Tenn. Code Ann. § 56-7-2809 — TN Code / Title 56 / Chapter 7 / Section 56-7-2809
Coverage without preexisting condition exclusion required - Alternative coverage - Network plans - Financial capacity limit
Status: in_force

(a) On and after July 1, 1997, each health insurance issuer that offers individual health insurance coverage in this state must offer to and accept for enrollment every eligible individual who applies for coverage without imposing any preexisting condition exclusion with respect to the coverage. (b) As used in this section, "eligible individual" means an individual: (1) For whom, as of the date on which the individual seeks coverage under this section, the aggregate of periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with the plan; (2) Who is not eligible for coverage under a group health plan, Title XVII of the Social Security Act, Part A or Part B ( 42 U.S.C. § 1391 et seq.), or state coverage pursuant to Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor program, and does not have other health insurance coverage; (3) Whose most recent coverage within the coverage period described in subdivision (b)(1) was not terminated based on nonpayment of premiums or fraud; and (4) Who, if offered the option of continuation coverage, accepted the coverage and exhausted the coverage. (c) Alternative Coverage Permitted. (1) In General. (A) The health insurance issuer may elect to limit the coverage offered under subsection (a) so long as it offers at least two (2) different policy forms of health insurance coverage, both of which: (i) Are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and (ii) Meet the requirement of subdivision (c)(2) or (c)(3), as elected by the issuer. (B) For purposes of this subsection (c), policy forms that have different cost-sharing arrangements or different riders shall be considered to be different policy forms. (2) Choice of Most Popular Policy Forms. The requirement of this subdivision (c)(2) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all the policy forms offered by the issuer in this state or applicable marketing or service area, as may be prescribed in regulation, by the issuer in the individual market in the period involved. (3) Choice of Two (2) Policy Forms with Representative Coverage. (A) The requirement of this subdivision (c)(3)(A) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers a lower-level coverage policy form, as defined in subdivision (c)(3)(B), and a higher-level coverage policy form, as defined in subdivision (c)(3)(C), each of which includes benefits substantially similar to other individual health insurance coverage offered by the issuer in that state and each of which is covered under a mechanism that provides for risk adjustment, risk spreading or a risk spreading mechanism, among issuers or policies of an issuer, or otherwise provides for some financial subsidization for eligible individuals, including through assistance to participating issuers. (B) A lower-level of coverage policy form provides that the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) but not greater than one hundred percent (100%) of a weighted average, described in subdivision (c)(3)(D). (C) A higher-level of coverage policy form provides that: (i) The actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of the coverage described in subdivision (c)(3)(B) offered by the issuer in the area involved; and (ii) The actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of a weighted average, described in subdivision (c)(3)(D). (D) For purposes of this subdivision (c)(3), the weighted average is the average actuarial value of the benefits provided by all the health insurance coverage issued, as elected by the issuer, either by that issuer or by all issuers in this state in the individual market during the previous year, not including coverage issued under this section, weighted by enrollment for the different coverage. (4) The issuer elections under subdivision (c)(1) shall apply uniformly to all eligible individuals in this state for that issuer. The election shall be made to the commissioner and shall be effective for no less than a two-year period. All elections shall be in a form and manner as prescribed by the commissioner. (5) For purposes of subdivision (c)(3), the actuarial value of benefits provided under individual health insurance coverage shall be calculated based on a standardized population and a set of standardized utilization and cost factors. (d) Special Rules for Network Plans. (1) In the case of a health insurance issuer that offers health insurance coverage in the individual market through a network plan, the issuer may: (A) Limit the individuals who may be enrolled under the coverage to those who live, reside, or work within the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the individuals if the issuer has demonstrated to the commissioner that it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees and it is applying this subdivision (d)(1)(B) uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals. (2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (d)(1)(B), may not offer coverage in the individual market within the service area for a period of one hundred eighty (180) days after the coverage is denied. (e) Application of Financial Capacity Limits. (1) A health insurance issuer may deny health insurance coverage in the individual market to an eligible individual 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 (e)(1) uniformly to all individuals in the individual market in the state and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals. (2) An issuer, upon denying individual health insurance coverage in accordance with subdivision (e)(1), may not offer the coverage in the individual market within the service area 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. (3) This subsection (e) may be applied on a service-area specific basis. (f) Subsection (a) shall not require a health insurance issuer offering health insurance coverage only in connection with group health plans or through bona fide associations to offer health insurance coverage in the individual market. Acts 1997, ch. 157, § 10.
(a) On and after July 1, 1997, each health insurance issuer that offers individual health insurance coverage in this state must offer to and accept for enrollment every eligible individual who applies for coverage without imposing any preexisting condition exclusion with respect to the coverage.
(b) As used in this section, "eligible individual" means an individual: (1) For whom, as of the date on which the individual seeks coverage under this section, the aggregate of periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with the plan; (2) Who is not eligible for coverage under a group health plan, Title XVII of the Social Security Act, Part A or Part B ( 42 U.S.C. § 1391 et seq.), or state coverage pursuant to Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor program, and does not have other health insurance coverage; (3) Whose most recent coverage within the coverage period described in subdivision (b)(1) was not terminated based on nonpayment of premiums or fraud; and (4) Who, if offered the option of continuation coverage, accepted the coverage and exhausted the coverage.
(1) For whom, as of the date on which the individual seeks coverage under this section, the aggregate of periods of creditable coverage is eighteen (18) or more months and whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan, or health insurance coverage offered in connection with the plan;
(2) Who is not eligible for coverage under a group health plan, Title XVII of the Social Security Act, Part A or Part B ( 42 U.S.C. § 1391 et seq.), or state coverage pursuant to Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor program, and does not have other health insurance coverage;
(3) Whose most recent coverage within the coverage period described in subdivision (b)(1) was not terminated based on nonpayment of premiums or fraud; and
(4) Who, if offered the option of continuation coverage, accepted the coverage and exhausted the coverage.
(c) Alternative Coverage Permitted. (1) In General. (A) The health insurance issuer may elect to limit the coverage offered under subsection (a) so long as it offers at least two (2) different policy forms of health insurance coverage, both of which: (i) Are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and (ii) Meet the requirement of subdivision (c)(2) or (c)(3), as elected by the issuer. (B) For purposes of this subsection (c), policy forms that have different cost-sharing arrangements or different riders shall be considered to be different policy forms. (2) Choice of Most Popular Policy Forms. The requirement of this subdivision (c)(2) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all the policy forms offered by the issuer in this state or applicable marketing or service area, as may be prescribed in regulation, by the issuer in the individual market in the period involved. (3) Choice of Two (2) Policy Forms with Representative Coverage. (A) The requirement of this subdivision (c)(3)(A) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers a lower-level coverage policy form, as defined in subdivision (c)(3)(B), and a higher-level coverage policy form, as defined in subdivision (c)(3)(C), each of which includes benefits substantially similar to other individual health insurance coverage offered by the issuer in that state and each of which is covered under a mechanism that provides for risk adjustment, risk spreading or a risk spreading mechanism, among issuers or policies of an issuer, or otherwise provides for some financial subsidization for eligible individuals, including through assistance to participating issuers. (B) A lower-level of coverage policy form provides that the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) but not greater than one hundred percent (100%) of a weighted average, described in subdivision (c)(3)(D). (C) A higher-level of coverage policy form provides that: (i) The actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of the coverage described in subdivision (c)(3)(B) offered by the issuer in the area involved; and (ii) The actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of a weighted average, described in subdivision (c)(3)(D). (D) For purposes of this subdivision (c)(3), the weighted average is the average actuarial value of the benefits provided by all the health insurance coverage issued, as elected by the issuer, either by that issuer or by all issuers in this state in the individual market during the previous year, not including coverage issued under this section, weighted by enrollment for the different coverage. (4) The issuer elections under subdivision (c)(1) shall apply uniformly to all eligible individuals in this state for that issuer. The election shall be made to the commissioner and shall be effective for no less than a two-year period. All elections shall be in a form and manner as prescribed by the commissioner. (5) For purposes of subdivision (c)(3), the actuarial value of benefits provided under individual health insurance coverage shall be calculated based on a standardized population and a set of standardized utilization and cost factors.
(1) In General. (A) The health insurance issuer may elect to limit the coverage offered under subsection (a) so long as it offers at least two (2) different policy forms of health insurance coverage, both of which: (i) Are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and (ii) Meet the requirement of subdivision (c)(2) or (c)(3), as elected by the issuer. (B) For purposes of this subsection (c), policy forms that have different cost-sharing arrangements or different riders shall be considered to be different policy forms.
(A) The health insurance issuer may elect to limit the coverage offered under subsection (a) so long as it offers at least two (2) different policy forms of health insurance coverage, both of which: (i) Are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and (ii) Meet the requirement of subdivision (c)(2) or (c)(3), as elected by the issuer.
(i) Are designed for, made generally available to, and actively marketed to, and enroll both eligible and other individuals by the issuer; and
(ii) Meet the requirement of subdivision (c)(2) or (c)(3), as elected by the issuer.
(B) For purposes of this subsection (c), policy forms that have different cost-sharing arrangements or different riders shall be considered to be different policy forms.
(2) Choice of Most Popular Policy Forms. The requirement of this subdivision (c)(2) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers the policy forms for individual health insurance coverage with the largest, and next to largest, premium volume of all the policy forms offered by the issuer in this state or applicable marketing or service area, as may be prescribed in regulation, by the issuer in the individual market in the period involved.
(3) Choice of Two (2) Policy Forms with Representative Coverage. (A) The requirement of this subdivision (c)(3)(A) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers a lower-level coverage policy form, as defined in subdivision (c)(3)(B), and a higher-level coverage policy form, as defined in subdivision (c)(3)(C), each of which includes benefits substantially similar to other individual health insurance coverage offered by the issuer in that state and each of which is covered under a mechanism that provides for risk adjustment, risk spreading or a risk spreading mechanism, among issuers or policies of an issuer, or otherwise provides for some financial subsidization for eligible individuals, including through assistance to participating issuers. (B) A lower-level of coverage policy form provides that the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) but not greater than one hundred percent (100%) of a weighted average, described in subdivision (c)(3)(D). (C) A higher-level of coverage policy form provides that: (i) The actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of the coverage described in subdivision (c)(3)(B) offered by the issuer in the area involved; and (ii) The actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of a weighted average, described in subdivision (c)(3)(D). (D) For purposes of this subdivision (c)(3), the weighted average is the average actuarial value of the benefits provided by all the health insurance coverage issued, as elected by the issuer, either by that issuer or by all issuers in this state in the individual market during the previous year, not including coverage issued under this section, weighted by enrollment for the different coverage.
(A) The requirement of this subdivision (c)(3)(A) is met, for health insurance coverage policy forms offered by an issuer in the individual market, if the issuer offers a lower-level coverage policy form, as defined in subdivision (c)(3)(B), and a higher-level coverage policy form, as defined in subdivision (c)(3)(C), each of which includes benefits substantially similar to other individual health insurance coverage offered by the issuer in that state and each of which is covered under a mechanism that provides for risk adjustment, risk spreading or a risk spreading mechanism, among issuers or policies of an issuer, or otherwise provides for some financial subsidization for eligible individuals, including through assistance to participating issuers.
(B) A lower-level of coverage policy form provides that the actuarial value of the benefits under the coverage is at least eighty-five percent (85%) but not greater than one hundred percent (100%) of a weighted average, described in subdivision (c)(3)(D).
(C) A higher-level of coverage policy form provides that: (i) The actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of the coverage described in subdivision (c)(3)(B) offered by the issuer in the area involved; and (ii) The actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of a weighted average, described in subdivision (c)(3)(D).
(i) The actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater than the actuarial value of the coverage described in subdivision (c)(3)(B) offered by the issuer in the area involved; and
(ii) The actuarial value of the benefits under the coverage is at least one hundred percent (100%) but not greater than one hundred twenty percent (120%) of a weighted average, described in subdivision (c)(3)(D).
(D) For purposes of this subdivision (c)(3), the weighted average is the average actuarial value of the benefits provided by all the health insurance coverage issued, as elected by the issuer, either by that issuer or by all issuers in this state in the individual market during the previous year, not including coverage issued under this section, weighted by enrollment for the different coverage.
(4) The issuer elections under subdivision (c)(1) shall apply uniformly to all eligible individuals in this state for that issuer. The election shall be made to the commissioner and shall be effective for no less than a two-year period. All elections shall be in a form and manner as prescribed by the commissioner.
(5) For purposes of subdivision (c)(3), the actuarial value of benefits provided under individual health insurance coverage shall be calculated based on a standardized population and a set of standardized utilization and cost factors.
(d) Special Rules for Network Plans. (1) In the case of a health insurance issuer that offers health insurance coverage in the individual market through a network plan, the issuer may: (A) Limit the individuals who may be enrolled under the coverage to those who live, reside, or work within the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the individuals if the issuer has demonstrated to the commissioner that it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees and it is applying this subdivision (d)(1)(B) uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals. (2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (d)(1)(B), may not offer coverage in the individual market within the service area for a period of one hundred eighty (180) days after the coverage is denied.
(1) In the case of a health insurance issuer that offers health insurance coverage in the individual market through a network plan, the issuer may: (A) Limit the individuals who may be enrolled under the coverage to those who live, reside, or work within the service area for the network plan; and (B) Within the service area of the plan, deny the coverage to the individuals if the issuer has demonstrated to the commissioner that it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees and it is applying this subdivision (d)(1)(B) uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.
(A) Limit the individuals who may be enrolled under the coverage to those who live, reside, or work within the service area for the network plan; and
(B) Within the service area of the plan, deny the coverage to the individuals if the issuer has demonstrated to the commissioner that it will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders and enrollees and individual enrollees and it is applying this subdivision (d)(1)(B) uniformly to individuals without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.
(2) An issuer, upon denying health insurance coverage in any service area in accordance with subdivision (d)(1)(B), may not offer coverage in the individual market within the service area for a period of one hundred eighty (180) days after the coverage is denied.
(e) Application of Financial Capacity Limits. (1) A health insurance issuer may deny health insurance coverage in the individual market to an eligible individual 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 (e)(1) uniformly to all individuals in the individual market in the state and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals. (2) An issuer, upon denying individual health insurance coverage in accordance with subdivision (e)(1), may not offer the coverage in the individual market within the service area 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. (3) This subsection (e) may be applied on a service-area specific basis.
(1) A health insurance issuer may deny health insurance coverage in the individual market to an eligible individual 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 (e)(1) uniformly to all individuals in the individual market in the state and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.
(A) It does not have the financial reserves necessary to underwrite additional coverage; and
(B) It is applying this subdivision (e)(1) uniformly to all individuals in the individual market in the state and without regard to any health status-related factor of the individuals and without regard to whether the individuals are eligible individuals.
(2) An issuer, upon denying individual health insurance coverage in accordance with subdivision (e)(1), may not offer the coverage in the individual market within the service area 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.
(3) This subsection (e) may be applied on a service-area specific basis.
(f) Subsection (a) shall not require a health insurance issuer offering health insurance coverage only in connection with group health plans or through bona fide associations to offer health insurance coverage in the individual market.
Acts 1997, ch. 157, § 10.
Tenn. Code Ann. § 56-6-802 — TN Code / Title 56 / Chapter 6 / Section 56-6-802
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Actuary" means a person who is a member in good standing of the American Academy of Actuaries; (2) "Controlling person" means any person, firm, association or corporation who directly or indirectly has the power to direct, or cause to be directed, the management, control or activities of the reinsurance intermediary; (3) "Insurer" means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer; (4) "Licensed producer" means an agent, broker or reinsurance intermediary licensed pursuant to the applicable provisions of this title; (5) "Qualified United States financial institution" means an institution that: (A) Is organized or, in the case of a United States office of a foreign banking organization, licensed, under the laws of the United States or any state; (B) Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies; and (C) Has been determined by either the commissioner or the Securities Valuation Office of the National Association of Insurance Commissioners to meet the standards of financial condition and standing considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner; (6) "Reinsurance intermediary" means a reinsurance intermediary broker, or a reinsurance intermediary manager; provided, that an entity that controls, is controlled by or under common control with the reinsurer, and that facilitates the administration of reinsurance business pursuant to a reinsurance agreement between the ceding company and the reinsurer, is not a reinsurance intermediary; (7) "Reinsurance intermediary broker (RB)" means any person, other than an officer or employee of the ceding insurer, firm, association or corporation who solicits, negotiates or places reinsurance cessions or retrocessions on behalf of a ceding insurer without the authority or power to bind reinsurance on behalf of the insurer; (8) (A) "Reinsurance intermediary manager (RM)" means any person, firm, association or corporation that has authority to bind or manages all or part of the assumed reinsurance business of a reinsurer, including the management of a separate division, department or underwriting office, and acts as an agent for the reinsurer whether known as an RM, manager or other similar term; (B) Notwithstanding subdivision (8)(A), the following persons shall not be considered an RM, with respect to such reinsurer, for the purposes of this part: (i) An employee of the reinsurer; (ii) A United States manager of the United States branch of an alien reinsurer; (iii) An underwriting manager who, pursuant to contract, manages all the reinsurance operations of the reinsurer, is under common control with the reinsurer, subject to chapter 11 of this title, and whose compensation is not based on the volume of premiums written; or (iv) The manager of a group, association, pool or organization of insurers that engage in joint underwriting or joint reinsurance and that are subject to examination by the insurance commissioner of the state in which the manager's principal business office is located; (9) "Reinsurer" means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer with the authority to assume reinsurance; and (10) "To be in violation" means that the reinsurance intermediary, insurer, or reinsurer for whom the reinsurance intermediary was acting failed to substantially comply with this part. Acts 1993, ch. 253, § 9.
As used in this part, unless the context otherwise requires:
(1) "Actuary" means a person who is a member in good standing of the American Academy of Actuaries;
(2) "Controlling person" means any person, firm, association or corporation who directly or indirectly has the power to direct, or cause to be directed, the management, control or activities of the reinsurance intermediary;
(3) "Insurer" means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer;
(4) "Licensed producer" means an agent, broker or reinsurance intermediary licensed pursuant to the applicable provisions of this title;
(5) "Qualified United States financial institution" means an institution that: (A) Is organized or, in the case of a United States office of a foreign banking organization, licensed, under the laws of the United States or any state; (B) Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies; and (C) Has been determined by either the commissioner or the Securities Valuation Office of the National Association of Insurance Commissioners to meet the standards of financial condition and standing considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner;
(A) Is organized or, in the case of a United States office of a foreign banking organization, licensed, under the laws of the United States or any state;
(B) Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies; and
(C) Has been determined by either the commissioner or the Securities Valuation Office of the National Association of Insurance Commissioners to meet the standards of financial condition and standing considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the commissioner;
(6) "Reinsurance intermediary" means a reinsurance intermediary broker, or a reinsurance intermediary manager; provided, that an entity that controls, is controlled by or under common control with the reinsurer, and that facilitates the administration of reinsurance business pursuant to a reinsurance agreement between the ceding company and the reinsurer, is not a reinsurance intermediary;
(7) "Reinsurance intermediary broker (RB)" means any person, other than an officer or employee of the ceding insurer, firm, association or corporation who solicits, negotiates or places reinsurance cessions or retrocessions on behalf of a ceding insurer without the authority or power to bind reinsurance on behalf of the insurer;
(8) (A) "Reinsurance intermediary manager (RM)" means any person, firm, association or corporation that has authority to bind or manages all or part of the assumed reinsurance business of a reinsurer, including the management of a separate division, department or underwriting office, and acts as an agent for the reinsurer whether known as an RM, manager or other similar term; (B) Notwithstanding subdivision (8)(A), the following persons shall not be considered an RM, with respect to such reinsurer, for the purposes of this part: (i) An employee of the reinsurer; (ii) A United States manager of the United States branch of an alien reinsurer; (iii) An underwriting manager who, pursuant to contract, manages all the reinsurance operations of the reinsurer, is under common control with the reinsurer, subject to chapter 11 of this title, and whose compensation is not based on the volume of premiums written; or (iv) The manager of a group, association, pool or organization of insurers that engage in joint underwriting or joint reinsurance and that are subject to examination by the insurance commissioner of the state in which the manager's principal business office is located;
(A) "Reinsurance intermediary manager (RM)" means any person, firm, association or corporation that has authority to bind or manages all or part of the assumed reinsurance business of a reinsurer, including the management of a separate division, department or underwriting office, and acts as an agent for the reinsurer whether known as an RM, manager or other similar term;
(B) Notwithstanding subdivision (8)(A), the following persons shall not be considered an RM, with respect to such reinsurer, for the purposes of this part: (i) An employee of the reinsurer; (ii) A United States manager of the United States branch of an alien reinsurer; (iii) An underwriting manager who, pursuant to contract, manages all the reinsurance operations of the reinsurer, is under common control with the reinsurer, subject to chapter 11 of this title, and whose compensation is not based on the volume of premiums written; or (iv) The manager of a group, association, pool or organization of insurers that engage in joint underwriting or joint reinsurance and that are subject to examination by the insurance commissioner of the state in which the manager's principal business office is located;
(i) An employee of the reinsurer;
(ii) A United States manager of the United States branch of an alien reinsurer;
(iii) An underwriting manager who, pursuant to contract, manages all the reinsurance operations of the reinsurer, is under common control with the reinsurer, subject to chapter 11 of this title, and whose compensation is not based on the volume of premiums written; or
(iv) The manager of a group, association, pool or organization of insurers that engage in joint underwriting or joint reinsurance and that are subject to examination by the insurance commissioner of the state in which the manager's principal business office is located;
(9) "Reinsurer" means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer with the authority to assume reinsurance; and
(10) "To be in violation" means that the reinsurance intermediary, insurer, or reinsurer for whom the reinsurance intermediary was acting failed to substantially comply with this part.
Acts 1993, ch. 253, § 9.
Tenn. Code Ann. § 56-13-109 — TN Code / Title 56 / Chapter 13 / Section 56-13-109
Inspection and examination - Audits
Status: in_force

(a) At least once every three (3) years, and whenever the commissioner determines it to be prudent, the commissioner shall visit each captive insurance company and thoroughly inspect and examine its affairs to ascertain its financial condition, its ability to fulfill its obligations and whether it has complied with this chapter. The commissioner may extend such three-year period to five (5) years; provided, that the captive insurance company is subject to a comprehensive annual audit by independent auditors approved by the commissioner during such five-year period. The comprehensive audit shall be of a scope satisfactory to the commissioner. The expenses and charges of the examination shall be paid by the captive insurance company. If the captive insurance company chooses to be audited annually by an independent auditor, it is a best practice for the captive insurance company to rotate independent auditors every five (5) years, but the captive insurance company is not required to rotate independent auditors unless the commissioner determines otherwise on a case-by-case basis. (b) Any other law or regulation to the contrary notwithstanding, an association captive insurance company, all of whose insureds operate municipal or cooperative electric systems, shall not be required to have performed an audit of its annual statutory financial statements by an independent certified public accountant, unless, within ninety (90) days before the close of the fiscal year of the association captive insurance company, a majority of the association members who are insured, directly or indirectly by it, request an audit. (c) Sections 56-1-401 - 56-1-420 shall apply to examinations conducted under this section. (d) All examination reports, preliminary examination reports or results, working papers, recorded information, documents and copies thereof produced by, obtained by or disclosed to the commissioner or any other person in the course of an examination made under this section are confidential and are not subject to subpoena and may not be made public by the commissioner or an employee or agent of the commissioner without the written consent of the captive insurance company, except to the extent provided in this subsection (d). Nothing in this subsection (d), shall prevent the commissioner from using such information in furtherance of the commissioner's regulatory authority under this title. The commissioner shall have the discretion to grant access to such information to public officers having jurisdiction over the regulation of insurance in any other state or country, or to law enforcement officers of this state or any other state or agency of the federal government at any time, only if the officers receiving the information agree in writing to maintain the confidentiality of the information in a manner consistent with this subsection (d). Amended by 2024 Tenn. Acts, ch. 643,s 9, eff. 4/4/2024. Acts 2011 , ch. 468, § 1.
(a) At least once every three (3) years, and whenever the commissioner determines it to be prudent, the commissioner shall visit each captive insurance company and thoroughly inspect and examine its affairs to ascertain its financial condition, its ability to fulfill its obligations and whether it has complied with this chapter. The commissioner may extend such three-year period to five (5) years; provided, that the captive insurance company is subject to a comprehensive annual audit by independent auditors approved by the commissioner during such five-year period. The comprehensive audit shall be of a scope satisfactory to the commissioner. The expenses and charges of the examination shall be paid by the captive insurance company. If the captive insurance company chooses to be audited annually by an independent auditor, it is a best practice for the captive insurance company to rotate independent auditors every five (5) years, but the captive insurance company is not required to rotate independent auditors unless the commissioner determines otherwise on a case-by-case basis.
(b) Any other law or regulation to the contrary notwithstanding, an association captive insurance company, all of whose insureds operate municipal or cooperative electric systems, shall not be required to have performed an audit of its annual statutory financial statements by an independent certified public accountant, unless, within ninety (90) days before the close of the fiscal year of the association captive insurance company, a majority of the association members who are insured, directly or indirectly by it, request an audit.
(c) Sections 56-1-401 - 56-1-420 shall apply to examinations conducted under this section.
(d) All examination reports, preliminary examination reports or results, working papers, recorded information, documents and copies thereof produced by, obtained by or disclosed to the commissioner or any other person in the course of an examination made under this section are confidential and are not subject to subpoena and may not be made public by the commissioner or an employee or agent of the commissioner without the written consent of the captive insurance company, except to the extent provided in this subsection (d). Nothing in this subsection (d), shall prevent the commissioner from using such information in furtherance of the commissioner's regulatory authority under this title. The commissioner shall have the discretion to grant access to such information to public officers having jurisdiction over the regulation of insurance in any other state or country, or to law enforcement officers of this state or any other state or agency of the federal government at any time, only if the officers receiving the information agree in writing to maintain the confidentiality of the information in a manner consistent with this subsection (d).
Amended by 2024 Tenn. Acts, ch. 643,s 9, eff. 4/4/2024.
Acts 2011 , ch. 468, § 1.
Tenn. Code Ann. § 56-7-2317 — TN Code / Title 56 / Chapter 7 / Section 56-7-2317
Preexisting conditions - Converted policy benefits in first policy year limited by group policy benefits
Status: in_force

The converted policy shall not exclude a preexisting condition not excluded by the group policy. However, the converted policy may provide that any hospital, surgical or medical benefits payable under the policy may be reduced by the amount of the benefits payable under the group policy after the termination of the individual's insurance under the group policy. The converted policy may also include provisions so that during the first policy year the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the individual's insurance under the group policy remained in force and effect. Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1506.
The converted policy shall not exclude a preexisting condition not excluded by the group policy. However, the converted policy may provide that any hospital, surgical or medical benefits payable under the policy may be reduced by the amount of the benefits payable under the group policy after the termination of the individual's insurance under the group policy. The converted policy may also include provisions so that during the first policy year the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the individual's insurance under the group policy remained in force and effect.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1506.
Tenn. Code Ann. § 56-7-1609 — TN Code / Title 56 / Chapter 7 / Section 56-7-1609
Authority to enforce
Status: in_force

The commissioner has sole authority to enforce this part or seek remedies for its violation. Acts 1981, ch. 415, § 10.
The commissioner has sole authority to enforce this part or seek remedies for its violation.
Acts 1981, ch. 415, § 10.
Tenn. Code Ann. § 56-7-1505 — TN Code / Title 56 / Chapter 7 / Section 56-7-1505
Disclosure - Outline of coverage - Consumer information
Status: in_force

(a) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant upon request, but no later than when the agent first discusses the policy's provisions or limits of coverage with the applicant. In the case of direct response solicitation, the insurer shall include the outline of coverage when an application is distributed to the potential buyer. (b) The commissioner shall by rule or regulation prescribe the format and content of the outline of coverage required by subsection (a). For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and (3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions. (c) The commissioner shall prescribe by rule or regulation a standard form and the contents of an informational brochure for persons eligible for medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies, the commissioner may require by regulation that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare but in no event later than the time of policy delivery. (d) The commissioner shall promulgate rules and regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for medicare other than: (1) Medicare supplement policies; or (2) Disability income policies. (e) The commissioner shall promulgate reasonable rules and regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for medicare. Acts 1992, ch. 735, § 5; 1996, ch. 750, § 20.
(a) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant upon request, but no later than when the agent first discusses the policy's provisions or limits of coverage with the applicant. In the case of direct response solicitation, the insurer shall include the outline of coverage when an application is distributed to the potential buyer.
(b) The commissioner shall by rule or regulation prescribe the format and content of the outline of coverage required by subsection (a). For purposes of this section, "format" means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. The outline of coverage shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and (3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums, and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and
(3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c) The commissioner shall prescribe by rule or regulation a standard form and the contents of an informational brochure for persons eligible for medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies, the commissioner may require by regulation that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare but in no event later than the time of policy delivery.
(d) The commissioner shall promulgate rules and regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for medicare other than: (1) Medicare supplement policies; or (2) Disability income policies.
(1) Medicare supplement policies; or
(2) Disability income policies.
(e) The commissioner shall promulgate reasonable rules and regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for medicare.
Acts 1992, ch. 735, § 5; 1996, ch. 750, § 20.
Tenn. Code Ann. § 56-37-104 — TN Code / Title 56 / Chapter 37 / Section 56-37-104
Investigation of applicants
Status: in_force

(a) Upon the filing of an application and the payment of the nonrefundable supervision fee, as provided in § 45-1-118(i) , the commissioner shall make an investigation of each applicant and shall issue a license if the applicant is qualified in accordance with this chapter. If the commissioner does not so find, the commissioner shall, at the request of the applicant, give the applicant a full hearing in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (b) The commissioner shall issue or renew a license, as may be applied for, when the commissioner is satisfied that the person to be licensed: (1) Is competent and trustworthy and intends to act in good faith in the capacity involved by the license for which the person applied; (2) Has a good business reputation and has had experience, training or education so as to be qualified in the business for which the license is required; and (3) If a corporation, is a corporation incorporated under the laws of this state or a foreign corporation authorized to transact business in this state. Amended by 2014 Tenn. Acts, ch. 736,s 36, eff. 7/1/2015. Acts 1980, ch. 920, § 4.
(a) Upon the filing of an application and the payment of the nonrefundable supervision fee, as provided in § 45-1-118(i) , the commissioner shall make an investigation of each applicant and shall issue a license if the applicant is qualified in accordance with this chapter. If the commissioner does not so find, the commissioner shall, at the request of the applicant, give the applicant a full hearing in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b) The commissioner shall issue or renew a license, as may be applied for, when the commissioner is satisfied that the person to be licensed: (1) Is competent and trustworthy and intends to act in good faith in the capacity involved by the license for which the person applied; (2) Has a good business reputation and has had experience, training or education so as to be qualified in the business for which the license is required; and (3) If a corporation, is a corporation incorporated under the laws of this state or a foreign corporation authorized to transact business in this state.
(1) Is competent and trustworthy and intends to act in good faith in the capacity involved by the license for which the person applied;
(2) Has a good business reputation and has had experience, training or education so as to be qualified in the business for which the license is required; and
(3) If a corporation, is a corporation incorporated under the laws of this state or a foreign corporation authorized to transact business in this state.
Amended by 2014 Tenn. Acts, ch. 736,s 36, eff. 7/1/2015.
Acts 1980, ch. 920, § 4.
Tenn. Code Ann. § 56-7-1302 — TN Code / Title 56 / Chapter 7 / Section 56-7-1302
Cancellation of automobile insurance policies - Grounds
Status: in_force

(a) Every private passenger automobile liability insurance policy shall be subject to this part. (b) Unless the policy has been in effect less than sixty (60) days at the time notice of cancellation is mailed, and it is not a renewal policy, the company shall not exercise its right to cancel the insurance afforded in the policy unless the cancellation is based on one (1) or more of the following reasons: (1) Nonpayment of premium; (2) (A) The policy was obtained through a material misrepresentation; (B) The named insured failed to disclose fully the insured's motor vehicle accidents and moving traffic violations for the preceding thirty-six (36) months if called for in the application; or (C) The named insured failed to disclose in the written application or in response to inquiry by the insured's broker or by the insurer or its agent information necessary for the acceptance or proper rating of the risk; (3) (A) Any insured violated any of the terms or conditions of the policy; (B) Any insured made a false or fraudulent claim or knowingly aided or abetted another in the presentation of a false or fraudulent claim; or (C) If, after the effective date of the insurance, the policy is extended, with or without charge, to provide coverage for the operation of an automobile by a person or persons not listed on the original application, or a supplement to the application, the company shall be allowed sixty (60) days, after written request to the company for insurance on the driver or drivers, to accept or reject the additional risk and, if the additional risk is not acceptable to the company, the policy may be cancelled; provided, that notice shall be mailed within sixty (60) days from the date of the request; (4) The named insured or any other operator, either resident in the same household, or who customarily operates an automobile insured under the policy: (A) Has had a driver's license or motor vehicle registration suspended or revoked within the thirty-six (36) months prior to notice of cancellation; (B) Is or becomes subject to epilepsy or heart attacks, and cannot produce a certificate from a physician testifying to the person's unqualified ability to operate a motor vehicle; or (C) Is or has been convicted of or forfeits bail, during the thirty-six (36) months immediately preceding the effective date of the policy or during the policy period, for: (i) Any felony; (ii) Criminal negligence resulting in death, homicide or assault, arising out of the operation of a motor vehicle; (iii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs; (iv) Leaving the scene of an accident without stopping to report; (v) Theft of a motor vehicle; (vi) Making false statements in an application for a driver license; or (vii) A third violation, committed within a period of thirty-six (36) months, of: (a) Any ordinance, law or regulation limiting the speed of motor vehicles; or (b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or (5) The insured automobile is: (A) Altered so as to increase the risk substantially; (B) Used as an authorized emergency vehicle; or (C) Subject to an inspection law and has not been inspected or, if inspected, has failed to qualify. (c) No automobile liability insurance policy may be cancelled solely because the driver was involved in a collision not adjudicated the driver's fault. Acts 1968, ch. 582, § 1; T.C.A., § 56-1154; Acts 1993, ch. 380, § 1.
(a) Every private passenger automobile liability insurance policy shall be subject to this part.
(b) Unless the policy has been in effect less than sixty (60) days at the time notice of cancellation is mailed, and it is not a renewal policy, the company shall not exercise its right to cancel the insurance afforded in the policy unless the cancellation is based on one (1) or more of the following reasons: (1) Nonpayment of premium; (2) (A) The policy was obtained through a material misrepresentation; (B) The named insured failed to disclose fully the insured's motor vehicle accidents and moving traffic violations for the preceding thirty-six (36) months if called for in the application; or (C) The named insured failed to disclose in the written application or in response to inquiry by the insured's broker or by the insurer or its agent information necessary for the acceptance or proper rating of the risk; (3) (A) Any insured violated any of the terms or conditions of the policy; (B) Any insured made a false or fraudulent claim or knowingly aided or abetted another in the presentation of a false or fraudulent claim; or (C) If, after the effective date of the insurance, the policy is extended, with or without charge, to provide coverage for the operation of an automobile by a person or persons not listed on the original application, or a supplement to the application, the company shall be allowed sixty (60) days, after written request to the company for insurance on the driver or drivers, to accept or reject the additional risk and, if the additional risk is not acceptable to the company, the policy may be cancelled; provided, that notice shall be mailed within sixty (60) days from the date of the request; (4) The named insured or any other operator, either resident in the same household, or who customarily operates an automobile insured under the policy: (A) Has had a driver's license or motor vehicle registration suspended or revoked within the thirty-six (36) months prior to notice of cancellation; (B) Is or becomes subject to epilepsy or heart attacks, and cannot produce a certificate from a physician testifying to the person's unqualified ability to operate a motor vehicle; or (C) Is or has been convicted of or forfeits bail, during the thirty-six (36) months immediately preceding the effective date of the policy or during the policy period, for: (i) Any felony; (ii) Criminal negligence resulting in death, homicide or assault, arising out of the operation of a motor vehicle; (iii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs; (iv) Leaving the scene of an accident without stopping to report; (v) Theft of a motor vehicle; (vi) Making false statements in an application for a driver license; or (vii) A third violation, committed within a period of thirty-six (36) months, of: (a) Any ordinance, law or regulation limiting the speed of motor vehicles; or (b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or (5) The insured automobile is: (A) Altered so as to increase the risk substantially; (B) Used as an authorized emergency vehicle; or (C) Subject to an inspection law and has not been inspected or, if inspected, has failed to qualify.
(1) Nonpayment of premium;
(2) (A) The policy was obtained through a material misrepresentation; (B) The named insured failed to disclose fully the insured's motor vehicle accidents and moving traffic violations for the preceding thirty-six (36) months if called for in the application; or (C) The named insured failed to disclose in the written application or in response to inquiry by the insured's broker or by the insurer or its agent information necessary for the acceptance or proper rating of the risk;
(A) The policy was obtained through a material misrepresentation;
(B) The named insured failed to disclose fully the insured's motor vehicle accidents and moving traffic violations for the preceding thirty-six (36) months if called for in the application; or
(C) The named insured failed to disclose in the written application or in response to inquiry by the insured's broker or by the insurer or its agent information necessary for the acceptance or proper rating of the risk;
(3) (A) Any insured violated any of the terms or conditions of the policy; (B) Any insured made a false or fraudulent claim or knowingly aided or abetted another in the presentation of a false or fraudulent claim; or (C) If, after the effective date of the insurance, the policy is extended, with or without charge, to provide coverage for the operation of an automobile by a person or persons not listed on the original application, or a supplement to the application, the company shall be allowed sixty (60) days, after written request to the company for insurance on the driver or drivers, to accept or reject the additional risk and, if the additional risk is not acceptable to the company, the policy may be cancelled; provided, that notice shall be mailed within sixty (60) days from the date of the request;
(A) Any insured violated any of the terms or conditions of the policy;
(B) Any insured made a false or fraudulent claim or knowingly aided or abetted another in the presentation of a false or fraudulent claim; or
(C) If, after the effective date of the insurance, the policy is extended, with or without charge, to provide coverage for the operation of an automobile by a person or persons not listed on the original application, or a supplement to the application, the company shall be allowed sixty (60) days, after written request to the company for insurance on the driver or drivers, to accept or reject the additional risk and, if the additional risk is not acceptable to the company, the policy may be cancelled; provided, that notice shall be mailed within sixty (60) days from the date of the request;
(4) The named insured or any other operator, either resident in the same household, or who customarily operates an automobile insured under the policy: (A) Has had a driver's license or motor vehicle registration suspended or revoked within the thirty-six (36) months prior to notice of cancellation; (B) Is or becomes subject to epilepsy or heart attacks, and cannot produce a certificate from a physician testifying to the person's unqualified ability to operate a motor vehicle; or (C) Is or has been convicted of or forfeits bail, during the thirty-six (36) months immediately preceding the effective date of the policy or during the policy period, for: (i) Any felony; (ii) Criminal negligence resulting in death, homicide or assault, arising out of the operation of a motor vehicle; (iii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs; (iv) Leaving the scene of an accident without stopping to report; (v) Theft of a motor vehicle; (vi) Making false statements in an application for a driver license; or (vii) A third violation, committed within a period of thirty-six (36) months, of: (a) Any ordinance, law or regulation limiting the speed of motor vehicles; or (b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or
(A) Has had a driver's license or motor vehicle registration suspended or revoked within the thirty-six (36) months prior to notice of cancellation;
(B) Is or becomes subject to epilepsy or heart attacks, and cannot produce a certificate from a physician testifying to the person's unqualified ability to operate a motor vehicle; or
(C) Is or has been convicted of or forfeits bail, during the thirty-six (36) months immediately preceding the effective date of the policy or during the policy period, for: (i) Any felony; (ii) Criminal negligence resulting in death, homicide or assault, arising out of the operation of a motor vehicle; (iii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs; (iv) Leaving the scene of an accident without stopping to report; (v) Theft of a motor vehicle; (vi) Making false statements in an application for a driver license; or (vii) A third violation, committed within a period of thirty-six (36) months, of: (a) Any ordinance, law or regulation limiting the speed of motor vehicles; or (b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or
(i) Any felony;
(ii) Criminal negligence resulting in death, homicide or assault, arising out of the operation of a motor vehicle;
(iii) Operating a motor vehicle while in an intoxicated condition or while under the influence of drugs;
(iv) Leaving the scene of an accident without stopping to report;
(v) Theft of a motor vehicle;
(vi) Making false statements in an application for a driver license; or
(vii) A third violation, committed within a period of thirty-six (36) months, of: (a) Any ordinance, law or regulation limiting the speed of motor vehicles; or (b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or
(a) Any ordinance, law or regulation limiting the speed of motor vehicles; or
(b) Any of the motor vehicle laws of any state, the violation of which constitutes a misdemeanor, whether or not the violations were repetitions of the same offense or were different offenses; or
(5) The insured automobile is: (A) Altered so as to increase the risk substantially; (B) Used as an authorized emergency vehicle; or (C) Subject to an inspection law and has not been inspected or, if inspected, has failed to qualify.
(A) Altered so as to increase the risk substantially;
(B) Used as an authorized emergency vehicle; or
(C) Subject to an inspection law and has not been inspected or, if inspected, has failed to qualify.
(c) No automobile liability insurance policy may be cancelled solely because the driver was involved in a collision not adjudicated the driver's fault.
Acts 1968, ch. 582, § 1; T.C.A., § 56-1154; Acts 1993, ch. 380, § 1.
Tenn. Code Ann. § 56-27-128 — TN Code / Title 56 / Chapter 27 / Section 56-27-128
Subscriptions to provide medical care for needy - Governmental or private contributions authorized
Status: in_force

A medical service plan corporation may, in its discretion, receive and accept from governmental or private agencies or from other persons as defined in this chapter, payments covering all or part of the costs of subscriptions to provide medical care for needy and other individuals. However, all contracts for medical care shall be between the medical service plan corporation and the person to receive the care. Acts 1945, ch. 113, § 21; C. Supp. 1950, § 4186.37 (Williams, § 4186.38); T.C.A. (orig. ed.), § 56-2928.
A medical service plan corporation may, in its discretion, receive and accept from governmental or private agencies or from other persons as defined in this chapter, payments covering all or part of the costs of subscriptions to provide medical care for needy and other individuals. However, all contracts for medical care shall be between the medical service plan corporation and the person to receive the care.
Acts 1945, ch. 113, § 21; C. Supp. 1950, § 4186.37 (Williams, § 4186.38); T.C.A. (orig. ed.), § 56-2928.
Tenn. Code Ann. § 56-6-903 — TN Code / Title 56 / Chapter 6 / Section 56-6-903
License requirement
Status: in_force

(a) No person shall act or hold out as being a public adjuster as defined in § 56-6-902 , unless licensed as a public adjuster in accordance with this part. (b) A person licensed as a public adjuster shall not misrepresent to a claimant that the person is an adjuster acting on behalf of or aiding an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster, unless so appointed by an insurer in writing to act on the insurer's behalf for that specific claim or purpose. (c) A business entity acting as a public adjuster is required to obtain a public adjuster license. Application shall be made using the uniform business entity application. Before approving the application, the commissioner shall find that: (1) The business entity has paid the fees set forth in the rule promulgated under § 56-6-905(a)(5) ; and (2) The business entity has designated a licensed public adjuster responsible for the business entity's compliance with the insurance laws, rules and regulations of this state. (d) Notwithstanding this section, a license as a public adjuster shall not be required of the following: (1) An attorney at law admitted to practice in this state, or an employee of the attorney acting under the attorney's supervision; (2) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract; (3) A person employed only for the purpose of obtaining facts surrounding a loss, or furnishing technical assistance to a licensed public adjuster, including, but not limited to, photographers, contractors, appraisers of value, private investigators, engineers and handwriting experts; (4) A licensed health care provider, or employee of a licensed health care provider, who prepares or files a health claim form on behalf of a patient; (5) A person who settles subrogation claims between insurers; or (6) A person who is employed by, or under contract to, an insurance company. Acts 2006, ch. 997, § 4.
(a) No person shall act or hold out as being a public adjuster as defined in § 56-6-902 , unless licensed as a public adjuster in accordance with this part.
(b) A person licensed as a public adjuster shall not misrepresent to a claimant that the person is an adjuster acting on behalf of or aiding an insurer in any capacity, including acting as an employee of the insurer or acting as an independent adjuster, unless so appointed by an insurer in writing to act on the insurer's behalf for that specific claim or purpose.
(c) A business entity acting as a public adjuster is required to obtain a public adjuster license. Application shall be made using the uniform business entity application. Before approving the application, the commissioner shall find that: (1) The business entity has paid the fees set forth in the rule promulgated under § 56-6-905(a)(5) ; and (2) The business entity has designated a licensed public adjuster responsible for the business entity's compliance with the insurance laws, rules and regulations of this state.
(1) The business entity has paid the fees set forth in the rule promulgated under § 56-6-905(a)(5) ; and
(2) The business entity has designated a licensed public adjuster responsible for the business entity's compliance with the insurance laws, rules and regulations of this state.
(d) Notwithstanding this section, a license as a public adjuster shall not be required of the following: (1) An attorney at law admitted to practice in this state, or an employee of the attorney acting under the attorney's supervision; (2) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract; (3) A person employed only for the purpose of obtaining facts surrounding a loss, or furnishing technical assistance to a licensed public adjuster, including, but not limited to, photographers, contractors, appraisers of value, private investigators, engineers and handwriting experts; (4) A licensed health care provider, or employee of a licensed health care provider, who prepares or files a health claim form on behalf of a patient; (5) A person who settles subrogation claims between insurers; or (6) A person who is employed by, or under contract to, an insurance company.
(1) An attorney at law admitted to practice in this state, or an employee of the attorney acting under the attorney's supervision;
(2) A person who negotiates or settles claims arising under a life or health insurance policy or an annuity contract;
(3) A person employed only for the purpose of obtaining facts surrounding a loss, or furnishing technical assistance to a licensed public adjuster, including, but not limited to, photographers, contractors, appraisers of value, private investigators, engineers and handwriting experts;
(4) A licensed health care provider, or employee of a licensed health care provider, who prepares or files a health claim form on behalf of a patient;
(5) A person who settles subrogation claims between insurers; or
(6) A person who is employed by, or under contract to, an insurance company.
Acts 2006, ch. 997, § 4.
Tenn. Code Ann. § 56-8-204 — TN Code / Title 56 / Chapter 8 / Section 56-8-204
Discriminatory acts defined
Status: in_force

(a) Any of the following acts are prohibited as unfairly discriminatory: (1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage, or adding a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status; (2) Excluding or limiting coverage or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status; (3) Terminating group coverage for a subject of abuse on the basis of the insured's abuse status where coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this subdivision (3) prohibits the insurer or health carrier from requiring the subject of abuse to pay the full premium for the person's coverage under the health plan or from requiring the subject of abuse to reside or work within its service area. Nothing in this subdivision (3) gives a subject of abuse any greater rights than the subject would otherwise have had to continued coverage under Tennessee or federal law. The continuation coverage required by this section shall be satisfied by any COBRA coverage provided to a subject of abuse and is not intended to be in addition to any coverage provided under COBRA; or (4) Disclosing or transferring any information, by a person employed by or contracting with a health carrier, relating to an applicant's or insured's abuse status or abuse-related medical condition, or the applicant's or insured's status as a family member, employer or associate of, or in a relationship with a subject of abuse, except: (A) For purposes related to the provision of health care services; (B) For the purpose of administering claims, utilization review or case management; or (C) Where required by the commissioner or a court of competent jurisdiction. (b) Nothing in this section shall be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information thereby obtained for the purpose of acts or practices permitted by this part. A subject of abuse, at the subject's absolute discretion, may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and nothing in this section shall be construed as authorizing the health carrier to disregard that information. Acts 1996, ch. 723, § 3.
(a) Any of the following acts are prohibited as unfairly discriminatory: (1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage, or adding a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status; (2) Excluding or limiting coverage or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status; (3) Terminating group coverage for a subject of abuse on the basis of the insured's abuse status where coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this subdivision (3) prohibits the insurer or health carrier from requiring the subject of abuse to pay the full premium for the person's coverage under the health plan or from requiring the subject of abuse to reside or work within its service area. Nothing in this subdivision (3) gives a subject of abuse any greater rights than the subject would otherwise have had to continued coverage under Tennessee or federal law. The continuation coverage required by this section shall be satisfied by any COBRA coverage provided to a subject of abuse and is not intended to be in addition to any coverage provided under COBRA; or (4) Disclosing or transferring any information, by a person employed by or contracting with a health carrier, relating to an applicant's or insured's abuse status or abuse-related medical condition, or the applicant's or insured's status as a family member, employer or associate of, or in a relationship with a subject of abuse, except: (A) For purposes related to the provision of health care services; (B) For the purpose of administering claims, utilization review or case management; or (C) Where required by the commissioner or a court of competent jurisdiction.
(1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage, or adding a premium differential to any health benefit plan on the basis of the applicant's or insured's abuse status;
(2) Excluding or limiting coverage or denying a claim incurred by an insured as a result of abuse on the basis of the insured's abuse status;
(3) Terminating group coverage for a subject of abuse on the basis of the insured's abuse status where coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser's coverage has terminated voluntarily or involuntarily. Nothing in this subdivision (3) prohibits the insurer or health carrier from requiring the subject of abuse to pay the full premium for the person's coverage under the health plan or from requiring the subject of abuse to reside or work within its service area. Nothing in this subdivision (3) gives a subject of abuse any greater rights than the subject would otherwise have had to continued coverage under Tennessee or federal law. The continuation coverage required by this section shall be satisfied by any COBRA coverage provided to a subject of abuse and is not intended to be in addition to any coverage provided under COBRA; or
(4) Disclosing or transferring any information, by a person employed by or contracting with a health carrier, relating to an applicant's or insured's abuse status or abuse-related medical condition, or the applicant's or insured's status as a family member, employer or associate of, or in a relationship with a subject of abuse, except: (A) For purposes related to the provision of health care services; (B) For the purpose of administering claims, utilization review or case management; or (C) Where required by the commissioner or a court of competent jurisdiction.
(A) For purposes related to the provision of health care services;
(B) For the purpose of administering claims, utilization review or case management; or
(C) Where required by the commissioner or a court of competent jurisdiction.
(b) Nothing in this section shall be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information thereby obtained for the purpose of acts or practices permitted by this part. A subject of abuse, at the subject's absolute discretion, may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and nothing in this section shall be construed as authorizing the health carrier to disregard that information.
Acts 1996, ch. 723, § 3.
Tenn. Code Ann. § 56-6-1106 — TN Code / Title 56 / Chapter 6 / Section 56-6-1106
Termination or change in terms and conditions by insurer
Status: in_force

Notwithstanding any other law to the contrary: (1) An insurer may terminate or otherwise change the terms and conditions of a policy of portable electronics insurance only upon providing the policyholder and enrolled customers with at least thirty (30) days' notice; (2) If the insurer changes the terms and conditions, then the insurer shall provide the vendor policyholder with a revised policy or endorsement and each enrolled customer with a revised certificate, endorsement, updated brochure, or other evidence indicating a change in the terms and conditions has occurred and a summary of material changes; (3) Notwithstanding subdivision (1): (A) An insurer may terminate an enrolled customer's enrollment under a portable electronics insurance policy upon fifteen (15) days' notice for discovery of fraud or material misrepresentation in obtaining coverage or in the presentation of a claim thereunder; and (B) An insurer may immediately terminate an enrolled customer's enrollment under a portable electronics insurance policy: (i) For nonpayment of premium; (ii) If the enrolled customer ceases to have active service with the vendor of portable electronics; or (iii) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty (30) calendar days after exhaustion of the limit. However, if notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer; (4) If a portable electronics insurance policy is terminated by a policyholder, then the policyholder shall mail or deliver written notice to each enrolled customer advising the enrolled customer of the termination of the policy and the effective date of termination. The written notice shall be mailed or delivered to the enrolled customer at least thirty (30) days prior to the termination; and (5) (A) Whenever notice by an insurer is required pursuant to this section, the notice shall be in writing and may be mailed or delivered to the vendor of portable electronics at the vendor's mailing address and to its affected enrolled customers' last known mailing addresses on file with the insurer; (B) If notice is mailed pursuant to this section, then the insurer or vendor of portable electronics, as the case may be, shall maintain proof of mailing in a form authorized or accepted by the United States postal service or other commercial mail delivery service; (C) An insurer or vendor policyholder may comply with any notice required by this section by providing electronic notice to a vendor or its affected enrolled customers, as the case may be, by electronic means. If notice is accomplished through electronic means the insurer or vendor of portable electronics, as the case may be, shall maintain proof that the notice was sent. Acts 2011, ch. 312, § 7.
Notwithstanding any other law to the contrary:
(1) An insurer may terminate or otherwise change the terms and conditions of a policy of portable electronics insurance only upon providing the policyholder and enrolled customers with at least thirty (30) days' notice;
(2) If the insurer changes the terms and conditions, then the insurer shall provide the vendor policyholder with a revised policy or endorsement and each enrolled customer with a revised certificate, endorsement, updated brochure, or other evidence indicating a change in the terms and conditions has occurred and a summary of material changes;
(3) Notwithstanding subdivision (1): (A) An insurer may terminate an enrolled customer's enrollment under a portable electronics insurance policy upon fifteen (15) days' notice for discovery of fraud or material misrepresentation in obtaining coverage or in the presentation of a claim thereunder; and (B) An insurer may immediately terminate an enrolled customer's enrollment under a portable electronics insurance policy: (i) For nonpayment of premium; (ii) If the enrolled customer ceases to have active service with the vendor of portable electronics; or (iii) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty (30) calendar days after exhaustion of the limit. However, if notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer;
(A) An insurer may terminate an enrolled customer's enrollment under a portable electronics insurance policy upon fifteen (15) days' notice for discovery of fraud or material misrepresentation in obtaining coverage or in the presentation of a claim thereunder; and
(B) An insurer may immediately terminate an enrolled customer's enrollment under a portable electronics insurance policy: (i) For nonpayment of premium; (ii) If the enrolled customer ceases to have active service with the vendor of portable electronics; or (iii) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty (30) calendar days after exhaustion of the limit. However, if notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer;
(i) For nonpayment of premium;
(ii) If the enrolled customer ceases to have active service with the vendor of portable electronics; or
(iii) If an enrolled customer exhausts the aggregate limit of liability, if any, under the terms of the portable electronics insurance policy and the insurer sends notice of termination to the enrolled customer within thirty (30) calendar days after exhaustion of the limit. However, if notice is not timely sent, enrollment shall continue notwithstanding the aggregate limit of liability until the insurer sends notice of termination to the enrolled customer;
(4) If a portable electronics insurance policy is terminated by a policyholder, then the policyholder shall mail or deliver written notice to each enrolled customer advising the enrolled customer of the termination of the policy and the effective date of termination. The written notice shall be mailed or delivered to the enrolled customer at least thirty (30) days prior to the termination; and
(5) (A) Whenever notice by an insurer is required pursuant to this section, the notice shall be in writing and may be mailed or delivered to the vendor of portable electronics at the vendor's mailing address and to its affected enrolled customers' last known mailing addresses on file with the insurer; (B) If notice is mailed pursuant to this section, then the insurer or vendor of portable electronics, as the case may be, shall maintain proof of mailing in a form authorized or accepted by the United States postal service or other commercial mail delivery service; (C) An insurer or vendor policyholder may comply with any notice required by this section by providing electronic notice to a vendor or its affected enrolled customers, as the case may be, by electronic means. If notice is accomplished through electronic means the insurer or vendor of portable electronics, as the case may be, shall maintain proof that the notice was sent.
(A) Whenever notice by an insurer is required pursuant to this section, the notice shall be in writing and may be mailed or delivered to the vendor of portable electronics at the vendor's mailing address and to its affected enrolled customers' last known mailing addresses on file with the insurer;
(B) If notice is mailed pursuant to this section, then the insurer or vendor of portable electronics, as the case may be, shall maintain proof of mailing in a form authorized or accepted by the United States postal service or other commercial mail delivery service;
(C) An insurer or vendor policyholder may comply with any notice required by this section by providing electronic notice to a vendor or its affected enrolled customers, as the case may be, by electronic means. If notice is accomplished through electronic means the insurer or vendor of portable electronics, as the case may be, shall maintain proof that the notice was sent.
Acts 2011, ch. 312, § 7.
Tenn. Code Ann. § 56-26-124 — TN Code / Title 56 / Chapter 26 / Section 56-26-124
Accident and sickness insurance - Patients in tax supported institutions not to be excluded
Status: in_force

No policy of sickness and accident insurance delivered or issued for delivery to any person in this state on or after January 1, 1975, including both individual policies and group policies, shall exclude covered benefits because the insured is a patient hospitalized in a tax supported institution of this state or any county or municipality; provided, that the institution charges patients for the same services in the absence of insurance. Acts 1959, ch. 38, § 1; 1967, ch. 23, § 1; 1974, ch. 426, § 1; T.C.A., § 56-3324.
No policy of sickness and accident insurance delivered or issued for delivery to any person in this state on or after January 1, 1975, including both individual policies and group policies, shall exclude covered benefits because the insured is a patient hospitalized in a tax supported institution of this state or any county or municipality; provided, that the institution charges patients for the same services in the absence of insurance.
Acts 1959, ch. 38, § 1; 1967, ch. 23, § 1; 1974, ch. 426, § 1; T.C.A., § 56-3324.
Tenn. Code Ann. § 56-9-317 — TN Code / Title 56 / Chapter 9 / Section 56-9-317
Preferences - Definition - Avoidance by liquidator - When transfer is made or perfected - Liens - Jurisdiction of chancery court - Preferences in favor of attorneys or insiders of insurer - Federal home loan bank
Status: in_force

(a) (1) A preference is a transfer of any of the property of an insurer to or for the benefit of a creditor, for or on account of an antecedent debt, made or suffered by the insurer within one (1) year before the filing of a successful petition for liquidation under this chapter, the effect of which transfer may be to enable the creditor to obtain a greater percentage of this debt than another creditor of the same class would receive. If a liquidation order is entered while the insurer is already subject to a rehabilitation order, then the transfers shall be deemed preferences if made or suffered within one (1) year before the filing of the successful petition for rehabilitation, or within two (2) years before the filing of the successful petition for liquidation, whichever time is shorter. (2) Any preference may be avoided by the liquidator if: (A) The insurer was insolvent at the time of the transfer; (B) The transfer was made within four (4) months before the filing of the petition; (C) The creditor receiving it or to be benefited thereby or the creditor's agent acting with reference thereto had, at the time when the transfer was made, reasonable cause to believe that the insurer was insolvent or was about to become insolvent; or (D) The creditor receiving it was an officer, or any employee or attorney or other person who was in fact in a position of comparable influence in the insurer to an officer, whether or not the person held the position, or any shareholder holding directly or indirectly more than five percent (5%) of any class of any equity security issued by the insurer, or any other person, firm, corporation, association or aggregation of persons with whom the insurer did not deal at arm's length. (3) Where the preference is voidable, the liquidator may recover the property or, if it has been converted, its value from any person who has received or converted the property, except where a bona fide purchaser or lienor has given less than fair equivalent value, the purchaser or lienor shall have a lien upon the property to the extent of the consideration actually given by the purchaser or lienor. Where a preference by way of lien or security title is voidable, the court may on due notice order the lien or title to be preserved for the benefit of the estate, in which event the lien or title shall pass to the liquidator. (b) (1) A transfer of property other than real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent lien obtainable by legal or equitable proceedings on a simple contract could become superior to the rights of the transferee. (2) A transfer of real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent bona fide purchaser from the insurer could obtain rights superior to the rights of the transferee. (3) A transfer that creates an equitable lien shall not be deemed to be perfected if there are available means by which a legal lien could be created. (4) A transfer not perfected prior to the filing of a petition for liquidation shall be deemed to be made immediately before the filing of the successful petition. (5) This subsection (b) shall apply whether or not there are or were creditors who might have obtained liens or persons who might have become bona fide purchasers. (c) (1) A lien obtainable by legal or equitable proceedings upon a simple contract is one arising in the ordinary course of the proceedings upon the entry or docketing of a judgment or decree, or upon attachment, garnishment, execution, or like process, whether before, upon, or after judgment or decree and whether before or upon levy. It does not include liens which under applicable law are given a special priority over other liens that are prior in time. (2) A lien obtainable by legal or equitable proceedings could become superior to the rights of a transferee, or a purchaser could obtain rights superior to the rights of a transferee within the meaning of subsection (b), if the consequences would follow only from the lien or purchase itself, or from the lien or purchase followed by any step wholly within the control of the respective lienholder or purchaser, with or without the aid of ministerial action by public officials. Such a lien could not, however, become superior and such a purchase could not create superior rights for the purpose of subsection (b) through any acts subsequent to the obtaining of such a lien or subsequent to such a purchase that require the agreement or concurrence of any third party or that require any further judicial action or ruling. (d) A transfer of property for or on account of a new and contemporaneous consideration, which is deemed under subsection (b) to be made or suffered after the transfer because of delay in perfecting it, does not thereby become a transfer for or on account of an antecedent debt if any acts required by the applicable law to be performed in order to perfect the transfer as against liens or bona fide purchasers' rights are performed within twenty-one (21) days or any period expressly allowed by the law, whichever is less. A transfer to secure a future loan, if such a loan is actually made, or a transfer that becomes security for a future loan, shall have the same effect as a transfer for or on account of a new and contemporaneous consideration. (e) If any lien deemed voidable under subdivision (a)(2) has been dissolved by the furnishing of a bond or other obligation, the surety on which has been indemnified directly or indirectly by the transfer of, or the creation of, a lien upon any property of an insurer before the filing of a petition under this chapter that results in a liquidation order, the indemnifying transfer or lien shall also be deemed voidable. (f) The property affected by any lien deemed voidable under subsections (a) and (e) shall be discharged from the lien, and that property and any of the indemnifying property transferred to or for the benefit of a surety shall pass to the liquidator, except that the court may, on due notice, order any such lien to be preserved for the benefit of the estate, and the court may direct that the conveyance be executed as may be proper or adequate to evidence the title of the liquidator. (g) The chancery court of Davidson County has summary jurisdiction of any proceeding by the liquidator to hear and determine the rights of any parties under this section. Reasonable notice of any hearing in the proceeding shall be given to all parties in interest, including the obligee of a releasing bond or other like obligation. Where an order is entered for the recovery of indemnifying property in kind or for the avoidance of an indemnifying lien, the court, upon application of any party in interest, shall in the same proceeding ascertain the value of the property or lien, and if the value is less than the amount for which the property is indemnified or than the amount of the lien, the transferee or lienholder may elect to retain the property or lien upon payment of its value, as ascertained by the court, to the liquidator, within reasonable times as the court shall fix. (h) The liability of the surety under a releasing bond or other like obligation is discharged to the extent of the value of the indemnifying property recovered or the indemnifying lien nullified and avoided by the liquidator, or, where the property is retained under subsection (g), to the extent of the amount paid to the liquidator. (i) If a creditor has been preferred, and afterward in good faith gives the insurer further credit without security of any kind, for property that becomes a part of the insurer's estate, the amount of the new credit remaining unpaid at the time of the petition may be set off against the preference that would otherwise be recoverable from the creditor. (j) If an insurer, directly or indirectly, within four (4) months before the filing of a successful petition for liquidation under this chapter, or at any time in contemplation of a proceeding to liquidate it, pays money or transfers property to an attorney for services rendered or to be rendered, the transactions may be examined by the court on its own motion or shall be examined by the court on petition of the liquidator and shall be held valid only to the extent of a reasonable amount to be determined by the court, and the excess may be recovered by the liquidator for the benefits of the estate; provided, that where the attorney is in a position of influence in the insurer or an affiliate thereof, payment of any money or the transfer of any property to the attorney for services rendered or to be rendered shall be governed by subdivision (a)(2)(D). (k) (1) Every officer, manager, employee, shareholder, member, subscriber, attorney or any other person acting on behalf of the insurer who knowingly participates in giving any preference, when the person has reasonable cause to believe the insurer is, or is about to become, insolvent at the time of the preference, is personally liable to the liquidator for the amount of the preference. It is permissible to infer that there is a reasonable cause to so believe if the transfer was made within four (4) months before the date of filing of the successful petition for liquidation. (2) Every person receiving any property from the insurer or the benefit of the property as a preference voidable under subsection (a) is personally liable therefor and is bound to account to the liquidator. (3) Nothing in this subsection (k) shall prejudice any other claim by the liquidator against any person. (l) Notwithstanding subdivision (a)(2) and any other provision of this title, a liquidator or rehabilitator shall not avoid any preference arising under or in connection with a federal home loan bank security agreement or any pledge agreement, security agreement, collateral agreement, guarantee agreement, or other similar arrangement or credit enhancement relating to a security agreement to which a federal home loan bank is a party. Amended by 2019 Tenn. Acts, ch. 430,s 6, eff. 5/21/2019. Acts 1991, ch. 142, § 4.
(a) (1) A preference is a transfer of any of the property of an insurer to or for the benefit of a creditor, for or on account of an antecedent debt, made or suffered by the insurer within one (1) year before the filing of a successful petition for liquidation under this chapter, the effect of which transfer may be to enable the creditor to obtain a greater percentage of this debt than another creditor of the same class would receive. If a liquidation order is entered while the insurer is already subject to a rehabilitation order, then the transfers shall be deemed preferences if made or suffered within one (1) year before the filing of the successful petition for rehabilitation, or within two (2) years before the filing of the successful petition for liquidation, whichever time is shorter. (2) Any preference may be avoided by the liquidator if: (A) The insurer was insolvent at the time of the transfer; (B) The transfer was made within four (4) months before the filing of the petition; (C) The creditor receiving it or to be benefited thereby or the creditor's agent acting with reference thereto had, at the time when the transfer was made, reasonable cause to believe that the insurer was insolvent or was about to become insolvent; or (D) The creditor receiving it was an officer, or any employee or attorney or other person who was in fact in a position of comparable influence in the insurer to an officer, whether or not the person held the position, or any shareholder holding directly or indirectly more than five percent (5%) of any class of any equity security issued by the insurer, or any other person, firm, corporation, association or aggregation of persons with whom the insurer did not deal at arm's length. (3) Where the preference is voidable, the liquidator may recover the property or, if it has been converted, its value from any person who has received or converted the property, except where a bona fide purchaser or lienor has given less than fair equivalent value, the purchaser or lienor shall have a lien upon the property to the extent of the consideration actually given by the purchaser or lienor. Where a preference by way of lien or security title is voidable, the court may on due notice order the lien or title to be preserved for the benefit of the estate, in which event the lien or title shall pass to the liquidator.
(1) A preference is a transfer of any of the property of an insurer to or for the benefit of a creditor, for or on account of an antecedent debt, made or suffered by the insurer within one (1) year before the filing of a successful petition for liquidation under this chapter, the effect of which transfer may be to enable the creditor to obtain a greater percentage of this debt than another creditor of the same class would receive. If a liquidation order is entered while the insurer is already subject to a rehabilitation order, then the transfers shall be deemed preferences if made or suffered within one (1) year before the filing of the successful petition for rehabilitation, or within two (2) years before the filing of the successful petition for liquidation, whichever time is shorter.
(2) Any preference may be avoided by the liquidator if: (A) The insurer was insolvent at the time of the transfer; (B) The transfer was made within four (4) months before the filing of the petition; (C) The creditor receiving it or to be benefited thereby or the creditor's agent acting with reference thereto had, at the time when the transfer was made, reasonable cause to believe that the insurer was insolvent or was about to become insolvent; or (D) The creditor receiving it was an officer, or any employee or attorney or other person who was in fact in a position of comparable influence in the insurer to an officer, whether or not the person held the position, or any shareholder holding directly or indirectly more than five percent (5%) of any class of any equity security issued by the insurer, or any other person, firm, corporation, association or aggregation of persons with whom the insurer did not deal at arm's length.
(A) The insurer was insolvent at the time of the transfer;
(B) The transfer was made within four (4) months before the filing of the petition;
(C) The creditor receiving it or to be benefited thereby or the creditor's agent acting with reference thereto had, at the time when the transfer was made, reasonable cause to believe that the insurer was insolvent or was about to become insolvent; or
(D) The creditor receiving it was an officer, or any employee or attorney or other person who was in fact in a position of comparable influence in the insurer to an officer, whether or not the person held the position, or any shareholder holding directly or indirectly more than five percent (5%) of any class of any equity security issued by the insurer, or any other person, firm, corporation, association or aggregation of persons with whom the insurer did not deal at arm's length.
(3) Where the preference is voidable, the liquidator may recover the property or, if it has been converted, its value from any person who has received or converted the property, except where a bona fide purchaser or lienor has given less than fair equivalent value, the purchaser or lienor shall have a lien upon the property to the extent of the consideration actually given by the purchaser or lienor. Where a preference by way of lien or security title is voidable, the court may on due notice order the lien or title to be preserved for the benefit of the estate, in which event the lien or title shall pass to the liquidator.
(b) (1) A transfer of property other than real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent lien obtainable by legal or equitable proceedings on a simple contract could become superior to the rights of the transferee. (2) A transfer of real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent bona fide purchaser from the insurer could obtain rights superior to the rights of the transferee. (3) A transfer that creates an equitable lien shall not be deemed to be perfected if there are available means by which a legal lien could be created. (4) A transfer not perfected prior to the filing of a petition for liquidation shall be deemed to be made immediately before the filing of the successful petition. (5) This subsection (b) shall apply whether or not there are or were creditors who might have obtained liens or persons who might have become bona fide purchasers.
(1) A transfer of property other than real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent lien obtainable by legal or equitable proceedings on a simple contract could become superior to the rights of the transferee.
(2) A transfer of real property shall be deemed to be made or suffered when it becomes so far perfected that no subsequent bona fide purchaser from the insurer could obtain rights superior to the rights of the transferee.
(3) A transfer that creates an equitable lien shall not be deemed to be perfected if there are available means by which a legal lien could be created.
(4) A transfer not perfected prior to the filing of a petition for liquidation shall be deemed to be made immediately before the filing of the successful petition.
(5) This subsection (b) shall apply whether or not there are or were creditors who might have obtained liens or persons who might have become bona fide purchasers.
(c) (1) A lien obtainable by legal or equitable proceedings upon a simple contract is one arising in the ordinary course of the proceedings upon the entry or docketing of a judgment or decree, or upon attachment, garnishment, execution, or like process, whether before, upon, or after judgment or decree and whether before or upon levy. It does not include liens which under applicable law are given a special priority over other liens that are prior in time. (2) A lien obtainable by legal or equitable proceedings could become superior to the rights of a transferee, or a purchaser could obtain rights superior to the rights of a transferee within the meaning of subsection (b), if the consequences would follow only from the lien or purchase itself, or from the lien or purchase followed by any step wholly within the control of the respective lienholder or purchaser, with or without the aid of ministerial action by public officials. Such a lien could not, however, become superior and such a purchase could not create superior rights for the purpose of subsection (b) through any acts subsequent to the obtaining of such a lien or subsequent to such a purchase that require the agreement or concurrence of any third party or that require any further judicial action or ruling.
(1) A lien obtainable by legal or equitable proceedings upon a simple contract is one arising in the ordinary course of the proceedings upon the entry or docketing of a judgment or decree, or upon attachment, garnishment, execution, or like process, whether before, upon, or after judgment or decree and whether before or upon levy. It does not include liens which under applicable law are given a special priority over other liens that are prior in time.
(2) A lien obtainable by legal or equitable proceedings could become superior to the rights of a transferee, or a purchaser could obtain rights superior to the rights of a transferee within the meaning of subsection (b), if the consequences would follow only from the lien or purchase itself, or from the lien or purchase followed by any step wholly within the control of the respective lienholder or purchaser, with or without the aid of ministerial action by public officials. Such a lien could not, however, become superior and such a purchase could not create superior rights for the purpose of subsection (b) through any acts subsequent to the obtaining of such a lien or subsequent to such a purchase that require the agreement or concurrence of any third party or that require any further judicial action or ruling.
(d) A transfer of property for or on account of a new and contemporaneous consideration, which is deemed under subsection (b) to be made or suffered after the transfer because of delay in perfecting it, does not thereby become a transfer for or on account of an antecedent debt if any acts required by the applicable law to be performed in order to perfect the transfer as against liens or bona fide purchasers' rights are performed within twenty-one (21) days or any period expressly allowed by the law, whichever is less. A transfer to secure a future loan, if such a loan is actually made, or a transfer that becomes security for a future loan, shall have the same effect as a transfer for or on account of a new and contemporaneous consideration.
(e) If any lien deemed voidable under subdivision (a)(2) has been dissolved by the furnishing of a bond or other obligation, the surety on which has been indemnified directly or indirectly by the transfer of, or the creation of, a lien upon any property of an insurer before the filing of a petition under this chapter that results in a liquidation order, the indemnifying transfer or lien shall also be deemed voidable.
(f) The property affected by any lien deemed voidable under subsections (a) and (e) shall be discharged from the lien, and that property and any of the indemnifying property transferred to or for the benefit of a surety shall pass to the liquidator, except that the court may, on due notice, order any such lien to be preserved for the benefit of the estate, and the court may direct that the conveyance be executed as may be proper or adequate to evidence the title of the liquidator.
(g) The chancery court of Davidson County has summary jurisdiction of any proceeding by the liquidator to hear and determine the rights of any parties under this section. Reasonable notice of any hearing in the proceeding shall be given to all parties in interest, including the obligee of a releasing bond or other like obligation. Where an order is entered for the recovery of indemnifying property in kind or for the avoidance of an indemnifying lien, the court, upon application of any party in interest, shall in the same proceeding ascertain the value of the property or lien, and if the value is less than the amount for which the property is indemnified or than the amount of the lien, the transferee or lienholder may elect to retain the property or lien upon payment of its value, as ascertained by the court, to the liquidator, within reasonable times as the court shall fix.
(h) The liability of the surety under a releasing bond or other like obligation is discharged to the extent of the value of the indemnifying property recovered or the indemnifying lien nullified and avoided by the liquidator, or, where the property is retained under subsection (g), to the extent of the amount paid to the liquidator.
(i) If a creditor has been preferred, and afterward in good faith gives the insurer further credit without security of any kind, for property that becomes a part of the insurer's estate, the amount of the new credit remaining unpaid at the time of the petition may be set off against the preference that would otherwise be recoverable from the creditor.
(j) If an insurer, directly or indirectly, within four (4) months before the filing of a successful petition for liquidation under this chapter, or at any time in contemplation of a proceeding to liquidate it, pays money or transfers property to an attorney for services rendered or to be rendered, the transactions may be examined by the court on its own motion or shall be examined by the court on petition of the liquidator and shall be held valid only to the extent of a reasonable amount to be determined by the court, and the excess may be recovered by the liquidator for the benefits of the estate; provided, that where the attorney is in a position of influence in the insurer or an affiliate thereof, payment of any money or the transfer of any property to the attorney for services rendered or to be rendered shall be governed by subdivision (a)(2)(D).
(k) (1) Every officer, manager, employee, shareholder, member, subscriber, attorney or any other person acting on behalf of the insurer who knowingly participates in giving any preference, when the person has reasonable cause to believe the insurer is, or is about to become, insolvent at the time of the preference, is personally liable to the liquidator for the amount of the preference. It is permissible to infer that there is a reasonable cause to so believe if the transfer was made within four (4) months before the date of filing of the successful petition for liquidation. (2) Every person receiving any property from the insurer or the benefit of the property as a preference voidable under subsection (a) is personally liable therefor and is bound to account to the liquidator. (3) Nothing in this subsection (k) shall prejudice any other claim by the liquidator against any person.
(1) Every officer, manager, employee, shareholder, member, subscriber, attorney or any other person acting on behalf of the insurer who knowingly participates in giving any preference, when the person has reasonable cause to believe the insurer is, or is about to become, insolvent at the time of the preference, is personally liable to the liquidator for the amount of the preference. It is permissible to infer that there is a reasonable cause to so believe if the transfer was made within four (4) months before the date of filing of the successful petition for liquidation.
(2) Every person receiving any property from the insurer or the benefit of the property as a preference voidable under subsection (a) is personally liable therefor and is bound to account to the liquidator.
(3) Nothing in this subsection (k) shall prejudice any other claim by the liquidator against any person.
(l) Notwithstanding subdivision (a)(2) and any other provision of this title, a liquidator or rehabilitator shall not avoid any preference arising under or in connection with a federal home loan bank security agreement or any pledge agreement, security agreement, collateral agreement, guarantee agreement, or other similar arrangement or credit enhancement relating to a security agreement to which a federal home loan bank is a party.
Amended by 2019 Tenn. Acts, ch. 430,s 6, eff. 5/21/2019.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-6-1102 — TN Code / Title 56 / Chapter 6 / Section 56-6-1102
Requirement to hold a limited lines license to sell or offer coverage
Status: in_force

(a) A vendor is required to hold a limited lines license to sell or offer coverage under a policy of portable electronics insurance. A vendor who has met the requirements of this part shall be entitled to a limited lines business entity producer's license, without examination, authorizing the vendor to sell or offer coverage under a policy of portable electronics insurance. (b) A limited lines license issued to a vendor under this section shall authorize any employee or authorized representative of the vendor to sell or offer coverage under a policy of portable electronics insurance to a customer at each location at which the vendor engages in portable electronics transactions. (c) In connection with a vendor's initial application for licensure and at renewal, the vendor shall provide a list to the commissioner of all locations in this state at which the vendor offers coverage. (d) Notwithstanding any law to the contrary, a license issued pursuant to this section shall authorize the licensee and its employees or authorized representatives to engage in activities permitted in this part. Acts 2011, ch. 312, § 3.
(a) A vendor is required to hold a limited lines license to sell or offer coverage under a policy of portable electronics insurance. A vendor who has met the requirements of this part shall be entitled to a limited lines business entity producer's license, without examination, authorizing the vendor to sell or offer coverage under a policy of portable electronics insurance.
(b) A limited lines license issued to a vendor under this section shall authorize any employee or authorized representative of the vendor to sell or offer coverage under a policy of portable electronics insurance to a customer at each location at which the vendor engages in portable electronics transactions.
(c) In connection with a vendor's initial application for licensure and at renewal, the vendor shall provide a list to the commissioner of all locations in this state at which the vendor offers coverage.
(d) Notwithstanding any law to the contrary, a license issued pursuant to this section shall authorize the licensee and its employees or authorized representatives to engage in activities permitted in this part.
Acts 2011, ch. 312, § 3.
Tenn. Code Ann. § 56-46-102 — TN Code / Title 56 / Chapter 46 / Section 56-46-102
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Adjusted RBC Report" means an RBC report that has been adjusted by the commissioner in accordance with § 56-46-103(e) ; (2) "Corrective order" means an order issued by the commissioner specifying corrective actions that the commissioner has determined are required; (3) "Domestic insurer" means any insurance company domiciled in Tennessee; (4) "Foreign insurer" means any insurance company that is licensed to do business in Tennessee under this title but is not domiciled in Tennessee; (5) "Life and/or health insurer" means any insurance company licensed for those lines in Tennessee, or a property and casualty insurer writing only accident and health insurance; (6) "NAIC" means the National Association of Insurance Commissioners; (7) "Negative trend" means, with respect to a life and/or health insurer, negative trend over a period of time, as determined in accordance with the "Trend Test Calculation" included in the RBC Instructions; (8) "Property and casualty insurer" means any insurance company licensed in those lines in Tennessee, but does not include monoline mortgage guaranty insurers, financial guaranty insurers and title insurers; (9) "RBC Instructions" means the RBC Report including risk-based capital instructions adopted by the NAIC, as the RBC Instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC; (10) "RBC Level" means an insurer's Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level RBC, or Mandatory Control Level RBC where: (A) "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions; (B) "Company Action Level RBC" means, with respect to any insurer, the product of 2.0 and its Authorized Control Level RBC; (C) "Mandatory Control Level RBC" means the product of 0.70 and the authorized Control Level RBC; and (D) "Regulatory Action Level RBC" means the product of 1.5 and its authorized Control Level RBC; (11) "RBC Plan" means a comprehensive financial plan containing the elements specified in § 56-46-104(b) . If the commissioner rejects the RBC Plan, and it is revised by the insurer, with or without the commissioner's recommendation, the plan shall be called the "Revised RBC Plan"; (12) "RBC Report" means the report required in § 56-46-103 ; and (13) "Total adjusted capital" means the sum of: (A) An insurer's statutory capital and surplus as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed pursuant to § 56-1-501 ; and (B) The other items, if any, that the RBC Instructions may provide. Amended by 2014 Tenn. Acts, ch. 559,Secs.s1, s2 eff. 3/21/2014. Acts 1996, ch. 750, § 3.
As used in this part, unless the context otherwise requires:
(1) "Adjusted RBC Report" means an RBC report that has been adjusted by the commissioner in accordance with § 56-46-103(e) ;
(2) "Corrective order" means an order issued by the commissioner specifying corrective actions that the commissioner has determined are required;
(3) "Domestic insurer" means any insurance company domiciled in Tennessee;
(4) "Foreign insurer" means any insurance company that is licensed to do business in Tennessee under this title but is not domiciled in Tennessee;
(5) "Life and/or health insurer" means any insurance company licensed for those lines in Tennessee, or a property and casualty insurer writing only accident and health insurance;
(6) "NAIC" means the National Association of Insurance Commissioners;
(7) "Negative trend" means, with respect to a life and/or health insurer, negative trend over a period of time, as determined in accordance with the "Trend Test Calculation" included in the RBC Instructions;
(8) "Property and casualty insurer" means any insurance company licensed in those lines in Tennessee, but does not include monoline mortgage guaranty insurers, financial guaranty insurers and title insurers;
(9) "RBC Instructions" means the RBC Report including risk-based capital instructions adopted by the NAIC, as the RBC Instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC;
(10) "RBC Level" means an insurer's Company Action Level RBC, Regulatory Action Level RBC, Authorized Control Level RBC, or Mandatory Control Level RBC where: (A) "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions; (B) "Company Action Level RBC" means, with respect to any insurer, the product of 2.0 and its Authorized Control Level RBC; (C) "Mandatory Control Level RBC" means the product of 0.70 and the authorized Control Level RBC; and (D) "Regulatory Action Level RBC" means the product of 1.5 and its authorized Control Level RBC;
(A) "Authorized Control Level RBC" means the number determined under the risk-based capital formula in accordance with the RBC Instructions;
(B) "Company Action Level RBC" means, with respect to any insurer, the product of 2.0 and its Authorized Control Level RBC;
(C) "Mandatory Control Level RBC" means the product of 0.70 and the authorized Control Level RBC; and
(D) "Regulatory Action Level RBC" means the product of 1.5 and its authorized Control Level RBC;
(11) "RBC Plan" means a comprehensive financial plan containing the elements specified in § 56-46-104(b) . If the commissioner rejects the RBC Plan, and it is revised by the insurer, with or without the commissioner's recommendation, the plan shall be called the "Revised RBC Plan";
(12) "RBC Report" means the report required in § 56-46-103 ; and
(13) "Total adjusted capital" means the sum of: (A) An insurer's statutory capital and surplus as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed pursuant to § 56-1-501 ; and (B) The other items, if any, that the RBC Instructions may provide.
(A) An insurer's statutory capital and surplus as determined in accordance with the statutory accounting applicable to the annual financial statements required to be filed pursuant to § 56-1-501 ; and
(B) The other items, if any, that the RBC Instructions may provide.
Amended by 2014 Tenn. Acts, ch. 559,Secs.s1, s2 eff. 3/21/2014.
Acts 1996, ch. 750, § 3.
Tenn. Code Ann. § 56-7-3704 — TN Code / Title 56 / Chapter 7 / Section 56-7-3704
Appeals of an electronic and non-electronic initial adverse determination
Status: in_force

(a) (1) For prior authorization adverse determination appeals submitted electronically, a utilization review organization shall ensure that such appeals are reviewed or made by a licensed physician or healthcare professional with the same or a similar specialty as the healthcare professional who requested the initial prior authorization. The reviewing healthcare professional shall: (A) Possess a current and valid non-restricted license to practice in this state or another state or territory of the United States; (B) Be knowledgeable of, and have experience providing, the healthcare services under appeal; (C) Not have been directly involved in making the adverse determination; and (D) Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical records provided by the enrollee's healthcare provider, and any medical literature provided. (2) Utilization review organizations shall perform: (A) A non-urgent prior authorization review within seven (7) calendar days; and (B) An urgent care prior authorization review within seventy-two (72) hours, plus, if applicable, one (1) additional business day. (3) A health carrier or utilization review organization, or a healthcare professional on its behalf, shall not receive compensation as an incentive for issuing an adverse decision. (b) (1) Utilization review organizations shall review all prior authorization adverse determination appeals that are not submitted electronically in accordance with standards set by the National Committee on Quality Assurance. (2) For purposes of this part, prior authorization appeals submitted via facsimile are not submitted electronically. Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
(a) (1) For prior authorization adverse determination appeals submitted electronically, a utilization review organization shall ensure that such appeals are reviewed or made by a licensed physician or healthcare professional with the same or a similar specialty as the healthcare professional who requested the initial prior authorization. The reviewing healthcare professional shall: (A) Possess a current and valid non-restricted license to practice in this state or another state or territory of the United States; (B) Be knowledgeable of, and have experience providing, the healthcare services under appeal; (C) Not have been directly involved in making the adverse determination; and (D) Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical records provided by the enrollee's healthcare provider, and any medical literature provided. (2) Utilization review organizations shall perform: (A) A non-urgent prior authorization review within seven (7) calendar days; and (B) An urgent care prior authorization review within seventy-two (72) hours, plus, if applicable, one (1) additional business day. (3) A health carrier or utilization review organization, or a healthcare professional on its behalf, shall not receive compensation as an incentive for issuing an adverse decision.
(1) For prior authorization adverse determination appeals submitted electronically, a utilization review organization shall ensure that such appeals are reviewed or made by a licensed physician or healthcare professional with the same or a similar specialty as the healthcare professional who requested the initial prior authorization. The reviewing healthcare professional shall: (A) Possess a current and valid non-restricted license to practice in this state or another state or territory of the United States; (B) Be knowledgeable of, and have experience providing, the healthcare services under appeal; (C) Not have been directly involved in making the adverse determination; and (D) Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical records provided by the enrollee's healthcare provider, and any medical literature provided.
(A) Possess a current and valid non-restricted license to practice in this state or another state or territory of the United States;
(B) Be knowledgeable of, and have experience providing, the healthcare services under appeal;
(C) Not have been directly involved in making the adverse determination; and
(D) Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical records provided by the enrollee's healthcare provider, and any medical literature provided.
(2) Utilization review organizations shall perform: (A) A non-urgent prior authorization review within seven (7) calendar days; and (B) An urgent care prior authorization review within seventy-two (72) hours, plus, if applicable, one (1) additional business day.
(A) A non-urgent prior authorization review within seven (7) calendar days; and
(B) An urgent care prior authorization review within seventy-two (72) hours, plus, if applicable, one (1) additional business day.
(3) A health carrier or utilization review organization, or a healthcare professional on its behalf, shall not receive compensation as an incentive for issuing an adverse decision.
(b) (1) Utilization review organizations shall review all prior authorization adverse determination appeals that are not submitted electronically in accordance with standards set by the National Committee on Quality Assurance. (2) For purposes of this part, prior authorization appeals submitted via facsimile are not submitted electronically.
(1) Utilization review organizations shall review all prior authorization adverse determination appeals that are not submitted electronically in accordance with standards set by the National Committee on Quality Assurance.
(2) For purposes of this part, prior authorization appeals submitted via facsimile are not submitted electronically.
Amended by 2023 Tenn. Acts, ch. 395, s 4, eff. 1/1/2025.
Tenn. Code Ann. § 56-11-113 — TN Code / Title 56 / Chapter 11 / Section 56-11-113
Order of liquidation or rehabilitation - Recovery by receivers
Status: in_force

(a) If an order for liquidation or rehabilitation of a domestic insurer or health maintenance organization has been entered, the receiver appointed under the order shall have a right to recover on behalf of the insurer or health maintenance organization: (1) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer or health maintenance organization, the amount of distributions, other than distributions of shares of the same class of stock, paid by the insurer or health maintenance organization on its capital stock; or (2) Any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or health maintenance organization or its subsidiaries to a director, officer or employee, where the distribution or payment pursuant to subdivision (a)(1) or (a)(2) is made at any time during the one (1) year preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (b)-(d). (b) No such distribution shall be recoverable if the parent or affiliate shows that when paid the distribution was lawful and reasonable, and that the insurer or health maintenance organization did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer or health maintenance organization to fulfill its contractual obligations. (c) Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or health maintenance organization or affiliate at the time the distributions were paid, shall be liable up to the amount of distributions or payments the person received under subsection (a). Any person who otherwise controlled the insurer or health maintenance organization at the time the distributions were declared shall be liable up to the amount of distributions the person would have received had the person been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable. (d) The maximum amount recoverable under this section shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer or health maintenance organization to pay the contractual obligations of the impaired or insolvent insurer or health maintenance organization and to reimburse any guaranty funds. (e) To the extent that any person liable under subsection (c) is insolvent or otherwise fails to pay claims due from it pursuant to subsection (c), its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid shall be jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it. Amended by 2014 Tenn. Acts, ch. 583,Secs.s23, s24 eff. 3/28/2014. Acts 1986, ch. 572, § 13; 2000, ch. 708, § 3k; T.C.A. § 56-11-213.
(a) If an order for liquidation or rehabilitation of a domestic insurer or health maintenance organization has been entered, the receiver appointed under the order shall have a right to recover on behalf of the insurer or health maintenance organization: (1) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer or health maintenance organization, the amount of distributions, other than distributions of shares of the same class of stock, paid by the insurer or health maintenance organization on its capital stock; or (2) Any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or health maintenance organization or its subsidiaries to a director, officer or employee, where the distribution or payment pursuant to subdivision (a)(1) or (a)(2) is made at any time during the one (1) year preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (b)-(d).
(1) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer or health maintenance organization, the amount of distributions, other than distributions of shares of the same class of stock, paid by the insurer or health maintenance organization on its capital stock; or
(2) Any payment in the form of a bonus, termination settlement or extraordinary lump sum salary adjustment made by the insurer or health maintenance organization or its subsidiaries to a director, officer or employee, where the distribution or payment pursuant to subdivision (a)(1) or (a)(2) is made at any time during the one (1) year preceding the petition for liquidation, conservation or rehabilitation, as the case may be, subject to the limitations of subsections (b)-(d).
(b) No such distribution shall be recoverable if the parent or affiliate shows that when paid the distribution was lawful and reasonable, and that the insurer or health maintenance organization did not know and could not reasonably have known that the distribution might adversely affect the ability of the insurer or health maintenance organization to fulfill its contractual obligations.
(c) Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or health maintenance organization or affiliate at the time the distributions were paid, shall be liable up to the amount of distributions or payments the person received under subsection (a). Any person who otherwise controlled the insurer or health maintenance organization at the time the distributions were declared shall be liable up to the amount of distributions the person would have received had the person been paid immediately. If two (2) or more persons are liable with respect to the same distributions, they shall be jointly and severally liable.
(d) The maximum amount recoverable under this section shall be the amount needed in excess of all other available assets of the impaired or insolvent insurer or health maintenance organization to pay the contractual obligations of the impaired or insolvent insurer or health maintenance organization and to reimburse any guaranty funds.
(e) To the extent that any person liable under subsection (c) is insolvent or otherwise fails to pay claims due from it pursuant to subsection (c), its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid shall be jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it.
Amended by 2014 Tenn. Acts, ch. 583,Secs.s23, s24 eff. 3/28/2014.
Acts 1986, ch. 572, § 13; 2000, ch. 708, § 3k; T.C.A. § 56-11-213.
Tenn. Code Ann. § 56-1-906 — TN Code / Title 56 / Chapter 1 / Section 56-1-906
Calendar year statutory valuation interest rates
Status: in_force

(a) The interest rates used in determining the minimum standard for the valuation of the following shall be the calendar year statutory valuation interest rates as defined in this section: (1) Life insurance policies issued in a particular calendar year, on or after the operative date of § 56-7-401(h) ; (2) Individual annuity and pure endowment contracts issued in a particular calendar year, on or after January 1, 1983; (3) Annuities and pure endowments purchased in a particular calendar year, on or after January 1, 1983, under group annuity and pure endowment contracts; and (4) The net increase, if any, in a particular calendar year after January 1, 1983, in amounts held under guaranteed interest contracts. (b) For calendar year statutory valuation interest rates: (1) The calendar year statutory valuation interest rates, I , shall be determined as follows and the results rounded to the nearer one-quarter of one percent (0.25%), where R 1 is the lesser of R and 0.09, R 2 is the greater of R and 0.09, R is the reference interest rate defined in this section, and W is the weighting factor defined in this section: (A) For life insurance: Click here to view formula. (B) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options: Click here to view formula. (C) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in subdivision (b)(1)(B), the formula for life insurance in subdivision (b)(1)(A) shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of ten (10) years and the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply to annuities and guaranteed interest contracts with guarantee duration of ten (10) years or less; (D) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply; (E) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply; (2) (A) However, if the calendar year statutory valuation interest rate for a life insurance policy issued in any calendar year determined without reference to this subdivision (b)(2)(A) differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one half of one percent (0.5%), the calendar year statutory valuation interest rate for the life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year; (B) For purposes of applying subdivision (b)(2)(A), the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980, using the reference interest rate defined in 1979, and shall be determined for each subsequent calendar year regardless of when § 56-7-401(h) becomes operative; (c) The weighting factors referred to in the formulas described in subsection (b) are given in the following tables: (1) (A) Weighting factors for life insurance: Guarantee Duration (Years) Weighting Factors 10 or less 0.50 More than 10, but not more than 20 0.45 More than 20 0.35 (B) For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both which are guaranteed in the original policy; (2) Weighting factor for single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options: 0.80; (3) Weighting factors for other annuities and for guaranteed interest contracts, except as provided in subdivision (c)(2), shall be as specified in subdivisions (c)(3)(A), (B) and (C), according to the rules and definitions in subdivisions (c)(3)(D), (E) and (F): (A) For annuities and guaranteed interest contracts valued on an issue year basis: Guarantee Duration Weighting Factor for Plan Type (Years) A B C 5 or less: 0.80 0.60 0.50 More than 5, but not more than 10: 0.75 0.60 0.50 More than 10, but not more than 20: 0.65 0.50 0.45 More than 20: 0.45 0.35 0.35 (B) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors in subdivision (c)(3)(A) increased by: For Plan Type A B C 0.15 0.25 0.05 (C) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, that do not guarantee interest on considerations received more than one (1) year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than twelve (12) months beyond the valuation date, the factors in subdivision (c)(3)(A) or derived in subdivision (c)(3)(B) increased by: For Plan Type A B C 0.05 0.05 0.05 (D) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guarantee duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee duration in excess of twenty (20) years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence. (E) Plan type as used in subdivisions (c)(3)(A)-(C) is defined as follows: (i) Plan Type A: At any time policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but installments over five (5) years or more; (c) As an immediate life annuity; or (d) No withdrawal permitted; (ii) Plan Type B: Before expiration of the interest rate guarantee, policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but in installments over five (5) years or more; (c) No withdrawal permitted; or (d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years; (iii) Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five (5) years either: (a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or (b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund. (F) (i) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. (ii) As used in this section, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund. (d) The reference interest rate referred to in subsection (b) means: (1) For life insurance, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year preceding the year of issue, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (2) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or year of purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (3) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration in excess of ten (10) years, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (4) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration of ten (10) years or less, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (5) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; or (6) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, except as stated in subdivision (d)(2), the average over a period of twelve (12) months, ending on June 30 of the calendar year of the change in the fund, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc. (e) For alternative method for determining reference interest rates, in the event that the monthly average of the composite yield on seasoned corporate bonds is no longer published by Moody's Investors Service, Inc., or in the event that the NAIC determines that the monthly average of the composite yield on seasoned corporate bonds as published by Moody's Investors Service, Inc., is no longer appropriate for the determination of the reference interest rate, then an alternative method for determination of the reference interest rate adopted by the NAIC and approved by regulations promulgated by the commissioner may be substituted. Added by 2013 Tenn. Acts, ch. 260, s 3, eff. 7/1/2013.
(a) The interest rates used in determining the minimum standard for the valuation of the following shall be the calendar year statutory valuation interest rates as defined in this section: (1) Life insurance policies issued in a particular calendar year, on or after the operative date of § 56-7-401(h) ; (2) Individual annuity and pure endowment contracts issued in a particular calendar year, on or after January 1, 1983; (3) Annuities and pure endowments purchased in a particular calendar year, on or after January 1, 1983, under group annuity and pure endowment contracts; and (4) The net increase, if any, in a particular calendar year after January 1, 1983, in amounts held under guaranteed interest contracts.
(1) Life insurance policies issued in a particular calendar year, on or after the operative date of § 56-7-401(h) ;
(2) Individual annuity and pure endowment contracts issued in a particular calendar year, on or after January 1, 1983;
(3) Annuities and pure endowments purchased in a particular calendar year, on or after January 1, 1983, under group annuity and pure endowment contracts; and
(4) The net increase, if any, in a particular calendar year after January 1, 1983, in amounts held under guaranteed interest contracts.
(b) For calendar year statutory valuation interest rates: (1) The calendar year statutory valuation interest rates, I , shall be determined as follows and the results rounded to the nearer one-quarter of one percent (0.25%), where R 1 is the lesser of R and 0.09, R 2 is the greater of R and 0.09, R is the reference interest rate defined in this section, and W is the weighting factor defined in this section: (A) For life insurance: Click here to view formula. (B) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options: Click here to view formula. (C) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in subdivision (b)(1)(B), the formula for life insurance in subdivision (b)(1)(A) shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of ten (10) years and the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply to annuities and guaranteed interest contracts with guarantee duration of ten (10) years or less; (D) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply; (E) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply; (2) (A) However, if the calendar year statutory valuation interest rate for a life insurance policy issued in any calendar year determined without reference to this subdivision (b)(2)(A) differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one half of one percent (0.5%), the calendar year statutory valuation interest rate for the life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year; (B) For purposes of applying subdivision (b)(2)(A), the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980, using the reference interest rate defined in 1979, and shall be determined for each subsequent calendar year regardless of when § 56-7-401(h) becomes operative;
(1) The calendar year statutory valuation interest rates, I , shall be determined as follows and the results rounded to the nearer one-quarter of one percent (0.25%), where R 1 is the lesser of R and 0.09, R 2 is the greater of R and 0.09, R is the reference interest rate defined in this section, and W is the weighting factor defined in this section: (A) For life insurance: Click here to view formula. (B) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options: Click here to view formula. (C) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in subdivision (b)(1)(B), the formula for life insurance in subdivision (b)(1)(A) shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of ten (10) years and the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply to annuities and guaranteed interest contracts with guarantee duration of ten (10) years or less; (D) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply; (E) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply;
(A) For life insurance: Click here to view formula.
Click here to view formula.
(B) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and from guaranteed interest contracts with cash settlement options: Click here to view formula.
Click here to view formula.
(C) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on an issue year basis, except as stated in subdivision (b)(1)(B), the formula for life insurance in subdivision (b)(1)(A) shall apply to annuities and guaranteed interest contracts with guarantee durations in excess of ten (10) years and the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply to annuities and guaranteed interest contracts with guarantee duration of ten (10) years or less;
(D) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply;
(E) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, the formula for single premium immediate annuities in subdivision (b)(1)(B) shall apply;
(2) (A) However, if the calendar year statutory valuation interest rate for a life insurance policy issued in any calendar year determined without reference to this subdivision (b)(2)(A) differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one half of one percent (0.5%), the calendar year statutory valuation interest rate for the life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year; (B) For purposes of applying subdivision (b)(2)(A), the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980, using the reference interest rate defined in 1979, and shall be determined for each subsequent calendar year regardless of when § 56-7-401(h) becomes operative;
(A) However, if the calendar year statutory valuation interest rate for a life insurance policy issued in any calendar year determined without reference to this subdivision (b)(2)(A) differs from the corresponding actual rate for similar policies issued in the immediately preceding calendar year by less than one half of one percent (0.5%), the calendar year statutory valuation interest rate for the life insurance policies shall be equal to the corresponding actual rate for the immediately preceding calendar year;
(B) For purposes of applying subdivision (b)(2)(A), the calendar year statutory valuation interest rate for life insurance policies issued in a calendar year shall be determined for 1980, using the reference interest rate defined in 1979, and shall be determined for each subsequent calendar year regardless of when § 56-7-401(h) becomes operative;
(c) The weighting factors referred to in the formulas described in subsection (b) are given in the following tables: (1) (A) Weighting factors for life insurance: Guarantee Duration (Years) Weighting Factors 10 or less 0.50 More than 10, but not more than 20 0.45 More than 20 0.35 (B) For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both which are guaranteed in the original policy; (2) Weighting factor for single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options: 0.80; (3) Weighting factors for other annuities and for guaranteed interest contracts, except as provided in subdivision (c)(2), shall be as specified in subdivisions (c)(3)(A), (B) and (C), according to the rules and definitions in subdivisions (c)(3)(D), (E) and (F): (A) For annuities and guaranteed interest contracts valued on an issue year basis: Guarantee Duration Weighting Factor for Plan Type (Years) A B C 5 or less: 0.80 0.60 0.50 More than 5, but not more than 10: 0.75 0.60 0.50 More than 10, but not more than 20: 0.65 0.50 0.45 More than 20: 0.45 0.35 0.35 (B) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors in subdivision (c)(3)(A) increased by: For Plan Type A B C 0.15 0.25 0.05 (C) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, that do not guarantee interest on considerations received more than one (1) year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than twelve (12) months beyond the valuation date, the factors in subdivision (c)(3)(A) or derived in subdivision (c)(3)(B) increased by: For Plan Type A B C 0.05 0.05 0.05 (D) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guarantee duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee duration in excess of twenty (20) years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence. (E) Plan type as used in subdivisions (c)(3)(A)-(C) is defined as follows: (i) Plan Type A: At any time policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but installments over five (5) years or more; (c) As an immediate life annuity; or (d) No withdrawal permitted; (ii) Plan Type B: Before expiration of the interest rate guarantee, policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but in installments over five (5) years or more; (c) No withdrawal permitted; or (d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years; (iii) Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five (5) years either: (a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or (b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund. (F) (i) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. (ii) As used in this section, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.
(1) (A) Weighting factors for life insurance: Guarantee Duration (Years) Weighting Factors 10 or less 0.50 More than 10, but not more than 20 0.45 More than 20 0.35 (B) For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both which are guaranteed in the original policy;
(A) Weighting factors for life insurance: Guarantee Duration (Years) Weighting Factors 10 or less 0.50 More than 10, but not more than 20 0.45 More than 20 0.35
Guarantee Duration (Years) Weighting Factors 10 or less 0.50 More than 10, but not more than 20 0.45 More than 20 0.35
Guarantee Duration (Years)
Weighting Factors
10 or less
0.50
More than 10, but not more than 20
0.45
More than 20
0.35
(B) For life insurance, the guarantee duration is the maximum number of years the life insurance can remain in force on a basis guaranteed in the policy or under options to convert to plans of life insurance with premium rates or nonforfeiture values or both which are guaranteed in the original policy;
(2) Weighting factor for single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options: 0.80;
(3) Weighting factors for other annuities and for guaranteed interest contracts, except as provided in subdivision (c)(2), shall be as specified in subdivisions (c)(3)(A), (B) and (C), according to the rules and definitions in subdivisions (c)(3)(D), (E) and (F): (A) For annuities and guaranteed interest contracts valued on an issue year basis: Guarantee Duration Weighting Factor for Plan Type (Years) A B C 5 or less: 0.80 0.60 0.50 More than 5, but not more than 10: 0.75 0.60 0.50 More than 10, but not more than 20: 0.65 0.50 0.45 More than 20: 0.45 0.35 0.35 (B) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors in subdivision (c)(3)(A) increased by: For Plan Type A B C 0.15 0.25 0.05 (C) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, that do not guarantee interest on considerations received more than one (1) year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than twelve (12) months beyond the valuation date, the factors in subdivision (c)(3)(A) or derived in subdivision (c)(3)(B) increased by: For Plan Type A B C 0.05 0.05 0.05 (D) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guarantee duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee duration in excess of twenty (20) years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence. (E) Plan type as used in subdivisions (c)(3)(A)-(C) is defined as follows: (i) Plan Type A: At any time policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but installments over five (5) years or more; (c) As an immediate life annuity; or (d) No withdrawal permitted; (ii) Plan Type B: Before expiration of the interest rate guarantee, policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but in installments over five (5) years or more; (c) No withdrawal permitted; or (d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years; (iii) Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five (5) years either: (a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or (b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund. (F) (i) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. (ii) As used in this section, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.
(A) For annuities and guaranteed interest contracts valued on an issue year basis: Guarantee Duration Weighting Factor for Plan Type (Years) A B C 5 or less: 0.80 0.60 0.50 More than 5, but not more than 10: 0.75 0.60 0.50 More than 10, but not more than 20: 0.65 0.50 0.45 More than 20: 0.45 0.35 0.35
Guarantee Duration Weighting Factor for Plan Type (Years) A B C 5 or less: 0.80 0.60 0.50 More than 5, but not more than 10: 0.75 0.60 0.50 More than 10, but not more than 20: 0.65 0.50 0.45 More than 20: 0.45 0.35 0.35
Guarantee Duration
Weighting Factor for Plan Type
(Years)
A
B
C
5 or less:
0.80
0.60
0.50
More than 5, but not more than 10:
0.75
0.60
0.50
More than 10, but not more than 20:
0.65
0.50
0.45
More than 20:
0.45
0.35
(B) For annuities and guaranteed interest contracts valued on a change in fund basis, the factors in subdivision (c)(3)(A) increased by: For Plan Type A B C 0.15 0.25 0.05
For Plan Type A B C 0.15 0.25 0.05
For Plan Type
A
B
C
0.15
0.25
0.05
(C) For annuities and guaranteed interest contracts valued on an issue year basis, other than those with no cash settlement options, that do not guarantee interest on considerations received more than one (1) year after issue or purchase and for annuities and guaranteed interest contracts valued on a change in fund basis that do not guarantee interest rates on considerations received more than twelve (12) months beyond the valuation date, the factors in subdivision (c)(3)(A) or derived in subdivision (c)(3)(B) increased by: For Plan Type A B C 0.05 0.05 0.05
For Plan Type A B C 0.05 0.05 0.05
For Plan Type
A
B
C
0.05
(D) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the guarantee duration is the number of years for which the contract guarantees interest rates in excess of the calendar year statutory valuation interest rate for life insurance policies with guarantee duration in excess of twenty (20) years. For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the guaranteed duration is the number of years from the date of issue or date of purchase to the date annuity benefits are scheduled to commence.
(E) Plan type as used in subdivisions (c)(3)(A)-(C) is defined as follows: (i) Plan Type A: At any time policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but installments over five (5) years or more; (c) As an immediate life annuity; or (d) No withdrawal permitted; (ii) Plan Type B: Before expiration of the interest rate guarantee, policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but in installments over five (5) years or more; (c) No withdrawal permitted; or (d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years; (iii) Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five (5) years either: (a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or (b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund.
(i) Plan Type A: At any time policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but installments over five (5) years or more; (c) As an immediate life annuity; or (d) No withdrawal permitted;
(a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company;
(b) Without an adjustment but installments over five (5) years or more;
(c) As an immediate life annuity; or
(d) No withdrawal permitted;
(ii) Plan Type B: Before expiration of the interest rate guarantee, policyholder may withdraw funds only: (a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; (b) Without an adjustment but in installments over five (5) years or more; (c) No withdrawal permitted; or (d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years;
(a) With an adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company;
(b) Without an adjustment but in installments over five (5) years or more;
(c) No withdrawal permitted; or
(d) At the end of interest rate guarantee, funds may be withdrawn without an adjustment in a single sum or installments over less than five (5) years;
(iii) Plan Type C: Policyholder may withdraw funds before expiration of interest rate guarantee in a single sum or installments over less than five (5) years either: (a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or (b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund.
(a) Without adjustment to reflect changes in interest rates or asset values since receipt of the funds by the insurance company; or
(b) Subject only to a fixed surrender charge stipulated in the contract as a percentage of the fund.
(F) (i) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis. (ii) As used in this section, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.
(i) A company may elect to value guaranteed interest contracts with cash settlement options and annuities with cash settlement options on either an issue year basis or on a change in fund basis. Guaranteed interest contracts with no cash settlement options and other annuities with no cash settlement options must be valued on an issue year basis.
(ii) As used in this section, an issue year basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard for the entire duration of the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of issue or year of purchase of the annuity or guaranteed interest contract, and the change in fund basis of valuation refers to a valuation basis under which the interest rate used to determine the minimum valuation standard applicable to each change in the fund held under the annuity or guaranteed interest contract is the calendar year valuation interest rate for the year of the change in the fund.
(d) The reference interest rate referred to in subsection (b) means: (1) For life insurance, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year preceding the year of issue, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (2) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or year of purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (3) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration in excess of ten (10) years, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (4) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration of ten (10) years or less, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; (5) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; or (6) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, except as stated in subdivision (d)(2), the average over a period of twelve (12) months, ending on June 30 of the calendar year of the change in the fund, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.
(1) For life insurance, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year preceding the year of issue, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.;
(2) For single premium immediate annuities and for annuity benefits involving life contingencies arising from other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or year of purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.;
(3) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration in excess of ten (10) years, the lesser of the average over a period of thirty-six (36) months and the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.;
(4) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a year of issue basis, except as stated in subdivision (d)(2), with guarantee duration of ten (10) years or less, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.;
(5) For other annuities with no cash settlement options and for guaranteed interest contracts with no cash settlement options, the average over a period of twelve (12) months, ending on June 30 of the calendar year of issue or purchase, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.; or
(6) For other annuities with cash settlement options and guaranteed interest contracts with cash settlement options, valued on a change in fund basis, except as stated in subdivision (d)(2), the average over a period of twelve (12) months, ending on June 30 of the calendar year of the change in the fund, of the monthly average of the composite yield on seasoned corporate bonds, as published by Moody's Investors Service, Inc.
(e) For alternative method for determining reference interest rates, in the event that the monthly average of the composite yield on seasoned corporate bonds is no longer published by Moody's Investors Service, Inc., or in the event that the NAIC determines that the monthly average of the composite yield on seasoned corporate bonds as published by Moody's Investors Service, Inc., is no longer appropriate for the determination of the reference interest rate, then an alternative method for determination of the reference interest rate adopted by the NAIC and approved by regulations promulgated by the commissioner may be substituted.
Added by 2013 Tenn. Acts, ch. 260, s 3, eff. 7/1/2013.
1_906_1 - Attachment
1_906_2 - Attachment
Tenn. Code Ann. § 56-6-103 — TN Code / Title 56 / Chapter 6 / Section 56-6-103
License required
Status: in_force

A person shall not sell, solicit or negotiate insurance in this state for any class or classes of insurance unless the person is licensed for that line of authority in accordance with this part. Acts 2002, ch. 798, § 4.
A person shall not sell, solicit or negotiate insurance in this state for any class or classes of insurance unless the person is licensed for that line of authority in accordance with this part.
Acts 2002, ch. 798, § 4.
Tenn. Code Ann. § 56-7-705 — TN Code / Title 56 / Chapter 7 / Section 56-7-705
Misrepresentations as to terms, benefits, or advantages of industrial life, health or accident insurance policies forbidden - "Industrial insurance" defined
Status: in_force

No insurance company or association transacting an industrial life, health, or accident business in this state, and no officer, director, or agent thereof, shall knowingly issue, circulate, or cause to be issued or circulated, any estimate, illustration, circular, or statement of any sort misrepresenting the terms of any policy issued by it, or the benefits or advantages promised by the policy, or dividends or shares or surplus to be received on the policy, or shall use any name or title of any policy or class of policies that misrepresent the true nature of the policy; provided, that "industrial insurance", as used in this section, means insurance on which the premiums are payable in weekly installments. Acts 1917, ch. 7, § 1; Shan., § 3369a150; Code 1932, § 6443; T.C.A. (orig. ed.), § 56-1132; Acts 1989, ch. 591, § 113.
No insurance company or association transacting an industrial life, health, or accident business in this state, and no officer, director, or agent thereof, shall knowingly issue, circulate, or cause to be issued or circulated, any estimate, illustration, circular, or statement of any sort misrepresenting the terms of any policy issued by it, or the benefits or advantages promised by the policy, or dividends or shares or surplus to be received on the policy, or shall use any name or title of any policy or class of policies that misrepresent the true nature of the policy; provided, that "industrial insurance", as used in this section, means insurance on which the premiums are payable in weekly installments.
Acts 1917, ch. 7, § 1; Shan., § 3369a150; Code 1932, § 6443; T.C.A. (orig. ed.), § 56-1132; Acts 1989, ch. 591, § 113.
Tenn. Code Ann. § 56-40-101 — TN Code / Title 56 / Chapter 40 / Section 56-40-101
Annual registration - Exclusion of catastrophic loss
Status: in_force

(a) Each plan that purchases a contract of insurance that provides for indemnification of claims made by plan participants, except in the event of a catastrophic loss, shall register annually with the department of commerce and insurance, in the manner and on forms prescribed by the department. (b) "Catastrophic loss," as used in this section, means any contract of insurance that provides for indemnification of claims made by plan participants in the amount of twenty-five thousand dollars ($25,000) or more per individual participant or an accumulated loss in any one (1) plan contract year in the amount of and over one hundred fifty thousand dollars ($150,000) for the employee plan. Acts 1987, ch. 365, § 1.
(a) Each plan that purchases a contract of insurance that provides for indemnification of claims made by plan participants, except in the event of a catastrophic loss, shall register annually with the department of commerce and insurance, in the manner and on forms prescribed by the department.
(b) "Catastrophic loss," as used in this section, means any contract of insurance that provides for indemnification of claims made by plan participants in the amount of twenty-five thousand dollars ($25,000) or more per individual participant or an accumulated loss in any one (1) plan contract year in the amount of and over one hundred fifty thousand dollars ($150,000) for the employee plan.
Acts 1987, ch. 365, § 1.
Tenn. Code Ann. § 56-13-406 — TN Code / Title 56 / Chapter 13 / Section 56-13-406
Minimum capitalization
Status: in_force

(a) An SPFC shall initially possess and maintain, minimum capitalization of not less than two hundred and fifty thousand dollars ($250,000). All of the minimum initial capitalization shall be in cash. All other funds of the SPFC in excess of its minimum initial capitalization shall be in the form of cash, cash equivalent, or securities invested as approved by the commissioner. (b) Additional capitalization for the SPFC shall be determined, if so required, by the commissioner after giving due consideration to the SPFC's plan of operation, feasibility study, pro-formas, and the nature of the risks being insured or reinsured, which may be prescribed in formulas approved by the commissioner. Acts 2011, ch. 468, § 1.
(a) An SPFC shall initially possess and maintain, minimum capitalization of not less than two hundred and fifty thousand dollars ($250,000). All of the minimum initial capitalization shall be in cash. All other funds of the SPFC in excess of its minimum initial capitalization shall be in the form of cash, cash equivalent, or securities invested as approved by the commissioner.
(b) Additional capitalization for the SPFC shall be determined, if so required, by the commissioner after giving due consideration to the SPFC's plan of operation, feasibility study, pro-formas, and the nature of the risks being insured or reinsured, which may be prescribed in formulas approved by the commissioner.
Acts 2011, ch. 468, § 1.