Tenn. Code Ann. § 56-7-2805 — TN Code / Title 56 / Chapter 7 / Section 56-7-2805
Small group market - Network plans - Financial capacity limits - Applicability
Status: in_force

(a) Issuance of Coverage in the Small Group Market. (1) Subject to subsections (b)-(e), each health insurance issuer that offers health insurance coverage in the small group market in this state must accept: (A) Every small employer in the state that applies for the coverage; and (B) For enrollment under the coverage every eligible individual who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction that is inconsistent with § 56-7-2804 on an eligible individual being a participant or beneficiary. (2) Eligible Individual Defined. As used in this section, "eligible individual" means, with respect to a health insurance issuer that offers health insurance coverage to a small employer in connection with a group health plan in the small group market, the individual in relation to the employer as shall be determined: (A) In accordance with the terms of the plan; (B) As provided by the issuer under rules of the issuer that are uniformly applicable in this state to small employers in the small group market; and (C) In accordance with all applicable state laws governing the issuer and the market. (b) Special Rules for Network Plans. (1) In the case of a health insurance issuer that offers health insurance coverage in the small group market through a network plan, the issuer may: (A) Limit the employers that may apply for the coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the employers if the issuer has demonstrated to the commissioner that: (i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and (ii) It is applying this subdivision (b)(1)(B) uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents. (2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (b)(1)(B), may not offer coverage in the small group market within the service area for a period of one hundred eighty (180) days after the date the coverage is denied. (c) Application of Financial Capacity Limits. (1) A health insurance issuer may deny health insurance coverage in the small group market if the issuer has demonstrated to the commissioner that: (A) It does not have the financial reserves necessary to underwrite additional coverage; and (B) It is applying this subdivision (c)(1) uniformly to all employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents. (2) A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with subdivision (c)(1) in this state may not offer coverage in connection with group health plans in the small group market in the state for a period of one hundred eighty (180) days after the date the coverage is denied or until the issuer has demonstrated to the commissioner that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. The commissioner may provide for the application of this subsection (c) on a service-area-specific basis. (d) Exception to Requirement for Failure to Meet Certain Minimum Participation or Contribution Rules. (1) Subsection (a) shall not be construed to preclude a health insurance issuer from establishing employer contribution rules or group participation rules for the offering of health insurance coverage in connection with a health group plan in the small group market, as allowed under applicable state law. (2) As used in subdivision (d)(1): (A) "Employer contribution rule" means a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries; and (B) "Group participation rule" means a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specified percentage or number of eligible individuals or employees of an employer. (e) Exception for Coverage Offered Only to Bona Fide Association Members. Subsection (a) shall not apply to health insurance coverage offered by a health insurance issuer if the coverage is made available in the small group market only through one (1) or more bona fide associations. (f) In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer: (1) Shall make a reasonable disclosure to the employer, as part of its solicitation and sales materials, of the availability of information described in subsection (g); and (2) Upon request of the small employer, provide such information. (g) (1) Subject to subdivision (g)(3), with respect to a health insurance issuer offering health insurance coverage to a small employer, information described in this subsection (g) is information concerning: (A) The provisions of the coverage concerning issuer's right to change premium rates and the factors that may affect changes in premium rates; (B) The provisions of the coverage relating to renewability of coverage; (C) The provisions of the coverage relating to any preexisting condition exclusion; and (D) The benefits and premiums available under all health insurance coverage for which the employer is qualified. (2) Information under this subsection (g) shall be provided to small employers in a manner determined to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage. (3) An issuer is not required to disclose any information under subsection (f) that is proprietary and trade secret information under applicable law. (h) The requirements of this part addressing the small and large group markets shall not apply to any group health plan, and health insurance coverage offered in connection with a group health plan, for any plan year if, on the first day of the plan year, the plan has fewer than two (2) participants who are current employees. (i) Rules to be used in the determination of employer size are: (1) All persons treated as a single employer under § 414(b), (c), (m) , or (o) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 414(b), (c), (m), and (o) ), shall be treated as one (1) employer; (2) In the case of an employer that was not in existence throughout the preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year; and (3) Any reference in this subsection (i) to an employer shall include a reference to any predecessor of the employer. Acts 1997 , ch. 157, § 6.
(a) Issuance of Coverage in the Small Group Market. (1) Subject to subsections (b)-(e), each health insurance issuer that offers health insurance coverage in the small group market in this state must accept: (A) Every small employer in the state that applies for the coverage; and (B) For enrollment under the coverage every eligible individual who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction that is inconsistent with § 56-7-2804 on an eligible individual being a participant or beneficiary. (2) Eligible Individual Defined. As used in this section, "eligible individual" means, with respect to a health insurance issuer that offers health insurance coverage to a small employer in connection with a group health plan in the small group market, the individual in relation to the employer as shall be determined: (A) In accordance with the terms of the plan; (B) As provided by the issuer under rules of the issuer that are uniformly applicable in this state to small employers in the small group market; and (C) In accordance with all applicable state laws governing the issuer and the market.
(1) Subject to subsections (b)-(e), each health insurance issuer that offers health insurance coverage in the small group market in this state must accept: (A) Every small employer in the state that applies for the coverage; and (B) For enrollment under the coverage every eligible individual who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction that is inconsistent with § 56-7-2804 on an eligible individual being a participant or beneficiary.
(A) Every small employer in the state that applies for the coverage; and
(B) For enrollment under the coverage every eligible individual who applies for enrollment during the period in which the individual first becomes eligible to enroll under the terms of the group health plan and may not place any restriction that is inconsistent with § 56-7-2804 on an eligible individual being a participant or beneficiary.
(2) Eligible Individual Defined. As used in this section, "eligible individual" means, with respect to a health insurance issuer that offers health insurance coverage to a small employer in connection with a group health plan in the small group market, the individual in relation to the employer as shall be determined: (A) In accordance with the terms of the plan; (B) As provided by the issuer under rules of the issuer that are uniformly applicable in this state to small employers in the small group market; and (C) In accordance with all applicable state laws governing the issuer and the market.
(A) In accordance with the terms of the plan;
(B) As provided by the issuer under rules of the issuer that are uniformly applicable in this state to small employers in the small group market; and
(C) In accordance with all applicable state laws governing the issuer and the market.
(b) Special Rules for Network Plans. (1) In the case of a health insurance issuer that offers health insurance coverage in the small group market through a network plan, the issuer may: (A) Limit the employers that may apply for the coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the employers if the issuer has demonstrated to the commissioner that: (i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and (ii) It is applying this subdivision (b)(1)(B) uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents. (2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (b)(1)(B), may not offer coverage in the small group market within the service area for a period of one hundred eighty (180) days after the date the coverage is denied.
(1) In the case of a health insurance issuer that offers health insurance coverage in the small group market through a network plan, the issuer may: (A) Limit the employers that may apply for the coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the employers if the issuer has demonstrated to the commissioner that: (i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and (ii) It is applying this subdivision (b)(1)(B) uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
(A) Limit the employers that may apply for the coverage to those with eligible individuals who live, work, or reside in the service area for the network plan; and
(B) Within the service area of the plan, deny the coverage to the employers if the issuer has demonstrated to the commissioner that: (i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and (ii) It is applying this subdivision (b)(1)(B) uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
(i) It will not have the capacity to deliver services adequately to enrollees of any additional groups because of its obligations to existing group contract holders and enrollees; and
(ii) It is applying this subdivision (b)(1)(B) uniformly to all employers without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
(2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (b)(1)(B), may not offer coverage in the small group market within the service area for a period of one hundred eighty (180) days after the date the coverage is denied.
(c) Application of Financial Capacity Limits. (1) A health insurance issuer may deny health insurance coverage in the small group market if the issuer has demonstrated to the commissioner that: (A) It does not have the financial reserves necessary to underwrite additional coverage; and (B) It is applying this subdivision (c)(1) uniformly to all employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents. (2) A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with subdivision (c)(1) in this state may not offer coverage in connection with group health plans in the small group market in the state for a period of one hundred eighty (180) days after the date the coverage is denied or until the issuer has demonstrated to the commissioner that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. The commissioner may provide for the application of this subsection (c) on a service-area-specific basis.
(1) A health insurance issuer may deny health insurance coverage in the small group market if the issuer has demonstrated to the commissioner that: (A) It does not have the financial reserves necessary to underwrite additional coverage; and (B) It is applying this subdivision (c)(1) uniformly to all employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
(A) It does not have the financial reserves necessary to underwrite additional coverage; and
(B) It is applying this subdivision (c)(1) uniformly to all employers in the small group market in this state consistent with applicable state law and without regard to the claims experience of those employers and their employees and their dependents, or any health status-related factor relating to the employees and dependents.
(2) A health insurance issuer upon denying health insurance coverage in connection with group health plans in accordance with subdivision (c)(1) in this state may not offer coverage in connection with group health plans in the small group market in the state for a period of one hundred eighty (180) days after the date the coverage is denied or until the issuer has demonstrated to the commissioner that the issuer has sufficient financial reserves to underwrite additional coverage, whichever is later. The commissioner may provide for the application of this subsection (c) on a service-area-specific basis.
(d) Exception to Requirement for Failure to Meet Certain Minimum Participation or Contribution Rules. (1) Subsection (a) shall not be construed to preclude a health insurance issuer from establishing employer contribution rules or group participation rules for the offering of health insurance coverage in connection with a health group plan in the small group market, as allowed under applicable state law. (2) As used in subdivision (d)(1): (A) "Employer contribution rule" means a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries; and (B) "Group participation rule" means a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specified percentage or number of eligible individuals or employees of an employer.
(1) Subsection (a) shall not be construed to preclude a health insurance issuer from establishing employer contribution rules or group participation rules for the offering of health insurance coverage in connection with a health group plan in the small group market, as allowed under applicable state law.
(2) As used in subdivision (d)(1): (A) "Employer contribution rule" means a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries; and (B) "Group participation rule" means a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specified percentage or number of eligible individuals or employees of an employer.
(A) "Employer contribution rule" means a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries; and
(B) "Group participation rule" means a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specified percentage or number of eligible individuals or employees of an employer.
(e) Exception for Coverage Offered Only to Bona Fide Association Members. Subsection (a) shall not apply to health insurance coverage offered by a health insurance issuer if the coverage is made available in the small group market only through one (1) or more bona fide associations.
(f) In connection with the offering of any health insurance coverage to a small employer, a health insurance issuer: (1) Shall make a reasonable disclosure to the employer, as part of its solicitation and sales materials, of the availability of information described in subsection (g); and (2) Upon request of the small employer, provide such information.
(1) Shall make a reasonable disclosure to the employer, as part of its solicitation and sales materials, of the availability of information described in subsection (g); and
(2) Upon request of the small employer, provide such information.
(g) (1) Subject to subdivision (g)(3), with respect to a health insurance issuer offering health insurance coverage to a small employer, information described in this subsection (g) is information concerning: (A) The provisions of the coverage concerning issuer's right to change premium rates and the factors that may affect changes in premium rates; (B) The provisions of the coverage relating to renewability of coverage; (C) The provisions of the coverage relating to any preexisting condition exclusion; and (D) The benefits and premiums available under all health insurance coverage for which the employer is qualified. (2) Information under this subsection (g) shall be provided to small employers in a manner determined to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage. (3) An issuer is not required to disclose any information under subsection (f) that is proprietary and trade secret information under applicable law.
(1) Subject to subdivision (g)(3), with respect to a health insurance issuer offering health insurance coverage to a small employer, information described in this subsection (g) is information concerning: (A) The provisions of the coverage concerning issuer's right to change premium rates and the factors that may affect changes in premium rates; (B) The provisions of the coverage relating to renewability of coverage; (C) The provisions of the coverage relating to any preexisting condition exclusion; and (D) The benefits and premiums available under all health insurance coverage for which the employer is qualified.
(A) The provisions of the coverage concerning issuer's right to change premium rates and the factors that may affect changes in premium rates;
(B) The provisions of the coverage relating to renewability of coverage;
(C) The provisions of the coverage relating to any preexisting condition exclusion; and
(D) The benefits and premiums available under all health insurance coverage for which the employer is qualified.
(2) Information under this subsection (g) shall be provided to small employers in a manner determined to be understandable by the average small employer, and shall be sufficient to reasonably inform small employers of their rights and obligations under the health insurance coverage.
(3) An issuer is not required to disclose any information under subsection (f) that is proprietary and trade secret information under applicable law.
(h) The requirements of this part addressing the small and large group markets shall not apply to any group health plan, and health insurance coverage offered in connection with a group health plan, for any plan year if, on the first day of the plan year, the plan has fewer than two (2) participants who are current employees.
(i) Rules to be used in the determination of employer size are: (1) All persons treated as a single employer under § 414(b), (c), (m) , or (o) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 414(b), (c), (m), and (o) ), shall be treated as one (1) employer; (2) In the case of an employer that was not in existence throughout the preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year; and (3) Any reference in this subsection (i) to an employer shall include a reference to any predecessor of the employer.
(1) All persons treated as a single employer under § 414(b), (c), (m) , or (o) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 414(b), (c), (m), and (o) ), shall be treated as one (1) employer;
(2) In the case of an employer that was not in existence throughout the preceding calendar year, the determination of whether the employer is a small or large employer shall be based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year; and
(3) Any reference in this subsection (i) to an employer shall include a reference to any predecessor of the employer.
Acts 1997 , ch. 157, § 6.
Tenn. Code Ann. § 56-46-109 — TN Code / Title 56 / Chapter 46 / Section 56-46-109
Confidentiality of reports - Disclosure in advertising, etc. prohibited - Reports not to be used for ratemaking
Status: in_force

(a) All RBC reports, to the extent the information in the RBC report is not required to be set forth in a publicly available annual statement schedule, and RBC Plans, including the results or report of any examination or analysis of an insurer performed pursuant to this part and any corrective order issued by the commissioner pursuant to examination or analysis, with respect to any domestic insurer or foreign insurer that are in the possession or control of the department of commerce and insurance shall be confidential by law and privileged, shall not be subject to § 10-7-503 or § 56-1-602 , shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties. (b) It is the judgment of the general assembly that the comparison of an insurer's Total Adjusted Capital to any of its RBC Levels is a regulatory tool that may indicate the need for possible corrective action with respect to the insurer, and is not intended as a means to rank insurers generally. Therefore, except as otherwise required under this part, the making, publishing, disseminating, circulating or placing before the public, or causing, directly or indirectly to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing an assertion, representation or statement with regard to the RBC Levels of any insurer, or of any component derived in the calculation, by any insurer, agent, broker or other person engaged in any manner in the insurance business would be misleading and is therefore prohibited; provided, that if any materially false statement with respect to the comparison regarding an insurer's Total Adjusted Capital to its RBC Levels (or any of them) or an inappropriate comparison of any other amount to the insurer's RBC Levels is published in any written publication and the insurer is able to demonstrate to the commissioner with substantial proof the falsity of the statement, or the inappropriateness, as the case may be, then the insurer may publish an announcement in a written publication if the sole purpose of the announcement is to rebut the materially false statement. (c) It is the further judgment of the general assembly that the RBC Instructions, RBC Reports, Adjusted RBC Reports, RBC Plan or Revised RBC Plans are intended solely for use by the commissioner in monitoring the solvency of insurers and the need for possible corrective action with respect to insurers and shall not be used by the commissioner for ratemaking nor considered as evidence in any rate proceeding nor used by the commissioner to calculate or derive any elements of an appropriate premium level or rate of return for any line of insurance that an insurer or any affiliate is authorized to write. (d) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection (a). (e) In order to assist in the performance of the commissioner's duties, the commissioner may: (1) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection (a), with other state, federal and international regulatory agencies, with the NAIC and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information; (2) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and (3) Enter into agreements governing sharing and use of information consistent with this subsection (e). (f) Disclosure of documents, materials or information to the commissioner under this section or as a result of sharing as authorized in subsection (e) shall not constitute waiver of any applicable privilege or claim of confidentiality. Amended by 2014 Tenn. Acts, ch. 559, Secs.s 2, s 4, s 5 eff. 3/21/2014. Acts 1996, ch. 750, § 10.
(a) All RBC reports, to the extent the information in the RBC report is not required to be set forth in a publicly available annual statement schedule, and RBC Plans, including the results or report of any examination or analysis of an insurer performed pursuant to this part and any corrective order issued by the commissioner pursuant to examination or analysis, with respect to any domestic insurer or foreign insurer that are in the possession or control of the department of commerce and insurance shall be confidential by law and privileged, shall not be subject to § 10-7-503 or § 56-1-602 , shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. However, the commissioner is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties.
(b) It is the judgment of the general assembly that the comparison of an insurer's Total Adjusted Capital to any of its RBC Levels is a regulatory tool that may indicate the need for possible corrective action with respect to the insurer, and is not intended as a means to rank insurers generally. Therefore, except as otherwise required under this part, the making, publishing, disseminating, circulating or placing before the public, or causing, directly or indirectly to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing an assertion, representation or statement with regard to the RBC Levels of any insurer, or of any component derived in the calculation, by any insurer, agent, broker or other person engaged in any manner in the insurance business would be misleading and is therefore prohibited; provided, that if any materially false statement with respect to the comparison regarding an insurer's Total Adjusted Capital to its RBC Levels (or any of them) or an inappropriate comparison of any other amount to the insurer's RBC Levels is published in any written publication and the insurer is able to demonstrate to the commissioner with substantial proof the falsity of the statement, or the inappropriateness, as the case may be, then the insurer may publish an announcement in a written publication if the sole purpose of the announcement is to rebut the materially false statement.
(c) It is the further judgment of the general assembly that the RBC Instructions, RBC Reports, Adjusted RBC Reports, RBC Plan or Revised RBC Plans are intended solely for use by the commissioner in monitoring the solvency of insurers and the need for possible corrective action with respect to insurers and shall not be used by the commissioner for ratemaking nor considered as evidence in any rate proceeding nor used by the commissioner to calculate or derive any elements of an appropriate premium level or rate of return for any line of insurance that an insurer or any affiliate is authorized to write.
(d) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection (a).
(e) In order to assist in the performance of the commissioner's duties, the commissioner may: (1) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection (a), with other state, federal and international regulatory agencies, with the NAIC and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information; (2) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and (3) Enter into agreements governing sharing and use of information consistent with this subsection (e).
(1) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subsection (a), with other state, federal and international regulatory agencies, with the NAIC and its affiliates and subsidiaries, and with state, federal and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information;
(2) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC and its affiliates and subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and
(3) Enter into agreements governing sharing and use of information consistent with this subsection (e).
(f) Disclosure of documents, materials or information to the commissioner under this section or as a result of sharing as authorized in subsection (e) shall not constitute waiver of any applicable privilege or claim of confidentiality.
Amended by 2014 Tenn. Acts, ch. 559, Secs.s 2, s 4, s 5 eff. 3/21/2014.
Acts 1996, ch. 750, § 10.
Tenn. Code Ann. § 56-6-106 — TN Code / Title 56 / Chapter 6 / Section 56-6-106
Application for license
Status: in_force

(a) An individual residing in this state applying for an insurance producer license shall make application to the commissioner on the uniform application and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the commissioner shall find that the individual: (1) Is at least eighteen (18) years of age; (2) Has not committed any act that is a ground for denial, suspension or revocation set forth in § 56-6-112 ; (3) If the individual is applying for a title insurance line of authority, has completed a pre-licensing course of study that consists of a minimum of thirty (30) hours of course work for title insurance; (4) Has paid the fees set forth in § 56-6-121 ; and (5) Has successfully passed the examinations for the lines of authority for which the person has applied. (b) A business entity may obtain an insurance producer's license; however, only an individual licensed producer or limited lines producer shall sell, solicit or negotiate a contract of insurance in this state. Application shall be made using the uniform business entity application. An individual authorized and acting on behalf of the business entity shall declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the commissioner shall find that: (1) The business entity has paid the applicable fees set forth in § 56-6-121 ; and (2) The business entity has designated a principal or officer who also holds a current producer license responsible for the business entity's compliance with the insurance laws, rules and regulations of this state. (c) The commissioner may require any documents reasonably necessary to verify the information contained in an application. Amended by 2024 Tenn. Acts, ch. 890,s 1, eff. 7/1/2024. Amended by 2023 Tenn. Acts, ch. 57, s 2, eff. 3/21/2023. Amended by 2014 Tenn. Acts, ch. 650, s 1, eff. 4/8/2014. Acts 2002, ch. 798, § 7; 2007 , ch. 228, § 2.
(a) An individual residing in this state applying for an insurance producer license shall make application to the commissioner on the uniform application and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the commissioner shall find that the individual: (1) Is at least eighteen (18) years of age; (2) Has not committed any act that is a ground for denial, suspension or revocation set forth in § 56-6-112 ; (3) If the individual is applying for a title insurance line of authority, has completed a pre-licensing course of study that consists of a minimum of thirty (30) hours of course work for title insurance; (4) Has paid the fees set forth in § 56-6-121 ; and (5) Has successfully passed the examinations for the lines of authority for which the person has applied.
(1) Is at least eighteen (18) years of age;
(2) Has not committed any act that is a ground for denial, suspension or revocation set forth in § 56-6-112 ;
(3) If the individual is applying for a title insurance line of authority, has completed a pre-licensing course of study that consists of a minimum of thirty (30) hours of course work for title insurance;
(4) Has paid the fees set forth in § 56-6-121 ; and
(5) Has successfully passed the examinations for the lines of authority for which the person has applied.
(b) A business entity may obtain an insurance producer's license; however, only an individual licensed producer or limited lines producer shall sell, solicit or negotiate a contract of insurance in this state. Application shall be made using the uniform business entity application. An individual authorized and acting on behalf of the business entity shall declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the commissioner shall find that: (1) The business entity has paid the applicable fees set forth in § 56-6-121 ; and (2) The business entity has designated a principal or officer who also holds a current producer license responsible for the business entity's compliance with the insurance laws, rules and regulations of this state.
(1) The business entity has paid the applicable fees set forth in § 56-6-121 ; and
(2) The business entity has designated a principal or officer who also holds a current producer license responsible for the business entity's compliance with the insurance laws, rules and regulations of this state.
(c) The commissioner may require any documents reasonably necessary to verify the information contained in an application.
Amended by 2024 Tenn. Acts, ch. 890,s 1, eff. 7/1/2024.
Amended by 2023 Tenn. Acts, ch. 57, s 2, eff. 3/21/2023.
Amended by 2014 Tenn. Acts, ch. 650, s 1, eff. 4/8/2014.
Acts 2002, ch. 798, § 7; 2007 , ch. 228, § 2.
Tenn. Code Ann. § 56-7-2318 — TN Code / Title 56 / Chapter 7 / Section 56-7-2318
Optional coverage
Status: in_force

(a) (1) Subject to the provisions and conditions of §§ 56-7-2312 - 56-7-2322, the employee or member shall be entitled to obtain a converted policy providing, at the option of the employee or member, coverage on an expense incurred basis under any one (1) of the plans meeting the following requirements: (A) Plan A: (i) Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800); (B) Plan B: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or (C) Plan C: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400). (2) The maximum dollar amounts in Plan A shall be determined by the commissioner and may be redetermined by the commissioner from time to time as to converted policies issued subsequent to the redetermination. The redetermination shall not be made more often than once in three (3) years. The maximum dollar amounts in Plans A, B, and C shall be rounded to the nearest multiple of ten dollars ($10.00). (b) The insurer may also, in lieu of the plans of benefits set forth in subsection (a), provide alternate plans with benefits exceeding those in Plan A, B, or C, with the approval of the commissioner. (c) If the benefits level required in subsections (a) and (b) exceeds the benefits level provided under the group policy, the conversion policy may offer benefits that are substantially similar to those provided under the group policy in lieu of those required in subsections (a) and (b). (d) The insurer may, at its option, also offer alternate plans of group health conversion in addition to those required by this part. Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1507.
(a) (1) Subject to the provisions and conditions of §§ 56-7-2312 - 56-7-2322, the employee or member shall be entitled to obtain a converted policy providing, at the option of the employee or member, coverage on an expense incurred basis under any one (1) of the plans meeting the following requirements: (A) Plan A: (i) Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800); (B) Plan B: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or (C) Plan C: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400). (2) The maximum dollar amounts in Plan A shall be determined by the commissioner and may be redetermined by the commissioner from time to time as to converted policies issued subsequent to the redetermination. The redetermination shall not be made more often than once in three (3) years. The maximum dollar amounts in Plans A, B, and C shall be rounded to the nearest multiple of ten dollars ($10.00).
(1) Subject to the provisions and conditions of §§ 56-7-2312 - 56-7-2322, the employee or member shall be entitled to obtain a converted policy providing, at the option of the employee or member, coverage on an expense incurred basis under any one (1) of the plans meeting the following requirements: (A) Plan A: (i) Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800); (B) Plan B: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or (C) Plan C: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400).
(A) Plan A: (i) Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800);
(i) Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days;
(ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
(iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800);
(B) Plan B: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or
(i) Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days;
(ii) Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
(iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or
(C) Plan C: (i) Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days; (ii) Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and (iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400).
(i) Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days;
(ii) Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
(iii) Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400).
(2) The maximum dollar amounts in Plan A shall be determined by the commissioner and may be redetermined by the commissioner from time to time as to converted policies issued subsequent to the redetermination. The redetermination shall not be made more often than once in three (3) years. The maximum dollar amounts in Plans A, B, and C shall be rounded to the nearest multiple of ten dollars ($10.00).
(b) The insurer may also, in lieu of the plans of benefits set forth in subsection (a), provide alternate plans with benefits exceeding those in Plan A, B, or C, with the approval of the commissioner.
(c) If the benefits level required in subsections (a) and (b) exceeds the benefits level provided under the group policy, the conversion policy may offer benefits that are substantially similar to those provided under the group policy in lieu of those required in subsections (a) and (b).
(d) The insurer may, at its option, also offer alternate plans of group health conversion in addition to those required by this part.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1507.
Tenn. Code Ann. § 56-2-603 — TN Code / Title 56 / Chapter 2 / Section 56-2-603
Method of service - Notice to defendant
Status: in_force

(a) The service of process shall be made by delivering to and leaving with the commissioner or some person in apparent charge of the commissioner's office two (2) copies of the service of process and the payment to the commissioner or other person of the fees prescribed by law. (b) The commissioner shall forthwith mail by registered mail one (1) of the copies of the process to the defendant at its last known principal place of business, and shall keep a record of all process so served upon the commissioner. (c) The service of process is sufficient; provided, that notice of the service and a copy of the process are sent within ten (10) days thereafter by registered mail by plaintiff or plaintiff's attorney to the defendant at its last known principal place of business, and the defendant's receipt, or receipt issued by the post office with which the letter is registered, showing the name of the sender of the letter and the name and address of the person to whom the letter is addressed, and the affidavit of the plaintiff or plaintiff's attorney showing a compliance with this section are filed with the clerk of the court in which the action is pending on or before the date the defendant is required to appear, or within a further time that the court allows. Acts 1955, ch. 2, § 2; T.C.A., §§ 56-329, 56-248.
(a) The service of process shall be made by delivering to and leaving with the commissioner or some person in apparent charge of the commissioner's office two (2) copies of the service of process and the payment to the commissioner or other person of the fees prescribed by law.
(b) The commissioner shall forthwith mail by registered mail one (1) of the copies of the process to the defendant at its last known principal place of business, and shall keep a record of all process so served upon the commissioner.
(c) The service of process is sufficient; provided, that notice of the service and a copy of the process are sent within ten (10) days thereafter by registered mail by plaintiff or plaintiff's attorney to the defendant at its last known principal place of business, and the defendant's receipt, or receipt issued by the post office with which the letter is registered, showing the name of the sender of the letter and the name and address of the person to whom the letter is addressed, and the affidavit of the plaintiff or plaintiff's attorney showing a compliance with this section are filed with the clerk of the court in which the action is pending on or before the date the defendant is required to appear, or within a further time that the court allows.
Acts 1955, ch. 2, § 2; T.C.A., §§ 56-329, 56-248.
Tenn. Code Ann. § 56-32-121 — TN Code / Title 56 / Chapter 32 / Section 56-32-121
Applicability of other laws - Construction
Status: in_force

(a) Except as otherwise provided in this chapter, the insurance laws and the hospital or medical service corporation laws are not applicable to any HMO granted a certificate of authority under this chapter. This subsection (a) does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state, except with respect to its HMO activities authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by an HMO granted a certificate of authority, or its representatives, shall not be construed to violate any law relating to solicitation or advertising by health professions. (c) Any HMO authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from title 63, chapter 6, relating to the practice of medicine. (d) The Insurance Holding Company System Act of 1986, compiled in chapter 11 of this title, shall be applicable to HMOs to the extent provided in that act, and to the extent provided in § 56-32-122 . (e) HMOs providing utilization review services for mental health and chemical dependency care for their own enrollees shall be subject to chapter 6, part 7 of this title, regarding the provision of utilization review services for mental health or chemical dependency care. This subsection (e) shall not apply to utilization review services provided to TennCare enrollees. Acts 1986, ch. 713, § 21; 2000, ch. 708, §3b; 2003 , ch. 58, § 1; T.C.A. § 56-32-221.
(a) Except as otherwise provided in this chapter, the insurance laws and the hospital or medical service corporation laws are not applicable to any HMO granted a certificate of authority under this chapter. This subsection (a) does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance law or the hospital or medical service corporation laws of this state, except with respect to its HMO activities authorized and regulated pursuant to this chapter.
(b) Solicitation of enrollees by an HMO granted a certificate of authority, or its representatives, shall not be construed to violate any law relating to solicitation or advertising by health professions.
(c) Any HMO authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from title 63, chapter 6, relating to the practice of medicine.
(d) The Insurance Holding Company System Act of 1986, compiled in chapter 11 of this title, shall be applicable to HMOs to the extent provided in that act, and to the extent provided in § 56-32-122 .
(e) HMOs providing utilization review services for mental health and chemical dependency care for their own enrollees shall be subject to chapter 6, part 7 of this title, regarding the provision of utilization review services for mental health or chemical dependency care. This subsection (e) shall not apply to utilization review services provided to TennCare enrollees.
Acts 1986, ch. 713, § 21; 2000, ch. 708, §3b; 2003 , ch. 58, § 1; T.C.A. § 56-32-221.
Tenn. Code Ann. § 56-35-122 — TN Code / Title 56 / Chapter 35 / Section 56-35-122
Rules and regulations
Status: in_force

The commissioner is authorized to make reasonable rules and regulations as are or may be necessary for the administration of this chapter, but no rule or regulation shall take effect until it has been duly filed in the commissioner's office and until and after the expiration of thirty (30) days' written notice to all title insurance companies doing business in the state and after a hearing, if a hearing has been requested in writing by any title insurance company prior to the termination of the thirty-day period. Acts 1955, ch. 173, § 15; T.C.A., § 56-3422.
The commissioner is authorized to make reasonable rules and regulations as are or may be necessary for the administration of this chapter, but no rule or regulation shall take effect until it has been duly filed in the commissioner's office and until and after the expiration of thirty (30) days' written notice to all title insurance companies doing business in the state and after a hearing, if a hearing has been requested in writing by any title insurance company prior to the termination of the thirty-day period.
Acts 1955, ch. 173, § 15; T.C.A., § 56-3422.
Tenn. Code Ann. § 56-31-110 — TN Code / Title 56 / Chapter 31 / Section 56-31-110
Application for license - Form - Accompanying documents - Filing fee
Status: in_force

Applications for licenses shall be made on forms approved by the commissioner, containing information that the commissioner deems necessary. Every application for a license shall be accompanied by copies of the following documents: (1) A certified copy of its charter or certificate of incorporation; (2) A copy of its bylaws certified by the secretary and the president of the corporation; (3) The proposed contract between the corporation and the participating optometrists showing the terms under which vision care services are to be furnished to subscribers; (4) Subscription contracts to be issued to subscribers showing a table of the rates to be charged and the benefits to which they are entitled; (5) A statement of the county or counties in which the corporation proposes to operate vision service plans; (6) A statement of its financial condition and business in such form and detail as the commissioner requires, signed and sworn to by the president and secretary, and payment of the sum of twenty-five dollars ($25.00) for filing of the statement; (7) A copy of any proposed prospectus and advertising material to be used in solicitation of contracts; and (8) Proof satisfactory to the commissioner that in the county or counties in which the corporation proposes to operate, fifty-one percent (51%) or more of the resident optometrists of that county have agreed to render vision services for which the corporation agrees to pay, or that at least twenty-five percent (25%) of the optometrists duly licensed to practice in this state have agreed to render vision services for corporations organized or to be organized pursuant to this chapter. Acts 1969, ch. 118, § 11; T.C.A., § 56-3710.
Applications for licenses shall be made on forms approved by the commissioner, containing information that the commissioner deems necessary. Every application for a license shall be accompanied by copies of the following documents:
(1) A certified copy of its charter or certificate of incorporation;
(2) A copy of its bylaws certified by the secretary and the president of the corporation;
(3) The proposed contract between the corporation and the participating optometrists showing the terms under which vision care services are to be furnished to subscribers;
(4) Subscription contracts to be issued to subscribers showing a table of the rates to be charged and the benefits to which they are entitled;
(5) A statement of the county or counties in which the corporation proposes to operate vision service plans;
(6) A statement of its financial condition and business in such form and detail as the commissioner requires, signed and sworn to by the president and secretary, and payment of the sum of twenty-five dollars ($25.00) for filing of the statement;
(7) A copy of any proposed prospectus and advertising material to be used in solicitation of contracts; and
(8) Proof satisfactory to the commissioner that in the county or counties in which the corporation proposes to operate, fifty-one percent (51%) or more of the resident optometrists of that county have agreed to render vision services for which the corporation agrees to pay, or that at least twenty-five percent (25%) of the optometrists duly licensed to practice in this state have agreed to render vision services for corporations organized or to be organized pursuant to this chapter.
Acts 1969, ch. 118, § 11; T.C.A., § 56-3710.
Tenn. Code Ann. § 56-29-116 — TN Code / Title 56 / Chapter 29 / Section 56-29-116
[Repealed]
Status: repealed

Acts 1949, ch. 234, § 4; C. Supp. 1950, § 4186.46 (Williams, § 4186.49); Acts 1978, ch. 513, § 2; T.C.A. (orig. ed.), §56-3116, repealed by Acts 2011 , ch. 344, § 16, effective 7/1/2011.
Tenn. Code Ann. § 56-26-102 — TN Code / Title 56 / Chapter 26 / Section 56-26-102
Filing and approval of policy forms - Loss ratio guarantee
Status: in_force

(a) (1) No policy of accident and sickness insurance for individual or small employer coverage shall be delivered or issued for delivery in this state, nor shall any endorsement, rider, certificate or application nor any initial or new premium rates on any previously approved policy, endorsement, rider, certificate or application that becomes a part of any such policy be used in connection with the policy until a copy of the form, of the premium rates, and of the classifications of risk pertaining to the policy has been filed with and approved by the commissioner. Approval of such forms, rates, and classifications may be granted in whole or in part at the discretion of the commissioner. (2) No approval shall be issued by the commissioner pursuant to this section unless the commissioner determines that the benefits provided in the policy are reasonable in relation to the premium charged based upon reasonable rules promulgated by the commissioner. (3) Within thirty (30) days of receiving an insurer's filing, if the commissioner has not previously issued notice of either approval or disapproval related to the insurer's filing, either the commissioner or the insurer may initiate an informal conference between the parties to seek additional information or responsive material from the other in order to resolve any outstanding matters related to the filing. In no event shall such period of conference extend beyond sixty (60) days of the commissioner's receipt of the insurer's original filing. At a date no later than sixty (60) days from the receipt of the insurer's original filing the commissioner shall issue either a notice of approval or disapproval regarding the insurer's filing unless the insurer and the commissioner mutually agree in writing to an extension not to exceed one hundred twenty (120) days from the receipt of the insurer's original filing. (4) No policy, endorsement, rider, certificate or application shall be issued until the filing has been approved by the commissioner as provided in this section. The commissioner shall notify, in writing, the filer if the form or rates do not comply with this chapter and are therefore disapproved, specifying the reasons for the commissioner's determination. After such notice, it is unlawful for the filer to issue the form or rates in this state. (5) In a notice issued under subdivision (a)(4), the commissioner shall state that a hearing shall be granted upon written request by the insurer. The insurer has thirty (30) days to submit a written request for a hearing. If a hearing is requested, then such hearing shall be held within thirty (30) days of receipt by the commissioner of the written request. Any hearing conducted shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (b) In accordance with regulations issued by the commissioner, medical loss ratio information shall be provided for each medical loss ratio reporting year by all accident and sickness insurers. If, pursuant to federal or state law, the accident and sickness insurer is required to provide a rebate based upon medical loss ratio requirements, the insurer shall notify the commissioner within ten (10) days of becoming aware of such rebate. The commissioner at that time shall evaluate the solvency and financial impact of such rebate. The commissioner retains the right to intervene with the secretary of the United States department of health and human services on behalf of an insurer deemed to be financially unsound to request that the secretary of the United States department of health and human services defer all or a portion of the rebate payments owed by the insurer. (c) Subsequent to January 1, 2012, all filings submitted pursuant to this section shall be filed electronically; provided, however, that the commissioner may in certain circumstances, in the commissioner's own discretion, waive the electronic filing requirement. The commissioner may designate an entity to receive the electronic filings submitted pursuant to this section. (d) The requirements of this section shall supersede and replace all other requirements related to the filing, approval and disapproval of major medical health insurance premium rates. As used in this section, "major medical health insurance premium rates" shall include any individual or small employer coverage as offered by an issuer of accident and sickness insurance, a nonprofit hospital and medical service corporation, medical service corporation, a hospital service corporation, and a health maintenance organization. As used in this section, "major medical health insurance" shall not include any policy as described by § 2791(c) of the Public Health Service Act ( 42 U.S.C. § 300gg-91(c) ). In the event that conflicts exist between this section and another provision in this title, this section shall govern. (e) The provisions of this chapter are severable. If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application. Acts 1955, ch. 4, § 2; 1976, ch. 590, § 1; 1978, ch. 513, § 3; T.C.A., § 56-3302; Acts 1995, ch. 323, § 1; 2011 , ch. 344, § 12.
(a) (1) No policy of accident and sickness insurance for individual or small employer coverage shall be delivered or issued for delivery in this state, nor shall any endorsement, rider, certificate or application nor any initial or new premium rates on any previously approved policy, endorsement, rider, certificate or application that becomes a part of any such policy be used in connection with the policy until a copy of the form, of the premium rates, and of the classifications of risk pertaining to the policy has been filed with and approved by the commissioner. Approval of such forms, rates, and classifications may be granted in whole or in part at the discretion of the commissioner. (2) No approval shall be issued by the commissioner pursuant to this section unless the commissioner determines that the benefits provided in the policy are reasonable in relation to the premium charged based upon reasonable rules promulgated by the commissioner. (3) Within thirty (30) days of receiving an insurer's filing, if the commissioner has not previously issued notice of either approval or disapproval related to the insurer's filing, either the commissioner or the insurer may initiate an informal conference between the parties to seek additional information or responsive material from the other in order to resolve any outstanding matters related to the filing. In no event shall such period of conference extend beyond sixty (60) days of the commissioner's receipt of the insurer's original filing. At a date no later than sixty (60) days from the receipt of the insurer's original filing the commissioner shall issue either a notice of approval or disapproval regarding the insurer's filing unless the insurer and the commissioner mutually agree in writing to an extension not to exceed one hundred twenty (120) days from the receipt of the insurer's original filing. (4) No policy, endorsement, rider, certificate or application shall be issued until the filing has been approved by the commissioner as provided in this section. The commissioner shall notify, in writing, the filer if the form or rates do not comply with this chapter and are therefore disapproved, specifying the reasons for the commissioner's determination. After such notice, it is unlawful for the filer to issue the form or rates in this state. (5) In a notice issued under subdivision (a)(4), the commissioner shall state that a hearing shall be granted upon written request by the insurer. The insurer has thirty (30) days to submit a written request for a hearing. If a hearing is requested, then such hearing shall be held within thirty (30) days of receipt by the commissioner of the written request. Any hearing conducted shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(1) No policy of accident and sickness insurance for individual or small employer coverage shall be delivered or issued for delivery in this state, nor shall any endorsement, rider, certificate or application nor any initial or new premium rates on any previously approved policy, endorsement, rider, certificate or application that becomes a part of any such policy be used in connection with the policy until a copy of the form, of the premium rates, and of the classifications of risk pertaining to the policy has been filed with and approved by the commissioner. Approval of such forms, rates, and classifications may be granted in whole or in part at the discretion of the commissioner.
(2) No approval shall be issued by the commissioner pursuant to this section unless the commissioner determines that the benefits provided in the policy are reasonable in relation to the premium charged based upon reasonable rules promulgated by the commissioner.
(3) Within thirty (30) days of receiving an insurer's filing, if the commissioner has not previously issued notice of either approval or disapproval related to the insurer's filing, either the commissioner or the insurer may initiate an informal conference between the parties to seek additional information or responsive material from the other in order to resolve any outstanding matters related to the filing. In no event shall such period of conference extend beyond sixty (60) days of the commissioner's receipt of the insurer's original filing. At a date no later than sixty (60) days from the receipt of the insurer's original filing the commissioner shall issue either a notice of approval or disapproval regarding the insurer's filing unless the insurer and the commissioner mutually agree in writing to an extension not to exceed one hundred twenty (120) days from the receipt of the insurer's original filing.
(4) No policy, endorsement, rider, certificate or application shall be issued until the filing has been approved by the commissioner as provided in this section. The commissioner shall notify, in writing, the filer if the form or rates do not comply with this chapter and are therefore disapproved, specifying the reasons for the commissioner's determination. After such notice, it is unlawful for the filer to issue the form or rates in this state.
(5) In a notice issued under subdivision (a)(4), the commissioner shall state that a hearing shall be granted upon written request by the insurer. The insurer has thirty (30) days to submit a written request for a hearing. If a hearing is requested, then such hearing shall be held within thirty (30) days of receipt by the commissioner of the written request. Any hearing conducted shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b) In accordance with regulations issued by the commissioner, medical loss ratio information shall be provided for each medical loss ratio reporting year by all accident and sickness insurers. If, pursuant to federal or state law, the accident and sickness insurer is required to provide a rebate based upon medical loss ratio requirements, the insurer shall notify the commissioner within ten (10) days of becoming aware of such rebate. The commissioner at that time shall evaluate the solvency and financial impact of such rebate. The commissioner retains the right to intervene with the secretary of the United States department of health and human services on behalf of an insurer deemed to be financially unsound to request that the secretary of the United States department of health and human services defer all or a portion of the rebate payments owed by the insurer.
(c) Subsequent to January 1, 2012, all filings submitted pursuant to this section shall be filed electronically; provided, however, that the commissioner may in certain circumstances, in the commissioner's own discretion, waive the electronic filing requirement. The commissioner may designate an entity to receive the electronic filings submitted pursuant to this section.
(d) The requirements of this section shall supersede and replace all other requirements related to the filing, approval and disapproval of major medical health insurance premium rates. As used in this section, "major medical health insurance premium rates" shall include any individual or small employer coverage as offered by an issuer of accident and sickness insurance, a nonprofit hospital and medical service corporation, medical service corporation, a hospital service corporation, and a health maintenance organization. As used in this section, "major medical health insurance" shall not include any policy as described by § 2791(c) of the Public Health Service Act ( 42 U.S.C. § 300gg-91(c) ). In the event that conflicts exist between this section and another provision in this title, this section shall govern.
(e) The provisions of this chapter are severable. If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application.
Acts 1955, ch. 4, § 2; 1976, ch. 590, § 1; 1978, ch. 513, § 3; T.C.A., § 56-3302; Acts 1995, ch. 323, § 1; 2011 , ch. 344, § 12.
Tenn. Code Ann. § 56-1-110 — TN Code / Title 56 / Chapter 1 / Section 56-1-110
Claims to be brought in chancery court of Davidson county
Status: in_force

(a) Claims challenging liability imposed by this title must be brought in the chancery court of Davidson County pursuant to the procedures set out in title 67, chapter 1, part 9. (b) (1) The commissioner may, against any person, agency, or company licensed, registered, or permitted by or operating under a certificate of authority issued by the commissioner, or acting in an unlawful capacity that brings such person, agency, or company under the jurisdiction of the commissioner, assess the actual and reasonable costs of the investigation, prosecution, and hearing of any disciplinary action held in accordance with the contested case provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, in which sanctions of any kind are imposed on that person, agency, or company. These costs may include, but are not limited to, those incurred and assessed for the time of the prosecuting attorneys, investigators, expert witnesses, administrative judges, and any other persons involved in the investigation, prosecution, and hearing of the action. (2) The commissioner may promulgate rules establishing a schedule of costs that may be assessed pursuant to this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act. (3) (A) All costs assessed pursuant to this section become final thirty (30) days after the date of a final order of assessment is served. (B) If the individual or entity disciplined fails to pay an assessment when it becomes final, the commissioner may apply to the chancery court of Davidson County, which shall have jurisdiction over recovery of the costs, for a judgment and seek execution of the judgment. Acts 2018, ch. 873, § 2.
(a) Claims challenging liability imposed by this title must be brought in the chancery court of Davidson County pursuant to the procedures set out in title 67, chapter 1, part 9.
(b) (1) The commissioner may, against any person, agency, or company licensed, registered, or permitted by or operating under a certificate of authority issued by the commissioner, or acting in an unlawful capacity that brings such person, agency, or company under the jurisdiction of the commissioner, assess the actual and reasonable costs of the investigation, prosecution, and hearing of any disciplinary action held in accordance with the contested case provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, in which sanctions of any kind are imposed on that person, agency, or company. These costs may include, but are not limited to, those incurred and assessed for the time of the prosecuting attorneys, investigators, expert witnesses, administrative judges, and any other persons involved in the investigation, prosecution, and hearing of the action. (2) The commissioner may promulgate rules establishing a schedule of costs that may be assessed pursuant to this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act. (3) (A) All costs assessed pursuant to this section become final thirty (30) days after the date of a final order of assessment is served. (B) If the individual or entity disciplined fails to pay an assessment when it becomes final, the commissioner may apply to the chancery court of Davidson County, which shall have jurisdiction over recovery of the costs, for a judgment and seek execution of the judgment.
(1) The commissioner may, against any person, agency, or company licensed, registered, or permitted by or operating under a certificate of authority issued by the commissioner, or acting in an unlawful capacity that brings such person, agency, or company under the jurisdiction of the commissioner, assess the actual and reasonable costs of the investigation, prosecution, and hearing of any disciplinary action held in accordance with the contested case provisions of the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, part 3, in which sanctions of any kind are imposed on that person, agency, or company. These costs may include, but are not limited to, those incurred and assessed for the time of the prosecuting attorneys, investigators, expert witnesses, administrative judges, and any other persons involved in the investigation, prosecution, and hearing of the action.
(2) The commissioner may promulgate rules establishing a schedule of costs that may be assessed pursuant to this section. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act.
(3) (A) All costs assessed pursuant to this section become final thirty (30) days after the date of a final order of assessment is served. (B) If the individual or entity disciplined fails to pay an assessment when it becomes final, the commissioner may apply to the chancery court of Davidson County, which shall have jurisdiction over recovery of the costs, for a judgment and seek execution of the judgment.
(A) All costs assessed pursuant to this section become final thirty (30) days after the date of a final order of assessment is served.
(B) If the individual or entity disciplined fails to pay an assessment when it becomes final, the commissioner may apply to the chancery court of Davidson County, which shall have jurisdiction over recovery of the costs, for a judgment and seek execution of the judgment.
Acts 2018, ch. 873, § 2.
Tenn. Code Ann. § 56-29-103 — TN Code / Title 56 / Chapter 29 / Section 56-29-103
Existing corporations that may operate under this chapter - Prerequisites
Status: in_force

Any corporation now organized and existing under title 48, chapter 11 [repealed] as it existed prior to July 1, 1969, or any corporation now existing and operating under chapter 28 of this title, may become a corporation with the powers of a corporation newly organized under this chapter and become subject to this chapter by amending its charter so as to provide for both medical benefits and hospital services as provided by this chapter and conforming to this chapter, but shall at all times be required before the amendment becomes effective to have the amendment approved by the commissioner, as provided in § 56-29-104 . Acts 1949, ch. 234, § 2; C. Supp. 1950, § 4186.44 (Williams, § 4186.47); impl. am. Acts 1968, ch. 523, § 1(17.06); impl. am. Acts 1971, ch. 137, § 2; T.C.A. (orig. ed.), § 56-3103.
Any corporation now organized and existing under title 48, chapter 11 [repealed] as it existed prior to July 1, 1969, or any corporation now existing and operating under chapter 28 of this title, may become a corporation with the powers of a corporation newly organized under this chapter and become subject to this chapter by amending its charter so as to provide for both medical benefits and hospital services as provided by this chapter and conforming to this chapter, but shall at all times be required before the amendment becomes effective to have the amendment approved by the commissioner, as provided in § 56-29-104 .
Acts 1949, ch. 234, § 2; C. Supp. 1950, § 4186.44 (Williams, § 4186.47); impl. am. Acts 1968, ch. 523, § 1(17.06); impl. am. Acts 1971, ch. 137, § 2; T.C.A. (orig. ed.), § 56-3103.
Tenn. Code Ann. § 56-3-106 — TN Code / Title 56 / Chapter 3 / Section 56-3-106
Pensions to officers, directors, or trustees, or to members of their families prohibited to domestic stock or mutual life insurance companies or fraternal benefit societies - Employees' retirement plans permitted
Status: in_force

(a) No domestic stock or mutual life insurance company or fraternal benefit society shall grant any pension to any officer, director or trustee of the company or society, or to any member of the person's family after the person's death, or to any other person whomsoever except that the company or society may provide for an employees' retirement plan for its employees, which plan may or may not require contributions from the employees. (b) Before the company or society enters into the employees' retirement plan, it shall first submit that plan to the commissioner for approval pursuant to the requirements of this section, and the plan shall not become effective until it has been so approved. After the effective date of the plan, the commissioner may, upon a finding that the plan no longer meets the requirements of this section, order the company or society to discontinue contributions to the plan for a specified time with renewal of the contributions to be subject to the commissioner's subsequent approval. (c) The commissioner shall approve, or continue the approval of, an employees' retirement plan that meets the following requirements: (1) No benefit payment can be made to any employee under the plan until the entire reserve required for the benefit payment to the employee has been accumulated and set aside; and (2) If the plan is established for any classification of the employees of the company or society, such as home office employees, detached office employees, field representatives, agents, etc., it provides for participation and benefits on a nondiscriminatory basis for all employees in each classification who may elect to participate in the plan. (d) As used in this section, "employees" includes all persons employed by the company or society in any capacity, but does not include any director or trustee of the company or society who serves in that capacity only. Acts 1907, ch. 440, § 2; Shan., § 3348a26; Acts 1931, ch. 78, § 1; Code 1932, § 6197; 1933, ch. 150, § 1; 1939, ch. 72, § 1; C. Supp. 1950, § 6197; T.C.A. (orig. ed.), § 56-231; Acts 1969, ch. 161, § 2; impl. am. Acts 1971, ch. 137, § 2; 1978, ch. 559, § 1; T.C.A. (orig. ed.), § 56-322.
(a) No domestic stock or mutual life insurance company or fraternal benefit society shall grant any pension to any officer, director or trustee of the company or society, or to any member of the person's family after the person's death, or to any other person whomsoever except that the company or society may provide for an employees' retirement plan for its employees, which plan may or may not require contributions from the employees.
(b) Before the company or society enters into the employees' retirement plan, it shall first submit that plan to the commissioner for approval pursuant to the requirements of this section, and the plan shall not become effective until it has been so approved. After the effective date of the plan, the commissioner may, upon a finding that the plan no longer meets the requirements of this section, order the company or society to discontinue contributions to the plan for a specified time with renewal of the contributions to be subject to the commissioner's subsequent approval.
(c) The commissioner shall approve, or continue the approval of, an employees' retirement plan that meets the following requirements: (1) No benefit payment can be made to any employee under the plan until the entire reserve required for the benefit payment to the employee has been accumulated and set aside; and (2) If the plan is established for any classification of the employees of the company or society, such as home office employees, detached office employees, field representatives, agents, etc., it provides for participation and benefits on a nondiscriminatory basis for all employees in each classification who may elect to participate in the plan.
(1) No benefit payment can be made to any employee under the plan until the entire reserve required for the benefit payment to the employee has been accumulated and set aside; and
(2) If the plan is established for any classification of the employees of the company or society, such as home office employees, detached office employees, field representatives, agents, etc., it provides for participation and benefits on a nondiscriminatory basis for all employees in each classification who may elect to participate in the plan.
(d) As used in this section, "employees" includes all persons employed by the company or society in any capacity, but does not include any director or trustee of the company or society who serves in that capacity only.
Acts 1907, ch. 440, § 2; Shan., § 3348a26; Acts 1931, ch. 78, § 1; Code 1932, § 6197; 1933, ch. 150, § 1; 1939, ch. 72, § 1; C. Supp. 1950, § 6197; T.C.A. (orig. ed.), § 56-231; Acts 1969, ch. 161, § 2; impl. am. Acts 1971, ch. 137, § 2; 1978, ch. 559, § 1; T.C.A. (orig. ed.), § 56-322.
Tenn. Code Ann. § 56-1-602 — TN Code / Title 56 / Chapter 1 / Section 56-1-602
Records - Inspection by public
Status: in_force

(a) The records of the department shall, at all times, be open to the inspection of the public, subject to rules made by the commissioner for their safekeeping, free from any charge whatever. (b) The commissioner shall, on demand, furnish certified copies of any paper, report, or document on file in the commissioner's office to any person requesting them, upon payment of the fee allowed by law. Acts 1873, ch. 58, § 12; Shan., § 3342; mod. Code 1932, § 6167; T.C.A. (orig. ed.), § 56-135.
(a) The records of the department shall, at all times, be open to the inspection of the public, subject to rules made by the commissioner for their safekeeping, free from any charge whatever.
(b) The commissioner shall, on demand, furnish certified copies of any paper, report, or document on file in the commissioner's office to any person requesting them, upon payment of the fee allowed by law.
Acts 1873, ch. 58, § 12; Shan., § 3342; mod. Code 1932, § 6167; T.C.A. (orig. ed.), § 56-135.
Tenn. Code Ann. § 56-35-205 — TN Code / Title 56 / Chapter 35 / Section 56-35-205
Revocation of agent's authority
Status: in_force

Appointments of agents may be revoked, at any time, by an instrument in writing signed by the president or vice president of the appointing company and filed with the commissioner, and shall be effective from the date received and filed by the commissioner. Acts 1955, ch. 173, § 7; T.C.A., §§ 56-3411, 56-35-111.
Appointments of agents may be revoked, at any time, by an instrument in writing signed by the president or vice president of the appointing company and filed with the commissioner, and shall be effective from the date received and filed by the commissioner.
Acts 1955, ch. 173, § 7; T.C.A., §§ 56-3411, 56-35-111.
Tenn. Code Ann. § 56-25-301 — TN Code / Title 56 / Chapter 25 / Section 56-25-301
Organization - Certificate of authority
Status: in_force

A domestic society organized on or after January 1, 1991, shall be formed as follows: (1) Ten (10) or more citizens of the United States, a majority of whom are citizens of this state, who desire to form a fraternal benefit society, may make, sign and acknowledge before some officer competent to take acknowledgement of deeds, articles of incorporation, in which shall be stated: (A) The proposed corporate name of the society, which shall not so closely resemble the name of any society or insurance company or any governmental entity as to be misleading or confusing; (B) The purpose for which it is being formed and the mode in which its corporate powers are to be exercised. The purposes shall not include more liberal powers than are granted by this chapter; (C) The names and residences of the incorporators and the names, residences and official titles of all the officers, trustees, directors or other persons who are to have and exercise the general control of the management of the affairs and funds of the society the first year, or until the ensuing election at which all such officers shall be elected by the supreme governing body, which election shall be held not later than one (1) year from the date of issuance of the permanent certificate of authority. (2) (A) The articles of incorporation, duly certified copies of the society's bylaws and rules, copies of all proposed forms of certificates, applications therefor, and circulars to be issued by the society and a bond conditioned upon the return to applicants of the advance payments if the organization is not completed within one (1) year shall be filed with the commissioner, who may require further information the commissioner deems necessary. (B) The bond with sureties approved by the commissioner shall be in the amount, not less than three hundred thousand dollars ($300,000), nor more than one million five hundred thousand dollars ($1,500,000), as required by the commissioner. (C) All documents filed are to be in the English language. (D) If the purposes of the society conform to the requirements of this chapter and all provisions of the law have been complied with, the commissioner shall so certify, retain and file the articles of incorporation and furnish the incorporators a preliminary certificate of authority authorizing the society to solicit members as hereinafter provided. (3) No preliminary certificate of authority granted under this section shall be valid after one (1) year from its date or after the further period, not exceeding one (1) year, as may be authorized by the commissioner upon cause shown, unless the five hundred (500) applicants required by subdivision (4) have been secured and the organization has been completed as herein provided. The articles of incorporation and all other proceedings thereunder shall become null and void in one (1) year from the date of the preliminary certificate of authority, or at the expiration of the extended period, unless the society has completed its organization and received a certificate of authority to do business as hereinafter provided. (4) Upon receipt of a preliminary certificate of authority from the commissioner, the society may solicit members for the purpose of completing its organization, shall collect from each applicant the amount of not less than one (1) regular monthly premium in accordance with its table of rates and shall issue to each applicant a receipt for the amount so collected. No society shall incur any liability other than for the return of the advance premium, nor issue any certificate, nor pay or allow, or offer or promise to pay or allow, any benefit to any person until: (A) Actual bona fide applications for benefits have been secured on not less than five hundred (500) applicants, and any necessary evidence of insurability has been furnished to and approved by the society; (B) At least ten (10) subordinate lodges have been established into which the five hundred (500) applicants have been admitted; (C) There has been submitted to the commissioner, under oath of the president or secretary, or corresponding officer of the society, a list of the applicants, giving their names, addresses, date each was admitted, name and number of the subordinate lodge of which each applicant is a member, amount of benefits to be granted and premiums therefor; and (D) It has been shown to the commissioner, by sworn statement of the treasurer, or corresponding officer of the society, that at least five hundred (500) applicants have each paid in cash at least one (1) regular monthly premium as herein provided, which premiums in the aggregate shall amount to at least one hundred fifty thousand dollars ($150,000). The advance premiums shall be held in trust during the period of organization, and if the society has not qualified for a certificate of authority within one (1) year, as herein provided, the premiums shall be returned to the applicants. (5) The commissioner may make the examination and require any further information as the commissioner deems advisable. Upon presentations of satisfactory evidence that the society has complied with all law, the commissioner shall issue to the society a certificate of authority to that effect and that the society is authorized to transact business pursuant to this chapter. The certificate of authority shall be prima facie evidence of the existence of the society at the date of the certificate. The commissioner shall cause a record of the certificate of authority to be made. A certified copy of the record may be given in evidence with the like effect as the original certificate of authority. (6) Any incorporated society authorized to transact business in this state on January 1, 1991, shall not be required to reincorporate. Acts 1990, ch. 703, § 1.
A domestic society organized on or after January 1, 1991, shall be formed as follows:
(1) Ten (10) or more citizens of the United States, a majority of whom are citizens of this state, who desire to form a fraternal benefit society, may make, sign and acknowledge before some officer competent to take acknowledgement of deeds, articles of incorporation, in which shall be stated: (A) The proposed corporate name of the society, which shall not so closely resemble the name of any society or insurance company or any governmental entity as to be misleading or confusing; (B) The purpose for which it is being formed and the mode in which its corporate powers are to be exercised. The purposes shall not include more liberal powers than are granted by this chapter; (C) The names and residences of the incorporators and the names, residences and official titles of all the officers, trustees, directors or other persons who are to have and exercise the general control of the management of the affairs and funds of the society the first year, or until the ensuing election at which all such officers shall be elected by the supreme governing body, which election shall be held not later than one (1) year from the date of issuance of the permanent certificate of authority.
(A) The proposed corporate name of the society, which shall not so closely resemble the name of any society or insurance company or any governmental entity as to be misleading or confusing;
(B) The purpose for which it is being formed and the mode in which its corporate powers are to be exercised. The purposes shall not include more liberal powers than are granted by this chapter;
(C) The names and residences of the incorporators and the names, residences and official titles of all the officers, trustees, directors or other persons who are to have and exercise the general control of the management of the affairs and funds of the society the first year, or until the ensuing election at which all such officers shall be elected by the supreme governing body, which election shall be held not later than one (1) year from the date of issuance of the permanent certificate of authority.
(2) (A) The articles of incorporation, duly certified copies of the society's bylaws and rules, copies of all proposed forms of certificates, applications therefor, and circulars to be issued by the society and a bond conditioned upon the return to applicants of the advance payments if the organization is not completed within one (1) year shall be filed with the commissioner, who may require further information the commissioner deems necessary. (B) The bond with sureties approved by the commissioner shall be in the amount, not less than three hundred thousand dollars ($300,000), nor more than one million five hundred thousand dollars ($1,500,000), as required by the commissioner. (C) All documents filed are to be in the English language. (D) If the purposes of the society conform to the requirements of this chapter and all provisions of the law have been complied with, the commissioner shall so certify, retain and file the articles of incorporation and furnish the incorporators a preliminary certificate of authority authorizing the society to solicit members as hereinafter provided.
(A) The articles of incorporation, duly certified copies of the society's bylaws and rules, copies of all proposed forms of certificates, applications therefor, and circulars to be issued by the society and a bond conditioned upon the return to applicants of the advance payments if the organization is not completed within one (1) year shall be filed with the commissioner, who may require further information the commissioner deems necessary.
(B) The bond with sureties approved by the commissioner shall be in the amount, not less than three hundred thousand dollars ($300,000), nor more than one million five hundred thousand dollars ($1,500,000), as required by the commissioner.
(C) All documents filed are to be in the English language.
(D) If the purposes of the society conform to the requirements of this chapter and all provisions of the law have been complied with, the commissioner shall so certify, retain and file the articles of incorporation and furnish the incorporators a preliminary certificate of authority authorizing the society to solicit members as hereinafter provided.
(3) No preliminary certificate of authority granted under this section shall be valid after one (1) year from its date or after the further period, not exceeding one (1) year, as may be authorized by the commissioner upon cause shown, unless the five hundred (500) applicants required by subdivision (4) have been secured and the organization has been completed as herein provided. The articles of incorporation and all other proceedings thereunder shall become null and void in one (1) year from the date of the preliminary certificate of authority, or at the expiration of the extended period, unless the society has completed its organization and received a certificate of authority to do business as hereinafter provided.
(4) Upon receipt of a preliminary certificate of authority from the commissioner, the society may solicit members for the purpose of completing its organization, shall collect from each applicant the amount of not less than one (1) regular monthly premium in accordance with its table of rates and shall issue to each applicant a receipt for the amount so collected. No society shall incur any liability other than for the return of the advance premium, nor issue any certificate, nor pay or allow, or offer or promise to pay or allow, any benefit to any person until: (A) Actual bona fide applications for benefits have been secured on not less than five hundred (500) applicants, and any necessary evidence of insurability has been furnished to and approved by the society; (B) At least ten (10) subordinate lodges have been established into which the five hundred (500) applicants have been admitted; (C) There has been submitted to the commissioner, under oath of the president or secretary, or corresponding officer of the society, a list of the applicants, giving their names, addresses, date each was admitted, name and number of the subordinate lodge of which each applicant is a member, amount of benefits to be granted and premiums therefor; and (D) It has been shown to the commissioner, by sworn statement of the treasurer, or corresponding officer of the society, that at least five hundred (500) applicants have each paid in cash at least one (1) regular monthly premium as herein provided, which premiums in the aggregate shall amount to at least one hundred fifty thousand dollars ($150,000). The advance premiums shall be held in trust during the period of organization, and if the society has not qualified for a certificate of authority within one (1) year, as herein provided, the premiums shall be returned to the applicants.
(A) Actual bona fide applications for benefits have been secured on not less than five hundred (500) applicants, and any necessary evidence of insurability has been furnished to and approved by the society;
(B) At least ten (10) subordinate lodges have been established into which the five hundred (500) applicants have been admitted;
(C) There has been submitted to the commissioner, under oath of the president or secretary, or corresponding officer of the society, a list of the applicants, giving their names, addresses, date each was admitted, name and number of the subordinate lodge of which each applicant is a member, amount of benefits to be granted and premiums therefor; and
(D) It has been shown to the commissioner, by sworn statement of the treasurer, or corresponding officer of the society, that at least five hundred (500) applicants have each paid in cash at least one (1) regular monthly premium as herein provided, which premiums in the aggregate shall amount to at least one hundred fifty thousand dollars ($150,000). The advance premiums shall be held in trust during the period of organization, and if the society has not qualified for a certificate of authority within one (1) year, as herein provided, the premiums shall be returned to the applicants.
(5) The commissioner may make the examination and require any further information as the commissioner deems advisable. Upon presentations of satisfactory evidence that the society has complied with all law, the commissioner shall issue to the society a certificate of authority to that effect and that the society is authorized to transact business pursuant to this chapter. The certificate of authority shall be prima facie evidence of the existence of the society at the date of the certificate. The commissioner shall cause a record of the certificate of authority to be made. A certified copy of the record may be given in evidence with the like effect as the original certificate of authority.
(6) Any incorporated society authorized to transact business in this state on January 1, 1991, shall not be required to reincorporate.
Acts 1990, ch. 703, § 1.
Tenn. Code Ann. § 56-53-103 — TN Code / Title 56 / Chapter 53 / Section 56-53-103
Unlawful insurance act - Civil violations
Status: in_force

(a) Any person who commits, participates in, or aids, abets, or conspires to commit, or solicits another person to commit, or permits its employees or its agents to commit any of the following acts with an intent to induce reliance, has committed an unlawful insurance act: (1) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, claimant or applicant to an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The application for, rating of, or renewal of, any insurance policy; (B) A claim for payment or benefit pursuant to any insurance policy; (C) Payments made in accordance with the terms of any insurance policy; or (D) The application for the financing of any insurance premium; (2) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The solicitation for sale of any insurance policy or purported insurance policy; (B) An application for certificate of authority; (C) The financial condition of any insurer; or (D) The acquisition, formation, merger, affiliation or dissolution of any insurer; or (3) Solicits or accepts new or renewal insurance risks by or for an insurer that the person knows was insolvent or the insolvency of which the person recklessly disregards. (b) It shall be unlawful for any person to commit, or to attempt to commit, or aid, assist, abet or solicit another to commit, or to conspire to commit an unlawful insurance act. Acts 2001, ch. 356, § 4.
(a) Any person who commits, participates in, or aids, abets, or conspires to commit, or solicits another person to commit, or permits its employees or its agents to commit any of the following acts with an intent to induce reliance, has committed an unlawful insurance act: (1) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, claimant or applicant to an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The application for, rating of, or renewal of, any insurance policy; (B) A claim for payment or benefit pursuant to any insurance policy; (C) Payments made in accordance with the terms of any insurance policy; or (D) The application for the financing of any insurance premium; (2) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The solicitation for sale of any insurance policy or purported insurance policy; (B) An application for certificate of authority; (C) The financial condition of any insurer; or (D) The acquisition, formation, merger, affiliation or dissolution of any insurer; or (3) Solicits or accepts new or renewal insurance risks by or for an insurer that the person knows was insolvent or the insolvency of which the person recklessly disregards.
(1) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, by or on behalf of an insured, claimant or applicant to an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The application for, rating of, or renewal of, any insurance policy; (B) A claim for payment or benefit pursuant to any insurance policy; (C) Payments made in accordance with the terms of any insurance policy; or (D) The application for the financing of any insurance premium;
(A) The application for, rating of, or renewal of, any insurance policy;
(B) A claim for payment or benefit pursuant to any insurance policy;
(C) Payments made in accordance with the terms of any insurance policy; or
(D) The application for the financing of any insurance premium;
(2) Presents, causes to be presented, or prepares with knowledge or belief that it will be presented, to or by an insurer, insurance professional or a premium finance company in connection with an insurance transaction or premium finance transaction, any information that the person knows to contain false representations, or representations the falsity of which the person has recklessly disregarded, as to any material fact, or that withholds or conceals a material fact, concerning any of the following: (A) The solicitation for sale of any insurance policy or purported insurance policy; (B) An application for certificate of authority; (C) The financial condition of any insurer; or (D) The acquisition, formation, merger, affiliation or dissolution of any insurer; or
(A) The solicitation for sale of any insurance policy or purported insurance policy;
(B) An application for certificate of authority;
(C) The financial condition of any insurer; or
(D) The acquisition, formation, merger, affiliation or dissolution of any insurer; or
(3) Solicits or accepts new or renewal insurance risks by or for an insurer that the person knows was insolvent or the insolvency of which the person recklessly disregards.
(b) It shall be unlawful for any person to commit, or to attempt to commit, or aid, assist, abet or solicit another to commit, or to conspire to commit an unlawful insurance act.
Acts 2001, ch. 356, § 4.
Tenn. Code Ann. § 56-42-105 — TN Code / Title 56 / Chapter 42 / Section 56-42-105
Regulations and restrictions
Status: in_force

(a) The commissioner shall adopt regulations that include standards for full and fair disclosure, setting forth the manner, content and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions and definitions of terms. (b) No long-term care insurance policy may: (1) Be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; (2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; (3) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care. This evaluation of the amount of coverage provided shall be based on aggregate days of care covered for lower levels of care when compared to days of care covered for skilled care; or (4) Require a policyholder to have received skilled care before coverage for intermediate care or custodial care begins. (c) Preexisting condition: (1) No long-term care insurance policy or certificate, other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) , shall use a definition of "preexisting condition" that is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services, within six (6) months preceding the effective date coverage of an insured person; (2) No long-term care insurance policy or certificate other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless the loss or confinement begins within six (6) months following the effective date of coverage of an insured person; (3) The commissioner may extend the limitation periods set forth in subdivisions (c)(1) and (2) as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public; and (4) The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (c)(2) expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (c)(2). (d) Prior hospitalization/institutionalization: (1) No long-term care insurance policy may be delivered or issued for delivery in this state if the policy: (A) Conditions eligibility for any benefits on a prior hospitalization requirement; (B) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (C) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement. (2) A long-term care insurance policy containing any limitations or conditions for eligibility other than those prohibited in subdivision (d)(1) shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" the limitations or conditions, including any required number of days of confinement. (A) A long-term care insurance policy containing a benefit advertised, marketed or offered as a home health care or home care benefit may not condition receipt of benefits on a prior institutionalization requirement. (B) A long-term care insurance policy that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days from which benefits are paid. (C) No long-term care insurance policy or rider that provides benefits only following institutionalization shall condition the benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution. (e) The commissioner may adopt regulations establishing loss ratio standards for long-term care insurance policies; provided, that a specific reference to long-term care insurance policies is contained in the regulation. (f) Right to return - free look: (1) Individual long-term care insurance policyholders have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a notice prominently printed on the first page of the policy, or attached to the policy, stating in substance that the policyholder shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Upon return of the policy for cancellation, the company shall mail the premiums directly to the policyholder and shall not require the policyholder to meet with the agent to receive the refund; and (2) A person insured under a long-term care insurance policy issued pursuant to a direct response solicitation shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. Long-term care insurance policies issued pursuant to a direct response solicitation shall have a notice prominently printed on the first page, or attached to the first page, stating in substance that the insured person shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. (g) Outline of coverage: (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose. (2) The commissioner shall prescribe a standard format, including style, arrangement and overall appearance and the content of an outline of coverage. (3) (A) In the case of agent solicitations, an agent must deliver the outline of coverage prior to the presentation of an application or enrollment form. (B) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with the application or enrollment form. (C) In the case of a policy issued to a group defined in § 56-42-103(4)(A) , an outline of coverage shall not be required to be delivered; provided, that the information described in subdivision (g)(4) is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the commissioner. (4) The outline of coverage shall include: (A) A description of the principal benefits and coverage provided in the policy; (B) A statement of the principal exclusions, reductions and limitations contained in the policy; (C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described; (D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions; (E) A description of the terms under which the policy or certificate may be returned and premium refunded; (F) A brief description of the relationship of cost of care and benefits; and (G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under § 7702B(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702B(b) ). (h) A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, reductions and limitations contained in the policy; and (3) A statement that the group master policy determines governing contractual provisions. (i) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval. (j) At the time of the policy delivery, a policy summary shall be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request, but regardless of request shall make delivery no later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary shall also include: (1) An explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits; (2) An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits, if any, for each covered person; (3) Any exclusions, reductions and limitations on benefits of long-term care; (4) A statement that no long-term care inflation protection option is available under the policy; (5) If applicable to the policy type, the summary shall also include: (A) A disclosure of the effects of exercising other rights under the policy; (B) A disclosure of guarantees related to long-term care costs of insurance charges; and (C) Current and projected maximum lifetime benefits; and (6) The provisions of the policy summary listed in subdivisions (j)(1)-(5) may be incorporated into a basic illustration, or into the life insurance policy summary, which is required to be delivered in accordance with rules promulgated by the commissioner. (k) Any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report shall be provided to the policyholder. The report shall include: (1) Any long-term care benefits paid out during the month; (2) An explanation of any changes in the policy, e.g. death benefits or cash values, due to long-term care benefits being paid out; and (3) The amount of long-term care benefits existing or remaining. (l) If a claim under a long-term care insurance contract is denied, the issuer shall, within sixty (60) days of the date of a written request by the policyholder or certificate holder, or a representative of the policyholder or certificate holder: (1) Provide a written explanation of the reasons for the denial; and (2) Make available all information directly related to the denial. (m) Any policy or rider advertised, marketed or offered as long-term care or nursing home insurance shall comply with this chapter. (n) In addition to any other requirements under this chapter, the commissioner may require by rule that other information be given to the prospective applicant for long-term care insurance at the time of initial solicitation or thereafter. Acts 1988, ch. 873, § 6; 1990, ch. 799, §§1, 2; 2008 , ch. 1058, §§ 4- 8.
(a) The commissioner shall adopt regulations that include standards for full and fair disclosure, setting forth the manner, content and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions and definitions of terms.
(b) No long-term care insurance policy may: (1) Be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; (2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; (3) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care. This evaluation of the amount of coverage provided shall be based on aggregate days of care covered for lower levels of care when compared to days of care covered for skilled care; or (4) Require a policyholder to have received skilled care before coverage for intermediate care or custodial care begins.
(1) Be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;
(2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder;
(3) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care. This evaluation of the amount of coverage provided shall be based on aggregate days of care covered for lower levels of care when compared to days of care covered for skilled care; or
(4) Require a policyholder to have received skilled care before coverage for intermediate care or custodial care begins.
(c) Preexisting condition: (1) No long-term care insurance policy or certificate, other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) , shall use a definition of "preexisting condition" that is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services, within six (6) months preceding the effective date coverage of an insured person; (2) No long-term care insurance policy or certificate other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless the loss or confinement begins within six (6) months following the effective date of coverage of an insured person; (3) The commissioner may extend the limitation periods set forth in subdivisions (c)(1) and (2) as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public; and (4) The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (c)(2) expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (c)(2).
(1) No long-term care insurance policy or certificate, other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) , shall use a definition of "preexisting condition" that is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services, within six (6) months preceding the effective date coverage of an insured person;
(2) No long-term care insurance policy or certificate other than a policy or certificate issued to a group as defined in § 56-42-103(4)(A), (B) or (C) may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless the loss or confinement begins within six (6) months following the effective date of coverage of an insured person;
(3) The commissioner may extend the limitation periods set forth in subdivisions (c)(1) and (2) as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public; and
(4) The definition of "preexisting condition" does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (c)(2) expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (c)(2).
(d) Prior hospitalization/institutionalization: (1) No long-term care insurance policy may be delivered or issued for delivery in this state if the policy: (A) Conditions eligibility for any benefits on a prior hospitalization requirement; (B) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (C) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement. (2) A long-term care insurance policy containing any limitations or conditions for eligibility other than those prohibited in subdivision (d)(1) shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" the limitations or conditions, including any required number of days of confinement. (A) A long-term care insurance policy containing a benefit advertised, marketed or offered as a home health care or home care benefit may not condition receipt of benefits on a prior institutionalization requirement. (B) A long-term care insurance policy that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days from which benefits are paid. (C) No long-term care insurance policy or rider that provides benefits only following institutionalization shall condition the benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution.
(1) No long-term care insurance policy may be delivered or issued for delivery in this state if the policy: (A) Conditions eligibility for any benefits on a prior hospitalization requirement; (B) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (C) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.
(A) Conditions eligibility for any benefits on a prior hospitalization requirement;
(B) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
(C) Conditions eligibility for any benefits other than waiver of premium, post-confinement, post-acute care or recuperative benefits on a prior institutionalization requirement.
(2) A long-term care insurance policy containing any limitations or conditions for eligibility other than those prohibited in subdivision (d)(1) shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" the limitations or conditions, including any required number of days of confinement. (A) A long-term care insurance policy containing a benefit advertised, marketed or offered as a home health care or home care benefit may not condition receipt of benefits on a prior institutionalization requirement. (B) A long-term care insurance policy that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days from which benefits are paid. (C) No long-term care insurance policy or rider that provides benefits only following institutionalization shall condition the benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution.
(A) A long-term care insurance policy containing a benefit advertised, marketed or offered as a home health care or home care benefit may not condition receipt of benefits on a prior institutionalization requirement.
(B) A long-term care insurance policy that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty (30) days from which benefits are paid.
(C) No long-term care insurance policy or rider that provides benefits only following institutionalization shall condition the benefits upon admission to a facility for the same or related conditions within a period of less than thirty (30) days after discharge from the institution.
(e) The commissioner may adopt regulations establishing loss ratio standards for long-term care insurance policies; provided, that a specific reference to long-term care insurance policies is contained in the regulation.
(f) Right to return - free look: (1) Individual long-term care insurance policyholders have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a notice prominently printed on the first page of the policy, or attached to the policy, stating in substance that the policyholder shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Upon return of the policy for cancellation, the company shall mail the premiums directly to the policyholder and shall not require the policyholder to meet with the agent to receive the refund; and (2) A person insured under a long-term care insurance policy issued pursuant to a direct response solicitation shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. Long-term care insurance policies issued pursuant to a direct response solicitation shall have a notice prominently printed on the first page, or attached to the first page, stating in substance that the insured person shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason.
(1) Individual long-term care insurance policyholders have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a notice prominently printed on the first page of the policy, or attached to the policy, stating in substance that the policyholder shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Upon return of the policy for cancellation, the company shall mail the premiums directly to the policyholder and shall not require the policyholder to meet with the agent to receive the refund; and
(2) A person insured under a long-term care insurance policy issued pursuant to a direct response solicitation shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason. Long-term care insurance policies issued pursuant to a direct response solicitation shall have a notice prominently printed on the first page, or attached to the first page, stating in substance that the insured person shall have the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination, the insured person is not satisfied for any reason.
(g) Outline of coverage: (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose. (2) The commissioner shall prescribe a standard format, including style, arrangement and overall appearance and the content of an outline of coverage. (3) (A) In the case of agent solicitations, an agent must deliver the outline of coverage prior to the presentation of an application or enrollment form. (B) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with the application or enrollment form. (C) In the case of a policy issued to a group defined in § 56-42-103(4)(A) , an outline of coverage shall not be required to be delivered; provided, that the information described in subdivision (g)(4) is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the commissioner. (4) The outline of coverage shall include: (A) A description of the principal benefits and coverage provided in the policy; (B) A statement of the principal exclusions, reductions and limitations contained in the policy; (C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described; (D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions; (E) A description of the terms under which the policy or certificate may be returned and premium refunded; (F) A brief description of the relationship of cost of care and benefits; and (G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under § 7702B(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702B(b) ).
(1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose.
(2) The commissioner shall prescribe a standard format, including style, arrangement and overall appearance and the content of an outline of coverage.
(3) (A) In the case of agent solicitations, an agent must deliver the outline of coverage prior to the presentation of an application or enrollment form. (B) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with the application or enrollment form. (C) In the case of a policy issued to a group defined in § 56-42-103(4)(A) , an outline of coverage shall not be required to be delivered; provided, that the information described in subdivision (g)(4) is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the commissioner.
(A) In the case of agent solicitations, an agent must deliver the outline of coverage prior to the presentation of an application or enrollment form.
(B) In the case of direct response solicitations, the outline of coverage must be presented in conjunction with the application or enrollment form.
(C) In the case of a policy issued to a group defined in § 56-42-103(4)(A) , an outline of coverage shall not be required to be delivered; provided, that the information described in subdivision (g)(4) is contained in other materials relating to enrollment. Upon request, these other materials shall be made available to the commissioner.
(4) The outline of coverage shall include: (A) A description of the principal benefits and coverage provided in the policy; (B) A statement of the principal exclusions, reductions and limitations contained in the policy; (C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described; (D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions; (E) A description of the terms under which the policy or certificate may be returned and premium refunded; (F) A brief description of the relationship of cost of care and benefits; and (G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under § 7702B(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702B(b) ).
(A) A description of the principal benefits and coverage provided in the policy;
(B) A statement of the principal exclusions, reductions and limitations contained in the policy;
(C) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described;
(D) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;
(E) A description of the terms under which the policy or certificate may be returned and premium refunded;
(F) A brief description of the relationship of cost of care and benefits; and
(G) A statement that discloses to the policyholder or certificate holder whether the policy is intended to be a federally tax-qualified long-term care insurance contract under § 7702B(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702B(b) ).
(h) A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, reductions and limitations contained in the policy; and (3) A statement that the group master policy determines governing contractual provisions.
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the principal exclusions, reductions and limitations contained in the policy; and
(3) A statement that the group master policy determines governing contractual provisions.
(i) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval.
(j) At the time of the policy delivery, a policy summary shall be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request, but regardless of request shall make delivery no later than at the time of policy delivery. In addition to complying with all applicable requirements, the summary shall also include: (1) An explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits; (2) An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits, if any, for each covered person; (3) Any exclusions, reductions and limitations on benefits of long-term care; (4) A statement that no long-term care inflation protection option is available under the policy; (5) If applicable to the policy type, the summary shall also include: (A) A disclosure of the effects of exercising other rights under the policy; (B) A disclosure of guarantees related to long-term care costs of insurance charges; and (C) Current and projected maximum lifetime benefits; and (6) The provisions of the policy summary listed in subdivisions (j)(1)-(5) may be incorporated into a basic illustration, or into the life insurance policy summary, which is required to be delivered in accordance with rules promulgated by the commissioner.
(1) An explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;
(2) An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits, if any, for each covered person;
(3) Any exclusions, reductions and limitations on benefits of long-term care;
(4) A statement that no long-term care inflation protection option is available under the policy;
(5) If applicable to the policy type, the summary shall also include: (A) A disclosure of the effects of exercising other rights under the policy; (B) A disclosure of guarantees related to long-term care costs of insurance charges; and (C) Current and projected maximum lifetime benefits; and
(A) A disclosure of the effects of exercising other rights under the policy;
(B) A disclosure of guarantees related to long-term care costs of insurance charges; and
(C) Current and projected maximum lifetime benefits; and
(6) The provisions of the policy summary listed in subdivisions (j)(1)-(5) may be incorporated into a basic illustration, or into the life insurance policy summary, which is required to be delivered in accordance with rules promulgated by the commissioner.
(k) Any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status, a monthly report shall be provided to the policyholder. The report shall include: (1) Any long-term care benefits paid out during the month; (2) An explanation of any changes in the policy, e.g. death benefits or cash values, due to long-term care benefits being paid out; and (3) The amount of long-term care benefits existing or remaining.
(1) Any long-term care benefits paid out during the month;
(2) An explanation of any changes in the policy, e.g. death benefits or cash values, due to long-term care benefits being paid out; and
(3) The amount of long-term care benefits existing or remaining.
(l) If a claim under a long-term care insurance contract is denied, the issuer shall, within sixty (60) days of the date of a written request by the policyholder or certificate holder, or a representative of the policyholder or certificate holder: (1) Provide a written explanation of the reasons for the denial; and (2) Make available all information directly related to the denial.
(1) Provide a written explanation of the reasons for the denial; and
(2) Make available all information directly related to the denial.
(m) Any policy or rider advertised, marketed or offered as long-term care or nursing home insurance shall comply with this chapter.
(n) In addition to any other requirements under this chapter, the commissioner may require by rule that other information be given to the prospective applicant for long-term care insurance at the time of initial solicitation or thereafter.
Acts 1988, ch. 873, § 6; 1990, ch. 799, §§1, 2; 2008 , ch. 1058, §§ 4- 8.
Tenn. Code Ann. § 56-7-1014 — TN Code / Title 56 / Chapter 7 / Section 56-7-1014
Protocols and procedures for reimbursing physicians employed by federally qualified health centers - Expedited credentialing process
Status: in_force

(a) Health insurance entities, as defined in § 56-7-109 , that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 shall establish reasonable protocols and procedures for reimbursing physicians employed by federally qualified health centers, so long as the protocols and procedures do not violate National Committee for Quality Assurance (NCQA) standards. At a minimum, the protocols and procedures shall: (1) Subject to approval of a physician credentialing application, permit physician reimbursement for rendered services from the date the physician's completed credentialing application is received for consideration by the health insurance entity; provided, however, that a contractual relationship exists between the provider or the group or facility for whom the physician works; and (2) Require that any reimbursement paid the physician shall be retroactively recouped or rescinded in the event the physician's credentialing application is denied. (b) As an alternative to subsection (a), health insurance entities, as defined in § 56-7-109 , that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 may establish an expedited credentialing process for reimbursing physicians employed by federally qualified health centers, so long as the process does not violate NCQA standards. (c) As used in this section, "federally qualified health center" means entities defined in §§ 1861(aa) and 1905 of the federal Social Security Act ( 42 U.S.C. § 1395x and 42 U.S.C. § 1396d , respectively). (d) Nothing in this section shall require reimbursement of physician-rendered services that are not benefits or services covered by the health insurance entity. Acts 2006, ch. 966, § 1.
(a) Health insurance entities, as defined in § 56-7-109 , that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 shall establish reasonable protocols and procedures for reimbursing physicians employed by federally qualified health centers, so long as the protocols and procedures do not violate National Committee for Quality Assurance (NCQA) standards. At a minimum, the protocols and procedures shall: (1) Subject to approval of a physician credentialing application, permit physician reimbursement for rendered services from the date the physician's completed credentialing application is received for consideration by the health insurance entity; provided, however, that a contractual relationship exists between the provider or the group or facility for whom the physician works; and (2) Require that any reimbursement paid the physician shall be retroactively recouped or rescinded in the event the physician's credentialing application is denied.
(1) Subject to approval of a physician credentialing application, permit physician reimbursement for rendered services from the date the physician's completed credentialing application is received for consideration by the health insurance entity; provided, however, that a contractual relationship exists between the provider or the group or facility for whom the physician works; and
(2) Require that any reimbursement paid the physician shall be retroactively recouped or rescinded in the event the physician's credentialing application is denied.
(b) As an alternative to subsection (a), health insurance entities, as defined in § 56-7-109 , that contract with the state and perform services for the TennCare program or any successor program pursuant to title 71 may establish an expedited credentialing process for reimbursing physicians employed by federally qualified health centers, so long as the process does not violate NCQA standards.
(c) As used in this section, "federally qualified health center" means entities defined in §§ 1861(aa) and 1905 of the federal Social Security Act ( 42 U.S.C. § 1395x and 42 U.S.C. § 1396d , respectively).
(d) Nothing in this section shall require reimbursement of physician-rendered services that are not benefits or services covered by the health insurance entity.
Acts 2006, ch. 966, § 1.
Tenn. Code Ann. § 56-7-1015 — TN Code / Title 56 / Chapter 7 / Section 56-7-1015
Reimbursement for anatomic pathology services
Status: in_force

(a) No patient, insurer, or third party payor shall be required to reimburse any licensed practitioner for charges or claims submitted in violation of this part. (b) A clinical laboratory or physician, located in this state, or in another state, providing anatomic pathology services for patients in this state, shall present or cause to be presented a claim, bill or demand for payment for these services only to the following: (1) The patient directly; (2) The responsible insurer or other third-party payor; (3) The hospital, public health clinic, or nonprofit health clinic ordering such services; (4) The referring laboratory or a referring physician; provided, that: (A) A physician in the referring laboratory is performing or supervising the professional component of the anatomic pathology service for the patient; or (B) A referring physician has provided a written confirmation to the physician or laboratory providing the anatomic pathology service that the patient is not covered under any health care benefit program; (5) Governmental agencies and/or their specified public or private agent, agency, or organization on behalf of the recipient of the services. (c) Except for a physician billing for a referring laboratory's services pursuant to subsection (g) or (h), no licensed practitioner in the state shall, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless such services were rendered personally by the licensed practitioner or under the licensed practitioner's direct supervision in accordance with § 353 of the Public Health Service Act ( 42 U.S.C. § 263a ). (d) Nothing in this section shall be construed to mandate the assignment of benefits for anatomic pathology services as defined in this section or payment for anatomic pathology services under this section, or under any health care benefit program, to any practitioner or physician exempted from this section. (e) For purposes of this section, "anatomic pathology services" means: (1) Histopathology or surgical pathology, meaning the microscopic examination (professional component) and histologic processing of organ tissue (technical component) performed by a physician or under the supervision of a physician; (2) Cytopathology, meaning the microscopic examination of cells from the following: (A) Fluids; (B) Aspirates; (C) Washings; (D) Brushings; or (E) Smears, including the Pap test examination performed by a physician or under the supervision of a physician; (3) Hematology, meaning the microscopic evaluation of bone marrow aspirates and biopsies performed by a physician, or under the supervision of a physician, and peripheral blood smears when the attending or treating physician, or technologist requests that a blood smear be reviewed by a pathologist; (4) Sub-cellular pathology or molecular pathology, meaning the assessment of a patient specimen for the detection, localization, measurement, or analysis of one or more protein or nucleic acid targets; (5) Blood-banking services performed by pathologists. (f) For purposes of the section, "health care benefit program" means any group or individual insurance or health maintenance policy or contract, whether public or private, which provides benefits for medical items or services. (g) A referring physician may bill a patient not covered under a health care benefit program for an anatomic pathology service if the referring physician was billed pursuant to § 56-7-1015(b)(4) ; provided, that the referring physician complies with the disclosure requirement of § 63-6-214(b)(22) or § 63-9-111(b)(22) and does not, directly or indirectly, markup or increase the actual amount billed by the physician or clinical laboratory that performed the anatomic pathology service. (h) This section does not prohibit a laboratory, physician, physician's office or group practice directly performing the professional component of the anatomic pathology service from billing for a referring laboratory's services in instances where a sample or samples must be sent to another physician or laboratory for consultation or histologic processing. For purposes of this subsection (h), "referring laboratory" means a laboratory that performs histologic processing or consultation on an anatomic pathology specimen. (i) Nothing in this section shall be construed to mandate the billing of any patient not covered under a health care benefit program, or any referring physician who has ordered an anatomic pathology service for a patient not covered under a health care benefit program. (j) Nothing in this section shall apply to anatomic pathology services billed by gastroenterologists on patients in this state until July 1, 2014. (k) The respective state licensing boards having jurisdiction over any practitioner who may request or provide anatomic pathology services may revoke, suspend or deny renewal of the license of any practitioner who violates this section. Acts 2010 , ch. 952, § 1.
(a) No patient, insurer, or third party payor shall be required to reimburse any licensed practitioner for charges or claims submitted in violation of this part.
(b) A clinical laboratory or physician, located in this state, or in another state, providing anatomic pathology services for patients in this state, shall present or cause to be presented a claim, bill or demand for payment for these services only to the following: (1) The patient directly; (2) The responsible insurer or other third-party payor; (3) The hospital, public health clinic, or nonprofit health clinic ordering such services; (4) The referring laboratory or a referring physician; provided, that: (A) A physician in the referring laboratory is performing or supervising the professional component of the anatomic pathology service for the patient; or (B) A referring physician has provided a written confirmation to the physician or laboratory providing the anatomic pathology service that the patient is not covered under any health care benefit program; (5) Governmental agencies and/or their specified public or private agent, agency, or organization on behalf of the recipient of the services.
(1) The patient directly;
(2) The responsible insurer or other third-party payor;
(3) The hospital, public health clinic, or nonprofit health clinic ordering such services;
(4) The referring laboratory or a referring physician; provided, that: (A) A physician in the referring laboratory is performing or supervising the professional component of the anatomic pathology service for the patient; or (B) A referring physician has provided a written confirmation to the physician or laboratory providing the anatomic pathology service that the patient is not covered under any health care benefit program;
(A) A physician in the referring laboratory is performing or supervising the professional component of the anatomic pathology service for the patient; or
(B) A referring physician has provided a written confirmation to the physician or laboratory providing the anatomic pathology service that the patient is not covered under any health care benefit program;
(5) Governmental agencies and/or their specified public or private agent, agency, or organization on behalf of the recipient of the services.
(c) Except for a physician billing for a referring laboratory's services pursuant to subsection (g) or (h), no licensed practitioner in the state shall, directly or indirectly, charge, bill, or otherwise solicit payment for anatomic pathology services unless such services were rendered personally by the licensed practitioner or under the licensed practitioner's direct supervision in accordance with § 353 of the Public Health Service Act ( 42 U.S.C. § 263a ).
(d) Nothing in this section shall be construed to mandate the assignment of benefits for anatomic pathology services as defined in this section or payment for anatomic pathology services under this section, or under any health care benefit program, to any practitioner or physician exempted from this section.
(e) For purposes of this section, "anatomic pathology services" means: (1) Histopathology or surgical pathology, meaning the microscopic examination (professional component) and histologic processing of organ tissue (technical component) performed by a physician or under the supervision of a physician; (2) Cytopathology, meaning the microscopic examination of cells from the following: (A) Fluids; (B) Aspirates; (C) Washings; (D) Brushings; or (E) Smears, including the Pap test examination performed by a physician or under the supervision of a physician; (3) Hematology, meaning the microscopic evaluation of bone marrow aspirates and biopsies performed by a physician, or under the supervision of a physician, and peripheral blood smears when the attending or treating physician, or technologist requests that a blood smear be reviewed by a pathologist; (4) Sub-cellular pathology or molecular pathology, meaning the assessment of a patient specimen for the detection, localization, measurement, or analysis of one or more protein or nucleic acid targets; (5) Blood-banking services performed by pathologists.
(1) Histopathology or surgical pathology, meaning the microscopic examination (professional component) and histologic processing of organ tissue (technical component) performed by a physician or under the supervision of a physician;
(2) Cytopathology, meaning the microscopic examination of cells from the following: (A) Fluids; (B) Aspirates; (C) Washings; (D) Brushings; or (E) Smears, including the Pap test examination performed by a physician or under the supervision of a physician;
(A) Fluids;
(B) Aspirates;
(C) Washings;
(D) Brushings; or
(E) Smears, including the Pap test examination performed by a physician or under the supervision of a physician;
(3) Hematology, meaning the microscopic evaluation of bone marrow aspirates and biopsies performed by a physician, or under the supervision of a physician, and peripheral blood smears when the attending or treating physician, or technologist requests that a blood smear be reviewed by a pathologist;
(4) Sub-cellular pathology or molecular pathology, meaning the assessment of a patient specimen for the detection, localization, measurement, or analysis of one or more protein or nucleic acid targets;
(5) Blood-banking services performed by pathologists.
(f) For purposes of the section, "health care benefit program" means any group or individual insurance or health maintenance policy or contract, whether public or private, which provides benefits for medical items or services.
(g) A referring physician may bill a patient not covered under a health care benefit program for an anatomic pathology service if the referring physician was billed pursuant to § 56-7-1015(b)(4) ; provided, that the referring physician complies with the disclosure requirement of § 63-6-214(b)(22) or § 63-9-111(b)(22) and does not, directly or indirectly, markup or increase the actual amount billed by the physician or clinical laboratory that performed the anatomic pathology service.
(h) This section does not prohibit a laboratory, physician, physician's office or group practice directly performing the professional component of the anatomic pathology service from billing for a referring laboratory's services in instances where a sample or samples must be sent to another physician or laboratory for consultation or histologic processing. For purposes of this subsection (h), "referring laboratory" means a laboratory that performs histologic processing or consultation on an anatomic pathology specimen.
(i) Nothing in this section shall be construed to mandate the billing of any patient not covered under a health care benefit program, or any referring physician who has ordered an anatomic pathology service for a patient not covered under a health care benefit program.
(j) Nothing in this section shall apply to anatomic pathology services billed by gastroenterologists on patients in this state until July 1, 2014.
(k) The respective state licensing boards having jurisdiction over any practitioner who may request or provide anatomic pathology services may revoke, suspend or deny renewal of the license of any practitioner who violates this section.
Acts 2010 , ch. 952, § 1.
Tenn. Code Ann. § 56-2-1002 — TN Code / Title 56 / Chapter 2 / Section 56-2-1002
Purpose and intent
Status: in_force

(a) This part establishes the exclusive standards for data security, licensees' investigations of cybersecurity events, and licensees' notification of cybersecurity events to the commissioner and affected consumers. (b) This part does not create or imply a private cause of action for a violation of this part, nor does this part limit a private cause of action that otherwise exists. Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
(a) This part establishes the exclusive standards for data security, licensees' investigations of cybersecurity events, and licensees' notification of cybersecurity events to the commissioner and affected consumers.
(b) This part does not create or imply a private cause of action for a violation of this part, nor does this part limit a private cause of action that otherwise exists.
Added by 2021 Tenn. Acts, ch. 345, s 1, eff. 7/1/2021.
Tenn. Code Ann. § 56-12-215 — TN Code / Title 56 / Chapter 12 / Section 56-12-215
Tax and fee exemption
Status: in_force

The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property. Acts 1988, ch. 1032, § 15.
The association shall be exempt from payment of all fees and all taxes levied by this state or any of its subdivisions, except taxes levied on real property.
Acts 1988, ch. 1032, § 15.
Tenn. Code Ann. § 56-7-912 — TN Code / Title 56 / Chapter 7 / Section 56-7-912
Powers and duties of commissioner
Status: in_force

(a) Within sixty (60) days of the filing of any item described in § 56-7-905(c) , the commissioner shall approve the item unless it contains provisions that are contrary to this title. (b) The commissioner may adopt rules interpreting or making specific application of §§ 56-7-903 - 56-7-912, but has no power to vary or deviate from §§ 56-7-903 - 56-7-911 and this section, nor to extend the commissioner's power or jurisdiction to matters not provided for in §§ 56-7-903 - 56-7-912. (c) Notwithstanding subsection (b) or any other provision to the contrary, the commissioner may exempt credit life insurance for which no identifiable charge is made to the debtor from the application of §§ 56-7-903 - 56-7-911 and this section, if the commissioner finds that the application of §§ 56-7-903 - 56-7-911 and this section to the insurance is not necessary for the protection of insured debtors. Acts 1985, ch. 107, § 3.
(a) Within sixty (60) days of the filing of any item described in § 56-7-905(c) , the commissioner shall approve the item unless it contains provisions that are contrary to this title.
(b) The commissioner may adopt rules interpreting or making specific application of §§ 56-7-903 - 56-7-912, but has no power to vary or deviate from §§ 56-7-903 - 56-7-911 and this section, nor to extend the commissioner's power or jurisdiction to matters not provided for in §§ 56-7-903 - 56-7-912.
(c) Notwithstanding subsection (b) or any other provision to the contrary, the commissioner may exempt credit life insurance for which no identifiable charge is made to the debtor from the application of §§ 56-7-903 - 56-7-911 and this section, if the commissioner finds that the application of §§ 56-7-903 - 56-7-911 and this section to the insurance is not necessary for the protection of insured debtors.
Acts 1985, ch. 107, § 3.
Tenn. Code Ann. § 56-7-2312 — TN Code / Title 56 / Chapter 7 / Section 56-7-2312
Continuation of terminated group coverage - Conversion
Status: in_force

(a) A group policy delivered or issued for delivery in this state that provides hospital, surgical or major medical expense insurance, or any combination of these coverages, on an expense incurred basis, but not a policy that provides benefits for specific diseases or for accidental injuries only, shall provide that an employee or member whose insurance under the group policy has been terminated for any reason, except discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy, and under any group policy providing similar benefits that it replaces, for at least three (3) months immediately prior to termination, shall be entitled to have the coverage nonetheless continued under the group policy for the fractional policy month remaining at termination, plus three (3) additional policy months upon payment in advance to the employer of the full group premium for this continuation of coverage, including any portion of the premium usually paid by the person's former employer on or before the beginning of each month's coverage. (b) At the end of the period of continuation, the person shall be entitled to have issued to the person by the insurer a policy of health insurance that conforms to the applicable requirements specified in this chapter. (c) An employee or member shall not be entitled to have coverage continued if the group policy was terminated in its entirety or was terminated with respect to an insured class of which the employee was a member, but the employee shall have the right of conversion upon termination of the group policy. An employee or member shall not be entitled to have coverage continued or a converted policy issued to the employee if termination of the employee's insurance under the group policy occurred because: (1) The employee failed to pay any required contribution; (2) The employee is eligible for medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.); or (3) Any discontinued group coverage was replaced by similar group coverage within thirty-one (31) days. (d) (1) This section shall apply to individuals who are terminated from group coverage because of divorce or because of the death of the insured spouse, except that an individual to whom any of the foregoing applies shall be entitled to have the coverage continued under the group policy for the fractional policy month remaining at termination plus up to fifteen (15) additional policy months upon payment in advance to the employer the full month's group premium for this continuation of coverage on or before the beginning of each month's coverage, including any portion of the premium usually paid by the employer. This subsection (d) does not prohibit a group policy from granting a longer period of continued coverage than provided in this subsection (d), nor from offering broader coverage than provided in this subsection (d), nor from granting coverage after the death of the insured spouse as otherwise provided. Individuals whose group coverage is terminated during pregnancy shall be entitled to have their coverage continued under the group policy for the fractional month remaining at termination plus a period of not less than six (6) months after the pregnancy ends and not more than the end of the second three-month period following the three-month period within which the pregnancy ends. (2) Subdivision (d)(1) is applicable to all health benefits policies, plans, programs or contracts offered by commercial insurance companies, nonprofit insurance companies, prepaid plans, including health maintenance organizations, and to all health benefit programs provided state government employees. Acts 1980, ch. 537, § 1; 1986, ch. 716, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1501; 2008, ch. 935, §§ 1, 2.
(a) A group policy delivered or issued for delivery in this state that provides hospital, surgical or major medical expense insurance, or any combination of these coverages, on an expense incurred basis, but not a policy that provides benefits for specific diseases or for accidental injuries only, shall provide that an employee or member whose insurance under the group policy has been terminated for any reason, except discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy, and under any group policy providing similar benefits that it replaces, for at least three (3) months immediately prior to termination, shall be entitled to have the coverage nonetheless continued under the group policy for the fractional policy month remaining at termination, plus three (3) additional policy months upon payment in advance to the employer of the full group premium for this continuation of coverage, including any portion of the premium usually paid by the person's former employer on or before the beginning of each month's coverage.
(b) At the end of the period of continuation, the person shall be entitled to have issued to the person by the insurer a policy of health insurance that conforms to the applicable requirements specified in this chapter.
(c) An employee or member shall not be entitled to have coverage continued if the group policy was terminated in its entirety or was terminated with respect to an insured class of which the employee was a member, but the employee shall have the right of conversion upon termination of the group policy. An employee or member shall not be entitled to have coverage continued or a converted policy issued to the employee if termination of the employee's insurance under the group policy occurred because: (1) The employee failed to pay any required contribution; (2) The employee is eligible for medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.); or (3) Any discontinued group coverage was replaced by similar group coverage within thirty-one (31) days.
(1) The employee failed to pay any required contribution;
(2) The employee is eligible for medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.); or
(3) Any discontinued group coverage was replaced by similar group coverage within thirty-one (31) days.
(d) (1) This section shall apply to individuals who are terminated from group coverage because of divorce or because of the death of the insured spouse, except that an individual to whom any of the foregoing applies shall be entitled to have the coverage continued under the group policy for the fractional policy month remaining at termination plus up to fifteen (15) additional policy months upon payment in advance to the employer the full month's group premium for this continuation of coverage on or before the beginning of each month's coverage, including any portion of the premium usually paid by the employer. This subsection (d) does not prohibit a group policy from granting a longer period of continued coverage than provided in this subsection (d), nor from offering broader coverage than provided in this subsection (d), nor from granting coverage after the death of the insured spouse as otherwise provided. Individuals whose group coverage is terminated during pregnancy shall be entitled to have their coverage continued under the group policy for the fractional month remaining at termination plus a period of not less than six (6) months after the pregnancy ends and not more than the end of the second three-month period following the three-month period within which the pregnancy ends. (2) Subdivision (d)(1) is applicable to all health benefits policies, plans, programs or contracts offered by commercial insurance companies, nonprofit insurance companies, prepaid plans, including health maintenance organizations, and to all health benefit programs provided state government employees.
(1) This section shall apply to individuals who are terminated from group coverage because of divorce or because of the death of the insured spouse, except that an individual to whom any of the foregoing applies shall be entitled to have the coverage continued under the group policy for the fractional policy month remaining at termination plus up to fifteen (15) additional policy months upon payment in advance to the employer the full month's group premium for this continuation of coverage on or before the beginning of each month's coverage, including any portion of the premium usually paid by the employer. This subsection (d) does not prohibit a group policy from granting a longer period of continued coverage than provided in this subsection (d), nor from offering broader coverage than provided in this subsection (d), nor from granting coverage after the death of the insured spouse as otherwise provided. Individuals whose group coverage is terminated during pregnancy shall be entitled to have their coverage continued under the group policy for the fractional month remaining at termination plus a period of not less than six (6) months after the pregnancy ends and not more than the end of the second three-month period following the three-month period within which the pregnancy ends.
(2) Subdivision (d)(1) is applicable to all health benefits policies, plans, programs or contracts offered by commercial insurance companies, nonprofit insurance companies, prepaid plans, including health maintenance organizations, and to all health benefit programs provided state government employees.
Acts 1980, ch. 537, § 1; 1986, ch. 716, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1501; 2008, ch. 935, §§ 1, 2.
Tenn. Code Ann. § 56-51-140 — TN Code / Title 56 / Chapter 51 / Section 56-51-140
Administrative penalty in lieu of suspension or revocation
Status: in_force

In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, or entity subject to this act has been found to have violated any provision of this chapter, the department may: (1) Issue and cause to be served upon the organization, person, or entity charged with the violation a copy of the findings and an order requiring the organization, person, or entity to cease and desist from engaging in the act or practice that constitutes the violation; and (2) Impose a monetary penalty of not less than one hundred dollars ($100) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000). Acts 2000, ch. 948, § 40.
In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, or entity subject to this act has been found to have violated any provision of this chapter, the department may:
(1) Issue and cause to be served upon the organization, person, or entity charged with the violation a copy of the findings and an order requiring the organization, person, or entity to cease and desist from engaging in the act or practice that constitutes the violation; and
(2) Impose a monetary penalty of not less than one hundred dollars ($100) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000).
Acts 2000, ch. 948, § 40.
Tenn. Code Ann. § 56-11-206 — TN Code / Title 56 / Chapter 11 / Section 56-11-206
Exemptions from requirements of part - Request for waiver - Time limitation for compliance when exemption ceases to apply
Status: in_force

(a) An insurer or health maintenance organization shall be exempt from the requirements of this part, if: (1) The insurer or health maintenance organization has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program ( 7 U.S.C. § 1503 ), less than five hundred million dollars ($500,000,000); and (2) The insurance group of which the insurer is a member has annual direct written and unaffiliated assumed premium including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than one billion dollars ($1,000,000,000). (b) If an insurer or health maintenance organization qualifies for exemption pursuant to subdivision (a)(1), but the insurance group of which the insurer or health maintenance organization is a member does not qualify for exemption pursuant to subdivision (a)(2), then the ORSA Summary Report that may be required pursuant to § 56-11-205 shall include every insurer or health maintenance organization within the insurance group. This requirement may be satisfied by the submission of more than one (1) ORSA Summary Report for any combination of insurers or health maintenance organizations; provided, that any combination of reports includes every insurer or health maintenance organization within the insurance group. (c) If an insurer or health maintenance organization does not qualify for exemption pursuant to subdivision (a)(1), but the insurance group of which it is a member qualifies for exemption pursuant to subdivision (a)(2), then the only ORSA Summary Report that may be required pursuant to § 56-11-205 shall be the report applicable to that insurer or health maintenance organization. (d) An insurer or health maintenance organization that does not qualify for exemption pursuant to subsection (a) may apply to the commissioner for a waiver from the requirements of this part based upon unique circumstances. In deciding whether to grant the insurer's or health maintenance organization's request for waiver, the commissioner may consider the type and volume of business written, ownership and organizational structure, and any other factor the commissioner considers relevant to the insurer or health maintenance organization or insurance group of which the insurer or health maintenance organization is a member. If the insurer or health maintenance organization is part of an insurance group with insurers or health maintenance organizations domiciled in more than one (1) state, the commissioner shall coordinate with the lead state commissioner and with the other domiciliary commissioners in considering whether to grant the insurer's or health maintenance organization's request for a waiver. (e) Notwithstanding the exemptions stated in this section, the commissioner may require that: (1) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report based on unique circumstances including, but not limited to, the type and volume of business written, ownership and organizational structure, federal agency requests, and international supervisor requests; or (2) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report if the insurer or health maintenance organization has Risk-Based Capital for company action level event as set forth in § 56-46-104 , meets one (1) or more of the standards of an insurer deemed to be in hazardous financial condition as defined in Tenn. Comp. R. & Reg. 0780-01-66, or otherwise exhibits qualities of a troubled insurer or health maintenance organization as determined by the commissioner. (f) If an insurer or health maintenance organization that qualifies for an exemption pursuant to subsection (a) subsequently no longer qualifies for that exemption due to changes in premium as reflected in the insurer's or health maintenance organization's most recent annual statement or in the most recent annual statements of the insurers or health maintenance organizations within the insurance group of which the insurer or health maintenance organization is a member, the insurer or health maintenance organization shall have one (1) year following the year the threshold is exceeded to comply with the requirements of this part. Acts 2014, ch. 583, § 26.
(a) An insurer or health maintenance organization shall be exempt from the requirements of this part, if: (1) The insurer or health maintenance organization has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program ( 7 U.S.C. § 1503 ), less than five hundred million dollars ($500,000,000); and (2) The insurance group of which the insurer is a member has annual direct written and unaffiliated assumed premium including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than one billion dollars ($1,000,000,000).
(1) The insurer or health maintenance organization has annual direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program ( 7 U.S.C. § 1503 ), less than five hundred million dollars ($500,000,000); and
(2) The insurance group of which the insurer is a member has annual direct written and unaffiliated assumed premium including international direct and assumed premium, but excluding premiums reinsured with the Federal Crop Insurance Corporation and Federal Flood Program, less than one billion dollars ($1,000,000,000).
(b) If an insurer or health maintenance organization qualifies for exemption pursuant to subdivision (a)(1), but the insurance group of which the insurer or health maintenance organization is a member does not qualify for exemption pursuant to subdivision (a)(2), then the ORSA Summary Report that may be required pursuant to § 56-11-205 shall include every insurer or health maintenance organization within the insurance group. This requirement may be satisfied by the submission of more than one (1) ORSA Summary Report for any combination of insurers or health maintenance organizations; provided, that any combination of reports includes every insurer or health maintenance organization within the insurance group.
(c) If an insurer or health maintenance organization does not qualify for exemption pursuant to subdivision (a)(1), but the insurance group of which it is a member qualifies for exemption pursuant to subdivision (a)(2), then the only ORSA Summary Report that may be required pursuant to § 56-11-205 shall be the report applicable to that insurer or health maintenance organization.
(d) An insurer or health maintenance organization that does not qualify for exemption pursuant to subsection (a) may apply to the commissioner for a waiver from the requirements of this part based upon unique circumstances. In deciding whether to grant the insurer's or health maintenance organization's request for waiver, the commissioner may consider the type and volume of business written, ownership and organizational structure, and any other factor the commissioner considers relevant to the insurer or health maintenance organization or insurance group of which the insurer or health maintenance organization is a member. If the insurer or health maintenance organization is part of an insurance group with insurers or health maintenance organizations domiciled in more than one (1) state, the commissioner shall coordinate with the lead state commissioner and with the other domiciliary commissioners in considering whether to grant the insurer's or health maintenance organization's request for a waiver.
(e) Notwithstanding the exemptions stated in this section, the commissioner may require that: (1) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report based on unique circumstances including, but not limited to, the type and volume of business written, ownership and organizational structure, federal agency requests, and international supervisor requests; or (2) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report if the insurer or health maintenance organization has Risk-Based Capital for company action level event as set forth in § 56-46-104 , meets one (1) or more of the standards of an insurer deemed to be in hazardous financial condition as defined in Tenn. Comp. R. & Reg. 0780-01-66, or otherwise exhibits qualities of a troubled insurer or health maintenance organization as determined by the commissioner.
(1) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report based on unique circumstances including, but not limited to, the type and volume of business written, ownership and organizational structure, federal agency requests, and international supervisor requests; or
(2) An insurer or health maintenance organization maintain a risk management framework, conduct an ORSA and file an ORSA Summary Report if the insurer or health maintenance organization has Risk-Based Capital for company action level event as set forth in § 56-46-104 , meets one (1) or more of the standards of an insurer deemed to be in hazardous financial condition as defined in Tenn. Comp. R. & Reg. 0780-01-66, or otherwise exhibits qualities of a troubled insurer or health maintenance organization as determined by the commissioner.
(f) If an insurer or health maintenance organization that qualifies for an exemption pursuant to subsection (a) subsequently no longer qualifies for that exemption due to changes in premium as reflected in the insurer's or health maintenance organization's most recent annual statement or in the most recent annual statements of the insurers or health maintenance organizations within the insurance group of which the insurer or health maintenance organization is a member, the insurer or health maintenance organization shall have one (1) year following the year the threshold is exceeded to comply with the requirements of this part.
Acts 2014, ch. 583, § 26.