§ 56-7-2201. Short Title
This part shall be known and may be cited as the “Tennessee Small Employer Group Health Coverage Reform Act.”
§ 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 […]
§ 56-7-2203. Part Definitions
As used in this part, unless the context otherwise requires: “Actuarial certification” means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with § 56-7-2207, based upon the person’s examination, including a review of the appropriate records […]
§ 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 […]
§ 56-7-2205. Distinct Grouping — Additional Groupings
A distinct grouping may only be established by a small employer carrier on the basis that the applicable health benefit plans: 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; Have been acquired from another […]
§ 56-7-2206. Applicability
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: 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 […]
§ 56-7-2207. Health Benefit Plans — Preexisting Conditions — Late Enrollees — Premiums — Transfers — Place of Business — Filings — Documentation
Health benefit plans covering small employers are subject to the following: Except in the case of a late enrollee, any preexisting conditions provision may not limit or exclude coverage for a period beyond twelve (12) months following the insured’s effective date of coverage, and may only relate to conditions manifesting themselves in a manner that […]
§ 56-7-2208. Formation of Health Group Cooperative of Small Employers — Registration — Organization
A health group cooperative of small employers may be formed only for the purpose of obtaining insurance. A health group cooperative shall: Contain at least one thousand (1,000) eligible employees or have at least ten (10) participating employers; Establish requirements for membership. A small employer’s participation in a cooperative is voluntary, but an employer electing […]
§ 56-7-2209. Liability of Health Group Cooperative
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: An act performed in good faith in the execution of duties in connection with the cooperative; or An independent action of a small […]
§ 56-7-2210. Duties of a Health Group Cooperative
A health group cooperative: 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; Shall collect premiums to cover the cost of: Group health insurance plan coverage […]
§ 56-7-2211. Contracting With a Small Employer Insurer — Compliance With Federal Laws
A health group cooperative shall contract only with a small employer insurer that demonstrates: That the insurer or health maintenance organization is licensed and in good standing with the department; The capacity to administer the group health insurance plans; The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures; […]