§ 56-51-128. Provider Arrangements
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 organization is liable for the fee or fees rather than the subscriber, and […]
§ 56-51-129. Administrative, Provider, and Management Contracts
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 information that the prepaid limited health service organization has entered into a contract that requires it […]
§ 56-51-130. Contract Providers
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 that entity’s agent. This section does not preclude the prepaid […]
§ 56-51-131. Complaint System
Every prepaid limited health service organization, except the organizations that participate in the TennCare program, shall comply with § 56-32-110.
§ 56-51-132. Examination by the Department
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.
§ 56-51-133. Assets, Liabilities, and Investments
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.
§ 56-51-134. Annual, Quarterly, and Miscellaneous Reports
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, verified by the oath of at least two (2) officers covering the preceding calendar year. […]
§ 56-51-135. Agent Licensing
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: Solicit contracts or procure applications; or Engage or hold out as engaging in the business of analyzing or abstracting prepaid limited health services […]
§ 56-51-136. Minimum Net Worth and Working Capital Requirements
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. Except as set forth in subsection (c), the department may not issue a certificate of authority unless the prepaid limited health service organization is […]
§ 56-51-137. Insolvency Protection
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 amount of the deposit shall be reviewed annually or […]