reglab/housing_qa huggingface dataset:
TN Code § 56-7-3111 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3111. Disclosure of Maximum Allowable Cost Lists and Related Information

 A pharmacy shall not disclose to any third party the maximum allowable cost lists and any related information it receives from a pharmacy benefits manager or covered entity; provided, however, a pharmacy may share such lists and related information with a pharmacy services administrative organization or similar entity with which the pharmacy has a contract to provide administrative services for that pharmacy. If a pharmacy shares this information with a pharmacy services administrative organization or similar entity, that organization or entity shall not disclose the information to any third party.
TN Code § 56-7-3112 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3112. Fair Disclosure of State Funded Payments for Pharmacists' Services Act

  This section shall be known and may be cited as the “Fair Disclosure of State Funded Payments for Pharmacists' Services Act”.   As used in this section:  “Pharmacist” means a pharmacist as defined in § 63-10-204;   “Pharmacist services” means products, goods, or services provided as a part of the practice of pharmacy as defined in § 63-10-204 to individuals who reside or are employed in this state;   “Pharmacy” means the same as defined in § 63-10-204;   “Pharmacy benefits manager” or “PBM” means an entity that administers or manages a pharmacy benefits plan or program; and   “Pharmacy benefits plan or program” means any plan or program that is funded by state dollars to furnish, cover the cost of, or otherwise provide for pharmacist services to individuals who reside or are employed in this state.     A PBM, when seeking payment or reimbursement for pharmacist services provided in connection with a pharmacy benefits plan or program or reporting expenditures for pharmacist services provided in connection with a pharmacy benefits plan or program, shall itemize by individual claim:  The amount actually paid or to be paid to the pharmacy or pharmacist for the pharmacist services;   The identity of the pharmacy or pharmacist actually paid or to be paid; and   The prescription number or other identifier of the pharmacist services.     A PBM shall pay the amounts it receives for pharmacist services provided in connection with a pharmacy benefits plan or program to the pharmacies or pharmacists that provided the pharmacist services.   This section does not:  Require a PBM to set specific fees, rates, or schedules for payment for pharmacist services;   Prohibit a PBM from charging for any services in addition to pharmacist services; or   Require a PBM to pay a pharmacy or pharmacist more on any claim than the amount disclosed under subdivision (c)(1).     A violation of this section is an unfair trade practice under the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8, part 1 of this title.   All documents containing individual claim and payment information specified in subsections (c) and (d) shall be confidential records and not subject to the requirements of title 10, chapter 7, relating to public inspection of records.   A state agency administering a PBM contract may provide the information described in subsections (c) and (d) to a qualified independent auditor in accordance with § 4-3-1021; provided, the information is relevant to an audit authorized under § 4-3-1021, and the independent auditor has agreed to maintain the confidentiality of the information.
TN Code § 56-7-3113 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3113. Licensure as Pharmacy Benefits Manager

  No person or entity shall administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the department of commerce and insurance.   To obtain licensure as a pharmacy benefits manager, the person or entity must demonstrate to the department that the person or entity:  Is authorized to transact business in this state;   Is financially responsible, as determined by the department; and   Has not had a prior license to be a pharmacy benefits manager denied for cause or revoked by the department within five (5) years of the date on which licensure is sought.      In addition to the showing required by subsection (b), a person or entity seeking licensure as a pharmacy benefits manager shall also provide the following information to the department:  The person or entity's name, address, telephone number, email address, and website address; and   If the licensure is sought for an entity, the name, address, telephone number, and email address for a contact person.     Any material changes in the information described in this subsection (c) shall be filed with the department within sixty (60) days of the change.     A person or entity's license as a pharmacy benefits manager shall be renewed biennially.    Any person or entity seeking licensure as a pharmacy benefits manager shall pay a fee in the amount of one hundred dollars ($100) to the department to obtain the license. Any person or entity seeking renewal of a license as a pharmacy benefits manager shall pay a fee in the amount of fifty dollars ($50) to renew the license.   All fees paid pursuant to this section shall be used by the department for purposes of administering this section.      Failure to obtain licensure or renew a license pursuant to this section while acting as a pharmacy benefits manager in this state shall constitute a violation of this section and shall be punishable by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500).   Any person or entity assessed a fine pursuant to this section or denied a license or renewal of a license may appeal the fine or denial pursuant to the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
TN Code § 56-7-3114 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3114. Right to Provide Information Regarding Amount of Insured's Cost Share of Prescription Drug

 A pharmacy or pharmacist has the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in this section or for selling a lower priced drug to the insured if one is available.
TN Code § 56-7-3115 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3115. Prohibited Charges

 A covered entity or pharmacy benefits manager shall not charge a pharmacist or a pharmacy a fee related to a claim unless it is apparent at the time of claim processing and is reported on the remittance advice of an adjudicated claim. This section does not prohibit a covered entity or pharmacy benefits manager from entering into an agreement with a pharmacy or pharmacist which includes prospective performance-based incentives and increases payment to pharmacies or pharmacists.
TN Code § 56-7-3116 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3116. Prohibited Terms or Conditions in Contracts

 A covered entity or pharmacy benefits manager shall not include any term or condition in a contract with a pharmacy or pharmacist that requires a pharmacist to dispense a drug or other product to a patient contrary to a pharmacist's professional judgment.
TN Code § 56-7-3117 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3117. Disclosure of Material Changes to Contract Provisions

 A covered entity or pharmacy benefits manager shall disclose to a pharmacy or pharmacist in its network, at least thirty (30) days before the date the change becomes effective, any material change to a contract provision that affects the terms of reimbursement, the process for verifying benefits and eligibility, the dispute resolution procedure, the procedure for verifying drugs included in the formulary, and the procedure for contract termination. Nothing in this section prohibits a covered entity or pharmacy benefits manager from taking action without notice against a pharmacy or pharmacist in its network for a fraudulent claim or service.
TN Code § 56-7-3118 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 31 - Pharmacy Benefits Managers|§ 56-7-3118. Mutual Agreement on Terms and Conditions for Provision of Pharmacy Services — Use of Untrue, Deceptive, or Misleading Advertisement, Etc. Prohibited — Effect of Removal of Pharmacist or Pharmacy — Pattern or Practice of Reimbursing Pharmacies or Pharmacists Lesser Amount Prohibited

  Each contract between a covered entity or pharmacy benefits manager and a pharmacist or pharmacy must be mutually agreed upon and must outline the terms and conditions for the provision of pharmacy services.   A covered entity or pharmacy benefits manager shall not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.   Removal of a pharmacy or a pharmacist from the network of a covered entity or pharmacy benefits manager does not release the covered entity or pharmacy benefits manager from the obligation to make any payment due to the pharmacy or pharmacist for services that have been properly rendered prior to the pharmacy being removed from the network. Properly rendered services do not include any services related to a fraudulent claim or intentional misrepresentation.   A covered entity or pharmacy benefits manager shall not engage in a pattern or practice of reimbursing pharmacies or pharmacists in this state less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same drug or dispensed product or service.
TN Code § 56-7-3201 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 32 - Pharmacy Benefits|§ 56-7-3201. Part Definitions

 As used in this part, unless the context otherwise requires:   “Actual reimbursement” means the total amount that a covered entity or pharmacy benefits manager determines that a pharmacy or other dispenser will receive consistent with the provider agreement, and is the sum of the amount the covered entity or pharmacy benefits manager will pay directly to the pharmacy or other dispenser plus any applicable patient out-of-pocket cost paid directly by the patient to the pharmacy or other dispenser, for dispensing of a particular prescription or providing a covered service;   “Covered entity” means a covered entity as defined in § 56-7-3102; and   “Pharmacy benefits manager” means a pharmacy benefits manager as defined in § 56-7-3102.
TN Code § 56-7-3202 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 32 - Pharmacy Benefits|§ 56-7-3202. Calculation of Out-of-Pocket Costs for Prescription Drugs and Covered Services

  When a patient's out-of-pocket cost for a prescription or covered service is percentage-based, the covered entity or pharmacy benefits manager shall calculate the out-of-pocket cost such that when the out-of-pocket cost is added to the amount that the covered entity or pharmacy benefits manager will directly pay to the pharmacy or other dispenser the sum will equal the actual reimbursement.   The requirements of subsection (a) shall not apply when patient out-of-pocket cost for a prescription or covered service is percentage-based for only a specified portion or predefined subset of drug tiers or specialty drug categories and the remainder of the covered drug prescriptions or services available to the patient are associated with predefined and specific out-of-pocket costs.
TN Code § 56-7-3203 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 32 - Pharmacy Benefits|§ 56-7-3203. Disclosure of the Actual Reimbursement for a Particular Prescription or Covered Service

 A covered entity or pharmacy benefits manager shall not in any way restrict, by contract or otherwise, any pharmacy or other dispenser from disclosing to the patient or authorized representative of the patient the actual reimbursement for a particular prescription or covered service. A pharmacy or other dispenser may disclose the actual reimbursement either orally or in writing on any document, including, but not limited to, a receipt, patient profile and summary of the patient's expenditures for prescriptions or covered services.
TN Code § 56-7-3204 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 32 - Pharmacy Benefits|§ 56-7-3204. Construction of Part

 The requirements of this part shall only be construed to apply to policies, contracts and certificates executed, delivered, issued for delivery or renewed in this state on or after January 1, 2010.
TN Code § 56-7-3301 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 33 - Contracts With Health Care Providers|§ 56-7-3301. Part Definitions

 As used in this part, unless the context otherwise requires:   “Health care provider” or “provider” means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract;   “Health insurance entity” has the same meaning as in § 56-7-109; and   “Reasonably accurate” means information determined through application by the health insurance entity of contract rates, fee schedules and reimbursement rules and policies in effect as of the date inquiry is made by the provider.
TN Code § 56-7-3302 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 33 - Contracts With Health Care Providers|§ 56-7-3302. Clear Identification of Material Changes to Provider Manual

   A health insurance entity shall provide notice to a healthcare provider of any material change made in the sole discretion of the insurance entity to the entity's previously released provider manual or a reimbursement rule and policy at least sixty (60) days prior to the effective date of the change, and the health insurance entity shall ensure that any such material change is clearly identified in the following manner:  Disclosing or identifying the change in the provider manual through the use of bold print or a font, or both, with the bold print or font being the same or larger size as the font generally used throughout the policy or manual; and   Disclosing or identifying the change in the reimbursement rules and policies and the effective date of the change through the use of a separately categorized communication to the provider.     Any disclosures required under this subsection (a) may be distributed by either:  An internet web-accessible section associated with a web-accessible current version of the provider manual or reimbursement rules and policies; or   Written communication sent to a dedicated email address or as stipulated in the contract between the provider and the health insurance entity. The provider shall submit to the health insurance entity a dedicated email address to receive the disclosures required by this subsection (a).       Notwithstanding any law to the contrary, nothing in this part shall apply to 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 a contract between a healthcare provider and the state or federal government or their agencies for health services provided through Medicare.
TN Code § 56-7-3303 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 33 - Contracts With Health Care Providers|§ 56-7-3303. Establishment and Maintenance of Internet Web Site — Web-Based Preadjudication Tool

  By July 1, 2010, a health insurance entity shall establish and maintain an Internet web site, which shall be accessible to health care providers with whom the health insurance entity has an express and a valid network provider agreement or contract.    Excluding inpatient claims, every health insurance entity shall make available on the Internet web site established pursuant to subsection (a) a web-based preadjudication tool to be used by a health care provider prior to the provider's submitting either a clean claim as defined in § 56-7-109 or a claim combination to the claims adjudication system utilized by the health insurance entity. The preadjudication tool shall be designed in such a manner as to be capable of:  Providing reasonably accurate information to a health care provider regarding the manner in which the health insurance entity's claim system will adjudicate claims for specific billing codes or combinations of codes; and   Providing reasonably accurate information to a health care provider regarding the allowed amount for those claims submitted pursuant to this subdivision (b)(1) based on the health care provider's fee schedule and contract with the health insurance entity for which the claim will be submitted if the claim is determined to be a clean claim.     Nothing in this subsection (b) shall be construed as requiring the preadjudication tool to reflect the effects of coverage terms and conditions unrelated to application of contract rates, fee schedules and reimbursement rules and policies, including, without limitation, eligibility for coverage, deductibles and copayments, coordination of benefits and coverage limitations and exclusions; and nothing in this subsection (b) shall be construed as requiring the preadjudication tool to respond to a provider when the data submitted by the provider is insufficient to provide the information required by subdivisions (b)(1)(A) and (B).     Health insurance entity policies affecting the information available to a provider pursuant to subsection (b) shall be easily accessible by a health care provider on the web site established by the health insurance entity pursuant to subsection (a).
TN Code § 56-7-3304 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 33 - Contracts With Health Care Providers|§ 56-7-3304. Applicability of Part

 This part shall not apply to a contract between a health care provider and the state or federal government or their agencies for health care services provided through a program for medicare; the state group insurance program; TennCare or any successor program provided for in title 71, chapter 5; the CoverKids Act of 2006 provided for in title 71, chapter 3, part 11; the Cover Tennessee Act of 2006 provided for in chapter 7, part 30 of this title [repealed]; or the Access Tennessee Act of 2006 provided for in chapter 7, part 29 of this title.
TN Code § 56-7-3401 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 34 - Unclaimed Life Insurance Benefits Act|§ 56-7-3401. Short Title

 This part shall be known as the “Unclaimed Life Insurance Benefits Act”.
TN Code § 56-7-3402 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 34 - Unclaimed Life Insurance Benefits Act|§ 56-7-3402. Construction With Uniform Unclaimed Property Act

 Nothing in this part shall supersede the Uniform Unclaimed Property Act, compiled in title 66, chapter 29, part 1.
TN Code § 56-7-3403 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 34 - Unclaimed Life Insurance Benefits Act|§ 56-7-3403. Part Definitions

 As used in this part:   “Account owner” means the owner of a retained asset account who is a resident of this state;   “Annuity” means any active annuity contract issued in this state other than an annuity used to fund an employment-based retirement plan or program where the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants or that is used to fund a pre-need funeral contract as defined in § 62-5-403;   “Asymmetric conduct” means an insurer's use of the DMF prior to July 1, 2015, in connection with searching for information regarding whether annuitants under the insurer's annuities might be deceased, but not in connection with whether the insureds under its policies might be deceased;   “Beneficiary” means an individual or other entity entitled to benefits under a policy or annuity;   “Death master file” or “DMF” means the death master file from the United States social security administration or any other database or service that an insurer may determine is substantially as inclusive as the death master file for determining that a person has reportedly died;   “Death master file match” or “DMF match” means a search of a DMF that results in a match of a person's social security number or name and date of birth;   “Insurer” means any insurance company authorized to transact life insurance business in this state;   “Person” means the policy insured, annuity owner, annuitant, or account owner, as applicable under the policy, annuity, or retained asset account subject to this part;   “Policy” means any policy or certificate of life insurance issued in this state, but does not include any policy or certificate of life insurance that provides a death benefit under:  An employee benefit plan subject to the Employee Retirement Income Security Act of 1974, as periodically amended, compiled at 29 U.S.C. § 1002 et seq.;   Any federal employee benefit program;   Government plans or church plans as defined in the Employee Retirement Income Security Act of 1974, as periodically amended, compiled at 29 U.S.C. § 1002 et seq.;   A policy or certificate of life insurance that is used to fund a pre-need funeral contract as defined in § 62-5-403; or   A policy or certificate of credit life or accident and health insurance;     “Record keeping services” means those circumstances under which the insurer has agreed with a group life insurance policyholder to be responsible for obtaining, maintaining, and administering in its own systems information about each individual insured under the policyholder's group life insurance contract at least the following information:  Individual insured's social security number or name and date of birth;   Beneficiary designation information;   Coverage eligibility;   Benefit amount; and   Premium payment status.
TN Code § 56-7-3405 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 7 - Policies and Policyholders|Part 34 - Unclaimed Life Insurance Benefits Act|§ 56-7-3405. Failure to Comply With Part May Constitute Unfair Claims Settlement Practice — No Private Cause of Action Created

 A pattern of failures to meet the requirements of this part may constitute an unfair claims settlement practice under the Tennessee Unfair Trade Practices and Unfair Claims Settlement Act of 2009, compiled in chapter 8 of this title. Nothing in this part shall be construed to create or imply a private cause of action for a violation of this part.