Tenn. Code Ann. § 56-50-104 — TN Code / Title 56 / Chapter 50 / Section 56-50-104
License revocation and denial
Status: in_force

(a) The commissioner may refuse to issue, suspend, revoke or refuse to renew the license of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent if the commissioner finds that: (1) There was any material misrepresentation in the application for the license; (2) The licensee or any officer, partner, member or key management personnel has been convicted of fraudulent or dishonest practices, is subject to a final administrative action or is otherwise shown to be untrustworthy or incompetent; (3) The viatical settlement provider demonstrates a pattern of unreasonable payments to viators; (4) The licensee or any officer, partner, member or key management personnel has been found guilty of, or has pleaded guilty or nolo contendere to, any felony, or to a misdemeanor involving fraud or moral turpitude, regardless of whether a judgment of conviction has been entered by the court; (5) The viatical settlement provider has entered into any viatical settlement contract that has not been approved pursuant to this chapter; (6) The viatical settlement provider has failed to honor contractual obligations set out in a viatical settlement contract or a viatical settlement purchase agreement; (7) The licensee no longer meets the requirements for initial licensure; (8) The viatical settlement provider has assigned, transferred or pledged a viaticated policy to a person other than a viatical settlement provider licensed in this state, viatical settlement purchaser, an accredited investor as defined in 17 CFR 230.501(a) , or qualified institutional buyer as defined in 17 CFR 230.144A , both promulgated under the Federal Securities Act of 1933, financing entity, special purpose entity or related provider trust; or (9) The licensee or any officer, partner, member or key management personnel has violated this chapter. (b) The commissioner may suspend, revoke or refuse to renew the license of a viatical settlement broker or a life insurance producer operating as a viatical settlement broker pursuant to this chapter if the commissioner finds that the viatical settlement broker or life insurance producer has violated this chapter or has otherwise engaged in bad faith conduct with one (1) or more viators. (c) If the commissioner suspends, revokes or refuses to renew the license of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent, or suspends, revokes or refuses to renew a license of a life insurance producer operating as a viatical settlement broker pursuant to this chapter, the commissioner shall conduct a hearing in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3. If the commissioner denies a license application of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent, the commissioner shall notify the applicant in writing of the denial and the grounds for denial. Acts 2009, ch. 604, § 5.
(a) The commissioner may refuse to issue, suspend, revoke or refuse to renew the license of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent if the commissioner finds that: (1) There was any material misrepresentation in the application for the license; (2) The licensee or any officer, partner, member or key management personnel has been convicted of fraudulent or dishonest practices, is subject to a final administrative action or is otherwise shown to be untrustworthy or incompetent; (3) The viatical settlement provider demonstrates a pattern of unreasonable payments to viators; (4) The licensee or any officer, partner, member or key management personnel has been found guilty of, or has pleaded guilty or nolo contendere to, any felony, or to a misdemeanor involving fraud or moral turpitude, regardless of whether a judgment of conviction has been entered by the court; (5) The viatical settlement provider has entered into any viatical settlement contract that has not been approved pursuant to this chapter; (6) The viatical settlement provider has failed to honor contractual obligations set out in a viatical settlement contract or a viatical settlement purchase agreement; (7) The licensee no longer meets the requirements for initial licensure; (8) The viatical settlement provider has assigned, transferred or pledged a viaticated policy to a person other than a viatical settlement provider licensed in this state, viatical settlement purchaser, an accredited investor as defined in 17 CFR 230.501(a) , or qualified institutional buyer as defined in 17 CFR 230.144A , both promulgated under the Federal Securities Act of 1933, financing entity, special purpose entity or related provider trust; or (9) The licensee or any officer, partner, member or key management personnel has violated this chapter.
(1) There was any material misrepresentation in the application for the license;
(2) The licensee or any officer, partner, member or key management personnel has been convicted of fraudulent or dishonest practices, is subject to a final administrative action or is otherwise shown to be untrustworthy or incompetent;
(3) The viatical settlement provider demonstrates a pattern of unreasonable payments to viators;
(4) The licensee or any officer, partner, member or key management personnel has been found guilty of, or has pleaded guilty or nolo contendere to, any felony, or to a misdemeanor involving fraud or moral turpitude, regardless of whether a judgment of conviction has been entered by the court;
(5) The viatical settlement provider has entered into any viatical settlement contract that has not been approved pursuant to this chapter;
(6) The viatical settlement provider has failed to honor contractual obligations set out in a viatical settlement contract or a viatical settlement purchase agreement;
(7) The licensee no longer meets the requirements for initial licensure;
(8) The viatical settlement provider has assigned, transferred or pledged a viaticated policy to a person other than a viatical settlement provider licensed in this state, viatical settlement purchaser, an accredited investor as defined in 17 CFR 230.501(a) , or qualified institutional buyer as defined in 17 CFR 230.144A , both promulgated under the Federal Securities Act of 1933, financing entity, special purpose entity or related provider trust; or
(9) The licensee or any officer, partner, member or key management personnel has violated this chapter.
(b) The commissioner may suspend, revoke or refuse to renew the license of a viatical settlement broker or a life insurance producer operating as a viatical settlement broker pursuant to this chapter if the commissioner finds that the viatical settlement broker or life insurance producer has violated this chapter or has otherwise engaged in bad faith conduct with one (1) or more viators.
(c) If the commissioner suspends, revokes or refuses to renew the license of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent, or suspends, revokes or refuses to renew a license of a life insurance producer operating as a viatical settlement broker pursuant to this chapter, the commissioner shall conduct a hearing in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3. If the commissioner denies a license application of a viatical settlement provider, viatical settlement broker or viatical settlement investment agent, the commissioner shall notify the applicant in writing of the denial and the grounds for denial.
Acts 2009, ch. 604, § 5.
Tenn. Code Ann. § 56-53-107 — TN Code / Title 56 / Chapter 53 / Section 56-53-107
Civil remedies
Status: in_force

(a) (1) Any person injured in the person's business or property by reason of a violation of § 56-53-103 may recover for the injury from the person or persons violating § 56-53-103 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-103 directly resulting from the violation; and (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs. (2) An action maintained under subdivision (a)(1) may neither be certified as a class action nor be made part of a class action. (b) (1) Any person injured in the person's business or property by reason of a violation of § 56-53-102 may recover for the injury from the person or persons violating § 56-53-102 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-102 directly resulting from the violation; (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs; (C) All other economic damages directly resulting from the violation of § 56-53-102 ; (D) Reasonable investigative fees based on a reasonable estimate of the time and expense incurred in the investigation of the violation or violations of § 56-53-102 proved at trial; and (E) A penalty of no less than one hundred dollars ($100) and no greater than ten thousand dollars ($10,000). (2) An action maintained under subdivision (b)(1) may neither be certified as a class action nor be made part of a class action. (c) Any person injured in the person's business or property by a person violating § 56-53-102 , upon a showing of clear and convincing evidence that the violation was part of a pattern or practice of such violations, shall be entitled to recover threefold the injured person's economic damages. An action for treble damages must be brought within three (3) years of the violation. One third (1/3) of the treble damages awarded shall be payable to the state to be used solely for the purpose of investigation and prosecution of violations of this chapter or other fraudulent behavior relating to insurance transactions, or for public education relating to insurance fraud. An action maintained under this subsection (c) may neither be certified as class action nor be made part of a class action, unless the violations of § 56-53-102 giving rise to the action resulted in criminal conviction of the violator or violators under § 56-53-104 . (d) (1) The attorney general and reporter, district attorney general or other prosecutorial agency shall have authority to maintain civil proceedings on behalf of the department of commerce and insurance and any victims of violations of § 56-53-102 . In the action, the court shall proceed as soon as practicable to the hearing and determination of the hearing. Pending final determination, the court may at any time enter restraining orders or prohibitions, or take other actions, including the acceptance of satisfactory performance bonds, as it deems proper. (A) The circuit and chancery courts of the state shall have jurisdiction to prevent and restrain violations of § 56-53-102 by issuing appropriate orders. (B) In any action commenced under this subsection (d), the court, upon finding that any person has violated § 56-53-102 , shall levy a fine of up to five thousand dollars ($5,000) for each violation. (2) Any court in which a prosecution for violation of § 56-53-102 is pending shall have authority to stay or limit proceedings in any civil action regarding the same or related conduct. Any court in which is pending a civil action brought pursuant to this subsection (d) may stay or limit proceedings in actions brought pursuant to subsections (a)-(c) regarding the same or related conduct or may transfer the actions or consolidate them before itself or allow the plaintiffs in the actions to participate in the action brought pursuant to this subsection (d), as it shall prescribe. (e) Any cause of action under this section for violation of § 56-53-102 or § 56-53-103 must be brought within five (5) years of the commission of the acts constituting the violation, or within five (5) years of the time the plaintiff discovered, or with reasonable diligence could have discovered, the acts, whichever is later. (f) An insurer shall not pay damages awarded under this section, or provide a defense or money for a defense, on behalf of an insured under a contract of insurance or indemnification. A third party who has asserted a claim against an insured shall have no cause of action under this section against the insurer of the insured arising out of the insurer's processing or settlement of the third party's claim. An obligee under a surety bond shall not have a cause of action under this section against the surety arising out of the surety's processing or settlement of the obligee's claim against the bond. (g) Any person injured in the person's business or property by reason of a violation of § 56-53-102 or § 56-53-103 may recover under only one (1) of the subsections of this section. Acts 2001, ch. 356, § 8.
(a) (1) Any person injured in the person's business or property by reason of a violation of § 56-53-103 may recover for the injury from the person or persons violating § 56-53-103 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-103 directly resulting from the violation; and (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs. (2) An action maintained under subdivision (a)(1) may neither be certified as a class action nor be made part of a class action.
(1) Any person injured in the person's business or property by reason of a violation of § 56-53-103 may recover for the injury from the person or persons violating § 56-53-103 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-103 directly resulting from the violation; and (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs.
(A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-103 directly resulting from the violation; and
(B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs.
(2) An action maintained under subdivision (a)(1) may neither be certified as a class action nor be made part of a class action.
(b) (1) Any person injured in the person's business or property by reason of a violation of § 56-53-102 may recover for the injury from the person or persons violating § 56-53-102 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-102 directly resulting from the violation; (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs; (C) All other economic damages directly resulting from the violation of § 56-53-102 ; (D) Reasonable investigative fees based on a reasonable estimate of the time and expense incurred in the investigation of the violation or violations of § 56-53-102 proved at trial; and (E) A penalty of no less than one hundred dollars ($100) and no greater than ten thousand dollars ($10,000). (2) An action maintained under subdivision (b)(1) may neither be certified as a class action nor be made part of a class action.
(1) Any person injured in the person's business or property by reason of a violation of § 56-53-102 may recover for the injury from the person or persons violating § 56-53-102 , in any appropriate court having jurisdiction, the following: (A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-102 directly resulting from the violation; (B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs; (C) All other economic damages directly resulting from the violation of § 56-53-102 ; (D) Reasonable investigative fees based on a reasonable estimate of the time and expense incurred in the investigation of the violation or violations of § 56-53-102 proved at trial; and (E) A penalty of no less than one hundred dollars ($100) and no greater than ten thousand dollars ($10,000).
(A) Return of any profit, benefit, compensation or payment received by the person violating § 56-53-102 directly resulting from the violation;
(B) Reasonable attorneys' fees, related legal expenses, including internal legal expenses and court costs;
(C) All other economic damages directly resulting from the violation of § 56-53-102 ;
(D) Reasonable investigative fees based on a reasonable estimate of the time and expense incurred in the investigation of the violation or violations of § 56-53-102 proved at trial; and
(E) A penalty of no less than one hundred dollars ($100) and no greater than ten thousand dollars ($10,000).
(2) An action maintained under subdivision (b)(1) may neither be certified as a class action nor be made part of a class action.
(c) Any person injured in the person's business or property by a person violating § 56-53-102 , upon a showing of clear and convincing evidence that the violation was part of a pattern or practice of such violations, shall be entitled to recover threefold the injured person's economic damages. An action for treble damages must be brought within three (3) years of the violation. One third (1/3) of the treble damages awarded shall be payable to the state to be used solely for the purpose of investigation and prosecution of violations of this chapter or other fraudulent behavior relating to insurance transactions, or for public education relating to insurance fraud. An action maintained under this subsection (c) may neither be certified as class action nor be made part of a class action, unless the violations of § 56-53-102 giving rise to the action resulted in criminal conviction of the violator or violators under § 56-53-104 .
(d) (1) The attorney general and reporter, district attorney general or other prosecutorial agency shall have authority to maintain civil proceedings on behalf of the department of commerce and insurance and any victims of violations of § 56-53-102 . In the action, the court shall proceed as soon as practicable to the hearing and determination of the hearing. Pending final determination, the court may at any time enter restraining orders or prohibitions, or take other actions, including the acceptance of satisfactory performance bonds, as it deems proper. (A) The circuit and chancery courts of the state shall have jurisdiction to prevent and restrain violations of § 56-53-102 by issuing appropriate orders. (B) In any action commenced under this subsection (d), the court, upon finding that any person has violated § 56-53-102 , shall levy a fine of up to five thousand dollars ($5,000) for each violation. (2) Any court in which a prosecution for violation of § 56-53-102 is pending shall have authority to stay or limit proceedings in any civil action regarding the same or related conduct. Any court in which is pending a civil action brought pursuant to this subsection (d) may stay or limit proceedings in actions brought pursuant to subsections (a)-(c) regarding the same or related conduct or may transfer the actions or consolidate them before itself or allow the plaintiffs in the actions to participate in the action brought pursuant to this subsection (d), as it shall prescribe.
(1) The attorney general and reporter, district attorney general or other prosecutorial agency shall have authority to maintain civil proceedings on behalf of the department of commerce and insurance and any victims of violations of § 56-53-102 . In the action, the court shall proceed as soon as practicable to the hearing and determination of the hearing. Pending final determination, the court may at any time enter restraining orders or prohibitions, or take other actions, including the acceptance of satisfactory performance bonds, as it deems proper. (A) The circuit and chancery courts of the state shall have jurisdiction to prevent and restrain violations of § 56-53-102 by issuing appropriate orders. (B) In any action commenced under this subsection (d), the court, upon finding that any person has violated § 56-53-102 , shall levy a fine of up to five thousand dollars ($5,000) for each violation.
(A) The circuit and chancery courts of the state shall have jurisdiction to prevent and restrain violations of § 56-53-102 by issuing appropriate orders.
(B) In any action commenced under this subsection (d), the court, upon finding that any person has violated § 56-53-102 , shall levy a fine of up to five thousand dollars ($5,000) for each violation.
(2) Any court in which a prosecution for violation of § 56-53-102 is pending shall have authority to stay or limit proceedings in any civil action regarding the same or related conduct. Any court in which is pending a civil action brought pursuant to this subsection (d) may stay or limit proceedings in actions brought pursuant to subsections (a)-(c) regarding the same or related conduct or may transfer the actions or consolidate them before itself or allow the plaintiffs in the actions to participate in the action brought pursuant to this subsection (d), as it shall prescribe.
(e) Any cause of action under this section for violation of § 56-53-102 or § 56-53-103 must be brought within five (5) years of the commission of the acts constituting the violation, or within five (5) years of the time the plaintiff discovered, or with reasonable diligence could have discovered, the acts, whichever is later.
(f) An insurer shall not pay damages awarded under this section, or provide a defense or money for a defense, on behalf of an insured under a contract of insurance or indemnification. A third party who has asserted a claim against an insured shall have no cause of action under this section against the insurer of the insured arising out of the insurer's processing or settlement of the third party's claim. An obligee under a surety bond shall not have a cause of action under this section against the surety arising out of the surety's processing or settlement of the obligee's claim against the bond.
(g) Any person injured in the person's business or property by reason of a violation of § 56-53-102 or § 56-53-103 may recover under only one (1) of the subsections of this section.
Acts 2001, ch. 356, § 8.
Tenn. Code Ann. § 56-7-118 — TN Code / Title 56 / Chapter 7 / Section 56-7-118
Notice of premium increase
Status: in_force

Any insurance company that increases its premiums shall give thirty (30) days' notice of any increase to a customer who has an account paid by bank draft or preauthorized check. Acts 1992, ch. 633, § 1.
Any insurance company that increases its premiums shall give thirty (30) days' notice of any increase to a customer who has an account paid by bank draft or preauthorized check.
Acts 1992, ch. 633, § 1.
Tenn. Code Ann. § 56-20-117 — TN Code / Title 56 / Chapter 20 / Section 56-20-117
Exemption from deposit and surplus requirements
Status: in_force

Sections 56-2-101 - 56-2-104, 56-2-113 - 56-2-115, 56-2-201, and 56-2-301 do not apply to or affect, nor should they be construed as in any way applying to or affecting, domestic, state and county mutual fire insurance companies, the organization of which was and is authorized by this chapter and chapters 21 and 22 of this title. Acts 1955, ch. 13, § 7; T.C.A., § 56-1917.
Sections 56-2-101 - 56-2-104, 56-2-113 - 56-2-115, 56-2-201, and 56-2-301 do not apply to or affect, nor should they be construed as in any way applying to or affecting, domestic, state and county mutual fire insurance companies, the organization of which was and is authorized by this chapter and chapters 21 and 22 of this title.
Acts 1955, ch. 13, § 7; T.C.A., § 56-1917.
Tenn. Code Ann. § 56-6-917 — TN Code / Title 56 / Chapter 6 / Section 56-6-917
Ethical considerations
Status: in_force

(a) A public adjuster is obligated, under the public adjuster's license, to serve with objectivity and complete loyalty in the interest of the adjuster's client alone; and to render to the insured such information, counsel and service, as within the knowledge, understanding and opinion in good faith of the adjuster, as will best serve the insured's insurance claim needs and interest. (b) A public adjuster shall not solicit an insured for two (2) days after any loss and shall not contract with an insured for an additional three (3) days. For catastrophic losses, a public adjuster shall not solicit an insured for seven (7) days after the loss. This subsection (b) shall not apply to commercial insurance. (c) A public adjuster shall not permit an unlicensed employee or representative of the public adjuster to conduct business for which a license is required under this part. (d) A public adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the salary, fee, commission or other consideration established in the written contract with the insured, unless full written disclosure has been made to the insured. (e) A public adjuster shall not refer or direct the insured to get needed repairs or services in connection with a loss from any person with whom the public adjuster has a financial interest, or from whom the public adjuster may receive direct or indirect compensation for the referral, unless the interest or compensation is disclosed to the insured. (f) A public adjuster shall not, directly or indirectly, buy or obtain for resale or other remuneration, any salvage of the insured that is subject to a claim upon which the public adjuster is or has worked. (g) A public adjuster shall disclose to an insured if the adjuster has any interest or will be compensated by any construction firm, building appraisal firm, motor vehicle repair shop or any other firm that performs any work in conjunction with damages caused by the insured loss. "Firm" includes any individual corporation, partnership, association, joint-stock company or legal entity. (h) Any compensation or anything of value in connection with an insured's specific loss that will be received by a public adjuster shall be disclosed by the public adjuster to the insured in writing, including the source and amount of the compensation. (i) A public adjuster may not agree to any loss settlement without the insured's knowledge and consent. (j) Public adjusters shall adhere to the following general ethical requirements: (1) A public adjuster shall not undertake the adjustment of any claim, if the public adjuster is not sufficiently competent and knowledgeable as to the terms and conditions of the insurance coverage so as to properly discharge the duties as public adjuster, or that otherwise exceeds the public adjuster's current expertise; (2) A public adjuster shall not knowingly make any oral or written material misrepresentations or statements to any insured client or potential insured client that are false or maliciously critical and intended to injure any person engaged in the business of insurance; (3) No public adjuster, while so licensed by the commissioner, may represent or act as a company adjuster or independent adjuster on the same claim; (4) The contract shall not be construed to prevent an insured from pursuing any civil remedy after the three-business-day revocation or cancellation period; (5) A public adjuster shall not enter into a contract or accept a power of attorney that vests in the public adjuster the effective authority to choose the persons who shall repair the insured's property; and (6) A public adjuster shall ensure that all contracts for the public adjuster's services are in writing and set forth all material terms and conditions of the engagement. Acts 2006, ch. 997, § 18.
(a) A public adjuster is obligated, under the public adjuster's license, to serve with objectivity and complete loyalty in the interest of the adjuster's client alone; and to render to the insured such information, counsel and service, as within the knowledge, understanding and opinion in good faith of the adjuster, as will best serve the insured's insurance claim needs and interest.
(b) A public adjuster shall not solicit an insured for two (2) days after any loss and shall not contract with an insured for an additional three (3) days. For catastrophic losses, a public adjuster shall not solicit an insured for seven (7) days after the loss. This subsection (b) shall not apply to commercial insurance.
(c) A public adjuster shall not permit an unlicensed employee or representative of the public adjuster to conduct business for which a license is required under this part.
(d) A public adjuster shall not have a direct or indirect financial interest in any aspect of the claim, other than the salary, fee, commission or other consideration established in the written contract with the insured, unless full written disclosure has been made to the insured.
(e) A public adjuster shall not refer or direct the insured to get needed repairs or services in connection with a loss from any person with whom the public adjuster has a financial interest, or from whom the public adjuster may receive direct or indirect compensation for the referral, unless the interest or compensation is disclosed to the insured.
(f) A public adjuster shall not, directly or indirectly, buy or obtain for resale or other remuneration, any salvage of the insured that is subject to a claim upon which the public adjuster is or has worked.
(g) A public adjuster shall disclose to an insured if the adjuster has any interest or will be compensated by any construction firm, building appraisal firm, motor vehicle repair shop or any other firm that performs any work in conjunction with damages caused by the insured loss. "Firm" includes any individual corporation, partnership, association, joint-stock company or legal entity.
(h) Any compensation or anything of value in connection with an insured's specific loss that will be received by a public adjuster shall be disclosed by the public adjuster to the insured in writing, including the source and amount of the compensation.
(i) A public adjuster may not agree to any loss settlement without the insured's knowledge and consent.
(j) Public adjusters shall adhere to the following general ethical requirements: (1) A public adjuster shall not undertake the adjustment of any claim, if the public adjuster is not sufficiently competent and knowledgeable as to the terms and conditions of the insurance coverage so as to properly discharge the duties as public adjuster, or that otherwise exceeds the public adjuster's current expertise; (2) A public adjuster shall not knowingly make any oral or written material misrepresentations or statements to any insured client or potential insured client that are false or maliciously critical and intended to injure any person engaged in the business of insurance; (3) No public adjuster, while so licensed by the commissioner, may represent or act as a company adjuster or independent adjuster on the same claim; (4) The contract shall not be construed to prevent an insured from pursuing any civil remedy after the three-business-day revocation or cancellation period; (5) A public adjuster shall not enter into a contract or accept a power of attorney that vests in the public adjuster the effective authority to choose the persons who shall repair the insured's property; and (6) A public adjuster shall ensure that all contracts for the public adjuster's services are in writing and set forth all material terms and conditions of the engagement.
(1) A public adjuster shall not undertake the adjustment of any claim, if the public adjuster is not sufficiently competent and knowledgeable as to the terms and conditions of the insurance coverage so as to properly discharge the duties as public adjuster, or that otherwise exceeds the public adjuster's current expertise;
(2) A public adjuster shall not knowingly make any oral or written material misrepresentations or statements to any insured client or potential insured client that are false or maliciously critical and intended to injure any person engaged in the business of insurance;
(3) No public adjuster, while so licensed by the commissioner, may represent or act as a company adjuster or independent adjuster on the same claim;
(4) The contract shall not be construed to prevent an insured from pursuing any civil remedy after the three-business-day revocation or cancellation period;
(5) A public adjuster shall not enter into a contract or accept a power of attorney that vests in the public adjuster the effective authority to choose the persons who shall repair the insured's property; and
(6) A public adjuster shall ensure that all contracts for the public adjuster's services are in writing and set forth all material terms and conditions of the engagement.
Acts 2006, ch. 997, § 18.
Tenn. Code Ann. § 56-7-2506 — TN Code / Title 56 / Chapter 7 / Section 56-7-2506
Bone mass measurement coverage - Osteoporosis
Status: in_force

(a) This section shall be known and may be cited as the "Bone Mass Measurement Coverage Act." (b) The general assembly finds that: (1) Osteoporosis affects twenty-five million (25,000,000) Americans and each year results in one million five hundred thousand (1,500,000) fractures of the hip, spine, wrist, and other bones, costing the nation at least eighteen billion dollars ($18,000,000,000); (2) Osteoporosis progresses silently, in most cases undiagnosed until a fracture occurs, and once a fracture occurs, the disease is already advanced, and the likelihood is high that another fracture will occur; (3) One (1) in two (2) women and one (1) in five (5) men will suffer a fracture due to osteoporosis in their lifetime; (4) Because osteoporosis progresses silently and currently has no cure, early diagnosis and treatment are key to reducing the prevalence and devastation of this disease; (5) Medical experts agree that osteoporosis is preventable and treatable; however, once the disease progresses to the point of fracture its associated consequences often lead to disability and institutionalization, and exact a heavy toll on the quality of life; (6) Given the current national focus on health care reform and the reduction of unnecessary health care expenditures through the use of health promotion programs, bone mass measurement, related to the early diagnosis and the timely treatment of osteoporosis, is a cost effective approach for this state to embrace; (7) Bone mass measurement is a reliable way to detect the presence of low bone mass and to ascertain the extent of bone loss to help assess the individual's risk for fracture, and this aids in selecting appropriate therapies and interventions. Ordinary x-rays are not sensitive enough to detect osteoporosis until twenty-five to forty percent (25-40%) of bone mass has been lost, and the disease is far advanced; (8) While there are currently available technologies for bone mass measurement, other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future; and (9) Scientifically proven technologies for bone mass measurement and other services related to the diagnosis and treatment of osteoporosis can be used effectively to reduce the pain and financial burden that osteoporosis inflicts upon its victims. (c) The purpose of this section is to provide coverage to individuals with a condition or medical history for which bone mass measurement (bone density testing) is determined to be medically necessary for the individual's attending physician or primary care provider for the diagnosis and treatment of osteoporosis. (d) (1) Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, or health maintenance organization that provides coverage for accident and health services, and that is delivered, issued for delivery, amended or renewed on or after July 1, 1996, may also provide coverage for a qualified individual for scientifically proven bone mass measurement (bone density testing) for the diagnosis and treatment of osteoporosis. (2) Any increase in expenditure requirements on a municipality or a county resulting from this subsection (d) shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose. (3) This subsection (d) shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration. (e) As used in subsection (d): (1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of identifying bone mass or detecting bone loss; and (2) "Qualified individual" means a person with a condition for which bone mass measurement is determined to be medically necessary by the person's attending physician or primary care physician. Acts 1996, ch. 969, §§ 1, 3, 4.
(a) This section shall be known and may be cited as the "Bone Mass Measurement Coverage Act."
(b) The general assembly finds that: (1) Osteoporosis affects twenty-five million (25,000,000) Americans and each year results in one million five hundred thousand (1,500,000) fractures of the hip, spine, wrist, and other bones, costing the nation at least eighteen billion dollars ($18,000,000,000); (2) Osteoporosis progresses silently, in most cases undiagnosed until a fracture occurs, and once a fracture occurs, the disease is already advanced, and the likelihood is high that another fracture will occur; (3) One (1) in two (2) women and one (1) in five (5) men will suffer a fracture due to osteoporosis in their lifetime; (4) Because osteoporosis progresses silently and currently has no cure, early diagnosis and treatment are key to reducing the prevalence and devastation of this disease; (5) Medical experts agree that osteoporosis is preventable and treatable; however, once the disease progresses to the point of fracture its associated consequences often lead to disability and institutionalization, and exact a heavy toll on the quality of life; (6) Given the current national focus on health care reform and the reduction of unnecessary health care expenditures through the use of health promotion programs, bone mass measurement, related to the early diagnosis and the timely treatment of osteoporosis, is a cost effective approach for this state to embrace; (7) Bone mass measurement is a reliable way to detect the presence of low bone mass and to ascertain the extent of bone loss to help assess the individual's risk for fracture, and this aids in selecting appropriate therapies and interventions. Ordinary x-rays are not sensitive enough to detect osteoporosis until twenty-five to forty percent (25-40%) of bone mass has been lost, and the disease is far advanced; (8) While there are currently available technologies for bone mass measurement, other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future; and (9) Scientifically proven technologies for bone mass measurement and other services related to the diagnosis and treatment of osteoporosis can be used effectively to reduce the pain and financial burden that osteoporosis inflicts upon its victims.
(1) Osteoporosis affects twenty-five million (25,000,000) Americans and each year results in one million five hundred thousand (1,500,000) fractures of the hip, spine, wrist, and other bones, costing the nation at least eighteen billion dollars ($18,000,000,000);
(2) Osteoporosis progresses silently, in most cases undiagnosed until a fracture occurs, and once a fracture occurs, the disease is already advanced, and the likelihood is high that another fracture will occur;
(3) One (1) in two (2) women and one (1) in five (5) men will suffer a fracture due to osteoporosis in their lifetime;
(4) Because osteoporosis progresses silently and currently has no cure, early diagnosis and treatment are key to reducing the prevalence and devastation of this disease;
(5) Medical experts agree that osteoporosis is preventable and treatable; however, once the disease progresses to the point of fracture its associated consequences often lead to disability and institutionalization, and exact a heavy toll on the quality of life;
(6) Given the current national focus on health care reform and the reduction of unnecessary health care expenditures through the use of health promotion programs, bone mass measurement, related to the early diagnosis and the timely treatment of osteoporosis, is a cost effective approach for this state to embrace;
(7) Bone mass measurement is a reliable way to detect the presence of low bone mass and to ascertain the extent of bone loss to help assess the individual's risk for fracture, and this aids in selecting appropriate therapies and interventions. Ordinary x-rays are not sensitive enough to detect osteoporosis until twenty-five to forty percent (25-40%) of bone mass has been lost, and the disease is far advanced;
(8) While there are currently available technologies for bone mass measurement, other technologies for measuring bone mass are under investigation and may become scientifically proven technologies in the future; and
(9) Scientifically proven technologies for bone mass measurement and other services related to the diagnosis and treatment of osteoporosis can be used effectively to reduce the pain and financial burden that osteoporosis inflicts upon its victims.
(c) The purpose of this section is to provide coverage to individuals with a condition or medical history for which bone mass measurement (bone density testing) is determined to be medically necessary for the individual's attending physician or primary care provider for the diagnosis and treatment of osteoporosis.
(d) (1) Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, or health maintenance organization that provides coverage for accident and health services, and that is delivered, issued for delivery, amended or renewed on or after July 1, 1996, may also provide coverage for a qualified individual for scientifically proven bone mass measurement (bone density testing) for the diagnosis and treatment of osteoporosis. (2) Any increase in expenditure requirements on a municipality or a county resulting from this subsection (d) shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose. (3) This subsection (d) shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration.
(1) Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, or health maintenance organization that provides coverage for accident and health services, and that is delivered, issued for delivery, amended or renewed on or after July 1, 1996, may also provide coverage for a qualified individual for scientifically proven bone mass measurement (bone density testing) for the diagnosis and treatment of osteoporosis.
(2) Any increase in expenditure requirements on a municipality or a county resulting from this subsection (d) shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose.
(3) This subsection (d) shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration.
(e) As used in subsection (d): (1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of identifying bone mass or detecting bone loss; and (2) "Qualified individual" means a person with a condition for which bone mass measurement is determined to be medically necessary by the person's attending physician or primary care physician.
(1) "Bone mass measurement" means a radiologic or radioisotopic procedure or other scientifically proven technologies performed on an individual for the purpose of identifying bone mass or detecting bone loss; and
(2) "Qualified individual" means a person with a condition for which bone mass measurement is determined to be medically necessary by the person's attending physician or primary care physician.
Acts 1996, ch. 969, §§ 1, 3, 4.
Tenn. Code Ann. § 56-7-132 — TN Code / Title 56 / Chapter 7 / Section 56-7-132
Successor coverage health claims
Status: in_force

(a) As used in this section only, the following terms have the meaning as indicated: (1) "Original health insurer" means a health insurance entity as defined in § 56-7-109 that has verified eligibility for the date of service, or has communicated to a health care provider prior authorization or precertification for a service to be provided, to a person believed by the original health insurer to be covered under the group health care policy as of the date that eligibility was verified or prior authorization or precertification is issued, but that no longer covers the insured individual at the time the service is performed; (2) "Successor coverage health claim" means a claim for benefits or reimbursement under a group health care policy when the health care services performed were based upon verification of eligibility or were authorized by an original health insurer, but the original health insurer coverage has been replaced by a successor health insurer on or before the date that the services are provided to the covered person; and (3) "Successor health insurer" means a health insurance entity as defined by § 56-7-109 that provided group health coverage for the person at the time the original health insurer verified eligibility or approved prior authorization or precertification for the person or at the time the service was actually performed. (b) In the case of a successor coverage health claim, and notwithstanding the provisions of a successor health insurer group health care policy, a successor health insurer shall not: (1) Deny a claim because of failure to submit the claim timely; provided, that the claim was submitted within one hundred eighty (180) days of the date the claim was denied by the original health insurer; or (2) Deny the claim because of the covered person's failure to obtain prior authorization or precertification, if the successor insurer would have granted prior authorization or precertification for the service had it been asked to do so prior to the health care service being rendered to the covered person. (c) Except as may result from the application of subsection (b), nothing in this section shall require a successor health insurer to pay any claim or make reimbursement for any services not covered under the terms of its group health care policy. (d) This section shall not apply to TennCare or any successor program provided for in title 71, chapter 5, or CoverKids or any successor program provided for in title 71, chapter 3, part 11. (e) Nothing in this section shall create any obligation by an original health insurer to a successor health insurer to provide proof of eligibility inquiry by a health care provider. (f) Original health insurers and successor health insurers shall comply with the Prior Authorization Fairness Act, compiled in part 37 of this chapter. Amended by 2023 Tenn. Acts, ch. 395, s 2, eff. 1/1/2025. Acts 2009 , ch. 462, § 5.
(a) As used in this section only, the following terms have the meaning as indicated: (1) "Original health insurer" means a health insurance entity as defined in § 56-7-109 that has verified eligibility for the date of service, or has communicated to a health care provider prior authorization or precertification for a service to be provided, to a person believed by the original health insurer to be covered under the group health care policy as of the date that eligibility was verified or prior authorization or precertification is issued, but that no longer covers the insured individual at the time the service is performed; (2) "Successor coverage health claim" means a claim for benefits or reimbursement under a group health care policy when the health care services performed were based upon verification of eligibility or were authorized by an original health insurer, but the original health insurer coverage has been replaced by a successor health insurer on or before the date that the services are provided to the covered person; and (3) "Successor health insurer" means a health insurance entity as defined by § 56-7-109 that provided group health coverage for the person at the time the original health insurer verified eligibility or approved prior authorization or precertification for the person or at the time the service was actually performed.
(1) "Original health insurer" means a health insurance entity as defined in § 56-7-109 that has verified eligibility for the date of service, or has communicated to a health care provider prior authorization or precertification for a service to be provided, to a person believed by the original health insurer to be covered under the group health care policy as of the date that eligibility was verified or prior authorization or precertification is issued, but that no longer covers the insured individual at the time the service is performed;
(2) "Successor coverage health claim" means a claim for benefits or reimbursement under a group health care policy when the health care services performed were based upon verification of eligibility or were authorized by an original health insurer, but the original health insurer coverage has been replaced by a successor health insurer on or before the date that the services are provided to the covered person; and
(3) "Successor health insurer" means a health insurance entity as defined by § 56-7-109 that provided group health coverage for the person at the time the original health insurer verified eligibility or approved prior authorization or precertification for the person or at the time the service was actually performed.
(b) In the case of a successor coverage health claim, and notwithstanding the provisions of a successor health insurer group health care policy, a successor health insurer shall not: (1) Deny a claim because of failure to submit the claim timely; provided, that the claim was submitted within one hundred eighty (180) days of the date the claim was denied by the original health insurer; or (2) Deny the claim because of the covered person's failure to obtain prior authorization or precertification, if the successor insurer would have granted prior authorization or precertification for the service had it been asked to do so prior to the health care service being rendered to the covered person.
(1) Deny a claim because of failure to submit the claim timely; provided, that the claim was submitted within one hundred eighty (180) days of the date the claim was denied by the original health insurer; or
(2) Deny the claim because of the covered person's failure to obtain prior authorization or precertification, if the successor insurer would have granted prior authorization or precertification for the service had it been asked to do so prior to the health care service being rendered to the covered person.
(c) Except as may result from the application of subsection (b), nothing in this section shall require a successor health insurer to pay any claim or make reimbursement for any services not covered under the terms of its group health care policy.
(d) This section shall not apply to TennCare or any successor program provided for in title 71, chapter 5, or CoverKids or any successor program provided for in title 71, chapter 3, part 11.
(e) Nothing in this section shall create any obligation by an original health insurer to a successor health insurer to provide proof of eligibility inquiry by a health care provider.
(f) Original health insurers and successor health insurers shall comply with the Prior Authorization Fairness Act, compiled in part 37 of this chapter.
Amended by 2023 Tenn. Acts, ch. 395, s 2, eff. 1/1/2025.
Acts 2009 , ch. 462, § 5.
Tenn. Code Ann. § 56-51-112 — TN Code / Title 56 / Chapter 51 / Section 56-51-112
Prepaid limited health service contracts
Status: in_force

(a) Any entity issued a certificate of authority and otherwise in compliance with this chapter may enter into contracts in this state to provide an agreed-upon set of limited health services to subscribers in exchange for a prepaid per capita sum or a prepaid aggregate fixed sum from a health maintenance organization or a state or federal agency. (1) The department shall disapprove any form filed under this subsection (a), or withdraw any previous approval of the form, if the form: (A) Is in any respect in violation of, or does not comply with, this chapter or rule adopted under this chapter; (B) Contains or incorporates by reference, where the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract; (C) Has any title, heading, or other indication of its provisions that is misleading; (D) Is printed or otherwise reproduced in such a manner as to render any material provision of the form substantially illegible; (E) Contains provisions that are unfair, inequitable, or contrary to the public policy of this state or that encourage misrepresentation; or (F) Charges rates that are determined by the department to be inadequate, excessive, or unfairly discriminatory. (2) It is not the intent of this subsection (a) to restrict unduly the right to modify rates in the exercise of reasonable business judgment. (3) All contracts shall be for a minimum period of twelve (12) months, unless the contract holder requests, in writing, a shorter contract period. (b) Every prepaid limited health service organization shall provide each subscriber a contract, a certificate, membership card, or member handbook that must clearly state all of the services to which a subscriber is entitled under the contract and must include a clear and understandable statement of any limitations on the services or kinds of services to be provided, including any copayment feature or schedule of benefits required by the contract or by any insurer or entity that is underwriting any of the services offered by the prepaid limited health service organization. The contract, certificate, provider listing, or member handbook must also state where and in what manner the health services may be obtained. (c) The documents provided pursuant to subsection (b) must have a clear and understandable description of the method used by the prepaid limited health service organization for resolving subscriber grievances and must contain the address of the department and the department's toll-free consumer hotline. (d) All prepaid limited health service coverage, benefits, or services for a member of the family of the subscriber must, as to the family member's coverage, benefits, or services, provide also that the coverage, benefits, or services applicable for children will be provided with respect to a preenrolled newborn child of the subscriber, or covered family member of the subscriber, from the moment of birth, or adoption pursuant to state law. (e) No alteration of any written application for any prepaid limited health services contract may be made by any person other than the applicant without the applicant's written consent, except that insertions may be made by the prepaid limited health service organization for administrative purposes only, in a manner as to indicate clearly that the insertions are not to be ascribed to the applicant. (f) No contract may contain any waiver of rights or benefits provided to or available to subscribers under any law or rule applicable to prepaid limited health service organizations. (g) Each document provided pursuant to subsection (b) must state that emergency services, if any, will be provided to subscribers in emergency situations not permitting treatment through the prepaid limited health service organization providers, without prior notification to and approval of the organization. The prepaid limited health services document must contain a definition of emergency services, describe procedures for determination by the prepaid limited health service organization of whether the services qualify for reimbursement as emergency services, and contain specific examples of what does constitute an emergency. (h) (1) All prepaid limited health services contracts, certificates, and member handbooks must contain the following provision: "Grace Period: This contract has a (insert number of days, but not less than ten (10) days) ____________________-day grace period. This provision means that if any required premium is not paid on or before the date it is due, it may be paid subsequently during the grace period. During the grace period, the contract will stay in force." (2) Subdivision (h)(1) does not apply to certificates or member handbooks delivered to individual subscribers under a group prepaid limited health services contract when the employer who will hold the contract on behalf of the subscriber group pays the entire premium for the individual subscriber. However, the required provision applies to the group prepaid limited health services contract. (i) The contract must clearly disclose the intent of the prepaid limited health service organization as to the applicability or nonapplicability of coverage to preexisting conditions. The contract must also disclose what services are excludable. (j) All prepaid limited health service organization contracts that provide coverage for a member of the family of the subscriber, must, as to the family member's coverage, provide that coverage, benefits, or services applicable for children will be provided with respect to an adopted child of the subscriber, which child is placed in compliance with state adoption law, from the moment of placement in the residence of the subscriber. In the case of a newborn child, coverage begins from the moment of birth if a written agreement to adopt the child has been entered into by the subscriber prior to the birth of the child whether or not the agreement is enforceable. However, coverage for the child is not required if the child is not ultimately adopted by the subscriber in compliance with state adoption law. (k) Each prepaid limited health service organization shall provide prospective enrollees, upon request, with written information about the terms and conditions of the plan in accordance with subsection (b) to enable prospective enrollees to make informed decisions about accepting a managed-care system of limited health care delivery. All marketing materials printed by the prepaid limited health services organization must contain a notice in boldfaced type that states that the information required under this section is available to prospective enrollees upon request. (l) Each prepaid limited health service organization shall make available to all subscribers, upon request, a description of the authorization and referral process for services or a description of the process used to analyze the qualifications and credentials of providers under contract with the organization. Acts 2000, ch. 948, § 12.
(a) Any entity issued a certificate of authority and otherwise in compliance with this chapter may enter into contracts in this state to provide an agreed-upon set of limited health services to subscribers in exchange for a prepaid per capita sum or a prepaid aggregate fixed sum from a health maintenance organization or a state or federal agency. (1) The department shall disapprove any form filed under this subsection (a), or withdraw any previous approval of the form, if the form: (A) Is in any respect in violation of, or does not comply with, this chapter or rule adopted under this chapter; (B) Contains or incorporates by reference, where the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract; (C) Has any title, heading, or other indication of its provisions that is misleading; (D) Is printed or otherwise reproduced in such a manner as to render any material provision of the form substantially illegible; (E) Contains provisions that are unfair, inequitable, or contrary to the public policy of this state or that encourage misrepresentation; or (F) Charges rates that are determined by the department to be inadequate, excessive, or unfairly discriminatory. (2) It is not the intent of this subsection (a) to restrict unduly the right to modify rates in the exercise of reasonable business judgment. (3) All contracts shall be for a minimum period of twelve (12) months, unless the contract holder requests, in writing, a shorter contract period.
(1) The department shall disapprove any form filed under this subsection (a), or withdraw any previous approval of the form, if the form: (A) Is in any respect in violation of, or does not comply with, this chapter or rule adopted under this chapter; (B) Contains or incorporates by reference, where the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract; (C) Has any title, heading, or other indication of its provisions that is misleading; (D) Is printed or otherwise reproduced in such a manner as to render any material provision of the form substantially illegible; (E) Contains provisions that are unfair, inequitable, or contrary to the public policy of this state or that encourage misrepresentation; or (F) Charges rates that are determined by the department to be inadequate, excessive, or unfairly discriminatory.
(A) Is in any respect in violation of, or does not comply with, this chapter or rule adopted under this chapter;
(B) Contains or incorporates by reference, where the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract;
(C) Has any title, heading, or other indication of its provisions that is misleading;
(D) Is printed or otherwise reproduced in such a manner as to render any material provision of the form substantially illegible;
(E) Contains provisions that are unfair, inequitable, or contrary to the public policy of this state or that encourage misrepresentation; or
(F) Charges rates that are determined by the department to be inadequate, excessive, or unfairly discriminatory.
(2) It is not the intent of this subsection (a) to restrict unduly the right to modify rates in the exercise of reasonable business judgment.
(3) All contracts shall be for a minimum period of twelve (12) months, unless the contract holder requests, in writing, a shorter contract period.
(b) Every prepaid limited health service organization shall provide each subscriber a contract, a certificate, membership card, or member handbook that must clearly state all of the services to which a subscriber is entitled under the contract and must include a clear and understandable statement of any limitations on the services or kinds of services to be provided, including any copayment feature or schedule of benefits required by the contract or by any insurer or entity that is underwriting any of the services offered by the prepaid limited health service organization. The contract, certificate, provider listing, or member handbook must also state where and in what manner the health services may be obtained.
(c) The documents provided pursuant to subsection (b) must have a clear and understandable description of the method used by the prepaid limited health service organization for resolving subscriber grievances and must contain the address of the department and the department's toll-free consumer hotline.
(d) All prepaid limited health service coverage, benefits, or services for a member of the family of the subscriber must, as to the family member's coverage, benefits, or services, provide also that the coverage, benefits, or services applicable for children will be provided with respect to a preenrolled newborn child of the subscriber, or covered family member of the subscriber, from the moment of birth, or adoption pursuant to state law.
(e) No alteration of any written application for any prepaid limited health services contract may be made by any person other than the applicant without the applicant's written consent, except that insertions may be made by the prepaid limited health service organization for administrative purposes only, in a manner as to indicate clearly that the insertions are not to be ascribed to the applicant.
(f) No contract may contain any waiver of rights or benefits provided to or available to subscribers under any law or rule applicable to prepaid limited health service organizations.
(g) Each document provided pursuant to subsection (b) must state that emergency services, if any, will be provided to subscribers in emergency situations not permitting treatment through the prepaid limited health service organization providers, without prior notification to and approval of the organization. The prepaid limited health services document must contain a definition of emergency services, describe procedures for determination by the prepaid limited health service organization of whether the services qualify for reimbursement as emergency services, and contain specific examples of what does constitute an emergency.
(h) (1) All prepaid limited health services contracts, certificates, and member handbooks must contain the following provision: "Grace Period: This contract has a (insert number of days, but not less than ten (10) days) ____________________-day grace period. This provision means that if any required premium is not paid on or before the date it is due, it may be paid subsequently during the grace period. During the grace period, the contract will stay in force." (2) Subdivision (h)(1) does not apply to certificates or member handbooks delivered to individual subscribers under a group prepaid limited health services contract when the employer who will hold the contract on behalf of the subscriber group pays the entire premium for the individual subscriber. However, the required provision applies to the group prepaid limited health services contract.
(1) All prepaid limited health services contracts, certificates, and member handbooks must contain the following provision: "Grace Period: This contract has a (insert number of days, but not less than ten (10) days) ____________________-day grace period. This provision means that if any required premium is not paid on or before the date it is due, it may be paid subsequently during the grace period. During the grace period, the contract will stay in force."
"Grace Period: This contract has a (insert number of days, but not less than ten (10) days) ____________________-day grace period. This provision means that if any required premium is not paid on or before the date it is due, it may be paid subsequently during the grace period. During the grace period, the contract will stay in force."
(2) Subdivision (h)(1) does not apply to certificates or member handbooks delivered to individual subscribers under a group prepaid limited health services contract when the employer who will hold the contract on behalf of the subscriber group pays the entire premium for the individual subscriber. However, the required provision applies to the group prepaid limited health services contract.
(i) The contract must clearly disclose the intent of the prepaid limited health service organization as to the applicability or nonapplicability of coverage to preexisting conditions. The contract must also disclose what services are excludable.
(j) All prepaid limited health service organization contracts that provide coverage for a member of the family of the subscriber, must, as to the family member's coverage, provide that coverage, benefits, or services applicable for children will be provided with respect to an adopted child of the subscriber, which child is placed in compliance with state adoption law, from the moment of placement in the residence of the subscriber. In the case of a newborn child, coverage begins from the moment of birth if a written agreement to adopt the child has been entered into by the subscriber prior to the birth of the child whether or not the agreement is enforceable. However, coverage for the child is not required if the child is not ultimately adopted by the subscriber in compliance with state adoption law.
(k) Each prepaid limited health service organization shall provide prospective enrollees, upon request, with written information about the terms and conditions of the plan in accordance with subsection (b) to enable prospective enrollees to make informed decisions about accepting a managed-care system of limited health care delivery. All marketing materials printed by the prepaid limited health services organization must contain a notice in boldfaced type that states that the information required under this section is available to prospective enrollees upon request.
(l) Each prepaid limited health service organization shall make available to all subscribers, upon request, a description of the authorization and referral process for services or a description of the process used to analyze the qualifications and credentials of providers under contract with the organization.
Acts 2000, ch. 948, § 12.
Tenn. Code Ann. § 56-21-125 — TN Code / Title 56 / Chapter 21 / Section 56-21-125
Reinsurance of excess fire risks - Reinsurance in unauthorized company - Premium tax
Status: in_force

All amounts in excess of those provided by § 56-21-123 shall be reinsured concurrently with its writing. No company doing business under this chapter shall reinsure any of its business in any unauthorized company, except upon the written approval of the commissioner. The company shall pay the tax prescribed by chapter 4, part 2 of this title on all business it reinsures in companies not having their domicile in this state. Acts 1907, ch. 461, § 8; Shan., § 3369a23; Acts 1921, ch. 160, § 8; Code 1932, § 6274; modified; T.C.A. (orig. ed.), § 56-2027.
All amounts in excess of those provided by § 56-21-123 shall be reinsured concurrently with its writing. No company doing business under this chapter shall reinsure any of its business in any unauthorized company, except upon the written approval of the commissioner. The company shall pay the tax prescribed by chapter 4, part 2 of this title on all business it reinsures in companies not having their domicile in this state.
Acts 1907, ch. 461, § 8; Shan., § 3369a23; Acts 1921, ch. 160, § 8; Code 1932, § 6274; modified; T.C.A. (orig. ed.), § 56-2027.
Tenn. Code Ann. § 56-27-112 — TN Code / Title 56 / Chapter 27 / Section 56-27-112
Prerequisites for issuance of license
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 medical 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 physicians of standing in the area to be served to become participating physicians; (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 review and approval or disapproval of the commissioner as provided in §§ 56-26-102 and 56-26-202 and any rules promulgated under that section. Sections 56-26-102 and 56-26-202 and related rules shall apply to all medical service plans in the same manner as to accident and sickness policies subject to §§ 56-26-102 and 56-26-202 ; (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 medical service corporations, or by the participating physicians. 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 provision has been adequately made for operating expenses, payments to participating physicians and the establishment of legal reserves and other reserves as may be required by the commissioner; (7) The 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 medical service bills, including provision for unreported and undischarged medical cases and other known liabilities. In addition, a contingency or epidemic 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 or epidemic 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 that they are 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 doctors of medicine have agreed to render the medical services for which the corporation agrees to pay; and (9) A provision has been made in the subscription contract authorizing medical service other than participating physicians, 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 medical 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 that the commissioner deems in the public interest. Acts 1945, ch. 113, § 7; C. Supp. 1950, § 4186.24; T.C.A. (orig. ed.), § 56-2912; Acts 2011, ch. 344, § 13.
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 medical 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 physicians of standing in the area to be served to become participating physicians;
(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 review and approval or disapproval of the commissioner as provided in §§ 56-26-102 and 56-26-202 and any rules promulgated under that section. Sections 56-26-102 and 56-26-202 and related rules shall apply to all medical service plans in the same manner as to accident and sickness policies subject to §§ 56-26-102 and 56-26-202 ;
(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 medical service corporations, or by the participating physicians. 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 provision has been adequately made for operating expenses, payments to participating physicians and the establishment of legal reserves and other reserves as may be required by the commissioner;
(7) The 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 medical service bills, including provision for unreported and undischarged medical cases and other known liabilities. In addition, a contingency or epidemic 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 or epidemic 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 that they are 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 doctors of medicine have agreed to render the medical services for which the corporation agrees to pay; and
(9) A provision has been made in the subscription contract authorizing medical service other than participating physicians, 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 medical 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 that the commissioner deems in the public interest.
Acts 1945, ch. 113, § 7; C. Supp. 1950, § 4186.24; T.C.A. (orig. ed.), § 56-2912; Acts 2011, ch. 344, § 13.
Tenn. Code Ann. § 56-61-102 — TN Code / Title 56 / Chapter 61 / Section 56-61-102
Chapter definitions
Status: in_force

For purposes of this chapter, unless the context otherwise requires: (1) "Adverse determination" means: (A) A determination by a health carrier or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health carrier's health benefit plan does not meet the health carrier's requirements for medical necessity, appropriateness, healthcare setting, level of care or effectiveness and the requested benefit is therefore denied, reduced or terminated or payment is not provided or made, in whole or in part, for the benefit; (B) The denial, reduction, termination or failure to provide or make payment, in whole or in part, for a benefit based on a determination by a health carrier of a covered person's eligibility to participate in the health carrier's health benefit plan; or (C) Any prospective review or retrospective review determination that denies, reduces, or terminates or fails to provide or make payment for, in whole or in part, a benefit; (2) "Aggrieved person" means: (A) A healthcare provider; (B) A covered person; or (C) A covered person's authorized representative; (3) "Authorized representative" means: (A) A person to whom a covered person has given express written consent to represent the covered person for purposes of this chapter; (B) A person authorized by law to provide substituted consent for a covered person; (C) A family member of the covered person or the covered person's treating healthcare professional when the covered person is unable to provide consent; (D) A healthcare professional when the covered person's health benefit plan requires that a request for a benefit under the plan be initiated by the healthcare professional; or (E) In the case of an urgent care request, a healthcare professional with knowledge of the covered person's medical condition; (4) "Clinical peer" means a physician or other healthcare professional who holds a nonrestricted license in a state of the United States and in the same or similar specialty that would typically manage the medical condition, procedure or treatment under review; (5) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by the health carrier to determine the medical necessity and appropriateness of healthcare services; (6) "Closed plan" means a managed care plan that requires covered persons to use participating providers under the terms of the managed care plan or the plan will not provide covered benefits to the covered person; (7) "Commissioner" means the commissioner of commerce and insurance; (8) "Covered benefits" or "benefits" means those healthcare services to which a covered person is entitled under the terms of a health benefit plan; (9) "Covered person" means a policyholder, subscriber, enrollee or other individual participating in a health benefit plan; (10) "Emergency medical condition" means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention, where failure to provide medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy; (11) "Emergency services" means healthcare items and services furnished or required to evaluate and treat an emergency medical condition; (12) "External review organization" means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier; (13) "Facility" means an institution licensed under title 68 providing healthcare services or a healthcare setting, including but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation; (14) "Final adverse determination" means an adverse determination involving a covered benefit that has been upheld by a health carrier at the completion of the health carrier's internal grievance process procedures as set forth in this chapter; (15) "Grievance" means a written appeal of an adverse determination or final adverse determination submitted by or on behalf of a covered person regarding: (A) Availability, delivery or quality of healthcare services regarding an adverse determination; (B) Claims payment, handling or reimbursement for healthcare services; (C) Matters pertaining to the contractual relationship between a covered person and a health carrier; or (D) Matters pertaining to the contractual relationship between a healthcare provider and a health carrier; (16) "Health benefit plan" means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services; (17) "Health carrier" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or healthcare services; (18) "Healthcare professional" means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law; (19) "Healthcare provider" or "provider" means a healthcare professional or a facility; (20) "Healthcare services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease; (21) "Managed care plan" means a health benefit plan that requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use healthcare providers managed, owned, under contract with or employed by the health carrier. "Managed care plan" includes: (A) A closed plan, as defined in subdivision (6); and (B) An open plan, as defined in subdivision (26); (22) "Medical or scientific evidence" means evidence found in the following sources; provided, that subdivisions (22)(A)-(B) shall be considered to have more evidentiary value than subdivision (22)(E) and subdivision (22)(E), when considered solely and in the absence of subdivisions (22)(A)-(B), shall not be sufficient to establish medical or scientific evidence for purposes of this chapter: (A) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff; (B) Peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the national institutes of health's library of medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. for indexing in Excerpta Medicus (EMBASE); (C) Medical journals recognized by the secretary of health and human services under § 1861(t)(2) of the federal Social Security Act; (D) The following standard reference compendia: (i) The American Hospital Formulary Service - Drug Information; (ii) Drug Facts and Comparisons; (iii) The American Dental Association Accepted Dental Therapeutics; (iv) The United States Pharmacopoeia - Drug Information; or (E) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (i) The federal agency for healthcare research and quality; (ii) The national institutes of health; (iii) The national cancer institute; (iv) The national academy of sciences; (v) The centers for medicare and medicaid services; (vi) The federal food and drug administration; and (vii) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services; (23) "Medically necessary" or "medical necessity" means healthcare services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (A) In accordance with generally accepted standards of medical practice; (B) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; (C) Not primarily for the convenience of the patient, physician, or other healthcare provider; and (D) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease; (24) "NAIC" means the National Association of Insurance Commissioners; (25) "Network" means the group of participating providers providing services to a managed care plan; (26) "Open plan" means a managed care plan, other than a closed plan, that provides incentives, including financial incentives, for covered persons to use participating providers under the terms of the managed care plan; (27) "Participating provider" means a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide healthcare services to covered persons with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health carrier; (28) "Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the entities listed in this subdivision (28); (29) "Prospective review" means utilization review conducted prior to an admission or the provision of a healthcare service or a course of treatment in accordance with a health carrier's requirement that the healthcare service or course of treatment, in whole or in part, be approved prior to its provision or admission; (30) "Register" means the written records kept by a health carrier to document all grievances received during a calendar year; (31) "Retrospective review" means any review of a request for a benefit that is not a prospective review request. Retrospective review does not include the review of a claim that is limited to veracity of documentation or accuracy of coding; and (32) (A) "Urgent care request" means a request for a healthcare service or course of treatment with respect to which the time periods for making nonurgent care request determination: (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or (ii) In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the healthcare service or treatment that is the subject of the request; (B) (i) In determining whether a request is to be treated as an urgent care request, an individual acting on behalf of the health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine. (ii) Any request that a physician with knowledge of the covered person's medical condition determines is an urgent care request within the meaning of subdivision (32)(A) shall be treated as an urgent care request. Acts 2010, ch. 980, § 3.
For purposes of this chapter, unless the context otherwise requires:
(1) "Adverse determination" means: (A) A determination by a health carrier or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health carrier's health benefit plan does not meet the health carrier's requirements for medical necessity, appropriateness, healthcare setting, level of care or effectiveness and the requested benefit is therefore denied, reduced or terminated or payment is not provided or made, in whole or in part, for the benefit; (B) The denial, reduction, termination or failure to provide or make payment, in whole or in part, for a benefit based on a determination by a health carrier of a covered person's eligibility to participate in the health carrier's health benefit plan; or (C) Any prospective review or retrospective review determination that denies, reduces, or terminates or fails to provide or make payment for, in whole or in part, a benefit;
(A) A determination by a health carrier or its designee utilization review organization that, based upon the information provided, a request for a benefit under the health carrier's health benefit plan does not meet the health carrier's requirements for medical necessity, appropriateness, healthcare setting, level of care or effectiveness and the requested benefit is therefore denied, reduced or terminated or payment is not provided or made, in whole or in part, for the benefit;
(B) The denial, reduction, termination or failure to provide or make payment, in whole or in part, for a benefit based on a determination by a health carrier of a covered person's eligibility to participate in the health carrier's health benefit plan; or
(C) Any prospective review or retrospective review determination that denies, reduces, or terminates or fails to provide or make payment for, in whole or in part, a benefit;
(2) "Aggrieved person" means: (A) A healthcare provider; (B) A covered person; or (C) A covered person's authorized representative;
(A) A healthcare provider;
(B) A covered person; or
(C) A covered person's authorized representative;
(3) "Authorized representative" means: (A) A person to whom a covered person has given express written consent to represent the covered person for purposes of this chapter; (B) A person authorized by law to provide substituted consent for a covered person; (C) A family member of the covered person or the covered person's treating healthcare professional when the covered person is unable to provide consent; (D) A healthcare professional when the covered person's health benefit plan requires that a request for a benefit under the plan be initiated by the healthcare professional; or (E) In the case of an urgent care request, a healthcare professional with knowledge of the covered person's medical condition;
(A) A person to whom a covered person has given express written consent to represent the covered person for purposes of this chapter;
(B) A person authorized by law to provide substituted consent for a covered person;
(C) A family member of the covered person or the covered person's treating healthcare professional when the covered person is unable to provide consent;
(D) A healthcare professional when the covered person's health benefit plan requires that a request for a benefit under the plan be initiated by the healthcare professional; or
(E) In the case of an urgent care request, a healthcare professional with knowledge of the covered person's medical condition;
(4) "Clinical peer" means a physician or other healthcare professional who holds a nonrestricted license in a state of the United States and in the same or similar specialty that would typically manage the medical condition, procedure or treatment under review;
(5) "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by the health carrier to determine the medical necessity and appropriateness of healthcare services;
(6) "Closed plan" means a managed care plan that requires covered persons to use participating providers under the terms of the managed care plan or the plan will not provide covered benefits to the covered person;
(7) "Commissioner" means the commissioner of commerce and insurance;
(8) "Covered benefits" or "benefits" means those healthcare services to which a covered person is entitled under the terms of a health benefit plan;
(9) "Covered person" means a policyholder, subscriber, enrollee or other individual participating in a health benefit plan;
(10) "Emergency medical condition" means the sudden and, at the time, unexpected onset of a health condition that requires immediate medical attention, where failure to provide medical attention would result in serious impairment to bodily functions, serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy;
(11) "Emergency services" means healthcare items and services furnished or required to evaluate and treat an emergency medical condition;
(12) "External review organization" means an entity that conducts independent external reviews of adverse determinations and final adverse determinations of a health carrier;
(13) "Facility" means an institution licensed under title 68 providing healthcare services or a healthcare setting, including but not limited to, hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation;
(14) "Final adverse determination" means an adverse determination involving a covered benefit that has been upheld by a health carrier at the completion of the health carrier's internal grievance process procedures as set forth in this chapter;
(15) "Grievance" means a written appeal of an adverse determination or final adverse determination submitted by or on behalf of a covered person regarding: (A) Availability, delivery or quality of healthcare services regarding an adverse determination; (B) Claims payment, handling or reimbursement for healthcare services; (C) Matters pertaining to the contractual relationship between a covered person and a health carrier; or (D) Matters pertaining to the contractual relationship between a healthcare provider and a health carrier;
(A) Availability, delivery or quality of healthcare services regarding an adverse determination;
(B) Claims payment, handling or reimbursement for healthcare services;
(C) Matters pertaining to the contractual relationship between a covered person and a health carrier; or
(D) Matters pertaining to the contractual relationship between a healthcare provider and a health carrier;
(16) "Health benefit plan" means a policy, contract, certificate or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services;
(17) "Health carrier" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of healthcare services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or healthcare services;
(18) "Healthcare professional" means a physician or other healthcare practitioner licensed, accredited or certified to perform specified healthcare services consistent with state law;
(19) "Healthcare provider" or "provider" means a healthcare professional or a facility;
(20) "Healthcare services" means services for the diagnosis, prevention, treatment, cure or relief of a health condition, illness, injury or disease;
(21) "Managed care plan" means a health benefit plan that requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use healthcare providers managed, owned, under contract with or employed by the health carrier. "Managed care plan" includes: (A) A closed plan, as defined in subdivision (6); and (B) An open plan, as defined in subdivision (26);
(A) A closed plan, as defined in subdivision (6); and
(B) An open plan, as defined in subdivision (26);
(22) "Medical or scientific evidence" means evidence found in the following sources; provided, that subdivisions (22)(A)-(B) shall be considered to have more evidentiary value than subdivision (22)(E) and subdivision (22)(E), when considered solely and in the absence of subdivisions (22)(A)-(B), shall not be sufficient to establish medical or scientific evidence for purposes of this chapter: (A) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff; (B) Peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the national institutes of health's library of medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. for indexing in Excerpta Medicus (EMBASE); (C) Medical journals recognized by the secretary of health and human services under § 1861(t)(2) of the federal Social Security Act; (D) The following standard reference compendia: (i) The American Hospital Formulary Service - Drug Information; (ii) Drug Facts and Comparisons; (iii) The American Dental Association Accepted Dental Therapeutics; (iv) The United States Pharmacopoeia - Drug Information; or (E) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (i) The federal agency for healthcare research and quality; (ii) The national institutes of health; (iii) The national cancer institute; (iv) The national academy of sciences; (v) The centers for medicare and medicaid services; (vi) The federal food and drug administration; and (vii) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services;
(A) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff;
(B) Peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the national institutes of health's library of medicine for indexing in Index Medicus (Medline) and Elsevier Science Ltd. for indexing in Excerpta Medicus (EMBASE);
(C) Medical journals recognized by the secretary of health and human services under § 1861(t)(2) of the federal Social Security Act;
(D) The following standard reference compendia: (i) The American Hospital Formulary Service - Drug Information; (ii) Drug Facts and Comparisons; (iii) The American Dental Association Accepted Dental Therapeutics; (iv) The United States Pharmacopoeia - Drug Information; or
(i) The American Hospital Formulary Service - Drug Information;
(ii) Drug Facts and Comparisons;
(iii) The American Dental Association Accepted Dental Therapeutics;
(iv) The United States Pharmacopoeia - Drug Information; or
(E) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (i) The federal agency for healthcare research and quality; (ii) The national institutes of health; (iii) The national cancer institute; (iv) The national academy of sciences; (v) The centers for medicare and medicaid services; (vi) The federal food and drug administration; and (vii) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services;
(i) The federal agency for healthcare research and quality;
(ii) The national institutes of health;
(iii) The national cancer institute;
(iv) The national academy of sciences;
(v) The centers for medicare and medicaid services;
(vi) The federal food and drug administration; and
(vii) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services;
(23) "Medically necessary" or "medical necessity" means healthcare services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an illness, injury, disease or its symptoms, and that are: (A) In accordance with generally accepted standards of medical practice; (B) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease; (C) Not primarily for the convenience of the patient, physician, or other healthcare provider; and (D) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease;
(A) In accordance with generally accepted standards of medical practice;
(B) Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient's illness, injury or disease;
(C) Not primarily for the convenience of the patient, physician, or other healthcare provider; and
(D) Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient's illness, injury or disease;
(24) "NAIC" means the National Association of Insurance Commissioners;
(25) "Network" means the group of participating providers providing services to a managed care plan;
(26) "Open plan" means a managed care plan, other than a closed plan, that provides incentives, including financial incentives, for covered persons to use participating providers under the terms of the managed care plan;
(27) "Participating provider" means a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide healthcare services to covered persons with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health carrier;
(28) "Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the entities listed in this subdivision (28);
(29) "Prospective review" means utilization review conducted prior to an admission or the provision of a healthcare service or a course of treatment in accordance with a health carrier's requirement that the healthcare service or course of treatment, in whole or in part, be approved prior to its provision or admission;
(30) "Register" means the written records kept by a health carrier to document all grievances received during a calendar year;
(31) "Retrospective review" means any review of a request for a benefit that is not a prospective review request. Retrospective review does not include the review of a claim that is limited to veracity of documentation or accuracy of coding; and
(32) (A) "Urgent care request" means a request for a healthcare service or course of treatment with respect to which the time periods for making nonurgent care request determination: (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or (ii) In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the healthcare service or treatment that is the subject of the request; (B) (i) In determining whether a request is to be treated as an urgent care request, an individual acting on behalf of the health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine. (ii) Any request that a physician with knowledge of the covered person's medical condition determines is an urgent care request within the meaning of subdivision (32)(A) shall be treated as an urgent care request.
(A) "Urgent care request" means a request for a healthcare service or course of treatment with respect to which the time periods for making nonurgent care request determination: (i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or (ii) In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the healthcare service or treatment that is the subject of the request;
(i) Could seriously jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function; or
(ii) In the opinion of a physician with knowledge of the covered person's medical condition, would subject the covered person to severe pain that cannot be adequately managed without the healthcare service or treatment that is the subject of the request;
(B) (i) In determining whether a request is to be treated as an urgent care request, an individual acting on behalf of the health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine. (ii) Any request that a physician with knowledge of the covered person's medical condition determines is an urgent care request within the meaning of subdivision (32)(A) shall be treated as an urgent care request.
(i) In determining whether a request is to be treated as an urgent care request, an individual acting on behalf of the health carrier shall apply the judgment of a prudent layperson who possesses an average knowledge of health and medicine.
(ii) Any request that a physician with knowledge of the covered person's medical condition determines is an urgent care request within the meaning of subdivision (32)(A) shall be treated as an urgent care request.
Acts 2010, ch. 980, § 3.
Tenn. Code Ann. § 56-46-207 — TN Code / Title 56 / Chapter 46 / Section 56-46-207
Confidential hearings
Status: in_force

Upon the occurrence of any of the following events the health organization shall have the right to a confidential departmental hearing, on the record, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subdivision (1), (2), (3) or (4). Upon receipt of the health organization's request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten (10) nor more than thirty (30) days after the date of the health organization's request. The events include: (1) Notification to a health organization by the commissioner of an adjusted RBC report; (2) Notification to a health organization by the commissioner that: (A) The health organization's RBC plan or revised RBC plan is unsatisfactory; and (B) Notification constitutes a Regulatory Action Level Event with respect to the health organization; (3) Notification to a health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or (4) Notification to a health organization by the commissioner of a corrective order with respect to the health organization. Acts 2014, ch. 559, § 7.
Upon the occurrence of any of the following events the health organization shall have the right to a confidential departmental hearing, on the record, at which the health organization may challenge any determination or action by the commissioner. The health organization shall notify the commissioner of its request for a hearing within five (5) days after the notification by the commissioner under subdivision (1), (2), (3) or (4). Upon receipt of the health organization's request for a hearing, the commissioner shall set a date for the hearing, which shall be no less than ten (10) nor more than thirty (30) days after the date of the health organization's request. The events include:
(1) Notification to a health organization by the commissioner of an adjusted RBC report;
(2) Notification to a health organization by the commissioner that: (A) The health organization's RBC plan or revised RBC plan is unsatisfactory; and (B) Notification constitutes a Regulatory Action Level Event with respect to the health organization;
(A) The health organization's RBC plan or revised RBC plan is unsatisfactory; and
(B) Notification constitutes a Regulatory Action Level Event with respect to the health organization;
(3) Notification to a health organization by the commissioner that the health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event with respect to the health organization in accordance with its RBC plan or revised RBC plan; or
(4) Notification to a health organization by the commissioner of a corrective order with respect to the health organization.
Acts 2014, ch. 559, § 7.
Tenn. Code Ann. § 56-2-1006 — TN Code / Title 56 / Chapter 2 / Section 56-2-1006
Notification of a cybersecurity event
Status: in_force

(a) A licensee shall notify the commissioner as soon as practicable, and in no event more than three (3) business days, following a determination that a cybersecurity event has occurred if: (1) (A) The licensee is domiciled in this state, in the case of an insurer, as defined in § 56-6-102 , or this state is the licensee's home state, in the case of an insurance producer, as defined in § 56-6-102 ; and (B) The cybersecurity event has a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations; or (2) The licensee reasonably believes that the nonpublic information of two hundred fifty (250) or more consumers residing in this state is involved in the cybersecurity event and that the cybersecurity event is: (A) A cybersecurity event of which notice must be provided to a government body, self-regulatory agency, or other supervisory body pursuant to state or federal law; or (B) A cybersecurity event with a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations. (b) (1) A licensee that must notify the commissioner under subsection (a) shall provide to the commissioner, in a format directed by the commissioner, as much of the following information as is available: (A) The date of the cybersecurity event; (B) A description of how the nonpublic information was exposed, lost, stolen, or breached, including the specific roles and responsibilities of third-party service providers with respect to the nonpublic information, if any; (C) How the cybersecurity event was discovered; (D) Whether lost, stolen, or breached nonpublic information has been recovered and, if so, how recovery was accomplished; (E) The identity of the source of the cybersecurity event; (F) Whether the licensee has filed a police report or notified regulatory, governmental, or law enforcement agencies and, if so, when the notification was provided; (G) A description of the specific types of nonpublic information or particular data elements acquired without authorization, which may include types of medical information, types of financial information, or types of information allowing for consumer identification; (H) The period during which the licensee's information system was compromised by the cybersecurity event; (I) The number of total consumers in this state affected by the cybersecurity event. The licensee shall provide its best estimate of this number of consumers in its initial report to the commissioner and update this estimate with each subsequent report to the commissioner pursuant to this subsection (b); (J) The results of an internal review and whether the review identified whether automated controls or internal procedures were followed or adhered to; (K) A description of the efforts to remediate the situation that permitted the cybersecurity event to occur; (L) A copy of the licensee's privacy policy and a statement outlining the steps that the licensee will take to investigate which consumers were affected by the cybersecurity event and to notify affected consumers; (M) The name of a person who is both knowledgeable regarding the cybersecurity event and authorized to act on behalf of the licensee to serve as a representative of the licensee for contact from the commissioner; and (N) A copy of the notice sent to affected consumers, if the notice is required under subsection (c). (2) Licensees shall continually provide material updates or supplements to the information provided under subdivision (b)(1). (c) Following a determination that a cybersecurity event has occurred and that the cybersecurity event has a reasonable likelihood of materially harming a consumer, a licensee shall notify consumers residing in this state whose nonpublic information has been acquired, or reasonably believed to have been acquired, by the cybersecurity event. The disclosure must be made no later than forty-five (45) days after the determination of the cybersecurity event, unless a longer period of time is required due to the legitimate needs of law enforcement. For purposes of this section, notice may be provided by: (1) Written notice; (2) Electronic notice, if the notice provided is consistent with the provisions regarding electronic records and signatures set forth in 15 U.S.C. § 7001 , or if the licensee's primary method of communication with the consumer has been by electronic means. Electronic means may include email notification; or (3) Substitute notice, if the licensee demonstrates that the cost of providing notice would exceed two hundred fifty thousand dollars ($250,000), the affected class of subject persons to be notified exceeds five hundred thousand (500,000) persons, or the licensee does not have sufficient contact information and the notice consists of the following: (A) Email notice, when the licensee has an email address for the consumer; (B) Conspicuous posting of the notice on the licensee's website, if the licensee maintains a website page; and (C) Notification to major statewide media. (d) (1) If a licensee becomes aware of a cybersecurity event in the licensee's information system maintained by a third-party service provider, then the licensee must treat the event as if it occurred in an information system maintained by the licensee for purposes of subsection (a). (2) The licensee's time limitations for purposes of providing notification under subsection (a) begin running when the third-party service provider notifies the licensee of the cybersecurity event or the licensee otherwise gains actual knowledge of the cybersecurity event, whichever is sooner. (3) This part does not limit or abrogate an agreement between a licensee and another party to fulfill the investigation requirements imposed under § 56-2-1005 or the notice requirements imposed under this section. (e) (1) (A) In the case of a cybersecurity event involving nonpublic information that is used by, or in the possession, custody, or control of, a licensee acting as an assuming insurer that does not have a direct contractual relationship with the affected consumers, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of determining that a cybersecurity event has occurred. (B) The ceding insurers that have a direct contractual relationship with affected consumers must fulfill the consumer notification requirements required under this section. (2) (A) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a third-party service provider of a licensee that is an assuming insurer, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of the third-party service provider notifying the licensee of the cybersecurity event or the licensee otherwise gaining actual knowledge of the cybersecurity event, whichever is sooner. (B) The ceding insurers that have a direct contractual relationship with affected consumers shall fulfill the consumer notification requirements required under this section. (3) Except as provided in this subsection (e), a licensee acting as assuming insurer has no other notice obligations relating to a cybersecurity event under this section. (f) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a licensee that is an insurer, or the third-party service provider for which a consumer accessed the insurer's services through an independent insurance producer, and for which consumer notice is required under this part, the insurer shall notify the producers of record of all affected consumers, if known, as soon as practicable, but not later than when such notice is provided to the affected consumers. The insurer is excused from this obligation in those instances in which the insurer does not have the current producer of record information for an individual consumer. Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
(a) A licensee shall notify the commissioner as soon as practicable, and in no event more than three (3) business days, following a determination that a cybersecurity event has occurred if: (1) (A) The licensee is domiciled in this state, in the case of an insurer, as defined in § 56-6-102 , or this state is the licensee's home state, in the case of an insurance producer, as defined in § 56-6-102 ; and (B) The cybersecurity event has a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations; or (2) The licensee reasonably believes that the nonpublic information of two hundred fifty (250) or more consumers residing in this state is involved in the cybersecurity event and that the cybersecurity event is: (A) A cybersecurity event of which notice must be provided to a government body, self-regulatory agency, or other supervisory body pursuant to state or federal law; or (B) A cybersecurity event with a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations.
(1) (A) The licensee is domiciled in this state, in the case of an insurer, as defined in § 56-6-102 , or this state is the licensee's home state, in the case of an insurance producer, as defined in § 56-6-102 ; and (B) The cybersecurity event has a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations; or
(A) The licensee is domiciled in this state, in the case of an insurer, as defined in § 56-6-102 , or this state is the licensee's home state, in the case of an insurance producer, as defined in § 56-6-102 ; and
(B) The cybersecurity event has a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations; or
(2) The licensee reasonably believes that the nonpublic information of two hundred fifty (250) or more consumers residing in this state is involved in the cybersecurity event and that the cybersecurity event is: (A) A cybersecurity event of which notice must be provided to a government body, self-regulatory agency, or other supervisory body pursuant to state or federal law; or (B) A cybersecurity event with a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations.
(A) A cybersecurity event of which notice must be provided to a government body, self-regulatory agency, or other supervisory body pursuant to state or federal law; or
(B) A cybersecurity event with a reasonable likelihood of materially harming a consumer residing in this state or a material part of the licensee's normal operations.
(b) (1) A licensee that must notify the commissioner under subsection (a) shall provide to the commissioner, in a format directed by the commissioner, as much of the following information as is available: (A) The date of the cybersecurity event; (B) A description of how the nonpublic information was exposed, lost, stolen, or breached, including the specific roles and responsibilities of third-party service providers with respect to the nonpublic information, if any; (C) How the cybersecurity event was discovered; (D) Whether lost, stolen, or breached nonpublic information has been recovered and, if so, how recovery was accomplished; (E) The identity of the source of the cybersecurity event; (F) Whether the licensee has filed a police report or notified regulatory, governmental, or law enforcement agencies and, if so, when the notification was provided; (G) A description of the specific types of nonpublic information or particular data elements acquired without authorization, which may include types of medical information, types of financial information, or types of information allowing for consumer identification; (H) The period during which the licensee's information system was compromised by the cybersecurity event; (I) The number of total consumers in this state affected by the cybersecurity event. The licensee shall provide its best estimate of this number of consumers in its initial report to the commissioner and update this estimate with each subsequent report to the commissioner pursuant to this subsection (b); (J) The results of an internal review and whether the review identified whether automated controls or internal procedures were followed or adhered to; (K) A description of the efforts to remediate the situation that permitted the cybersecurity event to occur; (L) A copy of the licensee's privacy policy and a statement outlining the steps that the licensee will take to investigate which consumers were affected by the cybersecurity event and to notify affected consumers; (M) The name of a person who is both knowledgeable regarding the cybersecurity event and authorized to act on behalf of the licensee to serve as a representative of the licensee for contact from the commissioner; and (N) A copy of the notice sent to affected consumers, if the notice is required under subsection (c). (2) Licensees shall continually provide material updates or supplements to the information provided under subdivision (b)(1).
(1) A licensee that must notify the commissioner under subsection (a) shall provide to the commissioner, in a format directed by the commissioner, as much of the following information as is available: (A) The date of the cybersecurity event; (B) A description of how the nonpublic information was exposed, lost, stolen, or breached, including the specific roles and responsibilities of third-party service providers with respect to the nonpublic information, if any; (C) How the cybersecurity event was discovered; (D) Whether lost, stolen, or breached nonpublic information has been recovered and, if so, how recovery was accomplished; (E) The identity of the source of the cybersecurity event; (F) Whether the licensee has filed a police report or notified regulatory, governmental, or law enforcement agencies and, if so, when the notification was provided; (G) A description of the specific types of nonpublic information or particular data elements acquired without authorization, which may include types of medical information, types of financial information, or types of information allowing for consumer identification; (H) The period during which the licensee's information system was compromised by the cybersecurity event; (I) The number of total consumers in this state affected by the cybersecurity event. The licensee shall provide its best estimate of this number of consumers in its initial report to the commissioner and update this estimate with each subsequent report to the commissioner pursuant to this subsection (b); (J) The results of an internal review and whether the review identified whether automated controls or internal procedures were followed or adhered to; (K) A description of the efforts to remediate the situation that permitted the cybersecurity event to occur; (L) A copy of the licensee's privacy policy and a statement outlining the steps that the licensee will take to investigate which consumers were affected by the cybersecurity event and to notify affected consumers; (M) The name of a person who is both knowledgeable regarding the cybersecurity event and authorized to act on behalf of the licensee to serve as a representative of the licensee for contact from the commissioner; and (N) A copy of the notice sent to affected consumers, if the notice is required under subsection (c).
(A) The date of the cybersecurity event;
(B) A description of how the nonpublic information was exposed, lost, stolen, or breached, including the specific roles and responsibilities of third-party service providers with respect to the nonpublic information, if any;
(C) How the cybersecurity event was discovered;
(D) Whether lost, stolen, or breached nonpublic information has been recovered and, if so, how recovery was accomplished;
(E) The identity of the source of the cybersecurity event;
(F) Whether the licensee has filed a police report or notified regulatory, governmental, or law enforcement agencies and, if so, when the notification was provided;
(G) A description of the specific types of nonpublic information or particular data elements acquired without authorization, which may include types of medical information, types of financial information, or types of information allowing for consumer identification;
(H) The period during which the licensee's information system was compromised by the cybersecurity event;
(I) The number of total consumers in this state affected by the cybersecurity event. The licensee shall provide its best estimate of this number of consumers in its initial report to the commissioner and update this estimate with each subsequent report to the commissioner pursuant to this subsection (b);
(J) The results of an internal review and whether the review identified whether automated controls or internal procedures were followed or adhered to;
(K) A description of the efforts to remediate the situation that permitted the cybersecurity event to occur;
(L) A copy of the licensee's privacy policy and a statement outlining the steps that the licensee will take to investigate which consumers were affected by the cybersecurity event and to notify affected consumers;
(M) The name of a person who is both knowledgeable regarding the cybersecurity event and authorized to act on behalf of the licensee to serve as a representative of the licensee for contact from the commissioner; and
(N) A copy of the notice sent to affected consumers, if the notice is required under subsection (c).
(2) Licensees shall continually provide material updates or supplements to the information provided under subdivision (b)(1).
(c) Following a determination that a cybersecurity event has occurred and that the cybersecurity event has a reasonable likelihood of materially harming a consumer, a licensee shall notify consumers residing in this state whose nonpublic information has been acquired, or reasonably believed to have been acquired, by the cybersecurity event. The disclosure must be made no later than forty-five (45) days after the determination of the cybersecurity event, unless a longer period of time is required due to the legitimate needs of law enforcement. For purposes of this section, notice may be provided by: (1) Written notice; (2) Electronic notice, if the notice provided is consistent with the provisions regarding electronic records and signatures set forth in 15 U.S.C. § 7001 , or if the licensee's primary method of communication with the consumer has been by electronic means. Electronic means may include email notification; or (3) Substitute notice, if the licensee demonstrates that the cost of providing notice would exceed two hundred fifty thousand dollars ($250,000), the affected class of subject persons to be notified exceeds five hundred thousand (500,000) persons, or the licensee does not have sufficient contact information and the notice consists of the following: (A) Email notice, when the licensee has an email address for the consumer; (B) Conspicuous posting of the notice on the licensee's website, if the licensee maintains a website page; and (C) Notification to major statewide media.
(1) Written notice;
(2) Electronic notice, if the notice provided is consistent with the provisions regarding electronic records and signatures set forth in 15 U.S.C. § 7001 , or if the licensee's primary method of communication with the consumer has been by electronic means. Electronic means may include email notification; or
(3) Substitute notice, if the licensee demonstrates that the cost of providing notice would exceed two hundred fifty thousand dollars ($250,000), the affected class of subject persons to be notified exceeds five hundred thousand (500,000) persons, or the licensee does not have sufficient contact information and the notice consists of the following: (A) Email notice, when the licensee has an email address for the consumer; (B) Conspicuous posting of the notice on the licensee's website, if the licensee maintains a website page; and (C) Notification to major statewide media.
(A) Email notice, when the licensee has an email address for the consumer;
(B) Conspicuous posting of the notice on the licensee's website, if the licensee maintains a website page; and
(C) Notification to major statewide media.
(d) (1) If a licensee becomes aware of a cybersecurity event in the licensee's information system maintained by a third-party service provider, then the licensee must treat the event as if it occurred in an information system maintained by the licensee for purposes of subsection (a). (2) The licensee's time limitations for purposes of providing notification under subsection (a) begin running when the third-party service provider notifies the licensee of the cybersecurity event or the licensee otherwise gains actual knowledge of the cybersecurity event, whichever is sooner. (3) This part does not limit or abrogate an agreement between a licensee and another party to fulfill the investigation requirements imposed under § 56-2-1005 or the notice requirements imposed under this section.
(1) If a licensee becomes aware of a cybersecurity event in the licensee's information system maintained by a third-party service provider, then the licensee must treat the event as if it occurred in an information system maintained by the licensee for purposes of subsection (a).
(2) The licensee's time limitations for purposes of providing notification under subsection (a) begin running when the third-party service provider notifies the licensee of the cybersecurity event or the licensee otherwise gains actual knowledge of the cybersecurity event, whichever is sooner.
(3) This part does not limit or abrogate an agreement between a licensee and another party to fulfill the investigation requirements imposed under § 56-2-1005 or the notice requirements imposed under this section.
(e) (1) (A) In the case of a cybersecurity event involving nonpublic information that is used by, or in the possession, custody, or control of, a licensee acting as an assuming insurer that does not have a direct contractual relationship with the affected consumers, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of determining that a cybersecurity event has occurred. (B) The ceding insurers that have a direct contractual relationship with affected consumers must fulfill the consumer notification requirements required under this section. (2) (A) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a third-party service provider of a licensee that is an assuming insurer, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of the third-party service provider notifying the licensee of the cybersecurity event or the licensee otherwise gaining actual knowledge of the cybersecurity event, whichever is sooner. (B) The ceding insurers that have a direct contractual relationship with affected consumers shall fulfill the consumer notification requirements required under this section. (3) Except as provided in this subsection (e), a licensee acting as assuming insurer has no other notice obligations relating to a cybersecurity event under this section.
(1) (A) In the case of a cybersecurity event involving nonpublic information that is used by, or in the possession, custody, or control of, a licensee acting as an assuming insurer that does not have a direct contractual relationship with the affected consumers, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of determining that a cybersecurity event has occurred. (B) The ceding insurers that have a direct contractual relationship with affected consumers must fulfill the consumer notification requirements required under this section.
(A) In the case of a cybersecurity event involving nonpublic information that is used by, or in the possession, custody, or control of, a licensee acting as an assuming insurer that does not have a direct contractual relationship with the affected consumers, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of determining that a cybersecurity event has occurred.
(B) The ceding insurers that have a direct contractual relationship with affected consumers must fulfill the consumer notification requirements required under this section.
(2) (A) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a third-party service provider of a licensee that is an assuming insurer, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of the third-party service provider notifying the licensee of the cybersecurity event or the licensee otherwise gaining actual knowledge of the cybersecurity event, whichever is sooner. (B) The ceding insurers that have a direct contractual relationship with affected consumers shall fulfill the consumer notification requirements required under this section.
(A) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a third-party service provider of a licensee that is an assuming insurer, the assuming insurer shall notify the affected ceding insurers and the commissioner of the licensee's state of domicile within three (3) business days of the third-party service provider notifying the licensee of the cybersecurity event or the licensee otherwise gaining actual knowledge of the cybersecurity event, whichever is sooner.
(B) The ceding insurers that have a direct contractual relationship with affected consumers shall fulfill the consumer notification requirements required under this section.
(3) Except as provided in this subsection (e), a licensee acting as assuming insurer has no other notice obligations relating to a cybersecurity event under this section.
(f) In the case of a cybersecurity event involving nonpublic information in the possession, custody, or control of a licensee that is an insurer, or the third-party service provider for which a consumer accessed the insurer's services through an independent insurance producer, and for which consumer notice is required under this part, the insurer shall notify the producers of record of all affected consumers, if known, as soon as practicable, but not later than when such notice is provided to the affected consumers. The insurer is excused from this obligation in those instances in which the insurer does not have the current producer of record information for an individual consumer.
Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
Tenn. Code Ann. § 56-9-310 — TN Code / Title 56 / Chapter 9 / Section 56-9-310
Powers and authority of liquidator
Status: in_force

(a) The liquidator has the power to: (1) Appoint a special deputy or deputies to act for the liquidator under this chapter, and determine the deputy's reasonable compensation. The special deputy has powers of the liquidator granted by this section. The special deputy shall serve at the pleasure of the liquidator; (2) Employ employees and agents, legal counsel, actuaries, accountants, appraisers, consultants and other personnel the liquidator may deem necessary to assist in the liquidation; (3) Appoint, with the approval of the court, an advisory committee of policyholders, claimants or other creditors, including guaranty associations, should such a committee be deemed necessary. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in liquidation proceedings conducted under this chapter; (4) Fix the reasonable compensation of employees and agents, legal counsel, actuaries, accountants, appraisers and consultants with the approval of the court; (5) Pay reasonable compensation to persons appointed and defray from the funds or assets of the insurer all expenses of taking possession of, conserving, conducting, liquidating, disposing of, or otherwise dealing with the business and property of the insurer. In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the costs so incurred out of any appropriation for the maintenance of the department. Any amounts so advanced for expenses of administration shall be repaid to the commissioner for the use of the department out of the first available moneys of the insurer; (6) Hold hearings, subpoena witnesses to compel their attendance, administer oaths, examine any person under oath, and compel any person to subscribe to the person's testimony after it has been correctly reduced to writing, and, in connection therewith, require the production of any books, papers, records or other documents that the liquidator deems relevant to the inquiry; (7) Audit the books and records of all agents of the insurer insofar as those records relate to the business activities of the insurer; (8) Collect all debts and moneys due and claims belonging to the insurer, wherever located, and for this purpose to: (A) Institute timely action in other jurisdictions, in order to forestall garnishment and attachment proceedings against the debts; (B) Do such other acts as are necessary or expedient to collect, conserve or protect its assets or property, including the power to sell, compound, compromise or assign debts for purposes of collection upon the terms and conditions as the liquidator deems best; and (C) Pursue any creditor's remedies available to enforce the liquidator's claims; (9) Conduct public and private sales of the property of the insurer; (10) Use assets of the estate of an insurer under a liquidation order to transfer policy obligations to a solvent assuming insurer, if the transfer can be arranged without prejudice to applicable priorities under § 56-9-330 ; (11) Acquire, hypothecate, encumber, lease, improve, sell, transfer, abandon or otherwise dispose of or deal with any property of the insurer at its market value or upon the terms and conditions as are fair and reasonable. The liquidator also has the power to execute, acknowledge and deliver any and all deeds, assignments, releases and other instruments necessary or proper to effectuate any sale of property or other transaction in connection with the liquidation; (12) Borrow money on the security of the insurer's assets or without security and execute and deliver all documents necessary to that transaction for the purpose of facilitating the liquidation. Any such funds borrowed may be repaid as an administrative expense and have priority over any other claims in Class 1 under the priority of distribution; (13) Enter into any contracts necessary to carry out the order to liquidate, and affirm or disavow any contracts to which the insurer is a party. However, the liquidator shall not disavow, reject, or repudiate a federal home loan bank security agreement or any pledge agreement, security agreement, collateral agreement, guarantee agreement, or other similar arrangement or credit enhancement relating to a security agreement to which a federal home loan bank is a party; (14) Continue to prosecute and institute in the name of the insurer, or in the liquidator's own name, any and all suits and other legal proceedings, in this state or elsewhere, and abandon the prosecution of claims the liquidator deems unprofitable to pursue further. If the insurer is dissolved under § 56-9-309 , the liquidator shall have the power to apply to any court in this state or elsewhere for leave to substitute the liquidator for the insurer as plaintiff; (15) Prosecute any action that may exist in behalf of the creditors, members, policyholders or shareholders of the insurer against any officer of the insurer, or any other person; (16) Remove any or all records and property of the insurer to the offices of the commissioner or to any other place that may be convenient for the purposes of efficient and orderly execution of the liquidation. Guaranty associations and foreign guaranty associations shall have such reasonable access to the records of the insurer as is necessary for them to carry out their statutory obligations; (17) Deposit in one (1) or more banks in this state the sums required for meeting current administration expenses and dividend distributions; (18) Invest all sums not currently needed, unless the court orders otherwise; (19) File any necessary documents for record in the office of any recorder of deeds or record office in this state or elsewhere where property of the insurer is located; (20) Assert all defenses available to the insurer as against third persons, including statutes of limitation, statutes of frauds, and the defense of usury. A waiver of any defense by the insurer after a petition in liquidation has been filed shall not bind the liquidator. Whenever a guaranty association or foreign guaranty association has an obligation to defend any suit, the liquidator shall give precedence to the obligation and may defend only in the absence of a defense by the guaranty associations; (21) Exercise and enforce all the rights, remedies and powers of any creditor, shareholder, policyholder or member, including any power to avoid any transfer or lien that may be given by the general law and that is not included under §§ 56-9-315 - 56-9-317; (22) Intervene in any proceeding wherever instituted that might lead to the appointment of a receiver or trustee, and act as the receiver or trustee whenever the appointment is offered; (23) Enter into agreements with any receiver or commissioner of any other state relating to the rehabilitation, liquidation, conservation or dissolution of an insurer doing business in both states; and (24) Exercise all powers now held or hereafter conferred upon receivers by the laws of this state not inconsistent with this chapter. (b) The enumeration in this section of the powers and authority of the liquidator shall not be construed as a limitation upon the liquidator, nor shall it exclude in any manner the liquidator's right to do other acts not herein specifically enumerated or otherwise provided for, that may be necessary or appropriate for the accomplishment of or in aid of the purpose of liquidation. (c) Notwithstanding the powers of the liquidator as stated in subsections (a) and (b), the liquidator has no obligation to defend claims or to continue to defend claims subsequent to the entry of a liquidation order. Amended by 2019 Tenn. Acts, ch. 430,s 4, eff. 5/21/2019. Acts 1991, ch. 142, § 4.
(a) The liquidator has the power to: (1) Appoint a special deputy or deputies to act for the liquidator under this chapter, and determine the deputy's reasonable compensation. The special deputy has powers of the liquidator granted by this section. The special deputy shall serve at the pleasure of the liquidator; (2) Employ employees and agents, legal counsel, actuaries, accountants, appraisers, consultants and other personnel the liquidator may deem necessary to assist in the liquidation; (3) Appoint, with the approval of the court, an advisory committee of policyholders, claimants or other creditors, including guaranty associations, should such a committee be deemed necessary. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in liquidation proceedings conducted under this chapter; (4) Fix the reasonable compensation of employees and agents, legal counsel, actuaries, accountants, appraisers and consultants with the approval of the court; (5) Pay reasonable compensation to persons appointed and defray from the funds or assets of the insurer all expenses of taking possession of, conserving, conducting, liquidating, disposing of, or otherwise dealing with the business and property of the insurer. In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the costs so incurred out of any appropriation for the maintenance of the department. Any amounts so advanced for expenses of administration shall be repaid to the commissioner for the use of the department out of the first available moneys of the insurer; (6) Hold hearings, subpoena witnesses to compel their attendance, administer oaths, examine any person under oath, and compel any person to subscribe to the person's testimony after it has been correctly reduced to writing, and, in connection therewith, require the production of any books, papers, records or other documents that the liquidator deems relevant to the inquiry; (7) Audit the books and records of all agents of the insurer insofar as those records relate to the business activities of the insurer; (8) Collect all debts and moneys due and claims belonging to the insurer, wherever located, and for this purpose to: (A) Institute timely action in other jurisdictions, in order to forestall garnishment and attachment proceedings against the debts; (B) Do such other acts as are necessary or expedient to collect, conserve or protect its assets or property, including the power to sell, compound, compromise or assign debts for purposes of collection upon the terms and conditions as the liquidator deems best; and (C) Pursue any creditor's remedies available to enforce the liquidator's claims; (9) Conduct public and private sales of the property of the insurer; (10) Use assets of the estate of an insurer under a liquidation order to transfer policy obligations to a solvent assuming insurer, if the transfer can be arranged without prejudice to applicable priorities under § 56-9-330 ; (11) Acquire, hypothecate, encumber, lease, improve, sell, transfer, abandon or otherwise dispose of or deal with any property of the insurer at its market value or upon the terms and conditions as are fair and reasonable. The liquidator also has the power to execute, acknowledge and deliver any and all deeds, assignments, releases and other instruments necessary or proper to effectuate any sale of property or other transaction in connection with the liquidation; (12) Borrow money on the security of the insurer's assets or without security and execute and deliver all documents necessary to that transaction for the purpose of facilitating the liquidation. Any such funds borrowed may be repaid as an administrative expense and have priority over any other claims in Class 1 under the priority of distribution; (13) Enter into any contracts necessary to carry out the order to liquidate, and affirm or disavow any contracts to which the insurer is a party. However, the liquidator shall not disavow, reject, or repudiate a federal home loan bank security agreement or any pledge agreement, security agreement, collateral agreement, guarantee agreement, or other similar arrangement or credit enhancement relating to a security agreement to which a federal home loan bank is a party; (14) Continue to prosecute and institute in the name of the insurer, or in the liquidator's own name, any and all suits and other legal proceedings, in this state or elsewhere, and abandon the prosecution of claims the liquidator deems unprofitable to pursue further. If the insurer is dissolved under § 56-9-309 , the liquidator shall have the power to apply to any court in this state or elsewhere for leave to substitute the liquidator for the insurer as plaintiff; (15) Prosecute any action that may exist in behalf of the creditors, members, policyholders or shareholders of the insurer against any officer of the insurer, or any other person; (16) Remove any or all records and property of the insurer to the offices of the commissioner or to any other place that may be convenient for the purposes of efficient and orderly execution of the liquidation. Guaranty associations and foreign guaranty associations shall have such reasonable access to the records of the insurer as is necessary for them to carry out their statutory obligations; (17) Deposit in one (1) or more banks in this state the sums required for meeting current administration expenses and dividend distributions; (18) Invest all sums not currently needed, unless the court orders otherwise; (19) File any necessary documents for record in the office of any recorder of deeds or record office in this state or elsewhere where property of the insurer is located; (20) Assert all defenses available to the insurer as against third persons, including statutes of limitation, statutes of frauds, and the defense of usury. A waiver of any defense by the insurer after a petition in liquidation has been filed shall not bind the liquidator. Whenever a guaranty association or foreign guaranty association has an obligation to defend any suit, the liquidator shall give precedence to the obligation and may defend only in the absence of a defense by the guaranty associations; (21) Exercise and enforce all the rights, remedies and powers of any creditor, shareholder, policyholder or member, including any power to avoid any transfer or lien that may be given by the general law and that is not included under §§ 56-9-315 - 56-9-317; (22) Intervene in any proceeding wherever instituted that might lead to the appointment of a receiver or trustee, and act as the receiver or trustee whenever the appointment is offered; (23) Enter into agreements with any receiver or commissioner of any other state relating to the rehabilitation, liquidation, conservation or dissolution of an insurer doing business in both states; and (24) Exercise all powers now held or hereafter conferred upon receivers by the laws of this state not inconsistent with this chapter.
(1) Appoint a special deputy or deputies to act for the liquidator under this chapter, and determine the deputy's reasonable compensation. The special deputy has powers of the liquidator granted by this section. The special deputy shall serve at the pleasure of the liquidator;
(2) Employ employees and agents, legal counsel, actuaries, accountants, appraisers, consultants and other personnel the liquidator may deem necessary to assist in the liquidation;
(3) Appoint, with the approval of the court, an advisory committee of policyholders, claimants or other creditors, including guaranty associations, should such a committee be deemed necessary. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in liquidation proceedings conducted under this chapter;
(4) Fix the reasonable compensation of employees and agents, legal counsel, actuaries, accountants, appraisers and consultants with the approval of the court;
(5) Pay reasonable compensation to persons appointed and defray from the funds or assets of the insurer all expenses of taking possession of, conserving, conducting, liquidating, disposing of, or otherwise dealing with the business and property of the insurer. In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the costs so incurred out of any appropriation for the maintenance of the department. Any amounts so advanced for expenses of administration shall be repaid to the commissioner for the use of the department out of the first available moneys of the insurer;
(6) Hold hearings, subpoena witnesses to compel their attendance, administer oaths, examine any person under oath, and compel any person to subscribe to the person's testimony after it has been correctly reduced to writing, and, in connection therewith, require the production of any books, papers, records or other documents that the liquidator deems relevant to the inquiry;
(7) Audit the books and records of all agents of the insurer insofar as those records relate to the business activities of the insurer;
(8) Collect all debts and moneys due and claims belonging to the insurer, wherever located, and for this purpose to: (A) Institute timely action in other jurisdictions, in order to forestall garnishment and attachment proceedings against the debts; (B) Do such other acts as are necessary or expedient to collect, conserve or protect its assets or property, including the power to sell, compound, compromise or assign debts for purposes of collection upon the terms and conditions as the liquidator deems best; and (C) Pursue any creditor's remedies available to enforce the liquidator's claims;
(A) Institute timely action in other jurisdictions, in order to forestall garnishment and attachment proceedings against the debts;
(B) Do such other acts as are necessary or expedient to collect, conserve or protect its assets or property, including the power to sell, compound, compromise or assign debts for purposes of collection upon the terms and conditions as the liquidator deems best; and
(C) Pursue any creditor's remedies available to enforce the liquidator's claims;
(9) Conduct public and private sales of the property of the insurer;
(10) Use assets of the estate of an insurer under a liquidation order to transfer policy obligations to a solvent assuming insurer, if the transfer can be arranged without prejudice to applicable priorities under § 56-9-330 ;
(11) Acquire, hypothecate, encumber, lease, improve, sell, transfer, abandon or otherwise dispose of or deal with any property of the insurer at its market value or upon the terms and conditions as are fair and reasonable. The liquidator also has the power to execute, acknowledge and deliver any and all deeds, assignments, releases and other instruments necessary or proper to effectuate any sale of property or other transaction in connection with the liquidation;
(12) Borrow money on the security of the insurer's assets or without security and execute and deliver all documents necessary to that transaction for the purpose of facilitating the liquidation. Any such funds borrowed may be repaid as an administrative expense and have priority over any other claims in Class 1 under the priority of distribution;
(13) Enter into any contracts necessary to carry out the order to liquidate, and affirm or disavow any contracts to which the insurer is a party. However, the liquidator shall not disavow, reject, or repudiate a federal home loan bank security agreement or any pledge agreement, security agreement, collateral agreement, guarantee agreement, or other similar arrangement or credit enhancement relating to a security agreement to which a federal home loan bank is a party;
(14) Continue to prosecute and institute in the name of the insurer, or in the liquidator's own name, any and all suits and other legal proceedings, in this state or elsewhere, and abandon the prosecution of claims the liquidator deems unprofitable to pursue further. If the insurer is dissolved under § 56-9-309 , the liquidator shall have the power to apply to any court in this state or elsewhere for leave to substitute the liquidator for the insurer as plaintiff;
(15) Prosecute any action that may exist in behalf of the creditors, members, policyholders or shareholders of the insurer against any officer of the insurer, or any other person;
(16) Remove any or all records and property of the insurer to the offices of the commissioner or to any other place that may be convenient for the purposes of efficient and orderly execution of the liquidation. Guaranty associations and foreign guaranty associations shall have such reasonable access to the records of the insurer as is necessary for them to carry out their statutory obligations;
(17) Deposit in one (1) or more banks in this state the sums required for meeting current administration expenses and dividend distributions;
(18) Invest all sums not currently needed, unless the court orders otherwise;
(19) File any necessary documents for record in the office of any recorder of deeds or record office in this state or elsewhere where property of the insurer is located;
(20) Assert all defenses available to the insurer as against third persons, including statutes of limitation, statutes of frauds, and the defense of usury. A waiver of any defense by the insurer after a petition in liquidation has been filed shall not bind the liquidator. Whenever a guaranty association or foreign guaranty association has an obligation to defend any suit, the liquidator shall give precedence to the obligation and may defend only in the absence of a defense by the guaranty associations;
(21) Exercise and enforce all the rights, remedies and powers of any creditor, shareholder, policyholder or member, including any power to avoid any transfer or lien that may be given by the general law and that is not included under §§ 56-9-315 - 56-9-317;
(22) Intervene in any proceeding wherever instituted that might lead to the appointment of a receiver or trustee, and act as the receiver or trustee whenever the appointment is offered;
(23) Enter into agreements with any receiver or commissioner of any other state relating to the rehabilitation, liquidation, conservation or dissolution of an insurer doing business in both states; and
(24) Exercise all powers now held or hereafter conferred upon receivers by the laws of this state not inconsistent with this chapter.
(b) The enumeration in this section of the powers and authority of the liquidator shall not be construed as a limitation upon the liquidator, nor shall it exclude in any manner the liquidator's right to do other acts not herein specifically enumerated or otherwise provided for, that may be necessary or appropriate for the accomplishment of or in aid of the purpose of liquidation.
(c) Notwithstanding the powers of the liquidator as stated in subsections (a) and (b), the liquidator has no obligation to defend claims or to continue to defend claims subsequent to the entry of a liquidation order.
Amended by 2019 Tenn. Acts, ch. 430,s 4, eff. 5/21/2019.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-13-114 — TN Code / Title 56 / Chapter 13 / Section 56-13-114
Taxation
Status: in_force

(a) Each captive insurance company shall pay to the department, on or prior to March 15 of each year, a tax at the rate of four tenths of one percent (0.4%) on the first twenty million dollars ($20,000,000), and three-tenths of one percent (0.3%) on each dollar thereafter on the direct premiums collected or contracted for on policies or contracts of insurance written by the captive insurance company during the year ending December 31 next preceding, after deducting from the direct premiums subject to the tax the amounts paid to policyholders as return premiums. Return premiums shall include dividends on unabsorbed premiums or premium deposits returned or credited to policyholders. No tax shall be due or payable under this title as to considerations received for annuity contracts. (b) Each captive insurance company shall pay to the department, on or prior to March 15 of each year, a tax at the rate of 225-thousandths of one percent (0.225%) on the first twenty million dollars ($20,000,000) of assumed reinsurance premium, and 150-thousandths of one percent (0.150%) on the next twenty million dollars ($20,000,000), and 50-thousandths of one percent (0.050%) on the next twenty million dollars ($20,000,000), and 25-thousandths of one percent (0.025%) of each dollar thereafter. However, no reinsurance tax applies to premiums for risks or portions of risks that are subject to taxation on a direct basis pursuant to subsection (a). No reinsurance premium tax shall be payable in connection with the receipt of assets in exchange for the assumption of loss reserves and other liabilities of another insurer under common ownership and control; provided, that the commissioner verifies that such transaction is part of a plan to discontinue the operations of such other insurer, and if the intent of the parties to such transaction is to renew or maintain such business with the captive insurance company. (c) (1) Except with regard to a protected cell captive insurance company, as defined in § 56-13-202 , with more than ten (10) cells, the annual minimum aggregate tax to be paid by a captive insurance company calculated under subsections (a) and (b) shall be five thousand dollars ($5,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000). (2) For a protected cell captive insurance company with more than ten (10) cells, the annual minimum aggregate tax to be paid under subsections (a) and (b) shall be ten thousand dollars ($10,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000), plus five thousand dollars ($5,000) multiplied by the number of cells over ten (10). (3) A dormant captive insurance company that has been issued a letter of dormancy under § 56-13-124 is not subject to or liable for the payment of the annual minimum aggregate tax established under this subsection (c). (d) The tax provided for in this section shall constitute all taxes collectible under the laws of this state from any captive insurance company and from any insured on its payments to a captive insurance company, and no other occupation tax or other taxes shall be levied or collected from any captive insurance company by this state or any county, city, or municipality within this state, except ad valorem taxes on real and personal property used in the production of income. (e) Captive insurance companies, protected cells of captive insurance companies, and incorporated protected cells of captive insurance companies shall be subject to the fees in § 56-4-101 . (f) All premium taxes paid into the department under this chapter shall be held by the commissioner as expendable receipts for the purpose of administering this chapter and for promoting the Tennessee captive insurance industry. (g) The tax provided for in this section shall be calculated on an annual basis, notwithstanding policies or contracts of insurance or contracts of reinsurance issued on a multiyear basis. In the case of multiyear policies or contracts, the premium shall be prorated for purposes of determining the tax under this section. (h) Nothing in this section shall be construed to provide an exemption from the sales and use tax imposed by title 67, chapter 6. (i) (1) Entities in this state, including industrial insureds as defined in § 56-2-105(7) , who have procured insurance from a captive insurance company and, on or before December 31, 2018, either redomesticate that captive insurance company to this state pursuant to this chapter or transfer a complete line of business or complete geographic risk into a captive formed in this state between January 1, 2016, and December 31, 2018, shall not be liable for any unreported taxes due pursuant to § 56-2-411 on a policy or contract of insurance procured from the captive insurance company before the redomestication of the captive insurance company or transfer of line of business or complete geographic risk to this state; provided, that the policy or contract is substantially similar to a policy or contract of insurance procured from the captive insurance company after it is redomiciled or after the line of business or the complete geographic risk is transferred to this state. (2) In order for a transfer of a line of business or complete geographic risk to a Tennessee captive formed between January 1, 2016, and December 31, 2018, to qualify under subdivision (i)(1), the Tennessee captive formed between January 1, 2016, and December 31, 2018, must have and maintain, for no less than five (5) years from the date of formation, capital of at least fifteen million dollars ($15,000,000) and annual premiums of at least thirty million dollars ($30,000,000). (j) (1) Any captive insurance company failing to pay premium tax payments as provided by this chapter shall forfeit and pay to the state, in addition to the amount of the unpaid taxes, a penalty of five hundred dollars ($500) for the first month or fractional part of the first month of delinquency; provided, that should the period of delinquency exceed one (1) month, the company shall pay an additional five hundred dollars ($500) for the second month or fractional part of the second month. Any premium tax payment that is not paid within sixty (60) days of the due date is a violation of this chapter and is subject to § 56-13-120 . The commissioner has the discretion, upon written application and for good cause shown, to waive the penalties of this subdivision (j)(1). (2) All delinquencies shall bear interest at the rate of ten percent (10%) per annum from the date the amount was due until paid. The interest shall apply to any part of the tax unpaid by the due date and no interest may be waived. (k) The commissioner shall promulgate rules governing the manner in which the premium tax shall be paid. The rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The rules may provide for the making of premium tax payments through electronic means. The rules may also provide for a convenience fee to cover the costs of accepting electronic premium tax payments. In no event shall the convenience fee exceed the actual costs incurred by the department in accepting electronic premium tax payments in addition to any applicable penalty and interest fees. (l) Notwithstanding this section to the contrary, the commissioner, in the commissioner's sole discretion, may approve an alternative date for filing and paying the premium tax due under this section for captive insurance companies on a fiscal year-end. The alternative filing and payment date must be no later than seventy-five (75) days after the captive insurance company's fiscal year-end. Captive insurance companies on a fiscal year-end may apply for an alternate filing and payment date on forms developed by the commissioner. Amended by 2024 Tenn. Acts, ch. 643,s 11, eff. 4/4/2024. Amended by 2017 Tenn. Acts, ch. 354, s 1, s 4 eff. 5/11/2017. Amended by 2016 Tenn. Acts, ch. 1018, s 3, s 4, s 5 eff. 4/28/2016. Amended by 2015 Tenn. Acts, ch. 156, s 9, s 10, s 19 eff. 4/17/2015. Amended by 2015 Tenn. Acts, ch. 156, s 11, eff. 1/1/2016. Amended by 2013 Tenn. Acts, ch. 139, s 2, eff. 4/12/2013. Acts 2011 , ch. 468, § 1.
(a) Each captive insurance company shall pay to the department, on or prior to March 15 of each year, a tax at the rate of four tenths of one percent (0.4%) on the first twenty million dollars ($20,000,000), and three-tenths of one percent (0.3%) on each dollar thereafter on the direct premiums collected or contracted for on policies or contracts of insurance written by the captive insurance company during the year ending December 31 next preceding, after deducting from the direct premiums subject to the tax the amounts paid to policyholders as return premiums. Return premiums shall include dividends on unabsorbed premiums or premium deposits returned or credited to policyholders. No tax shall be due or payable under this title as to considerations received for annuity contracts.
(b) Each captive insurance company shall pay to the department, on or prior to March 15 of each year, a tax at the rate of 225-thousandths of one percent (0.225%) on the first twenty million dollars ($20,000,000) of assumed reinsurance premium, and 150-thousandths of one percent (0.150%) on the next twenty million dollars ($20,000,000), and 50-thousandths of one percent (0.050%) on the next twenty million dollars ($20,000,000), and 25-thousandths of one percent (0.025%) of each dollar thereafter. However, no reinsurance tax applies to premiums for risks or portions of risks that are subject to taxation on a direct basis pursuant to subsection (a). No reinsurance premium tax shall be payable in connection with the receipt of assets in exchange for the assumption of loss reserves and other liabilities of another insurer under common ownership and control; provided, that the commissioner verifies that such transaction is part of a plan to discontinue the operations of such other insurer, and if the intent of the parties to such transaction is to renew or maintain such business with the captive insurance company.
(c) (1) Except with regard to a protected cell captive insurance company, as defined in § 56-13-202 , with more than ten (10) cells, the annual minimum aggregate tax to be paid by a captive insurance company calculated under subsections (a) and (b) shall be five thousand dollars ($5,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000). (2) For a protected cell captive insurance company with more than ten (10) cells, the annual minimum aggregate tax to be paid under subsections (a) and (b) shall be ten thousand dollars ($10,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000), plus five thousand dollars ($5,000) multiplied by the number of cells over ten (10). (3) A dormant captive insurance company that has been issued a letter of dormancy under § 56-13-124 is not subject to or liable for the payment of the annual minimum aggregate tax established under this subsection (c).
(1) Except with regard to a protected cell captive insurance company, as defined in § 56-13-202 , with more than ten (10) cells, the annual minimum aggregate tax to be paid by a captive insurance company calculated under subsections (a) and (b) shall be five thousand dollars ($5,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000).
(2) For a protected cell captive insurance company with more than ten (10) cells, the annual minimum aggregate tax to be paid under subsections (a) and (b) shall be ten thousand dollars ($10,000), and the annual maximum aggregate tax shall be one hundred thousand dollars ($100,000), plus five thousand dollars ($5,000) multiplied by the number of cells over ten (10).
(3) A dormant captive insurance company that has been issued a letter of dormancy under § 56-13-124 is not subject to or liable for the payment of the annual minimum aggregate tax established under this subsection (c).
(d) The tax provided for in this section shall constitute all taxes collectible under the laws of this state from any captive insurance company and from any insured on its payments to a captive insurance company, and no other occupation tax or other taxes shall be levied or collected from any captive insurance company by this state or any county, city, or municipality within this state, except ad valorem taxes on real and personal property used in the production of income.
(e) Captive insurance companies, protected cells of captive insurance companies, and incorporated protected cells of captive insurance companies shall be subject to the fees in § 56-4-101 .
(f) All premium taxes paid into the department under this chapter shall be held by the commissioner as expendable receipts for the purpose of administering this chapter and for promoting the Tennessee captive insurance industry.
(g) The tax provided for in this section shall be calculated on an annual basis, notwithstanding policies or contracts of insurance or contracts of reinsurance issued on a multiyear basis. In the case of multiyear policies or contracts, the premium shall be prorated for purposes of determining the tax under this section.
(h) Nothing in this section shall be construed to provide an exemption from the sales and use tax imposed by title 67, chapter 6.
(i) (1) Entities in this state, including industrial insureds as defined in § 56-2-105(7) , who have procured insurance from a captive insurance company and, on or before December 31, 2018, either redomesticate that captive insurance company to this state pursuant to this chapter or transfer a complete line of business or complete geographic risk into a captive formed in this state between January 1, 2016, and December 31, 2018, shall not be liable for any unreported taxes due pursuant to § 56-2-411 on a policy or contract of insurance procured from the captive insurance company before the redomestication of the captive insurance company or transfer of line of business or complete geographic risk to this state; provided, that the policy or contract is substantially similar to a policy or contract of insurance procured from the captive insurance company after it is redomiciled or after the line of business or the complete geographic risk is transferred to this state. (2) In order for a transfer of a line of business or complete geographic risk to a Tennessee captive formed between January 1, 2016, and December 31, 2018, to qualify under subdivision (i)(1), the Tennessee captive formed between January 1, 2016, and December 31, 2018, must have and maintain, for no less than five (5) years from the date of formation, capital of at least fifteen million dollars ($15,000,000) and annual premiums of at least thirty million dollars ($30,000,000).
(1) Entities in this state, including industrial insureds as defined in § 56-2-105(7) , who have procured insurance from a captive insurance company and, on or before December 31, 2018, either redomesticate that captive insurance company to this state pursuant to this chapter or transfer a complete line of business or complete geographic risk into a captive formed in this state between January 1, 2016, and December 31, 2018, shall not be liable for any unreported taxes due pursuant to § 56-2-411 on a policy or contract of insurance procured from the captive insurance company before the redomestication of the captive insurance company or transfer of line of business or complete geographic risk to this state; provided, that the policy or contract is substantially similar to a policy or contract of insurance procured from the captive insurance company after it is redomiciled or after the line of business or the complete geographic risk is transferred to this state.
(2) In order for a transfer of a line of business or complete geographic risk to a Tennessee captive formed between January 1, 2016, and December 31, 2018, to qualify under subdivision (i)(1), the Tennessee captive formed between January 1, 2016, and December 31, 2018, must have and maintain, for no less than five (5) years from the date of formation, capital of at least fifteen million dollars ($15,000,000) and annual premiums of at least thirty million dollars ($30,000,000).
(j) (1) Any captive insurance company failing to pay premium tax payments as provided by this chapter shall forfeit and pay to the state, in addition to the amount of the unpaid taxes, a penalty of five hundred dollars ($500) for the first month or fractional part of the first month of delinquency; provided, that should the period of delinquency exceed one (1) month, the company shall pay an additional five hundred dollars ($500) for the second month or fractional part of the second month. Any premium tax payment that is not paid within sixty (60) days of the due date is a violation of this chapter and is subject to § 56-13-120 . The commissioner has the discretion, upon written application and for good cause shown, to waive the penalties of this subdivision (j)(1). (2) All delinquencies shall bear interest at the rate of ten percent (10%) per annum from the date the amount was due until paid. The interest shall apply to any part of the tax unpaid by the due date and no interest may be waived.
(1) Any captive insurance company failing to pay premium tax payments as provided by this chapter shall forfeit and pay to the state, in addition to the amount of the unpaid taxes, a penalty of five hundred dollars ($500) for the first month or fractional part of the first month of delinquency; provided, that should the period of delinquency exceed one (1) month, the company shall pay an additional five hundred dollars ($500) for the second month or fractional part of the second month. Any premium tax payment that is not paid within sixty (60) days of the due date is a violation of this chapter and is subject to § 56-13-120 . The commissioner has the discretion, upon written application and for good cause shown, to waive the penalties of this subdivision (j)(1).
(2) All delinquencies shall bear interest at the rate of ten percent (10%) per annum from the date the amount was due until paid. The interest shall apply to any part of the tax unpaid by the due date and no interest may be waived.
(k) The commissioner shall promulgate rules governing the manner in which the premium tax shall be paid. The rules shall be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. The rules may provide for the making of premium tax payments through electronic means. The rules may also provide for a convenience fee to cover the costs of accepting electronic premium tax payments. In no event shall the convenience fee exceed the actual costs incurred by the department in accepting electronic premium tax payments in addition to any applicable penalty and interest fees.
(l) Notwithstanding this section to the contrary, the commissioner, in the commissioner's sole discretion, may approve an alternative date for filing and paying the premium tax due under this section for captive insurance companies on a fiscal year-end. The alternative filing and payment date must be no later than seventy-five (75) days after the captive insurance company's fiscal year-end. Captive insurance companies on a fiscal year-end may apply for an alternate filing and payment date on forms developed by the commissioner.
Amended by 2024 Tenn. Acts, ch. 643,s 11, eff. 4/4/2024.
Amended by 2017 Tenn. Acts, ch. 354, s 1, s 4 eff. 5/11/2017.
Amended by 2016 Tenn. Acts, ch. 1018, s 3, s 4, s 5 eff. 4/28/2016.
Amended by 2015 Tenn. Acts, ch. 156, s 9, s 10, s 19 eff. 4/17/2015.
Amended by 2015 Tenn. Acts, ch. 156, s 11, eff. 1/1/2016.
Amended by 2013 Tenn. Acts, ch. 139, s 2, eff. 4/12/2013.
Acts 2011 , ch. 468, § 1.
Tenn. Code Ann. § 56-6-111 — TN Code / Title 56 / Chapter 6 / Section 56-6-111
Temporary licensing
Status: in_force

(a) The commissioner may issue a temporary insurance producer license for a period not to exceed one hundred eighty (180) days without requiring an examination if the commissioner deems that the temporary license is necessary for the servicing of an insurance business in the following cases: (1) To the surviving spouse or court-appointed personal representative of a licensed insurance producer who dies or becomes mentally or physically disabled to allow adequate time for the sale of the insurance business owned by the producer or for the recovery or return of the producer to the business or to provide for the training and licensing of new personnel to operate the producer's business; (2) To a member or employee of a business entity licensed as an insurance producer, upon the death or disability of an individual designated in the business entity application or the license; (3) To the designee of a licensed insurance producer entering active service in the armed forces of the United States; or (4) In any other circumstance where the commissioner deems that the public interest will best be served by the issuance of this license. (b) The commissioner may by order limit the authority of any temporary licensee in any way deemed necessary to protect insureds and the public. The commissioner may require the temporary licensee to have a suitable sponsor who is a licensed producer or insurer and who assumes responsibility for all acts of the temporary licensee and may impose other similar requirements designed to protect insureds and the public. A temporary license issued under this part may also be suspended or revoked pursuant to § 56-6-112 . A temporary license may not continue after the owner or the personal representative disposes of the business. Acts 2002, ch. 798, § 12.
(a) The commissioner may issue a temporary insurance producer license for a period not to exceed one hundred eighty (180) days without requiring an examination if the commissioner deems that the temporary license is necessary for the servicing of an insurance business in the following cases: (1) To the surviving spouse or court-appointed personal representative of a licensed insurance producer who dies or becomes mentally or physically disabled to allow adequate time for the sale of the insurance business owned by the producer or for the recovery or return of the producer to the business or to provide for the training and licensing of new personnel to operate the producer's business; (2) To a member or employee of a business entity licensed as an insurance producer, upon the death or disability of an individual designated in the business entity application or the license; (3) To the designee of a licensed insurance producer entering active service in the armed forces of the United States; or (4) In any other circumstance where the commissioner deems that the public interest will best be served by the issuance of this license.
(1) To the surviving spouse or court-appointed personal representative of a licensed insurance producer who dies or becomes mentally or physically disabled to allow adequate time for the sale of the insurance business owned by the producer or for the recovery or return of the producer to the business or to provide for the training and licensing of new personnel to operate the producer's business;
(2) To a member or employee of a business entity licensed as an insurance producer, upon the death or disability of an individual designated in the business entity application or the license;
(3) To the designee of a licensed insurance producer entering active service in the armed forces of the United States; or
(4) In any other circumstance where the commissioner deems that the public interest will best be served by the issuance of this license.
(b) The commissioner may by order limit the authority of any temporary licensee in any way deemed necessary to protect insureds and the public. The commissioner may require the temporary licensee to have a suitable sponsor who is a licensed producer or insurer and who assumes responsibility for all acts of the temporary licensee and may impose other similar requirements designed to protect insureds and the public. A temporary license issued under this part may also be suspended or revoked pursuant to § 56-6-112 . A temporary license may not continue after the owner or the personal representative disposes of the business.
Acts 2002, ch. 798, § 12.
Tenn. Code Ann. § 56-27-109 — TN Code / Title 56 / Chapter 27 / Section 56-27-109
Agreements with physicians
Status: in_force

A medical service plan corporation may enter into agreements with physicians qualified as set out in § 56-27-108 , under which the physicians become participating physicians of a plan operated by the corporation, and may make to the physicians payments that have accrued to them by reason of services performed under the plan and on behalf of the corporation by them. Payment for medical services shall be made only to a participating physician unless otherwise provided for in this chapter, except that the corporation, in the case of emergency services rendered to a subscriber, may reimburse any doctor of medicine who would be eligible to become a participating physician except for residence or state by which licensed, in accordance with the rates adopted by the board of directors with respect to participating physicians. A medical service plan corporation may enter into contracts for the payment of medical services to the subscribers or members of similar medical service plan corporations of other states subject to the supervision of other states, and shall have the right to reimburse any other medical service plan corporation or physicians of another state or other counties of this state in which the corporation does not transact business for services rendered to its subscribers or beneficiaries named in the certificates issued to the subscribers at the same rate paid participating physicians under the certificate of the subscriber. The contracts between the medical service plan corporation and physicians shall be subject to the supervision of and the approval of the commissioner. Acts 1945, ch. 113, § 14; C. Supp. 1950, § 4186.30 (Williams, § 4186.31); T.C.A. (orig. ed.), § 56-2909.
A medical service plan corporation may enter into agreements with physicians qualified as set out in § 56-27-108 , under which the physicians become participating physicians of a plan operated by the corporation, and may make to the physicians payments that have accrued to them by reason of services performed under the plan and on behalf of the corporation by them. Payment for medical services shall be made only to a participating physician unless otherwise provided for in this chapter, except that the corporation, in the case of emergency services rendered to a subscriber, may reimburse any doctor of medicine who would be eligible to become a participating physician except for residence or state by which licensed, in accordance with the rates adopted by the board of directors with respect to participating physicians. A medical service plan corporation may enter into contracts for the payment of medical services to the subscribers or members of similar medical service plan corporations of other states subject to the supervision of other states, and shall have the right to reimburse any other medical service plan corporation or physicians of another state or other counties of this state in which the corporation does not transact business for services rendered to its subscribers or beneficiaries named in the certificates issued to the subscribers at the same rate paid participating physicians under the certificate of the subscriber. The contracts between the medical service plan corporation and physicians shall be subject to the supervision of and the approval of the commissioner.
Acts 1945, ch. 113, § 14; C. Supp. 1950, § 4186.30 (Williams, § 4186.31); T.C.A. (orig. ed.), § 56-2909.