Tenn. Code Ann. § 56-7-3303 — TN Code / Title 56 / Chapter 7 / Section 56-7-3303
Establishment and maintenance of Internet web site - Web-based preadjudication tool
Status: in_force

(a) By July 1, 2010, a health insurance entity shall establish and maintain an Internet web site, which shall be accessible to health care providers with whom the health insurance entity has an express and a valid network provider agreement or contract. (b) (1) Excluding inpatient claims, every health insurance entity shall make available on the Internet web site established pursuant to subsection (a) a web-based preadjudication tool to be used by a health care provider prior to the provider's submitting either a clean claim as defined in § 56-7-109 or a claim combination to the claims adjudication system utilized by the health insurance entity. The preadjudication tool shall be designed in such a manner as to be capable of: (A) Providing reasonably accurate information to a health care provider regarding the manner in which the health insurance entity's claim system will adjudicate claims for specific billing codes or combinations of codes; and (B) Providing reasonably accurate information to a health care provider regarding the allowed amount for those claims submitted pursuant to this subdivision (b)(1) based on the health care provider's fee schedule and contract with the health insurance entity for which the claim will be submitted if the claim is determined to be a clean claim. (2) Nothing in this subsection (b) shall be construed as requiring the preadjudication tool to reflect the effects of coverage terms and conditions unrelated to application of contract rates, fee schedules and reimbursement rules and policies, including, without limitation, eligibility for coverage, deductibles and copayments, coordination of benefits and coverage limitations and exclusions; and nothing in this subsection (b) shall be construed as requiring the preadjudication tool to respond to a provider when the data submitted by the provider is insufficient to provide the information required by subdivisions (b)(1)(A) and (B). (c) Health insurance entity policies affecting the information available to a provider pursuant to subsection (b) shall be easily accessible by a health care provider on the web site established by the health insurance entity pursuant to subsection (a). Acts 2009 , ch. 334, § 4.
(a) By July 1, 2010, a health insurance entity shall establish and maintain an Internet web site, which shall be accessible to health care providers with whom the health insurance entity has an express and a valid network provider agreement or contract.
(b) (1) Excluding inpatient claims, every health insurance entity shall make available on the Internet web site established pursuant to subsection (a) a web-based preadjudication tool to be used by a health care provider prior to the provider's submitting either a clean claim as defined in § 56-7-109 or a claim combination to the claims adjudication system utilized by the health insurance entity. The preadjudication tool shall be designed in such a manner as to be capable of: (A) Providing reasonably accurate information to a health care provider regarding the manner in which the health insurance entity's claim system will adjudicate claims for specific billing codes or combinations of codes; and (B) Providing reasonably accurate information to a health care provider regarding the allowed amount for those claims submitted pursuant to this subdivision (b)(1) based on the health care provider's fee schedule and contract with the health insurance entity for which the claim will be submitted if the claim is determined to be a clean claim. (2) Nothing in this subsection (b) shall be construed as requiring the preadjudication tool to reflect the effects of coverage terms and conditions unrelated to application of contract rates, fee schedules and reimbursement rules and policies, including, without limitation, eligibility for coverage, deductibles and copayments, coordination of benefits and coverage limitations and exclusions; and nothing in this subsection (b) shall be construed as requiring the preadjudication tool to respond to a provider when the data submitted by the provider is insufficient to provide the information required by subdivisions (b)(1)(A) and (B).
(1) Excluding inpatient claims, every health insurance entity shall make available on the Internet web site established pursuant to subsection (a) a web-based preadjudication tool to be used by a health care provider prior to the provider's submitting either a clean claim as defined in § 56-7-109 or a claim combination to the claims adjudication system utilized by the health insurance entity. The preadjudication tool shall be designed in such a manner as to be capable of: (A) Providing reasonably accurate information to a health care provider regarding the manner in which the health insurance entity's claim system will adjudicate claims for specific billing codes or combinations of codes; and (B) Providing reasonably accurate information to a health care provider regarding the allowed amount for those claims submitted pursuant to this subdivision (b)(1) based on the health care provider's fee schedule and contract with the health insurance entity for which the claim will be submitted if the claim is determined to be a clean claim.
(A) Providing reasonably accurate information to a health care provider regarding the manner in which the health insurance entity's claim system will adjudicate claims for specific billing codes or combinations of codes; and
(B) Providing reasonably accurate information to a health care provider regarding the allowed amount for those claims submitted pursuant to this subdivision (b)(1) based on the health care provider's fee schedule and contract with the health insurance entity for which the claim will be submitted if the claim is determined to be a clean claim.
(2) Nothing in this subsection (b) shall be construed as requiring the preadjudication tool to reflect the effects of coverage terms and conditions unrelated to application of contract rates, fee schedules and reimbursement rules and policies, including, without limitation, eligibility for coverage, deductibles and copayments, coordination of benefits and coverage limitations and exclusions; and nothing in this subsection (b) shall be construed as requiring the preadjudication tool to respond to a provider when the data submitted by the provider is insufficient to provide the information required by subdivisions (b)(1)(A) and (B).
(c) Health insurance entity policies affecting the information available to a provider pursuant to subsection (b) shall be easily accessible by a health care provider on the web site established by the health insurance entity pursuant to subsection (a).
Acts 2009 , ch. 334, § 4.
Tenn. Code Ann. § 56-13-404 — TN Code / Title 56 / Chapter 13 / Section 56-13-404
Petition for certificate of authority - Transaction of business - Application requirements - Required filings - Confidentiality of information - Discoverability of information - Examinations and investigations - Rules and regulations - Fees - Taxation - Requirements for granting certificate
Status: in_force

(a) An SPFC, when permitted by its organizational documents, may apply to the commissioner for a certificate of authority to transact insurance or reinsurance business as authorized by this part. An SPFC shall only insure or reinsure the risks of its counterparty. Notwithstanding any other provision of this part, an SPFC may purchase reinsurance to cede the risks assumed under the SPFC contract as approved by the commissioner. (b) To transact business in this state, an SPFC shall: (1) Comply with the procedure established in § 56-13-103(c)(1) ; (2) Obtain from the commissioner a certificate of authority authorizing it to conduct insurance or reinsurance business, or both, in this state; (3) Hold at least one (1) management meeting each year in this state; (4) Maintain its principal place of business in this state; (5) Appoint a resident registered agent to accept service of process and to otherwise act on its behalf in this state. If the registered agent, with reasonable diligence, is not found at the registered office of the SPFC, the commissioner shall be an agent of the SPFC upon whom any process, notice, or demand may be served; (6) Provide such documentation of the insurance securitization as requested by the commissioner immediately upon closing of the transaction, including: (A) An opinion of legal counsel with respect to compliance with this part and any other applicable laws as of the effective date of the transaction; and (B) A statement under oath of its president and secretary demonstrating its financial condition; and (7) Provide a complete set of the documentation of the insurance securitization to the commissioner immediately following closing of the transaction. (c) A complete SPFC application shall include the following: (1) A certified copy of the SPFC's organizational documents; and (2) Evidence of: (A) The amount and liquidity of its assets relative to the risks to be assumed; (B) The adequacy of the expertise, experience, and character of the person or persons who manage the SPFC; (C) The overall soundness of the SPFC's plan of operation; (D) Other factors considered relevant by the commissioner in ascertaining whether the proposed SPFC is able to meet its policy obligations; and (E) The applicant SPFC's financial condition, including the source and form of the minimum capitalization to be contributed to the SPFC; (3) A plan of operation, consisting of a description of or statement of intent with respect to the contemplated insurance securitization, the SPFC contract, and related transactions, which shall include: (A) Draft documentation or, at the discretion of the commissioner, a written summary of all material agreements that are entered into to effectuate the SPFC contract and, before the effectuation of the SPFC contract, the insurance securitization, to include the names of the counterparty, the nature of the risks being assumed, the proposed use of protected cells, if any, and the maximum amounts, purpose, and nature and the interrelationships of the various transactions required to effectuate the insurance securitization; (B) The source and form of additional capitalization to be contributed to the SPFC; (C) The proposed investment strategy of the SPFC; (D) A description of the underwriting, reporting, and claims payment methods by which losses covered by the SPFC contract are reported, accounted for, and settled; and (E) A pro forma balance sheet and income statement illustrating various stress case scenarios for the performance of the SPFC under the SPFC contract; (4) Biographical affidavits in NAIC format of all of the prospective SPFC's officers and directors, providing the officers' and directors' legal names, any names under which they have or are conducting their affairs, and any other biographical information as the commissioner may request; (5) An affidavit from the applicant SPFC verifying: (A) The applicant SPFC complies with this part; (B) The applicant SPFC operates only pursuant to this part; (C) The applicant SPFC's investment strategy reflects and takes into account the liquidity of assets and the reasonable preservation, administration, and asset management of such assets relative to the risks associated with the SPFC contract and the insurance securitization transaction; (D) The securities proposed to be issued, if any, are valid legal obligations that are either properly registered with the commissioner or constitute an exempt security or form part of an exempt transaction; and (6) Any other statements or documents required by the commissioner to evaluate and complete the licensing of the SPFC. (d) In addition to the information required by subsection (c) and § 56-13-408 , if a protected cell is used, then an applicant SPFC shall file with the commissioner: (1) A business plan demonstrating how the applicant SPFC accounts for the loss and expense experience of each protected cell at a level of detail found to be sufficient by the commissioner, and how the applicant will report the experience to the commissioner; (2) A statement acknowledging that all financial records of the SPFC, including records pertaining to any protected cells, must be made available for inspection or examination by the commissioner; (3) All contracts or sample contracts between the SPFC and any counterparty, related to each protected cell; and (4) A description of the expenses allocated to each protected cell. (e) Information submitted pursuant to this section shall be and remain confidential, and shall not be made public by the commissioner without the written consent of the company, except that: (1) Such information may be discoverable by a party in a civil action or contested case to which the captive insurance company that submitted such information is a party, upon a showing by the party seeking to discover such information that: (A) The information sought is relevant to and necessary for the furtherance of such action or case; (B) The information sought is unavailable from other non-confidential sources; and (C) A subpoena issued by a judicial or administrative officer of competent jurisdiction has been submitted to the commissioner; and (2) The commissioner shall have the discretion to disclose such information to a public officer having jurisdiction over the regulation of insurance in another state; provided, that: (A) Such public official shall agree in writing to maintain the confidentiality of such information; and (B) The laws of the state in which such public official serves require such information to be and to remain confidential. (f) Section 56-13-109 applies to examinations, investigations, and processing conducted pursuant this part. (g) SPFCs are subject to any rules or regulations promulgated pursuant to § 56-13-121 , unless specifically exempted from such rule. (h) An SPFC shall make payments to the commissioner in accordance with the fee schedule established in chapter 4, part 1 of this title. The commissioner may retain legal, financial, and examination services from outside the department to examine and investigate the application, the reasonable cost of which may be charged against the applicant. The commissioner also may use internal resources to examine and investigate the application based upon an hourly rate for the services performed or the usual and customary fee charged by the financial services industry for similar work subject to a minimum fee of twelve thousand dollars ($12,000), six thousand dollars ($6,000) of which is payable upon filing of the application, and the remainder upon licensure. (i) An SPFC shall be subject to payment of premium taxes as required by § 56-13-114 . (j) The commissioner may grant a certificate of authority authorizing the SPFC to transact insurance or reinsurance business as an SPFC in this state, upon a finding by the commissioner that: (1) The SPFC's proposed plan of operation provides a reasonable and expected successful operation; (2) The terms of the SPFC contract and related transactions comply with this part; (3) The proposed plan of operation is not hazardous to any counterparty; (4) To the extent required by law or regulation, the commissioner or an equivalent regulatory authority of the state of domicile of each counterparty has notified the commissioner in writing or otherwise provided assurance satisfactory to the commissioner that it has approved or not disapproved the transaction; and (5) The certificate of authority authorizing the SPFC to transact business is limited only to the insurance or reinsurance activities that the SPFC is authorized to conduct pursuant to this part. (k) In evaluating the expectation of a successful operation, the commissioner shall consider, among other factors, whether the proposed SPFC and its management are of known good character and reasonably believed not to be affiliated, directly or indirectly, through ownership, control, management, reinsurance transactions, or other insurance or business relations, with a person known to have been involved in the improper manipulation of assets, accounts, or reinsurance. (l) To ensure the proposed plan of operation is not hazardous to any counterparty, the commissioner may require reasonable safeguards in the SPFC's plan of operation where applicable and appropriate in the circumstance, including, without limitation, that certain assets of the SPFC be held in a trust to secure the obligations of the SPFC to a counterparty under an SPFC contract. (m) A foreign or alien corporation or limited liability company, upon approval of the commissioner, may become a domestic SPFC after complying with § 56-13-103(c)(1)(A) . After such documents are successfully filed, the foreign or alien corporation or limited liability company is entitled to the necessary or appropriate certificates or licenses to transact business as an SPFC in this state and is subject to the authority and jurisdiction of this state. In connection with this redomestication, the commissioner may waive any requirements for public hearings. It is not necessary for a corporation or limited liability company redomesticating into this state to merge, consolidate, transfer assets, or otherwise engage in another reorganization, other than as specified in this section. Acts 2011, ch. 468, § 1.
(a) An SPFC, when permitted by its organizational documents, may apply to the commissioner for a certificate of authority to transact insurance or reinsurance business as authorized by this part. An SPFC shall only insure or reinsure the risks of its counterparty. Notwithstanding any other provision of this part, an SPFC may purchase reinsurance to cede the risks assumed under the SPFC contract as approved by the commissioner.
(b) To transact business in this state, an SPFC shall: (1) Comply with the procedure established in § 56-13-103(c)(1) ; (2) Obtain from the commissioner a certificate of authority authorizing it to conduct insurance or reinsurance business, or both, in this state; (3) Hold at least one (1) management meeting each year in this state; (4) Maintain its principal place of business in this state; (5) Appoint a resident registered agent to accept service of process and to otherwise act on its behalf in this state. If the registered agent, with reasonable diligence, is not found at the registered office of the SPFC, the commissioner shall be an agent of the SPFC upon whom any process, notice, or demand may be served; (6) Provide such documentation of the insurance securitization as requested by the commissioner immediately upon closing of the transaction, including: (A) An opinion of legal counsel with respect to compliance with this part and any other applicable laws as of the effective date of the transaction; and (B) A statement under oath of its president and secretary demonstrating its financial condition; and (7) Provide a complete set of the documentation of the insurance securitization to the commissioner immediately following closing of the transaction.
(1) Comply with the procedure established in § 56-13-103(c)(1) ;
(2) Obtain from the commissioner a certificate of authority authorizing it to conduct insurance or reinsurance business, or both, in this state;
(3) Hold at least one (1) management meeting each year in this state;
(4) Maintain its principal place of business in this state;
(5) Appoint a resident registered agent to accept service of process and to otherwise act on its behalf in this state. If the registered agent, with reasonable diligence, is not found at the registered office of the SPFC, the commissioner shall be an agent of the SPFC upon whom any process, notice, or demand may be served;
(6) Provide such documentation of the insurance securitization as requested by the commissioner immediately upon closing of the transaction, including: (A) An opinion of legal counsel with respect to compliance with this part and any other applicable laws as of the effective date of the transaction; and (B) A statement under oath of its president and secretary demonstrating its financial condition; and
(A) An opinion of legal counsel with respect to compliance with this part and any other applicable laws as of the effective date of the transaction; and
(B) A statement under oath of its president and secretary demonstrating its financial condition; and
(7) Provide a complete set of the documentation of the insurance securitization to the commissioner immediately following closing of the transaction.
(c) A complete SPFC application shall include the following: (1) A certified copy of the SPFC's organizational documents; and (2) Evidence of: (A) The amount and liquidity of its assets relative to the risks to be assumed; (B) The adequacy of the expertise, experience, and character of the person or persons who manage the SPFC; (C) The overall soundness of the SPFC's plan of operation; (D) Other factors considered relevant by the commissioner in ascertaining whether the proposed SPFC is able to meet its policy obligations; and (E) The applicant SPFC's financial condition, including the source and form of the minimum capitalization to be contributed to the SPFC; (3) A plan of operation, consisting of a description of or statement of intent with respect to the contemplated insurance securitization, the SPFC contract, and related transactions, which shall include: (A) Draft documentation or, at the discretion of the commissioner, a written summary of all material agreements that are entered into to effectuate the SPFC contract and, before the effectuation of the SPFC contract, the insurance securitization, to include the names of the counterparty, the nature of the risks being assumed, the proposed use of protected cells, if any, and the maximum amounts, purpose, and nature and the interrelationships of the various transactions required to effectuate the insurance securitization; (B) The source and form of additional capitalization to be contributed to the SPFC; (C) The proposed investment strategy of the SPFC; (D) A description of the underwriting, reporting, and claims payment methods by which losses covered by the SPFC contract are reported, accounted for, and settled; and (E) A pro forma balance sheet and income statement illustrating various stress case scenarios for the performance of the SPFC under the SPFC contract; (4) Biographical affidavits in NAIC format of all of the prospective SPFC's officers and directors, providing the officers' and directors' legal names, any names under which they have or are conducting their affairs, and any other biographical information as the commissioner may request; (5) An affidavit from the applicant SPFC verifying: (A) The applicant SPFC complies with this part; (B) The applicant SPFC operates only pursuant to this part; (C) The applicant SPFC's investment strategy reflects and takes into account the liquidity of assets and the reasonable preservation, administration, and asset management of such assets relative to the risks associated with the SPFC contract and the insurance securitization transaction; (D) The securities proposed to be issued, if any, are valid legal obligations that are either properly registered with the commissioner or constitute an exempt security or form part of an exempt transaction; and (6) Any other statements or documents required by the commissioner to evaluate and complete the licensing of the SPFC.
(1) A certified copy of the SPFC's organizational documents; and
(2) Evidence of: (A) The amount and liquidity of its assets relative to the risks to be assumed; (B) The adequacy of the expertise, experience, and character of the person or persons who manage the SPFC; (C) The overall soundness of the SPFC's plan of operation; (D) Other factors considered relevant by the commissioner in ascertaining whether the proposed SPFC is able to meet its policy obligations; and (E) The applicant SPFC's financial condition, including the source and form of the minimum capitalization to be contributed to the SPFC;
(A) The amount and liquidity of its assets relative to the risks to be assumed;
(B) The adequacy of the expertise, experience, and character of the person or persons who manage the SPFC;
(C) The overall soundness of the SPFC's plan of operation;
(D) Other factors considered relevant by the commissioner in ascertaining whether the proposed SPFC is able to meet its policy obligations; and
(E) The applicant SPFC's financial condition, including the source and form of the minimum capitalization to be contributed to the SPFC;
(3) A plan of operation, consisting of a description of or statement of intent with respect to the contemplated insurance securitization, the SPFC contract, and related transactions, which shall include: (A) Draft documentation or, at the discretion of the commissioner, a written summary of all material agreements that are entered into to effectuate the SPFC contract and, before the effectuation of the SPFC contract, the insurance securitization, to include the names of the counterparty, the nature of the risks being assumed, the proposed use of protected cells, if any, and the maximum amounts, purpose, and nature and the interrelationships of the various transactions required to effectuate the insurance securitization; (B) The source and form of additional capitalization to be contributed to the SPFC; (C) The proposed investment strategy of the SPFC; (D) A description of the underwriting, reporting, and claims payment methods by which losses covered by the SPFC contract are reported, accounted for, and settled; and (E) A pro forma balance sheet and income statement illustrating various stress case scenarios for the performance of the SPFC under the SPFC contract;
(A) Draft documentation or, at the discretion of the commissioner, a written summary of all material agreements that are entered into to effectuate the SPFC contract and, before the effectuation of the SPFC contract, the insurance securitization, to include the names of the counterparty, the nature of the risks being assumed, the proposed use of protected cells, if any, and the maximum amounts, purpose, and nature and the interrelationships of the various transactions required to effectuate the insurance securitization;
(B) The source and form of additional capitalization to be contributed to the SPFC;
(C) The proposed investment strategy of the SPFC;
(D) A description of the underwriting, reporting, and claims payment methods by which losses covered by the SPFC contract are reported, accounted for, and settled; and
(E) A pro forma balance sheet and income statement illustrating various stress case scenarios for the performance of the SPFC under the SPFC contract;
(4) Biographical affidavits in NAIC format of all of the prospective SPFC's officers and directors, providing the officers' and directors' legal names, any names under which they have or are conducting their affairs, and any other biographical information as the commissioner may request;
(5) An affidavit from the applicant SPFC verifying: (A) The applicant SPFC complies with this part; (B) The applicant SPFC operates only pursuant to this part; (C) The applicant SPFC's investment strategy reflects and takes into account the liquidity of assets and the reasonable preservation, administration, and asset management of such assets relative to the risks associated with the SPFC contract and the insurance securitization transaction; (D) The securities proposed to be issued, if any, are valid legal obligations that are either properly registered with the commissioner or constitute an exempt security or form part of an exempt transaction; and
(A) The applicant SPFC complies with this part;
(B) The applicant SPFC operates only pursuant to this part;
(C) The applicant SPFC's investment strategy reflects and takes into account the liquidity of assets and the reasonable preservation, administration, and asset management of such assets relative to the risks associated with the SPFC contract and the insurance securitization transaction;
(D) The securities proposed to be issued, if any, are valid legal obligations that are either properly registered with the commissioner or constitute an exempt security or form part of an exempt transaction; and
(6) Any other statements or documents required by the commissioner to evaluate and complete the licensing of the SPFC.
(d) In addition to the information required by subsection (c) and § 56-13-408 , if a protected cell is used, then an applicant SPFC shall file with the commissioner: (1) A business plan demonstrating how the applicant SPFC accounts for the loss and expense experience of each protected cell at a level of detail found to be sufficient by the commissioner, and how the applicant will report the experience to the commissioner; (2) A statement acknowledging that all financial records of the SPFC, including records pertaining to any protected cells, must be made available for inspection or examination by the commissioner; (3) All contracts or sample contracts between the SPFC and any counterparty, related to each protected cell; and (4) A description of the expenses allocated to each protected cell.
(1) A business plan demonstrating how the applicant SPFC accounts for the loss and expense experience of each protected cell at a level of detail found to be sufficient by the commissioner, and how the applicant will report the experience to the commissioner;
(2) A statement acknowledging that all financial records of the SPFC, including records pertaining to any protected cells, must be made available for inspection or examination by the commissioner;
(3) All contracts or sample contracts between the SPFC and any counterparty, related to each protected cell; and
(4) A description of the expenses allocated to each protected cell.
(e) Information submitted pursuant to this section shall be and remain confidential, and shall not be made public by the commissioner without the written consent of the company, except that: (1) Such information may be discoverable by a party in a civil action or contested case to which the captive insurance company that submitted such information is a party, upon a showing by the party seeking to discover such information that: (A) The information sought is relevant to and necessary for the furtherance of such action or case; (B) The information sought is unavailable from other non-confidential sources; and (C) A subpoena issued by a judicial or administrative officer of competent jurisdiction has been submitted to the commissioner; and (2) The commissioner shall have the discretion to disclose such information to a public officer having jurisdiction over the regulation of insurance in another state; provided, that: (A) Such public official shall agree in writing to maintain the confidentiality of such information; and (B) The laws of the state in which such public official serves require such information to be and to remain confidential.
(1) Such information may be discoverable by a party in a civil action or contested case to which the captive insurance company that submitted such information is a party, upon a showing by the party seeking to discover such information that: (A) The information sought is relevant to and necessary for the furtherance of such action or case; (B) The information sought is unavailable from other non-confidential sources; and (C) A subpoena issued by a judicial or administrative officer of competent jurisdiction has been submitted to the commissioner; and
(A) The information sought is relevant to and necessary for the furtherance of such action or case;
(B) The information sought is unavailable from other non-confidential sources; and
(C) A subpoena issued by a judicial or administrative officer of competent jurisdiction has been submitted to the commissioner; and
(2) The commissioner shall have the discretion to disclose such information to a public officer having jurisdiction over the regulation of insurance in another state; provided, that: (A) Such public official shall agree in writing to maintain the confidentiality of such information; and (B) The laws of the state in which such public official serves require such information to be and to remain confidential.
(A) Such public official shall agree in writing to maintain the confidentiality of such information; and
(B) The laws of the state in which such public official serves require such information to be and to remain confidential.
(f) Section 56-13-109 applies to examinations, investigations, and processing conducted pursuant this part.
(g) SPFCs are subject to any rules or regulations promulgated pursuant to § 56-13-121 , unless specifically exempted from such rule.
(h) An SPFC shall make payments to the commissioner in accordance with the fee schedule established in chapter 4, part 1 of this title. The commissioner may retain legal, financial, and examination services from outside the department to examine and investigate the application, the reasonable cost of which may be charged against the applicant. The commissioner also may use internal resources to examine and investigate the application based upon an hourly rate for the services performed or the usual and customary fee charged by the financial services industry for similar work subject to a minimum fee of twelve thousand dollars ($12,000), six thousand dollars ($6,000) of which is payable upon filing of the application, and the remainder upon licensure.
(i) An SPFC shall be subject to payment of premium taxes as required by § 56-13-114 .
(j) The commissioner may grant a certificate of authority authorizing the SPFC to transact insurance or reinsurance business as an SPFC in this state, upon a finding by the commissioner that: (1) The SPFC's proposed plan of operation provides a reasonable and expected successful operation; (2) The terms of the SPFC contract and related transactions comply with this part; (3) The proposed plan of operation is not hazardous to any counterparty; (4) To the extent required by law or regulation, the commissioner or an equivalent regulatory authority of the state of domicile of each counterparty has notified the commissioner in writing or otherwise provided assurance satisfactory to the commissioner that it has approved or not disapproved the transaction; and (5) The certificate of authority authorizing the SPFC to transact business is limited only to the insurance or reinsurance activities that the SPFC is authorized to conduct pursuant to this part.
(1) The SPFC's proposed plan of operation provides a reasonable and expected successful operation;
(2) The terms of the SPFC contract and related transactions comply with this part;
(3) The proposed plan of operation is not hazardous to any counterparty;
(4) To the extent required by law or regulation, the commissioner or an equivalent regulatory authority of the state of domicile of each counterparty has notified the commissioner in writing or otherwise provided assurance satisfactory to the commissioner that it has approved or not disapproved the transaction; and
(5) The certificate of authority authorizing the SPFC to transact business is limited only to the insurance or reinsurance activities that the SPFC is authorized to conduct pursuant to this part.
(k) In evaluating the expectation of a successful operation, the commissioner shall consider, among other factors, whether the proposed SPFC and its management are of known good character and reasonably believed not to be affiliated, directly or indirectly, through ownership, control, management, reinsurance transactions, or other insurance or business relations, with a person known to have been involved in the improper manipulation of assets, accounts, or reinsurance.
(l) To ensure the proposed plan of operation is not hazardous to any counterparty, the commissioner may require reasonable safeguards in the SPFC's plan of operation where applicable and appropriate in the circumstance, including, without limitation, that certain assets of the SPFC be held in a trust to secure the obligations of the SPFC to a counterparty under an SPFC contract.
(m) A foreign or alien corporation or limited liability company, upon approval of the commissioner, may become a domestic SPFC after complying with § 56-13-103(c)(1)(A) . After such documents are successfully filed, the foreign or alien corporation or limited liability company is entitled to the necessary or appropriate certificates or licenses to transact business as an SPFC in this state and is subject to the authority and jurisdiction of this state. In connection with this redomestication, the commissioner may waive any requirements for public hearings. It is not necessary for a corporation or limited liability company redomesticating into this state to merge, consolidate, transfer assets, or otherwise engage in another reorganization, other than as specified in this section.
Acts 2011, ch. 468, § 1.
Tenn. Code Ann. § 56-6-803 — TN Code / Title 56 / Chapter 6 / Section 56-6-803
Qualifications - Bond - Licensing
Status: in_force

(a) No person, firm, association or corporation shall act as an RB in this state if the RB maintains an office either directly or as a member or employee of a firm or association, or an officer, director or employee of a corporation: (1) In this state, unless the RB is a licensed producer in this state; or (2) In another state, unless the RB is a licensed producer in this state or another state having a law substantially similar to this law or the RB is licensed in this state as a nonresident reinsurance intermediary. (b) No person, firm, association or corporation shall act as an RM: (1) For a reinsurer domiciled in this state, unless the RM is a licensed producer in this state; (2) In this state, if the RM maintains an office either directly or as a member or employee of a firm or association, or an officer, director or employee of a corporation in this state, unless the RM is a licensed producer in this state; or (3) In another state for a nondomestic insurer, unless the RM is a licensed producer in this state or another state having a law substantially similar to this law, or the person is licensed in this state as a nonresident reinsurance intermediary. (c) The commissioner may require an RM subject to subsection (b) to: (1) File a bond in an amount from an insurer acceptable to the commissioner for the protection of the reinsurer; and (2) Maintain an errors and omissions policy in an amount acceptable to the commissioner. (d) The commissioner may issue a reinsurance intermediary license to any person, firm, association or corporation who has complied with the requirements of this part, subject to the following: (1) The license issued to a firm or association will authorize all the members of the firm or association and any designated employees to act as reinsurance intermediaries under the license, and all those persons shall be named in the application and any supplements to the application. The license issued to a corporation shall authorize all of the officers and any designated employees and directors of the corporation to act as reinsurance intermediaries on behalf of the corporation, and all those persons shall be named in the application and any supplements to the application; and (2) If the applicant for a reinsurance intermediary license is a nonresident, the applicant, as a condition precedent to receiving or holding a license, shall designate the commissioner as agent for service of process in the manner, and with the same legal effect, provided for by this part for designation of service of process upon unauthorized insurers; and also shall furnish the commissioner with the name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the nonresident reinsurance intermediary may be served. Such licensee shall promptly notify the commissioner in writing of every change in its designated agent for service of process, and such change shall not become effective until acknowledged by the commissioner. (e) The commissioner may refuse to issue a reinsurance intermediary license if, in the judgment of the commissioner, the applicant, anyone named on the application, or any member, principal, officer or director of the applicant is not trustworthy, or any controlling person of the applicant is not trustworthy to act as a reinsurance intermediary, or any of the foregoing has given cause for revocation or suspension of the license, or has failed to comply with any prerequisite for the issuance of the license. Upon written request, the commissioner will furnish a summary of the basis for refusal to issue a license, which document shall be privileged and not subject to the requirements of title 10, chapter 7. (f) Licensed attorneys at law of this state when acting in their professional capacity as attorneys are exempt from this section. Acts 1993, ch. 253, § 9.
(a) No person, firm, association or corporation shall act as an RB in this state if the RB maintains an office either directly or as a member or employee of a firm or association, or an officer, director or employee of a corporation: (1) In this state, unless the RB is a licensed producer in this state; or (2) In another state, unless the RB is a licensed producer in this state or another state having a law substantially similar to this law or the RB is licensed in this state as a nonresident reinsurance intermediary.
(1) In this state, unless the RB is a licensed producer in this state; or
(2) In another state, unless the RB is a licensed producer in this state or another state having a law substantially similar to this law or the RB is licensed in this state as a nonresident reinsurance intermediary.
(b) No person, firm, association or corporation shall act as an RM: (1) For a reinsurer domiciled in this state, unless the RM is a licensed producer in this state; (2) In this state, if the RM maintains an office either directly or as a member or employee of a firm or association, or an officer, director or employee of a corporation in this state, unless the RM is a licensed producer in this state; or (3) In another state for a nondomestic insurer, unless the RM is a licensed producer in this state or another state having a law substantially similar to this law, or the person is licensed in this state as a nonresident reinsurance intermediary.
(1) For a reinsurer domiciled in this state, unless the RM is a licensed producer in this state;
(2) In this state, if the RM maintains an office either directly or as a member or employee of a firm or association, or an officer, director or employee of a corporation in this state, unless the RM is a licensed producer in this state; or
(3) In another state for a nondomestic insurer, unless the RM is a licensed producer in this state or another state having a law substantially similar to this law, or the person is licensed in this state as a nonresident reinsurance intermediary.
(c) The commissioner may require an RM subject to subsection (b) to: (1) File a bond in an amount from an insurer acceptable to the commissioner for the protection of the reinsurer; and (2) Maintain an errors and omissions policy in an amount acceptable to the commissioner.
(1) File a bond in an amount from an insurer acceptable to the commissioner for the protection of the reinsurer; and
(2) Maintain an errors and omissions policy in an amount acceptable to the commissioner.
(d) The commissioner may issue a reinsurance intermediary license to any person, firm, association or corporation who has complied with the requirements of this part, subject to the following: (1) The license issued to a firm or association will authorize all the members of the firm or association and any designated employees to act as reinsurance intermediaries under the license, and all those persons shall be named in the application and any supplements to the application. The license issued to a corporation shall authorize all of the officers and any designated employees and directors of the corporation to act as reinsurance intermediaries on behalf of the corporation, and all those persons shall be named in the application and any supplements to the application; and (2) If the applicant for a reinsurance intermediary license is a nonresident, the applicant, as a condition precedent to receiving or holding a license, shall designate the commissioner as agent for service of process in the manner, and with the same legal effect, provided for by this part for designation of service of process upon unauthorized insurers; and also shall furnish the commissioner with the name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the nonresident reinsurance intermediary may be served. Such licensee shall promptly notify the commissioner in writing of every change in its designated agent for service of process, and such change shall not become effective until acknowledged by the commissioner.
(1) The license issued to a firm or association will authorize all the members of the firm or association and any designated employees to act as reinsurance intermediaries under the license, and all those persons shall be named in the application and any supplements to the application. The license issued to a corporation shall authorize all of the officers and any designated employees and directors of the corporation to act as reinsurance intermediaries on behalf of the corporation, and all those persons shall be named in the application and any supplements to the application; and
(2) If the applicant for a reinsurance intermediary license is a nonresident, the applicant, as a condition precedent to receiving or holding a license, shall designate the commissioner as agent for service of process in the manner, and with the same legal effect, provided for by this part for designation of service of process upon unauthorized insurers; and also shall furnish the commissioner with the name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the nonresident reinsurance intermediary may be served. Such licensee shall promptly notify the commissioner in writing of every change in its designated agent for service of process, and such change shall not become effective until acknowledged by the commissioner.
(e) The commissioner may refuse to issue a reinsurance intermediary license if, in the judgment of the commissioner, the applicant, anyone named on the application, or any member, principal, officer or director of the applicant is not trustworthy, or any controlling person of the applicant is not trustworthy to act as a reinsurance intermediary, or any of the foregoing has given cause for revocation or suspension of the license, or has failed to comply with any prerequisite for the issuance of the license. Upon written request, the commissioner will furnish a summary of the basis for refusal to issue a license, which document shall be privileged and not subject to the requirements of title 10, chapter 7.
(f) Licensed attorneys at law of this state when acting in their professional capacity as attorneys are exempt from this section.
Acts 1993, ch. 253, § 9.
Tenn. Code Ann. § 56-7-3120 — TN Code / Title 56 / Chapter 7 / Section 56-7-3120
Penalty for obtaining prescription drugs from contracted pharmacy prohibited - Interference with patient's right to choose contracted pharmacy or contracted provider of choice prohibited
Status: in_force

(a) A pharmacy benefits manager or a covered entity shall not require a person covered under a pharmacy benefit contract, that provides coverage for prescription drugs, including specialty drugs, to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining prescription drugs, including specialty drugs from a contracted pharmacy. (b) A pharmacy benefits manager or a covered entity shall not: (1) Interfere with the right of a patient, participant, or beneficiary to choose a contracted pharmacy or contracted provider of choice in a manner that violates § 56-7-2359 ; or (2) Offer financial or other incentives to a patient, participant, or beneficiary to persuade the patient, participant, or beneficiary to utilize a pharmacy owned by or financially beneficial to the pharmacy benefits manager or covered entity. Amended by 2022 Tenn. Acts, ch. 1070, s 5, eff. 1/1/2023. Added by 2021 Tenn. Acts, ch. 569, s 2, eff. 7/1/2021.
(a) A pharmacy benefits manager or a covered entity shall not require a person covered under a pharmacy benefit contract, that provides coverage for prescription drugs, including specialty drugs, to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining prescription drugs, including specialty drugs from a contracted pharmacy.
(b) A pharmacy benefits manager or a covered entity shall not: (1) Interfere with the right of a patient, participant, or beneficiary to choose a contracted pharmacy or contracted provider of choice in a manner that violates § 56-7-2359 ; or (2) Offer financial or other incentives to a patient, participant, or beneficiary to persuade the patient, participant, or beneficiary to utilize a pharmacy owned by or financially beneficial to the pharmacy benefits manager or covered entity.
(1) Interfere with the right of a patient, participant, or beneficiary to choose a contracted pharmacy or contracted provider of choice in a manner that violates § 56-7-2359 ; or
(2) Offer financial or other incentives to a patient, participant, or beneficiary to persuade the patient, participant, or beneficiary to utilize a pharmacy owned by or financially beneficial to the pharmacy benefits manager or covered entity.
Amended by 2022 Tenn. Acts, ch. 1070, s 5, eff. 1/1/2023.
Added by 2021 Tenn. Acts, ch. 569, s 2, eff. 7/1/2021.
Tenn. Code Ann. § 56-31-101 — TN Code / Title 56 / Chapter 31 / Section 56-31-101
Short title
Status: in_force

This chapter shall be known and may be cited as the "Vision Service Plan Law." Acts 1969, ch. 118, § 1; T.C.A., § 56-3701.
This chapter shall be known and may be cited as the "Vision Service Plan Law."
Acts 1969, ch. 118, § 1; T.C.A., § 56-3701.
Tenn. Code Ann. § 56-7-1119 — TN Code / Title 56 / Chapter 7 / Section 56-7-1119
Exclusion of coverage to owner or operator while logged onto transportation network company's digital network or providing a prearranged ride
Status: in_force

(a) As used in this section: (1) "Digital network" means any online-enabled application, software, web site, or system offered or utilized by a transportation network company that enables the prearrangement of rides with transportation network company drivers; (2) "Personal vehicle" means a vehicle that is used by a transportation network company driver and is: (A) Owned, leased, or otherwise authorized for use by the transportation network company driver; and (B) Not a taxicab, limousine, or for-hire vehicle; (3) "Prearranged ride" means the provision of transportation by a driver to a rider, beginning when a driver accepts a ride requested by a rider through a digital network controlled by a transportation network company, continuing while the driver transports a requesting rider, and ending when the last requesting rider departs from the personal vehicle. A prearranged ride does not include: (A) Shared expense carpool or vanpool arrangements provided by businesses engaged in the rental of motor vehicles; or (B) Transportation provided using a taxi, limousine, or other for-hire vehicle regulated pursuant to § 7-51-1003 ; (4) "Transportation network company" means a corporation, partnership, sole proprietorship, or other entity operating in this state that uses a digital network to connect transportation network company riders to transportation network company drivers who provide prearranged rides. A transportation network company shall not be deemed to control, direct, or manage the personal vehicles or transportation network company drivers that connect to its digital network, except where agreed to by written contract; (5) "Transportation network company driver" or "driver" means an individual who: (A) Receives connections to potential passengers and related services from a transportation network company in exchange for payment of a fee to the transportation network company; and (B) Uses a personal vehicle to provide a prearranged ride to riders upon connection through a digital network controlled by a transportation network company in return for compensation or payment of a fee; and (6) "Transportation network company rider" or "rider" means a person or persons who use a transportation network company's digital network to connect with a transportation network driver who provides prearranged rides to the rider in the driver's personal vehicle between points chosen by the rider. (b) Insurers that write automobile insurance in this state may exclude any and all coverage afforded under the policy issued to an owner or operator of a personal vehicle for any loss or injury that occurs while a driver is logged on to a transportation network company's digital network or while a driver provides a prearranged ride. This right to exclude all coverage may apply to any coverage included in an automobile insurance policy including, but not limited to: (1) Liability coverage for bodily injury and property damage; (2) Uninsured and underinsured motorist coverage; (3) Medical payments coverage; (4) Comprehensive physical damage coverage; and (5) Collision physical damage coverage. (c) The exclusions in subsection (b) shall apply notwithstanding any requirement under this title or under title 55, chapter 12. Nothing in this section requires that a personal automobile insurance policy provide coverage while the driver is logged on to the transportation network company's digital network, while the driver is engaged in a prearranged ride, or while the driver otherwise uses a vehicle to transport passengers for compensation. (d) Automobile insurers that exclude coverage as described in subsection (b) shall have no duty to defend or indemnify any claim expressly excluded. Nothing in this section shall invalidate or limit an exclusion contained in a policy, including any policy in use or approved for use in this state prior to May 20, 2015, that excludes coverage for vehicles used to carry persons or property for a charge or available for hire by the public. (e) An automobile insurer that defends or indemnifies a claim against a driver that is excluded under the terms of its policy as described in subsection (b) shall have a right of contribution against other insurers that provide automobile insurance to the same driver in satisfaction of the coverage requirements of § 55-12-141 at the time of loss. (f) In a claims coverage investigation, transportation network companies and any insurer potentially providing coverage under § 55-12-141 shall cooperate to facilitate the exchange of relevant information with directly involved parties and any insurer of the transportation network company driver, if applicable, including the precise times that a transportation network company driver logged on and off of the transportation network company's digital network in the twelve-hour period immediately preceding and in the twelve-hour period immediately following the accident and disclose to one another a clear description of the coverage, exclusions, and limits provided under any automobile insurance maintained under § 55-12-141 . (g) Nothing in this section shall preclude an insurer from providing coverage for a transportation network company driver's vehicle, if it so chooses to do so by contract or endorsement. (h) (1) Nothing in this section shall limit the right of a lender or secured party of a driver's vehicle to require a driver to maintain comprehensive damage coverage, collision damage coverage, or both for a driver's vehicle, or to show evidence of such coverage to the lender or secured party, that would cover the period when the driver is logged on to the transportation network company's digital network but is not engaged in a prearranged ride or when the driver is engaged in a prearranged ride. If the driver fails to maintain the required comprehensive or collision damage coverage, or to show evidence to the lender or secured party of the coverage upon reasonable request by the lender or secured party, the lender or secured party may obtain the coverage at the expense of the driver and shall have no duty to provide the disclosure under § 56-7-1106 . (2) If a lender or a secured party has a secured interest in a driver's vehicle and a transportation network company's insurer makes a payment for a claim for damage to the driver's vehicle that is covered under comprehensive or collision damage coverage held by the transportation network company, then the transportation network company shall cause its insurer to issue the payment either directly to the vehicle repair shop or jointly to the owner of the vehicle and the primary lender or secured party on the covered vehicle. Acts 2015, ch. 520, § 3.
(a) As used in this section: (1) "Digital network" means any online-enabled application, software, web site, or system offered or utilized by a transportation network company that enables the prearrangement of rides with transportation network company drivers; (2) "Personal vehicle" means a vehicle that is used by a transportation network company driver and is: (A) Owned, leased, or otherwise authorized for use by the transportation network company driver; and (B) Not a taxicab, limousine, or for-hire vehicle; (3) "Prearranged ride" means the provision of transportation by a driver to a rider, beginning when a driver accepts a ride requested by a rider through a digital network controlled by a transportation network company, continuing while the driver transports a requesting rider, and ending when the last requesting rider departs from the personal vehicle. A prearranged ride does not include: (A) Shared expense carpool or vanpool arrangements provided by businesses engaged in the rental of motor vehicles; or (B) Transportation provided using a taxi, limousine, or other for-hire vehicle regulated pursuant to § 7-51-1003 ; (4) "Transportation network company" means a corporation, partnership, sole proprietorship, or other entity operating in this state that uses a digital network to connect transportation network company riders to transportation network company drivers who provide prearranged rides. A transportation network company shall not be deemed to control, direct, or manage the personal vehicles or transportation network company drivers that connect to its digital network, except where agreed to by written contract; (5) "Transportation network company driver" or "driver" means an individual who: (A) Receives connections to potential passengers and related services from a transportation network company in exchange for payment of a fee to the transportation network company; and (B) Uses a personal vehicle to provide a prearranged ride to riders upon connection through a digital network controlled by a transportation network company in return for compensation or payment of a fee; and (6) "Transportation network company rider" or "rider" means a person or persons who use a transportation network company's digital network to connect with a transportation network driver who provides prearranged rides to the rider in the driver's personal vehicle between points chosen by the rider.
(1) "Digital network" means any online-enabled application, software, web site, or system offered or utilized by a transportation network company that enables the prearrangement of rides with transportation network company drivers;
(2) "Personal vehicle" means a vehicle that is used by a transportation network company driver and is: (A) Owned, leased, or otherwise authorized for use by the transportation network company driver; and (B) Not a taxicab, limousine, or for-hire vehicle;
(A) Owned, leased, or otherwise authorized for use by the transportation network company driver; and
(B) Not a taxicab, limousine, or for-hire vehicle;
(3) "Prearranged ride" means the provision of transportation by a driver to a rider, beginning when a driver accepts a ride requested by a rider through a digital network controlled by a transportation network company, continuing while the driver transports a requesting rider, and ending when the last requesting rider departs from the personal vehicle. A prearranged ride does not include: (A) Shared expense carpool or vanpool arrangements provided by businesses engaged in the rental of motor vehicles; or (B) Transportation provided using a taxi, limousine, or other for-hire vehicle regulated pursuant to § 7-51-1003 ;
(A) Shared expense carpool or vanpool arrangements provided by businesses engaged in the rental of motor vehicles; or
(B) Transportation provided using a taxi, limousine, or other for-hire vehicle regulated pursuant to § 7-51-1003 ;
(4) "Transportation network company" means a corporation, partnership, sole proprietorship, or other entity operating in this state that uses a digital network to connect transportation network company riders to transportation network company drivers who provide prearranged rides. A transportation network company shall not be deemed to control, direct, or manage the personal vehicles or transportation network company drivers that connect to its digital network, except where agreed to by written contract;
(5) "Transportation network company driver" or "driver" means an individual who: (A) Receives connections to potential passengers and related services from a transportation network company in exchange for payment of a fee to the transportation network company; and (B) Uses a personal vehicle to provide a prearranged ride to riders upon connection through a digital network controlled by a transportation network company in return for compensation or payment of a fee; and
(A) Receives connections to potential passengers and related services from a transportation network company in exchange for payment of a fee to the transportation network company; and
(B) Uses a personal vehicle to provide a prearranged ride to riders upon connection through a digital network controlled by a transportation network company in return for compensation or payment of a fee; and
(6) "Transportation network company rider" or "rider" means a person or persons who use a transportation network company's digital network to connect with a transportation network driver who provides prearranged rides to the rider in the driver's personal vehicle between points chosen by the rider.
(b) Insurers that write automobile insurance in this state may exclude any and all coverage afforded under the policy issued to an owner or operator of a personal vehicle for any loss or injury that occurs while a driver is logged on to a transportation network company's digital network or while a driver provides a prearranged ride. This right to exclude all coverage may apply to any coverage included in an automobile insurance policy including, but not limited to: (1) Liability coverage for bodily injury and property damage; (2) Uninsured and underinsured motorist coverage; (3) Medical payments coverage; (4) Comprehensive physical damage coverage; and (5) Collision physical damage coverage.
(1) Liability coverage for bodily injury and property damage;
(2) Uninsured and underinsured motorist coverage;
(3) Medical payments coverage;
(4) Comprehensive physical damage coverage; and
(5) Collision physical damage coverage.
(c) The exclusions in subsection (b) shall apply notwithstanding any requirement under this title or under title 55, chapter 12. Nothing in this section requires that a personal automobile insurance policy provide coverage while the driver is logged on to the transportation network company's digital network, while the driver is engaged in a prearranged ride, or while the driver otherwise uses a vehicle to transport passengers for compensation.
(d) Automobile insurers that exclude coverage as described in subsection (b) shall have no duty to defend or indemnify any claim expressly excluded. Nothing in this section shall invalidate or limit an exclusion contained in a policy, including any policy in use or approved for use in this state prior to May 20, 2015, that excludes coverage for vehicles used to carry persons or property for a charge or available for hire by the public.
(e) An automobile insurer that defends or indemnifies a claim against a driver that is excluded under the terms of its policy as described in subsection (b) shall have a right of contribution against other insurers that provide automobile insurance to the same driver in satisfaction of the coverage requirements of § 55-12-141 at the time of loss.
(f) In a claims coverage investigation, transportation network companies and any insurer potentially providing coverage under § 55-12-141 shall cooperate to facilitate the exchange of relevant information with directly involved parties and any insurer of the transportation network company driver, if applicable, including the precise times that a transportation network company driver logged on and off of the transportation network company's digital network in the twelve-hour period immediately preceding and in the twelve-hour period immediately following the accident and disclose to one another a clear description of the coverage, exclusions, and limits provided under any automobile insurance maintained under § 55-12-141 .
(g) Nothing in this section shall preclude an insurer from providing coverage for a transportation network company driver's vehicle, if it so chooses to do so by contract or endorsement.
(h) (1) Nothing in this section shall limit the right of a lender or secured party of a driver's vehicle to require a driver to maintain comprehensive damage coverage, collision damage coverage, or both for a driver's vehicle, or to show evidence of such coverage to the lender or secured party, that would cover the period when the driver is logged on to the transportation network company's digital network but is not engaged in a prearranged ride or when the driver is engaged in a prearranged ride. If the driver fails to maintain the required comprehensive or collision damage coverage, or to show evidence to the lender or secured party of the coverage upon reasonable request by the lender or secured party, the lender or secured party may obtain the coverage at the expense of the driver and shall have no duty to provide the disclosure under § 56-7-1106 . (2) If a lender or a secured party has a secured interest in a driver's vehicle and a transportation network company's insurer makes a payment for a claim for damage to the driver's vehicle that is covered under comprehensive or collision damage coverage held by the transportation network company, then the transportation network company shall cause its insurer to issue the payment either directly to the vehicle repair shop or jointly to the owner of the vehicle and the primary lender or secured party on the covered vehicle.
(1) Nothing in this section shall limit the right of a lender or secured party of a driver's vehicle to require a driver to maintain comprehensive damage coverage, collision damage coverage, or both for a driver's vehicle, or to show evidence of such coverage to the lender or secured party, that would cover the period when the driver is logged on to the transportation network company's digital network but is not engaged in a prearranged ride or when the driver is engaged in a prearranged ride. If the driver fails to maintain the required comprehensive or collision damage coverage, or to show evidence to the lender or secured party of the coverage upon reasonable request by the lender or secured party, the lender or secured party may obtain the coverage at the expense of the driver and shall have no duty to provide the disclosure under § 56-7-1106 .
(2) If a lender or a secured party has a secured interest in a driver's vehicle and a transportation network company's insurer makes a payment for a claim for damage to the driver's vehicle that is covered under comprehensive or collision damage coverage held by the transportation network company, then the transportation network company shall cause its insurer to issue the payment either directly to the vehicle repair shop or jointly to the owner of the vehicle and the primary lender or secured party on the covered vehicle.
Acts 2015, ch. 520, § 3.
Tenn. Code Ann. § 56-7-3101 — TN Code / Title 56 / Chapter 7 / Section 56-7-3101
Compliance - Promulgation of rules
Status: in_force

(a) Pharmacy benefits managers shall, and contracts for pharmacy benefits management must, comply with the requirements of this part. (b) (1) The commissioner of commerce and insurance shall promulgate rules to effectuate the purposes of this part and part 32 of this chapter, including, but not limited to, rules to: (A) Implement pharmacy benefits manager audits that are necessary to ensure compliance with this part and part 32 of this chapter; provided, such audits must not occur more than once every three (3) years unless the commissioner determines there is a need to investigate the financial condition of or legality of conduct by a pharmacy benefits manager; (B) Provide for additional requirements for pharmacy benefits managers to obtain licensure pursuant to § 56-7-3113 ; (C) Implement a complaint and administrative hearing process to effectuate § 56-7-3110 ; and (D) Provide for such fees as the commissioner determines are reasonably necessary to administer this part and part 32 of this chapter, including, but not limited to, a fee to cover the cost of supervising compliance with this part and part 32 of this chapter, payable by a pharmacy benefits manager upon being the subject of an audit pursuant to this section. (2) Rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. A violation of any rule issued pursuant to this section is a violation of this part. Amended by 2022 Tenn. Acts, ch. 998, s 1, eff. 5/4/2022. Acts 2007 , ch. 224, § 1.
(a) Pharmacy benefits managers shall, and contracts for pharmacy benefits management must, comply with the requirements of this part.
(b) (1) The commissioner of commerce and insurance shall promulgate rules to effectuate the purposes of this part and part 32 of this chapter, including, but not limited to, rules to: (A) Implement pharmacy benefits manager audits that are necessary to ensure compliance with this part and part 32 of this chapter; provided, such audits must not occur more than once every three (3) years unless the commissioner determines there is a need to investigate the financial condition of or legality of conduct by a pharmacy benefits manager; (B) Provide for additional requirements for pharmacy benefits managers to obtain licensure pursuant to § 56-7-3113 ; (C) Implement a complaint and administrative hearing process to effectuate § 56-7-3110 ; and (D) Provide for such fees as the commissioner determines are reasonably necessary to administer this part and part 32 of this chapter, including, but not limited to, a fee to cover the cost of supervising compliance with this part and part 32 of this chapter, payable by a pharmacy benefits manager upon being the subject of an audit pursuant to this section. (2) Rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. A violation of any rule issued pursuant to this section is a violation of this part.
(1) The commissioner of commerce and insurance shall promulgate rules to effectuate the purposes of this part and part 32 of this chapter, including, but not limited to, rules to: (A) Implement pharmacy benefits manager audits that are necessary to ensure compliance with this part and part 32 of this chapter; provided, such audits must not occur more than once every three (3) years unless the commissioner determines there is a need to investigate the financial condition of or legality of conduct by a pharmacy benefits manager; (B) Provide for additional requirements for pharmacy benefits managers to obtain licensure pursuant to § 56-7-3113 ; (C) Implement a complaint and administrative hearing process to effectuate § 56-7-3110 ; and (D) Provide for such fees as the commissioner determines are reasonably necessary to administer this part and part 32 of this chapter, including, but not limited to, a fee to cover the cost of supervising compliance with this part and part 32 of this chapter, payable by a pharmacy benefits manager upon being the subject of an audit pursuant to this section.
(A) Implement pharmacy benefits manager audits that are necessary to ensure compliance with this part and part 32 of this chapter; provided, such audits must not occur more than once every three (3) years unless the commissioner determines there is a need to investigate the financial condition of or legality of conduct by a pharmacy benefits manager;
(B) Provide for additional requirements for pharmacy benefits managers to obtain licensure pursuant to § 56-7-3113 ;
(C) Implement a complaint and administrative hearing process to effectuate § 56-7-3110 ; and
(D) Provide for such fees as the commissioner determines are reasonably necessary to administer this part and part 32 of this chapter, including, but not limited to, a fee to cover the cost of supervising compliance with this part and part 32 of this chapter, payable by a pharmacy benefits manager upon being the subject of an audit pursuant to this section.
(2) Rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. A violation of any rule issued pursuant to this section is a violation of this part.
Amended by 2022 Tenn. Acts, ch. 998, s 1, eff. 5/4/2022.
Acts 2007 , ch. 224, § 1.
Tenn. Code Ann. § 56-7-2701 — TN Code / Title 56 / Chapter 7 / Section 56-7-2701
[Repealed] Part definitions
Status: repealed

As used in this part, unless the context otherwise requires: (1) "Family member" means with respect to an individual, another individual related by blood to that individual; (2) "Genetic information" means information derived from genetic testing to determine the presence or absence of variations or mutations, including carrier status, in an individual's genetic material or genes that are scientifically or medically believed to cause a disease, disorder or syndrome, or are associated with a statistically increased risk of developing a disease, disorder or syndrome, that is asymptomatic at the time of testing. The testing does not include either routine physical examinations or chemical, blood or urine analysis unless conducted purposefully to obtain genetic information or questions regarding family history; (3) "Genetic services" means health services to obtain, assess, and interpret genetic information for diagnostic and therapeutic purposes, and for genetic education and counseling; (4) "Health insurance coverage" means a contractual arrangement for the provision of a payment for health care, including: (A) A group health plan; and (B) Any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract; (5) "Health insurance provider" means an insurer or other entity providing health insurance coverage; (6) "Life insurance coverage" means a written contractual arrangement for the provision of life insurance, as defined in § 56-2-201 ; (7) "Life insurance provider" means an insurer or other entity providing life insurance coverage; and (8) "Person" includes a corporation, company, association, firm, partnership, society, and joint stock company, as well as an individual. Repealed by 2023 Tenn. Acts, ch. 246, s 1, eff. 7/1/2023. Acts 1997 , ch. 121, § 1.
As used in this part, unless the context otherwise requires:
(1) "Family member" means with respect to an individual, another individual related by blood to that individual;
(2) "Genetic information" means information derived from genetic testing to determine the presence or absence of variations or mutations, including carrier status, in an individual's genetic material or genes that are scientifically or medically believed to cause a disease, disorder or syndrome, or are associated with a statistically increased risk of developing a disease, disorder or syndrome, that is asymptomatic at the time of testing. The testing does not include either routine physical examinations or chemical, blood or urine analysis unless conducted purposefully to obtain genetic information or questions regarding family history;
(3) "Genetic services" means health services to obtain, assess, and interpret genetic information for diagnostic and therapeutic purposes, and for genetic education and counseling;
(4) "Health insurance coverage" means a contractual arrangement for the provision of a payment for health care, including: (A) A group health plan; and (B) Any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract;
(A) A group health plan; and
(B) Any other health insurance arrangement, including any arrangement consisting of a hospital or medical expense incurred policy or certificate, hospital or medical service plan contract, or health maintenance organization subscriber contract;
(5) "Health insurance provider" means an insurer or other entity providing health insurance coverage;
(6) "Life insurance coverage" means a written contractual arrangement for the provision of life insurance, as defined in § 56-2-201 ;
(7) "Life insurance provider" means an insurer or other entity providing life insurance coverage; and
(8) "Person" includes a corporation, company, association, firm, partnership, society, and joint stock company, as well as an individual.
Repealed by 2023 Tenn. Acts, ch. 246, s 1, eff. 7/1/2023.
Acts 1997 , ch. 121, § 1.
Tenn. Code Ann. § 56-28-112 — TN Code / Title 56 / Chapter 28 / Section 56-28-112
Financial and statistical records
Status: in_force

The service corporation shall maintain adequate financial and statistical records in reasonable uniformity with accounting plans and statistical requirements of the annual statement blank required by the commissioner. Acts 1945, ch. 98, § 10; C. Supp. 1950, § 4186.10; T.C.A. (orig. ed.), § 56-3012.
The service corporation shall maintain adequate financial and statistical records in reasonable uniformity with accounting plans and statistical requirements of the annual statement blank required by the commissioner.
Acts 1945, ch. 98, § 10; C. Supp. 1950, § 4186.10; T.C.A. (orig. ed.), § 56-3012.
Tenn. Code Ann. § 56-9-301 — TN Code / Title 56 / Chapter 9 / Section 56-9-301
Rehabilitation of insurers - Grounds for filing petition
Status: in_force

The commissioner may apply by petition to the chancery court of Davidson County for an order authorizing the commissioner to rehabilitate a domestic insurer or an alien insurer domiciled in this state on any one (1) or more of the following grounds: (1) The insurer is in such condition that the further transaction of business would be hazardous financially to its policyholders, creditors or the public; (2) There is reasonable cause to believe that there has been embezzlement from the insurer, wrongful sequestration or diversion of the insurer's assets, forgery or fraud affecting the insurer, or other illegal conduct in, by, or with respect to the insurer that, if established, would endanger assets in an amount threatening the solvency of the insurer; (3) The insurer has failed to remove any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, employee, or other person, if the person has been found after notice and hearing by the commissioner to be dishonest or untrustworthy in a way affecting the insurer's business; (4) Control of the insurer, whether by stock ownership or otherwise, and whether direct or indirect, is in a person or persons found after notice and hearing to be untrustworthy; (5) Any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, director or trustee, employee, or other person, has refused to be examined under oath by the commissioner concerning the insurer's affairs, whether in this state or elsewhere, and after reasonable notice of the fact, the insurer has failed promptly and effectively to terminate the employment and status of the person and all the person's influence on management; (6) After demand by the commissioner in accordance with this chapter, the insurer has failed to promptly make available for examination any of its own property, books, accounts, documents, or other records, or those of any subsidiary or related company within the control of the insurer, or those of any person having executive authority in the insurer so far as they pertain to the insurer; (7) Without first obtaining the written consent of the commissioner, the insurer has transferred, or attempted to transfer, in any manner, or contrary to chapter 11 of this title, substantially its entire property or business, or has entered into any transaction, the effect of which is to merge, consolidate or reinsure substantially its entire property or business in or with the property or business of any other person; (8) The insurer or its property has been or is the subject of an application for the appointment of a receiver, trustee, custodian, conservator or sequestrator or similar fiduciary of the insurer or its property otherwise than as authorized under the insurance laws of this state, and such appointment has been made or is imminent, and the appointment might oust the courts of this state of jurisdiction or might prejudice orderly delinquency proceedings under this chapter; (9) Within the previous four (4) years, the insurer has willfully violated its charter or articles of incorporation, its bylaws, any insurance law of this state, or any valid order of the commissioner; (10) The insurer has failed to pay within sixty (60) days after due date any obligation to any state or any subdivision of a state or any judgment entered in any state, if the court in which the judgment was entered had jurisdiction over the subject matter, except that the nonpayment shall not be a ground until sixty (60) days after any good faith effort by the insurer to contest the obligation has been terminated, whether it is before the commissioner or in the courts, or the insurer has systematically attempted to compromise or renegotiate previously agreed settlements with its creditors on the ground that it is financially unable to pay its obligations in full; (11) The insurer has failed to file its annual report or other financial report required by statute within the time allowed by law and, after written demand by the commissioner, has failed to give an adequate explanation immediately; or (12) The board of directors, or the holders of a majority of the shares entitled to vote, or a majority of those individuals entitled to the control of those entities specified in § 56-9-102 , request or consent to rehabilitation under this chapter. Acts 1991, ch. 142, § 4.
The commissioner may apply by petition to the chancery court of Davidson County for an order authorizing the commissioner to rehabilitate a domestic insurer or an alien insurer domiciled in this state on any one (1) or more of the following grounds:
(1) The insurer is in such condition that the further transaction of business would be hazardous financially to its policyholders, creditors or the public;
(2) There is reasonable cause to believe that there has been embezzlement from the insurer, wrongful sequestration or diversion of the insurer's assets, forgery or fraud affecting the insurer, or other illegal conduct in, by, or with respect to the insurer that, if established, would endanger assets in an amount threatening the solvency of the insurer;
(3) The insurer has failed to remove any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, employee, or other person, if the person has been found after notice and hearing by the commissioner to be dishonest or untrustworthy in a way affecting the insurer's business;
(4) Control of the insurer, whether by stock ownership or otherwise, and whether direct or indirect, is in a person or persons found after notice and hearing to be untrustworthy;
(5) Any person who in fact has executive authority in the insurer, whether an officer, manager, general agent, director or trustee, employee, or other person, has refused to be examined under oath by the commissioner concerning the insurer's affairs, whether in this state or elsewhere, and after reasonable notice of the fact, the insurer has failed promptly and effectively to terminate the employment and status of the person and all the person's influence on management;
(6) After demand by the commissioner in accordance with this chapter, the insurer has failed to promptly make available for examination any of its own property, books, accounts, documents, or other records, or those of any subsidiary or related company within the control of the insurer, or those of any person having executive authority in the insurer so far as they pertain to the insurer;
(7) Without first obtaining the written consent of the commissioner, the insurer has transferred, or attempted to transfer, in any manner, or contrary to chapter 11 of this title, substantially its entire property or business, or has entered into any transaction, the effect of which is to merge, consolidate or reinsure substantially its entire property or business in or with the property or business of any other person;
(8) The insurer or its property has been or is the subject of an application for the appointment of a receiver, trustee, custodian, conservator or sequestrator or similar fiduciary of the insurer or its property otherwise than as authorized under the insurance laws of this state, and such appointment has been made or is imminent, and the appointment might oust the courts of this state of jurisdiction or might prejudice orderly delinquency proceedings under this chapter;
(9) Within the previous four (4) years, the insurer has willfully violated its charter or articles of incorporation, its bylaws, any insurance law of this state, or any valid order of the commissioner;
(10) The insurer has failed to pay within sixty (60) days after due date any obligation to any state or any subdivision of a state or any judgment entered in any state, if the court in which the judgment was entered had jurisdiction over the subject matter, except that the nonpayment shall not be a ground until sixty (60) days after any good faith effort by the insurer to contest the obligation has been terminated, whether it is before the commissioner or in the courts, or the insurer has systematically attempted to compromise or renegotiate previously agreed settlements with its creditors on the ground that it is financially unable to pay its obligations in full;
(11) The insurer has failed to file its annual report or other financial report required by statute within the time allowed by law and, after written demand by the commissioner, has failed to give an adequate explanation immediately; or
(12) The board of directors, or the holders of a majority of the shares entitled to vote, or a majority of those individuals entitled to the control of those entities specified in § 56-9-102 , request or consent to rehabilitation under this chapter.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-10-104 — TN Code / Title 56 / Chapter 10 / Section 56-10-104
Approval of the commissioner
Status: in_force

(a) The constituent corporations in the case of a merger or consolidation, or the domestic company and the acquiring corporation in the case of an exchange of stock, shall then submit to the commissioner three (3) copies of the proposed plan certified by the president or a vice president of each as having been adopted by its board of directors in accordance with § 56-10-103 , together with: (1) Financial statements of the constituent corporations, or of the domestic company and the acquiring corporation, for its last preceding fiscal year; (2) Pro forma financial statements of each such corporation based on the assumption that the plan was effective as proposed at the end of the last preceding fiscal year of the domestic company; (3) An estimate of expenses already incurred and of expenses expected to be incurred in connection with the proposed plan; (4) A written statement that sets forth for each such corporation the proposed changes, if any, in management policies and in the identity of its officers and directors, which are initially contemplated should the plan be effected as proposed; (5) A nonrefundable fee in an amount that the commissioner shall by rule establish; and (6) Any other information that the commissioner may require with respect to the plan. (b) (1) The commissioner shall hold a public hearing upon the terms, conditions and provisions of the proposed plan of merger, consolidation or exchange to determine if it is reasonable, fair and in the public interest. At the hearing, the shareholders and the policyholders of each such corporation, and any other interested parties, shall have the right to appear and to become parties to the proceeding. (2) The hearing shall be commenced not less than thirty (30) days after the date on which the plan is submitted to the commissioner. The hearing shall be held at the place, date and time that the commissioner specifies. Notice of the hearing shall be published in a newspaper having general circulation in the city or cities wherein are located the principal office of each corporation that is a party to the plan, once a week for two (2) successive weeks, the last publication of the notice to be not more than two (2) weeks prior to the hearing date. Written notice of the hearing shall be mailed at least ten (10) days prior to the hearing by each such corporation to each of their respective shareholders. All expenses of publication shall be borne as specified in the plan. (c) The commissioner shall issue a written order approving the plan as submitted to the commissioner, including any modifications that a majority of the whole board of directors of each corporation that is a party to the plan approves, if the commissioner finds that: (1) The plan, including all modifications, if effected, will not tend to affect adversely the financial stability, management, general capacity, or intention to continue the safe and prudent transaction of insurance business of any domestic insurance company that is a party to the plan; (2) The fulfillment of the plan will not affect either the contractual obligations of any domestic insurance company that is a party to the plan to its policyholders, or the ability and tendency of the company to render service to its policyholders in the future; and (3) The terms and conditions of the plan are consistent with law and are fair and reasonable. (d) The order of the commissioner approving or disapproving the plan shall be filed in conformity with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, within sixty (60) days after the date the plan is submitted to the commissioner. The commissioner shall give notice of the order to all parties to the proceeding and shall deliver copies thereof to each corporation that is a party to the plan. Any party to the proceeding aggrieved by the order shall be entitled to a judicial review thereof in accordance with provisions of title 27, chapter 9. Acts 1968, ch. 448, § 2; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3604; Acts 1988, ch. 663, § 2.
(a) The constituent corporations in the case of a merger or consolidation, or the domestic company and the acquiring corporation in the case of an exchange of stock, shall then submit to the commissioner three (3) copies of the proposed plan certified by the president or a vice president of each as having been adopted by its board of directors in accordance with § 56-10-103 , together with: (1) Financial statements of the constituent corporations, or of the domestic company and the acquiring corporation, for its last preceding fiscal year; (2) Pro forma financial statements of each such corporation based on the assumption that the plan was effective as proposed at the end of the last preceding fiscal year of the domestic company; (3) An estimate of expenses already incurred and of expenses expected to be incurred in connection with the proposed plan; (4) A written statement that sets forth for each such corporation the proposed changes, if any, in management policies and in the identity of its officers and directors, which are initially contemplated should the plan be effected as proposed; (5) A nonrefundable fee in an amount that the commissioner shall by rule establish; and (6) Any other information that the commissioner may require with respect to the plan.
(1) Financial statements of the constituent corporations, or of the domestic company and the acquiring corporation, for its last preceding fiscal year;
(2) Pro forma financial statements of each such corporation based on the assumption that the plan was effective as proposed at the end of the last preceding fiscal year of the domestic company;
(3) An estimate of expenses already incurred and of expenses expected to be incurred in connection with the proposed plan;
(4) A written statement that sets forth for each such corporation the proposed changes, if any, in management policies and in the identity of its officers and directors, which are initially contemplated should the plan be effected as proposed;
(5) A nonrefundable fee in an amount that the commissioner shall by rule establish; and
(6) Any other information that the commissioner may require with respect to the plan.
(b) (1) The commissioner shall hold a public hearing upon the terms, conditions and provisions of the proposed plan of merger, consolidation or exchange to determine if it is reasonable, fair and in the public interest. At the hearing, the shareholders and the policyholders of each such corporation, and any other interested parties, shall have the right to appear and to become parties to the proceeding. (2) The hearing shall be commenced not less than thirty (30) days after the date on which the plan is submitted to the commissioner. The hearing shall be held at the place, date and time that the commissioner specifies. Notice of the hearing shall be published in a newspaper having general circulation in the city or cities wherein are located the principal office of each corporation that is a party to the plan, once a week for two (2) successive weeks, the last publication of the notice to be not more than two (2) weeks prior to the hearing date. Written notice of the hearing shall be mailed at least ten (10) days prior to the hearing by each such corporation to each of their respective shareholders. All expenses of publication shall be borne as specified in the plan.
(1) The commissioner shall hold a public hearing upon the terms, conditions and provisions of the proposed plan of merger, consolidation or exchange to determine if it is reasonable, fair and in the public interest. At the hearing, the shareholders and the policyholders of each such corporation, and any other interested parties, shall have the right to appear and to become parties to the proceeding.
(2) The hearing shall be commenced not less than thirty (30) days after the date on which the plan is submitted to the commissioner. The hearing shall be held at the place, date and time that the commissioner specifies. Notice of the hearing shall be published in a newspaper having general circulation in the city or cities wherein are located the principal office of each corporation that is a party to the plan, once a week for two (2) successive weeks, the last publication of the notice to be not more than two (2) weeks prior to the hearing date. Written notice of the hearing shall be mailed at least ten (10) days prior to the hearing by each such corporation to each of their respective shareholders. All expenses of publication shall be borne as specified in the plan.
(c) The commissioner shall issue a written order approving the plan as submitted to the commissioner, including any modifications that a majority of the whole board of directors of each corporation that is a party to the plan approves, if the commissioner finds that: (1) The plan, including all modifications, if effected, will not tend to affect adversely the financial stability, management, general capacity, or intention to continue the safe and prudent transaction of insurance business of any domestic insurance company that is a party to the plan; (2) The fulfillment of the plan will not affect either the contractual obligations of any domestic insurance company that is a party to the plan to its policyholders, or the ability and tendency of the company to render service to its policyholders in the future; and (3) The terms and conditions of the plan are consistent with law and are fair and reasonable.
(1) The plan, including all modifications, if effected, will not tend to affect adversely the financial stability, management, general capacity, or intention to continue the safe and prudent transaction of insurance business of any domestic insurance company that is a party to the plan;
(2) The fulfillment of the plan will not affect either the contractual obligations of any domestic insurance company that is a party to the plan to its policyholders, or the ability and tendency of the company to render service to its policyholders in the future; and
(3) The terms and conditions of the plan are consistent with law and are fair and reasonable.
(d) The order of the commissioner approving or disapproving the plan shall be filed in conformity with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, within sixty (60) days after the date the plan is submitted to the commissioner. The commissioner shall give notice of the order to all parties to the proceeding and shall deliver copies thereof to each corporation that is a party to the plan. Any party to the proceeding aggrieved by the order shall be entitled to a judicial review thereof in accordance with provisions of title 27, chapter 9.
Acts 1968, ch. 448, § 2; impl. am. Acts 1971, ch. 137, § 2; T.C.A., § 56-3604; Acts 1988, ch. 663, § 2.
Tenn. Code Ann. § 56-42-103 — TN Code / Title 56 / Chapter 42 / Section 56-42-103
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Applicant" means: (A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (B) In the case of a group long-term care insurance policy, the proposed certificate holder; (2) "Certificate" means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state; (3) "Commissioner" means the commissioner of commerce and insurance; (4) "Group long-term care insurance" means a long-term care insurance policy that is delivered or issued for delivery in this state and issued to: (A) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination of employees or former employees, or for members or former members, or a combination of members or former members, of the labor organizations; (B) Any professional, trade or occupational association for its members or former or retired members, or combination of former or retired members, if the association: (i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (ii) Has been maintained in good faith for purposes other than obtaining insurance; (C) (i) An association or a trust or the trustee or trustees of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one (1) year and have a constitution and bylaws that provide that: (a) The association or associations hold regular meetings not less than annually to further purposes of the members; (b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (c) The members have voting privileges and representation on the governing board and committees; (ii) Thirty (30) days after the filing, the association or associations will be deemed to satisfy the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or (D) A group other than as described in subdivisions (4)(A)-(C), subject to a finding by the commissioner that: (i) The issuance of the group policy is not contrary to the best interest of the public; (ii) The issuance of the group policy would result in economies of acquisition or administration; and (iii) The benefits are reasonable in relation to the premiums charged; (5) "Long-term care insurance" means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis, for one (1) or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital. "Long-term care insurance" includes group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care insurance. "Long-term care insurance" also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity. "Long-term care insurance" includes group and individual policies or riders whether issued by insurers, fraternal benefit societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations or any similar organization. "Long-term care insurance" does not include any insurance policy that is offered primarily to provide basic medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage; (6) "Policy" means any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan, health maintenance organization or any similar organization; and (7) (A) "Qualified long-term care insurance contract" or "federally tax-qualified long-term care insurance contract" means an individual or group insurance contract that meets the requirements of § 7702(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702(b) ), as follows: (i) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(i) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (ii) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVII of the Social Security Act ( 42 U.S.C. § 1391 et seq.), or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subdivision (7)(A)(ii) do not apply to expenses that are reimbursable under Title XVII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(ii) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (iii) The contract is guaranteed renewable, within the meaning of § 7702B(b)(1)(C) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b)(1)(C) ); (iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision (7)(A)(v); (v) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and (vi) The contract meets the consumer protection provisions set forth in § 7702B(g) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(g) ). (B) "Qualified long-term care insurance contract" or "federally tax-qualified long term care insurance contract" also means the portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of § 7702B(b) and (e) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b) and (e) ). Acts 1988, ch. 873, §4; 2008 , ch. 1058, §§ 2, 3.
As used in this chapter, unless the context otherwise requires:
(1) "Applicant" means: (A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (B) In the case of a group long-term care insurance policy, the proposed certificate holder;
(A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and
(B) In the case of a group long-term care insurance policy, the proposed certificate holder;
(2) "Certificate" means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state;
(3) "Commissioner" means the commissioner of commerce and insurance;
(4) "Group long-term care insurance" means a long-term care insurance policy that is delivered or issued for delivery in this state and issued to: (A) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination of employees or former employees, or for members or former members, or a combination of members or former members, of the labor organizations; (B) Any professional, trade or occupational association for its members or former or retired members, or combination of former or retired members, if the association: (i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (ii) Has been maintained in good faith for purposes other than obtaining insurance; (C) (i) An association or a trust or the trustee or trustees of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one (1) year and have a constitution and bylaws that provide that: (a) The association or associations hold regular meetings not less than annually to further purposes of the members; (b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (c) The members have voting privileges and representation on the governing board and committees; (ii) Thirty (30) days after the filing, the association or associations will be deemed to satisfy the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or (D) A group other than as described in subdivisions (4)(A)-(C), subject to a finding by the commissioner that: (i) The issuance of the group policy is not contrary to the best interest of the public; (ii) The issuance of the group policy would result in economies of acquisition or administration; and (iii) The benefits are reasonable in relation to the premiums charged;
(A) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination of employees or former employees, or for members or former members, or a combination of members or former members, of the labor organizations;
(B) Any professional, trade or occupational association for its members or former or retired members, or combination of former or retired members, if the association: (i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (ii) Has been maintained in good faith for purposes other than obtaining insurance;
(i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and
(ii) Has been maintained in good faith for purposes other than obtaining insurance;
(C) (i) An association or a trust or the trustee or trustees of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one (1) year and have a constitution and bylaws that provide that: (a) The association or associations hold regular meetings not less than annually to further purposes of the members; (b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (c) The members have voting privileges and representation on the governing board and committees; (ii) Thirty (30) days after the filing, the association or associations will be deemed to satisfy the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or
(i) An association or a trust or the trustee or trustees of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one (1) year and have a constitution and bylaws that provide that: (a) The association or associations hold regular meetings not less than annually to further purposes of the members; (b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (c) The members have voting privileges and representation on the governing board and committees;
(a) The association or associations hold regular meetings not less than annually to further purposes of the members;
(b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and
(c) The members have voting privileges and representation on the governing board and committees;
(ii) Thirty (30) days after the filing, the association or associations will be deemed to satisfy the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or
(D) A group other than as described in subdivisions (4)(A)-(C), subject to a finding by the commissioner that: (i) The issuance of the group policy is not contrary to the best interest of the public; (ii) The issuance of the group policy would result in economies of acquisition or administration; and (iii) The benefits are reasonable in relation to the premiums charged;
(i) The issuance of the group policy is not contrary to the best interest of the public;
(ii) The issuance of the group policy would result in economies of acquisition or administration; and
(iii) The benefits are reasonable in relation to the premiums charged;
(5) "Long-term care insurance" means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis, for one (1) or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital. "Long-term care insurance" includes group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care insurance. "Long-term care insurance" also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity. "Long-term care insurance" includes group and individual policies or riders whether issued by insurers, fraternal benefit societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations or any similar organization. "Long-term care insurance" does not include any insurance policy that is offered primarily to provide basic medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage;
(6) "Policy" means any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan, health maintenance organization or any similar organization; and
(7) (A) "Qualified long-term care insurance contract" or "federally tax-qualified long-term care insurance contract" means an individual or group insurance contract that meets the requirements of § 7702(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702(b) ), as follows: (i) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(i) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (ii) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVII of the Social Security Act ( 42 U.S.C. § 1391 et seq.), or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subdivision (7)(A)(ii) do not apply to expenses that are reimbursable under Title XVII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(ii) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (iii) The contract is guaranteed renewable, within the meaning of § 7702B(b)(1)(C) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b)(1)(C) ); (iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision (7)(A)(v); (v) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and (vi) The contract meets the consumer protection provisions set forth in § 7702B(g) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(g) ). (B) "Qualified long-term care insurance contract" or "federally tax-qualified long term care insurance contract" also means the portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of § 7702B(b) and (e) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b) and (e) ).
(A) "Qualified long-term care insurance contract" or "federally tax-qualified long-term care insurance contract" means an individual or group insurance contract that meets the requirements of § 7702(b) of the Internal Revenue Code of 1986 ( 26 U.S.C. § 7702(b) ), as follows: (i) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(i) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (ii) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVII of the Social Security Act ( 42 U.S.C. § 1391 et seq.), or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subdivision (7)(A)(ii) do not apply to expenses that are reimbursable under Title XVII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(ii) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (iii) The contract is guaranteed renewable, within the meaning of § 7702B(b)(1)(C) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b)(1)(C) ); (iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision (7)(A)(v); (v) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and (vi) The contract meets the consumer protection provisions set forth in § 7702B(g) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(g) ).
(i) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(i) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;
(ii) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVII of the Social Security Act ( 42 U.S.C. § 1391 et seq.), or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subdivision (7)(A)(ii) do not apply to expenses that are reimbursable under Title XVII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(ii) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;
(iii) The contract is guaranteed renewable, within the meaning of § 7702B(b)(1)(C) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b)(1)(C) );
(iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision (7)(A)(v);
(v) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and
(vi) The contract meets the consumer protection provisions set forth in § 7702B(g) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(g) ).
(B) "Qualified long-term care insurance contract" or "federally tax-qualified long term care insurance contract" also means the portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of § 7702B(b) and (e) of the Internal Revenue Code of 1986 ( 26 U.S.C § 7702B(b) and (e) ).
Acts 1988, ch. 873, §4; 2008 , ch. 1058, §§ 2, 3.
Tenn. Code Ann. § 56-32-103 — TN Code / Title 56 / Chapter 32 / Section 56-32-103
Certificate of authority - Applications - Applicants - Exemptions - Excess or aggregate insurance
Status: in_force

(a) Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for and obtain a certificate of authority to establish and operate an HMO in compliance with this chapter. No person shall establish or operate an HMO in this state without obtaining a certificate of authority under this chapter. A foreign corporation may qualify under this chapter, subject to its registration to do business in this state as a foreign corporation. (b) Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following: (1) A copy of the organizational documents of the applicant, such as the articles of incorporation, articles of association, partnership agreement, trust agreement or other applicable documents, and all amendments to those documents; (2) A copy of the bylaws, rules and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant; (3) A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association; (4) A copy of any contract made or to be made between any providers or persons listed in subdivision (b)(3) and the applicant; (5) A copy of the form of evidence of coverage to be issued to the enrollees; (6) A copy of the form or group contract, if any, that is to be issued to employers, unions, trustees or other organizations; (7) Financial statements showing the applicant's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners; (8) A description of the proposed method of marketing, a financial plan that includes a projection of operating results anticipated until the organization has had net income for at least two (2) years, and a statement as to the sources of working capital as well as any other sources of funding; (9) A power of attorney duly executed by the applicant, if not domiciled in this state, appointing the commissioner and the commissioner's successors in office, and duly appointed deputies, as the true and lawful attorney of the applicant in and for this state upon whom all lawful process in any legal action or proceeding involving the HMO on a cause of action arising in this state may be served; (10) A statement reasonably describing the geographic area or areas to be served; (11) A description of the complaint procedure to be utilized pursuant to the Tennessee Health Carrier Grievance and External Review Procedure Act, compiled in chapter 61 of this title; and (12) Other information the commissioner may require to make the determination required in § 56-32-104 . (c) (1) An applicant or an HMO holding a certificate of authority granted under this section shall, unless otherwise provided for in this chapter, file a notice describing any material modification of the operation set out in the information required by subsection (b). The notice shall be filed with the commissioner prior to the modification. If the commissioner does not disapprove of the modification within thirty (30) days of filing, the modification shall be deemed approved. (2) (A) Significant expansions of an HMO's enrollee population shall be considered a material modification under subdivision (c)(1), necessitating the filing of: (i) Current financial statements showing the HMO's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners, as required by subdivision (b)(7); (ii) A description of the proposed plan of marketing, a financial plan that includes a projection of operating results anticipated for the two (2) years following the addition of the new enrollees, and a statement as to the sources of working capital as well as any other sources of funding, all as required by subdivision (b)(8); and (iii) Any other information required to be filed by subsection (b) that, as a result of the expansion of the HMO's enrollee population, has been materially modified. (B) This information shall be filed with, and reviewed by, the commissioner as delineated in subdivision (c)(1). (C) For purposes of this subsection (c), expansions of an HMO's enrollee population that do not exceed ten percent (10%) of the HMO's existing enrollee population in any six-month period shall not be considered a significant expansion of the HMO's enrollee population. (d) An applicant or an HMO holding a certificate of authority granted under this section shall file all contracts of excess or aggregate insurance with the commissioner. Any agreement between the organization and an insurer shall be subject to the laws of this state regarding excess and aggregate insurance. (e) An applicant must demonstrate to the commissioner of health or the commissioner's designee proof of capability to provide basic health care services efficiently, effectively and economically. The applicant shall meet the network adequacy requirements established pursuant to § 56-7-2356 . The commissioner of health shall report the commissioner's findings to the commissioner of commerce and insurance, who may then deny the application for a certificate of authority, as provided in §§ 56-32-104 and 56-32-118(b) . (f) The commissioner shall issue a temporary certificate of authority to any entity that provides or pays for medical services provided to recipients of medical assistance, as defined by § 71-5-103 , in exchange for a premium or subscription charge paid by the medical assistance program pursuant to the Medical Assistance Act, compiled in title 71, chapter 5, part 1, upon submission by the entity of an application for a certificate of authority as provided for in this chapter. The temporary certificate of authority shall not be issued to any entity that provides or pays for medical services on a per capita prepayment basis to any person not receiving medical services through the medical assistance program. The temporary certificate shall be valid for a period not to exceed one (1) year or until a certificate of authority is issued, whichever occurs first. The authority that allows payment under the Medical Assistance Act shall be extended to be concurrent with the temporary certificate of authority or until a new authority of payment is authorized by the medicaid agency. Acts 1986, ch. 713, § 3; 1987, ch. 454, §1; 1997 , ch. 60, § 1; 1998, ch. 1033, § 4; 2000, ch. 708, § 4; T.C.A. §56-32-203; Acts 2010 , ch. 980, § 29.
(a) Notwithstanding any law of this state to the contrary, any person may apply to the commissioner for and obtain a certificate of authority to establish and operate an HMO in compliance with this chapter. No person shall establish or operate an HMO in this state without obtaining a certificate of authority under this chapter. A foreign corporation may qualify under this chapter, subject to its registration to do business in this state as a foreign corporation.
(b) Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the commissioner, and shall set forth or be accompanied by the following: (1) A copy of the organizational documents of the applicant, such as the articles of incorporation, articles of association, partnership agreement, trust agreement or other applicable documents, and all amendments to those documents; (2) A copy of the bylaws, rules and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant; (3) A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association; (4) A copy of any contract made or to be made between any providers or persons listed in subdivision (b)(3) and the applicant; (5) A copy of the form of evidence of coverage to be issued to the enrollees; (6) A copy of the form or group contract, if any, that is to be issued to employers, unions, trustees or other organizations; (7) Financial statements showing the applicant's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners; (8) A description of the proposed method of marketing, a financial plan that includes a projection of operating results anticipated until the organization has had net income for at least two (2) years, and a statement as to the sources of working capital as well as any other sources of funding; (9) A power of attorney duly executed by the applicant, if not domiciled in this state, appointing the commissioner and the commissioner's successors in office, and duly appointed deputies, as the true and lawful attorney of the applicant in and for this state upon whom all lawful process in any legal action or proceeding involving the HMO on a cause of action arising in this state may be served; (10) A statement reasonably describing the geographic area or areas to be served; (11) A description of the complaint procedure to be utilized pursuant to the Tennessee Health Carrier Grievance and External Review Procedure Act, compiled in chapter 61 of this title; and (12) Other information the commissioner may require to make the determination required in § 56-32-104 .
(1) A copy of the organizational documents of the applicant, such as the articles of incorporation, articles of association, partnership agreement, trust agreement or other applicable documents, and all amendments to those documents;
(2) A copy of the bylaws, rules and regulations, or similar document, if any, regulating the conduct of the internal affairs of the applicant;
(3) A list of the names, addresses and official positions of the persons who are to be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee or other governing board or committee, the principal officers in the case of a corporation, and the partners or members in the case of a partnership or association;
(4) A copy of any contract made or to be made between any providers or persons listed in subdivision (b)(3) and the applicant;
(5) A copy of the form of evidence of coverage to be issued to the enrollees;
(6) A copy of the form or group contract, if any, that is to be issued to employers, unions, trustees or other organizations;
(7) Financial statements showing the applicant's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners;
(8) A description of the proposed method of marketing, a financial plan that includes a projection of operating results anticipated until the organization has had net income for at least two (2) years, and a statement as to the sources of working capital as well as any other sources of funding;
(9) A power of attorney duly executed by the applicant, if not domiciled in this state, appointing the commissioner and the commissioner's successors in office, and duly appointed deputies, as the true and lawful attorney of the applicant in and for this state upon whom all lawful process in any legal action or proceeding involving the HMO on a cause of action arising in this state may be served;
(10) A statement reasonably describing the geographic area or areas to be served;
(11) A description of the complaint procedure to be utilized pursuant to the Tennessee Health Carrier Grievance and External Review Procedure Act, compiled in chapter 61 of this title; and
(12) Other information the commissioner may require to make the determination required in § 56-32-104 .
(c) (1) An applicant or an HMO holding a certificate of authority granted under this section shall, unless otherwise provided for in this chapter, file a notice describing any material modification of the operation set out in the information required by subsection (b). The notice shall be filed with the commissioner prior to the modification. If the commissioner does not disapprove of the modification within thirty (30) days of filing, the modification shall be deemed approved. (2) (A) Significant expansions of an HMO's enrollee population shall be considered a material modification under subdivision (c)(1), necessitating the filing of: (i) Current financial statements showing the HMO's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners, as required by subdivision (b)(7); (ii) A description of the proposed plan of marketing, a financial plan that includes a projection of operating results anticipated for the two (2) years following the addition of the new enrollees, and a statement as to the sources of working capital as well as any other sources of funding, all as required by subdivision (b)(8); and (iii) Any other information required to be filed by subsection (b) that, as a result of the expansion of the HMO's enrollee population, has been materially modified. (B) This information shall be filed with, and reviewed by, the commissioner as delineated in subdivision (c)(1). (C) For purposes of this subsection (c), expansions of an HMO's enrollee population that do not exceed ten percent (10%) of the HMO's existing enrollee population in any six-month period shall not be considered a significant expansion of the HMO's enrollee population.
(1) An applicant or an HMO holding a certificate of authority granted under this section shall, unless otherwise provided for in this chapter, file a notice describing any material modification of the operation set out in the information required by subsection (b). The notice shall be filed with the commissioner prior to the modification. If the commissioner does not disapprove of the modification within thirty (30) days of filing, the modification shall be deemed approved.
(2) (A) Significant expansions of an HMO's enrollee population shall be considered a material modification under subdivision (c)(1), necessitating the filing of: (i) Current financial statements showing the HMO's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners, as required by subdivision (b)(7); (ii) A description of the proposed plan of marketing, a financial plan that includes a projection of operating results anticipated for the two (2) years following the addition of the new enrollees, and a statement as to the sources of working capital as well as any other sources of funding, all as required by subdivision (b)(8); and (iii) Any other information required to be filed by subsection (b) that, as a result of the expansion of the HMO's enrollee population, has been materially modified. (B) This information shall be filed with, and reviewed by, the commissioner as delineated in subdivision (c)(1). (C) For purposes of this subsection (c), expansions of an HMO's enrollee population that do not exceed ten percent (10%) of the HMO's existing enrollee population in any six-month period shall not be considered a significant expansion of the HMO's enrollee population.
(A) Significant expansions of an HMO's enrollee population shall be considered a material modification under subdivision (c)(1), necessitating the filing of: (i) Current financial statements showing the HMO's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners, as required by subdivision (b)(7); (ii) A description of the proposed plan of marketing, a financial plan that includes a projection of operating results anticipated for the two (2) years following the addition of the new enrollees, and a statement as to the sources of working capital as well as any other sources of funding, all as required by subdivision (b)(8); and (iii) Any other information required to be filed by subsection (b) that, as a result of the expansion of the HMO's enrollee population, has been materially modified.
(i) Current financial statements showing the HMO's assets, liabilities, and sources of financial support using the official blank form for HMOs prescribed by the National Association of Insurance Commissioners, as required by subdivision (b)(7);
(ii) A description of the proposed plan of marketing, a financial plan that includes a projection of operating results anticipated for the two (2) years following the addition of the new enrollees, and a statement as to the sources of working capital as well as any other sources of funding, all as required by subdivision (b)(8); and
(iii) Any other information required to be filed by subsection (b) that, as a result of the expansion of the HMO's enrollee population, has been materially modified.
(B) This information shall be filed with, and reviewed by, the commissioner as delineated in subdivision (c)(1).
(C) For purposes of this subsection (c), expansions of an HMO's enrollee population that do not exceed ten percent (10%) of the HMO's existing enrollee population in any six-month period shall not be considered a significant expansion of the HMO's enrollee population.
(d) An applicant or an HMO holding a certificate of authority granted under this section shall file all contracts of excess or aggregate insurance with the commissioner. Any agreement between the organization and an insurer shall be subject to the laws of this state regarding excess and aggregate insurance.
(e) An applicant must demonstrate to the commissioner of health or the commissioner's designee proof of capability to provide basic health care services efficiently, effectively and economically. The applicant shall meet the network adequacy requirements established pursuant to § 56-7-2356 . The commissioner of health shall report the commissioner's findings to the commissioner of commerce and insurance, who may then deny the application for a certificate of authority, as provided in §§ 56-32-104 and 56-32-118(b) .
(f) The commissioner shall issue a temporary certificate of authority to any entity that provides or pays for medical services provided to recipients of medical assistance, as defined by § 71-5-103 , in exchange for a premium or subscription charge paid by the medical assistance program pursuant to the Medical Assistance Act, compiled in title 71, chapter 5, part 1, upon submission by the entity of an application for a certificate of authority as provided for in this chapter. The temporary certificate of authority shall not be issued to any entity that provides or pays for medical services on a per capita prepayment basis to any person not receiving medical services through the medical assistance program. The temporary certificate shall be valid for a period not to exceed one (1) year or until a certificate of authority is issued, whichever occurs first. The authority that allows payment under the Medical Assistance Act shall be extended to be concurrent with the temporary certificate of authority or until a new authority of payment is authorized by the medicaid agency.
Acts 1986, ch. 713, § 3; 1987, ch. 454, §1; 1997 , ch. 60, § 1; 1998, ch. 1033, § 4; 2000, ch. 708, § 4; T.C.A. §56-32-203; Acts 2010 , ch. 980, § 29.
Tenn. Code Ann. § 56-14-112 — TN Code / Title 56 / Chapter 14 / Section 56-14-112
Actions against insurer - Service of process
Status: in_force

(a) An unauthorized company may be sued upon any cause of action arising in this state under any surplus lines insurance contract issued by it or certificate, cover note or other confirmation of the insurance issued by the surplus lines agent, pursuant to the same procedure as is provided for unauthorized insurers in chapter 2, part 6 of this title and § 56-7-105(b) . The policy issued by the insurer, or any certificate of insurance issued by the surplus lines agent, shall contain a provision stating the substance of this section and designating the person to whom the commissioner shall mail process. (b) Each unauthorized company assuming a surplus lines insurance risk pursuant to this chapter shall be deemed to have subjected itself to the requirements of this section. (c) This section shall be cumulative to any other methods that may be provided by law for service of process upon the insurer. Acts 1969, ch. 270, § 12; T.C.A., § 56-3812; Acts 2011, ch. 446, § 1.
(a) An unauthorized company may be sued upon any cause of action arising in this state under any surplus lines insurance contract issued by it or certificate, cover note or other confirmation of the insurance issued by the surplus lines agent, pursuant to the same procedure as is provided for unauthorized insurers in chapter 2, part 6 of this title and § 56-7-105(b) . The policy issued by the insurer, or any certificate of insurance issued by the surplus lines agent, shall contain a provision stating the substance of this section and designating the person to whom the commissioner shall mail process.
(b) Each unauthorized company assuming a surplus lines insurance risk pursuant to this chapter shall be deemed to have subjected itself to the requirements of this section.
(c) This section shall be cumulative to any other methods that may be provided by law for service of process upon the insurer.
Acts 1969, ch. 270, § 12; T.C.A., § 56-3812; Acts 2011, ch. 446, § 1.
Tenn. Code Ann. § 56-12-115 — TN Code / Title 56 / Chapter 12 / Section 56-12-115
Deduction from premium taxes
Status: in_force

Member insurers assessed a percentage of net direct written premiums for any preceding calendar year, as provided in § 56-12-107(a)(3) , shall be allowed a credit against premium taxes imposed on such member insurers by § 56-4-205 , up to twenty-five percent (25%) of the net premium taxes due in any one (1) calendar year until the aggregate of all assessments paid to the guaranty association has been offset by such premium tax credits. The guaranty association shall certify to the commissioner on an annual basis the names of the member insurers and the assessments paid. The provisions herein are applicable to all insolvencies occurring after April 28, 1975; provided, that only premium taxes paid on and after March 1977, will be subject to credit as herein provided. Acts 1971, ch. 180, § 15; 1975, ch. 63, § 1; T.C.A., § 56-4015.
Member insurers assessed a percentage of net direct written premiums for any preceding calendar year, as provided in § 56-12-107(a)(3) , shall be allowed a credit against premium taxes imposed on such member insurers by § 56-4-205 , up to twenty-five percent (25%) of the net premium taxes due in any one (1) calendar year until the aggregate of all assessments paid to the guaranty association has been offset by such premium tax credits. The guaranty association shall certify to the commissioner on an annual basis the names of the member insurers and the assessments paid. The provisions herein are applicable to all insolvencies occurring after April 28, 1975; provided, that only premium taxes paid on and after March 1977, will be subject to credit as herein provided.
Acts 1971, ch. 180, § 15; 1975, ch. 63, § 1; T.C.A., § 56-4015.
Tenn. Code Ann. § 56-31-130 — TN Code / Title 56 / Chapter 31 / Section 56-31-130
Construction of chapter
Status: in_force

This chapter is not to be construed as prohibiting any insurance company, properly qualified in this state to write accident or health or disability insurance, from making available any plan of vision service that may be approved by the commissioner under existing statutes or within the authority granted to benevolent associations. Acts 1969, ch. 118, § 30; T.C.A., § 56-3730.
This chapter is not to be construed as prohibiting any insurance company, properly qualified in this state to write accident or health or disability insurance, from making available any plan of vision service that may be approved by the commissioner under existing statutes or within the authority granted to benevolent associations.
Acts 1969, ch. 118, § 30; T.C.A., § 56-3730.
Tenn. Code Ann. § 56-51-149 — TN Code / Title 56 / Chapter 51 / Section 56-51-149
Civil liability
Status: in_force

The provisions of this chapter are cumulative to rights under the general civil and common law, and no action of the department abrogates the rights to damage or other relief in any court. Acts 2000, ch. 948, § 49.
The provisions of this chapter are cumulative to rights under the general civil and common law, and no action of the department abrogates the rights to damage or other relief in any court.
Acts 2000, ch. 948, § 49.
Tenn. Code Ann. § 56-5-106 — TN Code / Title 56 / Chapter 5 / Section 56-5-106
Filing by commercial risk insurers
Status: in_force

(a) (1) Except as provided in subsections (b), (c), and (d), every insurer of commercial risk insurance shall file with the commissioner all rates, supplementary rate information, policy forms and endorsements, not later than fifteen (15) days after the effective date; provided, that the rates, supplementary rate information, policy forms and endorsements need not be filed for inland marine risks that by general custom of the business are not written according to manual rules of rating plans. Upon request of the commissioner, supporting information shall also be filed. (2) The commissioner may, after a hearing providing not less than twenty (20) days' written notice to the insurer, disapprove any policy form or endorsement already in effect if it does not comply with the law or with rules adopted pursuant to this part or if it contains any provision that is unfair, deceptive or misleading. The disapproval order shall specify the reasons for the commissioner's findings and the date, not less than thirty (30) days after issuance of the order, when the disapproval is effective, and it shall thereafter be unlawful for the insurer to use the form or endorsement in this state. (b) (1) The following insurance coverages are exempt from filing requirements with respect to rates, supplementary rate information, policy forms, and endorsements, where applicable under this chapter, whether the insurance coverage is endorsed to or sold as a stand-alone policy: (A) Boiler and machinery; (B) Environmental impairment or pollution liability; (C) Kidnap and ransom; (D) Political risk or expropriation; (E) Employment practices liability; (F) Media liability; and (G) Product liability, product recall, and completed operations. (2) The exemption from filing requirements in this subsection (b) does not affect any other requirements of this title, including those applicable to cancellation of commercial insurance policies. (3) The insurer shall deliver to the insured and the producer of record a copy of a policy issued pursuant to this subsection (b). The policy may be delivered to the applicant or policyholder electronically and must contain a disclaimer in language the same as or substantially similar to the following: The rate provided for in this policy and all forms utilized are exempt from the filing requirements of Tenn. Code Ann. § 56-5-106 . (c) With respect to workers' compensation insurance, a rate service organization designated by one (1) or more insurers shall develop and file for approval with the commissioner in accordance with this section, a filing on behalf of authorized insurers containing advisory prospective loss costs and supporting actuarial and statistical data for workers' compensation insurance, including loss adjustment expenses. An advisory prospective loss costs filing shall become effective only when approved pursuant to § 50-6-402 . (d) Each workers' compensation insurer, or group of insurers under common ownership, shall individually file with the commissioner the multiplier and supporting information not later than fifteen (15) days after the effective date. Multipliers shall apply to the most recently approved, currently effective advisory prospective loss cost. (e) All multipliers filed pursuant to subsection (d) shall be actuarially justified and shall be certified by a member in good standing of the Casualty Actuarial Society. Amended by 2021 Tenn. Acts, ch. 537, s 7, eff. 5/25/2021. Amended by 2018 Tenn. Acts, ch. 996, Secs.s 1, s 2 eff. 5/21/2018. Amended by 2015 Tenn. Acts, ch. 188, s 2, eff. 4/22/2015. Acts 1983, ch. 66, § 7; 1996, ch. 944, § 36; 1997 , ch. 533, § 10; 1998, ch. 1024, § 17; 2001, ch. 192, §§ 3, 5, 15.
(a) (1) Except as provided in subsections (b), (c), and (d), every insurer of commercial risk insurance shall file with the commissioner all rates, supplementary rate information, policy forms and endorsements, not later than fifteen (15) days after the effective date; provided, that the rates, supplementary rate information, policy forms and endorsements need not be filed for inland marine risks that by general custom of the business are not written according to manual rules of rating plans. Upon request of the commissioner, supporting information shall also be filed. (2) The commissioner may, after a hearing providing not less than twenty (20) days' written notice to the insurer, disapprove any policy form or endorsement already in effect if it does not comply with the law or with rules adopted pursuant to this part or if it contains any provision that is unfair, deceptive or misleading. The disapproval order shall specify the reasons for the commissioner's findings and the date, not less than thirty (30) days after issuance of the order, when the disapproval is effective, and it shall thereafter be unlawful for the insurer to use the form or endorsement in this state.
(1) Except as provided in subsections (b), (c), and (d), every insurer of commercial risk insurance shall file with the commissioner all rates, supplementary rate information, policy forms and endorsements, not later than fifteen (15) days after the effective date; provided, that the rates, supplementary rate information, policy forms and endorsements need not be filed for inland marine risks that by general custom of the business are not written according to manual rules of rating plans. Upon request of the commissioner, supporting information shall also be filed.
(2) The commissioner may, after a hearing providing not less than twenty (20) days' written notice to the insurer, disapprove any policy form or endorsement already in effect if it does not comply with the law or with rules adopted pursuant to this part or if it contains any provision that is unfair, deceptive or misleading. The disapproval order shall specify the reasons for the commissioner's findings and the date, not less than thirty (30) days after issuance of the order, when the disapproval is effective, and it shall thereafter be unlawful for the insurer to use the form or endorsement in this state.
(b) (1) The following insurance coverages are exempt from filing requirements with respect to rates, supplementary rate information, policy forms, and endorsements, where applicable under this chapter, whether the insurance coverage is endorsed to or sold as a stand-alone policy: (A) Boiler and machinery; (B) Environmental impairment or pollution liability; (C) Kidnap and ransom; (D) Political risk or expropriation; (E) Employment practices liability; (F) Media liability; and (G) Product liability, product recall, and completed operations. (2) The exemption from filing requirements in this subsection (b) does not affect any other requirements of this title, including those applicable to cancellation of commercial insurance policies. (3) The insurer shall deliver to the insured and the producer of record a copy of a policy issued pursuant to this subsection (b). The policy may be delivered to the applicant or policyholder electronically and must contain a disclaimer in language the same as or substantially similar to the following: The rate provided for in this policy and all forms utilized are exempt from the filing requirements of Tenn. Code Ann. § 56-5-106 .
(1) The following insurance coverages are exempt from filing requirements with respect to rates, supplementary rate information, policy forms, and endorsements, where applicable under this chapter, whether the insurance coverage is endorsed to or sold as a stand-alone policy: (A) Boiler and machinery; (B) Environmental impairment or pollution liability; (C) Kidnap and ransom; (D) Political risk or expropriation; (E) Employment practices liability; (F) Media liability; and (G) Product liability, product recall, and completed operations.
(A) Boiler and machinery;
(B) Environmental impairment or pollution liability;
(C) Kidnap and ransom;
(D) Political risk or expropriation;
(E) Employment practices liability;
(F) Media liability; and
(G) Product liability, product recall, and completed operations.
(2) The exemption from filing requirements in this subsection (b) does not affect any other requirements of this title, including those applicable to cancellation of commercial insurance policies.
(3) The insurer shall deliver to the insured and the producer of record a copy of a policy issued pursuant to this subsection (b). The policy may be delivered to the applicant or policyholder electronically and must contain a disclaimer in language the same as or substantially similar to the following: The rate provided for in this policy and all forms utilized are exempt from the filing requirements of Tenn. Code Ann. § 56-5-106 .
The rate provided for in this policy and all forms utilized are exempt from the filing requirements of Tenn. Code Ann. § 56-5-106 .
(c) With respect to workers' compensation insurance, a rate service organization designated by one (1) or more insurers shall develop and file for approval with the commissioner in accordance with this section, a filing on behalf of authorized insurers containing advisory prospective loss costs and supporting actuarial and statistical data for workers' compensation insurance, including loss adjustment expenses. An advisory prospective loss costs filing shall become effective only when approved pursuant to § 50-6-402 .
(d) Each workers' compensation insurer, or group of insurers under common ownership, shall individually file with the commissioner the multiplier and supporting information not later than fifteen (15) days after the effective date. Multipliers shall apply to the most recently approved, currently effective advisory prospective loss cost.
(e) All multipliers filed pursuant to subsection (d) shall be actuarially justified and shall be certified by a member in good standing of the Casualty Actuarial Society.
Amended by 2021 Tenn. Acts, ch. 537, s 7, eff. 5/25/2021.
Amended by 2018 Tenn. Acts, ch. 996, Secs.s 1, s 2 eff. 5/21/2018.
Amended by 2015 Tenn. Acts, ch. 188, s 2, eff. 4/22/2015.
Acts 1983, ch. 66, § 7; 1996, ch. 944, § 36; 1997 , ch. 533, § 10; 1998, ch. 1024, § 17; 2001, ch. 192, §§ 3, 5, 15.
Tenn. Code Ann. § 56-61-117 — TN Code / Title 56 / Chapter 61 / Section 56-61-117
Expedited external review
Status: in_force

(a) Except as provided in subsection (f), an aggrieved person may make a request for an expedited external review with the health carrier at the time the aggrieved person receives: (1) An adverse determination if: (A) The adverse determination involves a medical condition of the covered person for which the timeframe for completion of an expedited internal review of a grievance involving an adverse determination set forth in § 56-61-109 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; and (B) The aggrieved person has filed a request for an expedited review of a grievance involving an adverse determination as set forth in § 56-61-109 ; or (2) A final adverse determination: (A) If the covered person has a medical condition where the timeframe for completion of a standard external review pursuant to § 56-61-116 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; or (B) If the final adverse determination concerns an admission, availability of care, continued stay or healthcare service for which the covered person received emergency services, but has not been discharged from a facility. (b) (1) Immediately upon receipt of the request, the health carrier shall determine whether the request meets the reviewability requirements set forth in § 56-61-116 . The health carrier shall immediately notify the aggrieved person of its eligibility determination regarding the availability of external review. (2) The notice of initial determination shall include a statement informing the aggrieved person that a health carrier's initial determination that an external review request is ineligible for review and that the aggrieved person may file a complaint with the commissioner. (A) The commissioner may determine that a request is eligible for external review notwithstanding a health carrier's initial determination that the request is ineligible and that it be referred to external review. (B) In making a determination under subdivision (b)(2)(A), the commissioner's decision shall be made in accordance with the terms of the covered person's health benefit plan and shall be subject to all applicable provisions of this chapter. (c) Upon making a determination that a request is eligible for expedited external review, the health carrier shall immediately notify the aggrieved person in writing that the request is eligible for external review. (d) At the same time, the health carrier shall immediately notify the external review organization and provide or transmit all necessary documents and information considered when making the adverse determination or final adverse determination electronically or by telephone, facsimile or any other expeditious method available. (e) In addition to the documents and information provided or transmitted pursuant to subsection (d), the external review organization, to the extent that the information or documents are available and the external review organization considers them appropriate, shall consider the following in reaching a decision: (1) The covered person's pertinent medical records; (2) The attending healthcare professional's recommendation; (3) Consulting reports from appropriate healthcare professionals and other documents submitted by the health carrier or the aggrieved person; (4) The terms of coverage under the covered person's health benefit plan with the health carrier to ensure that the external review organization's decision is not contrary to the terms of coverage under the covered person's health benefit plan with the health carrier; (5) The most appropriate practice guidelines, which shall include medical or scientific evidence based standards; (6) Applicable clinical review criteria developed and used by the health carrier in making adverse determinations; (7) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (A) The federal agency for healthcare research and quality; (B) The national institutes of health; (C) The national cancer institute; (D) The national academy of sciences; (E) The centers for medicare & medicaid services; (F) The federal food and drug administration; and (G) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services; and (8) The opinion of the external review organization's clinical reviewer or reviewers after considering subdivisions (e)(1)-(7) to the extent that the information and documents are available and the clinical reviewer or reviewers consider appropriate. (f) (1) (A) As expeditiously as the covered person's medical condition or circumstances requires, but in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements, the external review organization shall make a decision to uphold or reverse the adverse determination or final adverse determination; and (B) Notify the health carrier of the decision and the health carrier must immediately notify the aggrieved person of the external review organization's decision. The aggrieved person must receive the decision of the expedited external review within seventy-two (72) hours after the date of receipt of the request for expedited external review. (2) (A) If the notice provided pursuant to subdivision (f)(1) was not in writing, within forty-eight (48) hours after the date of providing such notice, the external review organization shall provide written confirmation of the decision to the health carrier; and include the information set forth in this section. (B) The health carrier shall immediately notify the aggrieved person of the external review organization's decision and include the information set forth in this section. (C) Upon receipt of notice of the decision rendered pursuant to subdivision (f)(1) reversing the adverse determination or final adverse determination, the health carrier shall immediately approve the coverage that was the subject of the adverse determination or the final adverse determination. (g) An expedited external review shall not be provided for retrospective adverse determinations or final adverse determinations. Acts 2010, ch. 980, § 18.
(a) Except as provided in subsection (f), an aggrieved person may make a request for an expedited external review with the health carrier at the time the aggrieved person receives: (1) An adverse determination if: (A) The adverse determination involves a medical condition of the covered person for which the timeframe for completion of an expedited internal review of a grievance involving an adverse determination set forth in § 56-61-109 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; and (B) The aggrieved person has filed a request for an expedited review of a grievance involving an adverse determination as set forth in § 56-61-109 ; or (2) A final adverse determination: (A) If the covered person has a medical condition where the timeframe for completion of a standard external review pursuant to § 56-61-116 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; or (B) If the final adverse determination concerns an admission, availability of care, continued stay or healthcare service for which the covered person received emergency services, but has not been discharged from a facility.
(1) An adverse determination if: (A) The adverse determination involves a medical condition of the covered person for which the timeframe for completion of an expedited internal review of a grievance involving an adverse determination set forth in § 56-61-109 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; and (B) The aggrieved person has filed a request for an expedited review of a grievance involving an adverse determination as set forth in § 56-61-109 ; or
(A) The adverse determination involves a medical condition of the covered person for which the timeframe for completion of an expedited internal review of a grievance involving an adverse determination set forth in § 56-61-109 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; and
(B) The aggrieved person has filed a request for an expedited review of a grievance involving an adverse determination as set forth in § 56-61-109 ; or
(2) A final adverse determination: (A) If the covered person has a medical condition where the timeframe for completion of a standard external review pursuant to § 56-61-116 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; or (B) If the final adverse determination concerns an admission, availability of care, continued stay or healthcare service for which the covered person received emergency services, but has not been discharged from a facility.
(A) If the covered person has a medical condition where the timeframe for completion of a standard external review pursuant to § 56-61-116 would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function; or
(B) If the final adverse determination concerns an admission, availability of care, continued stay or healthcare service for which the covered person received emergency services, but has not been discharged from a facility.
(b) (1) Immediately upon receipt of the request, the health carrier shall determine whether the request meets the reviewability requirements set forth in § 56-61-116 . The health carrier shall immediately notify the aggrieved person of its eligibility determination regarding the availability of external review. (2) The notice of initial determination shall include a statement informing the aggrieved person that a health carrier's initial determination that an external review request is ineligible for review and that the aggrieved person may file a complaint with the commissioner. (A) The commissioner may determine that a request is eligible for external review notwithstanding a health carrier's initial determination that the request is ineligible and that it be referred to external review. (B) In making a determination under subdivision (b)(2)(A), the commissioner's decision shall be made in accordance with the terms of the covered person's health benefit plan and shall be subject to all applicable provisions of this chapter.
(1) Immediately upon receipt of the request, the health carrier shall determine whether the request meets the reviewability requirements set forth in § 56-61-116 . The health carrier shall immediately notify the aggrieved person of its eligibility determination regarding the availability of external review.
(2) The notice of initial determination shall include a statement informing the aggrieved person that a health carrier's initial determination that an external review request is ineligible for review and that the aggrieved person may file a complaint with the commissioner. (A) The commissioner may determine that a request is eligible for external review notwithstanding a health carrier's initial determination that the request is ineligible and that it be referred to external review. (B) In making a determination under subdivision (b)(2)(A), the commissioner's decision shall be made in accordance with the terms of the covered person's health benefit plan and shall be subject to all applicable provisions of this chapter.
(A) The commissioner may determine that a request is eligible for external review notwithstanding a health carrier's initial determination that the request is ineligible and that it be referred to external review.
(B) In making a determination under subdivision (b)(2)(A), the commissioner's decision shall be made in accordance with the terms of the covered person's health benefit plan and shall be subject to all applicable provisions of this chapter.
(c) Upon making a determination that a request is eligible for expedited external review, the health carrier shall immediately notify the aggrieved person in writing that the request is eligible for external review.
(d) At the same time, the health carrier shall immediately notify the external review organization and provide or transmit all necessary documents and information considered when making the adverse determination or final adverse determination electronically or by telephone, facsimile or any other expeditious method available.
(e) In addition to the documents and information provided or transmitted pursuant to subsection (d), the external review organization, to the extent that the information or documents are available and the external review organization considers them appropriate, shall consider the following in reaching a decision: (1) The covered person's pertinent medical records; (2) The attending healthcare professional's recommendation; (3) Consulting reports from appropriate healthcare professionals and other documents submitted by the health carrier or the aggrieved person; (4) The terms of coverage under the covered person's health benefit plan with the health carrier to ensure that the external review organization's decision is not contrary to the terms of coverage under the covered person's health benefit plan with the health carrier; (5) The most appropriate practice guidelines, which shall include medical or scientific evidence based standards; (6) Applicable clinical review criteria developed and used by the health carrier in making adverse determinations; (7) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (A) The federal agency for healthcare research and quality; (B) The national institutes of health; (C) The national cancer institute; (D) The national academy of sciences; (E) The centers for medicare & medicaid services; (F) The federal food and drug administration; and (G) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services; and (8) The opinion of the external review organization's clinical reviewer or reviewers after considering subdivisions (e)(1)-(7) to the extent that the information and documents are available and the clinical reviewer or reviewers consider appropriate.
(1) The covered person's pertinent medical records;
(2) The attending healthcare professional's recommendation;
(3) Consulting reports from appropriate healthcare professionals and other documents submitted by the health carrier or the aggrieved person;
(4) The terms of coverage under the covered person's health benefit plan with the health carrier to ensure that the external review organization's decision is not contrary to the terms of coverage under the covered person's health benefit plan with the health carrier;
(5) The most appropriate practice guidelines, which shall include medical or scientific evidence based standards;
(6) Applicable clinical review criteria developed and used by the health carrier in making adverse determinations;
(7) Findings, studies or research conducted by or under the auspices of federal government agencies and nationally recognized federal research institutes, including: (A) The federal agency for healthcare research and quality; (B) The national institutes of health; (C) The national cancer institute; (D) The national academy of sciences; (E) The centers for medicare & medicaid services; (F) The federal food and drug administration; and (G) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services; and
(A) The federal agency for healthcare research and quality;
(B) The national institutes of health;
(C) The national cancer institute;
(D) The national academy of sciences;
(E) The centers for medicare & medicaid services;
(F) The federal food and drug administration; and
(G) Any national board recognized by the national institutes of health for the purpose of evaluating the medical value of healthcare services; and
(8) The opinion of the external review organization's clinical reviewer or reviewers after considering subdivisions (e)(1)-(7) to the extent that the information and documents are available and the clinical reviewer or reviewers consider appropriate.
(f) (1) (A) As expeditiously as the covered person's medical condition or circumstances requires, but in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements, the external review organization shall make a decision to uphold or reverse the adverse determination or final adverse determination; and (B) Notify the health carrier of the decision and the health carrier must immediately notify the aggrieved person of the external review organization's decision. The aggrieved person must receive the decision of the expedited external review within seventy-two (72) hours after the date of receipt of the request for expedited external review. (2) (A) If the notice provided pursuant to subdivision (f)(1) was not in writing, within forty-eight (48) hours after the date of providing such notice, the external review organization shall provide written confirmation of the decision to the health carrier; and include the information set forth in this section. (B) The health carrier shall immediately notify the aggrieved person of the external review organization's decision and include the information set forth in this section. (C) Upon receipt of notice of the decision rendered pursuant to subdivision (f)(1) reversing the adverse determination or final adverse determination, the health carrier shall immediately approve the coverage that was the subject of the adverse determination or the final adverse determination.
(1) (A) As expeditiously as the covered person's medical condition or circumstances requires, but in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements, the external review organization shall make a decision to uphold or reverse the adverse determination or final adverse determination; and (B) Notify the health carrier of the decision and the health carrier must immediately notify the aggrieved person of the external review organization's decision. The aggrieved person must receive the decision of the expedited external review within seventy-two (72) hours after the date of receipt of the request for expedited external review.
(A) As expeditiously as the covered person's medical condition or circumstances requires, but in no event more than seventy-two (72) hours after the date of receipt of the request for an expedited external review that meets the reviewability requirements, the external review organization shall make a decision to uphold or reverse the adverse determination or final adverse determination; and
(B) Notify the health carrier of the decision and the health carrier must immediately notify the aggrieved person of the external review organization's decision. The aggrieved person must receive the decision of the expedited external review within seventy-two (72) hours after the date of receipt of the request for expedited external review.
(2) (A) If the notice provided pursuant to subdivision (f)(1) was not in writing, within forty-eight (48) hours after the date of providing such notice, the external review organization shall provide written confirmation of the decision to the health carrier; and include the information set forth in this section. (B) The health carrier shall immediately notify the aggrieved person of the external review organization's decision and include the information set forth in this section. (C) Upon receipt of notice of the decision rendered pursuant to subdivision (f)(1) reversing the adverse determination or final adverse determination, the health carrier shall immediately approve the coverage that was the subject of the adverse determination or the final adverse determination.
(A) If the notice provided pursuant to subdivision (f)(1) was not in writing, within forty-eight (48) hours after the date of providing such notice, the external review organization shall provide written confirmation of the decision to the health carrier; and include the information set forth in this section.
(B) The health carrier shall immediately notify the aggrieved person of the external review organization's decision and include the information set forth in this section.
(C) Upon receipt of notice of the decision rendered pursuant to subdivision (f)(1) reversing the adverse determination or final adverse determination, the health carrier shall immediately approve the coverage that was the subject of the adverse determination or the final adverse determination.
(g) An expedited external review shall not be provided for retrospective adverse determinations or final adverse determinations.
Acts 2010, ch. 980, § 18.
Tenn. Code Ann. § 56-15-101 — TN Code / Title 56 / Chapter 15 / Section 56-15-101
General powers - Right to become sureties - Banking business prohibited
Status: in_force

Fidelity or bonding corporations have the power to execute as surety, and guarantee the performance of: (1) All bonds, stipulations, or undertakings conditioned for the faithful performance of any duty, public or private, including the bonds and obligations of such a character, as well of private individuals as of public officers, whether state, county, or municipal; (2) All bonds and obligations required to be executed in the course of judicial proceedings in any of the courts of the state; and (3) All bonds of administrators, executors, guardians and trustees, and of all persons acting in a fiduciary capacity, whether acting under the authority of any court of this state, or by virtue of a deed, will or other instrument executed by a private individual or corporation, or by virtue of any appointment to any position of trust or confidence by any private individual or corporation; provided, that no fidelity or bonding company shall receive deposits subject to check, or do a general banking business. A fidelity or bonding company that receives deposits subject to check, or does a general banking business commits a Class C misdemeanor. Acts 1895, ch. 113, § 2; Shan., § 2213; mod. Code 1932, § 3945; modified; T.C.A. (orig. ed.), § 56-1401; Acts 1989, ch. 591, § 113.
Fidelity or bonding corporations have the power to execute as surety, and guarantee the performance of:
(1) All bonds, stipulations, or undertakings conditioned for the faithful performance of any duty, public or private, including the bonds and obligations of such a character, as well of private individuals as of public officers, whether state, county, or municipal;
(2) All bonds and obligations required to be executed in the course of judicial proceedings in any of the courts of the state; and
(3) All bonds of administrators, executors, guardians and trustees, and of all persons acting in a fiduciary capacity, whether acting under the authority of any court of this state, or by virtue of a deed, will or other instrument executed by a private individual or corporation, or by virtue of any appointment to any position of trust or confidence by any private individual or corporation; provided, that no fidelity or bonding company shall receive deposits subject to check, or do a general banking business. A fidelity or bonding company that receives deposits subject to check, or does a general banking business commits a Class C misdemeanor.
Acts 1895, ch. 113, § 2; Shan., § 2213; mod. Code 1932, § 3945; modified; T.C.A. (orig. ed.), § 56-1401; Acts 1989, ch. 591, § 113.
Tenn. Code Ann. § 56-7-1605 — TN Code / Title 56 / Chapter 7 / Section 56-7-1605
Reading ease test score - Procedure - Certificate
Status: in_force

(a) In addition to any other requirements of law, no policy forms, except as stated in § 56-7-1604 , shall be delivered or issued for delivery in this state on or after the dates the forms are subject to this part, unless: (1) The text achieves a minimum score of forty (40) on the Flesch reading ease test or an equivalent score on any other comparable test as provided in subsection (d); (2) It is printed, except for specification pages, schedules and tables, in not less than ten-point type, one (1) point leaded; (3) The style, arrangement and overall appearance of the policy give no undue prominence to any portion of the text of the policy or to any endorsements or riders; and (4) It contains a table of contents or an index of the principal sections of the policy, if the policy has more than three thousand (3,000) words printed on three (3) or fewer pages of text, or if the policy has more than three (3) pages regardless of the number of words. (b) For the purposes of this section, a Flesch reading ease test score shall be measured by the following method: (1) For policy forms containing ten thousand (10,000) words or less of text, the entire form shall be analyzed. For policy forms containing more than ten thousand (10,000) words, the readability of two hundred (200) word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least twenty (20) printed lines; (2) The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015; (3) The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6; (4) The sum of the figures computed under subdivisions (b)(2) and (3) subtracted from 206.835 equals the Flesch reading ease score for the policy form; (5) For purposes of subdivisions (b)(2)-(4), the following procedures shall be used: (A) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one (1) word; (B) A unit of words ending with a period, semicolon, or colon, but excluding heading and captions, shall be counted as a sentence; and (C) "Syllable" means a unit of spoken language consisting of one (1) or more letters of a word as divided by an accepted dictionary. Where the dictionary shows two (2) or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used. (c) "Text," as used in this section, includes all printed matter except the following: (1) The name and address of the insurer; the name, number or title of the policy; the table of contents or index; captions and subcaptions; specification pages, schedules or tables; and (2) Any policy language that is drafted to conform to the requirements of any federal law, regulation or agency interpretation; any policy language required by any collectively bargained agreement; any medical terminology; any words which are defined in the policy; and any policy language required by law or regulation; provided, that the insurer identifies the language or terminology excepted by this subsection (c) and certifies, in writing, that the language or terminology is entitled to be excepted by this subsection (c). (d) Any other reading test may be approved by the commissioner for use as an alternative to the Flesch reading ease test if it is comparable in result to the Flesch reading ease test. (e) Filings subject to this section shall be accompanied by a certificate signed by an officer of the insurer stating that it meets the minimum reading ease score on the test used or stating that the score is lower than the minimum required, but should be approved in accordance with § 56-7-1607 . To confirm the accuracy of any certification, the commissioner may require the submission of further information to verify the certification in question. (f) At the option of the insurer, riders, endorsements, applications, and other forms made a part of the policy may be scored as separate forms or as part of the policy with which they may be used. Acts 1981, ch. 415, § 6.
(a) In addition to any other requirements of law, no policy forms, except as stated in § 56-7-1604 , shall be delivered or issued for delivery in this state on or after the dates the forms are subject to this part, unless: (1) The text achieves a minimum score of forty (40) on the Flesch reading ease test or an equivalent score on any other comparable test as provided in subsection (d); (2) It is printed, except for specification pages, schedules and tables, in not less than ten-point type, one (1) point leaded; (3) The style, arrangement and overall appearance of the policy give no undue prominence to any portion of the text of the policy or to any endorsements or riders; and (4) It contains a table of contents or an index of the principal sections of the policy, if the policy has more than three thousand (3,000) words printed on three (3) or fewer pages of text, or if the policy has more than three (3) pages regardless of the number of words.
(1) The text achieves a minimum score of forty (40) on the Flesch reading ease test or an equivalent score on any other comparable test as provided in subsection (d);
(2) It is printed, except for specification pages, schedules and tables, in not less than ten-point type, one (1) point leaded;
(3) The style, arrangement and overall appearance of the policy give no undue prominence to any portion of the text of the policy or to any endorsements or riders; and
(4) It contains a table of contents or an index of the principal sections of the policy, if the policy has more than three thousand (3,000) words printed on three (3) or fewer pages of text, or if the policy has more than three (3) pages regardless of the number of words.
(b) For the purposes of this section, a Flesch reading ease test score shall be measured by the following method: (1) For policy forms containing ten thousand (10,000) words or less of text, the entire form shall be analyzed. For policy forms containing more than ten thousand (10,000) words, the readability of two hundred (200) word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least twenty (20) printed lines; (2) The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015; (3) The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6; (4) The sum of the figures computed under subdivisions (b)(2) and (3) subtracted from 206.835 equals the Flesch reading ease score for the policy form; (5) For purposes of subdivisions (b)(2)-(4), the following procedures shall be used: (A) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one (1) word; (B) A unit of words ending with a period, semicolon, or colon, but excluding heading and captions, shall be counted as a sentence; and (C) "Syllable" means a unit of spoken language consisting of one (1) or more letters of a word as divided by an accepted dictionary. Where the dictionary shows two (2) or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.
(1) For policy forms containing ten thousand (10,000) words or less of text, the entire form shall be analyzed. For policy forms containing more than ten thousand (10,000) words, the readability of two hundred (200) word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least twenty (20) printed lines;
(2) The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015;
(3) The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6;
(4) The sum of the figures computed under subdivisions (b)(2) and (3) subtracted from 206.835 equals the Flesch reading ease score for the policy form;
(5) For purposes of subdivisions (b)(2)-(4), the following procedures shall be used: (A) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one (1) word; (B) A unit of words ending with a period, semicolon, or colon, but excluding heading and captions, shall be counted as a sentence; and (C) "Syllable" means a unit of spoken language consisting of one (1) or more letters of a word as divided by an accepted dictionary. Where the dictionary shows two (2) or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.
(A) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one (1) word;
(B) A unit of words ending with a period, semicolon, or colon, but excluding heading and captions, shall be counted as a sentence; and
(C) "Syllable" means a unit of spoken language consisting of one (1) or more letters of a word as divided by an accepted dictionary. Where the dictionary shows two (2) or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.
(c) "Text," as used in this section, includes all printed matter except the following: (1) The name and address of the insurer; the name, number or title of the policy; the table of contents or index; captions and subcaptions; specification pages, schedules or tables; and (2) Any policy language that is drafted to conform to the requirements of any federal law, regulation or agency interpretation; any policy language required by any collectively bargained agreement; any medical terminology; any words which are defined in the policy; and any policy language required by law or regulation; provided, that the insurer identifies the language or terminology excepted by this subsection (c) and certifies, in writing, that the language or terminology is entitled to be excepted by this subsection (c).
(1) The name and address of the insurer; the name, number or title of the policy; the table of contents or index; captions and subcaptions; specification pages, schedules or tables; and
(2) Any policy language that is drafted to conform to the requirements of any federal law, regulation or agency interpretation; any policy language required by any collectively bargained agreement; any medical terminology; any words which are defined in the policy; and any policy language required by law or regulation; provided, that the insurer identifies the language or terminology excepted by this subsection (c) and certifies, in writing, that the language or terminology is entitled to be excepted by this subsection (c).
(d) Any other reading test may be approved by the commissioner for use as an alternative to the Flesch reading ease test if it is comparable in result to the Flesch reading ease test.
(e) Filings subject to this section shall be accompanied by a certificate signed by an officer of the insurer stating that it meets the minimum reading ease score on the test used or stating that the score is lower than the minimum required, but should be approved in accordance with § 56-7-1607 . To confirm the accuracy of any certification, the commissioner may require the submission of further information to verify the certification in question.
(f) At the option of the insurer, riders, endorsements, applications, and other forms made a part of the policy may be scored as separate forms or as part of the policy with which they may be used.
Acts 1981, ch. 415, § 6.
Tenn. Code Ann. § 56-61-114 — TN Code / Title 56 / Chapter 61 / Section 56-61-114
Request for external review
Status: in_force

(a) Except for a request for an expedited external review as set forth in § 56-61-117 or § 56-61-118(n) , all requests for external review shall be made in writing to the health carrier. (b) Unless otherwise set forth by this chapter, an aggrieved person may file a request for external review after the receipt of a final adverse determination. Acts 2010, ch. 980, § 15.
(a) Except for a request for an expedited external review as set forth in § 56-61-117 or § 56-61-118(n) , all requests for external review shall be made in writing to the health carrier.
(b) Unless otherwise set forth by this chapter, an aggrieved person may file a request for external review after the receipt of a final adverse determination.
Acts 2010, ch. 980, § 15.