reglab/statecodes huggingface dataset:
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 18 - CANCELLATION OF COMMERCIAL RISK INSURANCE ACT (§§ 56-7-1801 — 56-7-1808) › Section 56-7-1806 - Revision of rates

(a)
In the event an insurance company intends to increase the premiums of a commercial risk policy by an amount that is more than twenty-five percent (25%) and the increase in premium is the result of comparing policies of equivalent exposures, the insurance company shall mail or deliver to the named insured and producer at the address shown on the policy, not less than sixty (60) days prior notice of its intention to increase the premiums, specifying the percentage of the increase.
(b)
Unless notice is provided as described in subsection (a), the insurer is required to extend the existing policy sixty (60) days from the date the notice is provided.
(c)
The premium for the policy provided in those circumstances shall be not more than a pro rata basis of the existing policy.
Acts 1986, ch. 656, § 6; 2005, ch. 52, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 18 - CANCELLATION OF COMMERCIAL RISK INSURANCE ACT (§§ 56-7-1801 — 56-7-1808) › Section 56-7-1807 - Noncompliance with this part

Failure to comply with this part shall be considered to be an unfair trade practice under §
56-8-104
.
Acts 1986, ch. 656, § 7.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 18 - CANCELLATION OF COMMERCIAL RISK INSURANCE ACT (§§ 56-7-1801 — 56-7-1808) › Section 56-7-1808 - Promulgation of rules and regulations by commissioner

(a)
The commissioner may, after notice and hearing, promulgate rules and regulations to carry out this part.
(b)
The rulemaking authority includes the power to increase or decrease the time within which notice is required by this part.
Acts 1986, ch. 656, § 8.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 19 - CANCELLATION OF PERSONAL RISK INSURANCE (§§ 56-7-1901 — 56-7-1902) › Section 56-7-1901 - Notice of intention not to renew

Except as provided in §
56-7-1304
, if an insurance company does not intend to renew a contract of any kind of personal risk insurance identified in §
56-5-102
, the company shall mail or deliver to the named insured, at the address shown in the policy, notice of its intention not to renew at least thirty (30) days prior to the expiration of the policy.
Acts 1989, ch. 157, § 1; 2003, ch. 215, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 19 - CANCELLATION OF PERSONAL RISK INSURANCE (§§ 56-7-1901 — 56-7-1902) › Section 56-7-1902 - Statement of reasons for nonrenewal - Liability of information providers

(a)
Unless the nonrenewal notice contains a reason for the nonrenewal action, the notice shall advise the insured that upon written request of the named insured, mailed or delivered to the insurer not later than fifteen (15) days after the effective date of the nonrenewal, the insurer will within twenty (20) days mail to the named insured a written statement specifying a reason for the nonrenewal action.
(b)
There shall be no liability on the part of, and no cause of action of any nature shall arise against, any insurer, its authorized representative, its agents, its employees, or against any firm, person or corporation furnishing information to the insurer, as to the reason for nonrenewal.
Acts 1989, ch. 157, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 20 - MEMPHIS PLAN ACT OF 1991 (§§ 56-7-2001 — 56-7-2005) › Section 56-7-2001 - Short title

This part shall be known and may be cited as the "Memphis Plan Act of 1991."
Acts 1991, ch. 353, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 20 - MEMPHIS PLAN ACT OF 1991 (§§ 56-7-2001 — 56-7-2005) › Section 56-7-2002 - Purpose

The general assembly finds that there is a problem with availability and affordability of health care services for lower income persons. It is, therefore, the intent of this general assembly to make coverage more available and affordable by authorizing the development of innovative plans to prepay the coverage.
Acts 1991, ch. 353, § 3.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 20 - MEMPHIS PLAN ACT OF 1991 (§§ 56-7-2001 — 56-7-2005) › Section 56-7-2003 - Plan not deemed to be insurance - Conditions

A plan that provides health care services to low income individuals on a prepaid basis shall not be deemed to be insurance within §
56-7-101
, or a service plan or corporation or health maintenance organization within chapters 27-32 of this title, or any other provision of this title; provided, that the plan meets the following conditions:
(1)
Eligibility in the plan is limited to persons employed in businesses employing two hundred (200) eligible persons or fewer and persons engaged in domestic service in private households and dependents of those persons, where the persons earn less than two hundred percent (200%) of the federal poverty level and are not covered under any other group insurance arrangement;
(2)
The plan is operated on a not-for-profit basis under the sponsorship of a not-for-profit organization;
(3)
Covered primary care services are provided to enrollees either by providers on staff of the sponsoring organization or by volunteers recruited from a local medical society who have, in both instances, agreed to provide their services for free or for nominal reimbursement for out-of-pocket expenses and/or expendable supplies directly related to, and incurred as a result of, the service provided to the enrollee;
(4)
Payments to outside contractors for marketing, claims administration and similar services total no more than ten percent (10%) of the total charges;
(5)
The plan has received the approval and endorsement of the local medical society in consultation with the Tennessee Medical Association;
(6)
Except as provided in subdivision (3), no portion of any fees or charges under the plan shall be paid directly or indirectly as salary to any officer or director of the sponsoring not-for-profit corporation; and
(7)
The sponsoring not-for-profit corporation files an annual report with the commissioner within ninety (90) days of the close of the corporation's fiscal year that includes, at a minimum, the following information:
(A)
The number of plan enrollees;
(B)
Total services rendered under the plan;
(C)
Plan financial statements;
(D)
Administrative costs and salaries paid by the plan; and
(E)
Other information that may be reasonably requested by the commissioner.
Acts 1991, ch. 353, § 4; 1999, ch. 158, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 20 - MEMPHIS PLAN ACT OF 1991 (§§ 56-7-2001 — 56-7-2005) › Section 56-7-2004 - Maintenance of minimum essential health coverage

Coverage made available under the plan shall constitute minimum essential health coverage for purposes of compliance with
26 U.S.C. § 5000A
.
Acts 2012, ch. 1089, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 20 - MEMPHIS PLAN ACT OF 1991 (§§ 56-7-2001 — 56-7-2005) › Section 56-7-2005 - Presumption that operating entity satisfies requirements regarding health care sharing ministries

Operation consistent with the standards described in §
56-7-2003
shall create a presumption that the operating entity satisfies the requirements of
26 U.S.C. § 5000A(d)(2)(B)(ii)
.
Acts 2012, ch. 1089, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 21 - PET INSURANCE (§§ 56-7-2101 — 56-7-2103) › Section 56-7-2101 - "Pet" defined

As used in this part, "pet" means any domesticated animal normally maintained in or near the household of its owner.
Acts 1992, ch. 598, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 21 - PET INSURANCE (§§ 56-7-2101 — 56-7-2103) › Section 56-7-2102 - Policies or contracts

Any insurer writing any coverage to which this title applies may offer group or individual policies or contracts that provide benefits for hospital and medical services for pets; provided, that these services are provided by a veterinarian licensed pursuant to title 63, chapter 12, or by the laws of any other state. The policy or contract may provide for exclusions or deductibles, or both.
Acts 1992, ch. 598, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 21 - PET INSURANCE (§§ 56-7-2101 — 56-7-2103) › Section 56-7-2103 - Disclosure

All policies issued pursuant to this part shall clearly disclose on the face of the policy:
(1)
The annual premium for the policy; and
(2)
The benefits provided by the policy.
Acts 1992, ch. 598, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2201 - Short title

This part shall be known and may be cited as the "Tennessee Small Employer Group Health Coverage Reform Act."
Acts 1992, ch. 808, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2202 - Legislative purpose

The purpose and intent of this part is to promote the availability of accident and health insurance coverage to small employers, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules for continuity of coverage for employers and covered individuals and to improve the efficiency and fairness of the small group accident and health insurance marketplace.
Acts 1992, ch. 808, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2204 - Affiliated companies

For the purposes of this part, companies that are affiliated companies or that are eligible to file a consolidated tax return shall be treated as one (1) carrier, except that with respect to affiliated companies, all of which are in existence and affiliated on January 1, 1992, the group of affiliated companies is considered to be one (1) carrier only after one (1) member of the group transfers any small employer business to another member of the group, and except that any insurance company, hospital service plan or medical service plan that is an affiliate of an HMO located in this state or any HMO located in this state that is an affiliate of an insurance company, a health service corporation or a medical service corporation may treat the HMO as a separate carrier and each HMO that operates only one (1) HMO in a service area of this state may be considered a separate carrier.
Acts 1992, ch. 808, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2205 - Distinct grouping - Additional groupings

(a)
A distinct grouping may only be established by a small employer carrier on the basis that the applicable health benefit plans:
(1)
Are marketed and sold through individuals and organizations that are not participating in the marketing or sale of other distinct groupings of small employers for the small employer carrier;
(2)
Have been acquired from another small employer carrier as a distinct grouping of plans; or
(3)
Are provided through an association with membership of not less than ten (10) small employers that has been formed for purposes other than obtaining insurance.
(b)
A small employer carrier may establish no more than two (2) additional groupings under subdivision (a)(1), (a)(2) or (a)(3) on the basis of underwriting criteria that are expected to produce substantial variation in the health care costs.
(c)
The commissioner may approve the establishment of additional distinct groupings upon application to the commissioner and the commissioner's determination that the action would enhance the efficiency and fairness of the small employer marketplace.
Acts 1992, ch. 808, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2206 - Applicability

(a)
A health benefit plan is subject to this part if it provides health benefits for small employers and if either of the following conditions is met:
(1)
Any part of the premiums or benefits is paid by a small employer, or any covered individual is reimbursed, whether through wage adjustments or otherwise, by a small employer for any portion of the premium, or for which the small employer has permitted payroll deduction for the covered individual, whether or not the coverage is issued through a group or individual policy of insurance, and whether or not the small employer pays any part of the premium; or
(2)
The health benefit plan is treated by the employer or any of the covered individuals as part of a plan or program for the purpose of § 106 or § 162 of the Internal Revenue Code (
26 U.S.C. §§ 106
and
162
).
(b)
Chapter 5, part 3 of this title does not apply to individual accident and health insurance policies or contracts to the extent they are subject to this part.
Acts 1992, ch. 808, § 6.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2209 - Liability of health group cooperative

(a)
A health group cooperative shall not be liable for, nor shall a member of the board of directors, the executive director, an employee, or an agent of a cooperative, be liable for:
(1)
An act performed in good faith in the execution of duties in connection with the cooperative; or
(2)
An independent action of a small employer insurer or a person who provides health care services under a health insurance plan.
(b)
A health group cooperative shall not be liable for, nor shall a member of the board of directors, the executive director, an employee, or an agent be liable for a failure to arrange for coverage of a particular illness, disease, or health condition.
Acts 2008, ch. 1036, § 4.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2210 - Duties of a health group cooperative

A health group cooperative:
(1)
Shall arrange for group health insurance plan coverage for small employers who are members of the cooperative by contracting with small employer insurers who meet the criteria established by this part for coverage under group health insurance plans;
(2)
Shall collect premiums to cover the cost of:
(A)
Group health insurance plan coverage purchased through the cooperative; and
(B)
The cooperative's administrative expenses;
(3)
May contract with agents to market coverage issued through the cooperative;
(4)
Shall establish administrative and accounting procedures for the operation of the cooperative;
(5)
May contract with a small employer insurer or third-party administrator to provide administrative services to the cooperative;
(6)
Shall contract with a small employer insurer for the provision of services to small employers covered through the cooperative;
(7)
Shall develop and implement a plan to maintain public awareness of the cooperative and publicize the eligibility requirements for, and the procedures for, enrollment in coverage through the cooperative;
(8)
May negotiate the premiums paid by its members; and
(9)
May obtain from the cooperative's selected insurer other ancillary health insurance products and services for its members as are customarily offered in conjunction with group health insurance plans.
Acts 2008, ch. 1036, § 5.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 22 - TENNESSEE SMALL EMPLOYER GROUP HEALTH COVERAGE REFORM ACT (§§ 56-7-2201 — 56-7-2211) › Section 56-7-2211 - Contracting with a small employer insurer - Compliance with federal laws

(a)
A health group cooperative shall contract only with a small employer insurer that demonstrates:
(1)
That the insurer or health maintenance organization is licensed and in good standing with the department;
(2)
The capacity to administer the group health insurance plans;
(3)
The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures;
(4)
The ability to conduct utilization management and applicable procedures and policies;
(5)
The ability to assure enrollees a sufficient number of health care providers, including specialty providers; and
(6)
A satisfactory grievance procedure and the ability to respond to enrollees' calls, questions, and complaints.
(b)
A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by federal law and this title or rules promulgated pursuant to this title.
Acts 2008, ch. 1036, § 6.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2301 - Health insurance - Newly born children - Coverage - Notification

(a)
All individual and group health insurance policies providing coverage on an expense incurred basis and individual and group service or indemnity type contracts issued by a nonprofit corporation that provide coverage for a child of the insured or subscriber shall, as to the child's coverage, also provide that the health insurance benefits applicable to children, if any, shall be payable with respect to a newly born child of the insured or subscriber from the moment of birth.
(b)
The coverage for newly born children shall, in addition to coverage for infants placed in the well-child care unit, consist of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. The coverage of newly born infants and pregnant women shall also include coverage for testing as provided in §
68-5-401(a)(2)
.
(c)
If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fee must be furnished to the insurer or nonprofit service or indemnity corporation within thirty-one (31) days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.
(d)
The requirements of this section apply to all insurance policies and subscriber contracts delivered or issued for delivery in this state more than one hundred twenty (120) days after July 1, 1974, and to those policies and subscriber contracts that are substantially amended after July 1, 1980.
(e)
If and only if a person or the person's spouse is pregnant at the time health insurance coverage is purchased, then at the time of the purchase this section may be contractually waived with respect to health insurance coverage for an unborn child and/or the right of the person to purchase health insurance coverage for the unborn child.
Acts 1974, ch. 422, § 1; 1976, ch. 493, § 1; T.C.A., § 56-1165; Acts 1980, ch. 525, § 1; 1982, ch. 710, §§ 1-3; 1992, ch. 984, § 1; T.C.A. §
56-7-1001(a)-(d)
; Acts 1995, ch. 334, § 1; 1997, ch. 312, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2303 - Forfeiture and lapse restrictions

(a)
No insurance company doing business in this state shall declare any life insurance policy or any noncancellable or guaranteed renewable accident and health insurance policy owned by a resident of this state forfeited or lapsed within six (6) months after default in payment of any premium, installment or interest, unless a written or printed notice stating the amount of the premium, installment or interest due on the policy, the place where it shall be paid and the name and address of the person or company to which it is payable, has been duly addressed and mailed with the required postage affixed, to the policy owner at the policy owner's last known post office address as shown by the records of the insurance company, on or before the day the premium, installment or interest is due and payable, before the beginning of the period of grace. The notice shall also state that unless the premium or other sums are paid to the company or its agent, the policy will lapse or be forfeited, except as to nonforfeiture options that may be provided for by any life insurance policy. "Policy owner," as used in this section, means the owner of the policy, or other person designated as the person to receive premium notices, all as shown by the records of the insurance company.
(b)
The affidavit of any responsible officer, clerk or agent of the insurance company authorized to mail the notice that it is the standard practice of the company to duly address and mail to policyowners the notice required by this section shall be prima facie evidence that the notice has been duly given.
(c)
No action shall be maintained to recover under a lapsed or forfeited policy on the ground that the insurance company failed to comply with this section, unless instituted within two (2) years from the due date upon which default was made in paying the premium, installment or interest for which it is claimed that lapse or forfeiture ensued.
(d)
This section does not apply to group or group-type policies, to industrial life or accident and health policies, to any policies upon which premiums are payable monthly or at more frequent intervals, or to policies for which premiums are billed to and payable through an employer.
Acts 1976, ch. 417, § 7; T.C.A., § 56-1176; Acts 1992, ch. 984, § 1; T.C.A. §
56-7-113
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2304 - Continuation of coverage on group contracts

The commissioner is authorized to adopt rules applicable to insurance policies and subscriber contracts provided by an insurance company or a nonprofit service corporation on a group or group-type basis establishing reasonable requirements for extension of benefits and determination of claim liability in the event of discontinuance of coverage for nonpayment of premiums or replacement of coverage by another carrier. All rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, and shall provide for any notices required that notice to the group policyholder or subscriber contract holder are deemed notice to the employee, member, or subscriber. No rule shall require the extension of coverage, except as to policies or contracts issued, altered, or amended after the effective date of the rule.
Amended by 2018 Tenn. Acts, ch. 873,s 11, eff. 5/3/2018.
Acts 1976, ch. 417, § 9; T.C.A., § 56-1177; Acts 1992, ch. 984, § 1; T.C.A. §
56-7-114
.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2306 - Group life insurance - Prior policies unaffected

Section
56-7-2305
does not apply to any policy or contract of group life insurance legally in effect March 8, 1957, or any renewal or renewals of the policy or contract.
Acts 1957, ch. 122, § 3; T.C.A., § 56-1143; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-602.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2310 - Character of life insurance policies to be printed or stamped thereon

All life insurance companies authorized to do the business of life insurance in this state are required to print, in conspicuous type, on the face or first page of each policy sold to citizens of this state, words correctly describing the character of the policy.
Acts 1905, ch. 392, § 1; Shan., § 3348a15; Code 1932, § 6186; Acts 1976, ch. 417, § 5; T.C.A. (orig. ed.), § 56-1115; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-304.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2313 - Converted policy - Conditions

Issuance of a converted policy shall be subject to the following conditions:
(1)
Written application for the converted policy shall be made and the first premium paid to the insurer not later than thirty-one (31) days after the termination under the group policy;
(2)
The converted policy shall be issued without evidence of insurability;
(3)
The initial premium for the converted policy for the first twelve (12) months and subsequent renewal premiums shall be determined in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the converted policy and to the type and amount of insurance provided;
(4)
The effective date of the converted policy shall be the day following the termination of insurance under the group policy; and
(5)
The converted policy shall cover the employee or member and the person's dependents who were covered by the group policy on the date of termination of insurance. At the option of the insurer, a separate converted policy may be issued to cover any dependent.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1502.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2314 - Conditions exempting insurer from conversion requirement

The insurer shall not be required to issue a converted policy covering any person if the person is or could be covered by medicare under Title XVIII of the federal Social Security Act (
42 U.S.C. § 1395
et seq.); furthermore, the insurer shall not be required to issue a converted policy covering any person if:
(1)
(A)
The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program;
(B)
The person is eligible for similar benefits, whether or not covered for the benefits, under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(C)
Similar benefits are provided for or are available to the person, pursuant to or in accordance with the requirements of any state or federal law; and
(2)
The benefit provided under the sources referred to in subdivision (1)(A) for the person or benefits provided or available under the sources referred to in subdivisions (1)(B) and (C) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards. The insurer's standards must bear some reasonable relationship to actual health care costs in the area in which the insured lives at the time of conversion and must be filed with the commissioner prior to their use in denying coverage.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1503.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2315 - Requests for information from insured persons - Grounds for nonrenewal of policy

(a)
A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of the policy of any person covered under the policy as to whether:
(1)
The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program;
(2)
The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(3)
Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law.
(b)
The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured under the policy for the following reasons only:
(1)
Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer's standards on file with the commissioner, or the converted policyholder fails to provide the requested information;
(2)
Fraud or material misrepresentation in applying for any benefits under the converted policy;
(3)
Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act (
42 U.S.C. § 1395
et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or
(4)
Other reasons approved by the commissioner.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1504.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2316 - Ceiling on converted policy benefits

An insurer shall not be required to issue a converted policy that provides benefits in excess of those provided under the group policy from which conversion is made.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1505.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2317 - Preexisting conditions - Converted policy benefits in first policy year limited by group policy benefits

The converted policy shall not exclude a preexisting condition not excluded by the group policy. However, the converted policy may provide that any hospital, surgical or medical benefits payable under the policy may be reduced by the amount of the benefits payable under the group policy after the termination of the individual's insurance under the group policy. The converted policy may also include provisions so that during the first policy year the benefits payable under the converted policy, together with the benefits payable under the group policy, shall not exceed those that would have been payable had the individual's insurance under the group policy remained in force and effect.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1506.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2319 - Optional election of retirement conversion rights

In the event coverage would be continued under the group policy on an employee following retirement prior to the time the employee is or could be covered by medicare, the employee may elect, in lieu of the continuation of group insurance, to have the same conversion rights as would apply had the employee's insurance terminated at retirement by reason of termination of employment or membership.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1508.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2320 - Medicare eligibility as affecting coverage - Persons who may claim conversion privilege

(a)
The converted policy may provide for reduction of coverage on any person upon the person's eligibility for coverage under medicare under Title XVIII of the federal Social Security Act (
42 U.S.C. § 1395
et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy.
(b)
Subject to the conditions set forth in subsection (a), the conversion privilege shall also be available to:
(1)
The surviving spouse, if any, at the death of the employee or member, with respect to the spouse and the children whose coverage under the group policy terminates by reason of the death, otherwise to each surviving child whose coverage under the group policy terminates by reason of the death, or, if the group policy provides for continuation of dependents' coverage following the employee's or member's death, at the end of the continuation;
(2)
The spouse of the employee or member upon termination of coverage of the spouse, while the employee or member remains insured under the group policy, by reason of ceasing to be a qualified family member under the group policy, with respect to the spouse and the children whose coverage under the group policy terminates at the same time;
(3)
A child, solely with respect to the child, upon termination of the child's coverage by reason of ceasing to be a qualified family member under the group policy, if a conversion privilege is not otherwise provided with respect to the termination; and
(4)
The spouse of the employee upon termination of coverage of the spouse by reason of termination of coverage of the employee or member because of eligibility for medicare.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1509.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2321 - Provision of group coverage in lieu of converted individual coverage

The insurer may elect to provide group insurance coverage in lieu of the issuance of a converted individual policy.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1510.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2322 - Notice of conversion privilege

A notification of the conversion privilege shall be included in each certificate of coverage.
Acts 1980, ch. 537, § 1; 1992, ch. 984, § 1; T.C.A., § 56-7-1511.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2323 - Reduction of benefits for school insurance benefits prohibited

No group policy of accident and sickness insurance offered for sale in this state shall be issued or renewed by any insurer or hospital service corporation or medical service corporation transacting business in this state that, by the terms of the policy, excludes or reduces the benefits payable or services to be rendered to or on behalf of any insured because benefits have been paid or are also payable under any blanket group or franchise school accident policy regardless of who makes the premium contribution, or under any individually underwritten and individually issued contract or plan of insurance that provides exclusively for accident and sickness benefits and for which one hundred percent (100%) of the premiums have been paid by the insured or a member of the insured's family or the insured's guardian, regardless of the mode or channel of premium payment to the insurer or of any discount received on the premium by virtue of the insured's membership in any organization or of the insured's status as an employee.
Acts 1976, ch. 412, § 1; T.C.A., § 56-3332; Acts 1992, ch. 984, § 1; T.C.A., § 56-26-130.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2324 - Student accident coverage - Benefit reduction restricted

Under any student accident coverage, regardless of the form of the contract, no provision may be included that reduces the benefits payable on account of the existence of group or individual insurance contracts that provide health insurance coverage on the student; provided, that this section does not apply to any student accident coverage where the school or institution is the policyholder and pays one hundred percent (100%) of the premium for the policy, without receipt of any premium contribution from any individual insured, parent or guardian.
Acts 1976, ch. 412, § 2; 1978, ch. 897, § 1; T.C.A., § 56-3333; Acts 1992, ch. 984, § 1; T.C.A., § 56-26-131.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2325 - Medical accident insurance issued to school children - Coverage

Where any policy of insurance, group or individual, issued after July 1, 1973, to school children, contains a provision whereby incurred medical benefits for accidents are payable for a specified number of days following the covered accident and if, during the specified period, written notice is given to the insurance company by the insured, accompanied by a written statement from the insured's licensed physician stating that medical treatment will be required after the termination of the specified period, then the company shall pay the medical expenses that are incurred within one (1) year from the date of the accident causing the loss for benefits as provided by the contract of insurance.
Acts 1973, ch. 311, § 1; T.C.A., § 56-1163; Acts 1992, ch. 984, § 1; T.C.A., § 56-7-1007.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2326 - Coverage for prescription eye drops - Refills

A policy or contract for a health benefit plan, as defined in §
56-7-2203
, that is issued, renewed, or entered into on or after January 1, 2018, and provides coverage for prescription eye drops shall not deny coverage for a refill of a prescription that is a covered benefit under the policy or contract of the insured and is otherwise eligible for a refill if:
(1)
The renewal is requested by the insured for a thirty-day supply of the drug at least twenty-three (23) days from:
(A)
The original date the prescription was dispensed to the insured; or
(B)
The date the most recent refill was dispensed to the insured;
(2)
The renewal is requested by the insured for a sixty-day supply of the drug at least forty-five (45) days from:
(A)
The original date the prescription was dispensed to the insured; or
(B)
The date the most recent refill was dispensed to the insured; or
(3)
The renewal is requested by the insured for a ninety-day supply of the drug at least sixty-eight (68) days from:
(A)
The original date the prescription was dispensed to the insured; or
(B)
The date the most recent refill was dispensed to the insured.
Added by 2017 Tenn. Acts, ch. 232,s 1, eff. 4/28/2017.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2347 - Coverage of children in custody of guardians

(a)
Notwithstanding any other law to the contrary, any individual, franchise, blanket or group policy issued pursuant to this title or any medical service plan, contract, hospital service corporation contract, hospital and medical service contract, fraternal benefit society or health maintenance organization that provides hospital expense insurance, surgical expense insurance, medical or major medical services insurance and that is entered into, delivered, issued for delivery, or renewed, excepting individual insurance policy renewal, by agreement or otherwise, beginning January 1, 1994, shall provide benefits for minor children who are by court order in the custody of a guardian who is a resident of this state covered under any such policy or plan issued to or on behalf of the guardian, unless the policy or plan specifically excludes or reduces the benefits.
(b)
This section shall not apply to policies that provide only hospital indemnity benefits or to policies that provide only benefits for specified accidents or specified diseases.
(c)
Any increase in expenditure requirements on a municipality or a county resulting from this section shall be appropriated from funds that the municipality or county receives from the state-shared taxes that are not earmarked by statute for a particular purpose.
Acts 1994, ch. 841, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2348 - Eligibility for medicaid

(a)
All entities providing health care benefits, including, but not limited to, insurers, ERISA group health plans, health maintenance organizations and nonprofit hospital and medical service plans, are prohibited from considering the availability or eligibility for medical assistance under
42 U.S.C. § 1396a
, which is referred to as "medicaid," when considering eligibility for coverage or calculating payments under their plans for eligible enrollees, subscribers, policyholders, or certificate holders.
(b)
To the extent that payment for covered expenses has been made under the state medicaid program for health care items or services furnished to an individual, the state is considered to have acquired the rights of the individual to payment by any other party for the health care items or services. Upon presentation of proof that the state medicaid program or any provider who has contracted with the state to provide medicaid services has paid for covered items or services, the insurer, ERISA group health plan, health maintenance organization, or nonprofit hospital and medical service plan shall make payment to the state medicaid program, or contracted provider under the medicaid program according to the coverage provided in the policy or contract on the same basis applicable to an agent or assignee of any other individual so covered.
Acts 1994, ch. 881, § 2.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2349 - Patients' right to truth - Alternative medical care, treatments, programs, or pharmaceuticals

(a)
This section shall be known and may be cited as the "Patients' Right to Truth Act of 1996."
(b)
Each managed care organization, health maintenance organization or preferred provider organization, referred to as the "plan" in this section, shall not in any way restrict medical personnel regarding informing patients of alternative medical care, treatments, programs or pharmaceuticals that may be available to the enrollee or participant, regardless of whether covered by the plan or not.
(c)
A violation of this section is punishable by payment of a civil penalty of not more than one thousand dollars ($1,000) for each violation, but not to exceed an aggregate penalty of ten thousand dollars ($10,000), unless the person knew or reasonably should have known the person was in violation of this section, in which case the penalty is not more than five thousand ($5,000) for each violation, but not to exceed an aggregate penalty of fifty thousand dollars ($50,000) in any six-month period.
Acts 1996, ch. 874, § 1.
2023 Tennessee Code › Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125) › Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722) › Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369) › Section 56-7-2350 - Maternity benefits - Minimum standards of coverage

(a)
The general assembly finds that Tennesseans are increasingly concerned that mothers and newborns receive proper medical care prior to hospital discharge. The general assembly further finds that the lack of proper medical care jeopardizes the health, safety and well-being of the mothers and newborns and may result in serious, costly repercussions not only for the mothers and newborns but also for the entire state. The general assembly, therefore, finds and declares the existence of an immediate and substantial threat to the public health, safety and welfare. The general assembly acknowledges and endorses the recently promulgated emergency rules of the departments of finance and administration and commerce and insurance to timely address these important concerns.
(b)
In accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5, the departments are authorized to promulgate permanent rules establishing minimum standards of coverage for maternity benefits offered by insurers. The rules will establish standards sufficient to protect and promote the health, safety and well-being of both the post-partum mother and the newborn and recognize the relationship between the mother and physician.
Acts 1996, ch. 964, § 1.