Tenn. Code Ann. § 56-2-201 — TN Code / Title 56 / Chapter 2 / Section 56-2-201
Definitions of kinds of insurance
Status: in_force

Kinds of insurance are defined as follows: (1) "Accident and health insurance" means insurance against bodily injury, disablement or death, by accident or accidental means, or the expense of bodily injury, disablement or death, against disablement or expense resulting from sickness, and every insurance pertaining thereto; providing for the mental and emotional welfare of an individual and members of the individual's family by defraying the cost of legal services; or providing aggregate or excess stop-loss coverage in connection with employee welfare benefit plans, managed care organizations participating in commercial plans or the TennCare program, or both, health maintenance organizations, long-term care facilities, physician-hospital organizations as defined in § 56-32-102 and provider aggregate or per-patient stop-loss protection insurance coverage as authorized by § 56-32-104 ; (2) "Casualty insurance" includes vehicle insurance, disability insurance, and in addition is: (A) "Boiler insurance," which is insurance against any liability and loss or damage to property resulting from accidents to or explosion of boilers, pipes, pressure containers, machinery, or apparatus, and to make inspection of and issue certificates of inspection upon boilers, machinery and apparatus of any kind, whether or not insured; (B) "Burglary and theft insurance," which is insurance against loss or damage by burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment, or from any attempt of burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment; also insurance against loss of or damage to moneys, coins, bullion, securities, notes, drafts, acceptances or any other valuable papers or documents, resulting from any cause, except while in the custody or possession of and being transported by any carrier for hire or in the mail; (C) "Collision insurance," which is insurance against loss of or damage to any property of the insured resulting from collision of any other object with the property, but not including collision to or by elevators, or to or by vessels, craft, piers or other instrumentalities of ocean or inland navigation; (D) "Credit insurance," which is insurance against loss or damage resulting from failure of debtors to pay their obligations to the insured; (E) "Elevator insurance," which is insurance against loss or damage to any property of the insured resulting from the ownership, maintenance or use of elevators, except loss or damage by fire, and to make inspection of and issue certificates of inspection on elevators; (F) "Glass insurance," which is insurance against loss of or damage to glass and its appurtenances resulting from any cause; (G) "Liability insurance," which is insurance against legal liability for the death, injury, or disability of any person, or for damage to property; and insurance of medical, hospital, surgical and funeral benefits to persons injured, regardless of legal liability of the insured, when issued as an incidental coverage with or supplemental to liability insurance; (H) "Livestock insurance," which is insurance against loss of or damage to any domesticated or wild animal resulting from any cause; (I) "Personal property floater," which is insurance of individuals, by an all-risk type of policy commonly known as the "personal property floater," against any and all kinds of loss of or damage to, or loss of use of, any personal property other than merchandise; (J) "Professional liability insurance," which is insurance against legal liability of the insured, and against loss, damage or expense incident to a claim of legal liability, and including any obligation of the insured to pay medical, hospital, surgical and funeral benefits to injured persons, regardless of legal liability of the insured, arising out of the death or injury of any person, or arising out of injury to the economic interest of any person as the result of negligence in rendering expert, fiduciary or professional service; (K) "Water insurance," which is insurance against loss of or damage to any property caused by the breakage or leakage of sprinklers, water pipes and other apparatus, or by water entering through leaks or openings in buildings, other than flood waters; (L) "Workers' compensation and employer's liability insurance," which is insurance of the obligations accepted by, imposed upon, or assumed by employers under law for death, disablement, or injury of employees; and (M) Insurance against any other kind of loss, damage, or liability properly the subject of insurance and not within any other kind or kinds of insurance as defined in this section, if the insurance is not disapproved by the commissioner as being contrary to law or public policy; (3) "Credit insurance" includes: (A) "Credit accident and health insurance," which means that form of insurance under which a borrower of money or a purchaser of goods is indemnified in connection with a specific loan or credit transaction against loss of time resulting from accident or sickness; and (B) "Credit life insurance," which means that form of insurance under which the life of a borrower of money or a purchaser of goods is insured in connection with a specified loan or credit transaction; (4) "Life insurance" means insurance on human lives and insurance appertaining to human lives or connected with human lives. For the purposes of this title, the transacting of life insurance includes the granting of annuities, both with and without a life or mortality contingency or element, and endowment benefits, additional benefits in the event of death by accident or accidental means, additional benefits in the event of the total and permanent disability of the insured, and optional modes of settlement of proceeds; (5) (A) "Property insurance" means insurance against loss of or damage to real or personal property of every kind and interest in the real or personal property, from any or all hazards or causes, and against loss consequential upon the loss or damage; (B) "Property insurance" includes, but is not limited to: (i) Insurance against loss or damage to property and loss of use and occupancy by fire, lightning, storm, flood, frost, freezing, snow, hail, ice, weather or climatic conditions, including excess or deficiency of moisture, rain or rising of the waters of the ocean or its tributaries, drought, insects, vermin, forces of nature, smoke, smudge, riot, riot attending strike, strikes, sabotage, civil commotion, vandalism or malicious mischief or caused by wrongful conversion, disposal or concealment of a motor vehicle or aircraft, whether or not handled under a conditional sales contract or subject to chattel mortgage, civil war, rebellion, insurrection, invasion, bombardment, military or usurped power, or by any order of civil authorities meant to prevent the spread of conflagration or epidemic or catastrophe, explosion with no fire ensuing, except explosion by steam boilers or flywheels, but there may be insured explosion of pressure vessels, not including steam boilers of more than fifteen pounds (15 lbs.) pressure, in buildings designed and used solely for residential purposes by not more than four (4) families, explosion of any kind originating outside the insured building, or outside the building containing the property insured, and explosion of pressure vessels that do not contain steam or that are not operated with steam coils or steam jackets; (ii) Insurance against loss or damage by insects or disease to farm crops or products, and loss of rental value of land used in producing the crops or products; (iii) Insurance against accidental injury to sprinklers, pumps, water pipes, elevator tanks and cylinders, steam pipes and radiators, plumbing and its fixtures, ventilating, refrigerating, heating, lighting or cooking apparatus, or their connections, or conduits or containers of any gas, fluid, or other substance, and against loss or damage to property of the insured caused by the breakage or leakage thereof, or by water, hail, rain, sleet or snow seeping or entering through water pipes, leaks or openings in buildings; (iv) Insurance against loss or damage caused by railroad equipment, motor vehicles, airplanes, seaplanes, dirigibles or other aircraft; (v) Insurance against loss of or damage to vessels, crafts, aircrafts, cars, automobiles and vehicles of every kind, as well as all goods, freights, cargoes, merchandise, effects, disbursements, profits, moneys, bullion, precious stones, securities, choses in action, evidence of debt, valuable papers, bottomry and respondentia interests therein, in respect to, appertaining to or in connection with, any and all risks or perils of navigation, transit, or transportation, including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed or similarly prepared for shipment or while awaiting the being assembled, packed, crated, baled, compressed or similarly prepared for shipment or during any delays, storage, transshipment incident thereto, including marine builder's risks and all personal property floater risks, and persons or property in connection with or appertaining to a marine, inland marine, transit or transportation insurance, including liability for loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance or use of the subject matter of the insurance, but not including life insurance or surety bonds, and precious stones, jewels, jewelry, gold, silver and other precious metals, whether used in business or trade, or otherwise, and whether in course of transportation or otherwise, and bridges, tunnels and other instrumentalities of transportation, and communication, excluding buildings, their furniture and furnishings, fixed contents and supplies held in storage, unless fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, are the only hazards to be covered, and piers, wharves, docks and ships, excluding the risks of fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, and other aids to navigation and transportation, including dry docks and marine railways, against all risks; (vi) "Marine protection and indemnity insurance," which means insurance against, or against legal liability of the insured for, loss, damage or expense arising out of, or incident to, the ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways, including liability of the insured for personal injury, illness or death or for loss of or damage to the property of another person; and (vii) Vehicle insurance; (C) Matters set out in subdivision (5)(B) are not deemed to limit the scope of property insurance as defined in subdivision (5)(A), nor shall the fact that certain coverages coming within the scope of property insurance, as defined in subdivision (5)(A), are also defined as part of another kind of insurance be deemed to limit the scope of the definition of property insurance or the right of a property insurer to provide the coverage; (6) "Surety insurance" includes: (A) Credit insurance; (B) "Fidelity insurance," which is insurance guaranteeing the fidelity of persons holding positions of public or private trust; (C) Guaranteeing the performance of contracts, and guaranteeing and executing bonds, undertakings, and contracts of suretyship; (D) Indemnifying banks, bankers, brokers, financial or moneyed corporations or associations or other persons against loss, resulting from any cause, of bills of exchange, notes, bonds, securities, evidences of debts, deeds, mortgages, warehouse receipts, or other valuable papers, documents, money, precious metals and articles made from precious metals, jewelry, watches, necklaces, bracelets, gems, precious and semiprecious stones, including any loss while the items are being transported in armored motor vehicles, or by messenger, but not including any other risks of transportation or navigation; also against loss or damage to the insured's premises, or to the insured furnishings, fixtures, equipment, safes and vaults in safes, caused by burglary, robbery, theft, vandalism or malicious mischief, or any attempt of burglary, robbery, theft, vandalism or malicious mischief; and (E) Insurance that guarantees the performance of any debt obligation of a public or private corporation; and (7) (A) "Vehicle insurance" means insurance against loss of or damage to any land vehicle or aircraft or any draft or riding animal or to property while contained therein or thereon, or being loaded or unloaded therein or therefrom, and against any loss, expense or liability for loss or damage to persons or property resulting from or incident to ownership, maintenance, or use of the vehicle or aircraft or animal; (B) Insurance against accidental death or accidental injury to individuals, including the named insured, while in, entering, alighting from, adjusting, repairing, cranking, or caused by being struck by a vehicle, aircraft, or draft or riding animal, if the insurance is issued as part of insurance on the vehicle, aircraft, or draft or riding animal, shall be deemed to be vehicle insurance. Acts 1951, ch. 212, § 1 (Williams, § 6107); T.C.A. (orig. ed.), § 56-306; Acts 1955, ch. 13, § 1; T.C.A. (orig. ed.), § 56-218; Acts 1984, ch. 582, § 1; 1986, ch. 504, § 1; 1988, ch. 948, § 1; 1994, ch. 888, § 1; 1995, ch. 221, § 1; 1996, ch. 780, § 1; 2008, ch. 831, § 14; 2012, ch. 798, § 17; 2013, ch. 409, § 2; 2016, ch. 724, § 1.
Kinds of insurance are defined as follows:
(1) "Accident and health insurance" means insurance against bodily injury, disablement or death, by accident or accidental means, or the expense of bodily injury, disablement or death, against disablement or expense resulting from sickness, and every insurance pertaining thereto; providing for the mental and emotional welfare of an individual and members of the individual's family by defraying the cost of legal services; or providing aggregate or excess stop-loss coverage in connection with employee welfare benefit plans, managed care organizations participating in commercial plans or the TennCare program, or both, health maintenance organizations, long-term care facilities, physician-hospital organizations as defined in § 56-32-102 and provider aggregate or per-patient stop-loss protection insurance coverage as authorized by § 56-32-104 ;
(2) "Casualty insurance" includes vehicle insurance, disability insurance, and in addition is: (A) "Boiler insurance," which is insurance against any liability and loss or damage to property resulting from accidents to or explosion of boilers, pipes, pressure containers, machinery, or apparatus, and to make inspection of and issue certificates of inspection upon boilers, machinery and apparatus of any kind, whether or not insured; (B) "Burglary and theft insurance," which is insurance against loss or damage by burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment, or from any attempt of burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment; also insurance against loss of or damage to moneys, coins, bullion, securities, notes, drafts, acceptances or any other valuable papers or documents, resulting from any cause, except while in the custody or possession of and being transported by any carrier for hire or in the mail; (C) "Collision insurance," which is insurance against loss of or damage to any property of the insured resulting from collision of any other object with the property, but not including collision to or by elevators, or to or by vessels, craft, piers or other instrumentalities of ocean or inland navigation; (D) "Credit insurance," which is insurance against loss or damage resulting from failure of debtors to pay their obligations to the insured; (E) "Elevator insurance," which is insurance against loss or damage to any property of the insured resulting from the ownership, maintenance or use of elevators, except loss or damage by fire, and to make inspection of and issue certificates of inspection on elevators; (F) "Glass insurance," which is insurance against loss of or damage to glass and its appurtenances resulting from any cause; (G) "Liability insurance," which is insurance against legal liability for the death, injury, or disability of any person, or for damage to property; and insurance of medical, hospital, surgical and funeral benefits to persons injured, regardless of legal liability of the insured, when issued as an incidental coverage with or supplemental to liability insurance; (H) "Livestock insurance," which is insurance against loss of or damage to any domesticated or wild animal resulting from any cause; (I) "Personal property floater," which is insurance of individuals, by an all-risk type of policy commonly known as the "personal property floater," against any and all kinds of loss of or damage to, or loss of use of, any personal property other than merchandise; (J) "Professional liability insurance," which is insurance against legal liability of the insured, and against loss, damage or expense incident to a claim of legal liability, and including any obligation of the insured to pay medical, hospital, surgical and funeral benefits to injured persons, regardless of legal liability of the insured, arising out of the death or injury of any person, or arising out of injury to the economic interest of any person as the result of negligence in rendering expert, fiduciary or professional service; (K) "Water insurance," which is insurance against loss of or damage to any property caused by the breakage or leakage of sprinklers, water pipes and other apparatus, or by water entering through leaks or openings in buildings, other than flood waters; (L) "Workers' compensation and employer's liability insurance," which is insurance of the obligations accepted by, imposed upon, or assumed by employers under law for death, disablement, or injury of employees; and (M) Insurance against any other kind of loss, damage, or liability properly the subject of insurance and not within any other kind or kinds of insurance as defined in this section, if the insurance is not disapproved by the commissioner as being contrary to law or public policy;
(A) "Boiler insurance," which is insurance against any liability and loss or damage to property resulting from accidents to or explosion of boilers, pipes, pressure containers, machinery, or apparatus, and to make inspection of and issue certificates of inspection upon boilers, machinery and apparatus of any kind, whether or not insured;
(B) "Burglary and theft insurance," which is insurance against loss or damage by burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment, or from any attempt of burglary, theft, larceny, robbery, forgery, fraud, vandalism, malicious mischief, confiscation or wrongful conversion, disposal or concealment; also insurance against loss of or damage to moneys, coins, bullion, securities, notes, drafts, acceptances or any other valuable papers or documents, resulting from any cause, except while in the custody or possession of and being transported by any carrier for hire or in the mail;
(C) "Collision insurance," which is insurance against loss of or damage to any property of the insured resulting from collision of any other object with the property, but not including collision to or by elevators, or to or by vessels, craft, piers or other instrumentalities of ocean or inland navigation;
(D) "Credit insurance," which is insurance against loss or damage resulting from failure of debtors to pay their obligations to the insured;
(E) "Elevator insurance," which is insurance against loss or damage to any property of the insured resulting from the ownership, maintenance or use of elevators, except loss or damage by fire, and to make inspection of and issue certificates of inspection on elevators;
(F) "Glass insurance," which is insurance against loss of or damage to glass and its appurtenances resulting from any cause;
(G) "Liability insurance," which is insurance against legal liability for the death, injury, or disability of any person, or for damage to property; and insurance of medical, hospital, surgical and funeral benefits to persons injured, regardless of legal liability of the insured, when issued as an incidental coverage with or supplemental to liability insurance;
(H) "Livestock insurance," which is insurance against loss of or damage to any domesticated or wild animal resulting from any cause;
(I) "Personal property floater," which is insurance of individuals, by an all-risk type of policy commonly known as the "personal property floater," against any and all kinds of loss of or damage to, or loss of use of, any personal property other than merchandise;
(J) "Professional liability insurance," which is insurance against legal liability of the insured, and against loss, damage or expense incident to a claim of legal liability, and including any obligation of the insured to pay medical, hospital, surgical and funeral benefits to injured persons, regardless of legal liability of the insured, arising out of the death or injury of any person, or arising out of injury to the economic interest of any person as the result of negligence in rendering expert, fiduciary or professional service;
(K) "Water insurance," which is insurance against loss of or damage to any property caused by the breakage or leakage of sprinklers, water pipes and other apparatus, or by water entering through leaks or openings in buildings, other than flood waters;
(L) "Workers' compensation and employer's liability insurance," which is insurance of the obligations accepted by, imposed upon, or assumed by employers under law for death, disablement, or injury of employees; and
(M) Insurance against any other kind of loss, damage, or liability properly the subject of insurance and not within any other kind or kinds of insurance as defined in this section, if the insurance is not disapproved by the commissioner as being contrary to law or public policy;
(3) "Credit insurance" includes: (A) "Credit accident and health insurance," which means that form of insurance under which a borrower of money or a purchaser of goods is indemnified in connection with a specific loan or credit transaction against loss of time resulting from accident or sickness; and (B) "Credit life insurance," which means that form of insurance under which the life of a borrower of money or a purchaser of goods is insured in connection with a specified loan or credit transaction;
(A) "Credit accident and health insurance," which means that form of insurance under which a borrower of money or a purchaser of goods is indemnified in connection with a specific loan or credit transaction against loss of time resulting from accident or sickness; and
(B) "Credit life insurance," which means that form of insurance under which the life of a borrower of money or a purchaser of goods is insured in connection with a specified loan or credit transaction;
(4) "Life insurance" means insurance on human lives and insurance appertaining to human lives or connected with human lives. For the purposes of this title, the transacting of life insurance includes the granting of annuities, both with and without a life or mortality contingency or element, and endowment benefits, additional benefits in the event of death by accident or accidental means, additional benefits in the event of the total and permanent disability of the insured, and optional modes of settlement of proceeds;
(5) (A) "Property insurance" means insurance against loss of or damage to real or personal property of every kind and interest in the real or personal property, from any or all hazards or causes, and against loss consequential upon the loss or damage; (B) "Property insurance" includes, but is not limited to: (i) Insurance against loss or damage to property and loss of use and occupancy by fire, lightning, storm, flood, frost, freezing, snow, hail, ice, weather or climatic conditions, including excess or deficiency of moisture, rain or rising of the waters of the ocean or its tributaries, drought, insects, vermin, forces of nature, smoke, smudge, riot, riot attending strike, strikes, sabotage, civil commotion, vandalism or malicious mischief or caused by wrongful conversion, disposal or concealment of a motor vehicle or aircraft, whether or not handled under a conditional sales contract or subject to chattel mortgage, civil war, rebellion, insurrection, invasion, bombardment, military or usurped power, or by any order of civil authorities meant to prevent the spread of conflagration or epidemic or catastrophe, explosion with no fire ensuing, except explosion by steam boilers or flywheels, but there may be insured explosion of pressure vessels, not including steam boilers of more than fifteen pounds (15 lbs.) pressure, in buildings designed and used solely for residential purposes by not more than four (4) families, explosion of any kind originating outside the insured building, or outside the building containing the property insured, and explosion of pressure vessels that do not contain steam or that are not operated with steam coils or steam jackets; (ii) Insurance against loss or damage by insects or disease to farm crops or products, and loss of rental value of land used in producing the crops or products; (iii) Insurance against accidental injury to sprinklers, pumps, water pipes, elevator tanks and cylinders, steam pipes and radiators, plumbing and its fixtures, ventilating, refrigerating, heating, lighting or cooking apparatus, or their connections, or conduits or containers of any gas, fluid, or other substance, and against loss or damage to property of the insured caused by the breakage or leakage thereof, or by water, hail, rain, sleet or snow seeping or entering through water pipes, leaks or openings in buildings; (iv) Insurance against loss or damage caused by railroad equipment, motor vehicles, airplanes, seaplanes, dirigibles or other aircraft; (v) Insurance against loss of or damage to vessels, crafts, aircrafts, cars, automobiles and vehicles of every kind, as well as all goods, freights, cargoes, merchandise, effects, disbursements, profits, moneys, bullion, precious stones, securities, choses in action, evidence of debt, valuable papers, bottomry and respondentia interests therein, in respect to, appertaining to or in connection with, any and all risks or perils of navigation, transit, or transportation, including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed or similarly prepared for shipment or while awaiting the being assembled, packed, crated, baled, compressed or similarly prepared for shipment or during any delays, storage, transshipment incident thereto, including marine builder's risks and all personal property floater risks, and persons or property in connection with or appertaining to a marine, inland marine, transit or transportation insurance, including liability for loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance or use of the subject matter of the insurance, but not including life insurance or surety bonds, and precious stones, jewels, jewelry, gold, silver and other precious metals, whether used in business or trade, or otherwise, and whether in course of transportation or otherwise, and bridges, tunnels and other instrumentalities of transportation, and communication, excluding buildings, their furniture and furnishings, fixed contents and supplies held in storage, unless fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, are the only hazards to be covered, and piers, wharves, docks and ships, excluding the risks of fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, and other aids to navigation and transportation, including dry docks and marine railways, against all risks; (vi) "Marine protection and indemnity insurance," which means insurance against, or against legal liability of the insured for, loss, damage or expense arising out of, or incident to, the ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways, including liability of the insured for personal injury, illness or death or for loss of or damage to the property of another person; and (vii) Vehicle insurance; (C) Matters set out in subdivision (5)(B) are not deemed to limit the scope of property insurance as defined in subdivision (5)(A), nor shall the fact that certain coverages coming within the scope of property insurance, as defined in subdivision (5)(A), are also defined as part of another kind of insurance be deemed to limit the scope of the definition of property insurance or the right of a property insurer to provide the coverage;
(A) "Property insurance" means insurance against loss of or damage to real or personal property of every kind and interest in the real or personal property, from any or all hazards or causes, and against loss consequential upon the loss or damage;
(B) "Property insurance" includes, but is not limited to: (i) Insurance against loss or damage to property and loss of use and occupancy by fire, lightning, storm, flood, frost, freezing, snow, hail, ice, weather or climatic conditions, including excess or deficiency of moisture, rain or rising of the waters of the ocean or its tributaries, drought, insects, vermin, forces of nature, smoke, smudge, riot, riot attending strike, strikes, sabotage, civil commotion, vandalism or malicious mischief or caused by wrongful conversion, disposal or concealment of a motor vehicle or aircraft, whether or not handled under a conditional sales contract or subject to chattel mortgage, civil war, rebellion, insurrection, invasion, bombardment, military or usurped power, or by any order of civil authorities meant to prevent the spread of conflagration or epidemic or catastrophe, explosion with no fire ensuing, except explosion by steam boilers or flywheels, but there may be insured explosion of pressure vessels, not including steam boilers of more than fifteen pounds (15 lbs.) pressure, in buildings designed and used solely for residential purposes by not more than four (4) families, explosion of any kind originating outside the insured building, or outside the building containing the property insured, and explosion of pressure vessels that do not contain steam or that are not operated with steam coils or steam jackets; (ii) Insurance against loss or damage by insects or disease to farm crops or products, and loss of rental value of land used in producing the crops or products; (iii) Insurance against accidental injury to sprinklers, pumps, water pipes, elevator tanks and cylinders, steam pipes and radiators, plumbing and its fixtures, ventilating, refrigerating, heating, lighting or cooking apparatus, or their connections, or conduits or containers of any gas, fluid, or other substance, and against loss or damage to property of the insured caused by the breakage or leakage thereof, or by water, hail, rain, sleet or snow seeping or entering through water pipes, leaks or openings in buildings; (iv) Insurance against loss or damage caused by railroad equipment, motor vehicles, airplanes, seaplanes, dirigibles or other aircraft; (v) Insurance against loss of or damage to vessels, crafts, aircrafts, cars, automobiles and vehicles of every kind, as well as all goods, freights, cargoes, merchandise, effects, disbursements, profits, moneys, bullion, precious stones, securities, choses in action, evidence of debt, valuable papers, bottomry and respondentia interests therein, in respect to, appertaining to or in connection with, any and all risks or perils of navigation, transit, or transportation, including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed or similarly prepared for shipment or while awaiting the being assembled, packed, crated, baled, compressed or similarly prepared for shipment or during any delays, storage, transshipment incident thereto, including marine builder's risks and all personal property floater risks, and persons or property in connection with or appertaining to a marine, inland marine, transit or transportation insurance, including liability for loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance or use of the subject matter of the insurance, but not including life insurance or surety bonds, and precious stones, jewels, jewelry, gold, silver and other precious metals, whether used in business or trade, or otherwise, and whether in course of transportation or otherwise, and bridges, tunnels and other instrumentalities of transportation, and communication, excluding buildings, their furniture and furnishings, fixed contents and supplies held in storage, unless fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, are the only hazards to be covered, and piers, wharves, docks and ships, excluding the risks of fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, and other aids to navigation and transportation, including dry docks and marine railways, against all risks; (vi) "Marine protection and indemnity insurance," which means insurance against, or against legal liability of the insured for, loss, damage or expense arising out of, or incident to, the ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways, including liability of the insured for personal injury, illness or death or for loss of or damage to the property of another person; and (vii) Vehicle insurance;
(i) Insurance against loss or damage to property and loss of use and occupancy by fire, lightning, storm, flood, frost, freezing, snow, hail, ice, weather or climatic conditions, including excess or deficiency of moisture, rain or rising of the waters of the ocean or its tributaries, drought, insects, vermin, forces of nature, smoke, smudge, riot, riot attending strike, strikes, sabotage, civil commotion, vandalism or malicious mischief or caused by wrongful conversion, disposal or concealment of a motor vehicle or aircraft, whether or not handled under a conditional sales contract or subject to chattel mortgage, civil war, rebellion, insurrection, invasion, bombardment, military or usurped power, or by any order of civil authorities meant to prevent the spread of conflagration or epidemic or catastrophe, explosion with no fire ensuing, except explosion by steam boilers or flywheels, but there may be insured explosion of pressure vessels, not including steam boilers of more than fifteen pounds (15 lbs.) pressure, in buildings designed and used solely for residential purposes by not more than four (4) families, explosion of any kind originating outside the insured building, or outside the building containing the property insured, and explosion of pressure vessels that do not contain steam or that are not operated with steam coils or steam jackets;
(ii) Insurance against loss or damage by insects or disease to farm crops or products, and loss of rental value of land used in producing the crops or products;
(iii) Insurance against accidental injury to sprinklers, pumps, water pipes, elevator tanks and cylinders, steam pipes and radiators, plumbing and its fixtures, ventilating, refrigerating, heating, lighting or cooking apparatus, or their connections, or conduits or containers of any gas, fluid, or other substance, and against loss or damage to property of the insured caused by the breakage or leakage thereof, or by water, hail, rain, sleet or snow seeping or entering through water pipes, leaks or openings in buildings;
(iv) Insurance against loss or damage caused by railroad equipment, motor vehicles, airplanes, seaplanes, dirigibles or other aircraft;
(v) Insurance against loss of or damage to vessels, crafts, aircrafts, cars, automobiles and vehicles of every kind, as well as all goods, freights, cargoes, merchandise, effects, disbursements, profits, moneys, bullion, precious stones, securities, choses in action, evidence of debt, valuable papers, bottomry and respondentia interests therein, in respect to, appertaining to or in connection with, any and all risks or perils of navigation, transit, or transportation, including war risks, on or under any seas or other waters, on land or in the air, or while being assembled, packed, crated, baled, compressed or similarly prepared for shipment or while awaiting the being assembled, packed, crated, baled, compressed or similarly prepared for shipment or during any delays, storage, transshipment incident thereto, including marine builder's risks and all personal property floater risks, and persons or property in connection with or appertaining to a marine, inland marine, transit or transportation insurance, including liability for loss of or damage to either, arising out of or in connection with the construction, repair, operation, maintenance or use of the subject matter of the insurance, but not including life insurance or surety bonds, and precious stones, jewels, jewelry, gold, silver and other precious metals, whether used in business or trade, or otherwise, and whether in course of transportation or otherwise, and bridges, tunnels and other instrumentalities of transportation, and communication, excluding buildings, their furniture and furnishings, fixed contents and supplies held in storage, unless fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, are the only hazards to be covered, and piers, wharves, docks and ships, excluding the risks of fire, tornado, sprinkler leakage, hail, explosion, earthquake, riot and/or civil commotion, and other aids to navigation and transportation, including dry docks and marine railways, against all risks;
(vi) "Marine protection and indemnity insurance," which means insurance against, or against legal liability of the insured for, loss, damage or expense arising out of, or incident to, the ownership, operation, chartering, maintenance, use, repair or construction of any vessel, craft or instrumentality in use in ocean or inland waterways, including liability of the insured for personal injury, illness or death or for loss of or damage to the property of another person; and
(vii) Vehicle insurance;
(C) Matters set out in subdivision (5)(B) are not deemed to limit the scope of property insurance as defined in subdivision (5)(A), nor shall the fact that certain coverages coming within the scope of property insurance, as defined in subdivision (5)(A), are also defined as part of another kind of insurance be deemed to limit the scope of the definition of property insurance or the right of a property insurer to provide the coverage;
(6) "Surety insurance" includes: (A) Credit insurance; (B) "Fidelity insurance," which is insurance guaranteeing the fidelity of persons holding positions of public or private trust; (C) Guaranteeing the performance of contracts, and guaranteeing and executing bonds, undertakings, and contracts of suretyship; (D) Indemnifying banks, bankers, brokers, financial or moneyed corporations or associations or other persons against loss, resulting from any cause, of bills of exchange, notes, bonds, securities, evidences of debts, deeds, mortgages, warehouse receipts, or other valuable papers, documents, money, precious metals and articles made from precious metals, jewelry, watches, necklaces, bracelets, gems, precious and semiprecious stones, including any loss while the items are being transported in armored motor vehicles, or by messenger, but not including any other risks of transportation or navigation; also against loss or damage to the insured's premises, or to the insured furnishings, fixtures, equipment, safes and vaults in safes, caused by burglary, robbery, theft, vandalism or malicious mischief, or any attempt of burglary, robbery, theft, vandalism or malicious mischief; and (E) Insurance that guarantees the performance of any debt obligation of a public or private corporation; and
(A) Credit insurance;
(B) "Fidelity insurance," which is insurance guaranteeing the fidelity of persons holding positions of public or private trust;
(C) Guaranteeing the performance of contracts, and guaranteeing and executing bonds, undertakings, and contracts of suretyship;
(D) Indemnifying banks, bankers, brokers, financial or moneyed corporations or associations or other persons against loss, resulting from any cause, of bills of exchange, notes, bonds, securities, evidences of debts, deeds, mortgages, warehouse receipts, or other valuable papers, documents, money, precious metals and articles made from precious metals, jewelry, watches, necklaces, bracelets, gems, precious and semiprecious stones, including any loss while the items are being transported in armored motor vehicles, or by messenger, but not including any other risks of transportation or navigation; also against loss or damage to the insured's premises, or to the insured furnishings, fixtures, equipment, safes and vaults in safes, caused by burglary, robbery, theft, vandalism or malicious mischief, or any attempt of burglary, robbery, theft, vandalism or malicious mischief; and
(E) Insurance that guarantees the performance of any debt obligation of a public or private corporation; and
(7) (A) "Vehicle insurance" means insurance against loss of or damage to any land vehicle or aircraft or any draft or riding animal or to property while contained therein or thereon, or being loaded or unloaded therein or therefrom, and against any loss, expense or liability for loss or damage to persons or property resulting from or incident to ownership, maintenance, or use of the vehicle or aircraft or animal; (B) Insurance against accidental death or accidental injury to individuals, including the named insured, while in, entering, alighting from, adjusting, repairing, cranking, or caused by being struck by a vehicle, aircraft, or draft or riding animal, if the insurance is issued as part of insurance on the vehicle, aircraft, or draft or riding animal, shall be deemed to be vehicle insurance.
(A) "Vehicle insurance" means insurance against loss of or damage to any land vehicle or aircraft or any draft or riding animal or to property while contained therein or thereon, or being loaded or unloaded therein or therefrom, and against any loss, expense or liability for loss or damage to persons or property resulting from or incident to ownership, maintenance, or use of the vehicle or aircraft or animal;
(B) Insurance against accidental death or accidental injury to individuals, including the named insured, while in, entering, alighting from, adjusting, repairing, cranking, or caused by being struck by a vehicle, aircraft, or draft or riding animal, if the insurance is issued as part of insurance on the vehicle, aircraft, or draft or riding animal, shall be deemed to be vehicle insurance.
Acts 1951, ch. 212, § 1 (Williams, § 6107); T.C.A. (orig. ed.), § 56-306; Acts 1955, ch. 13, § 1; T.C.A. (orig. ed.), § 56-218; Acts 1984, ch. 582, § 1; 1986, ch. 504, § 1; 1988, ch. 948, § 1; 1994, ch. 888, § 1; 1995, ch. 221, § 1; 1996, ch. 780, § 1; 2008, ch. 831, § 14; 2012, ch. 798, § 17; 2013, ch. 409, § 2; 2016, ch. 724, § 1.
Tenn. Code Ann. § 56-13-117 — TN Code / Title 56 / Chapter 13 / Section 56-13-117
Establishment of standards regarding risk management
Status: in_force

The commissioner may adopt rules establishing standards to ensure that a parent or its affiliated company, or an industrial insured or its affiliated company, is able to exercise control of the risk management function of any controlled unaffiliated business to be insured by a pure captive insurance company or an industrial insured captive insurance company, respectively; provided, however, that, until such time as rules under this section are adopted, the commissioner may approve the coverage of such risks by a pure captive insurance company or an industrial insured captive insurance company. Acts 2011, ch. 468, § 1.
The commissioner may adopt rules establishing standards to ensure that a parent or its affiliated company, or an industrial insured or its affiliated company, is able to exercise control of the risk management function of any controlled unaffiliated business to be insured by a pure captive insurance company or an industrial insured captive insurance company, respectively; provided, however, that, until such time as rules under this section are adopted, the commissioner may approve the coverage of such risks by a pure captive insurance company or an industrial insured captive insurance company.
Acts 2011, ch. 468, § 1.
Tenn. Code Ann. § 56-9-303 — TN Code / Title 56 / Chapter 9 / Section 56-9-303
Rehabilitator - Duties and authority
Status: in_force

(a) The commissioner as rehabilitator may appoint one (1) or more special deputies, who have all the powers and responsibilities of the rehabilitator granted under this section, and the commissioner may employ such counsel, clerks and assistants as deemed necessary. The compensation of the special deputy, counsel, clerks and assistants, and all expenses of taking possession of the insurer and of conducting the proceedings, shall be fixed by the commissioner, with the approval of the court, and shall be paid out of the funds or assets of the insurer. The persons appointed under this section shall serve at the pleasure of the commissioner. The commissioner, as rehabilitator, may, with the approval of the court, appoint an advisory committee of policyholders, claimants, or other creditors, including guaranty associations, should such a committee be deemed necessary. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in rehabilitation proceedings conducted under this chapter. (b) In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the costs so incurred out of any appropriation for the maintenance of the department. Any amounts so advanced for expenses of administration shall be repaid to the commissioner for the use of the department out of the first available moneys of the insurer. (c) The rehabilitator may take any action the rehabilitator deems necessary or appropriate to reform and revitalize the insurer. The rehabilitator has all the powers of the directors, officers, and managers, whose authority shall be suspended, except as they are redelegated by the rehabilitator. The rehabilitator has full power to direct and manage, to hire and discharge employees subject to any contract rights they may have, and to deal with the property and business of the insurer. (d) If it appears to the rehabilitator that there has been criminal or tortious conduct, or breach of any contractual or fiduciary obligation detrimental to the insurer by any officer, manager, agent, broker, employee or other person, the rehabilitator may pursue all appropriate legal remedies on behalf of the insurer. (e) If the rehabilitator determines that reorganization, consolidation, conversion, reinsurance, merger or other transformation of the insurer is appropriate, the rehabilitator shall prepare a plan to effect the changes. Upon application of the rehabilitator for approval of the plan, and after the notice and hearings as the court may prescribe, the court may either approve or disapprove the plan proposed, or may modify it and approve it as modified. Any plan approved under this section shall be, in the judgment of the court, fair and equitable to all parties concerned. If the plan is approved, the rehabilitator shall carry out the plan. In the case of a life insurer, the plan proposed may include the imposition of liens upon the policies of the company, if all rights of shareholders are first relinquished. A plan for a life insurer may also propose imposition of a moratorium upon loan and cash surrender rights under policies, for such period and to such an extent as may be necessary. (f) The rehabilitator has the power under §§ 56-9-315 and 56-9-316 to avoid fraudulent transfers. Acts 1991, ch. 142, § 4.
(a) The commissioner as rehabilitator may appoint one (1) or more special deputies, who have all the powers and responsibilities of the rehabilitator granted under this section, and the commissioner may employ such counsel, clerks and assistants as deemed necessary. The compensation of the special deputy, counsel, clerks and assistants, and all expenses of taking possession of the insurer and of conducting the proceedings, shall be fixed by the commissioner, with the approval of the court, and shall be paid out of the funds or assets of the insurer. The persons appointed under this section shall serve at the pleasure of the commissioner. The commissioner, as rehabilitator, may, with the approval of the court, appoint an advisory committee of policyholders, claimants, or other creditors, including guaranty associations, should such a committee be deemed necessary. The committee shall serve at the pleasure of the commissioner and shall serve without compensation other than reimbursement for reasonable travel and per diem living expenses. No other committee of any nature shall be appointed by the commissioner or the court in rehabilitation proceedings conducted under this chapter.
(b) In the event that the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the commissioner may advance the costs so incurred out of any appropriation for the maintenance of the department. Any amounts so advanced for expenses of administration shall be repaid to the commissioner for the use of the department out of the first available moneys of the insurer.
(c) The rehabilitator may take any action the rehabilitator deems necessary or appropriate to reform and revitalize the insurer. The rehabilitator has all the powers of the directors, officers, and managers, whose authority shall be suspended, except as they are redelegated by the rehabilitator. The rehabilitator has full power to direct and manage, to hire and discharge employees subject to any contract rights they may have, and to deal with the property and business of the insurer.
(d) If it appears to the rehabilitator that there has been criminal or tortious conduct, or breach of any contractual or fiduciary obligation detrimental to the insurer by any officer, manager, agent, broker, employee or other person, the rehabilitator may pursue all appropriate legal remedies on behalf of the insurer.
(e) If the rehabilitator determines that reorganization, consolidation, conversion, reinsurance, merger or other transformation of the insurer is appropriate, the rehabilitator shall prepare a plan to effect the changes. Upon application of the rehabilitator for approval of the plan, and after the notice and hearings as the court may prescribe, the court may either approve or disapprove the plan proposed, or may modify it and approve it as modified. Any plan approved under this section shall be, in the judgment of the court, fair and equitable to all parties concerned. If the plan is approved, the rehabilitator shall carry out the plan. In the case of a life insurer, the plan proposed may include the imposition of liens upon the policies of the company, if all rights of shareholders are first relinquished. A plan for a life insurer may also propose imposition of a moratorium upon loan and cash surrender rights under policies, for such period and to such an extent as may be necessary.
(f) The rehabilitator has the power under §§ 56-9-315 and 56-9-316 to avoid fraudulent transfers.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-19-123 — TN Code / Title 56 / Chapter 19 / Section 56-19-123
Violation of chapter - Penalty - Revocation of license
Status: in_force

Any person or corporation violating this chapter commits a Class C misdemeanor, and the commissioner has the power to revoke the license of any such person or corporation. Acts 1919, ch. 108, § 21; Shan. Supp., § 3369a58b28; Code 1932, § 6340; T.C.A. (orig. ed.), § 56-1723; Acts 1989, ch. 591, § 113.
Any person or corporation violating this chapter commits a Class C misdemeanor, and the commissioner has the power to revoke the license of any such person or corporation.
Acts 1919, ch. 108, § 21; Shan. Supp., § 3369a58b28; Code 1932, § 6340; T.C.A. (orig. ed.), § 56-1723; Acts 1989, ch. 591, § 113.
Tenn. Code Ann. § 56-32-130 — TN Code / Title 56 / Chapter 32 / Section 56-32-130
Prohibited retaliatory action
Status: in_force

(a) A managed health insurance issuer shall not terminate or nonrenew a contract with a health care provider, or take other retaliatory action against a health care provider, because the provider: (1) Communicated with an enrollee with respect to the enrollee's health status, health care or treatment options, if the health care provider is acting in good faith and within the provider's scope of practice as defined by law; (2) Disclosed accurate information about whether a health care service or treatment is covered by an enrollee's health coverage plan; or (3) Expressed personal disagreement with the decision made by the managed health insurance issuer regarding treatment or coverage provided to a patient of the provider, or assisted the enrollee in pursuing the grievance process relative to the decision of the managed health insurance issuer; provided, the health care provider makes it clear that the provider is acting in a personal capacity, and not as a representative of, or on behalf of, the managed health insurance issuer. (b) Nothing in this section shall prohibit: (1) A managed health insurance issuer from taking action against a provider if the health plan has evidence that the provider's actions are illegal, constitute health care liability or are contrary to accepted medical practices; (2) A contract provision or directive that requires any contracting party to keep confidential or to not use or disclose specific amounts paid to a provider, provider fee schedules, provider salaries and other proprietary information of a specific contract issued by a managed health insurance issuer; or (3) A managed health insurance issuer from making a determination not to pay for a particular medical treatment or service or to enforce reasonable peer review or utilization review protocols. (c) Nothing in this section shall be construed as permitting retaliatory action by a managed health insurance issuer against a provider because the provider disclosed to the patient accurate information regarding the basis of the provider reimbursement. (d) This section shall not be construed to create a cause of action or remedy that would not exist in the absence of this section, except for the purposes of enforcing the prohibitions set forth in this section. (e) (1) A managed health insurance issuer shall develop and implement procedures to ensure that health care providers are regularly informed of information maintained by the issuer to evaluate the performance or practice of the health care provider. The issuer shall consult with health care professionals in developing methodologies to collect the health care provider's profiling, tiering, comparison, or ratings data, which may include, but is not limited to, claims data. For those issuers that publicize or otherwise make known to participating providers or their members the results of the provider's performance, the managed health insurance issuer shall, sixty (60) days prior to the public publishing of provider-specific information such as profiling, tiering, performance comparison, including, but not limited to, pay for performance programs or ratings data, do all of the following: (A) Make available to the provider all methodologies, quality measures, data, analysis, and conclusions, ratings relied upon by the issuer and the degree to which each is relied upon by the issuer and allow the provider a reasonable opportunity to review and provide additional data or medical records and comments on the information proposed to be published by the issuer regarding the individual provider's profiling, tiering, comparison, or ratings; (B) Should a provider submit additional data or medical records or comments under this subsection (e), that submission shall be made within thirty (30) days of the receipt of notice that the issuer will publish the information. If a provider submits additional data or medical records or comments on the information proposed to be published by the issuer, and the issuer elects to alter the provider's profiling, tiering, comparison, or ratings in accordance with and pursuant to the additional data or medical records and comments, then the issuers shall accordingly modify the provider's profiling, tiering, comparison or ratings prior to public publication of provider-specific information; (C) The issuer shall provide with the publication of the provider performance rating information a prominently displayed disclosure of the data sources used to develop the rating information, an explanation of the limitations of data derived from these sources, and an explanation of the specific aspects or domains of provider performance that were measured to derive the ratings; and (D) Whenever the issuer periodically updates any data results or findings publicized pursuant to this section, and to the extent those updates result in a lower rating of the provider's performance rating, the issuer shall repeat the requirements established by subdivisions (e)(1)(A)-(C). (2) Notwithstanding any law, contract or other legal standard to the contrary, upon satisfying and complying with the requirements of this subsection (e), the issuer may publicize the results of a provider's performance rating in the manner and frequency that the issuer deems appropriate. Acts 1998, ch. 1033, §10; 2007 , ch. 406, § 1; T.C.A. §56-32-230; Acts 2012 , ch. 798, § 26.
(a) A managed health insurance issuer shall not terminate or nonrenew a contract with a health care provider, or take other retaliatory action against a health care provider, because the provider: (1) Communicated with an enrollee with respect to the enrollee's health status, health care or treatment options, if the health care provider is acting in good faith and within the provider's scope of practice as defined by law; (2) Disclosed accurate information about whether a health care service or treatment is covered by an enrollee's health coverage plan; or (3) Expressed personal disagreement with the decision made by the managed health insurance issuer regarding treatment or coverage provided to a patient of the provider, or assisted the enrollee in pursuing the grievance process relative to the decision of the managed health insurance issuer; provided, the health care provider makes it clear that the provider is acting in a personal capacity, and not as a representative of, or on behalf of, the managed health insurance issuer.
(1) Communicated with an enrollee with respect to the enrollee's health status, health care or treatment options, if the health care provider is acting in good faith and within the provider's scope of practice as defined by law;
(2) Disclosed accurate information about whether a health care service or treatment is covered by an enrollee's health coverage plan; or
(3) Expressed personal disagreement with the decision made by the managed health insurance issuer regarding treatment or coverage provided to a patient of the provider, or assisted the enrollee in pursuing the grievance process relative to the decision of the managed health insurance issuer; provided, the health care provider makes it clear that the provider is acting in a personal capacity, and not as a representative of, or on behalf of, the managed health insurance issuer.
(b) Nothing in this section shall prohibit: (1) A managed health insurance issuer from taking action against a provider if the health plan has evidence that the provider's actions are illegal, constitute health care liability or are contrary to accepted medical practices; (2) A contract provision or directive that requires any contracting party to keep confidential or to not use or disclose specific amounts paid to a provider, provider fee schedules, provider salaries and other proprietary information of a specific contract issued by a managed health insurance issuer; or (3) A managed health insurance issuer from making a determination not to pay for a particular medical treatment or service or to enforce reasonable peer review or utilization review protocols.
(1) A managed health insurance issuer from taking action against a provider if the health plan has evidence that the provider's actions are illegal, constitute health care liability or are contrary to accepted medical practices;
(2) A contract provision or directive that requires any contracting party to keep confidential or to not use or disclose specific amounts paid to a provider, provider fee schedules, provider salaries and other proprietary information of a specific contract issued by a managed health insurance issuer; or
(3) A managed health insurance issuer from making a determination not to pay for a particular medical treatment or service or to enforce reasonable peer review or utilization review protocols.
(c) Nothing in this section shall be construed as permitting retaliatory action by a managed health insurance issuer against a provider because the provider disclosed to the patient accurate information regarding the basis of the provider reimbursement.
(d) This section shall not be construed to create a cause of action or remedy that would not exist in the absence of this section, except for the purposes of enforcing the prohibitions set forth in this section.
(e) (1) A managed health insurance issuer shall develop and implement procedures to ensure that health care providers are regularly informed of information maintained by the issuer to evaluate the performance or practice of the health care provider. The issuer shall consult with health care professionals in developing methodologies to collect the health care provider's profiling, tiering, comparison, or ratings data, which may include, but is not limited to, claims data. For those issuers that publicize or otherwise make known to participating providers or their members the results of the provider's performance, the managed health insurance issuer shall, sixty (60) days prior to the public publishing of provider-specific information such as profiling, tiering, performance comparison, including, but not limited to, pay for performance programs or ratings data, do all of the following: (A) Make available to the provider all methodologies, quality measures, data, analysis, and conclusions, ratings relied upon by the issuer and the degree to which each is relied upon by the issuer and allow the provider a reasonable opportunity to review and provide additional data or medical records and comments on the information proposed to be published by the issuer regarding the individual provider's profiling, tiering, comparison, or ratings; (B) Should a provider submit additional data or medical records or comments under this subsection (e), that submission shall be made within thirty (30) days of the receipt of notice that the issuer will publish the information. If a provider submits additional data or medical records or comments on the information proposed to be published by the issuer, and the issuer elects to alter the provider's profiling, tiering, comparison, or ratings in accordance with and pursuant to the additional data or medical records and comments, then the issuers shall accordingly modify the provider's profiling, tiering, comparison or ratings prior to public publication of provider-specific information; (C) The issuer shall provide with the publication of the provider performance rating information a prominently displayed disclosure of the data sources used to develop the rating information, an explanation of the limitations of data derived from these sources, and an explanation of the specific aspects or domains of provider performance that were measured to derive the ratings; and (D) Whenever the issuer periodically updates any data results or findings publicized pursuant to this section, and to the extent those updates result in a lower rating of the provider's performance rating, the issuer shall repeat the requirements established by subdivisions (e)(1)(A)-(C). (2) Notwithstanding any law, contract or other legal standard to the contrary, upon satisfying and complying with the requirements of this subsection (e), the issuer may publicize the results of a provider's performance rating in the manner and frequency that the issuer deems appropriate.
(1) A managed health insurance issuer shall develop and implement procedures to ensure that health care providers are regularly informed of information maintained by the issuer to evaluate the performance or practice of the health care provider. The issuer shall consult with health care professionals in developing methodologies to collect the health care provider's profiling, tiering, comparison, or ratings data, which may include, but is not limited to, claims data. For those issuers that publicize or otherwise make known to participating providers or their members the results of the provider's performance, the managed health insurance issuer shall, sixty (60) days prior to the public publishing of provider-specific information such as profiling, tiering, performance comparison, including, but not limited to, pay for performance programs or ratings data, do all of the following: (A) Make available to the provider all methodologies, quality measures, data, analysis, and conclusions, ratings relied upon by the issuer and the degree to which each is relied upon by the issuer and allow the provider a reasonable opportunity to review and provide additional data or medical records and comments on the information proposed to be published by the issuer regarding the individual provider's profiling, tiering, comparison, or ratings; (B) Should a provider submit additional data or medical records or comments under this subsection (e), that submission shall be made within thirty (30) days of the receipt of notice that the issuer will publish the information. If a provider submits additional data or medical records or comments on the information proposed to be published by the issuer, and the issuer elects to alter the provider's profiling, tiering, comparison, or ratings in accordance with and pursuant to the additional data or medical records and comments, then the issuers shall accordingly modify the provider's profiling, tiering, comparison or ratings prior to public publication of provider-specific information; (C) The issuer shall provide with the publication of the provider performance rating information a prominently displayed disclosure of the data sources used to develop the rating information, an explanation of the limitations of data derived from these sources, and an explanation of the specific aspects or domains of provider performance that were measured to derive the ratings; and (D) Whenever the issuer periodically updates any data results or findings publicized pursuant to this section, and to the extent those updates result in a lower rating of the provider's performance rating, the issuer shall repeat the requirements established by subdivisions (e)(1)(A)-(C).
(A) Make available to the provider all methodologies, quality measures, data, analysis, and conclusions, ratings relied upon by the issuer and the degree to which each is relied upon by the issuer and allow the provider a reasonable opportunity to review and provide additional data or medical records and comments on the information proposed to be published by the issuer regarding the individual provider's profiling, tiering, comparison, or ratings;
(B) Should a provider submit additional data or medical records or comments under this subsection (e), that submission shall be made within thirty (30) days of the receipt of notice that the issuer will publish the information. If a provider submits additional data or medical records or comments on the information proposed to be published by the issuer, and the issuer elects to alter the provider's profiling, tiering, comparison, or ratings in accordance with and pursuant to the additional data or medical records and comments, then the issuers shall accordingly modify the provider's profiling, tiering, comparison or ratings prior to public publication of provider-specific information;
(C) The issuer shall provide with the publication of the provider performance rating information a prominently displayed disclosure of the data sources used to develop the rating information, an explanation of the limitations of data derived from these sources, and an explanation of the specific aspects or domains of provider performance that were measured to derive the ratings; and
(D) Whenever the issuer periodically updates any data results or findings publicized pursuant to this section, and to the extent those updates result in a lower rating of the provider's performance rating, the issuer shall repeat the requirements established by subdivisions (e)(1)(A)-(C).
(2) Notwithstanding any law, contract or other legal standard to the contrary, upon satisfying and complying with the requirements of this subsection (e), the issuer may publicize the results of a provider's performance rating in the manner and frequency that the issuer deems appropriate.
Acts 1998, ch. 1033, §10; 2007 , ch. 406, § 1; T.C.A. §56-32-230; Acts 2012 , ch. 798, § 26.
Tenn. Code Ann. § 56-1-910 — TN Code / Title 56 / Chapter 1 / Section 56-1-910
Optional reserve calculation
Status: in_force

(a) Reserves for policies and contracts issued prior to March 13, 1978, may be calculated, at the option of the company, according to any standards that produce greater aggregate reserves for all such policies and contracts than the minimum reserves required by the laws in effect immediately prior to March 13, 1978. (b) Reserves for any category of policies, contracts or benefits established by the commissioner, issued on or after March 13, 1978, may be calculated, at the option of the company, according to any standards that produce greater aggregate reserves for the category than those calculated according to the minimum standard provided in this part, but the rate or rates of interest used for policies and contracts, other than annuity and pure endowment contracts, shall not be greater than the corresponding rate or rates of interest used in calculating any nonforfeiture benefits provided in the policies or contracts. (c) A company, which adopts at any time a standard of valuation producing greater aggregate reserves than those calculated according to the minimum standard provided under this part may adopt a lower standard of valuation with the approval of the commissioner, but not lower than the minimum provided herein; provided that, for the purposes of this section, the holding of additional reserves previously determined by the appointed actuary to be necessary to render the opinion required by § 56-1-903 shall not be deemed to be the adoption of a higher standard of valuation. Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
(a) Reserves for policies and contracts issued prior to March 13, 1978, may be calculated, at the option of the company, according to any standards that produce greater aggregate reserves for all such policies and contracts than the minimum reserves required by the laws in effect immediately prior to March 13, 1978.
(b) Reserves for any category of policies, contracts or benefits established by the commissioner, issued on or after March 13, 1978, may be calculated, at the option of the company, according to any standards that produce greater aggregate reserves for the category than those calculated according to the minimum standard provided in this part, but the rate or rates of interest used for policies and contracts, other than annuity and pure endowment contracts, shall not be greater than the corresponding rate or rates of interest used in calculating any nonforfeiture benefits provided in the policies or contracts.
(c) A company, which adopts at any time a standard of valuation producing greater aggregate reserves than those calculated according to the minimum standard provided under this part may adopt a lower standard of valuation with the approval of the commissioner, but not lower than the minimum provided herein; provided that, for the purposes of this section, the holding of additional reserves previously determined by the appointed actuary to be necessary to render the opinion required by § 56-1-903 shall not be deemed to be the adoption of a higher standard of valuation.
Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Tenn. Code Ann. § 56-31-119 — TN Code / Title 56 / Chapter 31 / Section 56-31-119
License renewal - Agent's certificate of authority
Status: in_force

All licenses authorizing vision service plan corporations to transact business in this state shall be renewable on April 1 of each year, subject to the approval of the commissioner. The vision service plan corporations licensed to do business in this state under this chapter shall obtain from the commissioner a certificate of authority for every agent writing or soliciting vision service plan contracts for the corporation in this state, and the certificate shall be renewable January 1 of each year, subject to applicable sections of the insurance laws, including the revenue law of this state for life and health and accident insurance agents. Acts 1969, ch. 118, § 20; T.C.A., § 56-3719.
All licenses authorizing vision service plan corporations to transact business in this state shall be renewable on April 1 of each year, subject to the approval of the commissioner. The vision service plan corporations licensed to do business in this state under this chapter shall obtain from the commissioner a certificate of authority for every agent writing or soliciting vision service plan contracts for the corporation in this state, and the certificate shall be renewable January 1 of each year, subject to applicable sections of the insurance laws, including the revenue law of this state for life and health and accident insurance agents.
Acts 1969, ch. 118, § 20; T.C.A., § 56-3719.
Tenn. Code Ann. § 56-7-115 — TN Code / Title 56 / Chapter 7 / Section 56-7-115
Medical health care liability insurance - Availability for all classifications of practice
Status: in_force

(a) All insurance companies issuing health care liability insurance policies to physicians licensed to practice medicine in this state shall issue policies covering physicians of all classifications of practice; provided, that this subsection (a) shall not be construed to require the issuance of a policy contrary to established underwriting practices. (b) This section shall not be construed to prevent an insurance company issuing health care liability insurance policies to physicians licensed in the state from limiting the amount of the coverage of the policies or from making a premium surcharge for the insurance in accordance with established underwriting practices. Acts 1979, ch. 161, §§ 1, 2; T.C.A., § 56-1178; Acts 2012, ch. 798, § 20.
(a) All insurance companies issuing health care liability insurance policies to physicians licensed to practice medicine in this state shall issue policies covering physicians of all classifications of practice; provided, that this subsection (a) shall not be construed to require the issuance of a policy contrary to established underwriting practices.
(b) This section shall not be construed to prevent an insurance company issuing health care liability insurance policies to physicians licensed in the state from limiting the amount of the coverage of the policies or from making a premium surcharge for the insurance in accordance with established underwriting practices.
Acts 1979, ch. 161, §§ 1, 2; T.C.A., § 56-1178; Acts 2012, ch. 798, § 20.
Tenn. Code Ann. § 56-2-905 — TN Code / Title 56 / Chapter 2 / Section 56-2-905
Rules
Status: in_force

The commissioner may promulgate rules as are necessary to carry out this part in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. Added by 2018 Tenn. Acts, ch. 873,s 8, eff. 1/1/2019.
The commissioner may promulgate rules as are necessary to carry out this part in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Added by 2018 Tenn. Acts, ch. 873,s 8, eff. 1/1/2019.
Tenn. Code Ann. § 56-51-128 — TN Code / Title 56 / Chapter 51 / Section 56-51-128
Provider arrangements
Status: in_force

(a) Whenever a contract exists between a prepaid limited health service organization and a provider, and the organization fails to meet its obligations to pay fees for services already rendered to a subscriber, who is in good standing, the prepaid limited health service organization is liable for the fee or fees rather than the subscriber, and the contract must so state. (b) No subscriber, who is in good standing, of a prepaid limited health service organization is liable to any provider of health care services for any services covered by the prepaid limited health service organization. (c) No provider of prepaid limited health care services or any representative of the provider may collect or attempt to collect from a subscriber any money for services covered by a prepaid limited health service organization, and no provider or representative of the provider may maintain any action against a subscriber of a prepaid limited health service organization to collect money owed to the provider by a prepaid limited health service organization. (d) Every contract between a prepaid limited health service organization and a provider of health care services must be in writing and must contain a provision that the subscriber is not liable to the provider for any services covered by the subscriber's or enrollee's contract with the prepaid limited health service organization. (e) This section does not apply to the amount of any deductible or copayment that is not covered by the contract, or for services not authorized by the prepaid limited health service organization. (f) (1) For all provider contracts, the contracts must provide that the provider will provide no less than ninety (90) days' advance written notice to the prepaid limited health service organization before cancelling the contract with the prepaid limited health service organization for any reason. (2) For all provider contracts, the organization shall be responsible for notifying all providers of the provisions of this section and their responsibilities under this chapter. (g) Upon receipt by the prepaid limited health service organization of a ninety-day cancellation notice, the prepaid limited health service organization may, if requested by the provider, terminate the contract in less than ninety (90) days if the prepaid limited health service organization is not financially impaired or insolvent. (h) Provider contracts must provide that the prepaid limited health service organization will provide ninety (90) days' advance written notice to the provider before cancelling, without cause, the contract with the provider, except where a patient's health is subject to imminent danger or a provider's ability to practice is effectively impaired by an action by another governmental agency. (i) Every contract between a prepaid limited health service organization and a provider of health care services must contain a provision that if any provision of the agreement is held to be unenforceable or otherwise contrary to any applicable laws, regulations, or rules, the provision shall have no effect and shall be severable without affecting the validity or enforceability of the remaining provisions of this agreement. (j) A contract between a prepaid limited health service organization and a provider of limited health care services may not contain any provision restricting the provider's ability to communicate information to the provider's patient regarding care or treatment options for the patient when the provider deems knowledge of the information by the patient to be in the best interest of the health of the patient. Acts 2000, ch. 948, § 28.
(a) Whenever a contract exists between a prepaid limited health service organization and a provider, and the organization fails to meet its obligations to pay fees for services already rendered to a subscriber, who is in good standing, the prepaid limited health service organization is liable for the fee or fees rather than the subscriber, and the contract must so state.
(b) No subscriber, who is in good standing, of a prepaid limited health service organization is liable to any provider of health care services for any services covered by the prepaid limited health service organization.
(c) No provider of prepaid limited health care services or any representative of the provider may collect or attempt to collect from a subscriber any money for services covered by a prepaid limited health service organization, and no provider or representative of the provider may maintain any action against a subscriber of a prepaid limited health service organization to collect money owed to the provider by a prepaid limited health service organization.
(d) Every contract between a prepaid limited health service organization and a provider of health care services must be in writing and must contain a provision that the subscriber is not liable to the provider for any services covered by the subscriber's or enrollee's contract with the prepaid limited health service organization.
(e) This section does not apply to the amount of any deductible or copayment that is not covered by the contract, or for services not authorized by the prepaid limited health service organization.
(f) (1) For all provider contracts, the contracts must provide that the provider will provide no less than ninety (90) days' advance written notice to the prepaid limited health service organization before cancelling the contract with the prepaid limited health service organization for any reason. (2) For all provider contracts, the organization shall be responsible for notifying all providers of the provisions of this section and their responsibilities under this chapter.
(1) For all provider contracts, the contracts must provide that the provider will provide no less than ninety (90) days' advance written notice to the prepaid limited health service organization before cancelling the contract with the prepaid limited health service organization for any reason.
(2) For all provider contracts, the organization shall be responsible for notifying all providers of the provisions of this section and their responsibilities under this chapter.
(g) Upon receipt by the prepaid limited health service organization of a ninety-day cancellation notice, the prepaid limited health service organization may, if requested by the provider, terminate the contract in less than ninety (90) days if the prepaid limited health service organization is not financially impaired or insolvent.
(h) Provider contracts must provide that the prepaid limited health service organization will provide ninety (90) days' advance written notice to the provider before cancelling, without cause, the contract with the provider, except where a patient's health is subject to imminent danger or a provider's ability to practice is effectively impaired by an action by another governmental agency.
(i) Every contract between a prepaid limited health service organization and a provider of health care services must contain a provision that if any provision of the agreement is held to be unenforceable or otherwise contrary to any applicable laws, regulations, or rules, the provision shall have no effect and shall be severable without affecting the validity or enforceability of the remaining provisions of this agreement.
(j) A contract between a prepaid limited health service organization and a provider of limited health care services may not contain any provision restricting the provider's ability to communicate information to the provider's patient regarding care or treatment options for the patient when the provider deems knowledge of the information by the patient to be in the best interest of the health of the patient.
Acts 2000, ch. 948, § 28.
Tenn. Code Ann. § 56-7-1018 — TN Code / Title 56 / Chapter 7 / Section 56-7-1018
Coverage for complex rehabilitation technology in health benefit plan
Status: in_force

(a) As used in this section: (1) "Complex rehabilitation technology" has the same meaning as defined in § 71-5-159 ; (2) "Health benefit plan" means health insurance coverage as defined in § 56-7-109 ; and (3) "Health insurer" means a health insurance entity as defined in § 56-7-109 . (b) A health insurer that offers a health benefit plan that provides coverage of complex rehabilitation technology: (1) Shall not consider the location where the complex rehabilitation technology will be used when making a determination of medical necessity; and (2) Shall offer covered persons a prior authorization process that reviews billable codes and provides coverage determinations for complex rehabilitation technology. (c) If a health insurer notifies a person who is covered under a policy or contract for a health benefit plan that includes complex rehabilitation technology benefits and coverage that complex rehabilitation technology equipment that was approved in a prior authorization will be fully funded under the health benefit plan, then, as long as the person remains covered under the policy or contract at the time the complex rehabilitation technology is delivered to the person, the health insurer: (1) Shall pay one hundred percent (100%) of the amount approved in the prior authorization, subject to applicable copayment, coinsurance, or deductible requirements as provided in the policy; and (2) Shall not seek payment or reimbursement from the covered person, a complex rehabilitation technology vendor, or another party involved with the sale or delivery of the complex rehabilitation technology. (d) This section does not require a health insurer to offer coverage for complex rehabilitation technology in a health benefit plan. Added by 2022 Tenn. Acts, ch. 973, s 1, eff. 7/1/2022.
(a) As used in this section: (1) "Complex rehabilitation technology" has the same meaning as defined in § 71-5-159 ; (2) "Health benefit plan" means health insurance coverage as defined in § 56-7-109 ; and (3) "Health insurer" means a health insurance entity as defined in § 56-7-109 .
(1) "Complex rehabilitation technology" has the same meaning as defined in § 71-5-159 ;
(2) "Health benefit plan" means health insurance coverage as defined in § 56-7-109 ; and
(3) "Health insurer" means a health insurance entity as defined in § 56-7-109 .
(b) A health insurer that offers a health benefit plan that provides coverage of complex rehabilitation technology: (1) Shall not consider the location where the complex rehabilitation technology will be used when making a determination of medical necessity; and (2) Shall offer covered persons a prior authorization process that reviews billable codes and provides coverage determinations for complex rehabilitation technology.
(1) Shall not consider the location where the complex rehabilitation technology will be used when making a determination of medical necessity; and
(2) Shall offer covered persons a prior authorization process that reviews billable codes and provides coverage determinations for complex rehabilitation technology.
(c) If a health insurer notifies a person who is covered under a policy or contract for a health benefit plan that includes complex rehabilitation technology benefits and coverage that complex rehabilitation technology equipment that was approved in a prior authorization will be fully funded under the health benefit plan, then, as long as the person remains covered under the policy or contract at the time the complex rehabilitation technology is delivered to the person, the health insurer: (1) Shall pay one hundred percent (100%) of the amount approved in the prior authorization, subject to applicable copayment, coinsurance, or deductible requirements as provided in the policy; and (2) Shall not seek payment or reimbursement from the covered person, a complex rehabilitation technology vendor, or another party involved with the sale or delivery of the complex rehabilitation technology.
(1) Shall pay one hundred percent (100%) of the amount approved in the prior authorization, subject to applicable copayment, coinsurance, or deductible requirements as provided in the policy; and
(2) Shall not seek payment or reimbursement from the covered person, a complex rehabilitation technology vendor, or another party involved with the sale or delivery of the complex rehabilitation technology.
(d) This section does not require a health insurer to offer coverage for complex rehabilitation technology in a health benefit plan.
Added by 2022 Tenn. Acts, ch. 973, s 1, eff. 7/1/2022.
Tenn. Code Ann. § 56-7-1506 — TN Code / Title 56 / Chapter 7 / Section 56-7-1506
Notice - Right to return - Refunds
Status: in_force

Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate, or attached to the policy or certificate, stating in substance that the applicant has the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. The insurer shall mail the refund directly to the applicant in a timely manner and shall not require the applicant to meet with the agent to receive the refund. Acts 1992, ch. 735, § 6.
Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate, or attached to the policy or certificate, stating in substance that the applicant has the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. The insurer shall mail the refund directly to the applicant in a timely manner and shall not require the applicant to meet with the agent to receive the refund.
Acts 1992, ch. 735, § 6.
Tenn. Code Ann. § 56-7-3206 — TN Code / Title 56 / Chapter 7 / Section 56-7-3206
Calculation of coinsurance or deductible for prescription drug or device based on allowed amount of drug or device - Prohibited charges and reimbursements
Status: in_force

(a) Notwithstanding a law to the contrary, a pharmacy benefits manager or a covered entity shall base the calculation of any coinsurance or deductible for a prescription drug or device on the allowed amount of the drug or device. For purposes of this section, coinsurance or deductible does not mean or include copayments. (b) Notwithstanding a law to the contrary, a pharmacy benefits manager shall not charge a covered entity an amount greater than the reimbursement paid by a pharmacy benefits manager to a contracted pharmacy for the prescription drug or device. (c) (1) Notwithstanding any law to the contrary, a pharmacy benefits manager shall not reimburse a contracted pharmacy for a prescription drug or device an amount that is less than the actual cost to that pharmacy for the prescription drug or device. (2) (A) A pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement for failing to pay at least the actual cost to the pharmacy for the prescription drug or device. (B) A covered entity's or pharmacy benefits manager's appeals process established pursuant to subdivision (c)(2)(A) must: (i) Be approved by the commissioner of commerce and insurance; (ii) Comply with the timing and notice requirements of § 56-7-3108 and such other requirements as the commissioner of commerce and insurance may establish by rule; and (iii) Permit a pharmacy or its designated agent to file an appeal using the standard appeal form described in subdivision (c)(2)(D). (C) If a pharmacy chooses to contest a reimbursement for failing to pay at least the actual cost the pharmacy incurred for a particular drug or medical product or device, then the pharmacy has the right to designate a pharmacy services administrative organization or other agent to file and handle its appeal. (D) The commissioner of commerce and insurance shall create and make available to pharmacy benefits managers and covered entities a standard form to be used by a pharmacy or its designated agent to file an appeal pursuant to this subdivision (c)(2) with a pharmacy benefits manager or covered entity. (3) (A) If a pharmacy or agent acting on behalf of a pharmacy prevails in an appeal provided for in this subsection (c), then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall: (i) Make the necessary change to the challenged rate of reimbursement or actual cost; (ii) If the product involved in the appeal is a drug, then provide to the pharmacy or agent the national drug code number for the drug on which the change is based; (iii) Permit the challenging pharmacy to reverse and rebill the claim upon which the appeal is based; (iv) Pay or waive the cost of any transaction fee required to reverse and rebill the claim; (v) Reimburse the pharmacy at least the pharmacy's actual cost for the prescription drug or device; and (vi) Apply the findings from the appeal as to the rate of reimbursement and actual cost for the particular drug or medical product or device to other similarly situated pharmacies. (B) It is a violation of this subsection (c) if, after an appeal in which a pharmacy or agent acting on behalf of a pharmacy prevails, a pharmacy benefits manager or covered entity fails to reimburse the pharmacy at least actual cost. (C) As used in subdivision (c)(3)(A)(vi), "similarly situated" means a pharmacy: (i) That is in any of the pharmacy benefits manager's networks; (ii) That purchases the particular drug or medical product or device to which the finding applies from the same pharmaceutical wholesaler as the pharmacy that prevailed in the appeal; and (iii) To which the pharmacy benefits manager also applies the challenged rate of reimbursement or actual cost. (4) If a pharmacy or agent acting on behalf of a pharmacy loses or is denied an appeal provided for in this section, then: (A) If the product associated with the national drug code number or unique device identifier is available at a cost that is less than the challenged rate of reimbursement from a pharmaceutical wholesaler in this state, then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall provide the appealing pharmacy or agent with: (i) The name of the national or regional pharmaceutical wholesalers operating in this state that have the particular drug or medical product or device currently in stock at a price that is less than the amount of the challenged rate of reimbursement; and (ii) (a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or (b) If the product involved is a medical device, then the unique device identifier for the device; and (B) If the product associated with the national drug code number or unique device identifier is not available at a cost that is less than the challenged rate of reimbursement from the pharmaceutical wholesaler from whom the pharmacy purchases the majority of prescription pharmaceutical products for resale, then the pharmacy benefits manager shall adjust the challenged rate of reimbursement to an amount equal to or greater than the appealing pharmacy's actual cost and permit the pharmacy to reverse and rebill each claim affected by the inability to procure the pharmaceutical product at a cost that is equal to or less than the previously challenged rate of reimbursement. The pharmacy benefits manager shall pay or waive the cost of any transaction fee required to reverse and rebill the claim. (d) (1) Subsection (c) does not apply to a pharmacy benefits manager when utilizing a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services. (2) If a pharmacy benefits manager utilizes a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services, then the pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement paid at average acquisition cost and receive an adjusted payment by providing valid and reliable evidence that the reimbursement does not pay at least the actual cost to the pharmacy for the prescription drug or device. (e) A pharmacy benefits manager shall not include within the amount calculated to reimburse a pharmacy for actual cost pursuant to subsection (c) the amount of any professional dispensing fee that is payable to the pharmacy. (f) A pharmacy benefits manager shall pay a professional dispensing fee at a rate that is not less than the amount paid by the TennCare program to a pharmacy, if: (1) The pharmacy dispenses a prescription drug or device pursuant to an agreement with the pharmacy benefits manager or a covered entity; and (2) The pharmacy's annual prescription volume is at a level that, if the pharmacy were a TennCare-participating ambulatory pharmacy, would qualify the pharmacy for the enhanced amount of professional dispensing fee for a low-volume pharmacy under the operative version of the Division of TennCare Pharmacy Provider Manual, or a successor manual. (g) (1) The commissioner of commerce and insurance is authorized to promulgate rules to effectuate the purposes of this section. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (2) The commissioner shall institute an external appeals process for any appeal denied by a pharmacy benefits manager. (h) As used in this section: (1) "Actual cost": (A) Means the amount a pharmacy paid as evidenced by documentation that includes, but is not limited to, the invoice price minus discounts, price concessions, rebates, or other reductions; and (B) As used in subdivision (h)(1)(A), "discounts, price concessions, rebates, or other reductions" do not include a cash discount; and (2) "Allowed amount" means the cost of a prescription drug or device after applying pharmacy benefits manager or covered entity pricing discounts available at the time of the prescription claim transaction. Amended by 2022 Tenn. Acts, ch. 1070, s 2, eff. 1/1/2023. Amended by 2022 Tenn. Acts, ch. 1070, s 1, eff. 1/1/2023. Added by 2021 Tenn. Acts, ch. 569, s 3, eff. 7/1/2021.
(a) Notwithstanding a law to the contrary, a pharmacy benefits manager or a covered entity shall base the calculation of any coinsurance or deductible for a prescription drug or device on the allowed amount of the drug or device. For purposes of this section, coinsurance or deductible does not mean or include copayments.
(b) Notwithstanding a law to the contrary, a pharmacy benefits manager shall not charge a covered entity an amount greater than the reimbursement paid by a pharmacy benefits manager to a contracted pharmacy for the prescription drug or device.
(c) (1) Notwithstanding any law to the contrary, a pharmacy benefits manager shall not reimburse a contracted pharmacy for a prescription drug or device an amount that is less than the actual cost to that pharmacy for the prescription drug or device. (2) (A) A pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement for failing to pay at least the actual cost to the pharmacy for the prescription drug or device. (B) A covered entity's or pharmacy benefits manager's appeals process established pursuant to subdivision (c)(2)(A) must: (i) Be approved by the commissioner of commerce and insurance; (ii) Comply with the timing and notice requirements of § 56-7-3108 and such other requirements as the commissioner of commerce and insurance may establish by rule; and (iii) Permit a pharmacy or its designated agent to file an appeal using the standard appeal form described in subdivision (c)(2)(D). (C) If a pharmacy chooses to contest a reimbursement for failing to pay at least the actual cost the pharmacy incurred for a particular drug or medical product or device, then the pharmacy has the right to designate a pharmacy services administrative organization or other agent to file and handle its appeal. (D) The commissioner of commerce and insurance shall create and make available to pharmacy benefits managers and covered entities a standard form to be used by a pharmacy or its designated agent to file an appeal pursuant to this subdivision (c)(2) with a pharmacy benefits manager or covered entity. (3) (A) If a pharmacy or agent acting on behalf of a pharmacy prevails in an appeal provided for in this subsection (c), then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall: (i) Make the necessary change to the challenged rate of reimbursement or actual cost; (ii) If the product involved in the appeal is a drug, then provide to the pharmacy or agent the national drug code number for the drug on which the change is based; (iii) Permit the challenging pharmacy to reverse and rebill the claim upon which the appeal is based; (iv) Pay or waive the cost of any transaction fee required to reverse and rebill the claim; (v) Reimburse the pharmacy at least the pharmacy's actual cost for the prescription drug or device; and (vi) Apply the findings from the appeal as to the rate of reimbursement and actual cost for the particular drug or medical product or device to other similarly situated pharmacies. (B) It is a violation of this subsection (c) if, after an appeal in which a pharmacy or agent acting on behalf of a pharmacy prevails, a pharmacy benefits manager or covered entity fails to reimburse the pharmacy at least actual cost. (C) As used in subdivision (c)(3)(A)(vi), "similarly situated" means a pharmacy: (i) That is in any of the pharmacy benefits manager's networks; (ii) That purchases the particular drug or medical product or device to which the finding applies from the same pharmaceutical wholesaler as the pharmacy that prevailed in the appeal; and (iii) To which the pharmacy benefits manager also applies the challenged rate of reimbursement or actual cost. (4) If a pharmacy or agent acting on behalf of a pharmacy loses or is denied an appeal provided for in this section, then: (A) If the product associated with the national drug code number or unique device identifier is available at a cost that is less than the challenged rate of reimbursement from a pharmaceutical wholesaler in this state, then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall provide the appealing pharmacy or agent with: (i) The name of the national or regional pharmaceutical wholesalers operating in this state that have the particular drug or medical product or device currently in stock at a price that is less than the amount of the challenged rate of reimbursement; and (ii) (a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or (b) If the product involved is a medical device, then the unique device identifier for the device; and (B) If the product associated with the national drug code number or unique device identifier is not available at a cost that is less than the challenged rate of reimbursement from the pharmaceutical wholesaler from whom the pharmacy purchases the majority of prescription pharmaceutical products for resale, then the pharmacy benefits manager shall adjust the challenged rate of reimbursement to an amount equal to or greater than the appealing pharmacy's actual cost and permit the pharmacy to reverse and rebill each claim affected by the inability to procure the pharmaceutical product at a cost that is equal to or less than the previously challenged rate of reimbursement. The pharmacy benefits manager shall pay or waive the cost of any transaction fee required to reverse and rebill the claim.
(1) Notwithstanding any law to the contrary, a pharmacy benefits manager shall not reimburse a contracted pharmacy for a prescription drug or device an amount that is less than the actual cost to that pharmacy for the prescription drug or device.
(2) (A) A pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement for failing to pay at least the actual cost to the pharmacy for the prescription drug or device. (B) A covered entity's or pharmacy benefits manager's appeals process established pursuant to subdivision (c)(2)(A) must: (i) Be approved by the commissioner of commerce and insurance; (ii) Comply with the timing and notice requirements of § 56-7-3108 and such other requirements as the commissioner of commerce and insurance may establish by rule; and (iii) Permit a pharmacy or its designated agent to file an appeal using the standard appeal form described in subdivision (c)(2)(D). (C) If a pharmacy chooses to contest a reimbursement for failing to pay at least the actual cost the pharmacy incurred for a particular drug or medical product or device, then the pharmacy has the right to designate a pharmacy services administrative organization or other agent to file and handle its appeal. (D) The commissioner of commerce and insurance shall create and make available to pharmacy benefits managers and covered entities a standard form to be used by a pharmacy or its designated agent to file an appeal pursuant to this subdivision (c)(2) with a pharmacy benefits manager or covered entity.
(A) A pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement for failing to pay at least the actual cost to the pharmacy for the prescription drug or device.
(B) A covered entity's or pharmacy benefits manager's appeals process established pursuant to subdivision (c)(2)(A) must: (i) Be approved by the commissioner of commerce and insurance; (ii) Comply with the timing and notice requirements of § 56-7-3108 and such other requirements as the commissioner of commerce and insurance may establish by rule; and (iii) Permit a pharmacy or its designated agent to file an appeal using the standard appeal form described in subdivision (c)(2)(D).
(i) Be approved by the commissioner of commerce and insurance;
(ii) Comply with the timing and notice requirements of § 56-7-3108 and such other requirements as the commissioner of commerce and insurance may establish by rule; and
(iii) Permit a pharmacy or its designated agent to file an appeal using the standard appeal form described in subdivision (c)(2)(D).
(C) If a pharmacy chooses to contest a reimbursement for failing to pay at least the actual cost the pharmacy incurred for a particular drug or medical product or device, then the pharmacy has the right to designate a pharmacy services administrative organization or other agent to file and handle its appeal.
(D) The commissioner of commerce and insurance shall create and make available to pharmacy benefits managers and covered entities a standard form to be used by a pharmacy or its designated agent to file an appeal pursuant to this subdivision (c)(2) with a pharmacy benefits manager or covered entity.
(3) (A) If a pharmacy or agent acting on behalf of a pharmacy prevails in an appeal provided for in this subsection (c), then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall: (i) Make the necessary change to the challenged rate of reimbursement or actual cost; (ii) If the product involved in the appeal is a drug, then provide to the pharmacy or agent the national drug code number for the drug on which the change is based; (iii) Permit the challenging pharmacy to reverse and rebill the claim upon which the appeal is based; (iv) Pay or waive the cost of any transaction fee required to reverse and rebill the claim; (v) Reimburse the pharmacy at least the pharmacy's actual cost for the prescription drug or device; and (vi) Apply the findings from the appeal as to the rate of reimbursement and actual cost for the particular drug or medical product or device to other similarly situated pharmacies. (B) It is a violation of this subsection (c) if, after an appeal in which a pharmacy or agent acting on behalf of a pharmacy prevails, a pharmacy benefits manager or covered entity fails to reimburse the pharmacy at least actual cost. (C) As used in subdivision (c)(3)(A)(vi), "similarly situated" means a pharmacy: (i) That is in any of the pharmacy benefits manager's networks; (ii) That purchases the particular drug or medical product or device to which the finding applies from the same pharmaceutical wholesaler as the pharmacy that prevailed in the appeal; and (iii) To which the pharmacy benefits manager also applies the challenged rate of reimbursement or actual cost.
(A) If a pharmacy or agent acting on behalf of a pharmacy prevails in an appeal provided for in this subsection (c), then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall: (i) Make the necessary change to the challenged rate of reimbursement or actual cost; (ii) If the product involved in the appeal is a drug, then provide to the pharmacy or agent the national drug code number for the drug on which the change is based; (iii) Permit the challenging pharmacy to reverse and rebill the claim upon which the appeal is based; (iv) Pay or waive the cost of any transaction fee required to reverse and rebill the claim; (v) Reimburse the pharmacy at least the pharmacy's actual cost for the prescription drug or device; and (vi) Apply the findings from the appeal as to the rate of reimbursement and actual cost for the particular drug or medical product or device to other similarly situated pharmacies.
(i) Make the necessary change to the challenged rate of reimbursement or actual cost;
(ii) If the product involved in the appeal is a drug, then provide to the pharmacy or agent the national drug code number for the drug on which the change is based;
(iii) Permit the challenging pharmacy to reverse and rebill the claim upon which the appeal is based;
(iv) Pay or waive the cost of any transaction fee required to reverse and rebill the claim;
(v) Reimburse the pharmacy at least the pharmacy's actual cost for the prescription drug or device; and
(vi) Apply the findings from the appeal as to the rate of reimbursement and actual cost for the particular drug or medical product or device to other similarly situated pharmacies.
(B) It is a violation of this subsection (c) if, after an appeal in which a pharmacy or agent acting on behalf of a pharmacy prevails, a pharmacy benefits manager or covered entity fails to reimburse the pharmacy at least actual cost.
(C) As used in subdivision (c)(3)(A)(vi), "similarly situated" means a pharmacy: (i) That is in any of the pharmacy benefits manager's networks; (ii) That purchases the particular drug or medical product or device to which the finding applies from the same pharmaceutical wholesaler as the pharmacy that prevailed in the appeal; and (iii) To which the pharmacy benefits manager also applies the challenged rate of reimbursement or actual cost.
(i) That is in any of the pharmacy benefits manager's networks;
(ii) That purchases the particular drug or medical product or device to which the finding applies from the same pharmaceutical wholesaler as the pharmacy that prevailed in the appeal; and
(iii) To which the pharmacy benefits manager also applies the challenged rate of reimbursement or actual cost.
(4) If a pharmacy or agent acting on behalf of a pharmacy loses or is denied an appeal provided for in this section, then: (A) If the product associated with the national drug code number or unique device identifier is available at a cost that is less than the challenged rate of reimbursement from a pharmaceutical wholesaler in this state, then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall provide the appealing pharmacy or agent with: (i) The name of the national or regional pharmaceutical wholesalers operating in this state that have the particular drug or medical product or device currently in stock at a price that is less than the amount of the challenged rate of reimbursement; and (ii) (a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or (b) If the product involved is a medical device, then the unique device identifier for the device; and (B) If the product associated with the national drug code number or unique device identifier is not available at a cost that is less than the challenged rate of reimbursement from the pharmaceutical wholesaler from whom the pharmacy purchases the majority of prescription pharmaceutical products for resale, then the pharmacy benefits manager shall adjust the challenged rate of reimbursement to an amount equal to or greater than the appealing pharmacy's actual cost and permit the pharmacy to reverse and rebill each claim affected by the inability to procure the pharmaceutical product at a cost that is equal to or less than the previously challenged rate of reimbursement. The pharmacy benefits manager shall pay or waive the cost of any transaction fee required to reverse and rebill the claim.
(A) If the product associated with the national drug code number or unique device identifier is available at a cost that is less than the challenged rate of reimbursement from a pharmaceutical wholesaler in this state, then within seven (7) business days after notice of the appeal is received by the pharmacy benefits manager or covered entity, the pharmacy benefits manager or covered entity shall provide the appealing pharmacy or agent with: (i) The name of the national or regional pharmaceutical wholesalers operating in this state that have the particular drug or medical product or device currently in stock at a price that is less than the amount of the challenged rate of reimbursement; and (ii) (a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or (b) If the product involved is a medical device, then the unique device identifier for the device; and
(i) The name of the national or regional pharmaceutical wholesalers operating in this state that have the particular drug or medical product or device currently in stock at a price that is less than the amount of the challenged rate of reimbursement; and
(ii) (a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or (b) If the product involved is a medical device, then the unique device identifier for the device; and
(a) If the product involved in the appeal is a drug, then the national drug code number for the drug; or
(b) If the product involved is a medical device, then the unique device identifier for the device; and
(B) If the product associated with the national drug code number or unique device identifier is not available at a cost that is less than the challenged rate of reimbursement from the pharmaceutical wholesaler from whom the pharmacy purchases the majority of prescription pharmaceutical products for resale, then the pharmacy benefits manager shall adjust the challenged rate of reimbursement to an amount equal to or greater than the appealing pharmacy's actual cost and permit the pharmacy to reverse and rebill each claim affected by the inability to procure the pharmaceutical product at a cost that is equal to or less than the previously challenged rate of reimbursement. The pharmacy benefits manager shall pay or waive the cost of any transaction fee required to reverse and rebill the claim.
(d) (1) Subsection (c) does not apply to a pharmacy benefits manager when utilizing a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services. (2) If a pharmacy benefits manager utilizes a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services, then the pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement paid at average acquisition cost and receive an adjusted payment by providing valid and reliable evidence that the reimbursement does not pay at least the actual cost to the pharmacy for the prescription drug or device.
(1) Subsection (c) does not apply to a pharmacy benefits manager when utilizing a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services.
(2) If a pharmacy benefits manager utilizes a reimbursement methodology that is identical to the methodology provided for in the state plan for medical assistance approved by the federal centers for medicare and medicaid services, then the pharmacy benefits manager shall establish a process for a pharmacy to appeal a reimbursement paid at average acquisition cost and receive an adjusted payment by providing valid and reliable evidence that the reimbursement does not pay at least the actual cost to the pharmacy for the prescription drug or device.
(e) A pharmacy benefits manager shall not include within the amount calculated to reimburse a pharmacy for actual cost pursuant to subsection (c) the amount of any professional dispensing fee that is payable to the pharmacy.
(f) A pharmacy benefits manager shall pay a professional dispensing fee at a rate that is not less than the amount paid by the TennCare program to a pharmacy, if: (1) The pharmacy dispenses a prescription drug or device pursuant to an agreement with the pharmacy benefits manager or a covered entity; and (2) The pharmacy's annual prescription volume is at a level that, if the pharmacy were a TennCare-participating ambulatory pharmacy, would qualify the pharmacy for the enhanced amount of professional dispensing fee for a low-volume pharmacy under the operative version of the Division of TennCare Pharmacy Provider Manual, or a successor manual.
(1) The pharmacy dispenses a prescription drug or device pursuant to an agreement with the pharmacy benefits manager or a covered entity; and
(2) The pharmacy's annual prescription volume is at a level that, if the pharmacy were a TennCare-participating ambulatory pharmacy, would qualify the pharmacy for the enhanced amount of professional dispensing fee for a low-volume pharmacy under the operative version of the Division of TennCare Pharmacy Provider Manual, or a successor manual.
(g) (1) The commissioner of commerce and insurance is authorized to promulgate rules to effectuate the purposes of this section. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (2) The commissioner shall institute an external appeals process for any appeal denied by a pharmacy benefits manager.
(1) The commissioner of commerce and insurance is authorized to promulgate rules to effectuate the purposes of this section. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(2) The commissioner shall institute an external appeals process for any appeal denied by a pharmacy benefits manager.
(h) As used in this section: (1) "Actual cost": (A) Means the amount a pharmacy paid as evidenced by documentation that includes, but is not limited to, the invoice price minus discounts, price concessions, rebates, or other reductions; and (B) As used in subdivision (h)(1)(A), "discounts, price concessions, rebates, or other reductions" do not include a cash discount; and (2) "Allowed amount" means the cost of a prescription drug or device after applying pharmacy benefits manager or covered entity pricing discounts available at the time of the prescription claim transaction.
(1) "Actual cost": (A) Means the amount a pharmacy paid as evidenced by documentation that includes, but is not limited to, the invoice price minus discounts, price concessions, rebates, or other reductions; and (B) As used in subdivision (h)(1)(A), "discounts, price concessions, rebates, or other reductions" do not include a cash discount; and
(A) Means the amount a pharmacy paid as evidenced by documentation that includes, but is not limited to, the invoice price minus discounts, price concessions, rebates, or other reductions; and
(B) As used in subdivision (h)(1)(A), "discounts, price concessions, rebates, or other reductions" do not include a cash discount; and
(2) "Allowed amount" means the cost of a prescription drug or device after applying pharmacy benefits manager or covered entity pricing discounts available at the time of the prescription claim transaction.
Amended by 2022 Tenn. Acts, ch. 1070, s 2, eff. 1/1/2023.
Amended by 2022 Tenn. Acts, ch. 1070, s 1, eff. 1/1/2023.
Added by 2021 Tenn. Acts, ch. 569, s 3, eff. 7/1/2021.
Tenn. Code Ann. § 56-6-125 — TN Code / Title 56 / Chapter 6 / Section 56-6-125
Unfair trade practices
Status: in_force

(a) It is an unfair trade practice for an insurance producer to: (1) Hold the insurance producer out, directly or indirectly, to the public as a financial planner, investment adviser, consultant, financial counselor, risk manager or any other specialist engaged in the business of giving financial planning, risk management or advice relating to investments, insurance, real estate, tax matters or trust and estate matters when the person is in fact engaged only in the sale of insurance policies. This subdivision (a)(1) does not preclude persons who hold some form of formal recognized financial planning, risk management or consultant certification or designation from using this certification or designation when they are only selling insurance; (2) Engage in the business of financial planning without disclosing to the client prior to the execution of the agreement provided for in subdivision (a)(3), or solicitation of the sale of a product or service, that: (A) The person is also an insurance salesperson; and (B) That a commission for the sale of an insurance product will be received in addition to a fee for financial planning, if such is the case. The disclosure requirement under this subsection (a) may be met by including it in any disclosure required by federal or state securities law; or (3) Charge fees for the sale, solicitation or negotiation of insurance not authorized by a written agreement with an insurer, and, where applicable, incorporated in the insurer's rate filing. An insurance producer may charge fees for services not connected with the sale, solicitation and negotiation of insurance by the insurance producer if the fees are based upon a qualified written agreement, signed by the party to be charged in advance of the performance of the services under the agreement. A copy of the qualifying agreement must be provided to the party to be charged at the time the agreement is signed by the party. The agreement shall be considered as qualifying if it includes: (A) The services for which the fee is to be charged; (B) The amount of the fee to be charged or how it will be determined or calculated; and (C) A disclosure stating that the client is under no obligation to purchase any insurance product through the insurance producer or consultant. The insurance producer shall retain a copy of the agreement for not less than three (3) years after completion of services, and a copy shall be available to the commissioner upon request. (b) Notwithstanding subsection (a) or this title, an insurance producer may charge fees for services relating to an individual's purchase of an individual major medical policy as defined in [former] § 56-12-204(c)(3)(C) [repealed], where the insurer is not paying commission to the insurance producer, if the fees are based upon a qualified written agreement signed by the party to be charged in advance of the performance of the services under the agreement. An agreement under this subsection (b) is qualified if it meets the requirements contained in subdivisions (a)(3)(A)-(C). (c) Except as otherwise provided in subsections (a) and (b), this section does not permit persons to charge an additional fee for services that are associated with the sale, solicitation, negotiation, or servicing of insurance policies. Amended by 2017 Tenn. Acts, ch. 7, Secs.s 1, s 2 eff. 3/22/2017. Acts 2002, ch. 798, § 26; 2008 , ch. 1192, § 8.
(a) It is an unfair trade practice for an insurance producer to: (1) Hold the insurance producer out, directly or indirectly, to the public as a financial planner, investment adviser, consultant, financial counselor, risk manager or any other specialist engaged in the business of giving financial planning, risk management or advice relating to investments, insurance, real estate, tax matters or trust and estate matters when the person is in fact engaged only in the sale of insurance policies. This subdivision (a)(1) does not preclude persons who hold some form of formal recognized financial planning, risk management or consultant certification or designation from using this certification or designation when they are only selling insurance; (2) Engage in the business of financial planning without disclosing to the client prior to the execution of the agreement provided for in subdivision (a)(3), or solicitation of the sale of a product or service, that: (A) The person is also an insurance salesperson; and (B) That a commission for the sale of an insurance product will be received in addition to a fee for financial planning, if such is the case. The disclosure requirement under this subsection (a) may be met by including it in any disclosure required by federal or state securities law; or (3) Charge fees for the sale, solicitation or negotiation of insurance not authorized by a written agreement with an insurer, and, where applicable, incorporated in the insurer's rate filing. An insurance producer may charge fees for services not connected with the sale, solicitation and negotiation of insurance by the insurance producer if the fees are based upon a qualified written agreement, signed by the party to be charged in advance of the performance of the services under the agreement. A copy of the qualifying agreement must be provided to the party to be charged at the time the agreement is signed by the party. The agreement shall be considered as qualifying if it includes: (A) The services for which the fee is to be charged; (B) The amount of the fee to be charged or how it will be determined or calculated; and (C) A disclosure stating that the client is under no obligation to purchase any insurance product through the insurance producer or consultant. The insurance producer shall retain a copy of the agreement for not less than three (3) years after completion of services, and a copy shall be available to the commissioner upon request.
(1) Hold the insurance producer out, directly or indirectly, to the public as a financial planner, investment adviser, consultant, financial counselor, risk manager or any other specialist engaged in the business of giving financial planning, risk management or advice relating to investments, insurance, real estate, tax matters or trust and estate matters when the person is in fact engaged only in the sale of insurance policies. This subdivision (a)(1) does not preclude persons who hold some form of formal recognized financial planning, risk management or consultant certification or designation from using this certification or designation when they are only selling insurance;
(2) Engage in the business of financial planning without disclosing to the client prior to the execution of the agreement provided for in subdivision (a)(3), or solicitation of the sale of a product or service, that: (A) The person is also an insurance salesperson; and (B) That a commission for the sale of an insurance product will be received in addition to a fee for financial planning, if such is the case. The disclosure requirement under this subsection (a) may be met by including it in any disclosure required by federal or state securities law; or
(A) The person is also an insurance salesperson; and
(B) That a commission for the sale of an insurance product will be received in addition to a fee for financial planning, if such is the case. The disclosure requirement under this subsection (a) may be met by including it in any disclosure required by federal or state securities law; or
(3) Charge fees for the sale, solicitation or negotiation of insurance not authorized by a written agreement with an insurer, and, where applicable, incorporated in the insurer's rate filing. An insurance producer may charge fees for services not connected with the sale, solicitation and negotiation of insurance by the insurance producer if the fees are based upon a qualified written agreement, signed by the party to be charged in advance of the performance of the services under the agreement. A copy of the qualifying agreement must be provided to the party to be charged at the time the agreement is signed by the party. The agreement shall be considered as qualifying if it includes: (A) The services for which the fee is to be charged; (B) The amount of the fee to be charged or how it will be determined or calculated; and (C) A disclosure stating that the client is under no obligation to purchase any insurance product through the insurance producer or consultant. The insurance producer shall retain a copy of the agreement for not less than three (3) years after completion of services, and a copy shall be available to the commissioner upon request.
(A) The services for which the fee is to be charged;
(B) The amount of the fee to be charged or how it will be determined or calculated; and
(C) A disclosure stating that the client is under no obligation to purchase any insurance product through the insurance producer or consultant. The insurance producer shall retain a copy of the agreement for not less than three (3) years after completion of services, and a copy shall be available to the commissioner upon request.
(b) Notwithstanding subsection (a) or this title, an insurance producer may charge fees for services relating to an individual's purchase of an individual major medical policy as defined in [former] § 56-12-204(c)(3)(C) [repealed], where the insurer is not paying commission to the insurance producer, if the fees are based upon a qualified written agreement signed by the party to be charged in advance of the performance of the services under the agreement. An agreement under this subsection (b) is qualified if it meets the requirements contained in subdivisions (a)(3)(A)-(C).
(c) Except as otherwise provided in subsections (a) and (b), this section does not permit persons to charge an additional fee for services that are associated with the sale, solicitation, negotiation, or servicing of insurance policies.
Amended by 2017 Tenn. Acts, ch. 7, Secs.s 1, s 2 eff. 3/22/2017.
Acts 2002, ch. 798, § 26; 2008 , ch. 1192, § 8.
Tenn. Code Ann. § 56-7-2305 — TN Code / Title 56 / Chapter 7 / Section 56-7-2305
Group life - Required provisions
Status: in_force

(a) (1) Subject to the limitations of subdivision (a)(2), no policy of group life insurance shall be delivered in this state unless it contains in substance the provisions contained in subdivision (a)(3), or provisions that, in the opinion of the commissioner, are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder. (2) (A) Subdivisions (a)(3)(F)-(J) do not apply to policies issued to a creditor to insure debtors of the creditor; (B) The standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and (C) If the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions that, in the opinion of the commissioner, are equitable to the insured persons and to the policyholder, but nothing in this subdivision (a)(2)(C) shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies. (3) The mandatory provisions referred to in subdivision (a)(1) are: (A) A provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder has given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during the grace period; (B) A provision that the validity of the policy shall not be contested, except for nonpayment of premiums after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability shall be used in contesting the validity of the insurance with respect to which the statement was made after the insurance has been in force prior to the contest for a period of two (2) years during the person's lifetime nor unless it is contained in a written instrument signed by the person; (C) A provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument is or has been furnished to the person or to the person's beneficiary; (D) A provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the person's coverage; (E) A provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, the provision to contain a clear statement of the method of adjustment to be used; (F) A provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the policy in the event there is no designated beneficiary, as to all or any part of the sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of the sum not exceeding five hundred dollars ($500) to any person appearing to the insurer to be equitably entitled to the sum by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured; (G) A provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in subdivisions (a)(3)(H)-(J); (H) A provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, the person shall be entitled to have issued to the person by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits; provided, that application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after the termination; and provided, further, that: (i) The individual policy shall, at the option of the person, be on any one (1) of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance; (ii) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of the termination, less the amount of any life insurance for which the person is or becomes eligible under the same or any other group policy within thirty-one (31) days after the termination, except any amount of insurance that has matured on or before the date of the termination as an endowment payable to the person insured, whether in one (1) sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of the termination; and (iii) The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the person's age attained on the effective date of the individual policy; (I) A provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured under the policy at the date of the termination whose insurance terminates and who has been insured for at least five (5) years prior to the termination date shall be entitled to have issued to the person by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subdivision (a)(3)(H), except that the group policy may provide that the amount of the individual policy shall not exceed the smaller of: (i) The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after the termination; and (ii) Two thousand dollars ($2,000); (J) A provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with subdivision (a)(3)(H) or (I) and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the individual policy has been made; and (K) In the case of a policy issued to a creditor to insure debtors of the creditor, a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form that will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid under the policy by reason of the debtor's death shall be applied to reduce or extinguish the indebtedness. (b) In the case of a policy that provides that each insured debtor whose protection under the group insurance policy terminates by reason of absolute assignment by the creditor of the insured debtor's indebtedness for the discharge of which the debtor when incurring the indebtedness had agreed upon installment payments over a period of more than ten (10) years, there shall be a provision that each insured debtor shall be entitled to have issued to the person by the insurer, without evidence of insurability, upon application made to the insurer and upon the payment of the premium applicable to the class of risk to which the person belongs and to the form and amount of the policy at that person's then attained age within thirty-one (31) days after the assignment of the indebtedness, an individual policy of life insurance; provided, that the individual policy of life insurance shall be in any one (1) of the level premium forms customarily issued by the insurer, except term insurance, in an amount equal to the amount of the person's protection terminated under the group insurance policy because of the assignment, less the amount of insurance for which the insured debtor may become eligible and qualify under any group insurance policy in effect with the assignee at the date of the assignment or issued to the assignee within the period of thirty-one (31) days; and provided, further, that in the event that the assignment of the indebtedness is made by the creditor at the request of the insured debtor, the insurer may require satisfactory evidence of the debtor's insurability before making the individual policy of life insurance effective. If the insured debtor dies during the period within which the debtor would have been entitled to have an individual policy issued in accordance with this subsection (b), and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the policy has been made. (c) If any individual insured under a group life insurance policy delivered in this state becomes entitled under the terms of the policy to have an individual policy of life insurance issued to the person without evidence of insurability, subject to making of application and payment of the first premium within the period specified in the policy, and if the individual is not given notice of the existence of the right at least fifteen (15) days prior to the expiration date of the period, then the individual shall have an additional period within which to exercise the right, but nothing contained in this subsection (c) shall be construed to continue any insurance beyond the period provided in the policy. This additional period shall expire fifteen (15) days after the individual is given notice, but in no event shall the additional period extend beyond sixty (60) days after the expiration date of the period provided in the policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this subsection (c). Acts 1957, ch. 122, § 1; 1976, ch. 417, § 6; 1976, ch. 461, § 1; 1977, ch. 15, § 1; T.C.A., § 56-1141; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-601 ; Acts 1994, ch. 577, § 1.
(a) (1) Subject to the limitations of subdivision (a)(2), no policy of group life insurance shall be delivered in this state unless it contains in substance the provisions contained in subdivision (a)(3), or provisions that, in the opinion of the commissioner, are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder. (2) (A) Subdivisions (a)(3)(F)-(J) do not apply to policies issued to a creditor to insure debtors of the creditor; (B) The standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and (C) If the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions that, in the opinion of the commissioner, are equitable to the insured persons and to the policyholder, but nothing in this subdivision (a)(2)(C) shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies. (3) The mandatory provisions referred to in subdivision (a)(1) are: (A) A provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder has given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during the grace period; (B) A provision that the validity of the policy shall not be contested, except for nonpayment of premiums after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability shall be used in contesting the validity of the insurance with respect to which the statement was made after the insurance has been in force prior to the contest for a period of two (2) years during the person's lifetime nor unless it is contained in a written instrument signed by the person; (C) A provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument is or has been furnished to the person or to the person's beneficiary; (D) A provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the person's coverage; (E) A provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, the provision to contain a clear statement of the method of adjustment to be used; (F) A provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the policy in the event there is no designated beneficiary, as to all or any part of the sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of the sum not exceeding five hundred dollars ($500) to any person appearing to the insurer to be equitably entitled to the sum by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured; (G) A provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in subdivisions (a)(3)(H)-(J); (H) A provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, the person shall be entitled to have issued to the person by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits; provided, that application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after the termination; and provided, further, that: (i) The individual policy shall, at the option of the person, be on any one (1) of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance; (ii) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of the termination, less the amount of any life insurance for which the person is or becomes eligible under the same or any other group policy within thirty-one (31) days after the termination, except any amount of insurance that has matured on or before the date of the termination as an endowment payable to the person insured, whether in one (1) sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of the termination; and (iii) The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the person's age attained on the effective date of the individual policy; (I) A provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured under the policy at the date of the termination whose insurance terminates and who has been insured for at least five (5) years prior to the termination date shall be entitled to have issued to the person by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subdivision (a)(3)(H), except that the group policy may provide that the amount of the individual policy shall not exceed the smaller of: (i) The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after the termination; and (ii) Two thousand dollars ($2,000); (J) A provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with subdivision (a)(3)(H) or (I) and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the individual policy has been made; and (K) In the case of a policy issued to a creditor to insure debtors of the creditor, a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form that will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid under the policy by reason of the debtor's death shall be applied to reduce or extinguish the indebtedness.
(1) Subject to the limitations of subdivision (a)(2), no policy of group life insurance shall be delivered in this state unless it contains in substance the provisions contained in subdivision (a)(3), or provisions that, in the opinion of the commissioner, are more favorable to the persons insured, or at least as favorable to the persons insured and more favorable to the policyholder.
(2) (A) Subdivisions (a)(3)(F)-(J) do not apply to policies issued to a creditor to insure debtors of the creditor; (B) The standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and (C) If the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions that, in the opinion of the commissioner, are equitable to the insured persons and to the policyholder, but nothing in this subdivision (a)(2)(C) shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies.
(A) Subdivisions (a)(3)(F)-(J) do not apply to policies issued to a creditor to insure debtors of the creditor;
(B) The standard provisions required for individual life insurance policies shall not apply to group life insurance policies; and
(C) If the group life insurance policy is on a plan of insurance other than the term plan, it shall contain a nonforfeiture provision or provisions that, in the opinion of the commissioner, are equitable to the insured persons and to the policyholder, but nothing in this subdivision (a)(2)(C) shall be construed to require that group life insurance policies contain the same nonforfeiture provisions as are required for individual life insurance policies.
(3) The mandatory provisions referred to in subdivision (a)(1) are: (A) A provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder has given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during the grace period; (B) A provision that the validity of the policy shall not be contested, except for nonpayment of premiums after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability shall be used in contesting the validity of the insurance with respect to which the statement was made after the insurance has been in force prior to the contest for a period of two (2) years during the person's lifetime nor unless it is contained in a written instrument signed by the person; (C) A provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument is or has been furnished to the person or to the person's beneficiary; (D) A provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the person's coverage; (E) A provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, the provision to contain a clear statement of the method of adjustment to be used; (F) A provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the policy in the event there is no designated beneficiary, as to all or any part of the sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of the sum not exceeding five hundred dollars ($500) to any person appearing to the insurer to be equitably entitled to the sum by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured; (G) A provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in subdivisions (a)(3)(H)-(J); (H) A provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, the person shall be entitled to have issued to the person by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits; provided, that application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after the termination; and provided, further, that: (i) The individual policy shall, at the option of the person, be on any one (1) of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance; (ii) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of the termination, less the amount of any life insurance for which the person is or becomes eligible under the same or any other group policy within thirty-one (31) days after the termination, except any amount of insurance that has matured on or before the date of the termination as an endowment payable to the person insured, whether in one (1) sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of the termination; and (iii) The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the person's age attained on the effective date of the individual policy; (I) A provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured under the policy at the date of the termination whose insurance terminates and who has been insured for at least five (5) years prior to the termination date shall be entitled to have issued to the person by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subdivision (a)(3)(H), except that the group policy may provide that the amount of the individual policy shall not exceed the smaller of: (i) The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after the termination; and (ii) Two thousand dollars ($2,000); (J) A provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with subdivision (a)(3)(H) or (I) and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the individual policy has been made; and (K) In the case of a policy issued to a creditor to insure debtors of the creditor, a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form that will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid under the policy by reason of the debtor's death shall be applied to reduce or extinguish the indebtedness.
(A) A provision that the policyholder is entitled to a grace period of thirty-one (31) days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder has given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during the grace period;
(B) A provision that the validity of the policy shall not be contested, except for nonpayment of premiums after it has been in force for two (2) years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability shall be used in contesting the validity of the insurance with respect to which the statement was made after the insurance has been in force prior to the contest for a period of two (2) years during the person's lifetime nor unless it is contained in a written instrument signed by the person;
(C) A provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the persons insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument is or has been furnished to the person or to the person's beneficiary;
(D) A provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the person's coverage;
(E) A provision specifying an equitable adjustment of premiums or of benefits or of both to be made in the event the age of a person insured has been misstated, the provision to contain a clear statement of the method of adjustment to be used;
(F) A provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, subject to the policy in the event there is no designated beneficiary, as to all or any part of the sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of the sum not exceeding five hundred dollars ($500) to any person appearing to the insurer to be equitably entitled to the sum by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured;
(G) A provision that the insurer will issue to the policyholder for delivery to each person insured an individual certificate setting forth a statement as to the insurance protection to which the person is entitled, to whom the insurance benefits are payable, and the rights and conditions set forth in subdivisions (a)(3)(H)-(J);
(H) A provision that if the insurance, or any portion of it, on a person covered under the policy ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, the person shall be entitled to have issued to the person by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits; provided, that application for the individual policy shall be made, and the first premium paid to the insurer, within thirty-one (31) days after the termination; and provided, further, that: (i) The individual policy shall, at the option of the person, be on any one (1) of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance; (ii) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of the termination, less the amount of any life insurance for which the person is or becomes eligible under the same or any other group policy within thirty-one (31) days after the termination, except any amount of insurance that has matured on or before the date of the termination as an endowment payable to the person insured, whether in one (1) sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of the termination; and (iii) The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the person's age attained on the effective date of the individual policy;
(i) The individual policy shall, at the option of the person, be on any one (1) of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance;
(ii) The individual policy shall be in an amount not in excess of the amount of life insurance that ceases because of the termination, less the amount of any life insurance for which the person is or becomes eligible under the same or any other group policy within thirty-one (31) days after the termination, except any amount of insurance that has matured on or before the date of the termination as an endowment payable to the person insured, whether in one (1) sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount that is considered to cease because of the termination; and
(iii) The premium on the individual policy shall be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which the person then belongs, and to the person's age attained on the effective date of the individual policy;
(I) A provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured under the policy at the date of the termination whose insurance terminates and who has been insured for at least five (5) years prior to the termination date shall be entitled to have issued to the person by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by subdivision (a)(3)(H), except that the group policy may provide that the amount of the individual policy shall not exceed the smaller of: (i) The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after the termination; and (ii) Two thousand dollars ($2,000);
(i) The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under any group policy issued or reinstated by the same or another insurer within thirty-one (31) days after the termination; and
(ii) Two thousand dollars ($2,000);
(J) A provision that if a person insured under the group policy dies during the period within which the person would have been entitled to have an individual policy issued in accordance with subdivision (a)(3)(H) or (I) and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the individual policy has been made; and
(K) In the case of a policy issued to a creditor to insure debtors of the creditor, a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a form that will contain a statement that the life of the debtor is insured under the policy and that any death benefit paid under the policy by reason of the debtor's death shall be applied to reduce or extinguish the indebtedness.
(b) In the case of a policy that provides that each insured debtor whose protection under the group insurance policy terminates by reason of absolute assignment by the creditor of the insured debtor's indebtedness for the discharge of which the debtor when incurring the indebtedness had agreed upon installment payments over a period of more than ten (10) years, there shall be a provision that each insured debtor shall be entitled to have issued to the person by the insurer, without evidence of insurability, upon application made to the insurer and upon the payment of the premium applicable to the class of risk to which the person belongs and to the form and amount of the policy at that person's then attained age within thirty-one (31) days after the assignment of the indebtedness, an individual policy of life insurance; provided, that the individual policy of life insurance shall be in any one (1) of the level premium forms customarily issued by the insurer, except term insurance, in an amount equal to the amount of the person's protection terminated under the group insurance policy because of the assignment, less the amount of insurance for which the insured debtor may become eligible and qualify under any group insurance policy in effect with the assignee at the date of the assignment or issued to the assignee within the period of thirty-one (31) days; and provided, further, that in the event that the assignment of the indebtedness is made by the creditor at the request of the insured debtor, the insurer may require satisfactory evidence of the debtor's insurability before making the individual policy of life insurance effective. If the insured debtor dies during the period within which the debtor would have been entitled to have an individual policy issued in accordance with this subsection (b), and before the individual policy has become effective, the amount of life insurance that the person would have been entitled to have issued under the individual policy shall be payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium for the policy has been made.
(c) If any individual insured under a group life insurance policy delivered in this state becomes entitled under the terms of the policy to have an individual policy of life insurance issued to the person without evidence of insurability, subject to making of application and payment of the first premium within the period specified in the policy, and if the individual is not given notice of the existence of the right at least fifteen (15) days prior to the expiration date of the period, then the individual shall have an additional period within which to exercise the right, but nothing contained in this subsection (c) shall be construed to continue any insurance beyond the period provided in the policy. This additional period shall expire fifteen (15) days after the individual is given notice, but in no event shall the additional period extend beyond sixty (60) days after the expiration date of the period provided in the policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder shall constitute notice for the purpose of this subsection (c).
Acts 1957, ch. 122, § 1; 1976, ch. 417, § 6; 1976, ch. 461, § 1; 1977, ch. 15, § 1; T.C.A., § 56-1141; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-601 ; Acts 1994, ch. 577, § 1.
Tenn. Code Ann. § 56-7-802 — TN Code / Title 56 / Chapter 7 / Section 56-7-802
Measure of damages for loss by fire - Insured reimbursed for excess premiums
Status: in_force

If buildings within the state insured against loss by fire are totally destroyed by fire, the company shall not be liable beyond the actual value of the insured property at the time of the loss or damage; and if it appears that the insured has paid premiums on an amount in excess of the actual value, the insured shall be reimbursed the proportionate excess or premiums paid on the difference between the amount named in the policy and the actual value, with interest at six percent (6%) per annum from the date of issue; and the excess of premiums, and interest on the premiums, shall be allowed the insured from the time any companies carrying the insurance at the time of the loss have continuously carried the insurance on the destroyed buildings, whether under policies existing at the time of the loss or under previous policies in the same companies. Acts 1927, ch. 72, § 2; Code 1932, § 6173; T.C.A. (orig. ed.), § 56-1138.
If buildings within the state insured against loss by fire are totally destroyed by fire, the company shall not be liable beyond the actual value of the insured property at the time of the loss or damage; and if it appears that the insured has paid premiums on an amount in excess of the actual value, the insured shall be reimbursed the proportionate excess or premiums paid on the difference between the amount named in the policy and the actual value, with interest at six percent (6%) per annum from the date of issue; and the excess of premiums, and interest on the premiums, shall be allowed the insured from the time any companies carrying the insurance at the time of the loss have continuously carried the insurance on the destroyed buildings, whether under policies existing at the time of the loss or under previous policies in the same companies.
Acts 1927, ch. 72, § 2; Code 1932, § 6173; T.C.A. (orig. ed.), § 56-1138.
Tenn. Code Ann. § 56-1-904 — TN Code / Title 56 / Chapter 1 / Section 56-1-904
Computation of minimum standard
Status: in_force

Except as provided in §§ 56-1-905 , 56-1-906 and 56-1-913 , the minimum standard for the valuation of policies and contracts issued prior to January 1, 1962, shall be that provided by the laws in effect immediately prior to that date. Except as otherwise provided in §§ 56-1-905 , 56-1-906 and 56-1-913 , the minimum standard for the valuation of all policies and contracts issued on or after January 1, 1962, shall be the commissioner's reserve valuation methods defined in §§ 56-1-907 , 56-1-908 , 56-1-911 and 56-1-913 , three and one half percent (3.5%) interest, or in the case of life insurance policies and contracts, other than annuity and pure endowment contracts, issued on or after May 6, 1973, four percent (4%) interest for policies issued prior to March 13, 1978, five and one half percent (5.5%) interest for single premium life insurance policies and four and one half percent (4.5%) interest for all other policies issued on or after March 13, 1978, and the following tables: (1) For ordinary policies of life insurance issued on the standard basis, excluding any disability and accidental death benefits in the policies: the Commissioners 1941 Standard Ordinary Mortality Table for policies issued prior to the operative date of § 56-7-401(f) , the Commissioners 1958 Standard Ordinary Mortality Table for policies issued on or after the operative date of § 56-7-401(f) and prior to the operative date of § 56-7-401(h) ; provided, that, for any category of policies issued on female risks, all modified net premiums and present values referred to in this part may be calculated according to an age not more than six (6) years younger than the actual age of the insured; and for policies issued on or after the operative date of § 56-7-401(h) : (A) The Commissioners 1980 Standard Ordinary Mortality Table; (B) At the election of the company for any one (1) or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with Ten-Year Select Mortality Factors; or (C) Any ordinary mortality table, adopted after 1980 by the NAIC, which is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for such policies; (2) For industrial life insurance policies issued on the standard basis, excluding any disability and accidental death benefits in the policies: the 1941 Standard Industrial Mortality Table for policies issued prior to the operative date of § 56-7-401(g) , and for policies issued on or after the operative date of § 56-7-401(g) , the Commissioners 1961 Standard Industrial Mortality Table or any industrial mortality table adopted after 1980 by the NAIC that is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for the policies; (3) For individual annuity and pure endowment contracts, excluding any disability and accidental death benefits in the policies: the 1937 Standard Annuity Mortality Table, or at the option of the company, the Annuity Mortality Table for 1949, Ultimate or any modification of either of these tables approved by the commissioner; (4) For group annuity and pure endowment contracts, excluding any disability and accidental death benefits in the policies: the Group Annuity Mortality Table for 1951, a modification of the table approved by the commissioner, or at the option of the company, any of the tables or modifications of tables specified for individual annuity and pure endowment contracts; (5) For total and permanent disability benefits in or supplementary to ordinary policies or contracts: for policies or contracts issued on or after January 1, 1966, the tables of Period 2 disablement rates and the 1930 to 1950 termination rates of the 1952 Disability Study of the Society of Actuaries, with due regard to the type of benefit or any tables of disablement rates and termination rates adopted after 1980 by the NAIC, that are approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for those policies; for policies or contracts issued on or after January 1, 1961, and prior to January 1, 1966, either those tables or, at the option of the company, the Class (3) Disability Table (1926); and for policies issued prior to January 1, 1961, the Class (3) Disability Table (1926). Any such table shall, for active lives, be combined with a mortality table permitted for calculating the reserves for life insurance policies; (6) For accidental death benefits in or supplementary to policies issued on or after January 1, 1966: the 1959 Accidental Death Benefits Table or any accidental death benefits table adopted after 1980 by the NAIC that is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for those policies, for policies issued on or after January 1, 1961, and prior to January 1, 1966, either that table or, at the option of the company, the Inter-Company Double Indemnity Mortality Table; and for policies issued prior to January 1, 1961, the Inter-Company Double Indemnity Mortality Table. Either table shall be combined with a mortality table for calculating the reserves for life insurance policies; and (7) For group life insurance, life insurance issued on the substandard basis and other special benefits: tables approved by the commissioner. Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Except as provided in §§ 56-1-905 , 56-1-906 and 56-1-913 , the minimum standard for the valuation of policies and contracts issued prior to January 1, 1962, shall be that provided by the laws in effect immediately prior to that date. Except as otherwise provided in §§ 56-1-905 , 56-1-906 and 56-1-913 , the minimum standard for the valuation of all policies and contracts issued on or after January 1, 1962, shall be the commissioner's reserve valuation methods defined in §§ 56-1-907 , 56-1-908 , 56-1-911 and 56-1-913 , three and one half percent (3.5%) interest, or in the case of life insurance policies and contracts, other than annuity and pure endowment contracts, issued on or after May 6, 1973, four percent (4%) interest for policies issued prior to March 13, 1978, five and one half percent (5.5%) interest for single premium life insurance policies and four and one half percent (4.5%) interest for all other policies issued on or after March 13, 1978, and the following tables:
(1) For ordinary policies of life insurance issued on the standard basis, excluding any disability and accidental death benefits in the policies: the Commissioners 1941 Standard Ordinary Mortality Table for policies issued prior to the operative date of § 56-7-401(f) , the Commissioners 1958 Standard Ordinary Mortality Table for policies issued on or after the operative date of § 56-7-401(f) and prior to the operative date of § 56-7-401(h) ; provided, that, for any category of policies issued on female risks, all modified net premiums and present values referred to in this part may be calculated according to an age not more than six (6) years younger than the actual age of the insured; and for policies issued on or after the operative date of § 56-7-401(h) : (A) The Commissioners 1980 Standard Ordinary Mortality Table; (B) At the election of the company for any one (1) or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with Ten-Year Select Mortality Factors; or (C) Any ordinary mortality table, adopted after 1980 by the NAIC, which is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for such policies;
(A) The Commissioners 1980 Standard Ordinary Mortality Table;
(B) At the election of the company for any one (1) or more specified plans of life insurance, the Commissioners 1980 Standard Ordinary Mortality Table with Ten-Year Select Mortality Factors; or
(C) Any ordinary mortality table, adopted after 1980 by the NAIC, which is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for such policies;
(2) For industrial life insurance policies issued on the standard basis, excluding any disability and accidental death benefits in the policies: the 1941 Standard Industrial Mortality Table for policies issued prior to the operative date of § 56-7-401(g) , and for policies issued on or after the operative date of § 56-7-401(g) , the Commissioners 1961 Standard Industrial Mortality Table or any industrial mortality table adopted after 1980 by the NAIC that is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for the policies;
(3) For individual annuity and pure endowment contracts, excluding any disability and accidental death benefits in the policies: the 1937 Standard Annuity Mortality Table, or at the option of the company, the Annuity Mortality Table for 1949, Ultimate or any modification of either of these tables approved by the commissioner;
(4) For group annuity and pure endowment contracts, excluding any disability and accidental death benefits in the policies: the Group Annuity Mortality Table for 1951, a modification of the table approved by the commissioner, or at the option of the company, any of the tables or modifications of tables specified for individual annuity and pure endowment contracts;
(5) For total and permanent disability benefits in or supplementary to ordinary policies or contracts: for policies or contracts issued on or after January 1, 1966, the tables of Period 2 disablement rates and the 1930 to 1950 termination rates of the 1952 Disability Study of the Society of Actuaries, with due regard to the type of benefit or any tables of disablement rates and termination rates adopted after 1980 by the NAIC, that are approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for those policies; for policies or contracts issued on or after January 1, 1961, and prior to January 1, 1966, either those tables or, at the option of the company, the Class (3) Disability Table (1926); and for policies issued prior to January 1, 1961, the Class (3) Disability Table (1926). Any such table shall, for active lives, be combined with a mortality table permitted for calculating the reserves for life insurance policies;
(6) For accidental death benefits in or supplementary to policies issued on or after January 1, 1966: the 1959 Accidental Death Benefits Table or any accidental death benefits table adopted after 1980 by the NAIC that is approved by regulation promulgated by the commissioner for use in determining the minimum standard of valuation for those policies, for policies issued on or after January 1, 1961, and prior to January 1, 1966, either that table or, at the option of the company, the Inter-Company Double Indemnity Mortality Table; and for policies issued prior to January 1, 1961, the Inter-Company Double Indemnity Mortality Table. Either table shall be combined with a mortality table for calculating the reserves for life insurance policies; and
(7) For group life insurance, life insurance issued on the substandard basis and other special benefits: tables approved by the commissioner.
Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Tenn. Code Ann. § 56-7-905 — TN Code / Title 56 / Chapter 7 / Section 56-7-905
Credit life insurance policies - Prohibitions - Prerequisites - Filings - Reports
Status: in_force

(a) Credit life insurance policies that provide benefits differing in kind or character from the following shall not be permitted: (1) Individual policies of credit life insurance issued to debtors on the term plan; (2) Group policies of credit life insurance issued to creditors providing insurance upon the lives of debtors on the term plan; and (3) Other arrangements providing credit life insurance as may be approved by the commissioner. (b) No insurer shall issue a policy or certificate of credit life insurance covering a resident of this state unless: (1) The insurer is authorized to do business in this state; and (2) The policy or certificate is issued through holders of licenses or authorizations issued by the commissioner. (c) All policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders delivered or issued for delivery in this state and the schedules of premium rates pertaining to the policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders, shall be filed with the commissioner. (d) Insurers doing credit life insurance business in this state shall annually file with the commissioner a report of its credit life insurance experience on forms prescribed by the commissioner. Acts 1985, ch. 107, § 3.
(a) Credit life insurance policies that provide benefits differing in kind or character from the following shall not be permitted: (1) Individual policies of credit life insurance issued to debtors on the term plan; (2) Group policies of credit life insurance issued to creditors providing insurance upon the lives of debtors on the term plan; and (3) Other arrangements providing credit life insurance as may be approved by the commissioner.
(1) Individual policies of credit life insurance issued to debtors on the term plan;
(2) Group policies of credit life insurance issued to creditors providing insurance upon the lives of debtors on the term plan; and
(3) Other arrangements providing credit life insurance as may be approved by the commissioner.
(b) No insurer shall issue a policy or certificate of credit life insurance covering a resident of this state unless: (1) The insurer is authorized to do business in this state; and (2) The policy or certificate is issued through holders of licenses or authorizations issued by the commissioner.
(1) The insurer is authorized to do business in this state; and
(2) The policy or certificate is issued through holders of licenses or authorizations issued by the commissioner.
(c) All policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders delivered or issued for delivery in this state and the schedules of premium rates pertaining to the policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements and riders, shall be filed with the commissioner.
(d) Insurers doing credit life insurance business in this state shall annually file with the commissioner a report of its credit life insurance experience on forms prescribed by the commissioner.
Acts 1985, ch. 107, § 3.
Tenn. Code Ann. § 56-7-135 — TN Code / Title 56 / Chapter 7 / Section 56-7-135
Rebuttable presumption
Status: in_force

(a) The signature of an applicant for or party to an insurance contract on an application, amendment, or other document stating the type, amount, or terms and conditions of coverage, shall create a rebuttable presumption that the statements provided by the person bind all insureds under the contract and that the person signing such document has read, understands, and accepts the contents of such document. (b) The payment of premium for an insurance contract, or amendment thereto, by an insured shall create a rebuttable presumption that the coverage provided has been accepted by all insureds under the contract. Acts 2012, ch. 913, § 1.
(a) The signature of an applicant for or party to an insurance contract on an application, amendment, or other document stating the type, amount, or terms and conditions of coverage, shall create a rebuttable presumption that the statements provided by the person bind all insureds under the contract and that the person signing such document has read, understands, and accepts the contents of such document.
(b) The payment of premium for an insurance contract, or amendment thereto, by an insured shall create a rebuttable presumption that the coverage provided has been accepted by all insureds under the contract.
Acts 2012, ch. 913, § 1.