Title 56, Insurance

(a) A person, corporation, partnership, or other entity may not operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate of authority from the department pursuant to this chapter. (b) A political subdivision of this state…

(a) Before any entity may operate a prepaid limited health service organization, it must obtain a certificate of authority from the department. An application for a certificate of authority to operate a prepaid limited health service organization must be filed with the department…

(a) Following receipt of an application filed pursuant to § 56-51-106, the department shall review the application and notify the applicant of any deficiencies contained in the application. The department shall issue a certificate of authority to an applicant who has filed a comp…

In order to maintain its eligibility for a certificate of authority, a prepaid limited health service organization must continue to meet all conditions required to be met under this chapter and the rules adopted under this chapter for the initial application for and issuance of i…

Any entity licensed under this chapter that provides services solely to Title XIX program recipients under a contract with the state shall be exempt from §§ 56-51-106(12), 56-51-112(e) and (k), 56-51-113, 56-51-117, 56-51-123, 56-51-127, and 56-51-134(b)(5)(A) and (B). Further, t…

All contracts or forms utilized by the prepaid limited health services organization, whether directed to providers or enrollees, shall be written in the English language.

All prepaid limited health services contracts, marketing materials, and literature must disclose in boldfaced type the name of the organization and disclose that the organization is a prepaid limited health service organization licensed under this chapter.

(a) (1) Any entity issued a certificate of authority and otherwise in compliance with this chapter may enter into contracts in this state to provide an agreed-upon set of limited health services to subscribers in exchange for a prepaid per capita sum or a prepaid aggregate fixed …

(a) The rates charged by any prepaid limited health service organization to its subscribers shall not be excessive, inadequate, or unfairly discriminatory. The department may require whatever information it deems necessary to determine that a rate or proposed rate meets the requi…

(a) (1) No prepaid limited health services contract, certificate of coverage, application, enrollment form, rider, endorsement, and applicable rates to be charged may be delivered in this state unless the forms and rates have been filed with the department by or on behalf of the …

(1) A prepaid limited health services contract may contain additional provisions not inconsistent with this chapter that are:(1) Necessary because of the manner in which the organization is constituted or operated in order to state the rights and obligations of the parties to the…

A prepaid limited health service organization must comply with chapter 7, part 27 of this title.

(a) A prepaid limited health service organization may not expel or refuse to renew the coverage of or refuse to enroll any individual member of a subscriber group through a health maintenance organization or a state or federal agency on the basis of the race, color, creed, disabi…

No prepaid limited health services contract may contain any provision purporting to make any portion of the articles of incorporation, charter, bylaws, or other organizational document of the prepaid limited health service organization a part of the contract unless the provision …

(a) Every prepaid limited health services contract must be executed in the name of and on behalf of the prepaid limited health service organization by its officer, attorney in fact, employee, or representative duly authorized by the organization. (b) A facsimile signature of any …

(a) Any prepaid limited health services contract rider, endorsement, attachment, or addendum otherwise valid that contains any condition or provision not in compliance with the requirements of this chapter is not thereby rendered invalid, but must be construed and applied in acco…

Every prepaid limited health services contract must be construed according to the entirety of its terms and conditions as set forth in the contract and as amplified, extended, or modified by any application, endorsement, attachment, or addendum.

Unless delivered upon execution or issuance, a prepaid limited health services contract, certificate of coverage, or member handbook must be mailed or delivered to the health maintenance organization or to the state or federal agency with whom the prepaid limited health services …

(a) Except for nonpayment of premium or termination of eligibility, a prepaid limited health service organization may not cancel or otherwise terminate or fail to renew a prepaid limited health services contract without giving the subscriber and the health maintenance organizatio…

(a) No other provision of this title applies to a prepaid limited health service organization, unless a prepaid limited health service organization is specifically mentioned in the provision. (b) Except as provided in this chapter, this title does not apply to prepaid limited hea…

Each prepaid limited health service organization may accept from a health maintenance organization licensed pursuant to chapter 32 of this title, or a state or federal agency payments covering all or part of the cost of contracts entered into between the prepaid limited health se…

(a) No entity certificated as a prepaid limited health service organization, other than a licensed insurer or health maintenance organization insofar as its name is concerned, may use in its name, contracts, or literature any of the words “insurance,” “casualty,” “surety,” “mutua…

Every prepaid limited health services contract must provide that termination of the contract by the prepaid limited health service organization is without prejudice to any continuous loss that commenced while the contract was in force. Extension of benefits beyond the period the …

(a) Whenever a contract exists between a prepaid limited health service organization and a provider, and the organization fails to meet its obligations to pay fees for services already rendered to a subscriber, who is in good standing, the prepaid limited health service organizat…

(a) The department may require a prepaid limited health service organization to submit any contract for administrative services, contract with a provider physician, contract for management services, or contract with an affiliated entity to the department if the department has inf…

A prepaid limited health service organization that subcontracts with another entity to obtain a network of providers to furnish services to members or enrollees shall guarantee and assure the payment of all contracted amounts agreed to be paid to such providers by that entity or …

Every prepaid limited health service organization, except the organizations that participate in the TennCare program, shall comply with § 56-32-110.

The department shall examine the affairs, transactions, accounts, business records, and assets of any prepaid limited health service organization, in the same manner and subject to the same terms and conditions that apply to health maintenance organizations under § 56-32-115.

Section 56-32-111 shall apply in its entirety to determine what assets, liabilities, and investments are acceptable for a prepaid limited health service organization.

(a) Each prepaid limited health service organization must file with the department annually, within three (3) months after the end of its fiscal year, a report on the blank specified for health maintenance organizations by the National Association of Insurance Commissioners, veri…

(a) With respect to a prepaid limited health services contract, a person may not, unless licensed and appointed as a health insurance agent in accordance with the applicable provisions of the insurance code:(1) Solicit contracts or procure applications; or(2) Engage or hold out a…

(a) Except as set forth in subsection (c), each prepaid limited health service organization must at all times maintain a minimum net worth and working capital as required pursuant to § 56-32-112. (b) Except as set forth in subsection (c), the department may not issue a certificat…

(a) Except as required in subsection (b), each prepaid limited health service organization must deposit with the department cash or securities of the type eligible under § 56-32-111, which must have at all times a market value in the amount set forth in this subsection (a). The a…

(a) A prepaid limited health service organization must maintain in force a fidelity bond in its own name on its officers and employees, in an amount not less than fifty thousand dollars ($50,000) or in any other amount prescribed by the department. Except as otherwise provided by…

(a) The department may suspend the authority of a prepaid limited health service organization to enroll new subscribers, through its contract with a health maintenance organization or with a federal or state agency, or revoke any certificate issued to a prepaid limited health ser…

(1) In lieu of suspending or revoking a certificate of authority, or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, or entity subject to this act has been found to have violated any pro…

(a) In addition to the penalties and other enforcement provisions of this chapter, the department is vested with the power to seek both temporary and permanent injunctive relief when:(1) A prepaid limited health service organization is being operated by any person or entity witho…

Except as otherwise ordered by the court or as mutually agreed upon by the parties, every judgment or decree entered in any court against any prepaid limited health service organization for the recovery of money must be fully satisfied within sixty (60) days after the entry of th…

No judgment creditor or other claimant, other than the department, of a prepaid limited health service organization shall have the right to levy upon any of the assets or securities held in this state as a deposit under § 56-51-137.

(a) A delinquency proceeding under chapter 9, part 2, 3, or 4 of this title, or supervision by the department pursuant to chapter 9, part 5 of this title constitutes the sole and exclusive means of supervising, liquidating, reorganizing, rehabilitating, or conserving a prepaid li…

(1) Every prepaid limited health service organization subject to this chapter must pay to the department the following fees:(1) For filing an application for a certificate of authority: five hundred dollars ($500);(2) For filing an amendment to organization documents that require…

The department has the power to examine and investigate the affairs of every person, entity, or prepaid limited health service organization in order to determine whether the person, entity, or prepaid limited health service organization is operating in accordance with this chapte…

For the purposes of defining unfair methods of competition, unfair or deceptive acts or practices, § 56-8-104 applies to a prepaid limited health service organization.

Any person, entity, or prepaid limited health service organization subject to an order of the department under this chapter may obtain judicial review of the order by filing an appeal from the order, in accordance with the procedures for appeal under the Uniform Administrative Pr…

The provisions of this chapter are cumulative to rights under the general civil and common law, and no action of the department abrogates the rights to damage or other relief in any court.

(a) Any information pertaining to the diagnosis, treatment, or health of any enrollee of a prepaid limited health service organization is confidential and exempt from § 10-7-503, and shall only be available pursuant to specific written consent of the enrollee, or as otherwise pro…