reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 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.
Acts 1996, ch. 964, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2353 - Coverage of dental procedures performed on certain minors in hospitals

(a)
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:
(1)
The expense is covered under the contract or policy; and
(2)
The procedure is performed on a minor eight (8) years of age or younger and cannot be safely performed in a dental office setting.
(b)
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.
Acts 1997, ch. 363, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2357 - Section definitions - Health insurance issuer limitations - Actions not prohibited

(a)
As used in this section:
(1)
"Managed health insurance issuer" has the same meaning as defined in §
56-32-128(a)
; and
(2)
"Medical laboratory" has the same meaning as defined in §
68-29-103
.
(b)
A health insurance issuer or a managed health insurance issuer shall not:
(1)
Deny a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan; provided, that this subdivision (b)(1) does not prohibit a managed health insurance issuer or health insurance issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where a managed health insurance issuer or health insurance issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care needs; and
(2)
Prevent a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan; provided, that the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory.
(c)
Each health insurance issuer or managed health insurance issuer shall apply the same coinsurance, co-payment, deductible, and quantity limit factors within the same employee group and other plan-sponsored groups to all medical laboratory services provided by a licensed medical laboratory; provided, that all medical laboratories comply with the same terms and conditions.
(d)
This section does not prohibit:
(1)
A health insurance issuer or managed health insurance issuer from applying different coinsurance, co-payment, and deductible factors within the same employer group and other plan-sponsored groups; or
(2)
An employer or other plan-sponsored group from offering multiple options or choices of health insurance benefit plans, including, but not limited to, cafeteria benefit plans.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2358 - Continuity of care

(a)
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:
(1)
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;
(2)
In the second trimester of pregnancy to continue care with a treating provider until completion of postpartum care; and
(3)
Being treated at an inpatient facility to remain at the facility until the patient is discharged.
(b)
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.
Acts 1998, ch. 1033, § 8.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2362 - Payment on authorized services - Correction of submitted claims

(a)
(1)
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.
(2)
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.
(b)
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.
Acts 2001, ch. 340, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2363 - Colorectal cancer early detection

(a)
All individual and group health insurance policies providing coverage on an expense incurred basis, individual and group service contracts issued by a health maintenance organization, all self-insured group arrangements to the extent not preempted by federal law and all managed health care delivery entities of any type or description, that are delivered or issued on or after January 1, 2004, in this state shall include, or shall offer to prospective policyholders and existing policyholders on renewal, as an optional benefit, coverage for colorectal cancer examinations and laboratory tests specified in current American Cancer Society guidelines or federal Preventive Services Task Force guidelines for colorectal cancer screening of asymptomatic individuals.
(b)
The benefits required by this section shall be subject to the annual deductible and co-insurance established for all other similar benefits within the policy or contract; provided, that the annual deductible and co-insurance for the benefits required by this section are no greater than the annual deductible and co-insurance established for all other similar benefits within that policy or contract of insurance.
(c)
Nothing in this section shall apply to the TennCare program administered pursuant to the waivers approved by the federal department of health and human services, to accident-only, specified disease, hospital indemnity, medicare supplement, long-term care or other limited benefit health insurance policies, or to any health benefit that is individually underwritten.
Acts 2003, ch. 200, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2364 - Medication counseling

(a)
Notwithstanding any other law to the contrary, any insurer providing individual, franchise, blanket or group policy of insurance issued pursuant to this title, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, preferred provider organization or managed care organization, that provides hospital expense and surgical or medical expense insurance or that is entered into, delivered, issued for delivery or renewed in this state after January 1, 2004, may offer to provide reimbursement coverage for medication counseling the insured receives from a pharmacist pursuant to this section.
(b)
(1)
An insured who is prescribed and uses six (6) or more types of medication may be entitled to receive two (2) medication counseling sessions during the first year the patient begins the sessions, with a doctor of pharmacy licensed in accordance with title 63, chapter 10, part 4, who has received additional clinical training in the areas of medication management and counseling. The goal of the counseling shall be to reduce the number of unnecessary medications for patients, and to reduce the incidence of negative interactions among various medications a patient may be taking. The first medication counseling session shall consist of the following:
(A)
An examination of the patient's medical history;
(B)
An evaluation of the number and types of medications the patient uses, including over-the-counter medications;
(C)
A determination of the types of interactions among the medications;
(D)
A recommended medication therapy and thorough analysis of the benefit of the medication therapy;
(E)
An evaluation of the cost savings gained as a result of any changes made to the prescribed course of medication; and
(F)
A summary of expected outcomes and proposed follow-up examination dates.
(2)
A report and recommendation from the first counseling session shall be forwarded to the prescribing physician or physicians for review. The physician may implement the recommendations or may disapprove the recommendations.
(3)
The second medication counseling session shall be a follow-up session during which the patient's response to the medication therapy will be monitored.
(c)
Both the first and second counseling sessions during the first year may be reimbursable through the patient's insurance coverage. The patient or the pharmacist may request an additional counseling session upon providing verification to the insurer that the patient has developed a change in the patient's medical condition.
Acts 2003, ch. 407, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2366 - Notice of termination of coverage for spouses and former spouses

(a)
Every insured or policy holder of a group policy of accident and sickness insurance offered for sale in this state, that provides coverage for hospital or medical expenses that also provides coverage to the spouse of the insured, shall provide at least thirty (30) days' prior notice of the termination of coverage to the covered spouse as a result of a divorce, a legal separation, or other separation. The notice shall be written, filed with the court that is hearing the divorce or legal separation prior to or at the final hearing, and served upon the spouse as provided by Tennessee Rules of Civil Procedure. If no divorce, legal separation or similar legal proceeding is pending, then the notice shall be transmitted by certified mail, return receipt requested, to the last known address of the spouse.
(b)
(1)
The notice shall advise the spouse who is to be terminated that, when the divorce is final, the spouse shall not be eligible for continued coverage under the policy. The notice shall also advise the spouse of the availability of the COBRA continuation provision and of the procedures for applying for COBRA coverage, including identifying who should be contacted to obtain coverage. The notice shall indicate that the spouse who is to be terminated will be without health insurance coverage from the insured's policy and that the spouse must obtain coverage under COBRA continuation, or a separate source of insurance, if the spouse wishes to retain health insurance coverage.
(2)
For the purposes of this subsection (b), "COBRA continuation provision" means any of the following:
(A)
Section 4980B of the Internal Revenue Code of 1986 (
26 U.S.C. § 4980B
), other than subdivision (f)(1), insofar as it relates to pediatric vaccines;
(B)
The Employee Retirement Income Security Act (ERISA), Part 6 of Subtitle B of Title I (
29 U.S.C. § 1161
et seq.), other than § 609 (
29 U.S.C. § 1169
); or
(C)
Title XXII of the Public Health Service Act (
42 U.S.C. § 300bb-1
et seq.).
(c)
As an employer updates the plan summary, in the course of business, for any group policy of accident and sickness insurance that it may offer to its employees, the employer shall include a notice of the provisions of this section in the summary.
(d)
The attorney for the insured in any action for divorce shall advise the insured or policy holder of the obligation imposed by this section.
(e)
The administrative office of the courts shall develop a model notice to reflect this section.
Acts 2006, ch. 764, § 1; 2008, ch. 868, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2367 - Autism spectrum disorders

(a)
As used in this section, "autism spectrum disorders" means neurological disorders, usually appearing in the first three (3) years of a person's life, that affect normal brain functions and are typically manifested by impairments in communication and social interaction, as well as restrictive, repetitive, and stereotyped behaviors.
(b)
A contract or policy of an insurer that provides benefits for neurological disorders, whether under an individual or group health insurance policy providing coverage on an expense-incurred basis, an individual or group service contract issued by a health maintenance organization, a self-insured group arrangement to the extent not preempted by federal law or a managed health care delivery entity of any type or description shall provide benefits and coverage for treatment of autism spectrum disorders that are at least as comprehensive as those provided for other neurological disorders. These benefits and coverage for treatment shall be provided to any person less than twelve (12) years of age.
(c)
Benefits provided for treatment of autism spectrum disorders shall be subject to deductible and copayment requirements and benefit limits that are no more stringent than those established for the treatment of other neurological disorders.
(d)
An insurer that provides benefits for neurological disorders shall not refuse to renew policies, reissue policies, or otherwise terminate or restrict services to a person solely because the person is diagnosed with an autism spectrum disorder.
(e)
This section shall not expand the type or scope of treatment beyond that authorized for any other diagnosed neurological disorder and shall be effective upon any contract, policy, or plan that is delivered, issued for delivery, amended or renewed on or after January 1, 2007.
(f)
Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, or other limited benefit hospital insurance policies.
Acts 2006, ch. 894, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2368 - Health insurance coverage for hearing aids for children

(a)
As used in this section, unless the context otherwise requires:
(1)
"Child" or "children" means any person under eighteen (18) years of age; and
(2)
"Hearing aid" means any wearable, nonexperimental, nondisposable instrument or device designed for the ear and used to aid or compensate for impaired human hearing, including earmolds and services necessary to select, fit, and adjust the hearing aid, but excluding batteries, cords, and other assistive listening devices such as FM systems.
(b)
Every individual or group health insurance policy providing coverage on an expense-incurred basis, every policy or contract issued by a hospital or medical service corporation, every individual or group service contract issued by a health maintenance organization, and every self-insured group arrangement to the extent not preempted by federal law, which is delivered, issued for delivery, or renewed in this state on or after January 1, 2012, shall provide coverage of up to one thousand dollars ($1,000) per individual hearing aid per ear, every three (3) years, for every child covered by such policy whether as a dependent of the policy holder or otherwise.
(c)
The insured may choose a hearing aid exceeding one thousand dollars ($1,000) and pay the difference in cost above the amount of coverage required by this section. Reimbursement shall be provided according to the respective principles and policies of the insurer.
(d)
The insurer may require the policyholder to provide a prescription by a licensed audiologist or physician or show proof through other suitable documentation of the need for a hearing aid, and this section shall not preclude the insurer from conducting managed care, medical necessity, or utilization review or prevent the operation of such policy provisions as deductibles, coinsurance, allowable charge limitations, coordination of benefits or provisions restricting coverage to services by licensed, certified or carrier-approved providers or facilities.
(e)
This section shall not apply to insurance coverage providing benefits for the following:
(1)
Hospital confinement indemnity;
(2)
Disability income;
(3)
Accident only;
(4)
Long-term care;
(5)
Medicare supplement;
(6)
Limited benefit health;
(7)
Specified disease indemnity;
(8)
Sickness or bodily injury or death by accident, or both; and
(9)
Other limited benefit policies.
(f)
This section shall not apply to TennCare or any successor program provided for in title 71, chapter 5.
Acts 2011, ch. 199, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2369 - Section definitions - Health insurance issuer limitations - Actions not prohibited

(a)
As used in this section:
(1)
"Managed health insurance issuer" has the same meaning as defined in §
56-32-128
; and
(2)
"Medical laboratory" has the same meaning as defined in §
68-29-103
.
(b)
A health insurance issuer or a managed health insurance issuer shall not:
(1)
Deny a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan; provided, that this subdivision (b)(1) does not prohibit a managed health insurance issuer or health insurance issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where a managed health insurance issuer or health insurance issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care needs; and
(2)
Prevent a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan; provided, that the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory.
(c)
Each health insurance issuer or managed health insurance issuer shall apply the same coinsurance, co-payment, deductible, and quantity limit factors within the same employee group and other plan-sponsored groups to all medical laboratory services provided by a licensed medical laboratory; provided, that all medical laboratories comply with the same terms and conditions.
(d)
This section does not prohibit:
(1)
A health insurance issuer or managed health insurance issuer from applying different coinsurance, co-payment, and deductible factors within the same employer group and other plan-sponsored groups; or
(2)
An employer or other plan-sponsored group from offering multiple options or choices of health insurance benefit plans, including, but not limited to, cafeteria benefit plans.
Acts 2023, ch. 484, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2401 - Reimbursement for services of certain health care providers

(a)
Whenever any policy of insurance issued in this state provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed optometrist, as defined in §
63-8-102
; a licensed psychologist designated as a health service provider, as provided by title 63, chapter 11; licensed psychological examiner; certified psychological assistant supervised, as provided by title 63, chapter 11; licensed senior psychological examiner; a duly licensed podiatrist, as defined in §
63-3-101
; a person duly licensed to engage in independent practice as a licensed clinical social worker in accordance with §
63-23-105
; a duly licensed marital and family therapist, as defined in §
63-22-115
; or a duly licensed professional counselor, as defined in §
63-22-122
, the insured or other person entitled to benefits under the policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed physician; by a duly licensed optometrist; by a duly licensed podiatrist; by a duly licensed psychologist designated as a health service provider; by a duly licensed psychological examiner supervised, as provided by title 63, chapter 11; by a certified psychological assistant supervised, as provided by title 63, chapter 11; by a duly licensed senior psychological examiner; by a duly licensed independent practitioner of social work; by a duly licensed marital and family therapist; or by a duly licensed professional counselor, not to exceed the percentage of reimbursement provided for psychiatrists in the policy, notwithstanding any other provision in the policy.
(b)
Reimbursements shall be made in a timely manner.
(c)
The provisions of this section relating to podiatric services shall apply to all contracts, plans or policies issued or renewed on or after July 1, 1981.
(d)
As used in this section, "licensed psychologist designated as a health service provider" includes all psychologists previously licensed as clinical, school and counseling psychologists pursuant to title 63, chapter 11, prior to June 30, 1993, and who have been designated as health service providers.
Acts 1965, ch. 357, § 1; 1974, ch. 450, § 1; T.C.A., § 56-1145; Acts 1981, ch. 168, §§ 1, 2, 10; 1982, ch. 821, §§ 2, 3; 1985, ch. 27, § 1; 1992, ch. 984, § 2; 1992, ch. 991, § 19; T.C.A., §
56-7-108
; Acts 1994, ch. 845, § 1; 2001, ch. 334, §§ 9 - 11; 2010, ch. 726, § 1; 2012, ch. 595, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2402 - Participation by optometrists, podiatrists and social workers in medical, hospital, and hospital and medical service plans

(a)
Whenever any subscribers under any medical service plan or hospital service contract or hospital and medical service contract, as provided under chapters 27-29 of this title or any similar statutes, or any other persons covered by the plan or contract, are entitled to reimbursement for any services that are within the lawful scope of practice of a duly licensed optometrist as defined in §
63-8-102
; a duly licensed podiatrist as defined in §
63-3-101
; a person duly licensed to engage in independent practice as a licensed clinical social worker in accordance with §
63-23-105
; the subscriber or other person shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed physician; a duly licensed optometrist; a duly licensed podiatrist; or a person duly licensed to engage in independent practice as a licensed clinical social worker, notwithstanding any provision to the contrary in any other statute or in the plan or contract; and duly licensed optometrists and podiatrists shall be entitled to participate in the plans or contracts providing for the services to the same extent and subject to the same limitations as duly licensed physicians.
(b)
The provisions of this section relating to podiatric services apply to all contracts, plans or policies issued or renewed on or after July 1, 1981.
Acts 1965, ch. 357, § 2; T.C.A., § 56-1146; Acts 1981, ch. 168, §§ 3-5, 10; 1985, ch. 27, § 2; 1992, ch. 984, § 2; T.C.A., §
56-7-109
; Acts 2012, ch. 595, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2403 - Applicability and scope of sections 56-7-2401 and 56-7-2402

(a)
Sections
56-7-2401
and
56-7-2402
are not applicable to any policy or policies of insurance issued in this state prior to June 1, 1965, nor shall any part of §§
56-7-2401
and
56-7-2402
be construed as enlarging the scope of practice of optometry or podiatry or the requiring of any insurance policy, medical service plan, hospital service contract or hospital and medical service contract to provide for visual care services or foot care services.
(b)
The provisions of this section relating to podiatric services apply to all contracts, plans or policies issued or renewed on or after July 1, 1981.
Acts 1965, ch. 357, § 4a; T.C.A., § 56-1147; Acts 1981, ch. 168, §§ 6, 7, 10; 1992, ch. 984, § 2; T.C.A. §
56-7-110
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2404 - Reimbursable services within scope of practice of chiropractor - Discrimination prohibited

(a)
(1)
Whenever any policy of insurance issued in this state provides for reimbursement for any service that is within the lawful scope of practice of a duly licensed chiropractor, the insured or other person entitled to benefits under the policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or by a duly licensed chiropractor, notwithstanding any provision contained in the policy.
(2)
Whenever any insurance subscribers under any sickness and accident, medical service plan, hospital service contract or hospital and medical service contract, as provided under chapters 26-29 of this title or any similar statutes, or any other persons covered by the plan or contract, are entitled to reimbursement for any services that are within the lawful scope of practice of a duly licensed chiropractor, the subscriber or other person shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed medical physician or a duly licensed chiropractor, notwithstanding any provision to the contrary in any other statute or in the plan or contract; and duly licensed chiropractors shall be entitled to participate in the plans or contracts providing for the services to the same extent and subject to the same limitations as duly licensed medical physicians.
(b)
This section shall not be construed as enlarging the scope of practice of chiropractic or the requiring of any insurance policy, medical service plan, hospital service contract or hospital and medical service contract to provide for spinal, neurological or musculoskeletal care.
(c)
This section shall apply to all policies or plans issued or renewed on and after July 1, 1981.
Acts 1981, ch. 127, §§ 1, 2, 4, 5; 1992, ch. 984, § 2; T.C.A., §
56-7-116
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2405 - Health and accident policies - Surgical procedures within scope of dentistry and podiatry

(a)
"Physician" or "doctor," whenever used in any group or individual health or accident insurance policy issued in this state or in a medical service plan or hospital service contract or hospital and medical service contract, as provided in chapters 27-29 of this title or any similar statutes, providing for reimbursement or payment for surgical procedures or other medical or health care services that are specified in the policy, plan or contract, and are within the scope of practice of dentistry as defined in §
63-5-108
or within the scope of practice of a podiatrist as defined in §
63-3-101
, shall be construed to include a duly licensed dentist or duly licensed podiatrist who performs the specified procedures or services, any provision in any policy, plan or contract to the contrary notwithstanding.
(b)
This section shall apply to all policies, plans and contracts issued, renewed or reinstated on and after July 1, 1974, and to all other policies, plans and contracts otherwise in existence on July 1, 1974, whenever there is a premium or rate change under the policies, plans and contracts.
(c)
The provisions of this section relating to podiatric services shall apply to all contracts, plans or policies issued or renewed on or after July 1, 1981.
Acts 1974, ch. 515, §§ 1, 2; T.C.A., § 56-1166; Acts 1981, ch. 168, §§ 8-10; 1992, ch. 984, § 2; T.C.A., §
56-7-1002
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2406 - Health care services provided by St. Jude Children's Research Hospital

(a)
Each managed care organization (MCO), preferred provider organization (PPO), health maintenance organization (HMO), and other health organizations shall provide, through direct contract with St. Jude Children's Research Hospital or otherwise, all enrollees in the health care organization with access to the health care services at St. Jude Children's Research Hospital to the extent access is practical and feasible and the services are medically appropriate.
(b)
Reimbursement to St. Jude Children's Research Hospital for the services provided pursuant to this section shall be no greater than the reimbursement rate a managed care organization would pay other entities providing similar services to its enrollees.
(c)
Any dispute regarding the application of this section shall be resolved by a committee composed of the commissioner of health, the commissioner of commerce and insurance and the commissioner of finance and administration.
Acts 1994, ch. 882, §§ 1-3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2407 - Nurse midwife services

(a)
Whenever any contract, plan, or policy of insurance issued in this state provides for reimbursement of any service that is within the lawful scope of practice of a nurse midwife, duly licensed by the state board of nursing as a registered nurse and also duly certified as a nurse midwife by the American College of Nurse-Midwives, the insured or other person entitled to benefits under the contract, plan, or policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed physician or by a duly licensed and certified nurse midwife.
(b)
Reimbursements shall be made in a timely manner.
(c)
The provisions of this section relating to nurse midwife services shall apply to all contracts, plans, or policies issued or renewed on or after July 1, 1994.
Acts 1994, ch. 945, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2408 - Reimbursement for services by nurse in advanced practice

(a)
Whenever any contract, plan, or policy of insurance issued in this state provides for reimbursement of any service that is within the lawful scope of practice of a nurse in advanced practice, the insured or other person entitled to benefits under the contract, plan, or policy shall be entitled to reimbursement for the services, whether the services are performed by a duly licensed physician or a duly licensed nurse in advanced practice. As used in this section, "nurse in advanced practice" means a registered nurse who is duly licensed by the state board of nursing and who is also a nationally certified nurse practitioner, a nationally certified registered nurse anesthetist, or a nationally certified clinical specialist.
(b)
Reimbursements shall be made in a timely manner.
(c)
The provisions of this section relating to the services of a nurse in advanced practice apply to all contracts, plans, or policies issued or renewed on or after July 1, 1996.
Acts 1996, ch. 627, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2409 - Employer-based plans to offer at least one plan option providing copayment amounts for office visits with chiropractic physicians, physical or occupational therapists no greater than those for primary care physician visits

(a)
As used in this section:
(1)
"Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan;
(2)
"Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan;
(3)
"Covered person" has the same meaning as set forth in §
56-7-110(a)
; and
(4)
"Health insurance entity" has the same meaning as set forth in §
56-7-109
, but does not include government insurance plans created by title 8, chapter 27.
(b)
A health insurance entity offering employer-based plans must offer to employers no less than one (1) plan option in which the copayment and coinsurance amounts for services rendered during an office visit to a chiropractic physician licensed under title 63, chapter 4, or to a physical therapist or occupational therapist licensed under title 63, chapter 13, are no greater than the copayment and coinsurance amounts for the services rendered during an office visit to a primary care physician licensed under title 63, chapter 6 or title 63, chapter 9.
(c)
Compliance with this section shall not be required with respect to a particular insurance plan if it is determined that compliance would cause that plan to lose its status as a grandfathered health plan within the meaning of § 1251 of the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended, and § 2301 of the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152, as amended, both compiled in
42 U.S.C. § 18011
.
(d)
Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies, and any employer plan exempt from regulation under this title due to § 514 of the federal Employee Retirement Income Security Act of 1974 (ERISA) (
29 U.S.C. § 1144
).
Amended by 2014 Tenn. Acts, ch. 862, s 1, eff. 1/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 24 - MANDATED SCOPE OF PRACTICE (§§ 56-7-2401 — 56-7-2410) › Section 56-7-2410 - Limitation on copayments or coinsurance amount imposed for primary care services rendered during visit to physician assistant

(a)
As used in this section:
(1)
"Coinsurance" means a percentage of the contractual fee schedule applicable to a particular healthcare provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan;
(2)
"Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a healthcare provider under the terms of a particular health insurance policy or plan;
(3)
"Covered person" has the same meaning as set forth in §
56-7-110(a)
; and
(4)
"Health insurance entity" has the same meaning as set forth in §
56-7-109(a)
, but does not include the government insurance plans created pursuant to title 8, chapter 27, and title 71, chapter 5.
(b)
No health insurance entity shall impose on a covered person any copayment or coinsurance amount for services rendered during an office visit to a physician assistant licensed under title 63, chapter 19, and contracted or authorized as a primary care practitioner by that health insurance entity, that is greater than the copayment or coinsurance amount imposed on a covered person by that health insurance entity for the services rendered during an office visit to a physician licensed under title 63, chapter 6 or 9, and contracted or authorized by that health insurance entity as a primary care practitioner.
(c)
Nothing in this section shall prevent a health insurance entity from instituting measures designed to maintain quality and to control costs, including, but not limited to, imposing lower copayment or coinsurance amounts for services rendered by providers with proven clinical outcomes.
(d)
Nothing in this section shall apply to plans 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.
Added by 2015 Tenn. Acts, ch. 157,s 1, eff. 7/1/2015.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2501 - Sterilization operations - Policy provisions

(a)
Any law to the contrary notwithstanding, no contract of insurance that provides coverage for sterilization operations or procedures may be entered into or renewed on or after July 1, 1971, if the contract imposes any disclaimer, restriction on, or limitation of coverage with respect to the insured's reason for sterilization. All such contracts entered into or renewed on or after July 1, 1971, shall be construed to be in compliance with this section and any provisions in any contract that are in conflict with this section shall be of no force or effect.
(b)
Any contract for a sterilization operation or procedure shall not be cancelled by the insurer unless the cancellation coincides with cancellation of the entire policy.
Acts 1972, ch. 848, § 1; T.C.A., § 56-1162; Acts 1992, ch. 984, § 3; T.C.A., § 56-7-1006.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2503 - Accident and sickness - Denial of coverage for persons with mental illness or intellectual disabilities for lack of surgical facilities prohibited

Any law to the contrary notwithstanding, no policy of accident and sickness insurance may be entered into or renewed on or after July 1, 1974, if the policy by way of exclusion, definition, or otherwise denies coverage to an insured undergoing care and treatment in a facility for the care and treatment of persons with mental illness or intellectual disability, based upon the fact that the facility does not have organized facilities for operative surgery, if, in fact, the facility in question has, at the time a claim arises, a bona fide arrangement, by contract or otherwise, with an accredited hospital to perform the surgical procedures as may be required by the facility for persons with mental illness or intellectual disability.
Acts 1974, ch. 625, § 1; T.C.A., § 56-1168; Acts 1992, ch. 984, § 3; T.C.A., § 56-7-1004; Acts 2011, ch. 158, § 29.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2504 - Cancer treatment

(a)
In the event that coverage for the treatment of cancer by dose-intensive chemotherapy/autologous bone marrow transplants or stem cell transplants is provided for patients or enrollees included in the TennCare program, then each insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis, each corporation providing individual or group accident and sickness subscription contracts, and each health maintenance organization providing a health care plan for health care services shall offer and make available the coverage, in the manner provided in subsection (b), under the policy, contract or plan delivered, issued for delivery or renewed in this state on and after January 1, 1996.
(b)
The coverage may be offered at an additional cost but the health care service shall not be subject to any greater deductible than any other health care service under the policy, contract or plan. Any required copayment shall not exceed the standard copayment required by the insured's policy, contract or plan for health care services.
(c)
This section shall not apply to short-term travel, long-term care, credit insurance, dental insurance, disability income, medical surgical supplemental insurance, vision insurance, hospital indemnity, accident-only limited or specified disease policies, or to short-term nonrenewable policies of not more than six (6) months' duration.
Acts 1995, ch. 539, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2505 - Phenylketonuria (PKU)

(a)
Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, or health maintenance organization that provides hospital expense and surgical expense insurance and that is delivered, issued for delivery, amended or renewed on or after July 1, 1995, shall provide coverage for the treatment of phenylketonuria.
(b)
As used in this section, "treatment" means licensed professional medical services under the supervision of a physician and those special dietary formulas that are medically necessary for the therapeutic treatment of phenylketonuria.
Acts 1996, ch. 893, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 25 - MANDATED INSURER OR PLAN OPTIONS (§§ 56-7-2501 — 56-7-2508) › Section 56-7-2507 - Reconstructive breast surgery

(a)
(1)
Any individual, franchise, blanket or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society, health maintenance organization, or managed care organization that provides coverage for mastectomy surgery shall provide coverage for all stages of reconstructive breast surgery on the diseased breast as a result of a mastectomy, but not including a lumpectomy, as well as any surgical procedure on the nondiseased breast deemed necessary to establish symmetry between the two (2) breasts in the manner chosen by the patient and physician. The surgical procedure performed on a nondiseased breast to establish symmetry with the diseased breast must occur within five (5) years of the date the reconstructive breast surgery was performed on a diseased breast.
(2)
Coverage for reconstructive breast surgery shall be subject to applicable copayments, coinsurance and deductibles.
(b)
This section applies to any policy, plan, or contract entered into or renewed on or after July 1, 1997.
Acts 1997, ch. 452, § 1.