penalties for a violation of this section. Insurers that fail to prepare, implement, maintain and submit to the department of commerce and insurance an insurance anti-fraud plan are subject to a penalty of five hundred dollars ($500) per day, not to exceed twenty-five thousand dollars ($25,000).
Acts 1996, ch. 944, § 48.
Tenn. Code Ann. § 56-60-102 — TN Code / Title 56 / Chapter 60 / Section 56-60-102
Chapter definitions
Status: in_force

As used in this chapter: (1) "Affiliate" means an individual or entity that directly or indirectly through one (1) or more intermediaries, controls or is controlled by or is under common control with a contracting entity; (2) "Contracting entity" means any individual or entity that is engaged in the act of contracting with providers and that has entered into a provider network contract with a provider for the delivery of health care services. "Contracting entity" shall not include any self-funded employer-sponsored health insurance plan regulated under the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.). In addition, "contracting entity" shall not include any individual or entity that provides administrative services to a self-funded employer-sponsored health insurance plan; provided, however, that this exemption applies only to those administrative services performed for a self-funded employer-sponsored health insurance plan; (3) "Control" or "controlled by" or "under common control with" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of an individual or entity, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the individual or entity. "Control" is presumed to exist if any individual or entity, directly or indirectly, owns, controls, holds with the power to vote or holds proxies representing ten percent (10%) or more of the voting securities of any other individual or entity; (4) "Covered individual" means an individual who is covered under a health insurance plan; (5) "Department" means the department of commerce and insurance; (6) "Discount medical plan organization" means an entity that, in exchange for fees, dues, charges or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount; (7) "Entity" means a corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency or instrumentality, or any other legal or commercial entity; (8) "Health care services" means services for the diagnosis, prevention, treatment or cure of a health condition, illness, injury or disease; (9) (A) "Health insurance plan" means any hospital and medical expense incurred policy, nonprofit health care service plan contract, health maintenance organization subscriber contract or any other health care plan or arrangement that pays for or furnishes medical or health care services, whether by insurance or otherwise; (B) "Health insurance plan" does not include one (1) or more, or any combination of, the following: (i) Coverage only for accident, or 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; (viii) Coverage similar to subdivisions (9)(B)(i)-(vii) as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits; (ix) Dental or vision benefits; (x) Benefits for long-term care, nursing home care, home health care or community-based care; (xi) Specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or such other similar, limited benefits as are specified in regulations; (xii) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ); (xiii) Coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq.; or (xiv) Other similar limited benefit supplemental coverages; (10) "Physician" means any individual licensed as a chiropractic physician under title 63, chapter 4; a medical doctor under title 63, chapter 6; or an osteopathic physician under title 63, chapter 9; (11) "Physician hospital organization" means an organization that includes, but is not limited to, hospitals and physicians and that contracts with and provides administrative services to hospitals and physicians that have entered into or intend to enter into managed care arrangements; (12) "Physician organization" means an organization that contracts with and provides administrative services to physicians who have entered into managed care arrangements; (13) "Provider" means a physician, a physician organization or a physician hospital organization. "Provider" does not include a physician organization or physician hospital organization that leases or rents the physician organization's or physician hospital organization's network to a third party; (14) "Provider network contract" or "provider agreement" means a direct contract between a contracting entity and a provider for the delivery of health care services specifying the rights and responsibilities of the contracting entity and the provider in relation to access and payment for health care services to covered individuals; and (15) "Third party" means an organization that enters into a contract with a contracting entity or with another third party to gain access to a provider network contract. "Third party" also includes a contracting entity's subsidiaries and affiliates, except as provided in § 56-60-103 . "Third party" does not include any self-funded employer-sponsored health insurance plan regulated under the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.). In addition, "third party" does not include any individual or entity that provides administrative services to a self-funded employer-sponsored health insurance plan; provided, however, that this exemption applies only to those administrative services performed for a self-funded employer-sponsored health insurance plan. Acts 2009 , ch. 466, § 3; 2012 , ch. 715, § 1.
As used in this chapter:
(1) "Affiliate" means an individual or entity that directly or indirectly through one (1) or more intermediaries, controls or is controlled by or is under common control with a contracting entity;
(2) "Contracting entity" means any individual or entity that is engaged in the act of contracting with providers and that has entered into a provider network contract with a provider for the delivery of health care services. "Contracting entity" shall not include any self-funded employer-sponsored health insurance plan regulated under the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.). In addition, "contracting entity" shall not include any individual or entity that provides administrative services to a self-funded employer-sponsored health insurance plan; provided, however, that this exemption applies only to those administrative services performed for a self-funded employer-sponsored health insurance plan;
(3) "Control" or "controlled by" or "under common control with" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of an individual or entity, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the individual or entity. "Control" is presumed to exist if any individual or entity, directly or indirectly, owns, controls, holds with the power to vote or holds proxies representing ten percent (10%) or more of the voting securities of any other individual or entity;
(4) "Covered individual" means an individual who is covered under a health insurance plan;
(5) "Department" means the department of commerce and insurance;
(6) "Discount medical plan organization" means an entity that, in exchange for fees, dues, charges or other consideration, provides access for plan members to providers of medical services and the right to receive medical services from those providers at a discount;
(7) "Entity" means a corporation, business trust, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency or instrumentality, or any other legal or commercial entity;
(8) "Health care services" means services for the diagnosis, prevention, treatment or cure of a health condition, illness, injury or disease;
(9) (A) "Health insurance plan" means any hospital and medical expense incurred policy, nonprofit health care service plan contract, health maintenance organization subscriber contract or any other health care plan or arrangement that pays for or furnishes medical or health care services, whether by insurance or otherwise; (B) "Health insurance plan" does not include one (1) or more, or any combination of, the following: (i) Coverage only for accident, or 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; (viii) Coverage similar to subdivisions (9)(B)(i)-(vii) as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits; (ix) Dental or vision benefits; (x) Benefits for long-term care, nursing home care, home health care or community-based care; (xi) Specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or such other similar, limited benefits as are specified in regulations; (xii) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ); (xiii) Coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq.; or (xiv) Other similar limited benefit supplemental coverages;
(A) "Health insurance plan" means any hospital and medical expense incurred policy, nonprofit health care service plan contract, health maintenance organization subscriber contract or any other health care plan or arrangement that pays for or furnishes medical or health care services, whether by insurance or otherwise;
(B) "Health insurance plan" does not include one (1) or more, or any combination of, the following: (i) Coverage only for accident, or 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; (viii) Coverage similar to subdivisions (9)(B)(i)-(vii) as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits; (ix) Dental or vision benefits; (x) Benefits for long-term care, nursing home care, home health care or community-based care; (xi) Specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or such other similar, limited benefits as are specified in regulations; (xii) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ); (xiii) Coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq.; or (xiv) Other similar limited benefit supplemental coverages;
(i) Coverage only for accident, or 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;
(viii) Coverage similar to subdivisions (9)(B)(i)-(vii) as specified in federal regulations issued pursuant to P.L. 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits;
(ix) Dental or vision benefits;
(x) Benefits for long-term care, nursing home care, home health care or community-based care;
(xi) Specified disease or illness coverage, hospital indemnity or other fixed indemnity insurance, or such other similar, limited benefits as are specified in regulations;
(xii) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) );
(xiii) Coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq.; or
(xiv) Other similar limited benefit supplemental coverages;
(10) "Physician" means any individual licensed as a chiropractic physician under title 63, chapter 4; a medical doctor under title 63, chapter 6; or an osteopathic physician under title 63, chapter 9;
(11) "Physician hospital organization" means an organization that includes, but is not limited to, hospitals and physicians and that contracts with and provides administrative services to hospitals and physicians that have entered into or intend to enter into managed care arrangements;
(12) "Physician organization" means an organization that contracts with and provides administrative services to physicians who have entered into managed care arrangements;
(13) "Provider" means a physician, a physician organization or a physician hospital organization. "Provider" does not include a physician organization or physician hospital organization that leases or rents the physician organization's or physician hospital organization's network to a third party;
(14) "Provider network contract" or "provider agreement" means a direct contract between a contracting entity and a provider for the delivery of health care services specifying the rights and responsibilities of the contracting entity and the provider in relation to access and payment for health care services to covered individuals; and
(15) "Third party" means an organization that enters into a contract with a contracting entity or with another third party to gain access to a provider network contract. "Third party" also includes a contracting entity's subsidiaries and affiliates, except as provided in § 56-60-103 . "Third party" does not include any self-funded employer-sponsored health insurance plan regulated under the Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1001 et seq.). In addition, "third party" does not include any individual or entity that provides administrative services to a self-funded employer-sponsored health insurance plan; provided, however, that this exemption applies only to those administrative services performed for a self-funded employer-sponsored health insurance plan.
Acts 2009 , ch. 466, § 3; 2012 , ch. 715, § 1.
Tenn. Code Ann. § 56-55-113 — TN Code / Title 56 / Chapter 55 / Section 56-55-113
Rules and regulations
Status: in_force

The commissioner may adopt administrative rules consistent with this chapter that are necessary to implement this chapter. The rules shall include disclosures for the benefit of the warranty holder, record keeping requirements, registration fees, penalties, and procedures for public complaints. The rules shall also include the conditions under which surplus lines insurers may be rejected for the purpose of underwriting vehicle protection product warranty agreements. Acts 2005, ch. 244, § 14.
The commissioner may adopt administrative rules consistent with this chapter that are necessary to implement this chapter. The rules shall include disclosures for the benefit of the warranty holder, record keeping requirements, registration fees, penalties, and procedures for public complaints. The rules shall also include the conditions under which surplus lines insurers may be rejected for the purpose of underwriting vehicle protection product warranty agreements.
Acts 2005, ch. 244, § 14.
Tenn. Code Ann. § 56-54-110 — TN Code / Title 56 / Chapter 54 / Section 56-54-110
[Repealed]
Status: repealed

Repealed by 2021 Tenn. Acts, ch. 537, s 8, eff. 5/25/2021. Acts 2008 , ch. 1009, § 11.
Repealed by 2021 Tenn. Acts, ch. 537, s 8, eff. 5/25/2021.
Acts 2008 , ch. 1009, § 11.
Tenn. Code Ann. § 56-3-902 — TN Code / Title 56 / Chapter 3 / Section 56-3-902
Part definitions
Status: in_force

As used in this part: (1) (A) "Clearing corporation" means: (i) A corporation as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time; and (ii) "Treasury/reserve automated debt entry securities system" and "treasury direct" book-entry securities systems established pursuant to 5 U.S.C. Part 301, 12 U.S.C. Part 391 and 31 U.S.C. § 3100 et seq.; (B) With respect to securities issued by institutions organized or existing under the laws of any foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "clearing corporation" also means a corporation which is organized or existing under the laws of any foreign country and is legally qualified under such laws to effect transactions in securities by computerized book-entry; (2) "Commissioner" means the commissioner of commerce and insurance; (3) "Custodian" means a national bank, state bank, federal home loan bank, trust company or broker/dealer that participates in a clearing corporation; and (4) "Securities" means instruments as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time. Amended by 2024 Tenn. Acts, ch. 494,s 11, eff. 2/21/2024. Acts 2012 , ch. 680, § 4.
As used in this part:
(1) (A) "Clearing corporation" means: (i) A corporation as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time; and (ii) "Treasury/reserve automated debt entry securities system" and "treasury direct" book-entry securities systems established pursuant to 5 U.S.C. Part 301, 12 U.S.C. Part 391 and 31 U.S.C. § 3100 et seq.; (B) With respect to securities issued by institutions organized or existing under the laws of any foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "clearing corporation" also means a corporation which is organized or existing under the laws of any foreign country and is legally qualified under such laws to effect transactions in securities by computerized book-entry;
(A) "Clearing corporation" means: (i) A corporation as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time; and (ii) "Treasury/reserve automated debt entry securities system" and "treasury direct" book-entry securities systems established pursuant to 5 U.S.C. Part 301, 12 U.S.C. Part 391 and 31 U.S.C. § 3100 et seq.;
(i) A corporation as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time; and
(ii) "Treasury/reserve automated debt entry securities system" and "treasury direct" book-entry securities systems established pursuant to 5 U.S.C. Part 301, 12 U.S.C. Part 391 and 31 U.S.C. § 3100 et seq.;
(B) With respect to securities issued by institutions organized or existing under the laws of any foreign country or securities used to meet the deposit requirements pursuant to the laws of a foreign country as a condition of doing business therein, "clearing corporation" also means a corporation which is organized or existing under the laws of any foreign country and is legally qualified under such laws to effect transactions in securities by computerized book-entry;
(2) "Commissioner" means the commissioner of commerce and insurance;
(3) "Custodian" means a national bank, state bank, federal home loan bank, trust company or broker/dealer that participates in a clearing corporation; and
(4) "Securities" means instruments as defined in § 8-102(a) of the Uniform Commercial Code, codified in § 47-8-102(a) , as adopted by the Uniform Law Commission and the American Law Institute, as amended from time to time.
Amended by 2024 Tenn. Acts, ch. 494,s 11, eff. 2/21/2024.
Acts 2012 , ch. 680, § 4.
Tenn. Code Ann. § 56-2-204 — TN Code / Title 56 / Chapter 2 / Section 56-2-204
Casualty, accident, sickness, theft and marine insurance
Status: in_force

The company also has the power to insure: (1) Against all accidents: (A) To property in transit; and (B) To persons traveling or otherwise; (2) Against disabilities to persons by disease or sickness, or other bodily infirmities; (3) Against thefts of property; (4) Ships, steamboats, and other craft; and (5) Freight and sailors' wages, including all marine risks. Acts 1875, ch. 142, § 10; 1889, ch. 224, § 1; Shan., § 2262; mod. Code 1932, § 3975; T.C.A. (orig. ed.), §§ 56-207, 56-221.
The company also has the power to insure:
(1) Against all accidents: (A) To property in transit; and (B) To persons traveling or otherwise;
(A) To property in transit; and
(B) To persons traveling or otherwise;
(2) Against disabilities to persons by disease or sickness, or other bodily infirmities;
(3) Against thefts of property;
(4) Ships, steamboats, and other craft; and
(5) Freight and sailors' wages, including all marine risks.
Acts 1875, ch. 142, § 10; 1889, ch. 224, § 1; Shan., § 2262; mod. Code 1932, § 3975; T.C.A. (orig. ed.), §§ 56-207, 56-221.
Tenn. Code Ann. § 56-8-108 — TN Code / Title 56 / Chapter 8 / Section 56-8-108
Additional powers of commissioner
Status: in_force

(a) In addition to any other authority granted in this part, the commissioner shall have the authority to declare by rule certain acts to be unfair trade practices or unfair methods of competition or unfair or deceptive acts or practices in the business of insurance that are not specifically defined in this part. The commissioner may promulgate the rules by emergency rules upon making a finding that such is in the public interest. (b) The commissioner, at the rulemaking hearing, may administer oaths, and receive oral and documentary evidence. The commissioner shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence or other documents the commissioner deems relevant to the inquiry; provided, however, that in the case of depository institutions, the commissioner shall have the power to require the production of books, papers, records, correspondence or other documents that the commissioner deems relevant to the inquiry only on the insurance activities of the depository institution. No person shall be compelled to provide a document or disclose information that is privileged under statutory or common law. The commissioner may and, upon the request of any party, shall cause to be made a stenographic record of all the evidence and all the proceedings at the hearing. In case of a refusal of any person to comply with any subpoena or to testify with respect to any matter concerning which that person may be lawfully interrogated, the chancery court of Davidson County or the county where the person resides, on application of the commissioner, may issue an order requiring the person to comply with the subpoena and to testify. Any failure to obey any order of the court may be punished by the court as contempt. Acts 2008, ch. 1079, §§ 1, 9; 2009, ch. 566, § 12.
(a) In addition to any other authority granted in this part, the commissioner shall have the authority to declare by rule certain acts to be unfair trade practices or unfair methods of competition or unfair or deceptive acts or practices in the business of insurance that are not specifically defined in this part. The commissioner may promulgate the rules by emergency rules upon making a finding that such is in the public interest.
(b) The commissioner, at the rulemaking hearing, may administer oaths, and receive oral and documentary evidence. The commissioner shall have the power to subpoena witnesses, compel their attendance, and require the production of books, papers, records, correspondence or other documents the commissioner deems relevant to the inquiry; provided, however, that in the case of depository institutions, the commissioner shall have the power to require the production of books, papers, records, correspondence or other documents that the commissioner deems relevant to the inquiry only on the insurance activities of the depository institution. No person shall be compelled to provide a document or disclose information that is privileged under statutory or common law. The commissioner may and, upon the request of any party, shall cause to be made a stenographic record of all the evidence and all the proceedings at the hearing. In case of a refusal of any person to comply with any subpoena or to testify with respect to any matter concerning which that person may be lawfully interrogated, the chancery court of Davidson County or the county where the person resides, on application of the commissioner, may issue an order requiring the person to comply with the subpoena and to testify. Any failure to obey any order of the court may be punished by the court as contempt.
Acts 2008, ch. 1079, §§ 1, 9; 2009, ch. 566, § 12.
Tenn. Code Ann. § 56-20-106 — TN Code / Title 56 / Chapter 20 / Section 56-20-106
Notice of assessments - Time of payment - Expense and cost of collection
Status: in_force

The secretary shall, within thirty (30) days after any assessment has been made, notify every member of the corporation, by written or printed notice, signed by the secretary, stating the amount due the corporation from the members, the time when and to whom it shall be paid, and the use to be made of the money collected. Such time shall not be less than thirty (30) days nor more than sixty (60) days from the service of the notice, which notice may be served personally or by mail. If by mail, service shall be deemed complete when deposited in the post office at the place where the principal office of the corporation is located, directed to each member at the member's place of residence or business, and postage prepaid. The expense and cost of collection of the assessment shall be regulated by the bylaws. Acts 1895, ch. 220, § 7; Shan., § 3360; Code 1932, § 6242; T.C.A. (orig. ed.), § 56-1906.
The secretary shall, within thirty (30) days after any assessment has been made, notify every member of the corporation, by written or printed notice, signed by the secretary, stating the amount due the corporation from the members, the time when and to whom it shall be paid, and the use to be made of the money collected. Such time shall not be less than thirty (30) days nor more than sixty (60) days from the service of the notice, which notice may be served personally or by mail. If by mail, service shall be deemed complete when deposited in the post office at the place where the principal office of the corporation is located, directed to each member at the member's place of residence or business, and postage prepaid. The expense and cost of collection of the assessment shall be regulated by the bylaws.
Acts 1895, ch. 220, § 7; Shan., § 3360; Code 1932, § 6242; T.C.A. (orig. ed.), § 56-1906.
Tenn. Code Ann. § 56-7-2606 — TN Code / Title 56 / Chapter 7 / Section 56-7-2606
Coverage for chlamydia screening
Status: in_force

(a) The general assembly finds that chlamydia is a sexually transmitted disease that may cause serious complications in persons infected with it, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Pregnant women infected with chlamydia may suffer from symptoms such as stillbirths, low birth weight babies, and other serious physical and mental complications for their infants. Chlamydia is often asymptomatic in women and cannot be detected except with special, though inexpensive, screening tests. Cure of chlamydia is usually both easy and inexpensive. The general assembly further finds that having health care insurance and managed care plan coverage of annual chlamydia screening tests for females in conjunction with covered pap smears in the age group most likely to be infected with chlamydia will encourage the testing and treatment needed to detect and cure this destructive disease and result in a marked improvement in the general health of the citizens of this state. (b) As used in this section, unless the context otherwise requires: (1) "Chlamydia screening test" means any laboratory test of the urogenital tract that specifically detects for infection by one (1) or more agents of chlamydia trachomatis and which test is approved for those purposes by the federal food and drug administration; (2) "Insurer" means an insurance benefit plan, a fraternal benefit society, a nonprofit hospital service corporation, a nonprofit medical service corporation, a health care plan, a health maintenance organization, a managed care organization, or any similar entity by whatever name called; and (3) "Policy" means a major medical accident and sickness insurance policy, health benefit plan, contract, or policy issued by an insurer, except a disability income policy, specified disease policy, hospital indemnity policy, credit insurance policy, accident only policy, or other limited benefit plan policy or contract. (c) (1) Every insurer authorized to issue an individual or group accident and sickness insurance policy in this state that provides major medical insurance coverage and that includes coverage for any female shall make available on an optional basis as part of or as an endorsement to each such policy that is issued, delivered, issued for delivery, or renewed in this state on or after July 1, 1999, coverage for one (1) annual chlamydia screening test in conjunction with an annual pap smear for covered females who are not more than twenty-nine (29) years of age if the screening test is determined to be medically necessary. (2) The chlamydia screening test coverage may be subject to exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions approved by the commissioner. (3) Nothing in this subsection (c) shall be construed to prohibit the issuance of accident and sickness insurance policies that provide benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), nor to prohibit any managed care plan contract from providing benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), from having cost-sharing arrangements or to otherwise change the contractual relations between an insurer and their insureds or covered persons by whatever name called. (4) Nothing contained in this subsection (c) shall be construed to prohibit any insurer from providing benefits greater than or more favorable to the covered females. (5) The requirements of this subsection (c) with respect to a group or blanket accident and sickness insurance benefit plan, policy, or contract shall be satisfied if the coverage specified in this subsection (c) is made available to the master policyholder of the plan, policy, or contract. Nothing in this subsection (c) shall be construed to require the group insurer, nonprofit corporation, health care plan, health maintenance organization, managed care organization, or master policyholder to provide or to make available the coverage to any certificate holder insured under the group policy, plan, or contract. (6) Nothing contained in this subsection (c) shall be deemed to prohibit the payment of different levels of benefits or having differences in coinsurance percentages applicable to benefit levels for services provided by preferred and nonpreferred providers in accordance with preferred provider arrangements. (d) The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this section. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Acts 1999, ch. 61, § 2.
(a) The general assembly finds that chlamydia is a sexually transmitted disease that may cause serious complications in persons infected with it, including pelvic inflammatory disease, infertility, and ectopic pregnancy. Pregnant women infected with chlamydia may suffer from symptoms such as stillbirths, low birth weight babies, and other serious physical and mental complications for their infants. Chlamydia is often asymptomatic in women and cannot be detected except with special, though inexpensive, screening tests. Cure of chlamydia is usually both easy and inexpensive. The general assembly further finds that having health care insurance and managed care plan coverage of annual chlamydia screening tests for females in conjunction with covered pap smears in the age group most likely to be infected with chlamydia will encourage the testing and treatment needed to detect and cure this destructive disease and result in a marked improvement in the general health of the citizens of this state.
(b) As used in this section, unless the context otherwise requires: (1) "Chlamydia screening test" means any laboratory test of the urogenital tract that specifically detects for infection by one (1) or more agents of chlamydia trachomatis and which test is approved for those purposes by the federal food and drug administration; (2) "Insurer" means an insurance benefit plan, a fraternal benefit society, a nonprofit hospital service corporation, a nonprofit medical service corporation, a health care plan, a health maintenance organization, a managed care organization, or any similar entity by whatever name called; and (3) "Policy" means a major medical accident and sickness insurance policy, health benefit plan, contract, or policy issued by an insurer, except a disability income policy, specified disease policy, hospital indemnity policy, credit insurance policy, accident only policy, or other limited benefit plan policy or contract.
(1) "Chlamydia screening test" means any laboratory test of the urogenital tract that specifically detects for infection by one (1) or more agents of chlamydia trachomatis and which test is approved for those purposes by the federal food and drug administration;
(2) "Insurer" means an insurance benefit plan, a fraternal benefit society, a nonprofit hospital service corporation, a nonprofit medical service corporation, a health care plan, a health maintenance organization, a managed care organization, or any similar entity by whatever name called; and
(3) "Policy" means a major medical accident and sickness insurance policy, health benefit plan, contract, or policy issued by an insurer, except a disability income policy, specified disease policy, hospital indemnity policy, credit insurance policy, accident only policy, or other limited benefit plan policy or contract.
(c) (1) Every insurer authorized to issue an individual or group accident and sickness insurance policy in this state that provides major medical insurance coverage and that includes coverage for any female shall make available on an optional basis as part of or as an endorsement to each such policy that is issued, delivered, issued for delivery, or renewed in this state on or after July 1, 1999, coverage for one (1) annual chlamydia screening test in conjunction with an annual pap smear for covered females who are not more than twenty-nine (29) years of age if the screening test is determined to be medically necessary. (2) The chlamydia screening test coverage may be subject to exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions approved by the commissioner. (3) Nothing in this subsection (c) shall be construed to prohibit the issuance of accident and sickness insurance policies that provide benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), nor to prohibit any managed care plan contract from providing benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), from having cost-sharing arrangements or to otherwise change the contractual relations between an insurer and their insureds or covered persons by whatever name called. (4) Nothing contained in this subsection (c) shall be construed to prohibit any insurer from providing benefits greater than or more favorable to the covered females. (5) The requirements of this subsection (c) with respect to a group or blanket accident and sickness insurance benefit plan, policy, or contract shall be satisfied if the coverage specified in this subsection (c) is made available to the master policyholder of the plan, policy, or contract. Nothing in this subsection (c) shall be construed to require the group insurer, nonprofit corporation, health care plan, health maintenance organization, managed care organization, or master policyholder to provide or to make available the coverage to any certificate holder insured under the group policy, plan, or contract. (6) Nothing contained in this subsection (c) shall be deemed to prohibit the payment of different levels of benefits or having differences in coinsurance percentages applicable to benefit levels for services provided by preferred and nonpreferred providers in accordance with preferred provider arrangements.
(1) Every insurer authorized to issue an individual or group accident and sickness insurance policy in this state that provides major medical insurance coverage and that includes coverage for any female shall make available on an optional basis as part of or as an endorsement to each such policy that is issued, delivered, issued for delivery, or renewed in this state on or after July 1, 1999, coverage for one (1) annual chlamydia screening test in conjunction with an annual pap smear for covered females who are not more than twenty-nine (29) years of age if the screening test is determined to be medically necessary.
(2) The chlamydia screening test coverage may be subject to exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions approved by the commissioner.
(3) Nothing in this subsection (c) shall be construed to prohibit the issuance of accident and sickness insurance policies that provide benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), nor to prohibit any managed care plan contract from providing benefits greater than or more favorable to the insured than those benefits established pursuant to subdivision (c)(1), from having cost-sharing arrangements or to otherwise change the contractual relations between an insurer and their insureds or covered persons by whatever name called.
(4) Nothing contained in this subsection (c) shall be construed to prohibit any insurer from providing benefits greater than or more favorable to the covered females.
(5) The requirements of this subsection (c) with respect to a group or blanket accident and sickness insurance benefit plan, policy, or contract shall be satisfied if the coverage specified in this subsection (c) is made available to the master policyholder of the plan, policy, or contract. Nothing in this subsection (c) shall be construed to require the group insurer, nonprofit corporation, health care plan, health maintenance organization, managed care organization, or master policyholder to provide or to make available the coverage to any certificate holder insured under the group policy, plan, or contract.
(6) Nothing contained in this subsection (c) shall be deemed to prohibit the payment of different levels of benefits or having differences in coinsurance percentages applicable to benefit levels for services provided by preferred and nonpreferred providers in accordance with preferred provider arrangements.
(d) The commissioner is authorized to promulgate rules and regulations to effectuate the purposes of this section. The rules and regulations shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 1999, ch. 61, § 2.
Tenn. Code Ann. § 56-30-108 — TN Code / Title 56 / Chapter 30 / Section 56-30-108
Right to become participating dentists - Method of diagnosis and treatment unrestricted - Private dentist-patient relationship
Status: in_force

(a) Every dentist licensed to practice in this state under title 63, chapter 5, has the right to become a participating dentist in the dental service plan corporation operating in the county in which the dentist resides or practices. A dental service plan corporation shall impose no restrictions on the dentists who treat its subscribers as to methods of diagnosis or treatment. The private dentist-patient relationship shall be maintained, and a subscriber shall at all times have free choice of any dentist who is a participating dentist in the corporation and who agrees to accept a particular beneficiary as a patient. (b) Notwithstanding subsection (a), a dental service plan corporation may limit participation in a plan that is providing or managing dental benefits for the impoverished uninsured on behalf of, or as required by, any governmental entity. Acts 1961, ch. 340, § 8; 1965, ch. 309, § 1; T.C.A., §56-3508; Acts 2011 , ch. 216, § 1.
(a) Every dentist licensed to practice in this state under title 63, chapter 5, has the right to become a participating dentist in the dental service plan corporation operating in the county in which the dentist resides or practices. A dental service plan corporation shall impose no restrictions on the dentists who treat its subscribers as to methods of diagnosis or treatment. The private dentist-patient relationship shall be maintained, and a subscriber shall at all times have free choice of any dentist who is a participating dentist in the corporation and who agrees to accept a particular beneficiary as a patient.
(b) Notwithstanding subsection (a), a dental service plan corporation may limit participation in a plan that is providing or managing dental benefits for the impoverished uninsured on behalf of, or as required by, any governmental entity.
Acts 1961, ch. 340, § 8; 1965, ch. 309, § 1; T.C.A., §56-3508; Acts 2011 , ch. 216, § 1.
Tenn. Code Ann. § 56-59-109 — TN Code / Title 56 / Chapter 59 / Section 56-59-109
Insurance laws - Exemptions
Status: in_force

The general assembly finds that GAP waivers are not insurance. The general assembly also finds that GAP waivers complying with this chapter are exempt from the insurance laws of this state. Acts 2008, ch. 1055, § 10.
The general assembly finds that GAP waivers are not insurance. The general assembly also finds that GAP waivers complying with this chapter are exempt from the insurance laws of this state.
Acts 2008, ch. 1055, § 10.
Tenn. Code Ann. § 56-7-110 — TN Code / Title 56 / Chapter 7 / Section 56-7-110
Part definitions - Correction of payment errors - Retroactive denial of reimbursements
Status: in_force

(a) As used in this part: (1) "Covered person" means a person on whose behalf a health insurance entity offering health insurance coverage is obligated to pay benefits or provide services; (2) "Healthcare provider" means a person or entity performing services regulated pursuant to title 63 or title 68, chapter 11; (3) "Health insurance coverage" has the same meaning as in § 56-7-109 ; (4) "Health insurance entity" has the same meaning as in § 56-7-109 ; and (5) "Recoupment" or "recoup" means the action by a health insurance entity to recover amounts previously paid to a healthcare provider by withholding or offsetting the amounts against current payments to the healthcare provider. (b) A health insurance entity is not required to correct a payment error to a healthcare provider if the provider's request for a payment correction is filed more than fifteen (15) months after the date that the healthcare provider received payment for the claim from the health insurance entity. (c) (1) Except in cases of fraud or suspected fraud committed by the healthcare provider, a health insurance entity may only recoup reimbursements made to the provider during the fifteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider. (2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subsection (e). (3) Notwithstanding subdivision (c)(1), if a health insurance entity makes a payment pursuant to health insurance coverage issued pursuant to a state employee health plan provided for under title 8, chapter 27, then the health insurance entity may only recoup reimbursements made to a provider during an eighteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider. (d) Notwithstanding subsection (c), if a health insurance entity or an agent that contracted to provide eligibility verification verifies that an individual is a covered person, and if the healthcare provider provides services to the individual in reliance on the verification, then the health insurance entity shall not thereafter recoup a claim on the basis that the individual is not a covered person unless the recoupment occurs within six (6) months of the date that the health insurance entity paid the claim; otherwise, the health insurance entity is barred from making the recoupment unless there was fraud by the healthcare provider. (e) (1) Except in cases of fraud or suspected fraud, a health insurance entity that intends to recoup a previously paid claim shall give the healthcare provider thirty (30) days' advance written or electronic notice specifying the basis for the recoupment, and the notice must contain, at a minimum, the following information: (A) The CPT codes in the claims subject to the recoupment, or, if no CPT code is available, a description of the healthcare items or services for which the health insurance entity intends to recoup reimbursements; (B) A detailed explanation of why the previously made payment is being recouped, including, but not limited to: (i) Identification of the billing codes and modifiers that the health insurance entity believes should have been billed; and (ii) The health insurance entity's policies supporting the billing codes and modifiers that the health insurance entity believes should have been billed; (C) The claims subject to the recoupment, including applicable claim numbers; (D) The covered person's full legal name and any identification numbers; (E) The dates on which the healthcare provider provided the healthcare items or services, the costs of which are being recouped by the health insurance entity; (F) The estimated amount of recoupment; (G) Each claim's date of payment and how it was issued to the healthcare provider, including by mail or electronically, and, if applicable, the number of the check containing the recoupment or electronic payment identifying information; and (H) The process by which the healthcare provider may appeal the recoupment, including the instructions for the appeal process. (2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subdivision (e)(1). (f) If a healthcare provider initiates an appeal within thirty (30) days of the date of a notice of recoupment pursuant to subsection (e), then payment must not be withheld from the healthcare provider until all appeals are exhausted. (g) The notice required by subsection (e) may be included with the results of an audit submitted to a healthcare provider. (h) (1) If the commissioner finds that a health insurance entity has failed to comply with this section, then the commissioner may impose a penalty of two (2) times the amount of the claim or seven hundred fifty dollars ($750), whichever amount is less. (2) In the alternative to subdivision (h)(1), the healthcare provider may seek injunctive or other appropriate relief in the chancery or circuit court in the county where the provider resides or practices. (i) This section must not be waived, voided, or nullified by contract; provided, that a health insurance entity and a healthcare provider may toll the time periods described in subsections (c) and (d) through mutually negotiated and separate tolling agreements if both parties agree to toll such time periods. (j) The amount of a recoupment must equal the difference between the actual amount paid to a healthcare provider and the amount that should have been paid pursuant to subsection (k). (k) (1) This section does not interfere with or otherwise repeal the following: (A) The prompt payment appeals process described in § 56-32-126 ; (B) The Prior Authorization Fairness Act, compiled in part 37 of this chapter; (C) The authority of a receiver appointed by the commissioner pursuant to chapter 9 of this title to audit or collect overpayment made to providers more than eighteen (18) months from the date that a managed care organization (MCO) paid the claim; (D) The authority of the bureau of TennCare to collect overpayments made to providers more than fifteen (15) months from the date that the MCO paid the claim if discovered and verified by the bureau pursuant to an audit of an MCO; or (E) The subrogation rights or authority of the bureau of TennCare. (2) A health insurance entity that contracts directly with the bureau of TennCare in the provision of services for TennCare recipients is specifically excluded from this section only for the products and services made by the health insurance entity on behalf of the bureau of TennCare. (l) Only a health insurance entity or a health insurance entity's agent that contracts with healthcare providers or is responsible for paying contracted or noncontracted healthcare providers may seek to recover payments made to those healthcare providers. No other entity may pursue recoupments governed by this section. (m) A health insurance entity shall not base a recoupment on the extrapolation of other claims from an audit. (n) The commissioner is authorized to promulgate rules to effectuate this section in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Amended by 2024 Tenn. Acts, ch. 861,s 1, eff. 7/1/2024. Acts 2003 , ch. 257, § 1; 2009 , ch. 462, §§ 1 - 4, 7; 2009 , ch. 566, § 12.
(a) As used in this part: (1) "Covered person" means a person on whose behalf a health insurance entity offering health insurance coverage is obligated to pay benefits or provide services; (2) "Healthcare provider" means a person or entity performing services regulated pursuant to title 63 or title 68, chapter 11; (3) "Health insurance coverage" has the same meaning as in § 56-7-109 ; (4) "Health insurance entity" has the same meaning as in § 56-7-109 ; and (5) "Recoupment" or "recoup" means the action by a health insurance entity to recover amounts previously paid to a healthcare provider by withholding or offsetting the amounts against current payments to the healthcare provider.
(1) "Covered person" means a person on whose behalf a health insurance entity offering health insurance coverage is obligated to pay benefits or provide services;
(2) "Healthcare provider" means a person or entity performing services regulated pursuant to title 63 or title 68, chapter 11;
(3) "Health insurance coverage" has the same meaning as in § 56-7-109 ;
(4) "Health insurance entity" has the same meaning as in § 56-7-109 ; and
(5) "Recoupment" or "recoup" means the action by a health insurance entity to recover amounts previously paid to a healthcare provider by withholding or offsetting the amounts against current payments to the healthcare provider.
(b) A health insurance entity is not required to correct a payment error to a healthcare provider if the provider's request for a payment correction is filed more than fifteen (15) months after the date that the healthcare provider received payment for the claim from the health insurance entity.
(c) (1) Except in cases of fraud or suspected fraud committed by the healthcare provider, a health insurance entity may only recoup reimbursements made to the provider during the fifteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider. (2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subsection (e). (3) Notwithstanding subdivision (c)(1), if a health insurance entity makes a payment pursuant to health insurance coverage issued pursuant to a state employee health plan provided for under title 8, chapter 27, then the health insurance entity may only recoup reimbursements made to a provider during an eighteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider.
(1) Except in cases of fraud or suspected fraud committed by the healthcare provider, a health insurance entity may only recoup reimbursements made to the provider during the fifteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider.
(2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subsection (e).
(3) Notwithstanding subdivision (c)(1), if a health insurance entity makes a payment pursuant to health insurance coverage issued pursuant to a state employee health plan provided for under title 8, chapter 27, then the health insurance entity may only recoup reimbursements made to a provider during an eighteen-month period after the date that the health insurance entity paid the claim submitted by the healthcare provider.
(d) Notwithstanding subsection (c), if a health insurance entity or an agent that contracted to provide eligibility verification verifies that an individual is a covered person, and if the healthcare provider provides services to the individual in reliance on the verification, then the health insurance entity shall not thereafter recoup a claim on the basis that the individual is not a covered person unless the recoupment occurs within six (6) months of the date that the health insurance entity paid the claim; otherwise, the health insurance entity is barred from making the recoupment unless there was fraud by the healthcare provider.
(e) (1) Except in cases of fraud or suspected fraud, a health insurance entity that intends to recoup a previously paid claim shall give the healthcare provider thirty (30) days' advance written or electronic notice specifying the basis for the recoupment, and the notice must contain, at a minimum, the following information: (A) The CPT codes in the claims subject to the recoupment, or, if no CPT code is available, a description of the healthcare items or services for which the health insurance entity intends to recoup reimbursements; (B) A detailed explanation of why the previously made payment is being recouped, including, but not limited to: (i) Identification of the billing codes and modifiers that the health insurance entity believes should have been billed; and (ii) The health insurance entity's policies supporting the billing codes and modifiers that the health insurance entity believes should have been billed; (C) The claims subject to the recoupment, including applicable claim numbers; (D) The covered person's full legal name and any identification numbers; (E) The dates on which the healthcare provider provided the healthcare items or services, the costs of which are being recouped by the health insurance entity; (F) The estimated amount of recoupment; (G) Each claim's date of payment and how it was issued to the healthcare provider, including by mail or electronically, and, if applicable, the number of the check containing the recoupment or electronic payment identifying information; and (H) The process by which the healthcare provider may appeal the recoupment, including the instructions for the appeal process. (2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subdivision (e)(1).
(1) Except in cases of fraud or suspected fraud, a health insurance entity that intends to recoup a previously paid claim shall give the healthcare provider thirty (30) days' advance written or electronic notice specifying the basis for the recoupment, and the notice must contain, at a minimum, the following information: (A) The CPT codes in the claims subject to the recoupment, or, if no CPT code is available, a description of the healthcare items or services for which the health insurance entity intends to recoup reimbursements; (B) A detailed explanation of why the previously made payment is being recouped, including, but not limited to: (i) Identification of the billing codes and modifiers that the health insurance entity believes should have been billed; and (ii) The health insurance entity's policies supporting the billing codes and modifiers that the health insurance entity believes should have been billed; (C) The claims subject to the recoupment, including applicable claim numbers; (D) The covered person's full legal name and any identification numbers; (E) The dates on which the healthcare provider provided the healthcare items or services, the costs of which are being recouped by the health insurance entity; (F) The estimated amount of recoupment; (G) Each claim's date of payment and how it was issued to the healthcare provider, including by mail or electronically, and, if applicable, the number of the check containing the recoupment or electronic payment identifying information; and (H) The process by which the healthcare provider may appeal the recoupment, including the instructions for the appeal process.
(A) The CPT codes in the claims subject to the recoupment, or, if no CPT code is available, a description of the healthcare items or services for which the health insurance entity intends to recoup reimbursements;
(B) A detailed explanation of why the previously made payment is being recouped, including, but not limited to: (i) Identification of the billing codes and modifiers that the health insurance entity believes should have been billed; and (ii) The health insurance entity's policies supporting the billing codes and modifiers that the health insurance entity believes should have been billed;
(i) Identification of the billing codes and modifiers that the health insurance entity believes should have been billed; and
(ii) The health insurance entity's policies supporting the billing codes and modifiers that the health insurance entity believes should have been billed;
(C) The claims subject to the recoupment, including applicable claim numbers;
(D) The covered person's full legal name and any identification numbers;
(E) The dates on which the healthcare provider provided the healthcare items or services, the costs of which are being recouped by the health insurance entity;
(F) The estimated amount of recoupment;
(G) Each claim's date of payment and how it was issued to the healthcare provider, including by mail or electronically, and, if applicable, the number of the check containing the recoupment or electronic payment identifying information; and
(H) The process by which the healthcare provider may appeal the recoupment, including the instructions for the appeal process.
(2) If suspected fraud is not established, then a health insurance entity may only recoup reimbursements in accordance with subdivision (c)(1) and subdivision (e)(1).
(f) If a healthcare provider initiates an appeal within thirty (30) days of the date of a notice of recoupment pursuant to subsection (e), then payment must not be withheld from the healthcare provider until all appeals are exhausted.
(g) The notice required by subsection (e) may be included with the results of an audit submitted to a healthcare provider.
(h) (1) If the commissioner finds that a health insurance entity has failed to comply with this section, then the commissioner may impose a penalty of two (2) times the amount of the claim or seven hundred fifty dollars ($750), whichever amount is less. (2) In the alternative to subdivision (h)(1), the healthcare provider may seek injunctive or other appropriate relief in the chancery or circuit court in the county where the provider resides or practices.
(1) If the commissioner finds that a health insurance entity has failed to comply with this section, then the commissioner may impose a penalty of two (2) times the amount of the claim or seven hundred fifty dollars ($750), whichever amount is less.
(2) In the alternative to subdivision (h)(1), the healthcare provider may seek injunctive or other appropriate relief in the chancery or circuit court in the county where the provider resides or practices.
(i) This section must not be waived, voided, or nullified by contract; provided, that a health insurance entity and a healthcare provider may toll the time periods described in subsections (c) and (d) through mutually negotiated and separate tolling agreements if both parties agree to toll such time periods.
(j) The amount of a recoupment must equal the difference between the actual amount paid to a healthcare provider and the amount that should have been paid pursuant to subsection (k).
(k) (1) This section does not interfere with or otherwise repeal the following: (A) The prompt payment appeals process described in § 56-32-126 ; (B) The Prior Authorization Fairness Act, compiled in part 37 of this chapter; (C) The authority of a receiver appointed by the commissioner pursuant to chapter 9 of this title to audit or collect overpayment made to providers more than eighteen (18) months from the date that a managed care organization (MCO) paid the claim; (D) The authority of the bureau of TennCare to collect overpayments made to providers more than fifteen (15) months from the date that the MCO paid the claim if discovered and verified by the bureau pursuant to an audit of an MCO; or (E) The subrogation rights or authority of the bureau of TennCare. (2) A health insurance entity that contracts directly with the bureau of TennCare in the provision of services for TennCare recipients is specifically excluded from this section only for the products and services made by the health insurance entity on behalf of the bureau of TennCare.
(1) This section does not interfere with or otherwise repeal the following: (A) The prompt payment appeals process described in § 56-32-126 ; (B) The Prior Authorization Fairness Act, compiled in part 37 of this chapter; (C) The authority of a receiver appointed by the commissioner pursuant to chapter 9 of this title to audit or collect overpayment made to providers more than eighteen (18) months from the date that a managed care organization (MCO) paid the claim; (D) The authority of the bureau of TennCare to collect overpayments made to providers more than fifteen (15) months from the date that the MCO paid the claim if discovered and verified by the bureau pursuant to an audit of an MCO; or (E) The subrogation rights or authority of the bureau of TennCare.
(A) The prompt payment appeals process described in § 56-32-126 ;
(B) The Prior Authorization Fairness Act, compiled in part 37 of this chapter;
(C) The authority of a receiver appointed by the commissioner pursuant to chapter 9 of this title to audit or collect overpayment made to providers more than eighteen (18) months from the date that a managed care organization (MCO) paid the claim;
(D) The authority of the bureau of TennCare to collect overpayments made to providers more than fifteen (15) months from the date that the MCO paid the claim if discovered and verified by the bureau pursuant to an audit of an MCO; or
(E) The subrogation rights or authority of the bureau of TennCare.
(2) A health insurance entity that contracts directly with the bureau of TennCare in the provision of services for TennCare recipients is specifically excluded from this section only for the products and services made by the health insurance entity on behalf of the bureau of TennCare.
(l) Only a health insurance entity or a health insurance entity's agent that contracts with healthcare providers or is responsible for paying contracted or noncontracted healthcare providers may seek to recover payments made to those healthcare providers. No other entity may pursue recoupments governed by this section.
(m) A health insurance entity shall not base a recoupment on the extrapolation of other claims from an audit.
(n) The commissioner is authorized to promulgate rules to effectuate this section in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Amended by 2024 Tenn. Acts, ch. 861,s 1, eff. 7/1/2024.
Acts 2003 , ch. 257, § 1; 2009 , ch. 462, §§ 1 - 4, 7; 2009 , ch. 566, § 12.
Tenn. Code Ann. § 56-10-205 — TN Code / Title 56 / Chapter 10 / Section 56-10-205
Acquisition of securities in contravention of this part - Injunction
Status: in_force

No vote by the stockholder of record, or any other party so entitled to vote, of any security acquired or to be acquired in contravention of this part shall be valid or effective. The chancery court for the county where the principal office of the corporation is located may, without limiting the generality of its authority, upon the petition of the insurer referred to in § 56-10-202 , order the issuance or entry of any injunction or any other order which the court deems proper to effect this part. Acts 1969, ch. 271, § 5; T.C.A., § 56-3616.
No vote by the stockholder of record, or any other party so entitled to vote, of any security acquired or to be acquired in contravention of this part shall be valid or effective. The chancery court for the county where the principal office of the corporation is located may, without limiting the generality of its authority, upon the petition of the insurer referred to in § 56-10-202 , order the issuance or entry of any injunction or any other order which the court deems proper to effect this part.
Acts 1969, ch. 271, § 5; T.C.A., § 56-3616.