Tennessee Code Title 56. Insurance § 56-31-126

(1) A statement of the amounts payable to the corporation by the subscribers and the times at which the amounts shall be paid;

(2) A statement of the nature of the vision services to be paid for and the period during which the certificate is effective; and if there are any types of vision services to be excepted, with the approval of the commissioner, a detailed statement of the exceptions printed as specified in § 56-31-127;

(3) A statement of the terms or conditions, if any, upon which the certificate may be cancelled or otherwise terminated at the option of either party;

(4) A statement that the subscription and certificate constitute the contract between the corporation and the subscriber, and include the endorsements and attached papers, if any, and contain the entire contract;

(5) A statement that no statement by the subscriber in an application for a certificate shall void the contract or be used in any legal proceedings under the contract, unless the application or an exact copy of the application is included in or attached to the certificate, and that no agent or representative of the corporation, other than an officer or officers designated in the certificate, is authorized to change the contract or waive any of its provisions;

(6) A statement that if the subscriber defaults in making any payment under the certificate, the subsequent acceptance of a payment by the corporation or by its duly authorized agent shall reinstate the certificate, but the reinstatement shall not cover the costs of vision services incurred during the period of ten (10) days after date of the acceptance;

(7) A statement of the period of grace that will be allowed a subscriber for making any payment due under the contract. The grace period shall not be less than ten (10) days during the first contract year, and thereafter shall not be less than thirty (30) days;

(8) A statement authorizing vision service other than by participating optometrists in cases of emergency or when consented to by the vision service plan corporation, or when the subscriber requires vision services outside the county or counties or area served by the vision service plan corporation, in which case money benefits shall be provided as optional and as specified in the subscriber's contract and approved by the commissioner. The money benefits shall be so payable whether the vision service is performed by nonparticipating optometrists or by physicians. Otherwise, a statement that indemnity in the form of cash will not be paid to any subscriber except in reimbursements paid by the subscriber to an optometrist for which the corporation was liable at the time of the payment; and

(9) Other statements that may be required by published regulations of the commissioner.