reglab/housing_qa huggingface dataset:
TN Code § 56-51-118 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-118. Charter — Bylaw Provisions

 No prepaid limited health services contract may contain any provision purporting to make any portion of the articles of incorporation, charter, bylaws, or other organizational document of the prepaid limited health service organization a part of the contract unless the provision is set forth in full in the contract. Any contract provision in violation of this section is invalid unless the provision operates to the benefit of the subscriber.
TN Code § 56-51-119 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-119. Execution of Contracts

  Every prepaid limited health services contract must be executed in the name of and on behalf of the prepaid limited health service organization by its officer, attorney in fact, employee, or representative duly authorized by the organization.   A facsimile signature of any executing individual may be used in lieu of an original signature.   No prepaid limited health services contract that is otherwise valid is rendered invalid by reason of the apparent execution of the contract on behalf of the prepaid limited health service organization by the imprinted facsimile signature of an individual not authorized so to execute as of the date of the contract.
TN Code § 56-51-120 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-120. Validity of Noncomplying Contracts

  Any prepaid limited health services contract rider, endorsement, attachment, or addendum otherwise valid that contains any condition or provision not in compliance with the requirements of this chapter is not thereby rendered invalid, but must be construed and applied in accordance with the conditions and provisions as they would have applied had the contract, rider, endorsement, attachment, or addendum been in full compliance with this chapter. If an organization issues or delivers any contract for an amount that exceeds any limitations otherwise provided in this chapter, the organization is liable to the subscriber or the subscriber's beneficiary for the full amount stated in the contract in addition to any other penalties that may be imposed under this chapter.   Any prepaid limited health services contract delivered or issued for delivery in this state covering a subscriber, which subscriber pursuant to this chapter the organization may not lawfully cover under the contract, is cancelable at any time by the organization, any provision of the contract to the contrary notwithstanding, and the organization must promptly cancel the contract in accordance with the request of the department for cancellation. No illegality or cancellation may be deemed to relieve the organization of any liability incurred by it under the contract while in force or to prohibit the organization from retaining the pro rata earned premium or rate on the contract. This subsection (b) does not relieve the organization from any penalty otherwise incurred by the organization under this chapter for any such violation.
TN Code § 56-51-121 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-121. Construction of Contracts

 Every prepaid limited health services contract must be construed according to the entirety of its terms and conditions as set forth in the contract and as amplified, extended, or modified by any application, endorsement, attachment, or addendum.
TN Code § 56-51-122 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-122. Delivery of Contract

 Unless delivered upon execution or issuance, a prepaid limited health services contract, certificate of coverage, or member handbook must be mailed or delivered to the health maintenance organization or to the state or federal agency with whom the prepaid limited health services organization has contracted prior to the effective date of coverage by the prepaid limited health service organization.
TN Code § 56-51-123 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-123. Notice of Cancellation of Contract

  Except for nonpayment of premium or termination of eligibility, a prepaid limited health service organization may not cancel or otherwise terminate or fail to renew a prepaid limited health services contract without giving the subscriber and the health maintenance organization or state or federal agency with whom it has contracted at least forty-five (45) days' notice in writing of the cancellation, termination, or nonrenewal of the contract. The written notice must state the reason or reasons for the cancellation, termination, or nonrenewal. The only reasons for cancellation at the time other than the renewal period shall be as follows:  The subscriber's behavior is disruptive, unruly, abusive, unlawful, fraudulent, or uncooperative to the extent that the subscriber's continuing participation seriously impairs the organization's ability to provide services to other subscribers;   Fraud or material misrepresentation in applying for or presenting any claim for benefits under the contract;   Misuse of the documents provided as evidence of benefits available pursuant to the contract; or   Furnishing to the organization, by the subscriber, incorrect or incomplete information for the purposes of fraudulently obtaining services.     Prior to disenrollment, the organization must make an effort to resolve the problem through the grievance procedure and must determine that the subscriber's behavior is not due to use of the services provided or mental illness. All prepaid limited health services contracts must contain a clause that requires that this notice be given. In the case of a prepaid limited health services contract issued to an employer holding the contract on behalf of the subscriber group, the prepaid limited health service organization may make the notification through the employer, and, if the prepaid limited health service organization elects to take this action through the employer, the organization shall be deemed to have complied with this section upon notifying the employer of the requirements of this section and requesting the employer to forward the required notice to all subscribers.
TN Code § 56-51-124 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-124. Construction and Relationship With Other Laws

  No other provision of this title applies to a prepaid limited health service organization, unless a prepaid limited health service organization is specifically mentioned in the provision.   Except as provided in this chapter, this title does not apply to prepaid limited health service organizations certificated under this chapter. Any person, entity, or prepaid limited health service organization operating without a subsisting certificate of authority in violation of this chapter or rules adopted under this chapter, in addition to being subject to this chapter, is subject to the insurance code.   The department is vested with all powers granted to it under the insurance code with respect to the investigation of any violation of this chapter.
TN Code § 56-51-125 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-125. Acceptable Payments

 Each prepaid limited health service organization may accept from a health maintenance organization licensed pursuant to chapter 32 of this title, or a state or federal agency payments covering all or part of the cost of contracts entered into between the prepaid limited health service organization and its subscribers.
TN Code § 56-51-126 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-126. Certain Words Prohibited in Name of Organization

  No entity certificated as a prepaid limited health service organization, other than a licensed insurer or health maintenance organization insofar as its name is concerned, may use in its name, contracts, or literature any of the words “insurance,” “casualty,” “surety,” “mutual,” or “HMO,” or any other words descriptive of the insurance, casualty, HMO, or surety business or deceptively similar to the name or description of any insurance, HMO, or surety corporation doing business in this state.   No person, entity, or health care plan not certificated under this chapter may use in its name, logo, contracts, or literature the phrase “prepaid limited health services contract” or the initials “PLHSC” to imply, directly or indirectly, that it is a prepaid limited health service organization or hold itself out to be a prepaid limited health service organization.
TN Code § 56-51-127 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-127. Extension of Benefits

 Every prepaid limited health services contract must provide that termination of the contract by the prepaid limited health service organization is without prejudice to any continuous loss that commenced while the contract was in force. Extension of benefits beyond the period the contract was in force must be until the specific treatment or procedure undertaken upon any subscriber has been completed or for ninety (90) days, whichever is the lesser period of time.
TN Code § 56-51-129 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-129. Administrative, Provider, and Management Contracts

  The department may require a prepaid limited health service organization to submit any contract for administrative services, contract with a provider physician, contract for management services, or contract with an affiliated entity to the department if the department has information that the prepaid limited health service organization has entered into a contract that requires it to pay a fee that is unreasonably high in relation to the service provided.   After review of a contract, the department may order the prepaid limited health service organization to cancel the contract if it determines that the fees to be paid by the prepaid limited health service organization under the contract are so unreasonably high as compared with similar contracts entered into by the prepaid limited health service organization in similar circumstances that the contract is detrimental to the subscribers, stockholders, investors, or creditors of the prepaid limited health service organization.   All contracts for administrative services, management services, or provider services or contracts with affiliated entities, entered into or renewed by a prepaid limited health service organization, must contain a provision that the contract will be cancelled upon issuance of an order by the department pursuant to this section.
TN Code § 56-51-130 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-130. Contract Providers

 A prepaid limited health service organization that subcontracts with another entity to obtain a network of providers to furnish services to members or enrollees shall guarantee and assure the payment of all contracted amounts agreed to be paid to such providers by that entity or that entity's agent. This section does not preclude the prepaid limited health service organization from seeking reimbursement from the subcontractor for any amounts paid pursuant to this section. Nor does this section prevent the prepaid limited health service organization from asserting any legal defenses to the payment of a provider's claim that were available to the subcontractor. This section shall be effective for all provider claims for services delivered after January 1, 2001.
TN Code § 56-51-131 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-131. Complaint System

 Every prepaid limited health service organization, except the organizations that participate in the TennCare program, shall comply with § 56-32-110.
TN Code § 56-51-132 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-132. Examination by the Department

 The department shall examine the affairs, transactions, accounts, business records, and assets of any prepaid limited health service organization, in the same manner and subject to the same terms and conditions that apply to health maintenance organizations under § 56-32-115.
TN Code § 56-51-133 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-133. Assets, Liabilities, and Investments

 Section 56-32-111 shall apply in its entirety to determine what assets, liabilities, and investments are acceptable for a prepaid limited health service organization.
TN Code § 56-51-135 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-135. Agent Licensing

  With respect to a prepaid limited health services contract, a person may not, unless licensed and appointed as a health insurance agent in accordance with the applicable provisions of the insurance code:  Solicit contracts or procure applications; or   Engage or hold out as engaging in the business of analyzing or abstracting prepaid limited health services contracts or of counseling or advising or giving opinions to persons relative to the contracts other than as a consulting actuary advising a prepaid limited health service organization or as a salaried bona fide full-time employee so counseling and advising the employee's employer relative to coverage for the employer and the employer's employees.     All qualifications, disciplinary provisions, licensing and appointment procedures, fees, and related matters contained in the insurance code that apply to the appointment of health insurance agents by insurers also apply to prepaid limited health service organizations and to persons appointed by prepaid limited health service organizations as their agents.   Examination, licensure, or appointment is not required of any regular salaried officer or employee of a prepaid limited health service organization who devotes substantially all of the regular salaried  officer's or employee's services to activities other than the solicitation of prepaid limited health service organization contracts from the public, and who receives no commission or other compensation directly dependent upon the solicitation of the contracts.   As used in this section, the term “salaried” refers to basic remuneration and does not include commissions, bonuses, or any other compensatory measures.
TN Code § 56-51-136 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-136. Minimum Net Worth and Working Capital Requirements

  Except as set forth in subsection (c), each prepaid limited health service organization must at all times maintain a minimum net worth and working capital as required pursuant to § 56-32-112.   Except as set forth in subsection (c), the department may not issue a certificate of authority unless the prepaid limited health service organization is in compliance with § 56-32-112.   Notwithstanding subsections (a) and (b), the department is authorized to promulgate rules and regulations pursuant to the Uniform Administrative Procedures Act, compiled at title 4, chapter 5 that set forth minimum net worth and working capital requirements for any prepaid limited health service organization that limits the services it offers to services rendered by professionals licensed to practice the healing arts and regulated by a single health related board pursuant to title 63.
TN Code § 56-51-137 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-137. Insolvency Protection

  Except as required in subsection (b), each prepaid limited health service organization must deposit with the department cash or securities of the type eligible under § 56-32-111, which must have at all times a market value in the amount set forth in this subsection (a). The amount of the deposit shall be reviewed annually or more often as the department deems necessary. The market value of the deposit must be that which is prescribed in § 56-32-112(b).    If securities or assets deposited by a prepaid limited health service organization under this chapter are subject to material fluctuations in market value, the department may in its discretion require the organization to deposit and maintain on deposit additional securities or assets in an amount as may be reasonably necessary to assure that the deposit will at all times have a market value of not less than the amount specified under § 56-32-112(b).   If for any reason the market value of assets and securities of a prepaid limited health service organization held on deposit under this chapter falls below the amount required, the organization must promptly deposit other or additional assets or securities eligible for deposit sufficient to cure the deficiency. If the prepaid limited health service organization has failed to cure the deficiency within thirty (30) days after receipt of notice by certified mail from the department, the department may revoke the certificate of authority of the prepaid limited health service organization.   A prepaid limited health service organization may, at its option, deposit assets or securities in an amount exceeding its deposit required or otherwise permitted under this chapter for the purpose of absorbing fluctuations in the value of securities and assets deposited and to facilitate the exchange and substitution of securities and assets. During the solvency of the prepaid limited health service organization, any excess must be released to the organization upon its request. During the insolvency of the prepaid limited health service organization, any excess deposit may be released to the commissioner as receiver, rehabilitator, or liquidator as provided under chapter 9 of this title.     All income from deposits shall be an asset of the organization. A prepaid limited health service organization that has been allowed by the department to make a securities deposit may withdraw that deposit or any part of the deposit after making a substitute deposit of cash, securities, or any combination of these or other measures of equal amount and value as approved by the department.
TN Code § 56-51-138 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-138. Officers' and Employees' Fidelity Bond

  A prepaid limited health service organization must maintain in force a fidelity bond in its own name on its officers and employees, in an amount not less than fifty thousand dollars ($50,000) or in any other amount prescribed by the department. Except as otherwise provided by this subsection (a), the bond must be issued by an insurance company that is licensed to do business in this state.   In lieu of the bond specified in subsection (a), a prepaid limited health service organization may deposit with the department cash or securities or other investments of the types set forth in § 56-51-133. The deposit must be maintained in joint custody with the commissioner in the amount and subject to the same conditions required for a bond under this subsection (b).
TN Code § 56-51-140 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-140. Administrative Penalty in Lieu of Suspension or Revocation

 In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, or entity subject to this act has been found to have violated any provision of this chapter, the department may:   Issue and cause to be served upon the organization, person, or entity charged with the violation a copy of the findings and an order requiring the organization, person, or entity to cease and desist from engaging in the act or practice that constitutes the violation; and   Impose a monetary penalty of not less than one hundred dollars ($100) for each violation, but not to exceed an aggregate penalty of one hundred thousand dollars ($100,000).
TN Code § 56-51-141 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-141. Injunction

  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:  A prepaid limited health service organization is being operated by any person or entity without a certificate of authority;   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   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.     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.
TN Code § 56-51-142 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-142. Payment of Judgment by Prepaid Limited Health Service Organization

 Except as otherwise ordered by the court or as mutually agreed upon by the parties, every judgment or decree entered in any court against any prepaid limited health service organization for the recovery of money must be fully satisfied within sixty (60) days after the entry of the judgment or decree, or, in the case of an appeal from the judgment or decree, within sixty (60) days after the affirmance of the judgment or decree by the appellate court.
TN Code § 56-51-143 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-143. Levy Upon Deposit Limited

 No judgment creditor or other claimant, other than the department, of a prepaid limited health service organization shall have the right to levy upon any of the assets or securities held in this state as a deposit under § 56-51-137.
TN Code § 56-51-144 (2021)
2021 Tennessee Code|Title 56 - Insurance|Chapter 51 - Tennessee Prepaid Limited Health Service Organization Act of 2000|§ 56-51-144. Delinquency or Supervision

  A delinquency proceeding under chapter 9, part 2, 3, or 4 of this title, or supervision by the department pursuant to chapter 9, part 5 of this title constitutes the sole and exclusive means of supervising, liquidating, reorganizing, rehabilitating, or conserving a prepaid limited health service organization.   No prepaid limited health service organization is subject to the laws and regulations governing insurance or health maintenance organization insolvency guaranty funds. No insurance insolvency guaranty fund may provide protection to any individuals entitled to receive limited health services from a prepaid limited health service organization for services related to a prepaid limited health service contract.