§ 56-51-101. Short Title
This chapter shall be known and may be cited as the “Tennessee Prepaid Limited Health Service Organization Act of 2000.”
§ 56-51-102. Chapter Definitions
As used in this chapter, the term: “Capitation” means the fixed amount paid by a prepaid limited health service organization to a health care provider under contract with the prepaid limited health service organization in exchange for the rendering of covered limited health services; “Commissioner” means the commissioner of commerce and insurance; “Department” means the […]
§ 56-51-103. Exemption From Tennessee Insurance Code
Except as provided in this chapter, prepaid limited health service organizations are governed by this chapter and are exempt from this title unless specifically referenced.
§ 56-51-104. Insurance Business Not Authorized
Nothing in this title or this chapter authorizes any prepaid limited health service organization to transact any insurance business other than that specifically authorized by this chapter, or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by the department under the Tennessee insurance code.
§ 56-51-105. Certificate of Authority Required — Ambulance Service Plans — Exceptions
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. A political subdivision of this state that is operating an emergency medical services system and offers a prepaid ambulance service plan […]
§ 56-51-106. Application for Certificate of Authority
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 on a form prescribed by the department. The application must be sworn to […]
§ 56-51-107. Issuance of Certificate of Authority — Denial
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 completed application in conformity with § 56-51-106, upon payment of the fees specified […]
§ 56-51-108. Continued Eligibility for Certificate of Authority
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 its certificate of authority under §§ 56-51-106 and 56-51-107.
§ 56-51-109. Certain Entities Contracting With State Title Xix Agency
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, the commissioner may by rule exempt the entities from other provisions of this chapter where determined […]
§ 56-51-110. Use of English Required in Contracts and Forms
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.
§ 56-51-111. Language Used in Contracts and Marketing Materials
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.
§ 56-51-112. Prepaid Limited Health Service Contracts
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 sum from a health maintenance organization or a state or […]
§ 56-51-113. Rates for Subscribers — Requirements
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 requirements of this section. In determining whether a rate is in compliance with subsection (a), […]
§ 56-51-114. Changes in Rates and Benefits — Material Modifications — Addition of Limited Health Services
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 prepaid limited health service organization and have been approved by the department. […]
§ 56-51-115. Additional Contract Contents
A prepaid limited health services contract may contain additional provisions not inconsistent with this chapter that are: 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 contract; or Desired by the organization and neither prohibited by law nor […]
§ 56-51-116. Genetic Information Restrictions
A prepaid limited health service organization must comply with chapter 7, part 27 of this title.
§ 56-51-117. Restrictions Upon Expulsion or Refusal to Issue or Renew Contract
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, disability, marital status, sex, or national origin of the […]
§ 56-51-118. Charter — Bylaw Provisions
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 is set forth in full in the contract. Any contract provision in violation of […]
§ 56-51-119. Execution of Contracts
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. A facsimile signature of any executing individual may be used in lieu of an original signature. No prepaid […]
§ 56-51-120. Validity of Noncomplying Contracts
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 accordance with the conditions and provisions as they would have applied had the contract, rider, […]