reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-104 - Insurance business not authorized

Nothing in this title or this chapter authorizes any prepaid limited health service organization to transact any insurance business other than that specifically authorized by this chapter, or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by the department under the Tennessee insurance code.
Acts 2000, ch. 948, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-105 - Certificate of authority required - Ambulance service plans - Exceptions

(a)
A person, corporation, partnership, or other entity may not operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate of authority from the department pursuant to this chapter.
(b)
A political subdivision of this state that is operating an emergency medical services system and offers a prepaid ambulance service plan as a part of its emergency medical services system shall be exempt from this chapter and all other provisions of this title.
(c)
An insurer, while authorized to transact health insurance in this state, or a health maintenance organization possessing a valid certificate of authority in this state, or a duly licensed medical and hospital service corporation may also provide services under this chapter without additional qualification or authority, but shall be otherwise subject to the applicable provisions of this chapter.
Acts 2000, ch. 948, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-108 - Continued eligibility for certificate of authority

In order to maintain its eligibility for a certificate of authority, a prepaid limited health service organization must continue to meet all conditions required to be met under this chapter and the rules adopted under this chapter for the initial application for and issuance of its certificate of authority under §§
56-51-106
and
56-51-107
.
Acts 2000, ch. 948, § 8.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-109 - Certain entities contracting with state Title XIX agency

Any entity licensed under this chapter that provides services solely to Title XIX program recipients under a contract with the state shall be exempt from §§
56-51-106(12)
,
56-51-112(e) and (k)
,
56-51-113
,
56-51-117
,
56-51-123
,
56-51-127
, and
56-51-134(b)(5)(A) and (B)
. Further, the commissioner may by rule exempt the entities from other provisions of this chapter where determined by the commissioner to be reasonable and appropriate. The rules shall be promulgated in accordance with §
56-51-153
.
Acts 2000, ch. 948, § 9; 2004, ch. 507, § 3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-110 - Use of English required in contracts and forms

All contracts or forms utilized by the prepaid limited health services organization, whether directed to providers or enrollees, shall be written in the English language.
Acts 2000, ch. 948, § 10.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-111 - Language used in contracts and marketing materials

All prepaid limited health services contracts, marketing materials, and literature must disclose in boldfaced type the name of the organization and disclose that the organization is a prepaid limited health service organization licensed under this chapter.
Acts 2000, ch. 948, § 11.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-113 - Rates for subscribers - Requirements

(a)
The rates charged by any prepaid limited health service organization to its subscribers shall not be excessive, inadequate, or unfairly discriminatory. The department may require whatever information it deems necessary to determine that a rate or proposed rate meets the requirements of this section.
(b)
In determining whether a rate is in compliance with subsection (a), the department must take into consideration the limited services provided, the method in which the services are provided, and the method of provider payment. This section may not be construed as authorizing the department to establish by rule minimum loss ratios for prepaid limited health service organizations' rates.
Acts 2000, ch. 948, § 13.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-114 - Changes in rates and benefits - Material modifications - Addition of limited health services

(a)
(1)
No prepaid limited health services contract, certificate of coverage, application, enrollment form, rider, endorsement, and applicable rates to be charged may be delivered in this state unless the forms and rates have been filed with the department by or on behalf of the prepaid limited health service organization and have been approved by the department. Every form filed shall be identified by a unique form number placed in the lower left corner of each form. If a prepaid limited health service organization desires to amend any contract with its subscribers or any certificate or member handbook, or desires to change any rate charged for the contract or to change any basic prepaid limited health services contract, certificate, grievance procedure, or member handbook form, or application form where written application is required and is to be made a part of the contract, or printed amendment, addendum, rider, or endorsement form or form renewal certificate, it must file the changes thirty (30) days prior to the effective date of the proposed change. At least thirty (30) days' written notice must be provided to the subscriber before application of any approved change in rates. In the case of a group enrollee, there may be a contractual agreement with the prepaid limited health service organization to have the contract holder provide the required notice to the individual enrollees of the group. Any proposed change must contain information as required by this section.
(2)
The prepaid limited health service organization's certification must be prepared by an independent actuary. The chief executive officer of the prepaid limited health service organization must review and sign the certification indicating the officer's agreement with its conclusions. Following receipt of notice of any disapproval or withdrawal of approval, no prepaid limited health service organization may issue or use any form disapproved by the department or as to which the department has withdrawn approval.
(b)
If the filings are not disapproved by the department within thirty (30) days of the receipt of complete filings, the filings shall be deemed approved.
Acts 2000, ch. 948, § 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-115 - Additional contract contents

A prepaid limited health services contract may contain additional provisions not inconsistent with this chapter that are:
(1)
Necessary because of the manner in which the organization is constituted or operated in order to state the rights and obligations of the parties to the contract; or
(2)
Desired by the organization and neither prohibited by law nor in conflict with any provisions required to be included.
Acts 2000, ch. 948, § 15.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-116 - Genetic information restrictions

A prepaid limited health service organization must comply with chapter 7, part 27 of this title.
Acts 2000, ch. 948, § 16.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-117 - Restrictions upon expulsion or refusal to issue or renew contract

(a)
A prepaid limited health service organization may not expel or refuse to renew the coverage of or refuse to enroll any individual member of a subscriber group through a health maintenance organization or a state or federal agency on the basis of the race, color, creed, disability, marital status, sex, or national origin of the subscriber or individual.
(b)
A prepaid limited health service organization may not expel or refuse to renew the coverage of any individual member of a subscriber group through a health maintenance organization or a state or federal agency on the basis of the age or health status of the subscriber or individual.
(c)
For group solicitations through a contract with a health maintenance organization, a prepaid limited health service organization may preunderwrite to determine group acceptability. However, once a contract is issued, a prepaid limited health service organization must provide coverage to all existing enrollees and their dependents, and newly employed enrollees and their dependents who have enrolled within thirty (30) days of eligibility or membership.
(d)
Nothing in this section prohibits a prepaid limited health service organization from requiring in its contracts with health maintenance organizations that, as a condition of continued eligibility for membership, dependents of a subscriber upon reaching a specified age convert to a converted contract. Coverage must continue to be provided to children with a disability who are incapable of self-sustaining employment by reason of mental or physical disability, and substantially dependent upon the enrollee for support and maintenance.
Acts 2000, ch. 948, §17; 2011 , ch. 47, §§ 67, 68.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 18.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-119 - Execution of contracts

(a)
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.
(b)
A facsimile signature of any executing individual may be used in lieu of an original signature.
(c)
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.
Acts 2000, ch. 948, § 19.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-120 - Validity of noncomplying contracts

(a)
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.
(b)
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.
Acts 2000, ch. 948, § 20.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 21.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 22.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-123 - Notice of cancellation of contract

(a)
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:
(1)
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;
(2)
Fraud or material misrepresentation in applying for or presenting any claim for benefits under the contract;
(3)
Misuse of the documents provided as evidence of benefits available pursuant to the contract; or
(4)
Furnishing to the organization, by the subscriber, incorrect or incomplete information for the purposes of fraudulently obtaining services.
(b)
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.
Acts 2000, ch. 948, § 23.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-124 - Construction and relationship with other laws

(a)
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.
(b)
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.
(c)
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.
Acts 2000, ch. 948, § 24.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 25.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-126 - Certain words prohibited in name of organization

(a)
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.
(b)
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.
Acts 2000, ch. 948, § 26.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 27.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-129 - Administrative, provider, and management contracts

(a)
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.
(b)
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.
(c)
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.
Acts 2000, ch. 948, § 29.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 30.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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
.
Acts 2000, ch. 948, § 31.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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
.
Acts 2000, ch. 948, § 32.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 33.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-135 - Agent licensing

(a)
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:
(1)
Solicit contracts or procure applications; or
(2)
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.
(b)
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.
(c)
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.
(d)
As used in this section, the term "salaried" refers to basic remuneration and does not include commissions, bonuses, or any other compensatory measures.
Acts 2000, ch. 948, § 35.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-136 - Minimum net worth and working capital requirements

(a)
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
.
(b)
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
.
(c)
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.
Acts 2000, ch. 948, § 36.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-137 - Insolvency protection

(a)
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)
.
(b)
(1)
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)
.
(2)
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.
(3)
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.
(c)
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.
Acts 2000, ch. 948, § 37.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-138 - Officers' and employees' fidelity bond

(a)
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.
(b)
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).
Acts 2000, ch. 948, § 38.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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:
(1)
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
(2)
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).
Acts 2000, ch. 948, § 40.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-141 - Injunction

(a)
In addition to the penalties and other enforcement provisions of this chapter, the department is vested with the power to seek both temporary and permanent injunctive relief when:
(1)
A prepaid limited health service organization is being operated by any person or entity without a certificate of authority;
(2)
Any person, entity, or prepaid limited health service organization has engaged in any activity prohibited by this chapter or any rule adopted pursuant to this chapter; or
(3)
Any prepaid limited health service organization, person, or entity is renewing, issuing, or delivering a prepaid limited health services contract without a certificate of authority.
(b)
The department's authority to seek injunctive relief is not conditioned on having conducted any proceeding pursuant to the Uniform Administrative Procedures Act, compiled at title 4, chapter 5.
Acts 2000, ch. 948, § 41.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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.
Acts 2000, ch. 948, § 42.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 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
.
Acts 2000, ch. 948, § 43.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-144 - Delinquency or supervision

(a)
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.
(b)
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.
Acts 2000, ch. 948, § 44.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-145 - Fees

Every prepaid limited health service organization subject to this chapter must pay to the department the following fees:
(1)
For filing an application for a certificate of authority: five hundred dollars ($500);
(2)
For filing an amendment to organization documents that require approval: fifty dollars ($50.00);
(3)
Each annual report: one hundred dollars ($100); and
(4)
For each renewal of certificate of authority each year: one hundred dollars ($100).
Acts 2000, ch. 948, § 45.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-146 - Investigative power of department

The department has the power to examine and investigate the affairs of every person, entity, or prepaid limited health service organization in order to determine whether the person, entity, or prepaid limited health service organization is operating in accordance with this chapter, or has been or is engaged in any unfair method of competition or in any unfair or deceptive act or practice prohibited by §§
56-8-103
and
56-8-104
. The department also has the powers enumerated in chapter 8 of this title.
Acts 2000, ch. 948, § 46.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-147 - Unfair methods of competition, unfair or deceptive acts or practices defined

For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, §
56-8-104
applies to a prepaid limited health service organization.
Acts 2000, ch. 948, § 47.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-148 - Appeals from the department

Any person, entity, or prepaid limited health service organization subject to an order of the department under this chapter may obtain judicial review of the order by filing an appeal from the order, in accordance with the procedures for appeal under the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
Acts 2000, ch. 948, § 48.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-149 - Civil liability

The provisions of this chapter are cumulative to rights under the general civil and common law, and no action of the department abrogates the rights to damage or other relief in any court.
Acts 2000, ch. 948, § 49.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-150 - Confidentiality

(a)
Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from §
10-7-503
, and shall only be available pursuant to specific written consent of the enrollee, or as otherwise provided by law. With respect to any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant, a prepaid limited health service organization is entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the prepaid limited health service organization is entitled to claim.
(b)
Any proprietary financial information contained in contracts entered into with providers by prepaid limited health service organizations is confidential and exempt from §
10-7-503
.
(c)
Any information obtained or produced by the department pursuant to an examination or investigation is confidential and exempt from §
10-7-503
until the examination report has been filed and adopted by the commissioner or until the time, if ever, the information is used in litigation by the commissioner or in a contested case. Except for active criminal intelligence or criminal investigative information; personal financial and medical information; information that would defame or cause unwarranted damage to the good name or reputation of an individual; information that would impair the safety and financial soundness of the licensee or affiliated party; proprietary financial information; or information that would reveal the identity of a confidential source, all information obtained by the department pursuant to an examination shall be available after the examination report has been filed.
Acts 2000, ch. 948, § 50.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-151 - Acquisitions

Any acquisition of, control of, merger, or change of control of a prepaid limited health service organization shall be subject to chapter 11 of this title. For purposes of this section, the term "control" shall have the same meaning as that provided in §
56-11-101(b)(3)
.
Acts 2000, ch. 948, § 51; 2004, ch. 507, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-152 - Taxes imposed

(a)
The premiums, contributions and assessments received by prepaid limited health service organizations are subject to the tax imposed by §
56-32-124
; provided, however, that the premiums, contributions and assessments received by prepaid limited health service organizations pursuant to subcontracts with entities under contract to the Title XIX single state agency for the provision of health care services are exempt from the tax.
(b)
The department shall administer this section pursuant to §
56-32-124
.
(c)
The amount of taxes collected under this section shall be a single credit against the sum total of the taxes imposed by the Franchise Tax Law, compiled in title 67, chapter 4, part 21 and by the Excise Tax Law, compiled in title 67, chapter 4, part 20.
Acts 2000, ch. 948, §52; 2007 , ch. 299, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-153 - Rules

The department has authority to adopt rules to effectuate this chapter. The rules shall be adopted in accordance with the rulemaking provisions of the Uniform Administrative Procedures Act, compiled at title 4, chapter 5. The department may also adopt emergency rules as determined to be necessary to effectuate this chapter, in accordance with the Uniform Administrative Procedures Act. No rule shall be adopted without prior hearing and notice as provided under the Uniform Administrative Procedures Act. A violation of any such rule subjects the violator to §
56-51-139
.
Acts 2000, ch. 948, § 53.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-154 - Applicability of provisions of chapter 32 of this title to successor organizations

Provisions of chapter 32 of this title that are specifically applicable to health maintenance organizations that participate in the TennCare Program under Title XIX of the Social Security Act (
42 U.S.C. § 1396
et seq.), or any successor to the TennCare program, shall also be applicable to prepaid limited health service organizations that participate in the TennCare program or any successor program.
Acts 2000, ch. 948, § 54.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 51 - TENNESSEE PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT OF 2000 (§§ 56-51-101 — 56-51-155) › Section 56-51-155 - Holding company regulation

The Insurance Holding Company System Act of 1986, compiled in chapter 11 of this title, shall be applicable to prepaid limited health service organizations to the extent provided for in that act relative to health maintenance organizations.
Acts 2004, ch. 507, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 52 - TENNESSEE CHARITABLE GIFT ANNUITY ACT OF 2008 (§§ 56-52-101 — 56-52-111) › Section 56-52-101 - Short title - Construction - Application

(a)
This chapter applies to charitable gift annuities issued by charitable organizations as defined in §
56-52-102
and shall be known and may be cited as the "Tennessee Charitable Gift Annuity Act of 2008."
(b)
The issuance of a charitable gift annuity by a charitable organization authorized under this chapter does not constitute engaging in the business of insurance in this state except to the extent otherwise provided in this chapter.
(c)
All annuities, including those issued by charitable organizations, that do not meet the requirements of this chapter shall be subject to regulation as annuities under all applicable chapters of this title, except for private annuities issued by a member of a transferor's immediate family.
Acts 2008, ch. 831, §§ 1, 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 52 - TENNESSEE CHARITABLE GIFT ANNUITY ACT OF 2008 (§§ 56-52-101 — 56-52-111) › Section 56-52-102 - Chapter definitions

(a)
As used in this chapter, unless the context otherwise requires:
(1)
"Annuity" means a contract or agreement, both with and without a life or mortality element, to make periodic payments, whether in fixed or variable dollar amounts, or both, at specified intervals;
(2)
(A)
"Charitable gift annuity" means a transfer of cash, securities, annuities or other property by a donor to a charitable organization in return for an annuity issued by a charitable organization;
(B)
"Charitable gift annuity" does not include a charitable remainder trust or a charitable lead trust or other similar arrangement where the charitable organization does not issue an annuity and incur a financial obligation to guarantee annuity payments. "Charitable gift annuity" also does not mean any transfer of cash, securities, annuities or other property by a donor to a charitable organization in return for an annuity where a commission is paid to any person as a result of the transfer;
(3)
"Charitable gift annuity separate account" means any segregated account established by a charitable organization to which the organization allocates cash, securities, annuities or other property transferred by a donor to the organization that are to be applied to the terms of a charitable gift annuity issued in connection with the transfer to fund benefits under the charitable gift annuity;
(4)
"Charitable organization" means an entity described by:
(A)
Section 501(c)(3) of the Internal Revenue Code of 1986 (
26 U.S.C. § 501(c)(3)
); or
(B)
Section 170(c) of the Internal Revenue Code of 1986 (
26 U.S.C. § 170(c)
); and
(5)
"Commissioner" means the commissioner of commerce and insurance.
Acts 2008, ch. 831, §§ 1, 3.