Tenn. Code Ann. § 56-46-105 — TN Code / Title 56 / Chapter 46 / Section 56-46-105
Regulatory Action Level Events
Status: in_force

(a) "Regulatory Action Level Event" means, with respect to any insurer, any of the following events: (1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC; (2) The notification by the commissioner to an insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; (3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; (4) The failure of the insurer to file an RBC Report by the filing date, unless the insurer has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date; (5) The failure of the insurer to submit an RBC Plan to the commissioner within the time period set forth in § 56-46-104(c) ; (6) Notification by the commissioner to the insurer that: (A) The RBC Plan or Revised RBC Plan submitted by the insurer is, in the judgment of the commissioner, unsatisfactory; and (B) The notification constitutes a Regulatory Action Level Event with respect to the insurer; provided, that the insurer has not challenged the determination under § 56-46-108 ; (7) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(6), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge; (8) Notification by the commissioner to the insurer that the insurer has failed to adhere to its RBC Plan or Revised RBC Plan, but only if the failure has a substantial adverse effect on the ability of the insurer to eliminate the Company Action Level Event in accordance with its RBC Plan or Revised RBC Plan and the commissioner has so stated in the notification; provided, that the insurer has not challenged the determination under § 56-46-108 ; or (9) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(8), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge. (b) In the event of a Regulatory Action Level Event the commissioner shall: (1) Require the insurer to prepare and submit an RBC Plan or, if applicable, a Revised RBC Plan; (2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the insurer including a review of its RBC Plan or Revised RBC Plan; and (3) Subsequent to the examination or analysis, issue an order specifying corrective actions that the commissioner determines are required. (c) In determining corrective actions, the commissioner may take into account factors deemed relevant with respect to the insurer based upon the commissioner's examination or analysis of the assets, liabilities and operations of the insurer, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC Instructions. The RBC Plan or Revised RBC Plan shall be submitted: (1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event; (2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; or (3) If the insurer challenges a Revised RBC Plan pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge. (d) The commissioner may retain actuaries and investment experts and other consultants as may be necessary in the judgment of the commissioner to review the insurer's RBC Plan or Revised RBC Plan, examine or analyze the assets, liabilities and operations of the insurer and formulate the corrective order with respect to the insurer. The fees, costs and expenses relating to consultants shall be borne by the affected insurer or such other party as directed by the commissioner. Acts 1996, ch. 750, § 6.
(a) "Regulatory Action Level Event" means, with respect to any insurer, any of the following events: (1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC; (2) The notification by the commissioner to an insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ; (3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; (4) The failure of the insurer to file an RBC Report by the filing date, unless the insurer has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date; (5) The failure of the insurer to submit an RBC Plan to the commissioner within the time period set forth in § 56-46-104(c) ; (6) Notification by the commissioner to the insurer that: (A) The RBC Plan or Revised RBC Plan submitted by the insurer is, in the judgment of the commissioner, unsatisfactory; and (B) The notification constitutes a Regulatory Action Level Event with respect to the insurer; provided, that the insurer has not challenged the determination under § 56-46-108 ; (7) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(6), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge; (8) Notification by the commissioner to the insurer that the insurer has failed to adhere to its RBC Plan or Revised RBC Plan, but only if the failure has a substantial adverse effect on the ability of the insurer to eliminate the Company Action Level Event in accordance with its RBC Plan or Revised RBC Plan and the commissioner has so stated in the notification; provided, that the insurer has not challenged the determination under § 56-46-108 ; or (9) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(8), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge.
(1) The filing of an RBC Report by the insurer that indicates that the insurer's Total Adjusted Capital is greater than or equal to its Authorized Control Level RBC but less than its Regulatory Action Level RBC;
(2) The notification by the commissioner to an insurer of an Adjusted RBC Report that indicates the event in subdivision (a)(1); provided, that the insurer does not challenge the Adjusted RBC Report under § 56-46-108 ;
(3) If, pursuant to § 56-46-108 , the insurer challenges an Adjusted RBC Report that indicates the event in subdivision (a)(1), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge;
(4) The failure of the insurer to file an RBC Report by the filing date, unless the insurer has provided an explanation for the failure that is satisfactory to the commissioner and has cured the failure within ten (10) days after the filing date;
(5) The failure of the insurer to submit an RBC Plan to the commissioner within the time period set forth in § 56-46-104(c) ;
(6) Notification by the commissioner to the insurer that: (A) The RBC Plan or Revised RBC Plan submitted by the insurer is, in the judgment of the commissioner, unsatisfactory; and (B) The notification constitutes a Regulatory Action Level Event with respect to the insurer; provided, that the insurer has not challenged the determination under § 56-46-108 ;
(A) The RBC Plan or Revised RBC Plan submitted by the insurer is, in the judgment of the commissioner, unsatisfactory; and
(B) The notification constitutes a Regulatory Action Level Event with respect to the insurer; provided, that the insurer has not challenged the determination under § 56-46-108 ;
(7) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(6), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge;
(8) Notification by the commissioner to the insurer that the insurer has failed to adhere to its RBC Plan or Revised RBC Plan, but only if the failure has a substantial adverse effect on the ability of the insurer to eliminate the Company Action Level Event in accordance with its RBC Plan or Revised RBC Plan and the commissioner has so stated in the notification; provided, that the insurer has not challenged the determination under § 56-46-108 ; or
(9) If, pursuant to § 56-46-108 , the insurer challenges a determination by the commissioner under subdivision (b)(8), the notification by the commissioner to the insurer that the commissioner has, after a hearing, rejected the challenge.
(b) In the event of a Regulatory Action Level Event the commissioner shall: (1) Require the insurer to prepare and submit an RBC Plan or, if applicable, a Revised RBC Plan; (2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the insurer including a review of its RBC Plan or Revised RBC Plan; and (3) Subsequent to the examination or analysis, issue an order specifying corrective actions that the commissioner determines are required.
(1) Require the insurer to prepare and submit an RBC Plan or, if applicable, a Revised RBC Plan;
(2) Perform such examination or analysis as the commissioner deems necessary of the assets, liabilities and operations of the insurer including a review of its RBC Plan or Revised RBC Plan; and
(3) Subsequent to the examination or analysis, issue an order specifying corrective actions that the commissioner determines are required.
(c) In determining corrective actions, the commissioner may take into account factors deemed relevant with respect to the insurer based upon the commissioner's examination or analysis of the assets, liabilities and operations of the insurer, including, but not limited to, the results of any sensitivity tests undertaken pursuant to the RBC Instructions. The RBC Plan or Revised RBC Plan shall be submitted: (1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event; (2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; or (3) If the insurer challenges a Revised RBC Plan pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(1) Within forty-five (45) days after the occurrence of the Regulatory Action Level Event;
(2) If the insurer challenges an Adjusted RBC Report pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge; or
(3) If the insurer challenges a Revised RBC Plan pursuant to § 56-46-108 and the challenge is not frivolous in the judgment of the commissioner, within forty-five (45) days after the notification to the insurer that the commissioner has, after a hearing, rejected the insurer's challenge.
(d) The commissioner may retain actuaries and investment experts and other consultants as may be necessary in the judgment of the commissioner to review the insurer's RBC Plan or Revised RBC Plan, examine or analyze the assets, liabilities and operations of the insurer and formulate the corrective order with respect to the insurer. The fees, costs and expenses relating to consultants shall be borne by the affected insurer or such other party as directed by the commissioner.
Acts 1996, ch. 750, § 6.
Tenn. Code Ann. § 56-46-203 — TN Code / Title 56 / Chapter 46 / Section 56-46-203
Company Action Level Events
Status: in_force

(a) "Company Action Level Event" means any of the following events: (1) The filing of an RBC report by a health organization that indicates that: (A) The health organization's total adjusted capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; or (B) If a health organization has total adjusted capital which is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Health RBC instructions; (2) Notification by the commissioner to the health organization of an adjusted RBC report that indicates an event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ; or (3) If, pursuant to § 56-46-207 , a health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge. (b) If a Company Action Level Event occurs, the health organization shall prepare and submit to the commissioner an RBC plan that shall: (1) Identify the conditions that contribute to the Company Action Level Event; (2) Contain proposals of corrective actions that the health organization intends to take and that would be expected to result in the elimination of the Company Action Level Event; (3) Provide projections of the health organization's financial results in the current year and at least the two (2) succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory balance sheets, operating income, net income, capital and surplus, and RBC levels. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component; (4) Identify the key assumptions impacting the health organization's projections and the sensitivity of the projections to the assumptions; and (5) Identify the quality of, and problems associated with, the health organization's business, including but not limited to its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business, and use of reinsurance, if any, in each case. (c) The RBC plan shall be submitted: (1) Within forty-five (45) days of the Company Action Level Event; or (2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 , within forty-five (45) days after notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge. (d) Within sixty (60) days after the submission by a health organization of an RBC plan to the commissioner, the commissioner shall notify the health organization whether the RBC plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines the RBC plan is unsatisfactory, the notification to the health organization shall set forth the reasons for the determination, and may set forth proposed revisions which will render the RBC plan satisfactory, in the judgment of the commissioner. Upon notification from the commissioner, the health organization shall prepare a revised RBC plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the revised RBC plan to the commissioner: (1) Within forty-five (45) days after the notification from the commissioner; or (2) If the health organization challenges the notification from the commissioner under § 56-46-207 , within forty-five (45) days after a notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge. (e) If the commissioner notifies a health organization that its RBC plan or revised RBC plan is unsatisfactory, the commissioner may at the commissioner's discretion, subject to the health organization's right to a hearing under § 56-46-207 , specify in the notification that the notification constitutes a Regulatory Action Level Event. (f) Every domestic health organization that files an RBC plan or revised RBC plan with the commissioner shall file a copy of the RBC plan or revised RBC plan with the insurance commissioner in any state, in which the health organization is authorized to do business if: (1) The state has an RBC provision substantially similar to § 56-46-208(a) ; and (2) The insurance commissioner of that state has notified the health organization of its request for the filing in writing, in which case the health organization shall file a copy of the RBC plan or revised RBC plan in that state by the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or (B) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d). Acts 2014, ch. 559, § 7.
(a) "Company Action Level Event" means any of the following events: (1) The filing of an RBC report by a health organization that indicates that: (A) The health organization's total adjusted capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; or (B) If a health organization has total adjusted capital which is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Health RBC instructions; (2) Notification by the commissioner to the health organization of an adjusted RBC report that indicates an event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ; or (3) If, pursuant to § 56-46-207 , a health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(1) The filing of an RBC report by a health organization that indicates that: (A) The health organization's total adjusted capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; or (B) If a health organization has total adjusted capital which is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Health RBC instructions;
(A) The health organization's total adjusted capital is greater than or equal to its Regulatory Action Level RBC but less than its Company Action Level RBC; or
(B) If a health organization has total adjusted capital which is greater than or equal to its Company Action Level RBC but less than the product of its Authorized Control Level RBC and 3.0 and triggers the trend test determined in accordance with the trend test calculation included in the Health RBC instructions;
(2) Notification by the commissioner to the health organization of an adjusted RBC report that indicates an event in subdivision (a)(1); provided, that the health organization does not challenge the adjusted RBC report under § 56-46-207 ; or
(3) If, pursuant to § 56-46-207 , a health organization challenges an adjusted RBC report that indicates the event in subdivision (a)(1), the notification by the commissioner to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(b) If a Company Action Level Event occurs, the health organization shall prepare and submit to the commissioner an RBC plan that shall: (1) Identify the conditions that contribute to the Company Action Level Event; (2) Contain proposals of corrective actions that the health organization intends to take and that would be expected to result in the elimination of the Company Action Level Event; (3) Provide projections of the health organization's financial results in the current year and at least the two (2) succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory balance sheets, operating income, net income, capital and surplus, and RBC levels. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component; (4) Identify the key assumptions impacting the health organization's projections and the sensitivity of the projections to the assumptions; and (5) Identify the quality of, and problems associated with, the health organization's business, including but not limited to its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business, and use of reinsurance, if any, in each case.
(1) Identify the conditions that contribute to the Company Action Level Event;
(2) Contain proposals of corrective actions that the health organization intends to take and that would be expected to result in the elimination of the Company Action Level Event;
(3) Provide projections of the health organization's financial results in the current year and at least the two (2) succeeding years, both in the absence of proposed corrective actions and giving effect to the proposed corrective actions, including projections of statutory balance sheets, operating income, net income, capital and surplus, and RBC levels. The projections for both new and renewal business might include separate projections for each major line of business and separately identify each significant income, expense and benefit component;
(4) Identify the key assumptions impacting the health organization's projections and the sensitivity of the projections to the assumptions; and
(5) Identify the quality of, and problems associated with, the health organization's business, including but not limited to its assets, anticipated business growth and associated surplus strain, extraordinary exposure to risk, mix of business, and use of reinsurance, if any, in each case.
(c) The RBC plan shall be submitted: (1) Within forty-five (45) days of the Company Action Level Event; or (2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 , within forty-five (45) days after notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(1) Within forty-five (45) days of the Company Action Level Event; or
(2) If the health organization challenges an adjusted RBC report pursuant to § 56-46-207 , within forty-five (45) days after notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(d) Within sixty (60) days after the submission by a health organization of an RBC plan to the commissioner, the commissioner shall notify the health organization whether the RBC plan shall be implemented or is, in the judgment of the commissioner, unsatisfactory. If the commissioner determines the RBC plan is unsatisfactory, the notification to the health organization shall set forth the reasons for the determination, and may set forth proposed revisions which will render the RBC plan satisfactory, in the judgment of the commissioner. Upon notification from the commissioner, the health organization shall prepare a revised RBC plan, which may incorporate by reference any revisions proposed by the commissioner, and shall submit the revised RBC plan to the commissioner: (1) Within forty-five (45) days after the notification from the commissioner; or (2) If the health organization challenges the notification from the commissioner under § 56-46-207 , within forty-five (45) days after a notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(1) Within forty-five (45) days after the notification from the commissioner; or
(2) If the health organization challenges the notification from the commissioner under § 56-46-207 , within forty-five (45) days after a notification to the health organization that the commissioner has, after a hearing, rejected the health organization's challenge.
(e) If the commissioner notifies a health organization that its RBC plan or revised RBC plan is unsatisfactory, the commissioner may at the commissioner's discretion, subject to the health organization's right to a hearing under § 56-46-207 , specify in the notification that the notification constitutes a Regulatory Action Level Event.
(f) Every domestic health organization that files an RBC plan or revised RBC plan with the commissioner shall file a copy of the RBC plan or revised RBC plan with the insurance commissioner in any state, in which the health organization is authorized to do business if: (1) The state has an RBC provision substantially similar to § 56-46-208(a) ; and (2) The insurance commissioner of that state has notified the health organization of its request for the filing in writing, in which case the health organization shall file a copy of the RBC plan or revised RBC plan in that state by the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or (B) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d).
(1) The state has an RBC provision substantially similar to § 56-46-208(a) ; and
(2) The insurance commissioner of that state has notified the health organization of its request for the filing in writing, in which case the health organization shall file a copy of the RBC plan or revised RBC plan in that state by the later of: (A) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or (B) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d).
(A) Fifteen (15) days after the receipt of notice to file a copy of its RBC plan or revised RBC plan with the state; or
(B) The date on which the RBC plan or revised RBC plan is filed under subsections (c) and (d).
Acts 2014, ch. 559, § 7.
Tenn. Code Ann. § 56-7-2404 — TN Code / Title 56 / Chapter 7 / Section 56-7-2404
Reimbursable services within scope of practice of chiropractor - Discrimination prohibited
Status: in_force

(a) (1) Whenever any policy of insurance issued in this state provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed chiropractor, the insured or other person entitled to benefits under the policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or by a duly licensed chiropractor, notwithstanding any provision contained in the policy. (2) Whenever any insurance subscribers under any sickness and accident, medical service plan, hospital service contract or hospital and medical service contract, as provided under chapters 26-29 of this title or any similar statutes, or any other persons covered by the plan or contract, are entitled to reimbursement for any services that are within the lawful scope of practice of a duly licensed chiropractor, the subscriber or other person shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or a duly licensed chiropractor, notwithstanding any provision to the contrary in any other statute or in the plan or contract; and duly licensed chiropractors shall be entitled to participate in the plans or contracts providing for the services to the same extent and subject to the same limitations as duly licensed medical physicians. (b) This section shall not be construed as enlarging the scope of practice of chiropractic or the requiring of any insurance policy, medical service plan, hospital service contract or hospital and medical service contract to provide for spinal, neurological or musculoskeletal care. (c) This section shall apply to all policies or plans issued or renewed on and after July 1, 1981. Acts 1981, ch. 127, §§ 1, 2, 4, 5; 1992, ch. 984, § 2; T.C.A., § 56-7-116 .
(a) (1) Whenever any policy of insurance issued in this state provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed chiropractor, the insured or other person entitled to benefits under the policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or by a duly licensed chiropractor, notwithstanding any provision contained in the policy. (2) Whenever any insurance subscribers under any sickness and accident, medical service plan, hospital service contract or hospital and medical service contract, as provided under chapters 26-29 of this title or any similar statutes, or any other persons covered by the plan or contract, are entitled to reimbursement for any services that are within the lawful scope of practice of a duly licensed chiropractor, the subscriber or other person shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or a duly licensed chiropractor, notwithstanding any provision to the contrary in any other statute or in the plan or contract; and duly licensed chiropractors shall be entitled to participate in the plans or contracts providing for the services to the same extent and subject to the same limitations as duly licensed medical physicians.
(1) Whenever any policy of insurance issued in this state provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed chiropractor, the insured or other person entitled to benefits under the policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or by a duly licensed chiropractor, notwithstanding any provision contained in the policy.
(2) Whenever any insurance subscribers under any sickness and accident, medical service plan, hospital service contract or hospital and medical service contract, as provided under chapters 26-29 of this title or any similar statutes, or any other persons covered by the plan or contract, are entitled to reimbursement for any services that are within the lawful scope of practice of a duly licensed chiropractor, the subscriber or other person shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or a duly licensed chiropractor, notwithstanding any provision to the contrary in any other statute or in the plan or contract; and duly licensed chiropractors shall be entitled to participate in the plans or contracts providing for the services to the same extent and subject to the same limitations as duly licensed medical physicians.
(b) This section shall not be construed as enlarging the scope of practice of chiropractic or the requiring of any insurance policy, medical service plan, hospital service contract or hospital and medical service contract to provide for spinal, neurological or musculoskeletal care.
(c) This section shall apply to all policies or plans issued or renewed on and after July 1, 1981.
Acts 1981, ch. 127, §§ 1, 2, 4, 5; 1992, ch. 984, § 2; T.C.A., § 56-7-116 .
Tenn. Code Ann. § 56-51-147 — TN Code / Title 56 / Chapter 51 / Section 56-51-147
Unfair methods of competition, unfair or deceptive acts or practices defined
Status: in_force

For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, § 56-8-104 applies to a prepaid limited health service organization. Acts 2000, ch. 948, § 47.
For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, § 56-8-104 applies to a prepaid limited health service organization.
Acts 2000, ch. 948, § 47.
Tenn. Code Ann. § 56-1-204 — TN Code / Title 56 / Chapter 1 / Section 56-1-204
Inquisitorial power given commissioner and deputies
Status: in_force

Inquisitorial power is given to the commissioner or the commissioner's deputies to inquire into any violation of this title, and to examine any person under oath, and to compel production of books, records, or papers relative to the inquiry. Acts 1919, ch. 170, § 3; Shan. Supp., § 3323a1; Code 1932, § 6152; Acts 1978, ch. 530, § 1; T.C.A. (orig. ed.), § 56-107.
Inquisitorial power is given to the commissioner or the commissioner's deputies to inquire into any violation of this title, and to examine any person under oath, and to compel production of books, records, or papers relative to the inquiry.
Acts 1919, ch. 170, § 3; Shan. Supp., § 3323a1; Code 1932, § 6152; Acts 1978, ch. 530, § 1; T.C.A. (orig. ed.), § 56-107.
Tenn. Code Ann. § 56-2-302 — TN Code / Title 56 / Chapter 2 / Section 56-2-302
Notice of hearing on issuance of cease and desist order
Status: in_force

Whenever the commissioner determines that a company, corporation, association, person, or entity of whatever nature is violating or is about to violate § 56-2-105 , the commissioner may issue a notice of hearing and charges requiring the company, corporation, association, person, or entity of whatever nature to show cause why an order should not issue requiring the person or entity to cease and desist the unauthorized business of insurance in this state. Acts 1993, ch. 253, § 16.
Whenever the commissioner determines that a company, corporation, association, person, or entity of whatever nature is violating or is about to violate § 56-2-105 , the commissioner may issue a notice of hearing and charges requiring the company, corporation, association, person, or entity of whatever nature to show cause why an order should not issue requiring the person or entity to cease and desist the unauthorized business of insurance in this state.
Acts 1993, ch. 253, § 16.
Tenn. Code Ann. § 56-7-2316 — TN Code / Title 56 / Chapter 7 / Section 56-7-2316
Ceiling on converted policy benefits
Status: in_force

An insurer shall not be required to issue a converted policy that provides benefits in excess of those provided under the group policy from which conversion is made. Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1505.
An insurer shall not be required to issue a converted policy that provides benefits in excess of those provided under the group policy from which conversion is made.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1505.
Tenn. Code Ann. § 56-25-306 — TN Code / Title 56 / Chapter 25 / Section 56-25-306
Conversion to stock or mutual life insurance company
Status: in_force

Any domestic fraternal benefit society may be converted and licensed as a stock or mutual life insurance company by compliance with all the requirements of this title for stock or mutual life insurance companies. A plan of conversion shall be prepared in writing by the board of directors, setting forth in full the terms and conditions of conversion. The affirmative vote of two thirds (2/3) of all members of the supreme governing body at a regular or special meeting shall be necessary for the approval of the commissioner, who may give approval if the commissioner finds that the proposed change is in conformity with the requirements of law and not prejudicial to the certificate holders of the society. Acts 1990, ch. 703, § 1.
Any domestic fraternal benefit society may be converted and licensed as a stock or mutual life insurance company by compliance with all the requirements of this title for stock or mutual life insurance companies. A plan of conversion shall be prepared in writing by the board of directors, setting forth in full the terms and conditions of conversion. The affirmative vote of two thirds (2/3) of all members of the supreme governing body at a regular or special meeting shall be necessary for the approval of the commissioner, who may give approval if the commissioner finds that the proposed change is in conformity with the requirements of law and not prejudicial to the certificate holders of the society.
Acts 1990, ch. 703, § 1.
Tenn. Code Ann. § 56-32-128 — TN Code / Title 56 / Chapter 32 / Section 56-32-128
Point of service option or preferred provider organization plan
Status: in_force

(a) As used in this section, "managed health insurance issuer" means an entity that: (1) Offers health insurance coverage or benefits under a contract that restricts reimbursement for covered services to a defined network of providers; and (2) Is regulated under this title or is an entity that accepts the financial risks associated with the provision of health care services by persons who do not own or control, or who are not employed by, the entity. (b) (1) Every managed health insurance issuer shall offer, or contract with another carrier to offer, an additional benefit at the option of the employee, or other principal enrollee, as follows: (A) A point of service option that provides benefits for covered services through health professionals and providers who are not members of the network; or (B) A preferred provider organization plan. (2) The managed health insurance issuer shall fully disclose to the enrollee, in clear, understandable language, the terms and conditions of each option, the copayments or other cost-sharing features of each option and the costs associated with each option provided by the issuer. The commissioner shall promulgate rules regarding presentation of these terms and conditions, including a suggested standard format, to facilitate the comparison by the enrollee of the terms and conditions of each option. The obligation of a managed health insurance issuer to make the offer described in this section may be satisfied by the managed health insurance issuer providing to the employer or other plan sponsor presentation materials for dissemination to employees or principal enrollees. (c) The amount of any additional premium required for the options described in subsection (b) may be paid by the purchaser of the health plan or may be paid by the enrollee of the group. The additional premium, taking into account any copayments or other cost-sharing features, shall not exceed an amount that is fair and reasonable in relation to the benefits provided, as determined by the commissioner. (d) (1) Under the option described in subsection (b), the rate of reimbursement for health providers out of the network shall be the same as the rate of reimbursement for noncapitated providers in the network; provided, that copayment, co-insurance and other cost-sharing features may be different for out of network providers. (2) A managed health insurance issuer shall not be required to reimburse an out of network provider for nonemergency services unless the provider: (A) Has disclosed to the patient a reasonable range of the total charges for the services being provided; and (B) Has advised the patient that the provider may bill the patient for the balance of any charges that are not otherwise reimbursed by the managed health insurance issuer. If, after request by the patient, the provider fails to disclose a reasonable range of the total of charges for any nonemergency services provided, the patient shall not be liable for the charges. (e) The option described in subsection (b) shall be a part of every contract issued by a managed health insurance issuer; provided, that an employer who employs not more than one hundred (100) full-time employees may reject the point of service option in writing. (f) The requirements of this section shall be satisfied if the employer or other person sponsoring the health insurance or health benefits plan includes for all principal enrollees a preferred provider organization plan, a plan that offers unrestricted access to providers, or a point of service benefit as specified in this section. (g) Nothing contained in this section shall be construed or interpreted as applying to the TennCare programs administered pursuant to the waivers approved by the United States department of health and human services, to entities that qualify to participate in the Medicare+Choice program, or to individual health insurance contracts. (h) Notwithstanding any other law to the contrary, an HMO may underwrite directly the point of service benefit required by this section. Amended by 2013 Tenn. Acts, ch. 92,s 1, eff. 4/8/2013. Acts 1998, ch. 1033, §§ 2, 3; T.C.A. § 56-32-228.
(a) As used in this section, "managed health insurance issuer" means an entity that: (1) Offers health insurance coverage or benefits under a contract that restricts reimbursement for covered services to a defined network of providers; and (2) Is regulated under this title or is an entity that accepts the financial risks associated with the provision of health care services by persons who do not own or control, or who are not employed by, the entity.
(1) Offers health insurance coverage or benefits under a contract that restricts reimbursement for covered services to a defined network of providers; and
(2) Is regulated under this title or is an entity that accepts the financial risks associated with the provision of health care services by persons who do not own or control, or who are not employed by, the entity.
(b) (1) Every managed health insurance issuer shall offer, or contract with another carrier to offer, an additional benefit at the option of the employee, or other principal enrollee, as follows: (A) A point of service option that provides benefits for covered services through health professionals and providers who are not members of the network; or (B) A preferred provider organization plan. (2) The managed health insurance issuer shall fully disclose to the enrollee, in clear, understandable language, the terms and conditions of each option, the copayments or other cost-sharing features of each option and the costs associated with each option provided by the issuer. The commissioner shall promulgate rules regarding presentation of these terms and conditions, including a suggested standard format, to facilitate the comparison by the enrollee of the terms and conditions of each option. The obligation of a managed health insurance issuer to make the offer described in this section may be satisfied by the managed health insurance issuer providing to the employer or other plan sponsor presentation materials for dissemination to employees or principal enrollees.
(1) Every managed health insurance issuer shall offer, or contract with another carrier to offer, an additional benefit at the option of the employee, or other principal enrollee, as follows: (A) A point of service option that provides benefits for covered services through health professionals and providers who are not members of the network; or (B) A preferred provider organization plan.
(A) A point of service option that provides benefits for covered services through health professionals and providers who are not members of the network; or
(B) A preferred provider organization plan.
(2) The managed health insurance issuer shall fully disclose to the enrollee, in clear, understandable language, the terms and conditions of each option, the copayments or other cost-sharing features of each option and the costs associated with each option provided by the issuer. The commissioner shall promulgate rules regarding presentation of these terms and conditions, including a suggested standard format, to facilitate the comparison by the enrollee of the terms and conditions of each option. The obligation of a managed health insurance issuer to make the offer described in this section may be satisfied by the managed health insurance issuer providing to the employer or other plan sponsor presentation materials for dissemination to employees or principal enrollees.
(c) The amount of any additional premium required for the options described in subsection (b) may be paid by the purchaser of the health plan or may be paid by the enrollee of the group. The additional premium, taking into account any copayments or other cost-sharing features, shall not exceed an amount that is fair and reasonable in relation to the benefits provided, as determined by the commissioner.
(d) (1) Under the option described in subsection (b), the rate of reimbursement for health providers out of the network shall be the same as the rate of reimbursement for noncapitated providers in the network; provided, that copayment, co-insurance and other cost-sharing features may be different for out of network providers. (2) A managed health insurance issuer shall not be required to reimburse an out of network provider for nonemergency services unless the provider: (A) Has disclosed to the patient a reasonable range of the total charges for the services being provided; and (B) Has advised the patient that the provider may bill the patient for the balance of any charges that are not otherwise reimbursed by the managed health insurance issuer. If, after request by the patient, the provider fails to disclose a reasonable range of the total of charges for any nonemergency services provided, the patient shall not be liable for the charges.
(1) Under the option described in subsection (b), the rate of reimbursement for health providers out of the network shall be the same as the rate of reimbursement for noncapitated providers in the network; provided, that copayment, co-insurance and other cost-sharing features may be different for out of network providers.
(2) A managed health insurance issuer shall not be required to reimburse an out of network provider for nonemergency services unless the provider: (A) Has disclosed to the patient a reasonable range of the total charges for the services being provided; and (B) Has advised the patient that the provider may bill the patient for the balance of any charges that are not otherwise reimbursed by the managed health insurance issuer. If, after request by the patient, the provider fails to disclose a reasonable range of the total of charges for any nonemergency services provided, the patient shall not be liable for the charges.
(A) Has disclosed to the patient a reasonable range of the total charges for the services being provided; and
(B) Has advised the patient that the provider may bill the patient for the balance of any charges that are not otherwise reimbursed by the managed health insurance issuer. If, after request by the patient, the provider fails to disclose a reasonable range of the total of charges for any nonemergency services provided, the patient shall not be liable for the charges.
(e) The option described in subsection (b) shall be a part of every contract issued by a managed health insurance issuer; provided, that an employer who employs not more than one hundred (100) full-time employees may reject the point of service option in writing.
(f) The requirements of this section shall be satisfied if the employer or other person sponsoring the health insurance or health benefits plan includes for all principal enrollees a preferred provider organization plan, a plan that offers unrestricted access to providers, or a point of service benefit as specified in this section.
(g) Nothing contained in this section shall be construed or interpreted as applying to the TennCare programs administered pursuant to the waivers approved by the United States department of health and human services, to entities that qualify to participate in the Medicare+Choice program, or to individual health insurance contracts.
(h) Notwithstanding any other law to the contrary, an HMO may underwrite directly the point of service benefit required by this section.
Amended by 2013 Tenn. Acts, ch. 92,s 1, eff. 4/8/2013.
Acts 1998, ch. 1033, §§ 2, 3; T.C.A. § 56-32-228.
Tenn. Code Ann. § 56-1-411 — TN Code / Title 56 / Chapter 1 / Section 56-1-411
Extent of examination - Report - Hearing - Order - Penalty - Confidentiality of records
Status: in_force

(a) In the course of the examination, the commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of making the examination may examine: (1) Any insurance company transacting, or being organized to transact, business in this state; (2) Any corporation, association, or person engaged in or proposing to be engaged in the organization, promotion or solicitation of shares or capital contributions to, or aiding in the formation of, an insurance company; (3) As an incident to the examination of the insurance company itself, any corporation, association, or person holding shares of capital stock of an insurance company for the purpose of controlling the management of the insurance company as voting trustee or otherwise; (4) As an incident to the examination of the insurance company itself, any corporation, association, or person having a contract, written or oral, pertaining to the management or control of an insurance company as general agent, managing agent or attorney-in-fact; (5) As an incident to the examination of the insurance company itself, any corporation, association, or person that has substantial control, directly or indirectly, over any insurance company doing business in this state whether by ownership of its stock or otherwise, or any corporation, association, or person owning stock in any such insurance company, which stock constitutes a substantial proportion of the stock of the insurance company; (6) Any subsidiary or affiliate of any insurance company doing business in this state; (7) Any licensed agent, broker or solicitor or any corporation, association, or person making application for a license as an agent, broker or solicitor; and (8) Any corporation, association, or person engaged in the business of adjusting losses or financing premiums. (b) (1) Every company, corporation, association, or person being examined, its officers, directors and agents, shall provide to the commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, convenient and free access at its office to all books, records, securities, documents and any and all papers relating to the property, assets, business and affairs of the company. The officers, directors and agents of the company, corporation, association or person shall facilitate the examination and aid in the examination so far as it is in their power to do so. (2) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, has the power to: (A) Administer oaths and to examine under oath any person relative to the business of the company; and (B) Appraise or cause to be appraised by competent appraisers appointed by the commissioner or such other person all property in which the company has or claims an interest or that is security in any form for the payment of any debt or obligation to the company. (c) (1) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, shall make a full and true report of the examination, which shall comprise only facts ascertained from the books, papers, records, securities or documents or other evidence obtained by investigation and examined by them or ascertained from the testimony of officers or agents or other persons examined under oath concerning the business, affairs, assets and obligations of the company. The report of examination shall be verified by the oath of the examiner in charge of the examination and shall be prima facie evidence in any action or proceeding in the name of the state against the company, its officers or agents upon the facts stated in the report. (2) In the conduct of an examination, the criteria as set forth in the Examiners Handbook adopted by the National Association of Insurance Commissioners and the National Association of Insurance Commissioners Accounting Practices and Procedures Manuals that were in effect when the commissioner exercised discretion to make an examination under or to take other action permitted by this chapter shall be used. The commissioner may also employ other guidelines or procedures the commissioner deems appropriate. (d) (1) No later than sixty (60) days following completion of the examination, the examiner in charge shall file with the department a verified written report of examination under oath. Upon receipt of the verified report, the department shall transmit the report to the company examined, together with a notice that affords the company examined a reasonable opportunity of not more than thirty (30) days to make a written submission or rebuttal with respect to any matters contained in the examination report. (2) Within thirty (30) days of the end of the period allowed for the receipt of written submissions or rebuttals, the commissioner shall fully consider and review the report, together with any written submissions or rebuttals and any relevant portions of the examiner's work papers and enter an order: (A) Adopting the examination report as filed or with modification or corrections. If the examination report reveals that the company is operating in violation of any law, regulation or prior order of the commissioner, the commissioner may order the company to take any action the commissioner considers necessary and appropriate to cure the violation; (B) Rejecting the examination report with directions to the examiners to reopen the examination for purposes of obtaining additional data, documentation or information, and refiling pursuant to subdivision (c)(2); or (C) Calling for an investigatory hearing with no less than twenty (20) days' notice to the company for purposes of obtaining additional documentation, data, information and testimony. (3) If the examination reveals that the company is operating in violation of any law, regulation or prior order, the commissioner, in the written order, may require the company to take any action the commissioner considers necessary or appropriate in accordance with the report of examination or the hearing, if any, on the report. That order shall be subject to judicial review in accordance with title 27, chapter 9. (4) Nothing contained in this chapter shall prevent or be construed as prohibiting the commissioner from disclosing the content of an examination report, preliminary examination report or results, or any matter relating to the reports or results, to the department of insurance of this or any other state or country, or to law enforcement officials of this or any other state or agency of the federal government at any time, so long as the agency or office receiving the report or matters relating to the reports agrees in writing to hold it confidential and in a manner consistent with this section. (e) Any company, corporation, or association that, or person who, violates or aids and abets any violation of a written order issued pursuant to this section shall be punished by a fine of not more than five thousand dollars ($5,000), which shall be sued for and recovered pursuant to § 56-1-802 . (f) All working papers, recorded information, documents and copies of working papers, recorded information and documents produced by, obtained by or disclosed to the commissioner or any other person in the course of an examination made under this chapter must be given confidential treatment and may not be made public by the commissioner or any other person, except to the extent provided in subsection (d). Access may also be granted to the National Association of Insurance Commissioners. The parties must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section, unless the prior written consent of the company to which it pertains has been obtained. Acts 1895, ch. 160, § 4; Shan., § 3281; Code 1932, § 6095; Acts 1968, ch. 463, § 1; T.C.A. (orig. ed.), § 56-123; Acts 1993, ch. 253, §§ 4-6; 1996, ch. 750, § 15.
(a) In the course of the examination, the commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of making the examination may examine: (1) Any insurance company transacting, or being organized to transact, business in this state; (2) Any corporation, association, or person engaged in or proposing to be engaged in the organization, promotion or solicitation of shares or capital contributions to, or aiding in the formation of, an insurance company; (3) As an incident to the examination of the insurance company itself, any corporation, association, or person holding shares of capital stock of an insurance company for the purpose of controlling the management of the insurance company as voting trustee or otherwise; (4) As an incident to the examination of the insurance company itself, any corporation, association, or person having a contract, written or oral, pertaining to the management or control of an insurance company as general agent, managing agent or attorney-in-fact; (5) As an incident to the examination of the insurance company itself, any corporation, association, or person that has substantial control, directly or indirectly, over any insurance company doing business in this state whether by ownership of its stock or otherwise, or any corporation, association, or person owning stock in any such insurance company, which stock constitutes a substantial proportion of the stock of the insurance company; (6) Any subsidiary or affiliate of any insurance company doing business in this state; (7) Any licensed agent, broker or solicitor or any corporation, association, or person making application for a license as an agent, broker or solicitor; and (8) Any corporation, association, or person engaged in the business of adjusting losses or financing premiums.
(1) Any insurance company transacting, or being organized to transact, business in this state;
(2) Any corporation, association, or person engaged in or proposing to be engaged in the organization, promotion or solicitation of shares or capital contributions to, or aiding in the formation of, an insurance company;
(3) As an incident to the examination of the insurance company itself, any corporation, association, or person holding shares of capital stock of an insurance company for the purpose of controlling the management of the insurance company as voting trustee or otherwise;
(4) As an incident to the examination of the insurance company itself, any corporation, association, or person having a contract, written or oral, pertaining to the management or control of an insurance company as general agent, managing agent or attorney-in-fact;
(5) As an incident to the examination of the insurance company itself, any corporation, association, or person that has substantial control, directly or indirectly, over any insurance company doing business in this state whether by ownership of its stock or otherwise, or any corporation, association, or person owning stock in any such insurance company, which stock constitutes a substantial proportion of the stock of the insurance company;
(6) Any subsidiary or affiliate of any insurance company doing business in this state;
(7) Any licensed agent, broker or solicitor or any corporation, association, or person making application for a license as an agent, broker or solicitor; and
(8) Any corporation, association, or person engaged in the business of adjusting losses or financing premiums.
(b) (1) Every company, corporation, association, or person being examined, its officers, directors and agents, shall provide to the commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, convenient and free access at its office to all books, records, securities, documents and any and all papers relating to the property, assets, business and affairs of the company. The officers, directors and agents of the company, corporation, association or person shall facilitate the examination and aid in the examination so far as it is in their power to do so. (2) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, has the power to: (A) Administer oaths and to examine under oath any person relative to the business of the company; and (B) Appraise or cause to be appraised by competent appraisers appointed by the commissioner or such other person all property in which the company has or claims an interest or that is security in any form for the payment of any debt or obligation to the company.
(1) Every company, corporation, association, or person being examined, its officers, directors and agents, shall provide to the commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, convenient and free access at its office to all books, records, securities, documents and any and all papers relating to the property, assets, business and affairs of the company. The officers, directors and agents of the company, corporation, association or person shall facilitate the examination and aid in the examination so far as it is in their power to do so.
(2) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, has the power to: (A) Administer oaths and to examine under oath any person relative to the business of the company; and (B) Appraise or cause to be appraised by competent appraisers appointed by the commissioner or such other person all property in which the company has or claims an interest or that is security in any form for the payment of any debt or obligation to the company.
(A) Administer oaths and to examine under oath any person relative to the business of the company; and
(B) Appraise or cause to be appraised by competent appraisers appointed by the commissioner or such other person all property in which the company has or claims an interest or that is security in any form for the payment of any debt or obligation to the company.
(c) (1) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, shall make a full and true report of the examination, which shall comprise only facts ascertained from the books, papers, records, securities or documents or other evidence obtained by investigation and examined by them or ascertained from the testimony of officers or agents or other persons examined under oath concerning the business, affairs, assets and obligations of the company. The report of examination shall be verified by the oath of the examiner in charge of the examination and shall be prima facie evidence in any action or proceeding in the name of the state against the company, its officers or agents upon the facts stated in the report. (2) In the conduct of an examination, the criteria as set forth in the Examiners Handbook adopted by the National Association of Insurance Commissioners and the National Association of Insurance Commissioners Accounting Practices and Procedures Manuals that were in effect when the commissioner exercised discretion to make an examination under or to take other action permitted by this chapter shall be used. The commissioner may also employ other guidelines or procedures the commissioner deems appropriate.
(1) The commissioner, the commissioner's deputy, or the person appointed by the commissioner for the purpose of the examination, shall make a full and true report of the examination, which shall comprise only facts ascertained from the books, papers, records, securities or documents or other evidence obtained by investigation and examined by them or ascertained from the testimony of officers or agents or other persons examined under oath concerning the business, affairs, assets and obligations of the company. The report of examination shall be verified by the oath of the examiner in charge of the examination and shall be prima facie evidence in any action or proceeding in the name of the state against the company, its officers or agents upon the facts stated in the report.
(2) In the conduct of an examination, the criteria as set forth in the Examiners Handbook adopted by the National Association of Insurance Commissioners and the National Association of Insurance Commissioners Accounting Practices and Procedures Manuals that were in effect when the commissioner exercised discretion to make an examination under or to take other action permitted by this chapter shall be used. The commissioner may also employ other guidelines or procedures the commissioner deems appropriate.
(d) (1) No later than sixty (60) days following completion of the examination, the examiner in charge shall file with the department a verified written report of examination under oath. Upon receipt of the verified report, the department shall transmit the report to the company examined, together with a notice that affords the company examined a reasonable opportunity of not more than thirty (30) days to make a written submission or rebuttal with respect to any matters contained in the examination report. (2) Within thirty (30) days of the end of the period allowed for the receipt of written submissions or rebuttals, the commissioner shall fully consider and review the report, together with any written submissions or rebuttals and any relevant portions of the examiner's work papers and enter an order: (A) Adopting the examination report as filed or with modification or corrections. If the examination report reveals that the company is operating in violation of any law, regulation or prior order of the commissioner, the commissioner may order the company to take any action the commissioner considers necessary and appropriate to cure the violation; (B) Rejecting the examination report with directions to the examiners to reopen the examination for purposes of obtaining additional data, documentation or information, and refiling pursuant to subdivision (c)(2); or (C) Calling for an investigatory hearing with no less than twenty (20) days' notice to the company for purposes of obtaining additional documentation, data, information and testimony. (3) If the examination reveals that the company is operating in violation of any law, regulation or prior order, the commissioner, in the written order, may require the company to take any action the commissioner considers necessary or appropriate in accordance with the report of examination or the hearing, if any, on the report. That order shall be subject to judicial review in accordance with title 27, chapter 9. (4) Nothing contained in this chapter shall prevent or be construed as prohibiting the commissioner from disclosing the content of an examination report, preliminary examination report or results, or any matter relating to the reports or results, to the department of insurance of this or any other state or country, or to law enforcement officials of this or any other state or agency of the federal government at any time, so long as the agency or office receiving the report or matters relating to the reports agrees in writing to hold it confidential and in a manner consistent with this section.
(1) No later than sixty (60) days following completion of the examination, the examiner in charge shall file with the department a verified written report of examination under oath. Upon receipt of the verified report, the department shall transmit the report to the company examined, together with a notice that affords the company examined a reasonable opportunity of not more than thirty (30) days to make a written submission or rebuttal with respect to any matters contained in the examination report.
(2) Within thirty (30) days of the end of the period allowed for the receipt of written submissions or rebuttals, the commissioner shall fully consider and review the report, together with any written submissions or rebuttals and any relevant portions of the examiner's work papers and enter an order: (A) Adopting the examination report as filed or with modification or corrections. If the examination report reveals that the company is operating in violation of any law, regulation or prior order of the commissioner, the commissioner may order the company to take any action the commissioner considers necessary and appropriate to cure the violation; (B) Rejecting the examination report with directions to the examiners to reopen the examination for purposes of obtaining additional data, documentation or information, and refiling pursuant to subdivision (c)(2); or (C) Calling for an investigatory hearing with no less than twenty (20) days' notice to the company for purposes of obtaining additional documentation, data, information and testimony.
(A) Adopting the examination report as filed or with modification or corrections. If the examination report reveals that the company is operating in violation of any law, regulation or prior order of the commissioner, the commissioner may order the company to take any action the commissioner considers necessary and appropriate to cure the violation;
(B) Rejecting the examination report with directions to the examiners to reopen the examination for purposes of obtaining additional data, documentation or information, and refiling pursuant to subdivision (c)(2); or
(C) Calling for an investigatory hearing with no less than twenty (20) days' notice to the company for purposes of obtaining additional documentation, data, information and testimony.
(3) If the examination reveals that the company is operating in violation of any law, regulation or prior order, the commissioner, in the written order, may require the company to take any action the commissioner considers necessary or appropriate in accordance with the report of examination or the hearing, if any, on the report. That order shall be subject to judicial review in accordance with title 27, chapter 9.
(4) Nothing contained in this chapter shall prevent or be construed as prohibiting the commissioner from disclosing the content of an examination report, preliminary examination report or results, or any matter relating to the reports or results, to the department of insurance of this or any other state or country, or to law enforcement officials of this or any other state or agency of the federal government at any time, so long as the agency or office receiving the report or matters relating to the reports agrees in writing to hold it confidential and in a manner consistent with this section.
(e) Any company, corporation, or association that, or person who, violates or aids and abets any violation of a written order issued pursuant to this section shall be punished by a fine of not more than five thousand dollars ($5,000), which shall be sued for and recovered pursuant to § 56-1-802 .
(f) All working papers, recorded information, documents and copies of working papers, recorded information and documents produced by, obtained by or disclosed to the commissioner or any other person in the course of an examination made under this chapter must be given confidential treatment and may not be made public by the commissioner or any other person, except to the extent provided in subsection (d). Access may also be granted to the National Association of Insurance Commissioners. The parties must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section, unless the prior written consent of the company to which it pertains has been obtained.
Acts 1895, ch. 160, § 4; Shan., § 3281; Code 1932, § 6095; Acts 1968, ch. 463, § 1; T.C.A. (orig. ed.), § 56-123; Acts 1993, ch. 253, §§ 4-6; 1996, ch. 750, § 15.
Tenn. Code Ann. § 56-6-909 — TN Code / Title 56 / Chapter 6 / Section 56-6-909
Issuance of license - Period in effect - Renewal - Notification of commissioner of changes - Lapse of license - Penalties - Retroactive and prospective reinstatement - Waiver of procedures in certain situations - Delegation of commissioner's duties
Status: in_force

(a) Unless denied licensure under this part, persons who have met the requirements of this part shall be issued a public adjuster license. (b) A public adjuster license shall remain in effect for a period of two (2) years, unless revoked, terminated or suspended. The commissioner may renew a license issued under this part, as long as the request for renewal and fee set forth in the rule promulgated under § 56-6-905(a)(5) is paid and any other requirements for license renewal are met by the date of the license's expiration. (c) The licensee shall inform the commissioner, by any means acceptable to the commissioner, of a change of address, change of legal name, or change of material information submitted on the application within thirty (30) days of the change. (d) A licensed public adjuster shall be subject to chapters 8 and 53 of this title. (e) (1) A public adjuster who allows the adjuster's license to lapse may, within twelve (12) months from the date of expiration, be issued a new public adjuster license upon the commissioner's receipt of the request for renewal. However, a penalty in the amount of double the unpaid renewal fee shall be required, and be subject to other penalties as provided by law, before the license will be renewed. (2) If the commissioner receives the request for reinstatement and the required lapsed license fee within sixty (60) days of the date the license lapsed, the commissioner shall reinstate the license retroactively to the date the license lapsed. If the commissioner receives the request for reinstatement and the required lapsed license fee after sixty (60) days, but within one (1) year of the date the license lapsed, the commissioner shall reinstate the license prospectively with the date the license is reinstated. If the person applies for reinstatement more than one (1) year from date of lapse, the person shall reapply for the license under this part. (f) A licensed public adjuster that is unable to comply with license renewal procedures due to military service, a long-term medical disability, or some other extenuating circumstance, may request a waiver of those procedures. The public adjuster also may request a waiver of any examination requirement, fine, or other sanction imposed for failure to comply with renewal procedures. (g) The license shall contain the licensee's name, city and state of business address, personal identification number, the date of issuance, the expiration date, and any other information the commissioner deems necessary. (h) In order to assist in the performance of the commissioner's duties, the commissioner may contract with nongovernmental entities, including, but not limited to the NAIC or any affiliates or subsidiaries that the NAIC oversees, to perform any functions, including testing and the collection of fees and data, related to licensing, that the commissioner may deem appropriate. Acts 2006, ch. 997, § 10.
(a) Unless denied licensure under this part, persons who have met the requirements of this part shall be issued a public adjuster license.
(b) A public adjuster license shall remain in effect for a period of two (2) years, unless revoked, terminated or suspended. The commissioner may renew a license issued under this part, as long as the request for renewal and fee set forth in the rule promulgated under § 56-6-905(a)(5) is paid and any other requirements for license renewal are met by the date of the license's expiration.
(c) The licensee shall inform the commissioner, by any means acceptable to the commissioner, of a change of address, change of legal name, or change of material information submitted on the application within thirty (30) days of the change.
(d) A licensed public adjuster shall be subject to chapters 8 and 53 of this title.
(e) (1) A public adjuster who allows the adjuster's license to lapse may, within twelve (12) months from the date of expiration, be issued a new public adjuster license upon the commissioner's receipt of the request for renewal. However, a penalty in the amount of double the unpaid renewal fee shall be required, and be subject to other penalties as provided by law, before the license will be renewed. (2) If the commissioner receives the request for reinstatement and the required lapsed license fee within sixty (60) days of the date the license lapsed, the commissioner shall reinstate the license retroactively to the date the license lapsed. If the commissioner receives the request for reinstatement and the required lapsed license fee after sixty (60) days, but within one (1) year of the date the license lapsed, the commissioner shall reinstate the license prospectively with the date the license is reinstated. If the person applies for reinstatement more than one (1) year from date of lapse, the person shall reapply for the license under this part.
(1) A public adjuster who allows the adjuster's license to lapse may, within twelve (12) months from the date of expiration, be issued a new public adjuster license upon the commissioner's receipt of the request for renewal. However, a penalty in the amount of double the unpaid renewal fee shall be required, and be subject to other penalties as provided by law, before the license will be renewed.
(2) If the commissioner receives the request for reinstatement and the required lapsed license fee within sixty (60) days of the date the license lapsed, the commissioner shall reinstate the license retroactively to the date the license lapsed. If the commissioner receives the request for reinstatement and the required lapsed license fee after sixty (60) days, but within one (1) year of the date the license lapsed, the commissioner shall reinstate the license prospectively with the date the license is reinstated. If the person applies for reinstatement more than one (1) year from date of lapse, the person shall reapply for the license under this part.
(f) A licensed public adjuster that is unable to comply with license renewal procedures due to military service, a long-term medical disability, or some other extenuating circumstance, may request a waiver of those procedures. The public adjuster also may request a waiver of any examination requirement, fine, or other sanction imposed for failure to comply with renewal procedures.
(g) The license shall contain the licensee's name, city and state of business address, personal identification number, the date of issuance, the expiration date, and any other information the commissioner deems necessary.
(h) In order to assist in the performance of the commissioner's duties, the commissioner may contract with nongovernmental entities, including, but not limited to the NAIC or any affiliates or subsidiaries that the NAIC oversees, to perform any functions, including testing and the collection of fees and data, related to licensing, that the commissioner may deem appropriate.
Acts 2006, ch. 997, § 10.
Tenn. Code Ann. § 56-7-1101 — TN Code / Title 56 / Chapter 7 / Section 56-7-1101
Priority and applicability of coverages
Status: in_force

(a) (1) In all cases arising out of the use of a motor vehicle on which the owner of the motor vehicle has any insurance coverages, the owner's policy is primary if the vehicle is being operated with the permission of the owner and within the scope of the permission granted. (2) Any other coverages that may be available to the permittee are not applicable unless and until the limits of all coverages provided by the owner's policy first are exhausted. (b) Any provision of subdivision (a)(1) or (a)(2) to the contrary notwithstanding, where the only insurance coverage provided by the owner of the vehicle is under a garage policy, then any coverage that may be available to the permittee shall be primary and the coverage under the owner's garage policy shall not be applicable unless and until the limits of all coverage available to the permittee shall be first exhausted; provided, that when any non-owned vehicle is in the possession, custody or control of a person who is in the business of storing, parking, servicing or repairing vehicles, then any insurance available to the owner shall not be applicable unless and until all insurance that is available under a garage policy of the person in possession has been exhausted. (c) When a claim arises out of the operation of a motor vehicle that is leased under a written lease agreement, and pursuant to which agreement the lessee provides coverage for the vehicle, then any other coverage that may be available for the vehicle through the lessor is not applicable unless and until the limits of all coverage provided by the lessee for the vehicle first are exhausted. (d) Subsections (a) and (c) are effective as to all policies written after May 7, 1973, and to all renewals of existing policies made after May 7, 1973. Subsection (b) is effective as to all policies written after April 5, 1974, and to all renewals of existing policies made after April 5, 1974. Acts 1973, ch. 209, §§ 1-3; 1974, ch. 779, §§ 1, 2; 1976, ch. 652, §§ 1, 2; T.C.A., § 56-1164.
(a) (1) In all cases arising out of the use of a motor vehicle on which the owner of the motor vehicle has any insurance coverages, the owner's policy is primary if the vehicle is being operated with the permission of the owner and within the scope of the permission granted. (2) Any other coverages that may be available to the permittee are not applicable unless and until the limits of all coverages provided by the owner's policy first are exhausted.
(1) In all cases arising out of the use of a motor vehicle on which the owner of the motor vehicle has any insurance coverages, the owner's policy is primary if the vehicle is being operated with the permission of the owner and within the scope of the permission granted.
(2) Any other coverages that may be available to the permittee are not applicable unless and until the limits of all coverages provided by the owner's policy first are exhausted.
(b) Any provision of subdivision (a)(1) or (a)(2) to the contrary notwithstanding, where the only insurance coverage provided by the owner of the vehicle is under a garage policy, then any coverage that may be available to the permittee shall be primary and the coverage under the owner's garage policy shall not be applicable unless and until the limits of all coverage available to the permittee shall be first exhausted; provided, that when any non-owned vehicle is in the possession, custody or control of a person who is in the business of storing, parking, servicing or repairing vehicles, then any insurance available to the owner shall not be applicable unless and until all insurance that is available under a garage policy of the person in possession has been exhausted.
(c) When a claim arises out of the operation of a motor vehicle that is leased under a written lease agreement, and pursuant to which agreement the lessee provides coverage for the vehicle, then any other coverage that may be available for the vehicle through the lessor is not applicable unless and until the limits of all coverage provided by the lessee for the vehicle first are exhausted.
(d) Subsections (a) and (c) are effective as to all policies written after May 7, 1973, and to all renewals of existing policies made after May 7, 1973. Subsection (b) is effective as to all policies written after April 5, 1974, and to all renewals of existing policies made after April 5, 1974.
Acts 1973, ch. 209, §§ 1-3; 1974, ch. 779, §§ 1, 2; 1976, ch. 652, §§ 1, 2; T.C.A., § 56-1164.
Tenn. Code Ann. § 56-8-106 — TN Code / Title 56 / Chapter 8 / Section 56-8-106
Lending of money, extension of credit, or renewal - Conditions prohibited - Disclosures
Status: in_force

(a) No person or depository institution, or affiliate of a depository institution, shall require as a condition precedent to the lending of money or extension of credit, or any renewal thereof, that the person to whom the money or credit is extended or whose obligation a creditor is to acquire or finance, negotiate any policy or renewal of any policy through a particular insurer or group of insurers or agent or broker or group of agents or brokers. Further, no person or depository institution, or affiliate of a depository institution, shall reject an insurance policy solely because the policy has been issued or underwritten by a person who is not associated with the depository institution or affiliate when insurance is required in connection with a loan or extension of credit. However, nothing in this subsection (a) shall be construed as prohibiting engaging in an arrangement that would not violate § 106 of the Bank Holding Company Act Amendments of 1972 ( 12 U.S.C. § 1972 ), as interpreted by the board of governors of the federal reserve system, or § 5(q) of the Home Owners' Loan Act ( 12 U.S.C. § 1464(q) ). (b) No person or depository institution, or affiliate of a depository institution, who lends money or extends credit shall: (1) As a condition for extending credit or offering any product or service that is equivalent to an extension of credit, require that a customer obtain insurance from a depository institution or an affiliate of a depository institution, or a particular insurer or producer; however, this subdivision (b)(1) does not prohibit a person or depository institution, or affiliate of a depository institution, from informing a customer or prospective customer that insurance is required in order to obtain a loan or credit, that loan or credit approval is contingent upon the procurement by the customer of acceptable insurance or that insurance is available from the person or depository institution or affiliate of a depository institution; (2) Unreasonably reject a policy furnished by the customer or borrower for the protection of the property securing the credit or lien. A rejection shall not be deemed unreasonable if it is based on reasonable standards, uniformly applied, relating to the extent of coverage required and the financial soundness and the services of an insurer. The standards shall not discriminate against any particular type of insurer, nor shall the standards call for rejection of a policy because it contains coverage in addition to that required in the credit transaction; (3) Require that any customer, borrower, mortgagor, purchaser, insurer, broker or insurance producer pay a separate charge in connection with the handling of any policy required as security for a loan on real estate, or pay a separate charge to substitute the policy of one (1) insurer for that of another. This subdivision (b)(3) does not include the interest that may be charged on premium loans or premium advancements in accordance with the terms of the loan or credit document. Further, this subdivision (b)(3) does not apply to charges that would be required when the person or depository institution or affiliate of a depository institution is the licensed producer providing the insurance; (4) Require any procedures or conditions of duly licensed producers or insurers not customarily required of those producers or insurers affiliated or in any way connected with the person who lends money or extends credit; (5) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state is responsible for the insurance sales activity of, or stands behind the credit of, the person, depository institution or its affiliate; (6) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state guarantees any returns on insurance products or is a source of payment on any insurance obligation of or sold by the person, depository institution or its affiliate; (7) Act as a producer unless properly licensed in accordance with § 56-6-103 ; (8) Pay or receive any commission, brokerage fee or other compensation as a producer, unless the person holds a valid producer's license for the applicable class of insurance. However, in addition to any other manner of compensation otherwise allowed by law, an unlicensed person may make a referral to a licensed producer; provided, that the person does not discuss specific insurance policy terms and conditions. Except as prohibited by federal law, the unlicensed person may be compensated for the referral; however, an unlicensed person who is neither employed by nor affiliated with the insurance producer may be compensated only if the compensation is a fixed dollar amount, not to exceed twenty-five dollars ($25.00) or such lesser amount as the commissioner may establish by rule, for each referral. An unlicensed person who is either employed by or affiliated with the insurance producer may be compensated only if the compensation is a fixed nominal dollar amount. Furthermore, any person who accepts deposits from the public in an area where such transactions are routinely conducted in the depository institution may receive for each customer referral no more than a one-time, nominal fee of a fixed dollar amount for each referral. In any event, the referral compensation shall not depend on whether the referred customer purchases an insurance product from the licensed producer; (9) Solicit or sell insurance, other than credit insurance or flood insurance, unless the solicitation or sale is completed through documents separate from any credit transactions; (10) Include the expense of insurance premiums, other than credit insurance premiums or flood insurance premiums, in the primary credit transaction without the express written consent of the customer; (11) Solicit or sell insurance unless its insurance sales activities are, to the extent practicable, physically separated from areas where retail deposits are routinely accepted by depository institutions; (12) Solicit or sell insurance unless it maintains separate and distinct books and records relating to the insurance transactions, including all files relating to and reflecting consumer complaints; or (13) Require, in connection with a loan or extension of credit secured by real property, that the debtor procure insurance for the protection of the property for an amount that exceeds the replacement cost of the structures existing on the secured property at the time of the loan or extension of credit or, in the case of a construction or improvement loan, insurance that exceeds the replacement value the structures are expected to have upon completion of the construction or improvements. (c) Every person or depository institution, or affiliate of a depository institution that lends money or extends credit and who solicits insurance primarily for personal, family or household purposes shall disclose to the customer in writing that the insurance related to the credit extension may be purchased from an insurer or producer of the customer's choice, subject only to the lender's right to reject a given insurer or agent as provided in subdivision (b)(2). Further, the disclosure shall inform the customer that the customer's choice of insurer or producer will not affect the credit decision or credit terms in any way, except that the depository institution may impose reasonable requirements concerning the creditworthiness of the insurer and the scope of coverage chosen as provided in subdivision (b)(2). (d) (1) A depository institution that solicits, sells, advertises or offers insurance, and any person that solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall disclose to the customer in writing, where practicable and in a clear and conspicuous manner, prior to a sale, that the insurance: (A) Is not a deposit; (B) Is not insured by the federal deposit insurance corporation or any other federal government agency; (C) Is not guaranteed by the depository institution, its affiliate, if applicable, or any person that is soliciting, selling, advertising or offering insurance, if applicable; and (D) Where appropriate, involves investment risk, including the possible loss of value. (2) For purposes of the requirements of subdivision (d)(1), an affiliate of a depository institution is subject to these requirements only to the extent that it sells, solicits, advertises, or offers insurance products or annuities at an office of a depository institution or on behalf of a depository institution. These requirements apply only when an individual purchases, applies to purchase, or is solicited to purchase insurance products or annuities primarily for personal, family or household purposes and only to the extent that the disclosure would be accurate. (3) A depository institution that solicits, sells, advertises or offers insurance, and any person who solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall obtain written acknowledgement of the receipt of the disclosure from the customer at the time the customer receives the disclosure or at the time of the initial purchase of the insurance policy. If the solicitation is conducted by telephone, the person or depository institution shall obtain an oral acknowledgement of receipt of the disclosure, maintain sufficient documentation to show that the acknowledgement was given by the customer and make reasonable efforts to obtain a written acknowledgement from the customer. If a customer affirmatively consents to receiving the disclosures electronically and if the disclosures are provided in a format that the customer may retain or obtain later, the person or depository institution may provide the disclosure and obtain acknowledgement of the receipt of the disclosure from the customer using electronic media. (4) For the purposes of subdivision (d)(1), a person is selling, soliciting, advertising or offering insurance on behalf of a depository institution, whether at an office of the depository institution or another location, if at least one (1) of the following applies: (A) The person represents to the customer that the sale, solicitation, advertisement or offer of the insurance is by or on behalf of the depository institution; (B) The depository institution refers a customer to the person who sells insurance and the depository institution has a contractual arrangement to receive commissions or fees derived from the sale of insurance resulting from the referral; or (C) Documents evidencing the sale, solicitation, advertisement or offer of insurance identify or refer to the depository institution. (e) The commissioner shall have the power to examine and investigate those insurance activities of any person, depository institution, affiliate of a depository institution or insurer that the commissioner believes may be in violation of this section. The person, depository institution, affiliate of a depository institution or insurer shall make its insurance books and records available to the commissioner and the commissioner's staff for inspection upon reasonable notice. (f) Nothing in this section shall prevent a person or depository institution, or affiliate of a depository institution, who lends money or extends credit from placing insurance on real or personal property in the event the mortgagor, borrower or purchaser has failed to provide required insurance in accordance with the terms of the loan or credit document. Amended by 2015 Tenn. Acts, ch. 227,s 1, eff. 4/21/2015. Acts 2008, ch. 1079, §§ 1, 7.
(a) No person or depository institution, or affiliate of a depository institution, shall require as a condition precedent to the lending of money or extension of credit, or any renewal thereof, that the person to whom the money or credit is extended or whose obligation a creditor is to acquire or finance, negotiate any policy or renewal of any policy through a particular insurer or group of insurers or agent or broker or group of agents or brokers. Further, no person or depository institution, or affiliate of a depository institution, shall reject an insurance policy solely because the policy has been issued or underwritten by a person who is not associated with the depository institution or affiliate when insurance is required in connection with a loan or extension of credit. However, nothing in this subsection (a) shall be construed as prohibiting engaging in an arrangement that would not violate § 106 of the Bank Holding Company Act Amendments of 1972 ( 12 U.S.C. § 1972 ), as interpreted by the board of governors of the federal reserve system, or § 5(q) of the Home Owners' Loan Act ( 12 U.S.C. § 1464(q) ).
(b) No person or depository institution, or affiliate of a depository institution, who lends money or extends credit shall: (1) As a condition for extending credit or offering any product or service that is equivalent to an extension of credit, require that a customer obtain insurance from a depository institution or an affiliate of a depository institution, or a particular insurer or producer; however, this subdivision (b)(1) does not prohibit a person or depository institution, or affiliate of a depository institution, from informing a customer or prospective customer that insurance is required in order to obtain a loan or credit, that loan or credit approval is contingent upon the procurement by the customer of acceptable insurance or that insurance is available from the person or depository institution or affiliate of a depository institution; (2) Unreasonably reject a policy furnished by the customer or borrower for the protection of the property securing the credit or lien. A rejection shall not be deemed unreasonable if it is based on reasonable standards, uniformly applied, relating to the extent of coverage required and the financial soundness and the services of an insurer. The standards shall not discriminate against any particular type of insurer, nor shall the standards call for rejection of a policy because it contains coverage in addition to that required in the credit transaction; (3) Require that any customer, borrower, mortgagor, purchaser, insurer, broker or insurance producer pay a separate charge in connection with the handling of any policy required as security for a loan on real estate, or pay a separate charge to substitute the policy of one (1) insurer for that of another. This subdivision (b)(3) does not include the interest that may be charged on premium loans or premium advancements in accordance with the terms of the loan or credit document. Further, this subdivision (b)(3) does not apply to charges that would be required when the person or depository institution or affiliate of a depository institution is the licensed producer providing the insurance; (4) Require any procedures or conditions of duly licensed producers or insurers not customarily required of those producers or insurers affiliated or in any way connected with the person who lends money or extends credit; (5) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state is responsible for the insurance sales activity of, or stands behind the credit of, the person, depository institution or its affiliate; (6) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state guarantees any returns on insurance products or is a source of payment on any insurance obligation of or sold by the person, depository institution or its affiliate; (7) Act as a producer unless properly licensed in accordance with § 56-6-103 ; (8) Pay or receive any commission, brokerage fee or other compensation as a producer, unless the person holds a valid producer's license for the applicable class of insurance. However, in addition to any other manner of compensation otherwise allowed by law, an unlicensed person may make a referral to a licensed producer; provided, that the person does not discuss specific insurance policy terms and conditions. Except as prohibited by federal law, the unlicensed person may be compensated for the referral; however, an unlicensed person who is neither employed by nor affiliated with the insurance producer may be compensated only if the compensation is a fixed dollar amount, not to exceed twenty-five dollars ($25.00) or such lesser amount as the commissioner may establish by rule, for each referral. An unlicensed person who is either employed by or affiliated with the insurance producer may be compensated only if the compensation is a fixed nominal dollar amount. Furthermore, any person who accepts deposits from the public in an area where such transactions are routinely conducted in the depository institution may receive for each customer referral no more than a one-time, nominal fee of a fixed dollar amount for each referral. In any event, the referral compensation shall not depend on whether the referred customer purchases an insurance product from the licensed producer; (9) Solicit or sell insurance, other than credit insurance or flood insurance, unless the solicitation or sale is completed through documents separate from any credit transactions; (10) Include the expense of insurance premiums, other than credit insurance premiums or flood insurance premiums, in the primary credit transaction without the express written consent of the customer; (11) Solicit or sell insurance unless its insurance sales activities are, to the extent practicable, physically separated from areas where retail deposits are routinely accepted by depository institutions; (12) Solicit or sell insurance unless it maintains separate and distinct books and records relating to the insurance transactions, including all files relating to and reflecting consumer complaints; or (13) Require, in connection with a loan or extension of credit secured by real property, that the debtor procure insurance for the protection of the property for an amount that exceeds the replacement cost of the structures existing on the secured property at the time of the loan or extension of credit or, in the case of a construction or improvement loan, insurance that exceeds the replacement value the structures are expected to have upon completion of the construction or improvements.
(1) As a condition for extending credit or offering any product or service that is equivalent to an extension of credit, require that a customer obtain insurance from a depository institution or an affiliate of a depository institution, or a particular insurer or producer; however, this subdivision (b)(1) does not prohibit a person or depository institution, or affiliate of a depository institution, from informing a customer or prospective customer that insurance is required in order to obtain a loan or credit, that loan or credit approval is contingent upon the procurement by the customer of acceptable insurance or that insurance is available from the person or depository institution or affiliate of a depository institution;
(2) Unreasonably reject a policy furnished by the customer or borrower for the protection of the property securing the credit or lien. A rejection shall not be deemed unreasonable if it is based on reasonable standards, uniformly applied, relating to the extent of coverage required and the financial soundness and the services of an insurer. The standards shall not discriminate against any particular type of insurer, nor shall the standards call for rejection of a policy because it contains coverage in addition to that required in the credit transaction;
(3) Require that any customer, borrower, mortgagor, purchaser, insurer, broker or insurance producer pay a separate charge in connection with the handling of any policy required as security for a loan on real estate, or pay a separate charge to substitute the policy of one (1) insurer for that of another. This subdivision (b)(3) does not include the interest that may be charged on premium loans or premium advancements in accordance with the terms of the loan or credit document. Further, this subdivision (b)(3) does not apply to charges that would be required when the person or depository institution or affiliate of a depository institution is the licensed producer providing the insurance;
(4) Require any procedures or conditions of duly licensed producers or insurers not customarily required of those producers or insurers affiliated or in any way connected with the person who lends money or extends credit;
(5) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state is responsible for the insurance sales activity of, or stands behind the credit of, the person, depository institution or its affiliate;
(6) Use an advertisement or other insurance promotional material that would cause a reasonable person to mistakenly believe that the federal government or the state guarantees any returns on insurance products or is a source of payment on any insurance obligation of or sold by the person, depository institution or its affiliate;
(7) Act as a producer unless properly licensed in accordance with § 56-6-103 ;
(8) Pay or receive any commission, brokerage fee or other compensation as a producer, unless the person holds a valid producer's license for the applicable class of insurance. However, in addition to any other manner of compensation otherwise allowed by law, an unlicensed person may make a referral to a licensed producer; provided, that the person does not discuss specific insurance policy terms and conditions. Except as prohibited by federal law, the unlicensed person may be compensated for the referral; however, an unlicensed person who is neither employed by nor affiliated with the insurance producer may be compensated only if the compensation is a fixed dollar amount, not to exceed twenty-five dollars ($25.00) or such lesser amount as the commissioner may establish by rule, for each referral. An unlicensed person who is either employed by or affiliated with the insurance producer may be compensated only if the compensation is a fixed nominal dollar amount. Furthermore, any person who accepts deposits from the public in an area where such transactions are routinely conducted in the depository institution may receive for each customer referral no more than a one-time, nominal fee of a fixed dollar amount for each referral. In any event, the referral compensation shall not depend on whether the referred customer purchases an insurance product from the licensed producer;
(9) Solicit or sell insurance, other than credit insurance or flood insurance, unless the solicitation or sale is completed through documents separate from any credit transactions;
(10) Include the expense of insurance premiums, other than credit insurance premiums or flood insurance premiums, in the primary credit transaction without the express written consent of the customer;
(11) Solicit or sell insurance unless its insurance sales activities are, to the extent practicable, physically separated from areas where retail deposits are routinely accepted by depository institutions;
(12) Solicit or sell insurance unless it maintains separate and distinct books and records relating to the insurance transactions, including all files relating to and reflecting consumer complaints; or
(13) Require, in connection with a loan or extension of credit secured by real property, that the debtor procure insurance for the protection of the property for an amount that exceeds the replacement cost of the structures existing on the secured property at the time of the loan or extension of credit or, in the case of a construction or improvement loan, insurance that exceeds the replacement value the structures are expected to have upon completion of the construction or improvements.
(c) Every person or depository institution, or affiliate of a depository institution that lends money or extends credit and who solicits insurance primarily for personal, family or household purposes shall disclose to the customer in writing that the insurance related to the credit extension may be purchased from an insurer or producer of the customer's choice, subject only to the lender's right to reject a given insurer or agent as provided in subdivision (b)(2). Further, the disclosure shall inform the customer that the customer's choice of insurer or producer will not affect the credit decision or credit terms in any way, except that the depository institution may impose reasonable requirements concerning the creditworthiness of the insurer and the scope of coverage chosen as provided in subdivision (b)(2).
(d) (1) A depository institution that solicits, sells, advertises or offers insurance, and any person that solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall disclose to the customer in writing, where practicable and in a clear and conspicuous manner, prior to a sale, that the insurance: (A) Is not a deposit; (B) Is not insured by the federal deposit insurance corporation or any other federal government agency; (C) Is not guaranteed by the depository institution, its affiliate, if applicable, or any person that is soliciting, selling, advertising or offering insurance, if applicable; and (D) Where appropriate, involves investment risk, including the possible loss of value. (2) For purposes of the requirements of subdivision (d)(1), an affiliate of a depository institution is subject to these requirements only to the extent that it sells, solicits, advertises, or offers insurance products or annuities at an office of a depository institution or on behalf of a depository institution. These requirements apply only when an individual purchases, applies to purchase, or is solicited to purchase insurance products or annuities primarily for personal, family or household purposes and only to the extent that the disclosure would be accurate. (3) A depository institution that solicits, sells, advertises or offers insurance, and any person who solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall obtain written acknowledgement of the receipt of the disclosure from the customer at the time the customer receives the disclosure or at the time of the initial purchase of the insurance policy. If the solicitation is conducted by telephone, the person or depository institution shall obtain an oral acknowledgement of receipt of the disclosure, maintain sufficient documentation to show that the acknowledgement was given by the customer and make reasonable efforts to obtain a written acknowledgement from the customer. If a customer affirmatively consents to receiving the disclosures electronically and if the disclosures are provided in a format that the customer may retain or obtain later, the person or depository institution may provide the disclosure and obtain acknowledgement of the receipt of the disclosure from the customer using electronic media. (4) For the purposes of subdivision (d)(1), a person is selling, soliciting, advertising or offering insurance on behalf of a depository institution, whether at an office of the depository institution or another location, if at least one (1) of the following applies: (A) The person represents to the customer that the sale, solicitation, advertisement or offer of the insurance is by or on behalf of the depository institution; (B) The depository institution refers a customer to the person who sells insurance and the depository institution has a contractual arrangement to receive commissions or fees derived from the sale of insurance resulting from the referral; or (C) Documents evidencing the sale, solicitation, advertisement or offer of insurance identify or refer to the depository institution.
(1) A depository institution that solicits, sells, advertises or offers insurance, and any person that solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall disclose to the customer in writing, where practicable and in a clear and conspicuous manner, prior to a sale, that the insurance: (A) Is not a deposit; (B) Is not insured by the federal deposit insurance corporation or any other federal government agency; (C) Is not guaranteed by the depository institution, its affiliate, if applicable, or any person that is soliciting, selling, advertising or offering insurance, if applicable; and (D) Where appropriate, involves investment risk, including the possible loss of value.
(A) Is not a deposit;
(B) Is not insured by the federal deposit insurance corporation or any other federal government agency;
(C) Is not guaranteed by the depository institution, its affiliate, if applicable, or any person that is soliciting, selling, advertising or offering insurance, if applicable; and
(D) Where appropriate, involves investment risk, including the possible loss of value.
(2) For purposes of the requirements of subdivision (d)(1), an affiliate of a depository institution is subject to these requirements only to the extent that it sells, solicits, advertises, or offers insurance products or annuities at an office of a depository institution or on behalf of a depository institution. These requirements apply only when an individual purchases, applies to purchase, or is solicited to purchase insurance products or annuities primarily for personal, family or household purposes and only to the extent that the disclosure would be accurate.
(3) A depository institution that solicits, sells, advertises or offers insurance, and any person who solicits, sells, advertises or offers insurance on behalf of a depository institution or on the premises of a depository institution shall obtain written acknowledgement of the receipt of the disclosure from the customer at the time the customer receives the disclosure or at the time of the initial purchase of the insurance policy. If the solicitation is conducted by telephone, the person or depository institution shall obtain an oral acknowledgement of receipt of the disclosure, maintain sufficient documentation to show that the acknowledgement was given by the customer and make reasonable efforts to obtain a written acknowledgement from the customer. If a customer affirmatively consents to receiving the disclosures electronically and if the disclosures are provided in a format that the customer may retain or obtain later, the person or depository institution may provide the disclosure and obtain acknowledgement of the receipt of the disclosure from the customer using electronic media.
(4) For the purposes of subdivision (d)(1), a person is selling, soliciting, advertising or offering insurance on behalf of a depository institution, whether at an office of the depository institution or another location, if at least one (1) of the following applies: (A) The person represents to the customer that the sale, solicitation, advertisement or offer of the insurance is by or on behalf of the depository institution; (B) The depository institution refers a customer to the person who sells insurance and the depository institution has a contractual arrangement to receive commissions or fees derived from the sale of insurance resulting from the referral; or (C) Documents evidencing the sale, solicitation, advertisement or offer of insurance identify or refer to the depository institution.
(A) The person represents to the customer that the sale, solicitation, advertisement or offer of the insurance is by or on behalf of the depository institution;
(B) The depository institution refers a customer to the person who sells insurance and the depository institution has a contractual arrangement to receive commissions or fees derived from the sale of insurance resulting from the referral; or
(C) Documents evidencing the sale, solicitation, advertisement or offer of insurance identify or refer to the depository institution.
(e) The commissioner shall have the power to examine and investigate those insurance activities of any person, depository institution, affiliate of a depository institution or insurer that the commissioner believes may be in violation of this section. The person, depository institution, affiliate of a depository institution or insurer shall make its insurance books and records available to the commissioner and the commissioner's staff for inspection upon reasonable notice.
(f) Nothing in this section shall prevent a person or depository institution, or affiliate of a depository institution, who lends money or extends credit from placing insurance on real or personal property in the event the mortgagor, borrower or purchaser has failed to provide required insurance in accordance with the terms of the loan or credit document.
Amended by 2015 Tenn. Acts, ch. 227,s 1, eff. 4/21/2015.
Acts 2008, ch. 1079, §§ 1, 7.
Tenn. Code Ann. § 56-7-709 — TN Code / Title 56 / Chapter 7 / Section 56-7-709
Penalty for violation of Sections 56-7-705 - 56-7-708
Status: in_force

Any violation of §§ 56-7-705 - 56-7-708 is a Class C misdemeanor. Acts 1917, ch. 7, § 4; Shan., § 3369a154; Code 1932, § 6447; T.C.A. (orig. ed.), § 56-1136; Acts 1989, ch. 591, § 113.
Any violation of §§ 56-7-705 - 56-7-708 is a Class C misdemeanor.
Acts 1917, ch. 7, § 4; Shan., § 3369a154; Code 1932, § 6447; T.C.A. (orig. ed.), § 56-1136; Acts 1989, ch. 591, § 113.
Tenn. Code Ann. § 56-35-132 — TN Code / Title 56 / Chapter 35 / Section 56-35-132
Rating organizations
Status: in_force

(a) Unless it files its own rates, every title insurance company shall be a member of or subscribe to a rating organization licensed under this chapter and every filing or any modification of any rate, schedule, form, contract, or other item required by this chapter or by any rule or regulation made by the commissioner shall be made on behalf of the title insurance company by the rating bureau of which it is a member or to which it subscribes. (b) A corporation, an unincorporated association, a partnership or an individual, whether located within or outside the state, may make application for a license as a rating organization for title insurance companies and shall file with the application: (1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and of its bylaws, rules and regulations governing the conduct of its business; (2) A list of its members and subscribers; (3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the rating organization may be served; and (4) A statement of its qualifications as a title insurance rating organization. (c) If the commissioner finds that the applicant is qualified, the commissioner shall issue a license authorizing the applicant to act as a rating organization for title insurance companies. The application shall be granted or denied in whole or in part by the commissioner within sixty (60) days after the date of its filing with the commissioner. The licenses issued pursuant to this section shall remain in effect until suspended or revoked by the commissioner. The fee for the license shall be five hundred dollars ($500). (d) Each rating organization shall furnish its ratemaking service without discrimination to all of its members and subscribers and shall, subject to reasonable rules and regulations, permit any title insurance company, not admitted to membership, to become a subscriber. The refusal of any rating organization to admit a title insurance company as a subscriber shall, at the request of the title insurance company, be reviewed by the commissioner at a hearing held upon at least ten (10) days' written notice to the rating organization and the title insurance company. If the rating organization fails to grant or reject a title insurance company's application for subscribership within thirty (30) days after it was made, the title insurance company may request a review by the commissioner as if the application had been rejected. If the commissioner finds that the title insurance company has been refused admittance to the rating organization as a subscriber without justification, the commissioner shall make an order directing the rating organization to admit the title insurance company as a subscriber. If the commissioner finds that the action of the rating organization in refusing admittance to a title insurance company as a subscriber is justified, the commissioner shall make an order affirming its action. (e) Except as provided in subsection (f), each member of or subscriber to a rating organization shall adhere to the schedule of rates filed in its behalf by the rating organization. (f) Any member of or subscriber to a rating organization may appeal to the commissioner from the decision of the rating organization in approving or rejecting any proposed change in or addition to the filings of the rating organization; and the commissioner shall, after a hearing held on not less than ten (10) days' written notice to the appellant and to the rating organization, issue an order approving the decision of the rating organization or directing it to give further consideration to the proposal. The failure of a rating organization to take action or make a decision within thirty (30) days after submission to it of a proposal under this subsection (f) shall constitute a rejection of the proposal within the meaning of this subsection (f). (g) The commissioner shall, at least once in five (5) years, make or cause to be made an examination of each rating organization licensed in this state. The reasonable cost of the examination shall be paid by the rating organization examined upon presentation to it of a detailed account of the cost. The officers, managers, agents and employees of the rating organization may be examined under oath and shall exhibit all books, records, accounts, documents or agreements governing its method of operation. The commissioner may waive the examination upon proof that the rating organization has, within a reasonably recent period, been examined by the insurance supervisory official of another state, pursuant to the laws of that state, and upon the filing with the commissioner of a copy of the report of the examination. Acts 1983, ch. 139, § 2.
(a) Unless it files its own rates, every title insurance company shall be a member of or subscribe to a rating organization licensed under this chapter and every filing or any modification of any rate, schedule, form, contract, or other item required by this chapter or by any rule or regulation made by the commissioner shall be made on behalf of the title insurance company by the rating bureau of which it is a member or to which it subscribes.
(b) A corporation, an unincorporated association, a partnership or an individual, whether located within or outside the state, may make application for a license as a rating organization for title insurance companies and shall file with the application: (1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and of its bylaws, rules and regulations governing the conduct of its business; (2) A list of its members and subscribers; (3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the rating organization may be served; and (4) A statement of its qualifications as a title insurance rating organization.
(1) A copy of its constitution, its articles of agreement or association or its certificate of incorporation, and of its bylaws, rules and regulations governing the conduct of its business;
(2) A list of its members and subscribers;
(3) The name and address of a resident of this state upon whom notices or orders of the commissioner or process affecting the rating organization may be served; and
(4) A statement of its qualifications as a title insurance rating organization.
(c) If the commissioner finds that the applicant is qualified, the commissioner shall issue a license authorizing the applicant to act as a rating organization for title insurance companies. The application shall be granted or denied in whole or in part by the commissioner within sixty (60) days after the date of its filing with the commissioner. The licenses issued pursuant to this section shall remain in effect until suspended or revoked by the commissioner. The fee for the license shall be five hundred dollars ($500).
(d) Each rating organization shall furnish its ratemaking service without discrimination to all of its members and subscribers and shall, subject to reasonable rules and regulations, permit any title insurance company, not admitted to membership, to become a subscriber. The refusal of any rating organization to admit a title insurance company as a subscriber shall, at the request of the title insurance company, be reviewed by the commissioner at a hearing held upon at least ten (10) days' written notice to the rating organization and the title insurance company. If the rating organization fails to grant or reject a title insurance company's application for subscribership within thirty (30) days after it was made, the title insurance company may request a review by the commissioner as if the application had been rejected. If the commissioner finds that the title insurance company has been refused admittance to the rating organization as a subscriber without justification, the commissioner shall make an order directing the rating organization to admit the title insurance company as a subscriber. If the commissioner finds that the action of the rating organization in refusing admittance to a title insurance company as a subscriber is justified, the commissioner shall make an order affirming its action.
(e) Except as provided in subsection (f), each member of or subscriber to a rating organization shall adhere to the schedule of rates filed in its behalf by the rating organization.
(f) Any member of or subscriber to a rating organization may appeal to the commissioner from the decision of the rating organization in approving or rejecting any proposed change in or addition to the filings of the rating organization; and the commissioner shall, after a hearing held on not less than ten (10) days' written notice to the appellant and to the rating organization, issue an order approving the decision of the rating organization or directing it to give further consideration to the proposal. The failure of a rating organization to take action or make a decision within thirty (30) days after submission to it of a proposal under this subsection (f) shall constitute a rejection of the proposal within the meaning of this subsection (f).
(g) The commissioner shall, at least once in five (5) years, make or cause to be made an examination of each rating organization licensed in this state. The reasonable cost of the examination shall be paid by the rating organization examined upon presentation to it of a detailed account of the cost. The officers, managers, agents and employees of the rating organization may be examined under oath and shall exhibit all books, records, accounts, documents or agreements governing its method of operation. The commissioner may waive the examination upon proof that the rating organization has, within a reasonably recent period, been examined by the insurance supervisory official of another state, pursuant to the laws of that state, and upon the filing with the commissioner of a copy of the report of the examination.
Acts 1983, ch. 139, § 2.
Tenn. Code Ann. § 56-2-123 — TN Code / Title 56 / Chapter 2 / Section 56-2-123
Confirmation of verbal authorization for medical care
Status: in_force

If verbal authorization is given to a health care provider, insured, or enrollee for medical care under any individual, franchise, blanket or group health insurance policy, medical service plan or contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, or managed care organization, the verbal authorization shall be confirmed by written authorization, facsimile transmission, or verbally by means of a confirmation number or other confirmation code. Acts 1997, ch. 201, § 1.
If verbal authorization is given to a health care provider, insured, or enrollee for medical care under any individual, franchise, blanket or group health insurance policy, medical service plan or contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, or managed care organization, the verbal authorization shall be confirmed by written authorization, facsimile transmission, or verbally by means of a confirmation number or other confirmation code.
Acts 1997, ch. 201, § 1.
Tenn. Code Ann. § 56-7-2501 — TN Code / Title 56 / Chapter 7 / Section 56-7-2501
Sterilization operations - Policy provisions
Status: in_force

(a) Any law to the contrary notwithstanding, no contract of insurance that provides coverage for sterilization operations or procedures may be entered into or renewed on or after July 1, 1971, if the contract imposes any disclaimer, restriction on, or limitation of coverage with respect to the insured's reason for sterilization. All such contracts entered into or renewed on or after July 1, 1971, shall be construed to be in compliance with this section and any provisions in any contract that are in conflict with this section shall be of no force or effect. (b) Any contract for a sterilization operation or procedure shall not be cancelled by the insurer unless the cancellation coincides with cancellation of the entire policy. Acts 1972, ch. 848, § 1; T.C.A., § 56-1162; Acts 1992, ch. 984, § 3; T.C.A., § 56-7-1006.
(a) Any law to the contrary notwithstanding, no contract of insurance that provides coverage for sterilization operations or procedures may be entered into or renewed on or after July 1, 1971, if the contract imposes any disclaimer, restriction on, or limitation of coverage with respect to the insured's reason for sterilization. All such contracts entered into or renewed on or after July 1, 1971, shall be construed to be in compliance with this section and any provisions in any contract that are in conflict with this section shall be of no force or effect.
(b) Any contract for a sterilization operation or procedure shall not be cancelled by the insurer unless the cancellation coincides with cancellation of the entire policy.
Acts 1972, ch. 848, § 1; T.C.A., § 56-1162; Acts 1992, ch. 984, § 3; T.C.A., § 56-7-1006.
Tenn. Code Ann. § 56-13-306 — TN Code / Title 56 / Chapter 13 / Section 56-13-306
Examination of a branch captive insurance company
Status: in_force

(a) The examination of a branch captive insurance company pursuant to § 56-13-109 shall be of branch business and branch operations only, if the branch captive insurance company provides annually to the commissioner a certificate of compliance, or its equivalent, issued by or filed with the licensing authority of the jurisdiction in which the branch captive insurance company is formed, and demonstrates to the commissioner's satisfaction that it is operating in sound financial condition in accordance with all applicable laws and regulations of such jurisdiction. (b) As a condition of licensure, an alien captive insurance company shall grant authority to the commissioner for examination of the affairs of the alien captive insurance company in the jurisdiction in which the alien captive insurance company is formed. Acts 2011, ch. 468, § 1.
(a) The examination of a branch captive insurance company pursuant to § 56-13-109 shall be of branch business and branch operations only, if the branch captive insurance company provides annually to the commissioner a certificate of compliance, or its equivalent, issued by or filed with the licensing authority of the jurisdiction in which the branch captive insurance company is formed, and demonstrates to the commissioner's satisfaction that it is operating in sound financial condition in accordance with all applicable laws and regulations of such jurisdiction.
(b) As a condition of licensure, an alien captive insurance company shall grant authority to the commissioner for examination of the affairs of the alien captive insurance company in the jurisdiction in which the alien captive insurance company is formed.
Acts 2011, ch. 468, § 1.
Tenn. Code Ann. § 56-7-2707 — TN Code / Title 56 / Chapter 7 / Section 56-7-2707
Coverage for genetic services not required
Status: in_force

Nothing in this part shall require an insurance provider to provide coverage of genetic services, unless the coverage of genetic services is already included within the scope of benefits of the provider's health insurance coverage. Acts 1997, ch. 121, § 2.
Nothing in this part shall require an insurance provider to provide coverage of genetic services, unless the coverage of genetic services is already included within the scope of benefits of the provider's health insurance coverage.
Acts 1997, ch. 121, § 2.
Tenn. Code Ann. § 56-5-103 — TN Code / Title 56 / Chapter 5 / Section 56-5-103
Standards
Status: in_force

(a) General. Rates: (1) Shall not be excessive, inadequate or unfairly discriminatory; or (2) In the case of an advisory prospective loss costs filing, shall reasonably reflect projected losses and loss adjustment expenses. (b) Excessiveness. A rate is excessive if it is likely to produce a profit that is unreasonably high for the insurance provided or if the expense provision included in the rate is unreasonably high in relation to the services rendered. (c) Inadequacy. A rate is not inadequate unless the rate is clearly insufficient to sustain projected losses and expenses in the class of business to which it applies and the use of the rate has or, if continued, will have the effect of substantially lessening competition or the tendency to create a monopoly. (d) Unfair Discrimination. Unfair discrimination exists if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses. A rate is not unfairly discriminatory because different premiums result for policyholders with like loss exposures with different expenses, or like expenses but different loss exposures, so long as the rate reflects the differences with reasonable accuracy. Acts 1983, ch. 66, § 4; 1996, ch. 944, § 35.
(a) General. Rates: (1) Shall not be excessive, inadequate or unfairly discriminatory; or (2) In the case of an advisory prospective loss costs filing, shall reasonably reflect projected losses and loss adjustment expenses.
(1) Shall not be excessive, inadequate or unfairly discriminatory; or
(2) In the case of an advisory prospective loss costs filing, shall reasonably reflect projected losses and loss adjustment expenses.
(b) Excessiveness. A rate is excessive if it is likely to produce a profit that is unreasonably high for the insurance provided or if the expense provision included in the rate is unreasonably high in relation to the services rendered.
(c) Inadequacy. A rate is not inadequate unless the rate is clearly insufficient to sustain projected losses and expenses in the class of business to which it applies and the use of the rate has or, if continued, will have the effect of substantially lessening competition or the tendency to create a monopoly.
(d) Unfair Discrimination. Unfair discrimination exists if, after allowing for practical limitations, price differentials fail to reflect equitably the differences in expected losses and expenses. A rate is not unfairly discriminatory because different premiums result for policyholders with like loss exposures with different expenses, or like expenses but different loss exposures, so long as the rate reflects the differences with reasonable accuracy.
Acts 1983, ch. 66, § 4; 1996, ch. 944, § 35.
Tenn. Code Ann. § 56-32-102 — TN Code / Title 56 / Chapter 32 / Section 56-32-102
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) For the purposes of regulating an HMO that participates in the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "affiliate" means any entity that exercises control over or is controlled by the HMO, directly or indirectly through: (A) Equity ownership of voting securities; (B) Common managerial control; or (C) Collusive participation by the management of the HMO and affiliate in the management of the HMO or the affiliate; (2) "Basic health care services" means all those health services that a defined population might reasonably require in order to be in good health, including as a minimum, but not limited to, emergency care, inpatient hospital and physician care, ambulatory physician care and outpatient preventative medical services. In addition, an HMO that participates in the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "basic health care services" includes, but is not limited to, services made necessary as the result of Title XIX federal programs or waivers for which TennCare is primarily responsible for implementation or enforcement; (3) "Coinsurance" means an enrollee's share of covered medical expenses when an enrollee and the HMO share in a specific ratio of the covered medical expenses; provided, however, that coinsurance shall not expand the ability of an HMO to offer out-of-network benefits except as otherwise provided in this chapter; (4) "Commissioner" means the commissioner of commerce and insurance; (5) "Enrollee" means an individual who is enrolled in an HMO; (6) "Evidence of coverage" means any certificate, agreement or contract issued to an enrollee setting out the coverage to which the enrollee is entitled; (7) "Health care services" means any services included in the furnishing to any individual of medical or dental care, or hospitalization, or incidental to the furnishing of the care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability; (8) "Health maintenance organization (HMO)" means any person that undertakes to provide or arrange for basic health care services to enrollees on a prepaid basis. The HMO may provide physician services directly through physician employees or under arrangements with individual physicians or a group or groups of physicians. The HMO may also provide or arrange for other health care services on a prepayment or other financial basis. Additionally, the HMO may provide or arrange for basic health care services on a prepayment or other financial basis with physician-hospital organizations; by so doing, the physician-hospital organization is not deemed to be an insurer or HMO; (9) (A) "Person" means any natural or artificial person including, but not limited to, an individual, partnership, association, trust or corporation; (B) For the purposes of regulating an HMO that participates in the TennCare program under Title XIX of the federal Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "person" includes an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity; (10) "Physician-hospital organization" means an organization formed to allow hospitals and physicians to jointly obtain provider contracts with HMOs and other payers of health care benefits. The organization may obtain direct aggregate or excess stop-loss insurance coverage; (11) "Provider" means any physician, hospital or other person that is licensed or otherwise authorized in this state to furnish health care services; and (12) "Uncovered expenditures" means the costs of health care services that are covered by an HMO for which an enrollee would also be liable in the event of the organization's insolvency. Acts 1986, ch. 713, § 2; 1995, ch. 221, §§ 2, 3; 1999, ch. 322, § 3; 2001, ch. 151, § 1; T.C.A. §56-32-202; Acts 2009 , ch. 579, § 19.
As used in this chapter, unless the context otherwise requires:
(1) For the purposes of regulating an HMO that participates in the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "affiliate" means any entity that exercises control over or is controlled by the HMO, directly or indirectly through: (A) Equity ownership of voting securities; (B) Common managerial control; or (C) Collusive participation by the management of the HMO and affiliate in the management of the HMO or the affiliate;
(A) Equity ownership of voting securities;
(B) Common managerial control; or
(C) Collusive participation by the management of the HMO and affiliate in the management of the HMO or the affiliate;
(2) "Basic health care services" means all those health services that a defined population might reasonably require in order to be in good health, including as a minimum, but not limited to, emergency care, inpatient hospital and physician care, ambulatory physician care and outpatient preventative medical services. In addition, an HMO that participates in the TennCare program under Title XIX of the Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "basic health care services" includes, but is not limited to, services made necessary as the result of Title XIX federal programs or waivers for which TennCare is primarily responsible for implementation or enforcement;
(3) "Coinsurance" means an enrollee's share of covered medical expenses when an enrollee and the HMO share in a specific ratio of the covered medical expenses; provided, however, that coinsurance shall not expand the ability of an HMO to offer out-of-network benefits except as otherwise provided in this chapter;
(4) "Commissioner" means the commissioner of commerce and insurance;
(5) "Enrollee" means an individual who is enrolled in an HMO;
(6) "Evidence of coverage" means any certificate, agreement or contract issued to an enrollee setting out the coverage to which the enrollee is entitled;
(7) "Health care services" means any services included in the furnishing to any individual of medical or dental care, or hospitalization, or incidental to the furnishing of the care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability;
(8) "Health maintenance organization (HMO)" means any person that undertakes to provide or arrange for basic health care services to enrollees on a prepaid basis. The HMO may provide physician services directly through physician employees or under arrangements with individual physicians or a group or groups of physicians. The HMO may also provide or arrange for other health care services on a prepayment or other financial basis. Additionally, the HMO may provide or arrange for basic health care services on a prepayment or other financial basis with physician-hospital organizations; by so doing, the physician-hospital organization is not deemed to be an insurer or HMO;
(9) (A) "Person" means any natural or artificial person including, but not limited to, an individual, partnership, association, trust or corporation; (B) For the purposes of regulating an HMO that participates in the TennCare program under Title XIX of the federal Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "person" includes an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity;
(A) "Person" means any natural or artificial person including, but not limited to, an individual, partnership, association, trust or corporation;
(B) For the purposes of regulating an HMO that participates in the TennCare program under Title XIX of the federal Social Security Act ( 42 U.S.C. § 1396 et seq.), or any successor to the TennCare program, "person" includes an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity;
(10) "Physician-hospital organization" means an organization formed to allow hospitals and physicians to jointly obtain provider contracts with HMOs and other payers of health care benefits. The organization may obtain direct aggregate or excess stop-loss insurance coverage;
(11) "Provider" means any physician, hospital or other person that is licensed or otherwise authorized in this state to furnish health care services; and
(12) "Uncovered expenditures" means the costs of health care services that are covered by an HMO for which an enrollee would also be liable in the event of the organization's insolvency.
Acts 1986, ch. 713, § 2; 1995, ch. 221, §§ 2, 3; 1999, ch. 322, § 3; 2001, ch. 151, § 1; T.C.A. §56-32-202; Acts 2009 , ch. 579, § 19.
Tenn. Code Ann. § 56-12-201 — TN Code / Title 56 / Chapter 12 / Section 56-12-201
Short title
Status: in_force

This part shall be known and may be cited as the "Tennessee Life and Health Insurance Guaranty Association Act." Acts 1988, ch. 1032, § 1.
This part shall be known and may be cited as the "Tennessee Life and Health Insurance Guaranty Association Act."
Acts 1988, ch. 1032, § 1.
Tenn. Code Ann. § 56-7-1020 — TN Code / Title 56 / Chapter 7 / Section 56-7-1020
Section definitions - Method of payment restrictions prohibited - Electronic funds transfer requirements - Contract renewal requirements - Violations and exclusions
Status: in_force

(a) As used in this section: (1) "Bundling" means the practice of combining distinct dental procedures into one (1) procedure for billing purposes; (2) "Covered person" means an individual who is covered by a dental benefit plan; (3) "Covered services" means dental services for which a reimbursement is available under the enrollee's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefits payments, or any other limitation; (4) "Credit card payment": (A) Means a type of electronic funds transfer in which a dental benefit plan or its contracted vendor issues a single-use series of numbers associated with the payment of dental services: (i) Performed by a dentist and chargeable to a predetermined dollar amount; and (ii) For which the dentist is responsible for processing the payment by a credit card terminal or internet portal; and (B) Includes virtual or online credit card payments for which no physical credit card is presented to the dentist and the single-use credit card expires upon payment processing; (5) "Dental benefit plan" means a limited health service benefit plan that provides coverage for dental services; (6) "Dental carrier" means a health insurance entity that provides coverage for dental services; (7) "Dental services": (A) Means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease; and (B) Does not include services delivered by a provider that are billed as medical expenses under a health insurance plan; (8) "Dentist" means a dentist licensed or otherwise authorized in this state to furnish dental services; (9) "Dentist agent" means a person who establishes an agency relationship contract with a dentist to process bills for services provided by the dentist under terms and conditions established between the agent and dentist. Such contracts may permit the dentist agent to submit bills, request reconsideration, and receive reimbursement; (10) "Downcoding" means the adjustment of a claim submitted to a dental benefit plan to a less complex or lower cost procedure code; (11) "Electronic funds transfer payment" means a payment by any method of electronic funds transfer other than healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 ; (12) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation; (13) "Material change" means a change to: (A) A dental benefit plan's rules, guidelines, policies, or procedures concerning payment for dental services; (B) The general practices of the dental benefit plan that decrease reimbursements paid to providers; or (C) How a dental benefit plan adjudicates and pays claims for services if the change would: (i) Require a provider to change how the provider submits claims to the plan; or (ii) Increase the provider's administrative expense; and (14) "Participating provider" or "provider" means a dentist licensed to practice dentistry in this state, who provides dental services to an enrollee at a fee set by or at a fee subject to the approval of an insurer, dental services plan, third-party administrator, or another party that contracts to provide dental services. (b) A dental benefit plan must not contain restrictions on methods of payment from the dental benefit plan or its vendors to the dentist in which the only acceptable payment method is a credit card payment. (c) (1) When initiating or changing payments to a dentist using electronic funds transfer payments, including virtual credit card payments, a dental benefit plan or its vendors shall: (A) Notify the dentist if any fees are associated with a particular payment method; (B) Advise the dentist of the available methods of payment; and (C) Provide clear instructions to the dentist as to how to select an alternative payment method. (2) A dental benefit plan or its vendor that initiates or changes payments to a dentist for healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 shall not charge a fee solely to transmit the payment to the dentist unless the dentist has consented to the fee. (3) When transmitting healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 , a dentist agent may charge reasonable fees for payments related to transaction management, data management, portal services, and other value-added services in addition to the bank transmittal. (d) (1) A dental carrier that contracts or renews a contract with a provider shall: (A) Make the dental carrier's current dental benefit plan policies or guidelines available online; and (B) If requested by a provider, send a copy of the policies to the provider through mail or electronic mail. (2) A dental benefit plan contract as described in subdivision (d)(1) must furnish to providers: (A) A summary of all material changes made to a dental benefit plan no less than thirty (30) days prior to the date the material change takes effect; (B) The downcoding and bundling policies that the dental carrier reasonably expects to be applied to the provider's services as a matter of policy; and (C) A description of the dental benefit plan's utilization review procedures, including, but not limited to: (i) A procedure for a covered person to obtain a review of an adverse determination; and (ii) A statement of a provider's rights and responsibilities regarding the procedure described in subdivision (d)(2)(C)(i). (3) A dental carrier shall not offer or maintain in this state a dental benefit plan that: (A) Based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient; or (B) Uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure. (4) A dental carrier shall ensure that an explanation of benefits for a dental benefit plan includes the reason for any downcoding or bundling result. (e) A violation of this section may subject the dental carrier, dental service plan, third-party administrator, or other party that covers any dental services to the sanctions described in § 56-2-305 . (f) This section does not apply to the TennCare program or a successor program provided for in the Medical Assistance Act of 1968, compiled in title 71, chapter 5, or to the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program. Added by 2024 Tenn. Acts, ch. 589,s 1, eff. 7/1/2024.
(a) As used in this section: (1) "Bundling" means the practice of combining distinct dental procedures into one (1) procedure for billing purposes; (2) "Covered person" means an individual who is covered by a dental benefit plan; (3) "Covered services" means dental services for which a reimbursement is available under the enrollee's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefits payments, or any other limitation; (4) "Credit card payment": (A) Means a type of electronic funds transfer in which a dental benefit plan or its contracted vendor issues a single-use series of numbers associated with the payment of dental services: (i) Performed by a dentist and chargeable to a predetermined dollar amount; and (ii) For which the dentist is responsible for processing the payment by a credit card terminal or internet portal; and (B) Includes virtual or online credit card payments for which no physical credit card is presented to the dentist and the single-use credit card expires upon payment processing; (5) "Dental benefit plan" means a limited health service benefit plan that provides coverage for dental services; (6) "Dental carrier" means a health insurance entity that provides coverage for dental services; (7) "Dental services": (A) Means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease; and (B) Does not include services delivered by a provider that are billed as medical expenses under a health insurance plan; (8) "Dentist" means a dentist licensed or otherwise authorized in this state to furnish dental services; (9) "Dentist agent" means a person who establishes an agency relationship contract with a dentist to process bills for services provided by the dentist under terms and conditions established between the agent and dentist. Such contracts may permit the dentist agent to submit bills, request reconsideration, and receive reimbursement; (10) "Downcoding" means the adjustment of a claim submitted to a dental benefit plan to a less complex or lower cost procedure code; (11) "Electronic funds transfer payment" means a payment by any method of electronic funds transfer other than healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 ; (12) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation; (13) "Material change" means a change to: (A) A dental benefit plan's rules, guidelines, policies, or procedures concerning payment for dental services; (B) The general practices of the dental benefit plan that decrease reimbursements paid to providers; or (C) How a dental benefit plan adjudicates and pays claims for services if the change would: (i) Require a provider to change how the provider submits claims to the plan; or (ii) Increase the provider's administrative expense; and (14) "Participating provider" or "provider" means a dentist licensed to practice dentistry in this state, who provides dental services to an enrollee at a fee set by or at a fee subject to the approval of an insurer, dental services plan, third-party administrator, or another party that contracts to provide dental services.
(1) "Bundling" means the practice of combining distinct dental procedures into one (1) procedure for billing purposes;
(2) "Covered person" means an individual who is covered by a dental benefit plan;
(3) "Covered services" means dental services for which a reimbursement is available under the enrollee's plan contract, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefits payments, or any other limitation;
(4) "Credit card payment": (A) Means a type of electronic funds transfer in which a dental benefit plan or its contracted vendor issues a single-use series of numbers associated with the payment of dental services: (i) Performed by a dentist and chargeable to a predetermined dollar amount; and (ii) For which the dentist is responsible for processing the payment by a credit card terminal or internet portal; and (B) Includes virtual or online credit card payments for which no physical credit card is presented to the dentist and the single-use credit card expires upon payment processing;
(A) Means a type of electronic funds transfer in which a dental benefit plan or its contracted vendor issues a single-use series of numbers associated with the payment of dental services: (i) Performed by a dentist and chargeable to a predetermined dollar amount; and (ii) For which the dentist is responsible for processing the payment by a credit card terminal or internet portal; and
(i) Performed by a dentist and chargeable to a predetermined dollar amount; and
(ii) For which the dentist is responsible for processing the payment by a credit card terminal or internet portal; and
(B) Includes virtual or online credit card payments for which no physical credit card is presented to the dentist and the single-use credit card expires upon payment processing;
(5) "Dental benefit plan" means a limited health service benefit plan that provides coverage for dental services;
(6) "Dental carrier" means a health insurance entity that provides coverage for dental services;
(7) "Dental services": (A) Means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease; and (B) Does not include services delivered by a provider that are billed as medical expenses under a health insurance plan;
(A) Means services for the diagnosis, prevention, treatment, or cure of a dental condition, illness, injury, or disease; and
(B) Does not include services delivered by a provider that are billed as medical expenses under a health insurance plan;
(8) "Dentist" means a dentist licensed or otherwise authorized in this state to furnish dental services;
(9) "Dentist agent" means a person who establishes an agency relationship contract with a dentist to process bills for services provided by the dentist under terms and conditions established between the agent and dentist. Such contracts may permit the dentist agent to submit bills, request reconsideration, and receive reimbursement;
(10) "Downcoding" means the adjustment of a claim submitted to a dental benefit plan to a less complex or lower cost procedure code;
(11) "Electronic funds transfer payment" means a payment by any method of electronic funds transfer other than healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 ;
(12) "Health insurance entity" means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization, and a nonprofit hospital and medical service corporation;
(13) "Material change" means a change to: (A) A dental benefit plan's rules, guidelines, policies, or procedures concerning payment for dental services; (B) The general practices of the dental benefit plan that decrease reimbursements paid to providers; or (C) How a dental benefit plan adjudicates and pays claims for services if the change would: (i) Require a provider to change how the provider submits claims to the plan; or (ii) Increase the provider's administrative expense; and
(A) A dental benefit plan's rules, guidelines, policies, or procedures concerning payment for dental services;
(B) The general practices of the dental benefit plan that decrease reimbursements paid to providers; or
(C) How a dental benefit plan adjudicates and pays claims for services if the change would: (i) Require a provider to change how the provider submits claims to the plan; or (ii) Increase the provider's administrative expense; and
(i) Require a provider to change how the provider submits claims to the plan; or
(ii) Increase the provider's administrative expense; and
(14) "Participating provider" or "provider" means a dentist licensed to practice dentistry in this state, who provides dental services to an enrollee at a fee set by or at a fee subject to the approval of an insurer, dental services plan, third-party administrator, or another party that contracts to provide dental services.
(b) A dental benefit plan must not contain restrictions on methods of payment from the dental benefit plan or its vendors to the dentist in which the only acceptable payment method is a credit card payment.
(c) (1) When initiating or changing payments to a dentist using electronic funds transfer payments, including virtual credit card payments, a dental benefit plan or its vendors shall: (A) Notify the dentist if any fees are associated with a particular payment method; (B) Advise the dentist of the available methods of payment; and (C) Provide clear instructions to the dentist as to how to select an alternative payment method. (2) A dental benefit plan or its vendor that initiates or changes payments to a dentist for healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 shall not charge a fee solely to transmit the payment to the dentist unless the dentist has consented to the fee. (3) When transmitting healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 , a dentist agent may charge reasonable fees for payments related to transaction management, data management, portal services, and other value-added services in addition to the bank transmittal.
(1) When initiating or changing payments to a dentist using electronic funds transfer payments, including virtual credit card payments, a dental benefit plan or its vendors shall: (A) Notify the dentist if any fees are associated with a particular payment method; (B) Advise the dentist of the available methods of payment; and (C) Provide clear instructions to the dentist as to how to select an alternative payment method.
(A) Notify the dentist if any fees are associated with a particular payment method;
(B) Advise the dentist of the available methods of payment; and
(C) Provide clear instructions to the dentist as to how to select an alternative payment method.
(2) A dental benefit plan or its vendor that initiates or changes payments to a dentist for healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 shall not charge a fee solely to transmit the payment to the dentist unless the dentist has consented to the fee.
(3) When transmitting healthcare electronic funds transfer and remittance advice transactions under 45 CFR 162.1601 and 162.1602 , a dentist agent may charge reasonable fees for payments related to transaction management, data management, portal services, and other value-added services in addition to the bank transmittal.
(d) (1) A dental carrier that contracts or renews a contract with a provider shall: (A) Make the dental carrier's current dental benefit plan policies or guidelines available online; and (B) If requested by a provider, send a copy of the policies to the provider through mail or electronic mail. (2) A dental benefit plan contract as described in subdivision (d)(1) must furnish to providers: (A) A summary of all material changes made to a dental benefit plan no less than thirty (30) days prior to the date the material change takes effect; (B) The downcoding and bundling policies that the dental carrier reasonably expects to be applied to the provider's services as a matter of policy; and (C) A description of the dental benefit plan's utilization review procedures, including, but not limited to: (i) A procedure for a covered person to obtain a review of an adverse determination; and (ii) A statement of a provider's rights and responsibilities regarding the procedure described in subdivision (d)(2)(C)(i). (3) A dental carrier shall not offer or maintain in this state a dental benefit plan that: (A) Based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient; or (B) Uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure. (4) A dental carrier shall ensure that an explanation of benefits for a dental benefit plan includes the reason for any downcoding or bundling result.
(1) A dental carrier that contracts or renews a contract with a provider shall: (A) Make the dental carrier's current dental benefit plan policies or guidelines available online; and (B) If requested by a provider, send a copy of the policies to the provider through mail or electronic mail.
(A) Make the dental carrier's current dental benefit plan policies or guidelines available online; and
(B) If requested by a provider, send a copy of the policies to the provider through mail or electronic mail.
(2) A dental benefit plan contract as described in subdivision (d)(1) must furnish to providers: (A) A summary of all material changes made to a dental benefit plan no less than thirty (30) days prior to the date the material change takes effect; (B) The downcoding and bundling policies that the dental carrier reasonably expects to be applied to the provider's services as a matter of policy; and (C) A description of the dental benefit plan's utilization review procedures, including, but not limited to: (i) A procedure for a covered person to obtain a review of an adverse determination; and (ii) A statement of a provider's rights and responsibilities regarding the procedure described in subdivision (d)(2)(C)(i).
(A) A summary of all material changes made to a dental benefit plan no less than thirty (30) days prior to the date the material change takes effect;
(B) The downcoding and bundling policies that the dental carrier reasonably expects to be applied to the provider's services as a matter of policy; and
(C) A description of the dental benefit plan's utilization review procedures, including, but not limited to: (i) A procedure for a covered person to obtain a review of an adverse determination; and (ii) A statement of a provider's rights and responsibilities regarding the procedure described in subdivision (d)(2)(C)(i).
(i) A procedure for a covered person to obtain a review of an adverse determination; and
(ii) A statement of a provider's rights and responsibilities regarding the procedure described in subdivision (d)(2)(C)(i).
(3) A dental carrier shall not offer or maintain in this state a dental benefit plan that: (A) Based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient; or (B) Uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.
(A) Based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient; or
(B) Uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.
(4) A dental carrier shall ensure that an explanation of benefits for a dental benefit plan includes the reason for any downcoding or bundling result.
(e) A violation of this section may subject the dental carrier, dental service plan, third-party administrator, or other party that covers any dental services to the sanctions described in § 56-2-305 .
(f) This section does not apply to the TennCare program or a successor program provided for in the Medical Assistance Act of 1968, compiled in title 71, chapter 5, or to the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11, or a successor program.
Added by 2024 Tenn. Acts, ch. 589,s 1, eff. 7/1/2024.
Tenn. Code Ann. § 56-7-1803 — TN Code / Title 56 / Chapter 7 / Section 56-7-1803
Prerequisites for effective notice of cancellation
Status: in_force

After a commercial risk insurance policy has been in effect for sixty (60) days, or, if the policy is a renewal, effective immediately, no notice of cancellation shall be effective unless it is based on the occurrence, after the effective date of the policy, of one (1) or more of the following: (1) Nonpayment of premium, including nonpayment of any additional premiums, calculated in accordance with the current rating manual of the insurer, justified by a physical change in the insured property or a change in its occupancy or use; (2) Conviction of the named insured of a crime having as one (1) of its necessary elements an act increasing any hazard insured against; (3) Discovery of fraud or material misrepresentation on the part of either of the following: (A) The insured or the insured's representative in obtaining the insurance; or (B) The named insured in pursuing a claim under the policy; (4) Failure to comply with written loss control recommendations; (5) Material change in the risk that increases the risk of loss after insurance coverage has been issued or renewed; (6) Determination by the commissioner that the continuation of the policy would jeopardize a company's solvency or would place the insurer in violation of the insurance laws of this state or any other state; (7) Violation or breach by the insured of any policy terms or conditions; or (8) Other reasons that are approved by the commissioner. Acts 1986, ch. 656, § 3.
After a commercial risk insurance policy has been in effect for sixty (60) days, or, if the policy is a renewal, effective immediately, no notice of cancellation shall be effective unless it is based on the occurrence, after the effective date of the policy, of one (1) or more of the following:
(1) Nonpayment of premium, including nonpayment of any additional premiums, calculated in accordance with the current rating manual of the insurer, justified by a physical change in the insured property or a change in its occupancy or use;
(2) Conviction of the named insured of a crime having as one (1) of its necessary elements an act increasing any hazard insured against;
(3) Discovery of fraud or material misrepresentation on the part of either of the following: (A) The insured or the insured's representative in obtaining the insurance; or (B) The named insured in pursuing a claim under the policy;
(A) The insured or the insured's representative in obtaining the insurance; or
(B) The named insured in pursuing a claim under the policy;
(4) Failure to comply with written loss control recommendations;
(5) Material change in the risk that increases the risk of loss after insurance coverage has been issued or renewed;
(6) Determination by the commissioner that the continuation of the policy would jeopardize a company's solvency or would place the insurer in violation of the insurance laws of this state or any other state;
(7) Violation or breach by the insured of any policy terms or conditions; or
(8) Other reasons that are approved by the commissioner.
Acts 1986, ch. 656, § 3.
Tenn. Code Ann. § 56-7-131 — TN Code / Title 56 / Chapter 7 / Section 56-7-131
Advanced payments - Prior to trial
Status: in_force

(a) In any action in which a person has made any payments to or on behalf of any claimant prior to trial, the payments shall not be construed as an admission of liability by the person in any action brought to recover for personal injuries or for damage to property. (b) In the event, however, that the action results in a verdict in favor of the claimant, the defendant shall be allowed to introduce evidence of the payments and the court shall then reduce the amount awarded to the plaintiff by the amount of payments made prior to the date of judgment. (c) No such payments made by any insurance company shall be construed to be in lieu of or in addition to any limits of liability of the insurance company under any policy of insurance, but the sums paid in advance shall be deemed to have been made pursuant to the limits of the policy and shall be credited to the insurer's obligation to the insured arising from the policy and shall be deducted from the insurer's obligation. (d) The making of any advance payments shall not interrupt the running of the statute of limitations on any claim. Acts 2008, ch. 1079, § 14.
(a) In any action in which a person has made any payments to or on behalf of any claimant prior to trial, the payments shall not be construed as an admission of liability by the person in any action brought to recover for personal injuries or for damage to property.
(b) In the event, however, that the action results in a verdict in favor of the claimant, the defendant shall be allowed to introduce evidence of the payments and the court shall then reduce the amount awarded to the plaintiff by the amount of payments made prior to the date of judgment.
(c) No such payments made by any insurance company shall be construed to be in lieu of or in addition to any limits of liability of the insurance company under any policy of insurance, but the sums paid in advance shall be deemed to have been made pursuant to the limits of the policy and shall be credited to the insurer's obligation to the insured arising from the policy and shall be deducted from the insurer's obligation.
(d) The making of any advance payments shall not interrupt the running of the statute of limitations on any claim.
Acts 2008, ch. 1079, § 14.
Tenn. Code Ann. § 56-6-126 — TN Code / Title 56 / Chapter 6 / Section 56-6-126
Severability
Status: in_force

If any provisions of this part or the application of a provision to any person or circumstances is held invalid, the remainder of the part, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected. Acts 2002, ch. 798, § 27.
If any provisions of this part or the application of a provision to any person or circumstances is held invalid, the remainder of the part, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be affected.
Acts 2002, ch. 798, § 27.
Tenn. Code Ann. § 56-27-117 — TN Code / Title 56 / Chapter 27 / Section 56-27-117
Annual statement - Form - Filing fee
Status: in_force

The service corporation shall annually, on or before March 1, file in the office of the department a statement of its operations for the calendar year, and showing financial condition as of December 31, then next preceding, in the form and content the commissioner shall prescribe, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of fifty dollars ($50.00). Acts 1945, ch. 113, § 17; C. Supp. 1950, § 4186.33 (Williams, § 4186.34); impl. am. Acts 1971, ch. 137, § 1; Acts 1979, ch. 298, § 6; T.C.A. (orig. ed.), § 56-2917.
The service corporation shall annually, on or before March 1, file in the office of the department a statement of its operations for the calendar year, and showing financial condition as of December 31, then next preceding, in the form and content the commissioner shall prescribe, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of fifty dollars ($50.00).
Acts 1945, ch. 113, § 17; C. Supp. 1950, § 4186.33 (Williams, § 4186.34); impl. am. Acts 1971, ch. 137, § 1; Acts 1979, ch. 298, § 6; T.C.A. (orig. ed.), § 56-2917.
Tenn. Code Ann. § 56-60-106 — TN Code / Title 56 / Chapter 60 / Section 56-60-106
Subsequent grants of access to another third party
Status: in_force

(a) Any third party, having itself been granted access to a provider's health care services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party, is obligated to comply with the rights and responsibilities imposed on contracting entities under §§ 56-60-104 and 56-60-105 . (b) Any third party that enters into a contract with another third party to access a provider's health care services and contractual discounts pursuant to a provider network contract is obligated to comply with the rights and responsibilities imposed on third parties under this section and § 56-60-105 . (c) Any third party that subsequently grants access to another third party will provide to the contracting entity the location of a web site or a telephone number that the contracting entity will make available to providers as provided in § 56-60-105(b)(2) that will identify to providers any individual or entity to whom the third party has granted access to the provider's health care services and contractual discounts pursuant to the provider network contract. The third party shall update the listing on the web site or available through the telephone number on a routine basis as additional individuals or entities are granted access and shall review the listing no less frequently than quarterly to ensure the completeness and accuracy of the information available. Acts 2009, ch. 466, § 7.
(a) Any third party, having itself been granted access to a provider's health care services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party, is obligated to comply with the rights and responsibilities imposed on contracting entities under §§ 56-60-104 and 56-60-105 .
(b) Any third party that enters into a contract with another third party to access a provider's health care services and contractual discounts pursuant to a provider network contract is obligated to comply with the rights and responsibilities imposed on third parties under this section and § 56-60-105 .
(c) Any third party that subsequently grants access to another third party will provide to the contracting entity the location of a web site or a telephone number that the contracting entity will make available to providers as provided in § 56-60-105(b)(2) that will identify to providers any individual or entity to whom the third party has granted access to the provider's health care services and contractual discounts pursuant to the provider network contract. The third party shall update the listing on the web site or available through the telephone number on a routine basis as additional individuals or entities are granted access and shall review the listing no less frequently than quarterly to ensure the completeness and accuracy of the information available.
Acts 2009, ch. 466, § 7.