reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-110 - Inapplicable or inconsistent provisions

If any provision of §§
56-26-108
- 56-26-114 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the commissioner, shall omit from the policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3310.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-111 - Sequence of policy provisions

The provisions that are the subject of §§
56-26-108
and
56-26-109
, or any corresponding provisions that are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in the sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related; provided, that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered, or issued.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3311.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-112 - Third-party ownership

"Insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for, and owning a policy covering the insured, or from being entitled under such a policy to any indemnities, benefits and rights provided in the policy.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3312.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-113 - Requirements of other jurisdictions

(a)
Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision that is not less favorable to the insured or the beneficiary than the provisions of this chapter and that is prescribed or required by the law of the state under which the insurer is organized.
(b)
Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of the other state or country.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3313.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-114 - Filing procedure

The commissioner may make reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper or advisable to the administration of this chapter. This section shall not abridge any other authority granted the commissioner by law.
Acts 1955, ch. 4, § 4; T.C.A., § 56-3314.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-115 - Policy provisions not specifically covered

No policy provision that is not subject to §§
56-26-108
- 56-26-114 shall make a policy or any portion thereof less favorable in any respect to the insured or the beneficiary than the provisions that are subject to this chapter.
Acts 1955, ch. 4, § 5; T.C.A., § 56-3315.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-116 - Effect of nonconforming policies

(a)
A policy delivered or issued for delivery to any person in this state in violation of this chapter shall be held valid but shall be construed as provided in this chapter.
(b)
When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties and obligations of the insurer, the insured and the beneficiary shall be governed by this chapter.
Acts 1955, ch. 4, § 5; T.C.A., § 56-3316.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-117 - Application as part of policy - Copy on request

The insured shall not be bound by any statement made in an application for a policy unless a copy of such application is attached to or endorsed on the policy when issued as part of the policy. If any such policy delivered or issued for delivery to any person in this state is reinstated or renewed, and the insured or the beneficiary or assignee of the policy makes written request to the insurer for a copy of the application, if any, for the reinstatement or renewal, the insurer shall within fifteen (15) days after the receipt of the request at its home office or any branch office of the insurer, deliver or mail to the person making the request a copy of the application. If the copy is not so delivered or mailed, the insurer shall be precluded from introducing the application as evidence in any action or proceeding based upon or involving the policy or its reinstatement or renewal.
Acts 1955, ch. 4, § 6; T.C.A., § 56-3317.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-118 - Alteration of application

No alteration of any written application for any such policy shall be made by any person other than the applicant without the applicant's written consent, except that insertions may be made by the insurer, for administrative purposes only, in such manner as to indicate clearly that the insertions are not to be ascribed to the applicant.
Acts 1955, ch. 4, § 6; T.C.A., § 56-3318.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-119 - False statements in application

The falsity of any statement in the application for any policy covered by this chapter may not bar the right to recovery thereunder unless the false statement materially affected either the acceptance of the risk or hazard assumed by the insurer and then not if the agent taking the application knew of the falsity.
Acts 1955, ch. 4, § 6; 1963, ch. 159, § 1; T.C.A., § 56-3319.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-120 - Acts not constituting waiver of defenses

The acknowledgment by any insurer of the receipt of notice given under any policy covered by this chapter, the furnishing of forms for filing proofs of loss, the acceptance of the proofs or the investigation of any claim thereunder, shall not operate as a waiver of any of the rights of the insurer in defense of any claim arising under the policy.
Acts 1955, ch. 4, § 7; T.C.A., § 56-3320.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-121 - Acceptance of premiums after expiration of policy - Misstatement of age

If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if the date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after the date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
Acts 1955, ch. 4, § 8; T.C.A., § 56-3321.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-122 - Policies exempt

(a)
Except as provided in subsection (b), nothing in this chapter applies to, or shall affect:
(1)
Any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage in such policy;
(2)
Any policy or contract of reinsurance;
(3)
Any blanket or group insurance policy; or
(4)
Life insurance or annuity contracts, or contracts supplemental thereto, that contain only the provisions relating to accident and sickness insurance as:
(A)
Provide additional benefits in case of death or dismemberment or loss of sight by accident; or
(B)
Operate to safeguard the contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract.
(b)
Sections
56-26-101
- 56-26-103 and 56-26-105 apply to any blanket or group insurance policy.
Acts 1955, ch. 4, § 9; 1976, ch. 397, § 4; T.C.A., § 56-3322.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-123 - Violation - Forfeiture - Revocation of license

(a)
Any person, partnership or corporation willfully violating any provision of this chapter or order of the commissioner made in accordance with this chapter shall forfeit to this state a sum not to exceed one thousand dollars ($1,000) for each violation, which may be recovered by a civil action.
(b)
The commissioner may also suspend or revoke the license of an insurer or agent for any willful violation.
Acts 1955, ch. 4, § 10; T.C.A., § 56-3323.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-124 - Accident and sickness insurance - Patients in tax supported institutions not to be excluded

No policy of sickness and accident insurance delivered or issued for delivery to any person in this state on or after January 1, 1975, including both individual policies and group policies, shall exclude covered benefits because the insured is a patient hospitalized in a tax supported institution of this state or any county or municipality; provided, that the institution charges patients for the same services in the absence of insurance.
Acts 1959, ch. 38, § 1; 1967, ch. 23, § 1; 1974, ch. 426, § 1; T.C.A., § 56-3324.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-125 - Insurer's right of cancellation to be stated on face of policy

No policy of accident, sickness or hospital insurance that is cancellable by the insurer shall be delivered or issued for delivery to any person in this state unless the policy shall show conspicuously on the face thereof the words "POLICY CANCELLABLE BY COMPANY," or similar wording which, in the opinion of the commissioner, has substantially the same meaning and effect.
Acts 1970, ch. 455, § 1; 1976, ch. 397, § 5; T.C.A., § 56-3325.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-126 - Insurer's option to renew to be stated on face of policy

No policy of accident, sickness or hospital insurance in which the insurer reserves the right to refuse renewal thereof shall be delivered or issued for delivery to any person in this state unless the policy shall show conspicuously on the face thereof the words, "RENEWABLE AT OPTION OF COMPANY," or similar wording which, in the opinion of the commissioner, has substantially the same meaning and effect.
Acts 1970, ch. 455, § 2; 1976, ch. 397, § 6; T.C.A., § 56-3326.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-127 - Group or franchise policies excluded

Sections
56-26-125
and
56-26-126
do not apply to such policies issued on a group or franchise basis.
Acts 1970, ch. 455, § 3; T.C.A., § 56-3327.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-128 - Violations - Penalty

Any person, firm, partnership or corporation willfully violating any provision of §
56-26-125
or §
56-26-126
shall be liable for the civil penalty provided in §
56-26-123
.
Acts 1970, ch. 455, § 4; T.C.A., § 56-3328.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-129 - Ten-day free look on health insurance

Every individual accident and health policy or contract shall have printed thereon or attached thereto a notice stating in substance that the person to whom the policy or contract is issued shall be permitted to return it within ten (10) days of its delivery to the purchaser and to have the premium paid by the purchaser refunded if, after examination of the policy or contract, the purchaser is not satisfied with it for any reason. If a policyholder or purchaser pursuant to the notice returns the policy or contract to the company at its home office or to the agent through whom it was purchased, it shall be void from the beginning and the parties shall be in the same position as if no policy or contract had been issued.
Acts 1976, ch. 397, § 7; T.C.A., § 56-3329.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-132 - Health care insurance advice for senior citizens

The commissioner shall cause to be prepared a booklet, the subject of which shall be health insurance advice for senior citizens. The purpose of this booklet shall be to help senior citizens in deciding whether or not to purchase health insurance to supplement medicare coverage.
Acts 1979, ch. 326, § 1; T.C.A., § 56-3334.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-133 - Effect of sole proprietor or partner's election against coverage under Workers' Compensation Law

(a)
This chapter shall not be interpreted or construed to deny coverage of any sole proprietor or partner under any individual or group accident and sickness policy such person may have in effect, in cases where the sole proprietor or partner has elected not to be covered by the Workers' Compensation Law, compiled in title 50, chapter 6, for injuries sustained by the person that would have been covered by the Workers' Compensation Law, had the sole proprietor or partner elected to come within the provisions of the Workers' Compensation Law, as provided in §
50-6-102
.
(b)
Nothing in this section shall require coverage of occupational injuries or sicknesses, if such are not covered under the terms of the policy without reference to eligibility for workers' compensation benefits.
Acts 1981, ch. 239, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 1 - GENERAL PROVISIONS (§§ 56-26-101 — 56-26-134) › Section 56-26-134 - No coverage for abortion services in health plans required to be established under federal health care reform plans

No health care plan required to be established in this state through an exchange pursuant to federal health care reform legislation enacted by the 111th Congress shall offer coverage for prohibited abortion services as described in §
39-15-213
.
Amended by 2023 Tenn. Acts, ch. 313, s 6, eff. 4/28/2023.
Acts 2010 , ch. 879, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 2 - GROUP POLICIES (§§ 56-26-201 — 56-26-204) › Section 56-26-201 - Part definitions

As used in this part:
(1)
"Employees" includes the officers, managers and employees of the employer, the individual proprietor or partner if the employer is an individual proprietor or partnership, the officers, managers and employees of subsidiary or affiliated corporations, and the individual proprietors, partners and employees of individuals and firms, if the business of the employer and the individual or firm is under common control through stock ownership, contract, or otherwise. "Employees" may include retired employees. A policy issued to insure employees of a public body may provide that "employees" include elected or appointed officials. The policy may provide that "employees" include the trustees or their employees, or both, if their duties are principally connected with the trusteeship of the policy; and
(2)
"Group accident and health insurance" means that form of accident and health insurance covering groups of persons as defined in the policy, with or without one (1) or more members of their families or one (1) or more of their dependents, or covering one (1) or more members of the families or one (1) or more dependents, under a policy issued to an employer or trustees of a fund established by an employer, or to an association or other organization that qualifies under §
56-26-204(a)
to establish a liability pool, a labor union or the trustees of a fund established by a labor union or an association, or the trustees of a fund established by two (2) or more employers in the same or related industry, or by one (1) or more labor unions or by one (1) or more employers and one (1) or more labor unions, or to a creditor or vendor in connection with a credit transaction (except for insurance regulated by or provided for in §
56-7-901
), who shall be deemed the policyholder, insuring employees of the employer for the benefit of persons other than the employer, or insuring members or employees of the association or labor union for the benefit of persons other than officers of the association or labor union, or insuring employees of the employers or members of the unions, for the benefit of persons other than the employers or the unions, or insuring the debtors of the creditor or vendor to reduce the unpaid indebtedness of the debtor or vendee to the extent of payment of the benefits under the policy (except for insurance regulated by or provided for in §
56-7-901
).
Amended by 2020 Tenn. Acts, ch. 515, s 3, eff. 7/1/2020.
Acts 1976, ch. 397, § 7; 1978, ch. 514, § 1; T.C.A., § 56-3330; Acts 1980, ch. 784, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 2 - GROUP POLICIES (§§ 56-26-201 — 56-26-204) › Section 56-26-202 - Filing and approval of policies - Required provisions

(a)
Except as otherwise required by §
56-26-102
, no policy of group accident and sickness insurance shall be delivered or issued for delivery in this state, unless the policy form and rates have been filed with and approved by the commissioner; provided, that in the case of experience-rated group insurance, premium rates and classifications of risk need not be filed, but shall be maintained by the insurance company and made available for review by the commissioner upon the commissioner's request; nor shall any such policy, endorsement, rider or application be issued until the earlier of the expiration of thirty (30) days after the form or rates have been filed or the commissioner giving the commissioner's written approval. The commissioner is authorized to promulgate rules necessary to implement the standards set out in this subsection (a).
(b)
The policy must contain, in substance, the following provisions:
(1)
A provision that the policy, the application of the employer, or executive officer or trustee of any association or labor union, and the individual applications, if any, of the employees, members or employees of members insured shall constitute the entire contract between the parties, and that all statements made in the applications shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense of a claim under the policy unless it is contained in a written application;
(2)
A provision that the insurer will issue to the policyholder for delivering to the persons insured under the policy, an individual certificate setting forth the benefits and the exceptions thereunder and referring to the master policy under which the coverage is provided; and
(3)
A provision that to the group or class thereof originally insured there shall be added from time to time all persons becoming newly eligible for and applying for insurance in the group or class.
Acts 1976, ch. 397, § 7; 1978, ch. 514, § 2; T.C.A., § 56-3331; Acts 2011, ch. 344, § 14.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 2 - GROUP POLICIES (§§ 56-26-201 — 56-26-204) › Section 56-26-203 - Benefits entitlement when husband and wife covered as employees of same employer - Family members

When a husband and wife are both employed by the same employer, and both have enrolled themselves and their eligible family members under their employer's group accident and health insurance policy issued in this state after April 2, 1981, each spouse may claim on the person's own behalf, or on behalf of the person's enrolled dependents, the combined maximum contractual benefits to which an employee is entitled under the terms of the group policy, not to exceed in the aggregate one hundred percent (100%) of the expenses incurred.
Acts 1981, ch. 92, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 3 - COST REPORTING (§§ 56-26-301 — 56-26-305) › Section 56-26-301 - Part definitions

As used in this part, unless the context otherwise requires:
(1)
"Administrator" means any person, company, corporation, partnership, association or legal entity collecting charges or premiums from, or adjusting or settling claims on, residents of this state in connection with health insurance coverage;
(2)
"Charge data" means information and figures concerning the dollar amount billed by hospitals to patients on account of care, services, goods, accommodations, facilities and equipment furnished by or in a hospital; provided, that "charge data" only includes categorical information and figures and does not include information and figures concerning individual patients;
(3)
"Commissioner" means the commissioner of commerce and insurance;
(4)
"Hospital" means any institution, place, building or agency as defined by §
68-11-201
and subject to §§
68-11-201
- 68-11-219;
(5)
"Insurer" means any person authorized to transact the business of insurance under this title; and
(6)
"Major purchasers" means persons who have health insurance coverage and who consist of one hundred (100) employees or more under a group plan of insurance; or any experience rated group regardless of size.
Acts 1980, ch. 876, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 3 - COST REPORTING (§§ 56-26-301 — 56-26-305) › Section 56-26-302 - Furnishing of charge data required

(a)
Insurers and administrators shall provide charge data by hospital and by diagnostic category when requested by major purchasers.
(b)
Charge data shall be provided under rules and regulations promulgated under §
56-26-305
.
Acts 1980, ch. 876, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 3 - COST REPORTING (§§ 56-26-301 — 56-26-305) › Section 56-26-303 - Requirement subject to available cost data

The requirements to furnish charge data pursuant to §
56-26-302
are subject to the cost data being reasonably available as determined by the commissioner.
Acts 1980, ch. 876, § 3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 3 - COST REPORTING (§§ 56-26-301 — 56-26-305) › Section 56-26-304 - Immunity from civil liability

Any person furnishing charge data pursuant to the requirements of this part shall be immune from any civil liability or damages claimed by any person by reason of actions in compliance with this part.
Acts 1980, ch. 876, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 26 - ACCIDENT AND SICKNESS INSURANCE (§§ 56-26-101 — 56-26-305) › Part 3 - COST REPORTING (§§ 56-26-301 — 56-26-305) › Section 56-26-305 - Powers of commissioner

The commissioner has the power and authority to enforce this part, including the power to promulgate reasonable rules and regulations, including, but not limited to:
(1)
Diagnostic categories that will be used;
(2)
Information that major purchasers may receive;
(3)
Fees that major purchasers may reasonably be charged for data requests;
(4)
Conditions under which data may be deemed to be reasonably available;
(5)
Information that must be reported and in what format or form; and
(6)
Any other matter necessary to implement this part.
Acts 1980, ch. 876, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-101 - Short title

This chapter shall be known and may be cited as the "Medical Service Plan Law, 1945."
Acts 1945, ch. 113, § 28; C. Supp. 1950, § 4186.17 (Williams, § 4186.45); T.C.A. (orig. ed.), § 56-2901.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-102 - Chapter definitions

As used in this chapter, unless the context otherwise requires:
(1)
"Beneficiary" means a person designated in the subscription certificate referred to in subdivision (9), as entitled to the medical services referred to in subdivision (9);
(2)
"Commissioner" means the commissioner of commerce and insurance;
(3)
"Covered dependent" is the spouse, an adult dependent or child of a subscriber who is named in the subscription certificate issued to the subscriber, and with respect to whom appropriate premium is specified in the certificate;
(4)
"Medical service plan" means a plan or arrangement under which medical services are or may be rendered to a subscriber, a covered dependent or other beneficiary by a licensed physician and surgeon at the expense of a medical service plan corporation or other person, in consideration of periodical prepayments made by the subscriber or another in the subscriber's behalf prior to the occurrence of the condition calling for the rendition of medical or surgical services;
(5)
"Medical service plan corporation" means a corporation organized without capital stock and not for profit, and incorporated in accordance with §
56-27-103
, specifically for the purpose of establishing, maintaining and operating a nonprofit medical service plan;
(6)
"Medical services" means the general and usual services and care rendered and administered by doctors of medicine. "Medical services" does not include hospital services;
(7)
"Participating physician" means a doctor of medicine licensed to practice medicine and surgery in this state under title 63, chapter 6, who agrees in writing with a medical service plan corporation to perform the medical services specified in the subscription certificates issued by the corporation, and at the rates of compensation as shall be determined by the board of directors of the corporation, and who agrees to abide by the bylaws, rules and regulations of the corporation applicable to participating physicians;
(8)
"Person" includes a natural person, a copartnership, an association, a common-law trust or a corporation; and
(9)
"Subscriber" means a person to whom a subscription certificate is issued by a medical service plan corporation that sets forth the beneficiaries and the kinds and extent of the medical services for which the corporation is liable to make payment.
Acts 1945, ch. 113, § 1; C. Supp. 1950, § 4186.18; impl. am. Acts 1971, ch. 137, § 2; T.C.A. (orig. ed.), § 56-2902.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-103 - Formation of nonprofit medical service plan corporation

Nine (9) natural persons of full age and of either sex, all of whom are residents of this state and citizens of the United States, and at least a majority of whom are doctors of medicine licensed to practice medicine and surgery in this state, may form, under the laws of this state relating to benevolent corporations, so far as these laws are applicable and are not inconsistent with this chapter, a nonprofit medical service plan corporation for the purpose of establishing and operating a medical service plan or plans. The corporation shall be subject to regulation and supervision by the commissioner and is expressly made subject to the applicable insurance laws of this code.
Acts 1945, ch. 113, § 3; C. Supp. 1950, § 4186.20; T.C.A. (orig. ed.), § 56-2903.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-104 - Articles of incorporation and amendments - Approval by commissioner

The articles of incorporation of the corporation and amendments to the articles shall be submitted to the commissioner, and shall be subject to the commissioner's approval, which shall be endorsed on the articles or the amendments before they are filed with the secretary of state; provided, that if the articles of incorporation of the corporation have been filed with the secretary of state prior to February 27, 1945, the approval of the articles by the commissioner shall be evidenced by a separate instrument in writing filed with the secretary of state.
Acts 1945, ch. 113, § 5; C. Supp. 1950, § 4186.22; T.C.A. (orig. ed.), § 56-2904.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-105 - Board of directors - Number - Qualifications - Nomination - Election - Compensation

A medical service plan corporation shall consist of a board of directors and of members, grouped in reasonable classes as the bylaws of the corporation as approved by the commissioner shall provide. The business of the corporation shall be managed by a board of directors of nine (9) persons possessing the same general qualifications as the incorporators, and selected by the members in the manner set out in the bylaws, for three-year terms. Five (5) members of the board shall be licensed doctors of medicine, nominated by the medical societies having territorial jurisdiction in the county in which the corporation has authority to operate, and the other four (4) members shall be representatives of the subscribers in the areas involved, and shall be nominated by the members of the corporation, and all nine (9) members of the board shall be elected by the members of the corporation as provided in this section. Directors or board members shall serve without pay for their work in this capacity, but may receive payment for particular services actually rendered, such as legal counsel, medical or surgical service, accounting or other required services, upon specific approval of the board of directors, the approval being made a part of the minutes of the board of directors.
Acts 1945, ch. 113, § 4; C. Supp. 1950, § 4186.21; T.C.A. (orig. ed.), § 56-2905.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-106 - Right to establish or operate plan - Unlawful acts

It is unlawful for any person except a medical service plan corporation, incorporated in accordance with this chapter, and operating in accordance with this chapter, and operating in accordance with authority from the commissioner or an insurance company properly qualified in this state to write accident, health or disability insurance, to establish, maintain, or operate a medical service plan, or to solicit subscribers to or enter into contracts with respect to a medical service plan. This prohibition, however, shall not be construed as preventing a person from furnishing medical services for the prevention of diseases among the person's employees or from furnishing the medical services as are required under the Workers' Compensation Law, compiled in title 50, chapter 6, and related legislation when the employee is not charged for the services.
Acts 1945, ch. 113, § 2; C. Supp. 1950, § 4186.19; T.C.A. (orig. ed.), § 56-2906.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-107 - Scope and extent of medical service

A medical service plan corporation shall be authorized to provide either or both general and special medical and surgical care benefits, including service that may be necessarily incident to medical care. The extent and scope of a medical service plan shall be clearly shown in the subscription contract, and may be limited only as clearly shown in the contract, and as approved by the commissioner.
Acts 1945, ch. 113, § 5; C. Supp. 1950, § 4186.22; T.C.A. (orig. ed.), § 56-2907.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-108 - Right to become participating physician - Method of diagnosis and treatment unrestricted - Private physician-patient relationship

(a)
Every doctor of medicine licensed to practice in this state under title 63, chapter 6, and who is reputable and in good standing, has the right to become a participating physician in the medical service plan corporation operating in the county in which the doctor resides or practices, for general or special medical care, as the case may be, under the terms and conditions that are imposed on other participating physicians under similar circumstances, or as prescribed in this chapter and approved by the commissioner. A medical service plan corporation shall impose no restrictions on the doctors of medicine who treat its subscribers as to methods of diagnosis or treatment. The private physician-patient relationship shall be maintained, and a subscriber shall at all times have free choice of any doctor of medicine who is a participating physician in the corporation and who agrees to accept a particular beneficiary as a patient.
(b)
It is the purpose of this section to make it clear that the creation of the relationship of patient and physician depends on the mutual assent of both parties. Contracts issued by the corporation to the subscribers shall not constitute individually or jointly obligations of the participating physician or physicians servicing the plan.
Acts 1945, ch. 113, § 6; C. Supp. 1950, § 4186.23; T.C.A. (orig. ed.), § 56-2908.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-109 - Agreements with physicians

A medical service plan corporation may enter into agreements with physicians qualified as set out in §
56-27-108
, under which the physicians become participating physicians of a plan operated by the corporation, and may make to the physicians payments that have accrued to them by reason of services performed under the plan and on behalf of the corporation by them. Payment for medical services shall be made only to a participating physician unless otherwise provided for in this chapter, except that the corporation, in the case of emergency services rendered to a subscriber, may reimburse any doctor of medicine who would be eligible to become a participating physician except for residence or state by which licensed, in accordance with the rates adopted by the board of directors with respect to participating physicians. A medical service plan corporation may enter into contracts for the payment of medical services to the subscribers or members of similar medical service plan corporations of other states subject to the supervision of other states, and shall have the right to reimburse any other medical service plan corporation or physicians of another state or other counties of this state in which the corporation does not transact business for services rendered to its subscribers or beneficiaries named in the certificates issued to the subscribers at the same rate paid participating physicians under the certificate of the subscriber. The contracts between the medical service plan corporation and physicians shall be subject to the supervision of and the approval of the commissioner.
Acts 1945, ch. 113, § 14; C. Supp. 1950, § 4186.30 (Williams, § 4186.31); T.C.A. (orig. ed.), § 56-2909.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-110 - License required

A corporation subject to this chapter may issue contracts only when the commissioner has by formal license authorized it to do so.
Acts 1945, ch. 113, § 7; C. Supp. 1950, § 4186.24; T.C.A. (orig. ed.), § 56-2910.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-111 - Application for license - Form - Accompanying documents - Filing fee

Application for the license shall be made on forms approved by the commissioner, containing information the commissioner deems necessary. Every application for the license shall be accompanied by copies of the following documents:
(1)
A certified copy of its charter or certificate of incorporation;
(2)
A copy of its bylaws, certified by the lawful custodian of the original;
(3)
Proposed contract between the corporation and the participating physicians showing terms under which medical service is to be furnished to subscribers;
(4)
Subscription contracts to be issued to subscribers showing a table of the rates to be charged and the benefits to which they are entitled, showing benefits expressed in service rather than in dollars; however, with equitable arrangements to protect the interests of subscribers when it becomes impossible for the services to be provided. The contracts should make clear that the responsibility for service to subscribers rests with the corporation, and not with the participating physicians;
(5)
A statement of the county or counties in which it proposes to operate medical service plans;
(6)
A statement of its financial condition and business in such form and detail as the commissioner may require, including the amounts of contributions paid for working capital and the name or names of each contributor, and the terms of the contribution, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of thirty dollars ($30.00). Contributions not paid, but agreed to be paid, may be reported as a separate item, but shall not be admitted as assets of the corporation;
(7)
A copy of its proposed prospectus and advertising material to be used in the solicitation of contracts; and
(8)
Proof satisfactory to the commissioner that in the county or counties in which the corporation proposes to operate, fifty-one percent (51%) or more of the resident doctors of medicine have agreed to render the medical services for which the corporation agrees to pay.
Acts 1945, ch. 113, § 7; C. Supp. 1950, § 4186.24; T.C.A. (orig. ed.), § 56-2911.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-113 - Investment of funds

The funds of the medical service corporations subject to this chapter shall be invested only in securities permitted by the laws of this state for the investment of assets of life insurance companies.
Acts 1945, ch. 113, § 16; C. Supp. 1950, § 4186.32 (Williams, § 4186.33); T.C.A. (orig. ed.), § 56-2913.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-114 - Administrative expenses

(a)
All acquisition and administrative expenses incurred in connection with the medical service corporation shall at all times be limited after the second year of operation to not exceed twenty-five percent (25%) of the total net premium income of the corporation. The expenses, during the first year, shall be limited to thirty-five percent (35%), and during the second year, the expenses shall be limited to thirty percent (30%). All acquisition and administrative expenses incurred shall be subject to the approval of the commissioner.
(b)
"Administrative expenses," as used in this section, includes all expenditures except payments for subscribers' claims.
(c)
Claim service expense shall be separately classified and included in administrative expense, unless otherwise ordered by the commissioner. No such corporation shall disburse as administrative expenses during any one (1) year a sum greater than the percentage limited by this section of payments received from subscribers during that calendar year.
Acts 1945, ch. 113, § 15; C. Supp. 1950, § 4186.31 (Williams, § 4186.32); T.C.A. (orig. ed.), § 56-2914.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-115 - Purchase of liability insurance authorized

A medical service plan corporation is authorized to purchase a contract of insurance protecting the corporation or any officer or employee of the corporation, or any physician from liability for injuries resulting from negligence, misfeasance, malfeasance, nonfeasance or health care liability on the part of any officer or employee of the corporation, or on the part of any physician in the course of rendering medical services to beneficiaries.
Acts 1945, ch. 113, § 22; C. Supp. 1950, § 4186.38 (Williams, § 4186.39); T.C.A. (orig. ed.), §56-2915; Acts 2012 , ch. 798, § 23.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-116 - Records to be maintained

The medical service corporation shall maintain adequate financial and statistical records in reasonable uniformity with accounting plans and statistical requirements of the annual statement blank required by the commissioner.
Acts 1945, ch. 113, § 10; C. Supp. 1950, § 4186.26 (Williams, § 4186.27); T.C.A. (orig. ed.), § 56-2916.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-117 - Annual statement - Form - Filing fee

The service corporation shall annually, on or before March 1, file in the office of the department a statement of its operations for the calendar year, and showing financial condition as of December 31, then next preceding, in the form and content the commissioner shall prescribe, signed and sworn to by its president and secretary, or other proper officers, and shall pay for the filing of the statement the sum of fifty dollars ($50.00).
Acts 1945, ch. 113, § 17; C. Supp. 1950, § 4186.33 (Williams, § 4186.34); impl. am. Acts 1971, ch. 137, § 1; Acts 1979, ch. 298, § 6; T.C.A. (orig. ed.), § 56-2917.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-118 - Examination - Rehabilitation or liquidation

The commissioner has the same authority to examine the service corporation as is granted to the commissioner for the examination of life, accident and health insurance companies, and has the same authority for the correction, rehabilitation or liquidation of the service corporation as is now provided by law for life, health and accident companies.
Acts 1945, ch. 113, § 9; C. Supp. 1950, § 4186.25 (Williams, § 4186.26); T.C.A. (orig. ed.), § 56-2918.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-119 - Fees and taxes

Every medical service corporation, or its agents, subject to this chapter, is subject to the fees and taxes as prescribed for life, health and accident insurance companies and agents of the companies doing business in this state. It is not the purpose of this chapter to discriminate in favor of the medical service corporations.
Acts 1945, ch. 113, § 19; C. Supp. 1950, § 4186.35 (Williams, § 4186.36); T.C.A. (orig. ed.), § 56-2919.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 27 - MEDICAL SERVICE PLAN LAW, 1945 (§§ 56-27-101 — 56-27-133) › Section 56-27-120 - Renewals of licenses - Agents' certificates of authority

All licenses authorizing medical service plan corporations to transact business in this state shall be renewable on April 1 of each year, subject to the approval of the commissioner. Every medical service corporation licensed to do business in this state under this chapter shall obtain from the commissioner a certificate of authority for every agent writing or soliciting medical service plan contracts for the medical service corporation in this state, and the certificate shall be renewable January 1 of each year, subject to applicable sections of the insurance laws, including the revenue law of this state for ordinary life, health and accident insurance agents.
Acts 1945, ch. 113, § 24; C. Supp. 1950, § 4186.40 (Williams, § 4186.41); T.C.A. (orig. ed.), § 56-2920.