reglab/housing_qa huggingface dataset:
TN Code § 56-7-2315 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2315. Requests for Information From Insured Persons — Grounds for Nonrenewal of Policy

  A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of the policy of any person covered under the policy as to whether:  The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program;   The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or   Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law.     The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured under the policy for the following reasons only:  Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the commissioner, or the converted policyholder fails to provide the requested information;   Fraud or material misrepresentation in applying for any benefits under the converted policy;   Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act (42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or   Other reasons approved by the commissioner.
TN Code § 56-7-2316 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2316. Ceiling on Converted Policy Benefits

 An insurer shall not be required to issue a converted policy that provides benefits in excess of those provided under the group policy from which conversion is made.
TN Code § 56-7-2317 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2317. Preexisting Conditions — Converted Policy Benefits in First Policy Year Limited by Group Policy Benefits

 The converted policy shall not exclude a preexisting condition not excluded by the group policy. However, the converted policy may provide that any hospital, surgical or medical benefits payable under the policy may be reduced by the amount of the benefits payable under the group policy after the termination of the individual's insurance under the group policy. The converted policy may also include provisions so that during the first policy year the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the individual's insurance under the group policy remained in force and effect.
TN Code § 56-7-2319 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2319. Optional Election of Retirement Conversion Rights

 In the event coverage would be continued under the group policy on an employee following retirement prior to the time the employee is or could be covered by medicare, the employee may elect, in lieu of the continuation of group insurance, to have the same conversion rights as would apply had the employee's insurance terminated at retirement by reason of termination of employment or membership.
TN Code § 56-7-2320 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2320. Medicare Eligibility as Affecting Coverage — Persons Who May Claim Conversion Privilege

  The converted policy may provide for reduction of coverage on any person upon the person's eligibility for coverage under medicare under Title XVIII of the federal Social Security Act (42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy.   Subject to the conditions set forth in subsection (a), the conversion privilege shall also be available to:  The surviving spouse, if any, at the death of the employee or member, with respect to the spouse and the children whose coverage under the group policy terminates by reason of the death, otherwise to each surviving child whose coverage under the group policy terminates by reason of the death, or, if the group policy provides for continuation of dependents' coverage following the employee's or member's death, at the end of the continuation;   The spouse of the employee or member upon termination of coverage of the spouse, while the employee or member remains insured under the group policy, by reason of ceasing to be a qualified family member under the group policy, with respect to the spouse and the children whose coverage under the group policy terminates at the same time;   A child, solely with respect to the child, upon termination of the child's coverage by reason of ceasing to be a qualified family member under the group policy, if a conversion privilege is not otherwise provided with respect to the termination; and   The spouse of the employee upon termination of coverage of the spouse by reason of termination of coverage of the employee or member because of eligibility for medicare.
TN Code § 56-7-2321 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2321. Provision of Group Coverage in Lieu of Converted Individual Coverage

 The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy.
TN Code § 56-7-2322 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2322. Notice of Conversion Privilege

 A notification of the conversion privilege shall be included in each certificate of coverage.
TN Code § 56-7-2323 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2323. Reduction of Benefits for School Insurance Benefits Prohibited

 No group policy of accident and sickness insurance offered for sale in this state shall be issued or renewed by any insurer or hospital service corporation or medical service corporation transacting business in this state that, by the terms of the policy, excludes or reduces the benefits payable or services to be rendered to or on behalf of any insured because benefits have been paid or are also payable under any blanket group or franchise school accident policy regardless of who makes the premium contribution, or under any individually underwritten and individually issued contract or plan of insurance that provides exclusively for accident and sickness benefits and for which one hundred percent (100%) of the premiums have been paid by the insured or a member of the insured's family or the insured's guardian, regardless of the mode or channel of premium payment to the insurer or of any discount received on the premium by virtue of the insured's membership in any organization or of the insured's status as an employee.
TN Code § 56-7-2324 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2324. Student Accident Coverage — Benefit Reduction Restricted

 Under any student accident coverage, regardless of the form of the contract, no provision may be included that reduces the benefits payable on account of the existence of group or individual insurance contracts that provide health insurance coverage on the student; provided, that this section does not apply to any student accident coverage where the school or institution is the policyholder and pays one hundred percent (100%) of the premium for the policy, without receipt of any premium contribution from any individual insured, parent or guardian.
TN Code § 56-7-2325 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2325. Medical Accident Insurance Issued to School Children — Coverage

 Where any policy of insurance, group or individual, issued after July 1, 1973, to school children, contains a provision whereby incurred medical benefits for accidents are payable for a specified number of days following the covered accident and if, during the specified period, written notice is given to the insurance company by the insured, accompanied by a written statement from the insured's licensed physician stating that medical treatment will be required after the termination of the specified period, then the company shall pay the medical expenses that are incurred within one (1) year from the date of the accident causing the loss for benefits as provided by the contract of insurance.
TN Code § 56-7-2326 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2326. Coverage for Prescription Eye Drops — Refills

 A policy or contract for a health benefit plan, as defined in § 56-7-2203, that is issued, renewed, or entered into on or after January 1, 2018, and provides coverage for prescription eye drops shall not deny coverage for a refill of a prescription that is a covered benefit under the policy or contract of the insured and is otherwise eligible for a refill if:   The renewal is requested by the insured for a thirty-day supply of the drug at least twenty-three (23) days from:  The original date the prescription was dispensed to the insured; or   The date the most recent refill was dispensed to the insured;     The renewal is requested by the insured for a sixty-day supply of the drug at least forty-five (45) days from:  The original date the prescription was dispensed to the insured; or   The date the most recent refill was dispensed to the insured; or     The renewal is requested by the insured for a ninety-day supply of the drug at least sixty-eight (68) days from:  The original date the prescription was dispensed to the insured; or   The date the most recent refill was dispensed to the insured.
TN Code § 56-7-2347 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2347. Coverage of Children in Custody of Guardians

  Notwithstanding any other law to the contrary, any individual, franchise, blanket or group policy issued pursuant to this title or any medical service plan, contract, hospital service corporation contract, hospital and medical service contract, fraternal benefit society or health maintenance organization that provides hospital expense insurance, surgical expense insurance, medical or major medical services insurance and that is entered into, delivered, issued for delivery, or renewed, excepting individual insurance policy renewal, by agreement or otherwise, beginning January 1, 1994, shall provide benefits for minor children who are by court order in the custody of a guardian who is a resident of this state covered under any such policy or plan issued to or on behalf of the guardian, unless the policy or plan specifically excludes or reduces the benefits.   This section shall not apply to policies that provide only hospital indemnity benefits or to policies that provide only benefits for specified accidents or specified diseases.   Any increase in expenditure requirements on a municipality or a county resulting from this section shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose.
TN Code § 56-7-2348 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2348. Eligibility for Medicaid

  All entities providing health care benefits, including, but not limited to, insurers, ERISA group health plans, health maintenance organizations and nonprofit hospital and medical service plans, are prohibited from considering the availability or eligibility for medical assistance under 42 U.S.C. § 1396a, which is referred to as “medicaid,” when considering eligibility for coverage or calculating payments under their plans for eligible enrollees, subscribers, policyholders, or certificate holders.   To the extent that payment for covered expenses has been made under the state medicaid program for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for the health care items or services. Upon presentation of proof that the state medicaid program or any provider who has contracted with the state to provide medicaid services has paid for covered items or services, the insurer, ERISA group health plan, health maintenance organization, or nonprofit hospital and medical service plan shall make payment to the state medicaid program, or contracted provider under the medicaid program according to the coverage provided in the policy or contract on the same basis applicable to an agent or assignee of any other individual so covered.
TN Code § 56-7-2349 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2349. Patients' Right to Truth — Alternative Medical Care, Treatments, Programs, or Pharmaceuticals

  This section shall be known and may be cited as the “Patients' Right to Truth Act of 1996.”   Each managed care organization, health maintenance organization or preferred provider organization, referred to as the “plan” in this section, shall not in any way restrict medical personnel regarding informing patients of alternative medical care, treatments, programs or pharmaceuticals that may be available to the enrollee or participant, regardless of whether covered by the plan or not.   A violation of this section is punishable by payment of a civil penalty of not more than one thousand dollars ($1,000) for each violation, but not to exceed an aggregate penalty of ten thousand dollars ($10,000), unless the person knew or reasonably should have known the person was in violation of this section, in which case the penalty is not more than five thousand ($5,000) for each violation, but not to exceed an aggregate penalty of fifty thousand dollars ($50,000) in any six-month period.
TN Code § 56-7-2350 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2350. Maternity Benefits — Minimum Standards of Coverage

  The general assembly finds that Tennesseans are increasingly concerned that mothers and newborns receive proper medical care prior to hospital discharge. The general assembly further finds that the lack of proper medical care jeopardizes the health, safety and well-being of the mothers and newborns and may result in serious, costly repercussions not only for the mothers and newborns but also for the entire state. The general assembly, therefore, finds and declares the existence of an immediate and substantial threat to the public health, safety and welfare. The general assembly acknowledges and endorses the recently promulgated emergency rules of the departments of finance and administration and commerce and insurance to timely address these important concerns.   In accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the departments are authorized to promulgate permanent rules establishing minimum standards of coverage for maternity benefits offered by insurers. The rules will establish standards sufficient to protect and promote the health, safety and well-being of both the post-partum mother and the newborn and recognize the relationship between the mother and physician.
TN Code § 56-7-2351 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2351. Pregnancy and Maternity Benefits — Termination of Coverage

 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.
TN Code § 56-7-2353 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2353. Coverage of Dental Procedures Performed on Certain Minors in Hospitals

  Any accident or sickness insurance or hospital, medical service contract or policy under this chapter or chapter 26, 27, 28, 29 or 32 of this title that takes effect on or after July 1, 1997, shall provide for reimbursement of anesthesia expenses, hospital expenses and physician expenses associated with any inpatient/outpatient hospital dental procedure where:  The expense is covered under the contract or policy; and   The procedure is performed on a minor eight (8) years of age or younger and cannot be safely performed in a dental office setting.     The benefit provided for by this section shall be subject to the same annual deductibles or co-insurance established for all other covered benefits within a given plan, policy or contract. Private third party payors may not reduce or eliminate coverage due to the requirements of this section. Nothing contained in this section shall be construed as applying to medical assistance programs funded with state and federal funds, if the programs require provision of services as medically necessary.
TN Code § 56-7-2354 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2354. Early Detection of Prostate Cancer

  Every contract that provides for hospital, surgical or medical care shall provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for men fifty (50) years of age and older and other men if a physician determines that early detection for prostate cancer is medically necessary. Nothing contained in this section shall be construed as applying to medical assistance programs funded with state and federal funds, if the programs require the provision of services as medically necessary.   Nothing in this section shall apply to accident only, specified disease, hospital indemnity, medicare supplement, long-term care or other limited benefit health insurance policies.
TN Code § 56-7-2358 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2358. Continuity of Care

  If a provider who is a member of a managed health insurance issuer's network terminates its agreement with the issuer, or the issuer terminates the provider without cause, then the provider and issuer shall allow a subscriber or enrollee who is:  Under active treatment for a particular injury or sickness, to continue to receive covered benefits from the treating provider for the injury or sickness for a period of one hundred twenty (120) days from the date of notice of termination;   In the second trimester of pregnancy to continue care with a treating provider until completion of postpartum care; and   Being treated at an inpatient facility to remain at the facility until the patient is discharged.     Subsection (a) shall apply only if the treating provider or inpatient facility agrees to continue to be bound by the terms, conditions and reimbursement rates of the provider's agreement with the issuer.
TN Code § 56-7-2362 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 23 - Mandated Insurer or Plan Coverage|§ 56-7-2362. Payment on Authorized Services — Correction of Submitted Claims

   If authorization is given and a pharmacy claim is adjudicated by a health insurer or its agent to any pharmacy services provider for care to be delivered to a covered beneficiary under any individual, franchise, blanket or group health insurance policy, medical service plan corporation contract, hospital service corporation contract, hospital and medical service corporation contract or fraternal benefit society, the health insurer acting directly or by delegation through an agent acting on behalf of the health insurer shall not subsequently rescind or modify that authorization or deny the authorized payment to the pharmacy services provider for the authorized service after the provider renders the authorized service in good faith and pursuant to the authorization, except for payments made as a result of the provider's misrepresentation or fraud.   If the bureau of TennCare provides notice to the health insurer or its agent that a person is eligible to participate in the TennCare program, and, if based on good faith reliance on the information, the health insurer makes a payment to a pharmacy provider for providing pharmacy services to the person enrolled in the TennCare program, and, if the bureau of TennCare later rescinds the eligibility for the person, then the bureau of TennCare shall remain liable to the health insurer for any amount the health insurer paid to the provider for the pharmacy services. The bureau of TennCare shall not be liable when the eligibility is rescinded in the case of fraud or death as defined in the contract. The bureau of TennCare shall not be liable due to an error or delay on the part of the managed care organization or its agents in processing eligibility information received from the bureau of TennCare.     Notwithstanding subsection (a), any organization may request the pharmacy to adjust or correct an adjudicated claim to correct incorrect data elements, including incorrect billing units, incorrect national drug code (NDC) numbers and incorrect prescriber identification numbers submitted in error and in good faith by the pharmacy. An organization shall provide the pharmacy an opportunity to correct claims submitted by the pharmacy in good faith. If the pharmacy does not correct the adjudicated claim requested within thirty (30) days of receipt of the request, then the organization may rescind, modify or recoup the funds paid on the requested claim and shall not be in violation of this section.