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Tennessee Statutes, Title 56

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Your Policy Risk Impact Agent

Tennessee/Statutes

← All Tennessee coverage

Title 56, Insurance

59 chapters · 1,882 sections in this title.

All chapters in Title 561,882 Ch 7, Policies and Policyholders389 Ch 6, Agents, Solicitors and Administrators133 Ch 2, Insurance Companies97 Ch 1, Department of Commerce and Insurance84 Ch 9, Insurers Rehabilitation and Liquidat…71 Ch 3, Operation of Insurance Companies61 Ch 13, Revised Tennessee Captive Insurance Act59 Ch 51, Tennessee Prepaid Limited Health Ser…55 Ch 26, Accident and Sickness Insurance42 Ch 4, Fees and Taxes41 Ch 12, Insurance Guaranty Associations41 Ch 25, Fraternal Benefit Societies38 Ch 35, Title Insurance Law38 Ch 30, Dental Service Plan Law, 196135

389 sections·Filtered byTitle 56✕Ch 7✕

Tenn. Code Ann. § 56-7-2908 Eligibility for program — Unfair practices. [Effective until June 30, 2030. See the Compiler's Notes.]
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(a) Eligibility for the program operated pursuant to this part shall be limited to citizens of the United States, except that individuals satisfying the federally defined exceptions contained in 8 U.S.C. § 1622(b) shall also be eligible to apply. (b) A federally defined eligible …
Tenn. Code Ann. § 56-7-2909 Administration of the program. [Effective until June 30, 2030. See the Compiler's Notes.]
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(a) The board shall provide for administration of the program by electing, in its plan of operation, to have the program administered in either or both of the following manners:(1) By the commissioner; or(2) By using a competitive procurement process to select one (1) or more ins…
Tenn. Code Ann. § 56-7-2910 Offering of coverage options — Exclusion of charges and expenses — Availability of third party payment — Recovery of ineligible benefits paid. [Effective until June 30, 2030. See the Compiler's Notes.]
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(a) The program shall offer at least one (1) form of coverage to each eligible person. Coverage may be modeled after one (1) of the healthcare options offered to state employees pursuant to [former] § 8-27-201, [repealed and reenacted; See Compiler's Notes.] or may combine a heal…
Funding. [Effective until June 30, 2030. See the Compiler's Notes.]

Showing 251–300 of 389

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Tenn. Code Ann. § 56-7-2911

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(a) The program shall be funded in the manner set forth as follows:(1) Premiums. (A) The board shall establish premium rates for program coverage as provided in subdivision (1)(B). Separate schedules of premium rates based on age, tobacco use and weight may apply for individual r…

Tenn. Code Ann. § 56-7-2912 Fraud and abuse. [Effective until June 30, 2030. See the Compiler's Notes.]

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The office of inspector general, created pursuant to § 71-5-2502, shall have the authority to investigate civil and criminal fraud and abuse of Access Tennessee, or any other violations of state criminal law related to the operation of the program. The powers of the office of ins…

Tenn. Code Ann. § 56-7-2913 Federal funding. [Effective until June 30, 2030. See the Compiler's Notes.]

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Notwithstanding any law to the contrary, if the state determines not to apply for or accept federal funding for the purposes of this part, any provisions of this part, including any eligibility requirements regarding federally defined eligible individuals as set forth in § 56-7-2…

Tenn. Code Ann. § 56-7-2914 Legislative review. [Effective until June 30, 2030. See the Compiler’s Notes.]

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This part shall be reviewed annually by the commerce and labor committee of the senate, the insurance committee of the house of representatives, the finance, ways and means committee of the senate and the finance, ways and means committee of the house of representatives, and thes…

Tenn. Code Ann. § 56-7-2916 Repealer. [Effective until June 30, 2030. See the Compiler’s Notes.]

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This part shall be repealed on June 30, 2030.

Tenn. Code Ann. § 56-7-305 Submission to commissioner for approval

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Every life insurance company shall submit to the commissioner for approval the words required in § 56-7-2310, to be printed on each policy, together with sample copy of every kind or class of policies offered for sale in this state, and every life insurance company shall print on…

Tenn. Code Ann. § 56-7-306 Revocation of license for violation of § 56-7-305 or § 56-7-2310

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The license of any insurance company doing business in this state may be revoked by the commissioner for violating § 56-7-305 or § 56-7-2310.

Tenn. Code Ann. § 56-7-308 Provisions in life insurance policies issued by foreign companies — Provisions in foreign policies of domestic companies

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The policies of a life insurance company not organized under the laws of this state may, if approved by the commissioner of this state, contain any provision that the law of the state, territory, district, or country under which the company is organized prescribes shall be in the…

Tenn. Code Ann. § 56-7-309 Life insurance — Policies for one-year preliminary term insurance — Reserve value

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(a) This section applies only to policies of life insurance issued prior to the operative date of § 56-7-401, the Standard Nonforfeiture Law. (b) Policies may be issued in this state providing for not more than one-year preliminary term insurance by the incorporation in the polic…

Tenn. Code Ann. § 56-7-310 Policies exemptions

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Sections 56-7-308, 56-7-309, 56-7-2307, and 56-7-2308, do not apply to annuities, industrial policies, or to corporations or associations operating on the assessment or fraternal plan.

Tenn. Code Ann. § 56-7-3101 Compliance — Promulgation of rules

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(a) Pharmacy benefits managers shall, and contracts for pharmacy benefits management must, comply with the requirements of this part. (b) (1) The commissioner of commerce and insurance shall promulgate rules to effectuate the purposes of this part and part 32 of this chapter, inc…

Tenn. Code Ann. § 56-7-3102 Part definitions

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(1) As used in this part, unless the context otherwise requires:(1) “Covered entity”:(A) Means an individual or entity that provides health coverage to covered individuals who are employed or reside in this state, and includes, but is not limited to:(i) A health insurance issuer;…

Tenn. Code Ann. § 56-7-3103 Audit of records of pharmacist or pharmacy

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(a) When an audit of records of a pharmacist or pharmacy is conducted by a covered entity, a pharmacy benefits manager, the state or its political subdivisions, or any other entity representing the same, it shall be conducted in the following manner:(1) Written notice shall be gi…

Tenn. Code Ann. § 56-7-3104 Calculation of reimbursement of pharmacy benefits manager

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(a) Reimbursement by a pharmacy benefits manager under a contract to a pharmacist or pharmacy for prescription drugs and other products and supplies that is calculated according to a formula that uses a nationally recognized reference in the pricing calculation shall use the most…

Tenn. Code Ann. § 56-7-3105 Contract compliance

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No contract entered into or amended on or after July 1, 2007, shall contain provisions in violation of this part.

Tenn. Code Ann. § 56-7-3106 Placement of drug on maximum allowable cost list

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(a) Before a pharmacy benefits manager or covered entity may place a drug on a maximum allowable cost list, the pharmacy benefits manager or covered entity must find that the drug is generally available for purchase by pharmacies in this state from a national or regional wholesal…

Tenn. Code Ann. § 56-7-3107 Information to be provided regarding maximum allowable cost lists — Updating maximum allowable cost lists

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(a) A pharmacy benefits manager or covered entity shall make available to each pharmacy with which the pharmacy benefits manager or covered entity has a contract and to each pharmacy included in a network of pharmacies served by a pharmacy services administrative organization wit…

Tenn. Code Ann. § 56-7-3108 Appeal by pharmacy of cost of particular drug or device on maximum allowable cost list — Procedure

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(a) A pharmacy benefits manager or covered entity shall establish a clearly defined process through which a pharmacy may contest the listed maximum allowable cost for a particular drug or medical product or device. If a pharmacy chooses to contest the listed maximum allowable cos…

Tenn. Code Ann. § 56-7-3109 Medical products and devices subject to requirements of part

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The medical products and devices subject to the requirements of this part are limited to the medical products and devices included as a pharmacy benefit under the pharmacy benefits contract.

Tenn. Code Ann. § 56-7-311 “Company” defined for §§ 56-7-308, 56-7-309, 56-7-2307, 56-7-2308, and 56-7-2311

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As used in §§ 56-7-308, 56-7-309, 56-7-2307, 56-7-2308, and 56-7-2311, “company” includes corporations and associations.

Tenn. Code Ann. § 56-7-3110 Sanctions for violation of part

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A violation of this part may subject the pharmacy benefits manager or covered entity to any of the sanctions described in § 56-2-305, subject to § 56-2-305(c)(7).

Tenn. Code Ann. § 56-7-3111 Disclosure of maximum allowable cost lists and related information

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A pharmacy shall not disclose to any third party the maximum allowable cost lists and any related information it receives from a pharmacy benefits manager or covered entity; provided, however, a pharmacy may share such lists and related information with a pharmacy services admini…

Tenn. Code Ann. § 56-7-3112 Fair Disclosure of State Funded Payments for Pharmacists' Services Act

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(a) This section is known and may be cited as the “Fair Disclosure of State Funded Payments for Pharmacists' Services Act.” (b) As used in this section:(1) “Pharmacist” means a pharmacist as defined in § 63-10-204;(2) “Pharmacist services” means products, goods, or services provi…

Tenn. Code Ann. § 56-7-3113 Licensure as pharmacy benefits manager

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(a) No person or entity shall administer the medication or device portion of pharmacy benefits coverage provided by a covered entity or otherwise act as a pharmacy benefits manager in this state unless the person or entity has obtained licensure through the department of commerce…

Tenn. Code Ann. § 56-7-3114 Right to provide information regarding amount of insured's cost share of prescription drug

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A pharmacy or pharmacist has the right to provide an insured information regarding the amount of the insured's cost share for a prescription drug. Neither a pharmacy nor a pharmacist shall be penalized by a pharmacy benefits manager for discussing any information described in thi…

Tenn. Code Ann. § 56-7-3115 Prohibited charges

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A covered entity or pharmacy benefits manager shall not charge a pharmacist or a pharmacy a fee related to a claim unless it is apparent at the time of claim processing and is reported on the remittance advice of an adjudicated claim. This section does not prohibit a covered enti…

Tenn. Code Ann. § 56-7-3116 Prohibited terms or conditions in contracts

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A covered entity or pharmacy benefits manager shall not include any term or condition in a contract with a pharmacy or pharmacist that requires a pharmacist to dispense a drug or other product to a patient contrary to a pharmacist's professional judgment.

Tenn. Code Ann. § 56-7-3117 Disclosure of material changes to contract provisions

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A covered entity or pharmacy benefits manager shall disclose to a pharmacy or pharmacist in its network, at least thirty (30) days before the date the change becomes effective, any material change to a contract provision that affects the terms of reimbursement, the process for ve…

Tenn. Code Ann. § 56-7-3118 Mutual agreement on terms and conditions for provision of pharmacy services — Use of untrue, deceptive, or misleading advertisement, etc. prohibited — Effect of removal of pharmacist or pharmacy — Pattern or practice of reimbursing pharmacies or pharmacists lesser amount prohibited

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(a) Each contract between a covered entity or pharmacy benefits manager and a pharmacist or pharmacy must be mutually agreed upon and must outline the terms and conditions for the provision of pharmacy services. (b) A covered entity or pharmacy benefits manager shall not cause or…

Tenn. Code Ann. § 56-7-3119 Dealings with 340B entities — Discrimination against 340B entity prohibited

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(a) A health insurance issuer, managed health insurance issuer as defined in § 56-32-128(a), pharmacy benefits manager, or other third-party payer shall not:(1) Reimburse a 340B entity for pharmacy-dispensed drugs at a rate lower than the rate paid for the same drug by national d…

Tenn. Code Ann. § 56-7-312 Stipulated form of insurance or cash equal to net reserve upon default

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(a) This section applies only to policies of life insurance issued prior to the operative date of § 56-7-401, the Standard Nonforfeiture Law. (b) In the event of default in the payment of any premium due on any policy, there shall be secured to the owner of the policy a stipulate…

Tenn. Code Ann. § 56-7-3120 Penalty for obtaining prescription drugs from contracted pharmacy prohibited — Interference with patient's right to choose contracted pharmacy or contracted provider of choice prohibited

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(a) A pharmacy benefits manager or a covered entity shall not require a person covered under a pharmacy benefit contract, that provides coverage for prescription drugs, including specialty drugs, to pay an additional fee, higher copay, higher coinsurance, second copay, second coi…

Tenn. Code Ann. § 56-7-3121 Utilization of any pharmacy in state — Preferred network of pharmacies and nonpreferred network of pharmacies

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(a) A pharmacy benefits manager shall allow patients, participants, and beneficiaries of the pharmacy benefits plans and programs that the pharmacy benefits manager serves to utilize any pharmacy within this state that is licensed to dispense the prescription pharmaceutical produ…

Tenn. Code Ann. § 56-7-3122 Applicability of part

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Notwithstanding another law, this part applies to plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.).

Tenn. Code Ann. § 56-7-3123 Confidentiality of information obtained or produced pursuant to audit — Disclosure of audit findings

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(a) Except as provided in subsection (b), any information obtained or produced by the department pursuant to an audit of a pharmacy benefits manager is confidential, is not a public record subject to disclosure, and is exempt from title 10, chapter 7. (b) Audit findings by the de…

Tenn. Code Ann. § 56-7-3124 Timely reimbursements of health insurance claims

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(a) A pharmacy benefits manager regulated under this part is subject to § 56-7-109 and its requirements for timing of payments to pharmacists. (b) Notwithstanding the penalties set out in this part, a violation of the prompt pay standards is governed by the penalties set out in §…

Tenn. Code Ann. § 56-7-3125 Eligibility criteria for 348B entities receiving in-kind funding. [Effective November 1, 2026.]

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A non-governmental entity receiving in-kind funding from the state or a political subdivision of the state pursuant to § 317 or § 318 of the Public Health Service Act (42 U.S.C. §§ 247b and 247c), is eligible to qualify as a 340B entity, as defined in § 56-7-3119, only if the ent…

Tenn. Code Ann. § 56-7-313 Certain provisions as to defaulted policies, loans and reserves cannot be waived

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No agreement between the company and the policyholder or applicant for insurance shall be held to waive §§ 56-2-115, 56-7-312, 56-7-401, and 56-7-2309.

Tenn. Code Ann. § 56-7-314 Purchase or assignment of life insurance by charitable organization — Date of insurable interest

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If an organization described in either § 170(c) or § 501(c)(3) of the Internal Revenue Code of 1986 (26 U.S.C. §§ 170(c) and 501(c)(3)), respectively, purchases or receives by assignment, before or after April 23, 1992, life insurance on an insured who consents in writing to the …

Tenn. Code Ann. § 56-7-315 Interest payable after receipt of claim

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An insurer of a life insurance policy or annuity issued for delivery in this state, with respect to a claim for benefits by reason of the death of the insured or annuitant, shall pay interest beginning on the fifteenth day following the date of death of the insured or annuitant, …

Tenn. Code Ann. § 56-7-3201 Part definitions

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(1) As used in this part, unless the context otherwise requires:(1) “Actual reimbursement” means the total amount that a covered entity or pharmacy benefits manager determines that a pharmacy or other dispenser will receive consistent with the provider agreement, and is the sum o…

Tenn. Code Ann. § 56-7-3202 Calculation of out-of-pocket costs for prescription drugs and covered services

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(a) When a patient's out-of-pocket cost for a prescription or covered service is percentage-based, the covered entity or pharmacy benefits manager shall calculate the out-of-pocket cost such that when the out-of-pocket cost is added to the amount that the covered entity or pharma…

Tenn. Code Ann. § 56-7-3203 Disclosure of the actual reimbursement for a particular prescription or covered service

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A covered entity or pharmacy benefits manager shall not in any way restrict, by contract or otherwise, any pharmacy or other dispenser from disclosing to the patient or authorized representative of the patient the actual reimbursement for a particular prescription or covered serv…

Tenn. Code Ann. § 56-7-3204 Construction of part

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The requirements of this part shall only be construed to apply to policies, contracts and certificates executed, delivered, issued for delivery or renewed in this state on or after January 1, 2010.

Tenn. Code Ann. § 56-7-3205 Calculation of enrollee's contribution to applicable cost sharing requirement

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(a) When calculating an enrollee's contribution to an applicable cost sharing requirement, an insurer shall include cost sharing amounts paid by the enrollee or on behalf of the enrollee by another person. (b) Subsection (a) does not apply to a prescription drug for which there i…

Tenn. Code Ann. § 56-7-3206 Calculation of coinsurance or deductible for prescription drug or device based on allowed amount of drug or device — Prohibited charges and reimbursements

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(a) Notwithstanding a law to the contrary, a pharmacy benefits manager or a covered entity shall base the calculation of any coinsurance or deductible for a prescription drug or device on the allowed amount of the drug or device. For purposes of this section, coinsurance or deduc…

Tenn. Code Ann. § 56-7-3207 Report of benefit percentage

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A pharmacy benefits manager has a responsibility to report to the plan and the patient any benefit percentage that either are entitled to as a benefit as a covered person.