Tenn. Code Ann. § 56-7-608 — TN Code / Title 56 / Chapter 7 / Section 56-7-608
Applicability of part
Status: in_force

Except for § 56-7-3506, and notwithstanding § 56-7-1005, this part does not apply to: (1) Any managed care organization contracting with the state to provide insurance through the TennCare program or the CoverKids program; or (2) Any plan described in Section 1251 of the federal Patient Protection and Affordable Care Act ( 42 U.S.C. § 18011 ) and Section 2301 of the federal Health Care and Education Reconciliation Act. Acts 2019, ch. 407, § 1.
Except for § 56-7-3506, and notwithstanding § 56-7-1005, this part does not apply to:
(1) Any managed care organization contracting with the state to provide insurance through the TennCare program or the CoverKids program; or
(2) Any plan described in Section 1251 of the federal Patient Protection and Affordable Care Act ( 42 U.S.C. § 18011 ) and Section 2301 of the federal Health Care and Education Reconciliation Act.
Acts 2019, ch. 407, § 1.
Tenn. Code Ann. § 56-32-111 — TN Code / Title 56 / Chapter 32 / Section 56-32-111
Investments
Status: in_force

With the exception of investments made in accordance with § 56-32-105 , the funds of an HMO shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or other securities or investments that the commissioner permits. Acts 1986, ch. 713, § 11; T.C.A. § 56-32-211.
With the exception of investments made in accordance with § 56-32-105 , the funds of an HMO shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or other securities or investments that the commissioner permits.
Acts 1986, ch. 713, § 11; T.C.A. § 56-32-211.
Tenn. Code Ann. § 56-12-203 — TN Code / Title 56 / Chapter 12 / Section 56-12-203
Part definitions
Status: in_force

As used in this part: (1) "Account" means any of the accounts created under § 56-12-205 ; (2) "Association" means the Tennessee life and health insurance guaranty association created under § 56-12-205 ; (3) "Commissioner" means the commissioner of commerce and insurance; (4) "Contractual obligation" means an obligation under a policy or contract or certificate under a group policy or contract, or a portion thereof, for which coverage is provided under § 56-12-204 ; (5) "Covered contract" or "covered policy" means a contract or policy, or a portion of a contract or policy, for which coverage is provided under § 56-12-204 ; (6) "Extra-contractual claims" includes, for example, claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys' fees and costs; (7) "Health benefit plan" means any hospital or medical expense policy or certificate, or health maintenance organization subscriber contract or any other similar health contract. The term does not include accident only insurance, credit insurance, dental only insurance, vision only insurance, Medicare supplement insurance, disability income insurance, coverage for on-site medical clinics, benefits for long-term care, home health care, community-based care or any combination thereof, specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates, or other limited benefit or supplemental health insurance excluded from the definition of health insurance in § 56-1-105 ; (8) "Impaired insurer" means a member insurer which, after July 1, 1989, is not an insolvent insurer, and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction; (9) "Insolvent insurer" means a member insurer which, after July 1, 1989, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency; (10) "Insurance" means life, annuity, and health benefits provided under a contract issued by a member insurer; (11) "Long-term care insurance" has the same meaning as set forth in § 56-42-103(5) ; (12) "Member insurer" means an insurer, health maintenance organization, or nonprofit hospital and medical service organization licensed or that holds a certificate of authority to transact in this state any kind of insurance or health maintenance organization business for which coverage is provided under § 56-12-204 , and includes an insurer or health maintenance organization whose license or certificate of authority in this state may have been suspended, revoked, not renewed, or voluntarily withdrawn, but does not include: (A) A fraternal benefit society; (B) A mandatory state pooling plan; (C) A mutual assessment company or other person that operates on an assessment basis; (D) An insurance exchange; (E) An organization that is authorized under the law of this state to issue charitable gift annuities; or (F) An entity similar to any of the above; (13) "Moody's Corporate Bond Yield Average" means the Monthly Average Corporates as published by Moody's Investors Service, Inc., or any successor thereto; (14) "Owner" of a policy or contract and "policyholder," "policy owner," and "contract owner" mean the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. "Owner", "policyholder", "policy owner", and "contract owner" does not include persons with a mere beneficial interest in a policy or contract; (15) "Person" means an individual, corporation, limited liability company, partnership, association, governmental body or entity, or voluntary organization; (16) "Premiums" means amounts or considerations, by whatever name called, received on covered policies or contracts less returned premiums, considerations, and deposits and less dividends and experience credits. "Premiums" does not include amounts or considerations received for policies or contracts, or for the portions of policies or contracts for which coverage is not provided under § 56-12-204(b) , except that assessable premium must not be reduced on account of § 56-12-204(b)(2)(C) relating to interest limitations or § 56-12-204(c)(2) relating to limitations with respect to one (1) individual, one (1) participant, and one (1) policy or contract owner. "Premiums" does not include: (A) Premiums on an unallocated annuity contract; or (B) With respect to multiple non-group policies of life insurance owned by one (1) owner, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, premiums in excess of five million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner; (17) "Principal place of business" of a person, other than a natural person, means the single state in which the natural person who establishes a policy for the direction, control, and coordination of the operations of the entity as a whole, primarily exercises that function as determined by the association in its reasonable judgment by considering the following factors: (A) The state in which the primary executive and administrative headquarters of the entity is located; (B) The state in which the principal office of the chief executive officer of the entity is located; (C) The state in which the board of directors or similar governing person or persons of the entity conducts the majority of its meetings; (D) The state in which the executive or management committee of the board of directors or similar governing person or persons of the entity conducts the majority of its meetings; and (E) The state from which the management of the overall operations of the entity is directed; (18) "Receivership court" means the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the member insurer; (19) "Resident" means a person to whom a contractual obligation is owed and who resides in this state on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer. A person may be a resident of only one (1) state, which, in the case of a person other than a natural person, is its principal place of business. Citizens of the United States who are either residents of foreign countries or residents of United States possessions, territories, or protectorates that do not have an association similar to the association created by this part are deemed residents of the state of domicile of the member insurer that issued the policies or contracts; (20) "State" means a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate; (21) "Structured settlement annuity" means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for, or with respect to, personal injury suffered by the plaintiff or other claimant; (22) "Supplemental contract" means a written agreement entered into for the distribution of proceeds under a life, health, or annuity policy or contract; and (23) "Unallocated annuity contract" means an annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate. Amended by 2019 Tenn. Acts, ch. 5,s 2, eff. 7/1/2019. Acts 1988, ch. 1032, § 4; 1995, ch. 110, § 1; 2000, ch. 895, § 12; 2010, ch. 713, § 1.
As used in this part:
(1) "Account" means any of the accounts created under § 56-12-205 ;
(2) "Association" means the Tennessee life and health insurance guaranty association created under § 56-12-205 ;
(3) "Commissioner" means the commissioner of commerce and insurance;
(4) "Contractual obligation" means an obligation under a policy or contract or certificate under a group policy or contract, or a portion thereof, for which coverage is provided under § 56-12-204 ;
(5) "Covered contract" or "covered policy" means a contract or policy, or a portion of a contract or policy, for which coverage is provided under § 56-12-204 ;
(6) "Extra-contractual claims" includes, for example, claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys' fees and costs;
(7) "Health benefit plan" means any hospital or medical expense policy or certificate, or health maintenance organization subscriber contract or any other similar health contract. The term does not include accident only insurance, credit insurance, dental only insurance, vision only insurance, Medicare supplement insurance, disability income insurance, coverage for on-site medical clinics, benefits for long-term care, home health care, community-based care or any combination thereof, specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates, or other limited benefit or supplemental health insurance excluded from the definition of health insurance in § 56-1-105 ;
(8) "Impaired insurer" means a member insurer which, after July 1, 1989, is not an insolvent insurer, and is placed under an order of rehabilitation or conservation by a court of competent jurisdiction;
(9) "Insolvent insurer" means a member insurer which, after July 1, 1989, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency;
(10) "Insurance" means life, annuity, and health benefits provided under a contract issued by a member insurer;
(11) "Long-term care insurance" has the same meaning as set forth in § 56-42-103(5) ;
(12) "Member insurer" means an insurer, health maintenance organization, or nonprofit hospital and medical service organization licensed or that holds a certificate of authority to transact in this state any kind of insurance or health maintenance organization business for which coverage is provided under § 56-12-204 , and includes an insurer or health maintenance organization whose license or certificate of authority in this state may have been suspended, revoked, not renewed, or voluntarily withdrawn, but does not include: (A) A fraternal benefit society; (B) A mandatory state pooling plan; (C) A mutual assessment company or other person that operates on an assessment basis; (D) An insurance exchange; (E) An organization that is authorized under the law of this state to issue charitable gift annuities; or (F) An entity similar to any of the above;
(A) A fraternal benefit society;
(B) A mandatory state pooling plan;
(C) A mutual assessment company or other person that operates on an assessment basis;
(D) An insurance exchange;
(E) An organization that is authorized under the law of this state to issue charitable gift annuities; or
(F) An entity similar to any of the above;
(13) "Moody's Corporate Bond Yield Average" means the Monthly Average Corporates as published by Moody's Investors Service, Inc., or any successor thereto;
(14) "Owner" of a policy or contract and "policyholder," "policy owner," and "contract owner" mean the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the member insurer. "Owner", "policyholder", "policy owner", and "contract owner" does not include persons with a mere beneficial interest in a policy or contract;
(15) "Person" means an individual, corporation, limited liability company, partnership, association, governmental body or entity, or voluntary organization;
(16) "Premiums" means amounts or considerations, by whatever name called, received on covered policies or contracts less returned premiums, considerations, and deposits and less dividends and experience credits. "Premiums" does not include amounts or considerations received for policies or contracts, or for the portions of policies or contracts for which coverage is not provided under § 56-12-204(b) , except that assessable premium must not be reduced on account of § 56-12-204(b)(2)(C) relating to interest limitations or § 56-12-204(c)(2) relating to limitations with respect to one (1) individual, one (1) participant, and one (1) policy or contract owner. "Premiums" does not include: (A) Premiums on an unallocated annuity contract; or (B) With respect to multiple non-group policies of life insurance owned by one (1) owner, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, premiums in excess of five million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner;
(A) Premiums on an unallocated annuity contract; or
(B) With respect to multiple non-group policies of life insurance owned by one (1) owner, whether the policy or contract owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees, or other persons, premiums in excess of five million dollars ($5,000,000) with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner;
(17) "Principal place of business" of a person, other than a natural person, means the single state in which the natural person who establishes a policy for the direction, control, and coordination of the operations of the entity as a whole, primarily exercises that function as determined by the association in its reasonable judgment by considering the following factors: (A) The state in which the primary executive and administrative headquarters of the entity is located; (B) The state in which the principal office of the chief executive officer of the entity is located; (C) The state in which the board of directors or similar governing person or persons of the entity conducts the majority of its meetings; (D) The state in which the executive or management committee of the board of directors or similar governing person or persons of the entity conducts the majority of its meetings; and (E) The state from which the management of the overall operations of the entity is directed;
(A) The state in which the primary executive and administrative headquarters of the entity is located;
(B) The state in which the principal office of the chief executive officer of the entity is located;
(C) The state in which the board of directors or similar governing person or persons of the entity conducts the majority of its meetings;
(D) The state in which the executive or management committee of the board of directors or similar governing person or persons of the entity conducts the majority of its meetings; and
(E) The state from which the management of the overall operations of the entity is directed;
(18) "Receivership court" means the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the member insurer;
(19) "Resident" means a person to whom a contractual obligation is owed and who resides in this state on the date of entry of a court order that determines a member insurer to be an impaired insurer or a court order that determines a member insurer to be an insolvent insurer. A person may be a resident of only one (1) state, which, in the case of a person other than a natural person, is its principal place of business. Citizens of the United States who are either residents of foreign countries or residents of United States possessions, territories, or protectorates that do not have an association similar to the association created by this part are deemed residents of the state of domicile of the member insurer that issued the policies or contracts;
(20) "State" means a state, the District of Columbia, Puerto Rico, and a United States possession, territory, or protectorate;
(21) "Structured settlement annuity" means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for, or with respect to, personal injury suffered by the plaintiff or other claimant;
(22) "Supplemental contract" means a written agreement entered into for the distribution of proceeds under a life, health, or annuity policy or contract; and
(23) "Unallocated annuity contract" means an annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.
Amended by 2019 Tenn. Acts, ch. 5,s 2, eff. 7/1/2019.
Acts 1988, ch. 1032, § 4; 1995, ch. 110, § 1; 2000, ch. 895, § 12; 2010, ch. 713, § 1.
Tenn. Code Ann. § 56-3-401 — TN Code / Title 56 / Chapter 3 / Section 56-3-401
Part definitions
Status: in_force

As used in this part, unless the context otherwise requires: (1) "Domestic insurance company" means an insurance company, other than life and fraternal insurance companies, nonprofit hospital and medical service corporations, nonprofit dental service corporations, nonprofit vision service corporations and title insurance companies, incorporated under the laws of this state; (2) "Fixed charges" includes interest on all bonds and other evidence of indebtedness, and amortization of debt discount and expenses; (3) "Institution" includes a corporation, a joint-stock association and a business trust; (4) "Net earnings available for fixed charges" means net income determined on either a consolidated or an unconsolidated basis after allowance for operating and maintenance expenses, depreciation and depletion, and taxes, other than federal and state income taxes, but excluding extraordinary nonrecurring items of income or expense appearing in the regular financial statements of the issuing, assuming or guaranteeing institution. In applying the test of "net earnings available for fixed charges" to an issuing, assuming or guaranteeing institution or a lessee, whether or not in legal existence during the whole of the test period, that has at or prior to the date of investment by the insurance company acquired the assets of any other institution by purchase, merger, consolidation or otherwise substantially as an entirety, net earnings available for fixed charges of the predecessor or constituent institution for such portion of the test period as preceded acquisition may be included in the net earnings of the issuing, assuming or guaranteeing institution or the lessee, in accordance with consolidated earnings statement covering the period. The requirements imposed by § 56-3-402(2) and (13) upon the issuing, assuming or guaranteeing institution or the lessee are deemed to have been met if at the time the investment is made an institution that meets the requirements has guaranteed the indebtedness or has otherwise become obligated to pay amounts that are applicable to the payment of and sufficient to discharge the principal of and interest on the indebtedness in accordance with the terms of the indebtedness; provided, that, in determining whether the requirements have been met, the pro forma annual interest on the indebtedness is included in the fixed charges of the institution applicable to the test period in question; (5) "Net earnings available for fixed charges and dividends" are determined in the same manner as "net earnings available for fixed charges" but after allowance for federal and state income taxes; (6) "Preferred dividend requirements" means dividends at the maximum prescribed rate on all preferred stock of the same class as that being acquired by the insurance company and on all stock ranking as to dividends on a parity with the dividends or prior to the dividends, whether or not the dividends are cumulative; and (7) "State" includes the several states, the District of Columbia, the Commonwealth of Puerto Rico and the possessions of the United States. Acts 1979, ch. 305, § 2; T.C.A., § 56-361.
As used in this part, unless the context otherwise requires:
(1) "Domestic insurance company" means an insurance company, other than life and fraternal insurance companies, nonprofit hospital and medical service corporations, nonprofit dental service corporations, nonprofit vision service corporations and title insurance companies, incorporated under the laws of this state;
(2) "Fixed charges" includes interest on all bonds and other evidence of indebtedness, and amortization of debt discount and expenses;
(3) "Institution" includes a corporation, a joint-stock association and a business trust;
(4) "Net earnings available for fixed charges" means net income determined on either a consolidated or an unconsolidated basis after allowance for operating and maintenance expenses, depreciation and depletion, and taxes, other than federal and state income taxes, but excluding extraordinary nonrecurring items of income or expense appearing in the regular financial statements of the issuing, assuming or guaranteeing institution. In applying the test of "net earnings available for fixed charges" to an issuing, assuming or guaranteeing institution or a lessee, whether or not in legal existence during the whole of the test period, that has at or prior to the date of investment by the insurance company acquired the assets of any other institution by purchase, merger, consolidation or otherwise substantially as an entirety, net earnings available for fixed charges of the predecessor or constituent institution for such portion of the test period as preceded acquisition may be included in the net earnings of the issuing, assuming or guaranteeing institution or the lessee, in accordance with consolidated earnings statement covering the period. The requirements imposed by § 56-3-402(2) and (13) upon the issuing, assuming or guaranteeing institution or the lessee are deemed to have been met if at the time the investment is made an institution that meets the requirements has guaranteed the indebtedness or has otherwise become obligated to pay amounts that are applicable to the payment of and sufficient to discharge the principal of and interest on the indebtedness in accordance with the terms of the indebtedness; provided, that, in determining whether the requirements have been met, the pro forma annual interest on the indebtedness is included in the fixed charges of the institution applicable to the test period in question;
(5) "Net earnings available for fixed charges and dividends" are determined in the same manner as "net earnings available for fixed charges" but after allowance for federal and state income taxes;
(6) "Preferred dividend requirements" means dividends at the maximum prescribed rate on all preferred stock of the same class as that being acquired by the insurance company and on all stock ranking as to dividends on a parity with the dividends or prior to the dividends, whether or not the dividends are cumulative; and
(7) "State" includes the several states, the District of Columbia, the Commonwealth of Puerto Rico and the possessions of the United States.
Acts 1979, ch. 305, § 2; T.C.A., § 56-361.
Tenn. Code Ann. § 56-6-117 — TN Code / Title 56 / Chapter 6 / Section 56-6-117
Notification to commissioner of termination
Status: in_force

(a) Termination for Cause. An insurer or authorized representative of the insurer that terminates the appointment, employment, contract or other insurance business relationship with a producer shall notify the commissioner within thirty (30) days following the effective date of the termination, using a format prescribed by the commissioner, if the reason for termination is one of the reasons set forth in § 56-6-112 or the insurer has knowledge the producer was found by a court, government body, or self-regulatory organization authorized by law to have engaged in any of the activities described in § 56-6-112 . Upon the written request of the commissioner, the insurer shall provide additional information, documents, records or other data pertaining to the termination or activity of the producer. (b) Termination Without Cause. An insurer or authorized representative of the insurer that terminates the appointment, employment, or contract with a producer for any reason not set forth in § 56-6-112 shall notify the commissioner within thirty (30) days following the effective date of the termination, using a format prescribed by the commissioner. Upon written request of the commissioner, the insurer shall provide additional information, documents, records or other data pertaining to the termination. (c) Termination of Appointment Fee. An insurer shall pay a termination of appointment fee, in the amount set forth in § 56-6-121 , for each insurance producer appointment terminated by the insurer. (d) Ongoing Notification Requirement. The insurer or the authorized representative of the insurer shall promptly notify the commissioner in a format acceptable to the commissioner if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the commissioner in accordance with subsection (a) had the insurer known of its existence at the time the insurer initially notified the commissioner. (e) Copy of Notification to be Provided to Producer. (1) Within fifteen (15) days after making the notification required by subsections (a), (b) and (d), the insurer shall mail a copy of the notification to the producer at the producer's last known address. If the producer is terminated for cause for any of the reasons listed in § 56-6-112 , the insurer shall provide a copy of the notification to the producer at the producer's last known address by certified mail, return receipt requested, postage prepaid or by overnight delivery using a nationally recognized carrier. (2) Within thirty (30) days after the producer has received the original or additional notification, the producer may file written comments concerning the substance of the notification with the commissioner. The producer shall, by the same means, simultaneously send a copy of the comments to the reporting insurer, and the comments shall become a part of the commissioner's file and accompany every copy of a report distributed or disclosed for any reason about the producer as permitted under subsection (g). (f) Immunities. (1) In the absence of actual malice, an insurer, the authorized representative of the insurer, a producer, the commissioner, or an organization of which the commissioner is a member and that compiles the information and makes it available to other commissioners or regulatory or law enforcement agencies shall not be subject to civil liability, and a civil cause of action of any nature shall not arise against these entities or their respective agents or employees, as a result of any statement or information required by or provided pursuant to this section or any information relating to any statement that may be requested in writing by the commissioner from an insurer or producer; or a statement by a terminating insurer or producer to an insurer or producer limited solely and exclusively to whether a termination for cause under subsection (a) was reported to the commissioner; provided, that the propriety of any termination for cause under subsection (a) is certified in writing by an officer or authorized representative of the insurer or producer terminating the relationship. (2) In any action brought against a person that may have immunity under subdivision (f)(1) for making any statement required by this section or providing any information relating to any statement that may be requested by the commissioner, the party bringing the action shall plead specifically in any allegation that subdivision (f)(1) does not apply because the person making the statement or providing the information did so with actual malice. (3) Subdivision (f)(1) or (f)(2) shall not abrogate or modify any existing statutory or common law privileges or immunities. (g) Confidentiality. (1) (A) All testimony, documents, other information in the control or possession of the department that is obtained by the commissioner in an investigation pursuant to this section shall, except as provided in subdivision (g)(1)(B), be confidential and absolutely privileged and shall not be: (i) Subject to § 10-7-503(a) or § 56-1-602 ; (ii) Subject to subpoena; (iii) Subject to discovery; or (iv) Admissible as evidence in any private civil action. (B) Notwithstanding subdivision (g)(1)(A), the commissioner is authorized to use the testimony, documents, and other information in the control or possession of the department in the furtherance of any regulatory or legal action brought as a part of the commissioner's duties. (2) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subdivision (g)(1). (3) In order to assist in the performance of the commissioner's duties under this part, the commissioner may: (A) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subdivision (g)(1), with other state, federal, and international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, federal, and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information; (B) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC, its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and (C) Enter into agreements governing sharing and use of information consistent with this subsection (g). (4) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (g)(3). (5) Nothing in this part shall prohibit the commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to § 10-7-503(a) to a database or other clearinghouse service maintained by the NAIC, its affiliates or subsidiaries. (h) Penalties for Failing to Report. An insurer or the authorized representative of the insurer, or a producer that fails to report as required under this section or that is found to have falsely reported with actual malice by a court of competent jurisdiction may, after notice and hearing, have its license or certificate of authority suspended or revoked. In addition to or in lieu of the suspension or revocation of a license or certificate of authority, the commissioner may subject violators of this part to a civil penalty in an amount not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000) for each violation. Acts 2002, ch. 798, § 18; 2011, ch. 90, § 1.
(a) Termination for Cause. An insurer or authorized representative of the insurer that terminates the appointment, employment, contract or other insurance business relationship with a producer shall notify the commissioner within thirty (30) days following the effective date of the termination, using a format prescribed by the commissioner, if the reason for termination is one of the reasons set forth in § 56-6-112 or the insurer has knowledge the producer was found by a court, government body, or self-regulatory organization authorized by law to have engaged in any of the activities described in § 56-6-112 . Upon the written request of the commissioner, the insurer shall provide additional information, documents, records or other data pertaining to the termination or activity of the producer.
(b) Termination Without Cause. An insurer or authorized representative of the insurer that terminates the appointment, employment, or contract with a producer for any reason not set forth in § 56-6-112 shall notify the commissioner within thirty (30) days following the effective date of the termination, using a format prescribed by the commissioner. Upon written request of the commissioner, the insurer shall provide additional information, documents, records or other data pertaining to the termination.
(c) Termination of Appointment Fee. An insurer shall pay a termination of appointment fee, in the amount set forth in § 56-6-121 , for each insurance producer appointment terminated by the insurer.
(d) Ongoing Notification Requirement. The insurer or the authorized representative of the insurer shall promptly notify the commissioner in a format acceptable to the commissioner if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the commissioner in accordance with subsection (a) had the insurer known of its existence at the time the insurer initially notified the commissioner.
(e) Copy of Notification to be Provided to Producer. (1) Within fifteen (15) days after making the notification required by subsections (a), (b) and (d), the insurer shall mail a copy of the notification to the producer at the producer's last known address. If the producer is terminated for cause for any of the reasons listed in § 56-6-112 , the insurer shall provide a copy of the notification to the producer at the producer's last known address by certified mail, return receipt requested, postage prepaid or by overnight delivery using a nationally recognized carrier. (2) Within thirty (30) days after the producer has received the original or additional notification, the producer may file written comments concerning the substance of the notification with the commissioner. The producer shall, by the same means, simultaneously send a copy of the comments to the reporting insurer, and the comments shall become a part of the commissioner's file and accompany every copy of a report distributed or disclosed for any reason about the producer as permitted under subsection (g).
(1) Within fifteen (15) days after making the notification required by subsections (a), (b) and (d), the insurer shall mail a copy of the notification to the producer at the producer's last known address. If the producer is terminated for cause for any of the reasons listed in § 56-6-112 , the insurer shall provide a copy of the notification to the producer at the producer's last known address by certified mail, return receipt requested, postage prepaid or by overnight delivery using a nationally recognized carrier.
(2) Within thirty (30) days after the producer has received the original or additional notification, the producer may file written comments concerning the substance of the notification with the commissioner. The producer shall, by the same means, simultaneously send a copy of the comments to the reporting insurer, and the comments shall become a part of the commissioner's file and accompany every copy of a report distributed or disclosed for any reason about the producer as permitted under subsection (g).
(f) Immunities. (1) In the absence of actual malice, an insurer, the authorized representative of the insurer, a producer, the commissioner, or an organization of which the commissioner is a member and that compiles the information and makes it available to other commissioners or regulatory or law enforcement agencies shall not be subject to civil liability, and a civil cause of action of any nature shall not arise against these entities or their respective agents or employees, as a result of any statement or information required by or provided pursuant to this section or any information relating to any statement that may be requested in writing by the commissioner from an insurer or producer; or a statement by a terminating insurer or producer to an insurer or producer limited solely and exclusively to whether a termination for cause under subsection (a) was reported to the commissioner; provided, that the propriety of any termination for cause under subsection (a) is certified in writing by an officer or authorized representative of the insurer or producer terminating the relationship. (2) In any action brought against a person that may have immunity under subdivision (f)(1) for making any statement required by this section or providing any information relating to any statement that may be requested by the commissioner, the party bringing the action shall plead specifically in any allegation that subdivision (f)(1) does not apply because the person making the statement or providing the information did so with actual malice. (3) Subdivision (f)(1) or (f)(2) shall not abrogate or modify any existing statutory or common law privileges or immunities.
(1) In the absence of actual malice, an insurer, the authorized representative of the insurer, a producer, the commissioner, or an organization of which the commissioner is a member and that compiles the information and makes it available to other commissioners or regulatory or law enforcement agencies shall not be subject to civil liability, and a civil cause of action of any nature shall not arise against these entities or their respective agents or employees, as a result of any statement or information required by or provided pursuant to this section or any information relating to any statement that may be requested in writing by the commissioner from an insurer or producer; or a statement by a terminating insurer or producer to an insurer or producer limited solely and exclusively to whether a termination for cause under subsection (a) was reported to the commissioner; provided, that the propriety of any termination for cause under subsection (a) is certified in writing by an officer or authorized representative of the insurer or producer terminating the relationship.
(2) In any action brought against a person that may have immunity under subdivision (f)(1) for making any statement required by this section or providing any information relating to any statement that may be requested by the commissioner, the party bringing the action shall plead specifically in any allegation that subdivision (f)(1) does not apply because the person making the statement or providing the information did so with actual malice.
(3) Subdivision (f)(1) or (f)(2) shall not abrogate or modify any existing statutory or common law privileges or immunities.
(g) Confidentiality. (1) (A) All testimony, documents, other information in the control or possession of the department that is obtained by the commissioner in an investigation pursuant to this section shall, except as provided in subdivision (g)(1)(B), be confidential and absolutely privileged and shall not be: (i) Subject to § 10-7-503(a) or § 56-1-602 ; (ii) Subject to subpoena; (iii) Subject to discovery; or (iv) Admissible as evidence in any private civil action. (B) Notwithstanding subdivision (g)(1)(A), the commissioner is authorized to use the testimony, documents, and other information in the control or possession of the department in the furtherance of any regulatory or legal action brought as a part of the commissioner's duties. (2) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subdivision (g)(1). (3) In order to assist in the performance of the commissioner's duties under this part, the commissioner may: (A) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subdivision (g)(1), with other state, federal, and international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, federal, and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information; (B) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC, its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and (C) Enter into agreements governing sharing and use of information consistent with this subsection (g). (4) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (g)(3). (5) Nothing in this part shall prohibit the commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to § 10-7-503(a) to a database or other clearinghouse service maintained by the NAIC, its affiliates or subsidiaries.
(1) (A) All testimony, documents, other information in the control or possession of the department that is obtained by the commissioner in an investigation pursuant to this section shall, except as provided in subdivision (g)(1)(B), be confidential and absolutely privileged and shall not be: (i) Subject to § 10-7-503(a) or § 56-1-602 ; (ii) Subject to subpoena; (iii) Subject to discovery; or (iv) Admissible as evidence in any private civil action. (B) Notwithstanding subdivision (g)(1)(A), the commissioner is authorized to use the testimony, documents, and other information in the control or possession of the department in the furtherance of any regulatory or legal action brought as a part of the commissioner's duties.
(A) All testimony, documents, other information in the control or possession of the department that is obtained by the commissioner in an investigation pursuant to this section shall, except as provided in subdivision (g)(1)(B), be confidential and absolutely privileged and shall not be: (i) Subject to § 10-7-503(a) or § 56-1-602 ; (ii) Subject to subpoena; (iii) Subject to discovery; or (iv) Admissible as evidence in any private civil action.
(i) Subject to § 10-7-503(a) or § 56-1-602 ;
(ii) Subject to subpoena;
(iii) Subject to discovery; or
(iv) Admissible as evidence in any private civil action.
(B) Notwithstanding subdivision (g)(1)(A), the commissioner is authorized to use the testimony, documents, and other information in the control or possession of the department in the furtherance of any regulatory or legal action brought as a part of the commissioner's duties.
(2) Neither the commissioner nor any person who received documents, materials or other information while acting under the authority of the commissioner shall be permitted or required to testify in any private civil action concerning any confidential documents, materials, or information subject to subdivision (g)(1).
(3) In order to assist in the performance of the commissioner's duties under this part, the commissioner may: (A) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subdivision (g)(1), with other state, federal, and international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, federal, and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information; (B) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC, its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and (C) Enter into agreements governing sharing and use of information consistent with this subsection (g).
(A) Share documents, materials or other information, including the confidential and privileged documents, materials or information subject to subdivision (g)(1), with other state, federal, and international regulatory agencies, with the NAIC, its affiliates or subsidiaries, and with state, federal, and international law enforcement authorities; provided, that the recipient agrees to maintain the confidentiality and privileged status of the document, material or other information;
(B) Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC, its affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions, and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material or information; and
(C) Enter into agreements governing sharing and use of information consistent with this subsection (g).
(4) No waiver of any applicable privilege or claim of confidentiality in the documents, materials, or information shall occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subdivision (g)(3).
(5) Nothing in this part shall prohibit the commissioner from releasing final, adjudicated actions including for cause terminations that are open to public inspection pursuant to § 10-7-503(a) to a database or other clearinghouse service maintained by the NAIC, its affiliates or subsidiaries.
(h) Penalties for Failing to Report. An insurer or the authorized representative of the insurer, or a producer that fails to report as required under this section or that is found to have falsely reported with actual malice by a court of competent jurisdiction may, after notice and hearing, have its license or certificate of authority suspended or revoked. In addition to or in lieu of the suspension or revocation of a license or certificate of authority, the commissioner may subject violators of this part to a civil penalty in an amount not less than one hundred dollars ($100) nor more than one thousand dollars ($1,000) for each violation.
Acts 2002, ch. 798, § 18; 2011, ch. 90, § 1.
Tenn. Code Ann. § 56-49-108 — TN Code / Title 56 / Chapter 49 / Section 56-49-108
Commissioner approval of forms and rates
Status: in_force

(a) All policy forms and certificates of insurance to be delivered or issued for delivery in this state and the schedules of premium rates pertaining to the policy forms or certificates shall be filed with the commissioner. (b) The commissioner shall within thirty (30) days after the filing of the policy forms and certificates of insurance disapprove a form that does not conform to this chapter or to other applicable provisions of the insurance statutes and regulations and shall, within thirty (30) days of filing, disapprove a schedule of premium rates pertaining to the form if it does not conform to the standard set forth in subsection (e). (c) If the commissioner disapproves a form or schedule of premium rates in accordance with subsection (b), the commissioner shall promptly notify the insurer in writing of the disapproval, and it shall be unlawful for the insurer to issue or use the form or schedule. In the notice, the commissioner shall specify the reasons for disapproval and state that a hearing will be granted upon request pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5. (d) Unless the commissioner disapproves the form or schedule of premium rates in accordance with subsections (b) and (c) or gives written approval of the form or schedule within thirty (30) days after the filing, the form or schedule shall be deemed approved on the thirty-first day after the filing. (e) The schedule of premium rates shall not be excessive, inadequate or unfairly discriminatory. In determining whether a schedule of premium rates is excessive, inadequate or unfairly discriminatory, the commissioner shall take into account past and prospective loss experience, general and administrative expenses, loss settlement and adjustment expenses, reasonable creditor compensation and other acquisition costs including insurance tracking costs, reserves, taxes, licenses, fees and assessments, reasonable insurer profit and other relevant data. Rates are not unfairly discriminatory because different premiums result for different policyholders, including group policyholders, with similar loss exposures but different expense factors or similar expense factors but different loss exposures, nor are rates unfairly discriminatory if they are averaged broadly among all persons insured in this state or all persons insured under a group insurance policy. (f) The commissioner may withdraw approval of an approved form or schedule of premium rates when the commissioner would be required to disapprove the form or schedule of premium rates if it were filed at the time of the withdrawal. The withdrawal shall be in writing and shall specify the reasons for withdrawal and the effective date of the withdrawal. An insurer adversely affected by a withdrawal may, within thirty (30) days after receiving the written notification of the withdrawal, request a hearing pursuant to the Uniform Administrative Procedures Act to determine whether the withdrawal should be annulled, modified or confirmed. Unless the commissioner grants an extension in writing in the withdrawal or subsequently grants an extension, the withdrawal shall, in the absence of a request for hearing, become effective, prospectively and not retroactively, on the ninety-first day following delivery of the notice of withdrawal and, if the request for hearing is filed, on the ninety-first day following delivery of written notice of the commissioner's determination. (g) Forms and rates filed and approved in accordance with this section shall be deemed to be in compliance in all respects with the laws of this state. Acts 1999, ch. 144, § 8.
(a) All policy forms and certificates of insurance to be delivered or issued for delivery in this state and the schedules of premium rates pertaining to the policy forms or certificates shall be filed with the commissioner.
(b) The commissioner shall within thirty (30) days after the filing of the policy forms and certificates of insurance disapprove a form that does not conform to this chapter or to other applicable provisions of the insurance statutes and regulations and shall, within thirty (30) days of filing, disapprove a schedule of premium rates pertaining to the form if it does not conform to the standard set forth in subsection (e).
(c) If the commissioner disapproves a form or schedule of premium rates in accordance with subsection (b), the commissioner shall promptly notify the insurer in writing of the disapproval, and it shall be unlawful for the insurer to issue or use the form or schedule. In the notice, the commissioner shall specify the reasons for disapproval and state that a hearing will be granted upon request pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(d) Unless the commissioner disapproves the form or schedule of premium rates in accordance with subsections (b) and (c) or gives written approval of the form or schedule within thirty (30) days after the filing, the form or schedule shall be deemed approved on the thirty-first day after the filing.
(e) The schedule of premium rates shall not be excessive, inadequate or unfairly discriminatory. In determining whether a schedule of premium rates is excessive, inadequate or unfairly discriminatory, the commissioner shall take into account past and prospective loss experience, general and administrative expenses, loss settlement and adjustment expenses, reasonable creditor compensation and other acquisition costs including insurance tracking costs, reserves, taxes, licenses, fees and assessments, reasonable insurer profit and other relevant data. Rates are not unfairly discriminatory because different premiums result for different policyholders, including group policyholders, with similar loss exposures but different expense factors or similar expense factors but different loss exposures, nor are rates unfairly discriminatory if they are averaged broadly among all persons insured in this state or all persons insured under a group insurance policy.
(f) The commissioner may withdraw approval of an approved form or schedule of premium rates when the commissioner would be required to disapprove the form or schedule of premium rates if it were filed at the time of the withdrawal. The withdrawal shall be in writing and shall specify the reasons for withdrawal and the effective date of the withdrawal. An insurer adversely affected by a withdrawal may, within thirty (30) days after receiving the written notification of the withdrawal, request a hearing pursuant to the Uniform Administrative Procedures Act to determine whether the withdrawal should be annulled, modified or confirmed. Unless the commissioner grants an extension in writing in the withdrawal or subsequently grants an extension, the withdrawal shall, in the absence of a request for hearing, become effective, prospectively and not retroactively, on the ninety-first day following delivery of the notice of withdrawal and, if the request for hearing is filed, on the ninety-first day following delivery of written notice of the commissioner's determination.
(g) Forms and rates filed and approved in accordance with this section shall be deemed to be in compliance in all respects with the laws of this state.
Acts 1999, ch. 144, § 8.
Tenn. Code Ann. § 56-7-1013 — TN Code / Title 56 / Chapter 7 / Section 56-7-1013
Access to health carriers' payment policies - Rules - Fee Schedules
Status: in_force

(a) (1) "Fee schedule" means a list of reimbursement amounts assigned to specific codes and used by a health insurance carrier pursuant to a contract between a health insurance carrier and a healthcare provider to calculate payments paid to the provider for therapies, procedures, materials, and other services delivered to enrollees. (2) As used in this section, "health insurance carrier" means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts with healthcare providers in connection with a plan of health insurance, health benefits or health services; (b) Health insurance carriers shall provide or make available to a healthcare provider, when contracting or renewing an existing contract with the provider, the payment or fee schedules or other information sufficient to enable the healthcare provider to determine the manner and amount of payments under the contract for the healthcare provider's services prior to final execution or renewal of the contract. The payment or fee schedule or other information submitted to a healthcare provider pursuant to this section shall include a description of processes and factors that may be applicable and that may affect actual payment, e.g., copayments, coinsurance, deductibles, risk sharing arrangements and liability of third parties. A health insurance carrier, upon request of a healthcare provider, shall make available to the healthcare provider examples of actual payment for procedures frequently performed by the provider that involve combinations of services or payment codes, if the actual payment for the procedures can not be ascertained from the fee schedule or other information submitted to a healthcare provider pursuant to this section. The provisions of this subsection (b) requiring the submission of a fee schedule or other information upon renewal of an existing contract shall not be applicable to renewal of an existing contract when the payment or fee schedule previously provided to the healthcare provider has not changed. (c) (1) Except as otherwise provided in subdivision (g)(2), a health insurance carrier shall provide notice of and identify any change to a provider's fee schedule and the effective date of the change at least ninety (90) days prior to the effective date of the change. The notice and identification required by this subdivision (c)(1) shall be sent to a dedicated email address or as otherwise stipulated in the contract between the provider and the health insurance carrier. The provider shall submit to the health insurance carrier a dedicated email address to receive the disclosures required by this part. (2) A health insurance carrier shall not require any hospital, by contract, reimbursement or otherwise, to notify the health insurance carrier of a hospital inpatient admission within less than one (1) business day of the hospital inpatient admission if the notification or admission occurs on a weekend or federal holiday. Nothing in this subsection (c) shall affect the applicability or administration of other provisions of a contract between a hospital and health insurance carrier, including, without limitation, preauthorization requirements for scheduled inpatient admissions. (3) This subsection (c) shall not apply to changes in standard codes and guidelines developed by the American Medical Association or a similar organization. (d) A healthcare provider receiving information pursuant to subsection (b) shall not share the information with an unrelated person without the prior written consent of the health insurance carrier. The remedies available to a health insurance carrier to enforce this subsection (d) shall include, but not be limited to, injunctive relief. A health insurance carrier seeking extraordinary relief to enforce this subsection (d) shall not be required to establish irreparable harm with regard to the sharing of competitively sensitive information. (e) This section shall not apply to nonprofit dental service corporations established under chapter 30 of this title. (f) A health insurance carrier shall: (1) Within ten (10) business days of receipt of a written request from a provider, deliver to the provider at the provider's dedicated email address that provider's fee schedule, free of charge, in either a partial or full version as requested by the provider, in a transferable industry standard spreadsheet, including Microsoft Excel or other comparable format; or (2) Provide access to the provider's fee schedule on a secure website, so that the provider may access the fee schedule at any time throughout the term of the provider's contract with the health insurance carrier. Nothing in this subdivision (f)(2) requires a health insurance carrier to provide a fee schedule through or on a website. (g) (1) Except as otherwise provided in subdivision (g)(2), no health insurance carrier shall make a change or changes to a provider's fee schedule except as follows: (A) Up to one (1) time during a consecutive twelve-month period. After a health insurance carrier makes a change or changes to the provider's fee schedule, it is prohibited from doing so again for at least twelve (12) months following the effective date of the change or changes; or (B) If a health insurance carrier and a hospital agree to the change or changes in writing. (2) Subdivisions (c)(1) and (g)(1) do not apply to the following changes to a fee schedule: (A) Any change in a provider's fee schedule due to a change effected by the federal or state government to its healthcare fee schedule, if the provider and health insurance carrier have previously agreed that the provider's fee schedule is based on a percentage or some other formula of a current government healthcare fee schedule, such as Medicare; (B) Any change in a provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and health insurance carrier or pharmacy benefits manager as defined by § 56-7-3102 have previously agreed that any reimbursement for drugs, immunizations, injectables, supplies, or devices will be based on a percentage, or some other formula, of a price index not established by the health insurance carrier, such as the average wholesale price or average sales price; (C) Any changes in the provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the health insurance carrier or pharmacy benefits manager as defined in § 56-7-3102 have previously agreed to any reimbursement for drugs, immunizations, injectables, supplies, or devices in accordance with § 56-7-3104 and based upon maximum allowable cost pricing as regulated by §§ 56-7-3101 and 56-7-3106 ; (D) Any change to Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, International Statistical Classification of Disease and Related Health Problems (ICD) Codes, or other coding sets recognized or used by Centers for Medicare and Medicaid Services (CMS) that a health insurance carrier utilized in creating a provider's fee schedule; (E) Any change to revenue codes as established by the National Uniform Billing Committee (NUBC); (F) Any changes in a provider's fee schedule due to one (1) or more of the following if previously agreed to in a provider's agreement with a health insurance carrier: (i) Payments made to the healthcare provider by the health insurance carrier or payments made to the health insurance carrier by the provider that are based on values or quality measures explicitly described in the written agreement between the provider and the health insurance carrier intended to improve care provided to the health insurance carrier's members; (ii) Escalator or de-escalator clauses; (iii) Provisions that require adjustments to payment due to population health management performance or results; or (iv) Any arrangements, initiatives, or value-based payments relating to or resulting from the implementation or operation of the Tennessee Health Care Innovation Initiative or any successor state program applicable to provider agreements covered by this section. (h) Notwithstanding any law to the contrary, including other provisions of this section, nothing in this section applies to: (1) An enrollee's benefit package, or coverage terms and conditions, unrelated to application of fee schedules and reimbursements, including, but not limited to, provisions regarding eligibility for coverage, deductibles and copayments, coordination of benefits, and coverage limitations and exclusions; (2) An entity that is subject to delinquency proceedings and for which the commissioner of commerce and insurance has been appointed receiver, or an entity placed under administrative supervision by order of the commissioner pursuant to the Insurers Rehabilitation and Liquidation Act, compiled in chapter 9 of this title; (3) A contract amendment that is made due to a change in federal or state law; (4) A contract between a health insurance carrier and a healthcare provider for items or services to be provided for individuals covered by any Medicare Advantage, Medicare Select, Medicare Supplement, Medicare and Medicaid Enrollees (MME), Medicare Dual Special Needs, and Medicare Private Fee for Service; or the state, local government, and local education insurance plans established under title 8, chapter 27; (5) The TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in part 29 of this chapter; any other plan managed by the health care finance administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27; or (6) The Prior Authorization Fairness Act, compiled in part 37 of this chapter. Amended by 2023 Tenn. Acts, ch. 395, s 3, eff. 1/1/2025. Amended by 2017 Tenn. Acts, ch. 88, Secs.s 3, s 4 eff. 1/1/2019. Amended by 2017 Tenn. Acts, ch. 88, s 2, eff. 1/1/2019. Acts 2002, ch. 638, §§ 1, 2; 2008 , ch. 987, § 1; 2009 , ch. 333, § 1.
(a) (1) "Fee schedule" means a list of reimbursement amounts assigned to specific codes and used by a health insurance carrier pursuant to a contract between a health insurance carrier and a healthcare provider to calculate payments paid to the provider for therapies, procedures, materials, and other services delivered to enrollees. (2) As used in this section, "health insurance carrier" means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts with healthcare providers in connection with a plan of health insurance, health benefits or health services;
(1) "Fee schedule" means a list of reimbursement amounts assigned to specific codes and used by a health insurance carrier pursuant to a contract between a health insurance carrier and a healthcare provider to calculate payments paid to the provider for therapies, procedures, materials, and other services delivered to enrollees.
(2) As used in this section, "health insurance carrier" means any entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner of commerce and insurance, that contracts with healthcare providers in connection with a plan of health insurance, health benefits or health services;
(b) Health insurance carriers shall provide or make available to a healthcare provider, when contracting or renewing an existing contract with the provider, the payment or fee schedules or other information sufficient to enable the healthcare provider to determine the manner and amount of payments under the contract for the healthcare provider's services prior to final execution or renewal of the contract. The payment or fee schedule or other information submitted to a healthcare provider pursuant to this section shall include a description of processes and factors that may be applicable and that may affect actual payment, e.g., copayments, coinsurance, deductibles, risk sharing arrangements and liability of third parties. A health insurance carrier, upon request of a healthcare provider, shall make available to the healthcare provider examples of actual payment for procedures frequently performed by the provider that involve combinations of services or payment codes, if the actual payment for the procedures can not be ascertained from the fee schedule or other information submitted to a healthcare provider pursuant to this section. The provisions of this subsection (b) requiring the submission of a fee schedule or other information upon renewal of an existing contract shall not be applicable to renewal of an existing contract when the payment or fee schedule previously provided to the healthcare provider has not changed.
(c) (1) Except as otherwise provided in subdivision (g)(2), a health insurance carrier shall provide notice of and identify any change to a provider's fee schedule and the effective date of the change at least ninety (90) days prior to the effective date of the change. The notice and identification required by this subdivision (c)(1) shall be sent to a dedicated email address or as otherwise stipulated in the contract between the provider and the health insurance carrier. The provider shall submit to the health insurance carrier a dedicated email address to receive the disclosures required by this part. (2) A health insurance carrier shall not require any hospital, by contract, reimbursement or otherwise, to notify the health insurance carrier of a hospital inpatient admission within less than one (1) business day of the hospital inpatient admission if the notification or admission occurs on a weekend or federal holiday. Nothing in this subsection (c) shall affect the applicability or administration of other provisions of a contract between a hospital and health insurance carrier, including, without limitation, preauthorization requirements for scheduled inpatient admissions. (3) This subsection (c) shall not apply to changes in standard codes and guidelines developed by the American Medical Association or a similar organization.
(1) Except as otherwise provided in subdivision (g)(2), a health insurance carrier shall provide notice of and identify any change to a provider's fee schedule and the effective date of the change at least ninety (90) days prior to the effective date of the change. The notice and identification required by this subdivision (c)(1) shall be sent to a dedicated email address or as otherwise stipulated in the contract between the provider and the health insurance carrier. The provider shall submit to the health insurance carrier a dedicated email address to receive the disclosures required by this part.
(2) A health insurance carrier shall not require any hospital, by contract, reimbursement or otherwise, to notify the health insurance carrier of a hospital inpatient admission within less than one (1) business day of the hospital inpatient admission if the notification or admission occurs on a weekend or federal holiday. Nothing in this subsection (c) shall affect the applicability or administration of other provisions of a contract between a hospital and health insurance carrier, including, without limitation, preauthorization requirements for scheduled inpatient admissions.
(3) This subsection (c) shall not apply to changes in standard codes and guidelines developed by the American Medical Association or a similar organization.
(d) A healthcare provider receiving information pursuant to subsection (b) shall not share the information with an unrelated person without the prior written consent of the health insurance carrier. The remedies available to a health insurance carrier to enforce this subsection (d) shall include, but not be limited to, injunctive relief. A health insurance carrier seeking extraordinary relief to enforce this subsection (d) shall not be required to establish irreparable harm with regard to the sharing of competitively sensitive information.
(e) This section shall not apply to nonprofit dental service corporations established under chapter 30 of this title.
(f) A health insurance carrier shall: (1) Within ten (10) business days of receipt of a written request from a provider, deliver to the provider at the provider's dedicated email address that provider's fee schedule, free of charge, in either a partial or full version as requested by the provider, in a transferable industry standard spreadsheet, including Microsoft Excel or other comparable format; or (2) Provide access to the provider's fee schedule on a secure website, so that the provider may access the fee schedule at any time throughout the term of the provider's contract with the health insurance carrier. Nothing in this subdivision (f)(2) requires a health insurance carrier to provide a fee schedule through or on a website.
(1) Within ten (10) business days of receipt of a written request from a provider, deliver to the provider at the provider's dedicated email address that provider's fee schedule, free of charge, in either a partial or full version as requested by the provider, in a transferable industry standard spreadsheet, including Microsoft Excel or other comparable format; or
(2) Provide access to the provider's fee schedule on a secure website, so that the provider may access the fee schedule at any time throughout the term of the provider's contract with the health insurance carrier. Nothing in this subdivision (f)(2) requires a health insurance carrier to provide a fee schedule through or on a website.
(g) (1) Except as otherwise provided in subdivision (g)(2), no health insurance carrier shall make a change or changes to a provider's fee schedule except as follows: (A) Up to one (1) time during a consecutive twelve-month period. After a health insurance carrier makes a change or changes to the provider's fee schedule, it is prohibited from doing so again for at least twelve (12) months following the effective date of the change or changes; or (B) If a health insurance carrier and a hospital agree to the change or changes in writing. (2) Subdivisions (c)(1) and (g)(1) do not apply to the following changes to a fee schedule: (A) Any change in a provider's fee schedule due to a change effected by the federal or state government to its healthcare fee schedule, if the provider and health insurance carrier have previously agreed that the provider's fee schedule is based on a percentage or some other formula of a current government healthcare fee schedule, such as Medicare; (B) Any change in a provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and health insurance carrier or pharmacy benefits manager as defined by § 56-7-3102 have previously agreed that any reimbursement for drugs, immunizations, injectables, supplies, or devices will be based on a percentage, or some other formula, of a price index not established by the health insurance carrier, such as the average wholesale price or average sales price; (C) Any changes in the provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the health insurance carrier or pharmacy benefits manager as defined in § 56-7-3102 have previously agreed to any reimbursement for drugs, immunizations, injectables, supplies, or devices in accordance with § 56-7-3104 and based upon maximum allowable cost pricing as regulated by §§ 56-7-3101 and 56-7-3106 ; (D) Any change to Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, International Statistical Classification of Disease and Related Health Problems (ICD) Codes, or other coding sets recognized or used by Centers for Medicare and Medicaid Services (CMS) that a health insurance carrier utilized in creating a provider's fee schedule; (E) Any change to revenue codes as established by the National Uniform Billing Committee (NUBC); (F) Any changes in a provider's fee schedule due to one (1) or more of the following if previously agreed to in a provider's agreement with a health insurance carrier: (i) Payments made to the healthcare provider by the health insurance carrier or payments made to the health insurance carrier by the provider that are based on values or quality measures explicitly described in the written agreement between the provider and the health insurance carrier intended to improve care provided to the health insurance carrier's members; (ii) Escalator or de-escalator clauses; (iii) Provisions that require adjustments to payment due to population health management performance or results; or (iv) Any arrangements, initiatives, or value-based payments relating to or resulting from the implementation or operation of the Tennessee Health Care Innovation Initiative or any successor state program applicable to provider agreements covered by this section.
(1) Except as otherwise provided in subdivision (g)(2), no health insurance carrier shall make a change or changes to a provider's fee schedule except as follows: (A) Up to one (1) time during a consecutive twelve-month period. After a health insurance carrier makes a change or changes to the provider's fee schedule, it is prohibited from doing so again for at least twelve (12) months following the effective date of the change or changes; or (B) If a health insurance carrier and a hospital agree to the change or changes in writing.
(A) Up to one (1) time during a consecutive twelve-month period. After a health insurance carrier makes a change or changes to the provider's fee schedule, it is prohibited from doing so again for at least twelve (12) months following the effective date of the change or changes; or
(B) If a health insurance carrier and a hospital agree to the change or changes in writing.
(2) Subdivisions (c)(1) and (g)(1) do not apply to the following changes to a fee schedule: (A) Any change in a provider's fee schedule due to a change effected by the federal or state government to its healthcare fee schedule, if the provider and health insurance carrier have previously agreed that the provider's fee schedule is based on a percentage or some other formula of a current government healthcare fee schedule, such as Medicare; (B) Any change in a provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and health insurance carrier or pharmacy benefits manager as defined by § 56-7-3102 have previously agreed that any reimbursement for drugs, immunizations, injectables, supplies, or devices will be based on a percentage, or some other formula, of a price index not established by the health insurance carrier, such as the average wholesale price or average sales price; (C) Any changes in the provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the health insurance carrier or pharmacy benefits manager as defined in § 56-7-3102 have previously agreed to any reimbursement for drugs, immunizations, injectables, supplies, or devices in accordance with § 56-7-3104 and based upon maximum allowable cost pricing as regulated by §§ 56-7-3101 and 56-7-3106 ; (D) Any change to Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, International Statistical Classification of Disease and Related Health Problems (ICD) Codes, or other coding sets recognized or used by Centers for Medicare and Medicaid Services (CMS) that a health insurance carrier utilized in creating a provider's fee schedule; (E) Any change to revenue codes as established by the National Uniform Billing Committee (NUBC); (F) Any changes in a provider's fee schedule due to one (1) or more of the following if previously agreed to in a provider's agreement with a health insurance carrier: (i) Payments made to the healthcare provider by the health insurance carrier or payments made to the health insurance carrier by the provider that are based on values or quality measures explicitly described in the written agreement between the provider and the health insurance carrier intended to improve care provided to the health insurance carrier's members; (ii) Escalator or de-escalator clauses; (iii) Provisions that require adjustments to payment due to population health management performance or results; or (iv) Any arrangements, initiatives, or value-based payments relating to or resulting from the implementation or operation of the Tennessee Health Care Innovation Initiative or any successor state program applicable to provider agreements covered by this section.
(A) Any change in a provider's fee schedule due to a change effected by the federal or state government to its healthcare fee schedule, if the provider and health insurance carrier have previously agreed that the provider's fee schedule is based on a percentage or some other formula of a current government healthcare fee schedule, such as Medicare;
(B) Any change in a provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and health insurance carrier or pharmacy benefits manager as defined by § 56-7-3102 have previously agreed that any reimbursement for drugs, immunizations, injectables, supplies, or devices will be based on a percentage, or some other formula, of a price index not established by the health insurance carrier, such as the average wholesale price or average sales price;
(C) Any changes in the provider's reimbursement for drugs, immunizations, injectables, supplies, or devices if the provider and the health insurance carrier or pharmacy benefits manager as defined in § 56-7-3102 have previously agreed to any reimbursement for drugs, immunizations, injectables, supplies, or devices in accordance with § 56-7-3104 and based upon maximum allowable cost pricing as regulated by §§ 56-7-3101 and 56-7-3106 ;
(D) Any change to Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, International Statistical Classification of Disease and Related Health Problems (ICD) Codes, or other coding sets recognized or used by Centers for Medicare and Medicaid Services (CMS) that a health insurance carrier utilized in creating a provider's fee schedule;
(E) Any change to revenue codes as established by the National Uniform Billing Committee (NUBC);
(F) Any changes in a provider's fee schedule due to one (1) or more of the following if previously agreed to in a provider's agreement with a health insurance carrier: (i) Payments made to the healthcare provider by the health insurance carrier or payments made to the health insurance carrier by the provider that are based on values or quality measures explicitly described in the written agreement between the provider and the health insurance carrier intended to improve care provided to the health insurance carrier's members; (ii) Escalator or de-escalator clauses; (iii) Provisions that require adjustments to payment due to population health management performance or results; or (iv) Any arrangements, initiatives, or value-based payments relating to or resulting from the implementation or operation of the Tennessee Health Care Innovation Initiative or any successor state program applicable to provider agreements covered by this section.
(i) Payments made to the healthcare provider by the health insurance carrier or payments made to the health insurance carrier by the provider that are based on values or quality measures explicitly described in the written agreement between the provider and the health insurance carrier intended to improve care provided to the health insurance carrier's members;
(ii) Escalator or de-escalator clauses;
(iii) Provisions that require adjustments to payment due to population health management performance or results; or
(iv) Any arrangements, initiatives, or value-based payments relating to or resulting from the implementation or operation of the Tennessee Health Care Innovation Initiative or any successor state program applicable to provider agreements covered by this section.
(h) Notwithstanding any law to the contrary, including other provisions of this section, nothing in this section applies to: (1) An enrollee's benefit package, or coverage terms and conditions, unrelated to application of fee schedules and reimbursements, including, but not limited to, provisions regarding eligibility for coverage, deductibles and copayments, coordination of benefits, and coverage limitations and exclusions; (2) An entity that is subject to delinquency proceedings and for which the commissioner of commerce and insurance has been appointed receiver, or an entity placed under administrative supervision by order of the commissioner pursuant to the Insurers Rehabilitation and Liquidation Act, compiled in chapter 9 of this title; (3) A contract amendment that is made due to a change in federal or state law; (4) A contract between a health insurance carrier and a healthcare provider for items or services to be provided for individuals covered by any Medicare Advantage, Medicare Select, Medicare Supplement, Medicare and Medicaid Enrollees (MME), Medicare Dual Special Needs, and Medicare Private Fee for Service; or the state, local government, and local education insurance plans established under title 8, chapter 27; (5) The TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in part 29 of this chapter; any other plan managed by the health care finance administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27; or (6) The Prior Authorization Fairness Act, compiled in part 37 of this chapter.
(1) An enrollee's benefit package, or coverage terms and conditions, unrelated to application of fee schedules and reimbursements, including, but not limited to, provisions regarding eligibility for coverage, deductibles and copayments, coordination of benefits, and coverage limitations and exclusions;
(2) An entity that is subject to delinquency proceedings and for which the commissioner of commerce and insurance has been appointed receiver, or an entity placed under administrative supervision by order of the commissioner pursuant to the Insurers Rehabilitation and Liquidation Act, compiled in chapter 9 of this title;
(3) A contract amendment that is made due to a change in federal or state law;
(4) A contract between a health insurance carrier and a healthcare provider for items or services to be provided for individuals covered by any Medicare Advantage, Medicare Select, Medicare Supplement, Medicare and Medicaid Enrollees (MME), Medicare Dual Special Needs, and Medicare Private Fee for Service; or the state, local government, and local education insurance plans established under title 8, chapter 27;
(5) The TennCare program or any successor Medicaid program provided for in title 71, chapter 5; the CoverKids Act of 2006, compiled in title 71, chapter 3, part 11; the Access Tennessee Act of 2006, compiled in part 29 of this chapter; any other plan managed by the health care finance administration division of the department of finance and administration or any successor division or department; or the group insurance plans offered under title 8, chapter 27; or
(6) The Prior Authorization Fairness Act, compiled in part 37 of this chapter.
Amended by 2023 Tenn. Acts, ch. 395, s 3, eff. 1/1/2025.
Amended by 2017 Tenn. Acts, ch. 88, Secs.s 3, s 4 eff. 1/1/2019.
Amended by 2017 Tenn. Acts, ch. 88, s 2, eff. 1/1/2019.
Acts 2002, ch. 638, §§ 1, 2; 2008 , ch. 987, § 1; 2009 , ch. 333, § 1.
Tenn. Code Ann. § 56-2-412 — TN Code / Title 56 / Chapter 2 / Section 56-2-412
Retaliatory provisions - Dividing commissions between agents
Status: in_force

(a) Whenever the laws of any other state of the United States require of insurance companies incorporated by or organized under the laws of this state, or the agents of the companies, any deposit of securities in such state for the protection of policyholders, or otherwise, greater than the amount required for similar purposes from similar companies of other states by the then existing laws of this state, then, in every such case, all companies of the states establishing an agency or agencies in this state shall be required to make the same deposit for a like purpose with the state treasurer and to pay into the state treasury the taxes, fines, penalties, license fees, or otherwise, an amount equal to the amount of the charges and payments imposed by law of such state upon companies of this state, and their agents. (b) Any commission received by a Tennessee resident agent may be shared with another resident agent or with a licensed nonresident insurance agent or broker; provided, that if the nonresident insurance agent or broker resides in, or is a licensed agent or broker in, a state that requires the retention of a stipulated percentage of the commission on risks placed in the state by nonresident agents or brokers, then and in that event the Tennessee resident agent shall require the same percentage of the commission as would be required if a Tennessee agent or broker placed similar insurance in the state of the residence of the nonresident insurance agent or broker; and provided further, that if the nonresident insurance agent or broker resides in a state, county or municipality that by statute or ordinance prohibits the division of commissions on insurance covering property or risks in the city, county or state of the nonresident agent or broker, then and in that event it shall be unlawful for the Tennessee resident agent or broker to pay the nonresident agent or broker any share or portion of the commission on insurance on property or risks in this state. Acts 1895, ch. 160, § 20; Shan., § 3304; Code 1932, § 6124; T.C.A. (orig. ed.), § 56-309; Acts 1955, ch. 128, § 1; T.C.A. (orig. ed.), § 56-241.
(a) Whenever the laws of any other state of the United States require of insurance companies incorporated by or organized under the laws of this state, or the agents of the companies, any deposit of securities in such state for the protection of policyholders, or otherwise, greater than the amount required for similar purposes from similar companies of other states by the then existing laws of this state, then, in every such case, all companies of the states establishing an agency or agencies in this state shall be required to make the same deposit for a like purpose with the state treasurer and to pay into the state treasury the taxes, fines, penalties, license fees, or otherwise, an amount equal to the amount of the charges and payments imposed by law of such state upon companies of this state, and their agents.
(b) Any commission received by a Tennessee resident agent may be shared with another resident agent or with a licensed nonresident insurance agent or broker; provided, that if the nonresident insurance agent or broker resides in, or is a licensed agent or broker in, a state that requires the retention of a stipulated percentage of the commission on risks placed in the state by nonresident agents or brokers, then and in that event the Tennessee resident agent shall require the same percentage of the commission as would be required if a Tennessee agent or broker placed similar insurance in the state of the residence of the nonresident insurance agent or broker; and provided further, that if the nonresident insurance agent or broker resides in a state, county or municipality that by statute or ordinance prohibits the division of commissions on insurance covering property or risks in the city, county or state of the nonresident agent or broker, then and in that event it shall be unlawful for the Tennessee resident agent or broker to pay the nonresident agent or broker any share or portion of the commission on insurance on property or risks in this state.
Acts 1895, ch. 160, § 20; Shan., § 3304; Code 1932, § 6124; T.C.A. (orig. ed.), § 56-309; Acts 1955, ch. 128, § 1; T.C.A. (orig. ed.), § 56-241.
Tenn. Code Ann. § 56-28-102 — TN Code / Title 56 / Chapter 28 / Section 56-28-102
Articles of incorporation and amendments - Approval by commissioner
Status: in_force

The articles of incorporation of the corporation and amendments to the articles shall be submitted to the department of commerce and insurance. The approval of the articles and amendments by the commissioner of commerce and insurance shall be endorsed on the articles and amendments before the articles and amendments are filed with the secretary of state; provided, that if the articles of incorporation of the corporation have been filed with the secretary of state prior to February 24, 1945, the approval of the articles by the commissioner shall be evidenced by a separate instrument in writing, filed with the secretary of state. Acts 1945, ch. 98, § 2; C. Supp. 1950, § 4186.2; impl. am. Acts 1971, ch. 137, §§ 1, 2; T.C.A. (orig. ed.), § 56-3002.
The articles of incorporation of the corporation and amendments to the articles shall be submitted to the department of commerce and insurance. The approval of the articles and amendments by the commissioner of commerce and insurance shall be endorsed on the articles and amendments before the articles and amendments are filed with the secretary of state; provided, that if the articles of incorporation of the corporation have been filed with the secretary of state prior to February 24, 1945, the approval of the articles by the commissioner shall be evidenced by a separate instrument in writing, filed with the secretary of state.
Acts 1945, ch. 98, § 2; C. Supp. 1950, § 4186.2; impl. am. Acts 1971, ch. 137, §§ 1, 2; T.C.A. (orig. ed.), § 56-3002.
Tenn. Code Ann. § 56-51-107 — TN Code / Title 56 / Chapter 51 / Section 56-51-107
Issuance of certificate of authority - Denial
Status: in_force

(a) Following receipt of an application filed pursuant to § 56-51-106 , the department shall review the application and notify the applicant of any deficiencies contained in the application. The department shall issue a certificate of authority to an applicant who has filed a completed application in conformity with § 56-51-106 , upon payment of the fees specified by § 56-51-145 and upon the department being satisfied that the following conditions are met: (1) The requirements of § 56-51-106 have been fulfilled; (2) The entity has met the applicable minimum net worth requirements and working capital requirements as provided under § 56-32-112 ; (3) The entity furnished evidence of adequate insurance coverage, including, but not limited to, general liability or professional liability coverage, or an adequate plan for self-insurance to respond to claims for injuries arising out of the furnishing of covered services; (4) The ownership, control, and management of the entity are competent and trustworthy and possess managerial experience that would make the proposed operation beneficial to the subscribers. The department shall not grant or continue authority to transact the business of a prepaid limited health service organization in this state at any time during which the department has good reason to believe that the ownership, control, or management of the organization includes any person whose business operations are or have been marked by business practices or conduct that is to the detriment of the public, stockholders, investors, or creditors; (5) The entity has demonstrated compliance with § 56-51-138 by obtaining a blanket fidelity bond in the amount of at least fifty thousand dollars ($50,000), issued by a licensed insurance carrier in this state, that will reimburse the entity in the event that anyone handling the funds of the entity either misappropriates or absconds with the funds. All employees handling the funds must be covered by the blanket fidelity bond. However, the fidelity bond need not cover an individual who owns one hundred percent (100%) of the stock of the organization if the stockholder maintains total control of the organization's financial assets, books and records, and fidelity bond coverage is not available for the individual. An agent licensed under this title may, either directly or indirectly, represent the prepaid limited health service organization in the solicitation, negotiation, effectuation, procurement, receipt, delivery, or forwarding of any subscriber's contract, or collect or forward any consideration paid by the subscriber to the prepaid limited health service organization. The licensed agent shall not be required to post the bond required by this subsection (a); (6) The prepaid limited health service organization has a grievance procedure that will facilitate the resolution of subscriber grievances and that includes both formal and informal steps available within the organization; (7) The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the department may consider: (A) The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection with the arrangements; (B) The adequacy of surplus, other sources of funding, and provisions for contingencies; and (C) The manner in which the requirements of § 56-51-137 have been fulfilled; (8) The agreements with providers for the provision of limited health services contain the provisions required by § 56-51-128 ; (9) Any deficiencies identified by the department have been corrected; and (10) All requirements of this chapter have been met. (b) If the certificate of authority is denied, the department shall notify the applicant and shall specify the reasons for denial in the notice. Acts 2000, ch. 948, § 7.
(a) Following receipt of an application filed pursuant to § 56-51-106 , the department shall review the application and notify the applicant of any deficiencies contained in the application. The department shall issue a certificate of authority to an applicant who has filed a completed application in conformity with § 56-51-106 , upon payment of the fees specified by § 56-51-145 and upon the department being satisfied that the following conditions are met: (1) The requirements of § 56-51-106 have been fulfilled; (2) The entity has met the applicable minimum net worth requirements and working capital requirements as provided under § 56-32-112 ; (3) The entity furnished evidence of adequate insurance coverage, including, but not limited to, general liability or professional liability coverage, or an adequate plan for self-insurance to respond to claims for injuries arising out of the furnishing of covered services; (4) The ownership, control, and management of the entity are competent and trustworthy and possess managerial experience that would make the proposed operation beneficial to the subscribers. The department shall not grant or continue authority to transact the business of a prepaid limited health service organization in this state at any time during which the department has good reason to believe that the ownership, control, or management of the organization includes any person whose business operations are or have been marked by business practices or conduct that is to the detriment of the public, stockholders, investors, or creditors; (5) The entity has demonstrated compliance with § 56-51-138 by obtaining a blanket fidelity bond in the amount of at least fifty thousand dollars ($50,000), issued by a licensed insurance carrier in this state, that will reimburse the entity in the event that anyone handling the funds of the entity either misappropriates or absconds with the funds. All employees handling the funds must be covered by the blanket fidelity bond. However, the fidelity bond need not cover an individual who owns one hundred percent (100%) of the stock of the organization if the stockholder maintains total control of the organization's financial assets, books and records, and fidelity bond coverage is not available for the individual. An agent licensed under this title may, either directly or indirectly, represent the prepaid limited health service organization in the solicitation, negotiation, effectuation, procurement, receipt, delivery, or forwarding of any subscriber's contract, or collect or forward any consideration paid by the subscriber to the prepaid limited health service organization. The licensed agent shall not be required to post the bond required by this subsection (a); (6) The prepaid limited health service organization has a grievance procedure that will facilitate the resolution of subscriber grievances and that includes both formal and informal steps available within the organization; (7) The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the department may consider: (A) The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection with the arrangements; (B) The adequacy of surplus, other sources of funding, and provisions for contingencies; and (C) The manner in which the requirements of § 56-51-137 have been fulfilled; (8) The agreements with providers for the provision of limited health services contain the provisions required by § 56-51-128 ; (9) Any deficiencies identified by the department have been corrected; and (10) All requirements of this chapter have been met.
(1) The requirements of § 56-51-106 have been fulfilled;
(2) The entity has met the applicable minimum net worth requirements and working capital requirements as provided under § 56-32-112 ;
(3) The entity furnished evidence of adequate insurance coverage, including, but not limited to, general liability or professional liability coverage, or an adequate plan for self-insurance to respond to claims for injuries arising out of the furnishing of covered services;
(4) The ownership, control, and management of the entity are competent and trustworthy and possess managerial experience that would make the proposed operation beneficial to the subscribers. The department shall not grant or continue authority to transact the business of a prepaid limited health service organization in this state at any time during which the department has good reason to believe that the ownership, control, or management of the organization includes any person whose business operations are or have been marked by business practices or conduct that is to the detriment of the public, stockholders, investors, or creditors;
(5) The entity has demonstrated compliance with § 56-51-138 by obtaining a blanket fidelity bond in the amount of at least fifty thousand dollars ($50,000), issued by a licensed insurance carrier in this state, that will reimburse the entity in the event that anyone handling the funds of the entity either misappropriates or absconds with the funds. All employees handling the funds must be covered by the blanket fidelity bond. However, the fidelity bond need not cover an individual who owns one hundred percent (100%) of the stock of the organization if the stockholder maintains total control of the organization's financial assets, books and records, and fidelity bond coverage is not available for the individual. An agent licensed under this title may, either directly or indirectly, represent the prepaid limited health service organization in the solicitation, negotiation, effectuation, procurement, receipt, delivery, or forwarding of any subscriber's contract, or collect or forward any consideration paid by the subscriber to the prepaid limited health service organization. The licensed agent shall not be required to post the bond required by this subsection (a);
(6) The prepaid limited health service organization has a grievance procedure that will facilitate the resolution of subscriber grievances and that includes both formal and informal steps available within the organization;
(7) The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the department may consider: (A) The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection with the arrangements; (B) The adequacy of surplus, other sources of funding, and provisions for contingencies; and (C) The manner in which the requirements of § 56-51-137 have been fulfilled;
(A) The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection with the arrangements;
(B) The adequacy of surplus, other sources of funding, and provisions for contingencies; and
(C) The manner in which the requirements of § 56-51-137 have been fulfilled;
(8) The agreements with providers for the provision of limited health services contain the provisions required by § 56-51-128 ;
(9) Any deficiencies identified by the department have been corrected; and
(10) All requirements of this chapter have been met.
(b) If the certificate of authority is denied, the department shall notify the applicant and shall specify the reasons for denial in the notice.
Acts 2000, ch. 948, § 7.
Tenn. Code Ann. § 56-7-125 — TN Code / Title 56 / Chapter 7 / Section 56-7-125
Written statement of rights for personal lines fire or homeowners insurance policyholders
Status: in_force

(a) At any time a policyholder files a property claim under a personal lines fire or homeowners insurance policy for structural damage with an estimated value at or above twenty thousand dollars ($20,000), the insurer shall provide the policyholder with a written statement setting forth certain basic rights to which the policyholder is entitled under the policyholder's policy. (b) At a minimum, the written statement required by subsection (a) shall advise policyholders of their rights to: (1) Receive quality repair work to restore the damages to the policyholders' property; (2) Have the repairs made by a contractor of the policyholders' choice, understanding that the contractor is hired by the policyholder and that this contractor does not work for or at the direction of the insurance company; (3) Receive a copy of the insurance policy free of charge upon request; (4) Be informed of the need to file a proof of loss, if required; (5) Receive the name, phone number, and address of the claim representative handling the loss; (6) Receive a detailed estimate of the scope of damage and costs of repairs. Should the contractor selected by the policyholder have questions concerning the insurance company's estimate, the policyholder or the policyholder's contractor should contact the policyholder's claim representative directly; (7) File supplemental claims as the need arises; and (8) File a complaint with the department by calling the policyholder service section at 1-800-342-4029, if the policyholder is unable to work out an agreement after speaking with the policyholder's claim representative, agent, and the company. (c) The written statement required by this section shall also inform the policyholder that the requirements of this section do not amend or replace any part of the policyholder's insurance policy and that the policyholder should carefully read and examine the policyholder's insurance policy, including all policy coverages, conditions, exclusions and rights. (d) Any insurer that fails to comply with this section shall be subject to the unfair claims settlement practice provisions under § 56-8-104(8) [repealed]. Acts 2001, ch. 226, §§ 1 - 4.
(a) At any time a policyholder files a property claim under a personal lines fire or homeowners insurance policy for structural damage with an estimated value at or above twenty thousand dollars ($20,000), the insurer shall provide the policyholder with a written statement setting forth certain basic rights to which the policyholder is entitled under the policyholder's policy.
(b) At a minimum, the written statement required by subsection (a) shall advise policyholders of their rights to: (1) Receive quality repair work to restore the damages to the policyholders' property; (2) Have the repairs made by a contractor of the policyholders' choice, understanding that the contractor is hired by the policyholder and that this contractor does not work for or at the direction of the insurance company; (3) Receive a copy of the insurance policy free of charge upon request; (4) Be informed of the need to file a proof of loss, if required; (5) Receive the name, phone number, and address of the claim representative handling the loss; (6) Receive a detailed estimate of the scope of damage and costs of repairs. Should the contractor selected by the policyholder have questions concerning the insurance company's estimate, the policyholder or the policyholder's contractor should contact the policyholder's claim representative directly; (7) File supplemental claims as the need arises; and (8) File a complaint with the department by calling the policyholder service section at 1-800-342-4029, if the policyholder is unable to work out an agreement after speaking with the policyholder's claim representative, agent, and the company.
(1) Receive quality repair work to restore the damages to the policyholders' property;
(2) Have the repairs made by a contractor of the policyholders' choice, understanding that the contractor is hired by the policyholder and that this contractor does not work for or at the direction of the insurance company;
(3) Receive a copy of the insurance policy free of charge upon request;
(4) Be informed of the need to file a proof of loss, if required;
(5) Receive the name, phone number, and address of the claim representative handling the loss;
(6) Receive a detailed estimate of the scope of damage and costs of repairs. Should the contractor selected by the policyholder have questions concerning the insurance company's estimate, the policyholder or the policyholder's contractor should contact the policyholder's claim representative directly;
(7) File supplemental claims as the need arises; and
(8) File a complaint with the department by calling the policyholder service section at 1-800-342-4029, if the policyholder is unable to work out an agreement after speaking with the policyholder's claim representative, agent, and the company.
(c) The written statement required by this section shall also inform the policyholder that the requirements of this section do not amend or replace any part of the policyholder's insurance policy and that the policyholder should carefully read and examine the policyholder's insurance policy, including all policy coverages, conditions, exclusions and rights.
(d) Any insurer that fails to comply with this section shall be subject to the unfair claims settlement practice provisions under § 56-8-104(8) [repealed].
Acts 2001, ch. 226, §§ 1 - 4.
Tenn. Code Ann. § 56-7-2352 — TN Code / Title 56 / Chapter 7 / Section 56-7-2352
Legislative findings - Coverage for off-label uses of approved drugs
Status: in_force

(a) The general assembly finds and declares the following: (1) The citizens of this state rely upon health insurance to cover the cost of obtaining health care; (2) It is essential that the citizens' expectation that their health care costs will be paid by their insurance policies is not disappointed and that they obtain the coverage necessary and appropriate for their care within the terms of their insurance policies; (3) Some insurers deny payment for drugs that have been approved by the federal food and drug administration (FDA) when the drugs are used for indications other than those stated in the labeling approved by the FDA, known as off-label use, while other insurers with similar coverage terms do pay for off-label use; (4) Denial of payment for off-label use can interrupt or effectively deny access to necessary and appropriate treatment for a person being treated for a life-threatening illness; (5) Equity among employers who obtain insurance coverage for their employees and fair competition among insurance companies require that insurance companies assure citizens reimbursement for drugs in the same way and in the way citizens expect; (6) Off-label use of an FDA-approved drug is legal when prescribed in a medically appropriate way and is often necessary to provide needed care. Approximately fifty percent (50%) of cancer drug treatment is for off-label indications. The FDA and the federal department of health and human services recognize the wide variety of effective uses of FDA-approved drugs for off-label indications. Information on the appropriate off-label use of FDA-approved drugs is obtained from compendia published by the United States Pharmacopeial Convention, the American Medical Association, and the American Society of Hospital Pharmacists. In addition, scientific studies of off-label use of drugs published in recognized peer-reviewed professional journals provide information on appropriate use of drugs for off-label indications. The Omnibus Budget Reconciliation Act of 1990 recognizes these three (3) compendia and peer-reviewed literature as appropriate sources for reimbursement, and requires medicaid agencies to pay for off-label use of drugs prescribed for medicaid patients if the use is stated in any of these sources. The Omnibus Budget Reconciliation Act of 1993 applies the same criteria and coverage to medicare patients. Twenty (20) states have also passed similar legislation, most based on uniform legislation. The National Association of Insurance Commissioners has also adopted a model act based on the ACCC model legislation; (7) Use of FDA-approved drugs for off-label indications provides efficacious drugs at a lower cost. To require that all appropriate uses of a drug undergo approval by the FDA would substantially increase the cost of drugs, delay or even deny patients' ability to obtain medically effective treatment. FDA approval for each use would require substantial expenditure and time to undergo the clinical trials necessary to obtain FDA approval. This is particularly the case when a drug is off-patent and in generic production, and consequently is available at a lower price. Once a drug is in generic production by multiple manufacturers, it is not economically feasible for a manufacturer to incur the cost of FDA approval; (8) Reimbursement for off-label indications of FDA-approved drugs is necessary to conform to the way in which appropriate medical treatment is provided, to make needed drugs available to patients, and to contain health care costs; and (9) This section shall not apply to a governmentally funded health care program, if the program requires the provision of medically necessary services. (b) As used in this section, unless the context requires otherwise: (1) "Insurance policy" means any individual, group, or blanket policy written by a medical expense indemnity corporation, a hospital service corporation, a health care service plan contract, or a private insurance plan issued, amended, delivered or renewed in this state, or that provides such insurance for residents of this state; (2) "Medical literature" means published scientific studies published in any peer-reviewed national professional journal; and (3) "Standard reference compendia" means: (A) The United States Pharmacopeia Drug Information; (B) The American Medical Association Drug Evaluations; (C) The American Hospital Formulary Service Drug Information; (D) The National Comprehensive Cancer Network Drugs and Biologics Compendium; (E) The Thomson Micromedex DrugDex; or (F) The Gold Standard/Elsevier Clinical Pharmacology. (c) (1) No insurance policy or contract regulated under this title that provides coverage for drugs shall exclude coverage of any such drug for a particular indication on the ground that the drug has not been approved by the FDA for that indication, if the drug is recognized for treatment of the indication in one (1) of the standard reference compendia, or in the medical literature; provided, that nothing in this section shall be construed to authorize the commissioner of health to approve any drug or direct any person that issues an insurance policy to make payments for the drug for a particular indication unless the drug is recognized for treatment of the indication in one (1) of the standard reference compendia or in the medical literature. (2) Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug. (3) This section shall not be construed to alter existing law with regard to provisions limiting the coverage of drugs that have not been approved by the FDA. (4) This section shall not be construed to require coverage for any drug when the FDA has determined its use to be contra-indicated. (5) This section shall not be construed to require coverage for experimental drugs not otherwise approved for any indication by the FDA. (6) Any dispute about coverage for off-label uses brought to the commissioner of health shall be resolved by the appropriate court-approved grievance process authorized by the department. (7) The commissioner of health shall have the authority to direct any person who issues an insurance policy to make payments required by this section. Acts 1997 , ch. 277, § 1; 2010 , ch. 890, § 1.
(a) The general assembly finds and declares the following: (1) The citizens of this state rely upon health insurance to cover the cost of obtaining health care; (2) It is essential that the citizens' expectation that their health care costs will be paid by their insurance policies is not disappointed and that they obtain the coverage necessary and appropriate for their care within the terms of their insurance policies; (3) Some insurers deny payment for drugs that have been approved by the federal food and drug administration (FDA) when the drugs are used for indications other than those stated in the labeling approved by the FDA, known as off-label use, while other insurers with similar coverage terms do pay for off-label use; (4) Denial of payment for off-label use can interrupt or effectively deny access to necessary and appropriate treatment for a person being treated for a life-threatening illness; (5) Equity among employers who obtain insurance coverage for their employees and fair competition among insurance companies require that insurance companies assure citizens reimbursement for drugs in the same way and in the way citizens expect; (6) Off-label use of an FDA-approved drug is legal when prescribed in a medically appropriate way and is often necessary to provide needed care. Approximately fifty percent (50%) of cancer drug treatment is for off-label indications. The FDA and the federal department of health and human services recognize the wide variety of effective uses of FDA-approved drugs for off-label indications. Information on the appropriate off-label use of FDA-approved drugs is obtained from compendia published by the United States Pharmacopeial Convention, the American Medical Association, and the American Society of Hospital Pharmacists. In addition, scientific studies of off-label use of drugs published in recognized peer-reviewed professional journals provide information on appropriate use of drugs for off-label indications. The Omnibus Budget Reconciliation Act of 1990 recognizes these three (3) compendia and peer-reviewed literature as appropriate sources for reimbursement, and requires medicaid agencies to pay for off-label use of drugs prescribed for medicaid patients if the use is stated in any of these sources. The Omnibus Budget Reconciliation Act of 1993 applies the same criteria and coverage to medicare patients. Twenty (20) states have also passed similar legislation, most based on uniform legislation. The National Association of Insurance Commissioners has also adopted a model act based on the ACCC model legislation; (7) Use of FDA-approved drugs for off-label indications provides efficacious drugs at a lower cost. To require that all appropriate uses of a drug undergo approval by the FDA would substantially increase the cost of drugs, delay or even deny patients' ability to obtain medically effective treatment. FDA approval for each use would require substantial expenditure and time to undergo the clinical trials necessary to obtain FDA approval. This is particularly the case when a drug is off-patent and in generic production, and consequently is available at a lower price. Once a drug is in generic production by multiple manufacturers, it is not economically feasible for a manufacturer to incur the cost of FDA approval; (8) Reimbursement for off-label indications of FDA-approved drugs is necessary to conform to the way in which appropriate medical treatment is provided, to make needed drugs available to patients, and to contain health care costs; and (9) This section shall not apply to a governmentally funded health care program, if the program requires the provision of medically necessary services.
(1) The citizens of this state rely upon health insurance to cover the cost of obtaining health care;
(2) It is essential that the citizens' expectation that their health care costs will be paid by their insurance policies is not disappointed and that they obtain the coverage necessary and appropriate for their care within the terms of their insurance policies;
(3) Some insurers deny payment for drugs that have been approved by the federal food and drug administration (FDA) when the drugs are used for indications other than those stated in the labeling approved by the FDA, known as off-label use, while other insurers with similar coverage terms do pay for off-label use;
(4) Denial of payment for off-label use can interrupt or effectively deny access to necessary and appropriate treatment for a person being treated for a life-threatening illness;
(5) Equity among employers who obtain insurance coverage for their employees and fair competition among insurance companies require that insurance companies assure citizens reimbursement for drugs in the same way and in the way citizens expect;
(6) Off-label use of an FDA-approved drug is legal when prescribed in a medically appropriate way and is often necessary to provide needed care. Approximately fifty percent (50%) of cancer drug treatment is for off-label indications. The FDA and the federal department of health and human services recognize the wide variety of effective uses of FDA-approved drugs for off-label indications. Information on the appropriate off-label use of FDA-approved drugs is obtained from compendia published by the United States Pharmacopeial Convention, the American Medical Association, and the American Society of Hospital Pharmacists. In addition, scientific studies of off-label use of drugs published in recognized peer-reviewed professional journals provide information on appropriate use of drugs for off-label indications. The Omnibus Budget Reconciliation Act of 1990 recognizes these three (3) compendia and peer-reviewed literature as appropriate sources for reimbursement, and requires medicaid agencies to pay for off-label use of drugs prescribed for medicaid patients if the use is stated in any of these sources. The Omnibus Budget Reconciliation Act of 1993 applies the same criteria and coverage to medicare patients. Twenty (20) states have also passed similar legislation, most based on uniform legislation. The National Association of Insurance Commissioners has also adopted a model act based on the ACCC model legislation;
(7) Use of FDA-approved drugs for off-label indications provides efficacious drugs at a lower cost. To require that all appropriate uses of a drug undergo approval by the FDA would substantially increase the cost of drugs, delay or even deny patients' ability to obtain medically effective treatment. FDA approval for each use would require substantial expenditure and time to undergo the clinical trials necessary to obtain FDA approval. This is particularly the case when a drug is off-patent and in generic production, and consequently is available at a lower price. Once a drug is in generic production by multiple manufacturers, it is not economically feasible for a manufacturer to incur the cost of FDA approval;
(8) Reimbursement for off-label indications of FDA-approved drugs is necessary to conform to the way in which appropriate medical treatment is provided, to make needed drugs available to patients, and to contain health care costs; and
(9) This section shall not apply to a governmentally funded health care program, if the program requires the provision of medically necessary services.
(b) As used in this section, unless the context requires otherwise: (1) "Insurance policy" means any individual, group, or blanket policy written by a medical expense indemnity corporation, a hospital service corporation, a health care service plan contract, or a private insurance plan issued, amended, delivered or renewed in this state, or that provides such insurance for residents of this state; (2) "Medical literature" means published scientific studies published in any peer-reviewed national professional journal; and (3) "Standard reference compendia" means: (A) The United States Pharmacopeia Drug Information; (B) The American Medical Association Drug Evaluations; (C) The American Hospital Formulary Service Drug Information; (D) The National Comprehensive Cancer Network Drugs and Biologics Compendium; (E) The Thomson Micromedex DrugDex; or (F) The Gold Standard/Elsevier Clinical Pharmacology.
(1) "Insurance policy" means any individual, group, or blanket policy written by a medical expense indemnity corporation, a hospital service corporation, a health care service plan contract, or a private insurance plan issued, amended, delivered or renewed in this state, or that provides such insurance for residents of this state;
(2) "Medical literature" means published scientific studies published in any peer-reviewed national professional journal; and
(3) "Standard reference compendia" means: (A) The United States Pharmacopeia Drug Information; (B) The American Medical Association Drug Evaluations; (C) The American Hospital Formulary Service Drug Information; (D) The National Comprehensive Cancer Network Drugs and Biologics Compendium; (E) The Thomson Micromedex DrugDex; or (F) The Gold Standard/Elsevier Clinical Pharmacology.
(A) The United States Pharmacopeia Drug Information;
(B) The American Medical Association Drug Evaluations;
(C) The American Hospital Formulary Service Drug Information;
(D) The National Comprehensive Cancer Network Drugs and Biologics Compendium;
(E) The Thomson Micromedex DrugDex; or
(F) The Gold Standard/Elsevier Clinical Pharmacology.
(c) (1) No insurance policy or contract regulated under this title that provides coverage for drugs shall exclude coverage of any such drug for a particular indication on the ground that the drug has not been approved by the FDA for that indication, if the drug is recognized for treatment of the indication in one (1) of the standard reference compendia, or in the medical literature; provided, that nothing in this section shall be construed to authorize the commissioner of health to approve any drug or direct any person that issues an insurance policy to make payments for the drug for a particular indication unless the drug is recognized for treatment of the indication in one (1) of the standard reference compendia or in the medical literature. (2) Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug. (3) This section shall not be construed to alter existing law with regard to provisions limiting the coverage of drugs that have not been approved by the FDA. (4) This section shall not be construed to require coverage for any drug when the FDA has determined its use to be contra-indicated. (5) This section shall not be construed to require coverage for experimental drugs not otherwise approved for any indication by the FDA. (6) Any dispute about coverage for off-label uses brought to the commissioner of health shall be resolved by the appropriate court-approved grievance process authorized by the department. (7) The commissioner of health shall have the authority to direct any person who issues an insurance policy to make payments required by this section.
(1) No insurance policy or contract regulated under this title that provides coverage for drugs shall exclude coverage of any such drug for a particular indication on the ground that the drug has not been approved by the FDA for that indication, if the drug is recognized for treatment of the indication in one (1) of the standard reference compendia, or in the medical literature; provided, that nothing in this section shall be construed to authorize the commissioner of health to approve any drug or direct any person that issues an insurance policy to make payments for the drug for a particular indication unless the drug is recognized for treatment of the indication in one (1) of the standard reference compendia or in the medical literature.
(2) Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.
(3) This section shall not be construed to alter existing law with regard to provisions limiting the coverage of drugs that have not been approved by the FDA.
(4) This section shall not be construed to require coverage for any drug when the FDA has determined its use to be contra-indicated.
(5) This section shall not be construed to require coverage for experimental drugs not otherwise approved for any indication by the FDA.
(6) Any dispute about coverage for off-label uses brought to the commissioner of health shall be resolved by the appropriate court-approved grievance process authorized by the department.
(7) The commissioner of health shall have the authority to direct any person who issues an insurance policy to make payments required by this section.
Acts 1997 , ch. 277, § 1; 2010 , ch. 890, § 1.
Tenn. Code Ann. § 56-49-103 — TN Code / Title 56 / Chapter 49 / Section 56-49-103
Chapter definitions
Status: in_force

As used in this chapter, unless the context otherwise requires: (1) "Actual cash value (ACV)" means the cost of replacing damaged or destroyed property with comparable new property, minus depreciation and obsolescence; (2) "Agent" means a person who receives a commission for insurance placed or written or who, on behalf of an insurer or creditor, solicits, negotiates, effects, procures, delivers, renews, continues or binds policies of insurance to which this chapter applies, except a regular salaried officer, employee or other representative of an insurer who devotes substantially all working time to activities other than those specified here and who receives no compensation that is directly dependent on the amount of insurance business written, and except a regular salaried officer or employee of a creditor who receives no compensation that is directly dependent on the amount of insurance effected or procured; (3) "Blanket insurance" means insurance that provides coverage on collateral as defined in a policy issued to a creditor, without specifically listing the collateral covered; (4) "Collateral" means personal property that is pledged as security for the satisfaction of a debt; (5) "Commissioner" means the commissioner of commerce and insurance; (6) "Credit agreement" means the written document that sets forth the terms of the credit transaction and includes the security agreement; (7) "Credit transaction" means a transaction by the terms of which the repayment of money loaned or credit commitment made, or payment of goods, services or properties sold or leased, is to be made at a future date or dates; (8) "Creditor" means the lender of money or vendor or lessor of goods, services, property, rights or privileges for which payment is arranged through a credit transaction, or any successor to the right, title or interest of a lender, vendor or lessor; (9) "Creditor-placed insurance" means insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to collateralized personal property as a result of fire, theft, collision or other risks of loss that would either impair a creditor's interest or adversely affect the value of collateral covered by limited dual interest insurance. It is purchased according to the terms of the credit agreement as a result of the debtor's failure to provide required physical damage insurance, with the cost of the coverage being charged to the debtor. It shall be either single interest insurance or limited dual interest insurance; (10) "Debtor" means the borrower of money or a purchaser or lessee of goods, services, property, rights or privileges, for which payment is arranged through a credit transaction; (11) "Insurance tracking" means monitoring evidence of insurance on collateralized credit transactions to determine whether insurance required by the credit agreement has lapsed, and communicating with debtors concerning the status of insurance coverage; (12) "Insurer" means an insurance company, association or exchange authorized to issue insurance policies in this state; (13) "Lapse" means that the insurance coverage required by the credit agreement is not in force; (14) "Limited dual interest insurance" means insurance purchased by the creditor to insure its interest in the collateral securing the debtor's credit transaction. This insurance waives the three (3) conditions for loss payment under single interest insurance and extends coverage on the collateral while in the possession of the debtor; (15) "Loss ratio" means the ratio of incurred losses to earned premium; (16) "Net debt" means the amount necessary to liquidate the remaining debt in a single lump-sum payment, excluding all unearned interest and other unearned charges; and (17) "Single interest insurance" means insurance purchased by the creditor to insure its interest in the collateral securing a debtor's credit transaction. Three (3) conditions must be met for payment of loss under the policy: (A) The debtor has defaulted in payment; (B) The creditor has legally repossessed the collateral, unless collateral has been stolen from the debtor; and (C) The creditor has suffered an impairment of interest. Acts 1999, ch. 144, § 3.
As used in this chapter, unless the context otherwise requires:
(1) "Actual cash value (ACV)" means the cost of replacing damaged or destroyed property with comparable new property, minus depreciation and obsolescence;
(2) "Agent" means a person who receives a commission for insurance placed or written or who, on behalf of an insurer or creditor, solicits, negotiates, effects, procures, delivers, renews, continues or binds policies of insurance to which this chapter applies, except a regular salaried officer, employee or other representative of an insurer who devotes substantially all working time to activities other than those specified here and who receives no compensation that is directly dependent on the amount of insurance business written, and except a regular salaried officer or employee of a creditor who receives no compensation that is directly dependent on the amount of insurance effected or procured;
(3) "Blanket insurance" means insurance that provides coverage on collateral as defined in a policy issued to a creditor, without specifically listing the collateral covered;
(4) "Collateral" means personal property that is pledged as security for the satisfaction of a debt;
(5) "Commissioner" means the commissioner of commerce and insurance;
(6) "Credit agreement" means the written document that sets forth the terms of the credit transaction and includes the security agreement;
(7) "Credit transaction" means a transaction by the terms of which the repayment of money loaned or credit commitment made, or payment of goods, services or properties sold or leased, is to be made at a future date or dates;
(8) "Creditor" means the lender of money or vendor or lessor of goods, services, property, rights or privileges for which payment is arranged through a credit transaction, or any successor to the right, title or interest of a lender, vendor or lessor;
(9) "Creditor-placed insurance" means insurance that is purchased unilaterally by the creditor, who is the named insured, subsequent to the date of the credit transaction, providing coverage against loss, expense or damage to collateralized personal property as a result of fire, theft, collision or other risks of loss that would either impair a creditor's interest or adversely affect the value of collateral covered by limited dual interest insurance. It is purchased according to the terms of the credit agreement as a result of the debtor's failure to provide required physical damage insurance, with the cost of the coverage being charged to the debtor. It shall be either single interest insurance or limited dual interest insurance;
(10) "Debtor" means the borrower of money or a purchaser or lessee of goods, services, property, rights or privileges, for which payment is arranged through a credit transaction;
(11) "Insurance tracking" means monitoring evidence of insurance on collateralized credit transactions to determine whether insurance required by the credit agreement has lapsed, and communicating with debtors concerning the status of insurance coverage;
(12) "Insurer" means an insurance company, association or exchange authorized to issue insurance policies in this state;
(13) "Lapse" means that the insurance coverage required by the credit agreement is not in force;
(14) "Limited dual interest insurance" means insurance purchased by the creditor to insure its interest in the collateral securing the debtor's credit transaction. This insurance waives the three (3) conditions for loss payment under single interest insurance and extends coverage on the collateral while in the possession of the debtor;
(15) "Loss ratio" means the ratio of incurred losses to earned premium;
(16) "Net debt" means the amount necessary to liquidate the remaining debt in a single lump-sum payment, excluding all unearned interest and other unearned charges; and
(17) "Single interest insurance" means insurance purchased by the creditor to insure its interest in the collateral securing a debtor's credit transaction. Three (3) conditions must be met for payment of loss under the policy: (A) The debtor has defaulted in payment; (B) The creditor has legally repossessed the collateral, unless collateral has been stolen from the debtor; and (C) The creditor has suffered an impairment of interest.
(A) The debtor has defaulted in payment;
(B) The creditor has legally repossessed the collateral, unless collateral has been stolen from the debtor; and
(C) The creditor has suffered an impairment of interest.
Acts 1999, ch. 144, § 3.
Tenn. Code Ann. § 56-5-301 — TN Code / Title 56 / Chapter 5 / Section 56-5-301
Applicability of part
Status: in_force

This part applies to personal risk insurance written on risks in this state by any insurer authorized to do business in this state. Acts 2011, ch. 94, § 2.
This part applies to personal risk insurance written on risks in this state by any insurer authorized to do business in this state.
Acts 2011, ch. 94, § 2.
Tenn. Code Ann. § 56-9-307 — TN Code / Title 56 / Chapter 9 / Section 56-9-307
Order of liquidation - Effect - Declaration of insolvency - Financial reports - Appeal pendency plan
Status: in_force

(a) An order to liquidate the business of a domestic insurer shall appoint the commissioner and the commissioner's successors in office as liquidator and shall direct the liquidator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court. The liquidator shall be vested by operation of law with the title to all of the property, contracts and rights of action, and all of the books and records of the insurer ordered liquidated, wherever located, as of the entry of the final order of liquidation. The filing or recording of the order with the clerk of the chancery court of Davidson County and the recorder of deeds of the county in which its principal office or place of business is located, or, in the case of real estate, with the recorder of deeds of the county where the property is located, shall impart the same notice as a deed, bill of sale or other evidence of title duly filed or recorded with that recorder of deeds would have imparted. (b) Upon issuance of the order, the rights and liabilities of any such insurer and of its creditors, policyholders, shareholders, members and all other persons interested in its estate shall become fixed as of the date of entry of the order of liquidation, except as provided in §§ 56-9-308 and 56-9-326 . (c) An order to liquidate the business of an alien insurer domiciled in this state shall be in the same terms and have the same legal effect as an order to liquidate a domestic insurer, except that the assets and the business in the United States shall be the only assets and business included in the order. (d) At the time of petitioning for an order of liquidation, or at any time thereafter, the commissioner, after making appropriate findings of an insurer's insolvency, may petition the court for a judicial declaration of the insolvency. After providing notice and hearing as it deems proper, the court may make the declaration. (e) Any order issued under this section shall require financial reports to the court by the liquidator. Financial reports shall include, at a minimum, the assets and liabilities of the insurer and all funds received or disbursed by the liquidator during the current period. Financial reports shall be filed within one (1) year of the liquidation order and at least annually thereafter. (f) (1) Within five (5) days after the initiation of an appeal of an order of liquidation, which order has not been stayed, the commissioner shall present for the court's approval a plan for the continued performance of the defendant company's policy claims obligations, including the duty to defend insureds under liability insurance policies, during the pendency of an appeal. The plan shall provide for the continued performance and payment of policy claims obligations in the normal course of events, notwithstanding the grounds alleged in support of the order of liquidation including the ground of insolvency. In the event the defendant company's financial condition will not, in the judgment of the commissioner, support the full performance of all policy claims obligations during the appeal pendency period, the plan may prefer the claims of certain policyholders and claimants over creditors and interested parties as well as other policyholders and claimants, as the commissioner finds to be fair and equitable, considering the relative circumstances of the policyholders and claimants. The court shall examine the plan submitted by the commissioner and if it finds the plan to be in the best interests of the parties, the court shall approve the plan. No action shall lie against the commissioner or any of the commissioner's deputies, agents, clerks, assistants or attorneys by any party based on preference in an appeal pendency plan approved by the court. (2) The appeal pendency plan shall not supersede or affect the obligations of any insurance guaranty association. (3) (A) Any such plans shall provide for equitable adjustments to be made by the liquidator to any distributions of assets to guaranty associations, in the event that the liquidator pays claims from assets of the estate, which would otherwise be the obligations of any particular guaranty association but for the appeal of the order of liquidation, such that all guaranty associations equally benefit on a pro rata basis from the assets of the estate. (B) In the event an order of liquidation is set aside upon any appeal, the company shall not be released from delinquency proceedings unless and until all funds advanced by any guaranty association, including reasonable administrative expenses in connection therewith relating to obligations of the company, are repaid in full, together with interest at the judgment rate of interest or unless an arrangement for repayment has been made with the consent of all applicable guaranty associations. Acts 1991, ch. 142, § 4.
(a) An order to liquidate the business of a domestic insurer shall appoint the commissioner and the commissioner's successors in office as liquidator and shall direct the liquidator immediately to take possession of the assets of the insurer and to administer them under the general supervision of the court. The liquidator shall be vested by operation of law with the title to all of the property, contracts and rights of action, and all of the books and records of the insurer ordered liquidated, wherever located, as of the entry of the final order of liquidation. The filing or recording of the order with the clerk of the chancery court of Davidson County and the recorder of deeds of the county in which its principal office or place of business is located, or, in the case of real estate, with the recorder of deeds of the county where the property is located, shall impart the same notice as a deed, bill of sale or other evidence of title duly filed or recorded with that recorder of deeds would have imparted.
(b) Upon issuance of the order, the rights and liabilities of any such insurer and of its creditors, policyholders, shareholders, members and all other persons interested in its estate shall become fixed as of the date of entry of the order of liquidation, except as provided in §§ 56-9-308 and 56-9-326 .
(c) An order to liquidate the business of an alien insurer domiciled in this state shall be in the same terms and have the same legal effect as an order to liquidate a domestic insurer, except that the assets and the business in the United States shall be the only assets and business included in the order.
(d) At the time of petitioning for an order of liquidation, or at any time thereafter, the commissioner, after making appropriate findings of an insurer's insolvency, may petition the court for a judicial declaration of the insolvency. After providing notice and hearing as it deems proper, the court may make the declaration.
(e) Any order issued under this section shall require financial reports to the court by the liquidator. Financial reports shall include, at a minimum, the assets and liabilities of the insurer and all funds received or disbursed by the liquidator during the current period. Financial reports shall be filed within one (1) year of the liquidation order and at least annually thereafter.
(f) (1) Within five (5) days after the initiation of an appeal of an order of liquidation, which order has not been stayed, the commissioner shall present for the court's approval a plan for the continued performance of the defendant company's policy claims obligations, including the duty to defend insureds under liability insurance policies, during the pendency of an appeal. The plan shall provide for the continued performance and payment of policy claims obligations in the normal course of events, notwithstanding the grounds alleged in support of the order of liquidation including the ground of insolvency. In the event the defendant company's financial condition will not, in the judgment of the commissioner, support the full performance of all policy claims obligations during the appeal pendency period, the plan may prefer the claims of certain policyholders and claimants over creditors and interested parties as well as other policyholders and claimants, as the commissioner finds to be fair and equitable, considering the relative circumstances of the policyholders and claimants. The court shall examine the plan submitted by the commissioner and if it finds the plan to be in the best interests of the parties, the court shall approve the plan. No action shall lie against the commissioner or any of the commissioner's deputies, agents, clerks, assistants or attorneys by any party based on preference in an appeal pendency plan approved by the court. (2) The appeal pendency plan shall not supersede or affect the obligations of any insurance guaranty association. (3) (A) Any such plans shall provide for equitable adjustments to be made by the liquidator to any distributions of assets to guaranty associations, in the event that the liquidator pays claims from assets of the estate, which would otherwise be the obligations of any particular guaranty association but for the appeal of the order of liquidation, such that all guaranty associations equally benefit on a pro rata basis from the assets of the estate. (B) In the event an order of liquidation is set aside upon any appeal, the company shall not be released from delinquency proceedings unless and until all funds advanced by any guaranty association, including reasonable administrative expenses in connection therewith relating to obligations of the company, are repaid in full, together with interest at the judgment rate of interest or unless an arrangement for repayment has been made with the consent of all applicable guaranty associations.
(1) Within five (5) days after the initiation of an appeal of an order of liquidation, which order has not been stayed, the commissioner shall present for the court's approval a plan for the continued performance of the defendant company's policy claims obligations, including the duty to defend insureds under liability insurance policies, during the pendency of an appeal. The plan shall provide for the continued performance and payment of policy claims obligations in the normal course of events, notwithstanding the grounds alleged in support of the order of liquidation including the ground of insolvency. In the event the defendant company's financial condition will not, in the judgment of the commissioner, support the full performance of all policy claims obligations during the appeal pendency period, the plan may prefer the claims of certain policyholders and claimants over creditors and interested parties as well as other policyholders and claimants, as the commissioner finds to be fair and equitable, considering the relative circumstances of the policyholders and claimants. The court shall examine the plan submitted by the commissioner and if it finds the plan to be in the best interests of the parties, the court shall approve the plan. No action shall lie against the commissioner or any of the commissioner's deputies, agents, clerks, assistants or attorneys by any party based on preference in an appeal pendency plan approved by the court.
(2) The appeal pendency plan shall not supersede or affect the obligations of any insurance guaranty association.
(3) (A) Any such plans shall provide for equitable adjustments to be made by the liquidator to any distributions of assets to guaranty associations, in the event that the liquidator pays claims from assets of the estate, which would otherwise be the obligations of any particular guaranty association but for the appeal of the order of liquidation, such that all guaranty associations equally benefit on a pro rata basis from the assets of the estate. (B) In the event an order of liquidation is set aside upon any appeal, the company shall not be released from delinquency proceedings unless and until all funds advanced by any guaranty association, including reasonable administrative expenses in connection therewith relating to obligations of the company, are repaid in full, together with interest at the judgment rate of interest or unless an arrangement for repayment has been made with the consent of all applicable guaranty associations.
(A) Any such plans shall provide for equitable adjustments to be made by the liquidator to any distributions of assets to guaranty associations, in the event that the liquidator pays claims from assets of the estate, which would otherwise be the obligations of any particular guaranty association but for the appeal of the order of liquidation, such that all guaranty associations equally benefit on a pro rata basis from the assets of the estate.
(B) In the event an order of liquidation is set aside upon any appeal, the company shall not be released from delinquency proceedings unless and until all funds advanced by any guaranty association, including reasonable administrative expenses in connection therewith relating to obligations of the company, are repaid in full, together with interest at the judgment rate of interest or unless an arrangement for repayment has been made with the consent of all applicable guaranty associations.
Acts 1991, ch. 142, § 4.
Tenn. Code Ann. § 56-7-114 — TN Code / Title 56 / Chapter 7 / Section 56-7-114
Certificates of insurance
Status: in_force

(a) For purposes of this section: (1) "Casualty insurance" has the same meaning as defined in § 56-2-201 ; (2) "Certificate of insurance": (A) Means a document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage; and (B) Does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card; (3) "Governmental entity" means any political subdivision of this state, including, but not limited to, any incorporated city or town, metropolitan government, county, utility district, or school district; (4) "Insurance producer" means a person licensed to sell, solicit, or negotiate property or casualty insurance under the laws of this state; (5) "Insurer" means a person duly licensed to transact a property or casualty insurance business in this state; (6) "Person" means any individual, partnership, corporation, association, or other legal entity, including any governmental entity; and (7) "Property insurance" has the same meaning as defined in § 56-2-201 . (b) A certificate of insurance is not a policy of insurance and does not amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance refers. A certificate of insurance does not confer any rights beyond what the referenced policy of insurance expressly provides. (c) A person shall not: (1) Prepare, issue, request, or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance referenced in the certificate of insurance; (2) Prepare, issue, request, or require the issuance of a certificate of insurance that purports to alter, amend, or extend the coverage provided by the policy of insurance referenced in the certificate of insurance; or (3) Alter or modify a certificate of insurance after issuance. (d) A certificate of insurance must not warrant that the policy of insurance referenced in the certificate of insurance complies with the insurance or indemnification requirements of a contract. The inclusion of a contract number or description within a certificate of insurance does not warrant that the policy of insurance referenced in the certificate of insurance complies with the insurance or indemnification requirements of a contract. (e) An insurer must provide a person with notice of a cancellation, nonrenewal, material change, or any similar notice concerning a policy of insurance only if the person has a right to the notice under the terms of the policy of insurance, an endorsement to the policy, or state law. The policy of insurance, an endorsement to a policy of insurance, and state law govern the terms and conditions of any notice under this subsection (e), including the required timing of the notice. (f) This section applies to all certificates of insurance issued in connection with property insurance or casualty insurance risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located. (g) A certificate of insurance, or any other document or correspondence relative to a certificate of insurance, prepared, issued, requested, or required in violation of this section is void. (h) The commissioner, in accordance with § 56-6-120 , may examine and investigate the activities of any person that the commissioner reasonably believes engaged in, or is currently engaging in, an act or practice prohibited by this section. (i) If a person intentionally violates this section, then the commissioner may take any of the following actions: (1) Issue an order requiring the person to cease and desist from the actions constituting the violation; and (2) Assess a civil penalty of not more than one thousand dollars ($1,000) per violation. (j) This section does not limit the authority of the commissioner to investigate conduct, enforce compliance, or issue penalties under this title. (k) The commissioner may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to carry out this section.
(a) For purposes of this section: (1) "Casualty insurance" has the same meaning as defined in § 56-2-201 ; (2) "Certificate of insurance": (A) Means a document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage; and (B) Does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card; (3) "Governmental entity" means any political subdivision of this state, including, but not limited to, any incorporated city or town, metropolitan government, county, utility district, or school district; (4) "Insurance producer" means a person licensed to sell, solicit, or negotiate property or casualty insurance under the laws of this state; (5) "Insurer" means a person duly licensed to transact a property or casualty insurance business in this state; (6) "Person" means any individual, partnership, corporation, association, or other legal entity, including any governmental entity; and (7) "Property insurance" has the same meaning as defined in § 56-2-201 .
(1) "Casualty insurance" has the same meaning as defined in § 56-2-201 ;
(2) "Certificate of insurance": (A) Means a document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage; and (B) Does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card;
(A) Means a document or instrument prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage; and
(B) Does not include a policy of insurance, insurance binder, policy endorsement, or automobile insurance identification or information card;
(3) "Governmental entity" means any political subdivision of this state, including, but not limited to, any incorporated city or town, metropolitan government, county, utility district, or school district;
(4) "Insurance producer" means a person licensed to sell, solicit, or negotiate property or casualty insurance under the laws of this state;
(5) "Insurer" means a person duly licensed to transact a property or casualty insurance business in this state;
(6) "Person" means any individual, partnership, corporation, association, or other legal entity, including any governmental entity; and
(7) "Property insurance" has the same meaning as defined in § 56-2-201 .
(b) A certificate of insurance is not a policy of insurance and does not amend, extend, or alter the coverage afforded by the policy to which the certificate of insurance refers. A certificate of insurance does not confer any rights beyond what the referenced policy of insurance expressly provides.
(c) A person shall not: (1) Prepare, issue, request, or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance referenced in the certificate of insurance; (2) Prepare, issue, request, or require the issuance of a certificate of insurance that purports to alter, amend, or extend the coverage provided by the policy of insurance referenced in the certificate of insurance; or (3) Alter or modify a certificate of insurance after issuance.
(1) Prepare, issue, request, or require the issuance of a certificate of insurance that contains any false or misleading information concerning the policy of insurance referenced in the certificate of insurance;
(2) Prepare, issue, request, or require the issuance of a certificate of insurance that purports to alter, amend, or extend the coverage provided by the policy of insurance referenced in the certificate of insurance; or
(3) Alter or modify a certificate of insurance after issuance.
(d) A certificate of insurance must not warrant that the policy of insurance referenced in the certificate of insurance complies with the insurance or indemnification requirements of a contract. The inclusion of a contract number or description within a certificate of insurance does not warrant that the policy of insurance referenced in the certificate of insurance complies with the insurance or indemnification requirements of a contract.
(e) An insurer must provide a person with notice of a cancellation, nonrenewal, material change, or any similar notice concerning a policy of insurance only if the person has a right to the notice under the terms of the policy of insurance, an endorsement to the policy, or state law. The policy of insurance, an endorsement to a policy of insurance, and state law govern the terms and conditions of any notice under this subsection (e), including the required timing of the notice.
(f) This section applies to all certificates of insurance issued in connection with property insurance or casualty insurance risks located in this state, regardless of where the policyholder, insurer, insurance producer, or person requesting or requiring the issuance of a certificate of insurance is located.
(g) A certificate of insurance, or any other document or correspondence relative to a certificate of insurance, prepared, issued, requested, or required in violation of this section is void.
(h) The commissioner, in accordance with § 56-6-120 , may examine and investigate the activities of any person that the commissioner reasonably believes engaged in, or is currently engaging in, an act or practice prohibited by this section.
(i) If a person intentionally violates this section, then the commissioner may take any of the following actions: (1) Issue an order requiring the person to cease and desist from the actions constituting the violation; and (2) Assess a civil penalty of not more than one thousand dollars ($1,000) per violation.
(1) Issue an order requiring the person to cease and desist from the actions constituting the violation; and
(2) Assess a civil penalty of not more than one thousand dollars ($1,000) per violation.
(j) This section does not limit the authority of the commissioner to investigate conduct, enforce compliance, or issue penalties under this title.
(k) The commissioner may promulgate rules pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, to carry out this section.
Tenn. Code Ann. § 56-1-905 — TN Code / Title 56 / Chapter 1 / Section 56-1-905
Computation of minimum standard for annuities and pure endowment contracts
Status: in_force

(a) Except as provided in § 56-1-906 , the minimum standard of valuation for individual annuity and pure endowment contracts issued on or after the operative date of this section and for annuities and pure endowments purchased on or after the operative date under group annuity and pure endowment contracts, shall be the commissioner's reserve valuation methods defined in §§ 56-1-907 and 56-1-908 and the following tables and interest rates: (1) For individual annuity and pure endowment contracts issued prior to March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table, or any modification of this table approved by the commissioner, and six percent (6%) interest for single premium immediate annuity contracts and four percent (4%) interest for all other individual annuity and pure endowment contracts; (2) For individual single premium immediate annuity contracts issued on or after March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 these contracts, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest; (3) For individual annuity and pure endowment contracts issued on or after March 13, 1978, other than single premium immediate annuity contracts, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 those contracts, or any modification of these tables approved by the commissioner, and five and one half percent (5.5%) interest for single premium deferred annuity and pure endowment contracts and four and one half percent (4.5%) interest for all other individual annuity and pure endowment contracts; (4) For annuities and pure endowments purchased prior to March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table or any modification of this table approved by the commissioner, and six percent (6%) interest; and (5) For annuities and pure endowments purchased on or after March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table, or any group annuity 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 annuities and pure endowments, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest. (b) After May 6, 1973, any company may file with the commissioner a written notice of its election to comply with this section after a specified date before January 1, 1979, which shall be the operative date of this section for that company. If a company makes no election, the operative date of this section for that company shall be January 1, 1979. Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
(a) Except as provided in § 56-1-906 , the minimum standard of valuation for individual annuity and pure endowment contracts issued on or after the operative date of this section and for annuities and pure endowments purchased on or after the operative date under group annuity and pure endowment contracts, shall be the commissioner's reserve valuation methods defined in §§ 56-1-907 and 56-1-908 and the following tables and interest rates: (1) For individual annuity and pure endowment contracts issued prior to March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table, or any modification of this table approved by the commissioner, and six percent (6%) interest for single premium immediate annuity contracts and four percent (4%) interest for all other individual annuity and pure endowment contracts; (2) For individual single premium immediate annuity contracts issued on or after March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 these contracts, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest; (3) For individual annuity and pure endowment contracts issued on or after March 13, 1978, other than single premium immediate annuity contracts, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 those contracts, or any modification of these tables approved by the commissioner, and five and one half percent (5.5%) interest for single premium deferred annuity and pure endowment contracts and four and one half percent (4.5%) interest for all other individual annuity and pure endowment contracts; (4) For annuities and pure endowments purchased prior to March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table or any modification of this table approved by the commissioner, and six percent (6%) interest; and (5) For annuities and pure endowments purchased on or after March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table, or any group annuity 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 annuities and pure endowments, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest.
(1) For individual annuity and pure endowment contracts issued prior to March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table, or any modification of this table approved by the commissioner, and six percent (6%) interest for single premium immediate annuity contracts and four percent (4%) interest for all other individual annuity and pure endowment contracts;
(2) For individual single premium immediate annuity contracts issued on or after March 13, 1978, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 these contracts, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest;
(3) For individual annuity and pure endowment contracts issued on or after March 13, 1978, other than single premium immediate annuity contracts, excluding any disability and accidental death benefits in those contracts: the 1971 Individual Annuity Mortality Table or any individual annuity 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 those contracts, or any modification of these tables approved by the commissioner, and five and one half percent (5.5%) interest for single premium deferred annuity and pure endowment contracts and four and one half percent (4.5%) interest for all other individual annuity and pure endowment contracts;
(4) For annuities and pure endowments purchased prior to March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table or any modification of this table approved by the commissioner, and six percent (6%) interest; and
(5) For annuities and pure endowments purchased on or after March 13, 1978, under group annuity and pure endowment contracts, excluding any disability and accidental death benefits purchased under those contracts: the 1971 Group Annuity Mortality Table, or any group annuity 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 annuities and pure endowments, or any modification of these tables approved by the commissioner, and seven and one half percent (7.5%) interest.
(b) After May 6, 1973, any company may file with the commissioner a written notice of its election to comply with this section after a specified date before January 1, 1979, which shall be the operative date of this section for that company. If a company makes no election, the operative date of this section for that company shall be January 1, 1979.
Added by 2013 Tenn. Acts, ch. 260,s 3, eff. 7/1/2013.
Tenn. Code Ann. § 56-31-103 — TN Code / Title 56 / Chapter 31 / Section 56-31-103
Nonprofit vision service corporation - Creation
Status: in_force

(a) Five (5) or more optometrists duly licensed to practice under the laws of this state may associate themselves by written articles of association for the incorporation of a nonprofit vision service corporation. (b) A majority of the directors of each nonprofit vision service corporation must at all times be optometrists duly licensed to practice under the laws of this state. (c) The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment of these laws or in addition to these laws shall not apply to any nonprofit vision service corporation unless expressly so provided in these laws or acts. Acts 1969, ch. 118, § 3; T.C.A., § 56-3703.
(a) Five (5) or more optometrists duly licensed to practice under the laws of this state may associate themselves by written articles of association for the incorporation of a nonprofit vision service corporation.
(b) A majority of the directors of each nonprofit vision service corporation must at all times be optometrists duly licensed to practice under the laws of this state.
(c) The laws of this state relative to insurance companies or to the business of insurance, and acts in amendment of these laws or in addition to these laws shall not apply to any nonprofit vision service corporation unless expressly so provided in these laws or acts.
Acts 1969, ch. 118, § 3; T.C.A., § 56-3703.
Tenn. Code Ann. § 56-7-117 — TN Code / Title 56 / Chapter 7 / Section 56-7-117
Required use of mail-order pharmacy prohibited
Status: in_force

(a) No group medical benefit contract issued by an insurance company, a hospital service corporation, a hospital and medical service corporation, a medical service corporation, a health maintenance organization or a health care center, that provides coverage for prescription drugs, may require any person covered under the contract to obtain prescription drugs from a mail-order pharmacy in order to obtain benefits for the drugs, or to pay an additional fee or be subjected to any other penalty for failing to utilize any mail-order pharmacy designated by the insurance company or other issuing organization. (b) The commissioner is authorized to promulgate regulations to implement and enforce this section. Acts 1990, ch. 836, §§ 1, 2.
(a) No group medical benefit contract issued by an insurance company, a hospital service corporation, a hospital and medical service corporation, a medical service corporation, a health maintenance organization or a health care center, that provides coverage for prescription drugs, may require any person covered under the contract to obtain prescription drugs from a mail-order pharmacy in order to obtain benefits for the drugs, or to pay an additional fee or be subjected to any other penalty for failing to utilize any mail-order pharmacy designated by the insurance company or other issuing organization.
(b) The commissioner is authorized to promulgate regulations to implement and enforce this section.
Acts 1990, ch. 836, §§ 1, 2.
Tenn. Code Ann. § 56-27-116 — TN Code / Title 56 / Chapter 27 / Section 56-27-116
Records to be maintained
Status: in_force

The medical service corporation shall maintain adequate financial and statistical records in reasonable uniformity with accounting plans and statistical requirements of the annual statement blank required by the commissioner. Acts 1945, ch. 113, § 10; C. Supp. 1950, § 4186.26 (Williams, § 4186.27); T.C.A. (orig. ed.), § 56-2916.
The medical service corporation shall maintain adequate financial and statistical records in reasonable uniformity with accounting plans and statistical requirements of the annual statement blank required by the commissioner.
Acts 1945, ch. 113, § 10; C. Supp. 1950, § 4186.26 (Williams, § 4186.27); T.C.A. (orig. ed.), § 56-2916.
Tenn. Code Ann. § 56-3-904 — TN Code / Title 56 / Chapter 3 / Section 56-3-904
Deposit of securities by domestic insurance companies
Status: in_force

(a) (1) Securities qualified for deposit under § 56-2-104 may be deposited with a clearing corporation. (2) Securities deposited with a clearing corporation and used to meet the deposit requirements set forth in § 56-2-104 shall be under the control of the commissioner and shall not be withdrawn by the insurance company without the approval of the commissioner. (b) Any insurance company holding securities as provided in subsection (a) shall provide to the commissioner evidence issued by its custodian through which the insurance company has deposited securities in a clearing corporation, in order to establish that: (1) The securities are actually recorded in an account in the name of the custodian; and (2) The records of the custodian reflect that such securities are held subject to the order of the commissioner. Acts 2012, ch. 680, § 4.
(a) (1) Securities qualified for deposit under § 56-2-104 may be deposited with a clearing corporation. (2) Securities deposited with a clearing corporation and used to meet the deposit requirements set forth in § 56-2-104 shall be under the control of the commissioner and shall not be withdrawn by the insurance company without the approval of the commissioner.
(1) Securities qualified for deposit under § 56-2-104 may be deposited with a clearing corporation.
(2) Securities deposited with a clearing corporation and used to meet the deposit requirements set forth in § 56-2-104 shall be under the control of the commissioner and shall not be withdrawn by the insurance company without the approval of the commissioner.
(b) Any insurance company holding securities as provided in subsection (a) shall provide to the commissioner evidence issued by its custodian through which the insurance company has deposited securities in a clearing corporation, in order to establish that: (1) The securities are actually recorded in an account in the name of the custodian; and (2) The records of the custodian reflect that such securities are held subject to the order of the commissioner.
(1) The securities are actually recorded in an account in the name of the custodian; and
(2) The records of the custodian reflect that such securities are held subject to the order of the commissioner.
Acts 2012, ch. 680, § 4.
Tenn. Code Ann. § 56-7-1502 — TN Code / Title 56 / Chapter 7 / Section 56-7-1502
Applicability
Status: in_force

(a) Except as otherwise specifically provided, this part applies to: (1) All medicare supplement policies delivered or issued for delivery in this state on or after July 1, 1992; and (2) All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state. (b) This part does not apply to a policy of one (1) or more employers or labor organizations, or of the trustees of a fund established by one (1) or more employers or labor organizations, or combination of employers and labor organizations, for employees or former employees, or a combination of employees and former employees, or for members or former members, or a combination of members and former members, of the labor organizations. (c) Except as otherwise specifically provided in § 56-7-1505(d) , this part is not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons, which policies are not marketed or held to be medicare supplement policies or benefit plans. Acts 1992, ch. 735, § 2; 1996, ch. 750, §§ 18, 19.
(a) Except as otherwise specifically provided, this part applies to: (1) All medicare supplement policies delivered or issued for delivery in this state on or after July 1, 1992; and (2) All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state.
(1) All medicare supplement policies delivered or issued for delivery in this state on or after July 1, 1992; and
(2) All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state.
(b) This part does not apply to a policy of one (1) or more employers or labor organizations, or of the trustees of a fund established by one (1) or more employers or labor organizations, or combination of employers and labor organizations, for employees or former employees, or a combination of employees and former employees, or for members or former members, or a combination of members and former members, of the labor organizations.
(c) Except as otherwise specifically provided in § 56-7-1505(d) , this part is not intended to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons, which policies are not marketed or held to be medicare supplement policies or benefit plans.
Acts 1992, ch. 735, § 2; 1996, ch. 750, §§ 18, 19.
Tenn. Code Ann. § 56-20-104 — TN Code / Title 56 / Chapter 20 / Section 56-20-104
Payment of losses or damages - Borrowing or assessments - General assessments
Status: in_force

(a) Should the amount of any loss or damage exceed the amount of money on hand, such of its officers as may be authorized by the bylaws to do so shall convene the directors or executive committee, who may borrow money on the credit of the corporation, sufficient to pay the loss, but no more, or make an assessment upon all the property insured pro rata according to its classification, and according to the amount insured, sufficient to pay what the cash in hand falls short of paying, or for the whole loss or damage, as the directors or executive committee may decide to be for the best interest of the corporation. If the directors or the executive committee deem it to be for the best interest of the corporation, they may, with the authority of a majority in value of the insurance held by members of the corporation, conferred by resolution, bylaw, or otherwise, previously given, make an estimate of the sums as, in their judgment, will be necessary to pay all losses, damages, and expenses for the current year, and supply any deficiency in the preceding year, and proceed to assess, levy, and collect the same of the members of the corporation at such times as, in their discretion, will be most advantageous to the corporation. (b) The assessment shall be made pro rata upon all property at the time insured, according to its classification or according to the amount insured, sufficient to pay the amount so estimated. (c) Not more than one (1) such general assessment shall be made in any one (1) year, nor shall any such assessment be made if more than ten percent (10%) of any previous assessment shall be in the treasury of the corporation, and not at the time required for losses actually suffered. (d) No assessment shall be invalid because made in whole or in part for the purpose of paying any money borrowed by the directors or executive committee, which has been used in the payment of any claim for the loss or damage against the corporation. Acts 1895, ch. 220, § 5; Shan., § 3358; Code 1932, § 6240; T.C.A. (orig. ed.), § 56-1904.
(a) Should the amount of any loss or damage exceed the amount of money on hand, such of its officers as may be authorized by the bylaws to do so shall convene the directors or executive committee, who may borrow money on the credit of the corporation, sufficient to pay the loss, but no more, or make an assessment upon all the property insured pro rata according to its classification, and according to the amount insured, sufficient to pay what the cash in hand falls short of paying, or for the whole loss or damage, as the directors or executive committee may decide to be for the best interest of the corporation. If the directors or the executive committee deem it to be for the best interest of the corporation, they may, with the authority of a majority in value of the insurance held by members of the corporation, conferred by resolution, bylaw, or otherwise, previously given, make an estimate of the sums as, in their judgment, will be necessary to pay all losses, damages, and expenses for the current year, and supply any deficiency in the preceding year, and proceed to assess, levy, and collect the same of the members of the corporation at such times as, in their discretion, will be most advantageous to the corporation.
(b) The assessment shall be made pro rata upon all property at the time insured, according to its classification or according to the amount insured, sufficient to pay the amount so estimated.
(c) Not more than one (1) such general assessment shall be made in any one (1) year, nor shall any such assessment be made if more than ten percent (10%) of any previous assessment shall be in the treasury of the corporation, and not at the time required for losses actually suffered.
(d) No assessment shall be invalid because made in whole or in part for the purpose of paying any money borrowed by the directors or executive committee, which has been used in the payment of any claim for the loss or damage against the corporation.
Acts 1895, ch. 220, § 5; Shan., § 3358; Code 1932, § 6240; T.C.A. (orig. ed.), § 56-1904.
Tenn. Code Ann. § 56-26-114 — TN Code / Title 56 / Chapter 26 / Section 56-26-114
Filing procedure
Status: in_force

The commissioner may make reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper or advisable to the administration of this chapter. This section shall not abridge any other authority granted the commissioner by law. Acts 1955, ch. 4, § 4; T.C.A., § 56-3314.
The commissioner may make reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper or advisable to the administration of this chapter. This section shall not abridge any other authority granted the commissioner by law.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3314.
Tenn. Code Ann. § 56-51-141 — TN Code / Title 56 / Chapter 51 / Section 56-51-141
Injunction
Status: in_force

(a) In addition to the penalties and other enforcement provisions of this chapter, the department is vested with the power to seek both temporary and permanent injunctive relief when: (1) A prepaid limited health service organization is being operated by any person or entity without a certificate of authority; (2) Any person, entity, or prepaid limited health service organization has engaged in any activity prohibited by this chapter or any rule adopted pursuant to this chapter; or (3) Any prepaid limited health service organization, person, or entity is renewing, issuing, or delivering a prepaid limited health services contract without a certificate of authority. (b) The department's authority to seek injunctive relief is not conditioned on having conducted any proceeding pursuant to the Uniform Administrative Procedures Act, compiled at title 4, chapter 5. Acts 2000, ch. 948, § 41.
(a) In addition to the penalties and other enforcement provisions of this chapter, the department is vested with the power to seek both temporary and permanent injunctive relief when: (1) A prepaid limited health service organization is being operated by any person or entity without a certificate of authority; (2) Any person, entity, or prepaid limited health service organization has engaged in any activity prohibited by this chapter or any rule adopted pursuant to this chapter; or (3) Any prepaid limited health service organization, person, or entity is renewing, issuing, or delivering a prepaid limited health services contract without a certificate of authority.
(1) A prepaid limited health service organization is being operated by any person or entity without a certificate of authority;
(2) Any person, entity, or prepaid limited health service organization has engaged in any activity prohibited by this chapter or any rule adopted pursuant to this chapter; or
(3) Any prepaid limited health service organization, person, or entity is renewing, issuing, or delivering a prepaid limited health services contract without a certificate of authority.
(b) The department's authority to seek injunctive relief is not conditioned on having conducted any proceeding pursuant to the Uniform Administrative Procedures Act, compiled at title 4, chapter 5.
Acts 2000, ch. 948, § 41.
Tenn. Code Ann. § 56-7-2351 — TN Code / Title 56 / Chapter 7 / Section 56-7-2351
Pregnancy and maternity benefits - Termination of coverage
Status: in_force

Any individual and group health insurance policy providing coverage on an expense incurred basis or any individual and group service or indemnity type contract issued by a nonprofit corporation or the TennCare program that provides coverage for pregnancy and/or maternity benefits may not be cancelled or terminated due to pregnancy of an enrollee in the plan. If and only if a person or the person's spouse is pregnant at the time the health insurance coverage is initially purchased, then at the time of the purchase, pregnancy and/or maternity benefits for the current pregnancy may be denied as a preexisting condition. This section shall apply to any person who should have been entitled to coverage for the benefits on or after January 1, 1996. Acts 1996, ch. 964, § 2.
Any individual and group health insurance policy providing coverage on an expense incurred basis or any individual and group service or indemnity type contract issued by a nonprofit corporation or the TennCare program that provides coverage for pregnancy and/or maternity benefits may not be cancelled or terminated due to pregnancy of an enrollee in the plan. If and only if a person or the person's spouse is pregnant at the time the health insurance coverage is initially purchased, then at the time of the purchase, pregnancy and/or maternity benefits for the current pregnancy may be denied as a preexisting condition. This section shall apply to any person who should have been entitled to coverage for the benefits on or after January 1, 1996.
Acts 1996, ch. 964, § 2.
Tenn. Code Ann. § 56-2-404 — TN Code / Title 56 / Chapter 2 / Section 56-2-404
Foreign government controlled company as public nuisance - Injunction
Status: in_force

Any violation of §§ 56-2-401 - 56-2-403 and this section by an insurance company or other insurance entity that is financially owned or financially controlled by any alien or foreign government outside the continental limits of the United States or the territories of the United States, or by any representative or agent of the company or entity, is declared to be a public nuisance, and the commissioner is authorized and empowered to enjoin the nuisance by injunctive proceedings in the chancery court in like manner as is provided by the general statutes pertaining to enjoining nuisances. Acts 1955, ch. 3, § 4; T.C.A., §§ 56-326, 56-231.
Any violation of §§ 56-2-401 - 56-2-403 and this section by an insurance company or other insurance entity that is financially owned or financially controlled by any alien or foreign government outside the continental limits of the United States or the territories of the United States, or by any representative or agent of the company or entity, is declared to be a public nuisance, and the commissioner is authorized and empowered to enjoin the nuisance by injunctive proceedings in the chancery court in like manner as is provided by the general statutes pertaining to enjoining nuisances.
Acts 1955, ch. 3, § 4; T.C.A., §§ 56-326, 56-231.