Tennessee Code Title 56. Insurance § 56-7-1022

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

(a) As used in this section:

(1) “Department” means the department of commerce and insurance;

(2) “Health insurance entity” means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including an insurance company, a health maintenance organization, or a nonprofit hospital and medical service corporation;

(3) “Marketplace” means the federally facilitated marketplace for health insurance policies sold in accordance with the federal Patient Protection and Affordable Care Act (42 U.S.C. § 18011 et seq.) for this state; and

(4) “Per term” means the applicable duration or period of time for a specific policy provision in a health insurance plan offered in accordance with this section, including the timeframe during which a deductible or maximum allotted benefit accumulates and is calculated.

(b) A health insurance entity may offer a short-term limited-duration plan on the marketplace if the plan:

(1) Provides no less than the following minimum coverage and benefits:

(A) A per person deductible of no more than ten thousand dollars ($10,000) per term;

(B) A per family deductible for all covered family members of no more than ten thousand dollars ($10,000) per term;

(D) A maximum out-of-pocket coinsurance of no more than five thousand dollars ($5,000) per term;

(E) A maximum benefit, per person, per term, of one million dollars ($1,000,000);

(F) Coverage with a copay of no more than fifty dollars ($50.00) per person, per term, for a visit with a physician for the enrollee's history and exam only;

(G) Coverage with a copay of no more than fifty dollars ($50.00) per person, per term, for an urgent care visit;

(H) A copay of no more than twenty percent (20%) of the reasonable and customary charges for:

(i) A preventative care visit;

(ii) An emergency room visit for accident or illness;

(iii) An inpatient hospital service;

(iv) An outpatient surgery;

(v) A lab; and

(vi) An x-ray; and

(I) Four (4) tiers of pharmacy benefits for outpatient prescription drugs as follows:

(i) For the first tier, coverage of preferred generic drugs with a copay of no more than twenty-five dollars ($25.00) and no deductible;

(ii) For the second tier, coverage of generic drugs;

(iii) For the third tier, coverage of preferred brand drugs; and

(iv) For the fourth tier, coverage of non-preferred generic and non-preferred brand name drugs; and

(2) Complies with the duration limitations or requirements imposed by federal law for a short-term limited-duration plan to be offered on the marketplace.

(1) A health insurance entity offering a plan pursuant to this section may require an individual to meet eligibility requirements to enroll in the plan;

(2) A plan offered pursuant to this section must comply with § 56-7-2356; and

(3) A health insurance entity may offer benefits or coverage under a short-term limited-duration plan on the marketplace that exceed the minimum requirements of subsection (b).

(d) If this section conflicts with federal law, then the federal law controls to the extent of the conflict.

(e) The department shall promulgate rules to effectuate this section. The rules must be promulgated in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.

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Cite this article: FindLaw.com - Tennessee Code Title 56. Insurance § 56-7-1022 - last updated January 02, 2024 | https://codes.findlaw.com/tn/title-56-insurance/tn-code-sect-56-7-1022/

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