Tennessee Code Title 56. Insurance § 56-2-117

Current as of January 02, 2024 | Updated by Findlaw Staff

(a) As used in this section, unless the context otherwise requires:

(1) “Group health plan” or “plan” means an employee welfare benefit plan, as that term is defined in § 3(1) of the Employee Retirement Income and Security Act of 1974 (ERISA) (29 U.S.C. § 1002(1)), including insured and self-insured plans, to the extent that the plan provides medical care, as that term is defined in § 2791(a)(2) of the Public Health Service Act (PHS Act) (42 U.S.C. § 300gg-91(a)(2)), including items and services paid for as medical care, to employees or their dependents directly or through insurance, reimbursement, or otherwise, that:

(A) Has fifty (50) or more participants as defined in section 3(7) of ERISA (29 U.S.C. § 1002(7)); or

(B) Is administered by an entity other than the employer that established and maintains the plan;

(2) “Health benefit plan issuer” means a company or insurance company, as those terms are defined in § 56-1-102, or a health maintenance organization, as that term is defined in § 56-32-102, that qualifies as a health insurance entity as that term is defined in § 56-7-109;

(3) “Plan administrator” means an administrator, as that term is defined in 29 U.S.C. § 1002(16)(A); and

(4) “Plan sponsor” has the same meaning as defined in 29 U.S.C. § 1002(16)(B).

(b) No later than thirty (30) days after a health benefit plan issuer receives a written request for a claims experience report from a plan, plan sponsor, or plan administrator, the health benefit plan issuer shall provide the report to the requesting party.

(c) To the extent such information is available to the health benefit plan issuer and is relevant to the request made under subsection (b), a report provided pursuant to subsection (b) must include the following information for the thirty-six-month period preceding the date of the request, for the entire period of coverage, or for the period of time specified in the request, whichever period is shortest:

(1) Aggregate paid claims experience by month, including claims experience for medical, dental, and pharmacy benefits, as applicable;

(2) Total premium or premium equivalent earned by month;

(3) Total number of covered employees on a monthly basis by coverage tier, including whether coverage was for:

(A) An employee only;

(B) An employee with dependents only;

(D) An employee with spouse and dependents; and

(4) An aggregate report of all claims exceeding seventy-five thousand dollars ($75,000).

(d) In the case of a request made under subsection (b) after the date of termination of coverage, the report provided under subsection (b) must contain the information outlined in subsection (c) that is available to the health benefit plan issuer as of the date of the request and is relevant to the request for the thirty-six-month period preceding the date of termination of coverage or for the entire policy period, whichever period is shorter.

(e) No later than thirty (30) days after the date of termination of coverage under a group health plan, a health benefit plan issuer shall provide to a plan, plan sponsor, or plan administrator who made a request under subsection (b) before the date of termination of coverage a supplemental written report of the information described in subsection (c) to update the claims experience report with information that was not included in the original report.

(f) A plan, plan sponsor, or plan administrator may use information in a written claims experience report provided under this section only as permitted or required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d et seq.) and its implementing regulations.

(g) Except where the release of information is otherwise prohibited by law, a health benefit plan issuer that releases information in accordance with this section has not violated a standard of care and is not liable for civil damages resulting from, and is not subject to criminal prosecution for, releasing such information.

(h) This section applies to the extent not preempted by ERISA.

Previous Part of Code Next Part of Code

Back to Chapter List

Cite this article: FindLaw.com - Tennessee Code Title 56. Insurance § 56-2-117 - last updated January 02, 2024 | https://codes.findlaw.com/tn/title-56-insurance/tn-code-sect-56-2-117/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

Was this helpful?

Welcome to FindLaw's Cases & Codes

A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw’s Learn About the Law.

Go to Learn About the Law

Did FindLaw Help You Understand This Legal Issue?

Make It a Preferred Google Search Source

Add to Google

Latest Blog Posts

Learn About The Law

Get help with your legal needs

FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.

Go to Learn About the Law

Need to Find an Attorney?

Search our directory by legal issue

Enter information in one or both fields (Required)