2015 Tennessee Code
Title 56 - Insurance
Chapter 26 - Accident and Sickness Insurance
Part 1 - General Provisions
§ 56-26-102 - Filing and approval of policy forms -- Loss ratio guarantee.
(a) (1) No policy of accident and sickness insurance for individual or small employer coverage shall be delivered or issued for delivery in this state, nor shall any endorsement, rider, certificate or application nor any initial or new premium rates on any previously approved policy, endorsement, rider, certificate or application that becomes a part of any such policy be used in connection with the policy until a copy of the form, of the premium rates, and of the classifications of risk pertaining to the policy has been filed with and approved by the commissioner. Approval of such forms, rates, and classifications may be granted in whole or in part at the discretion of the commissioner.
(2) No approval shall be issued by the commissioner pursuant to this section unless the commissioner determines that the benefits provided in the policy are reasonable in relation to the premium charged based upon reasonable rules promulgated by the commissioner.
(3) Within thirty (30) days of receiving an insurer's filing, if the commissioner has not previously issued notice of either approval or disapproval related to the insurer's filing, either the commissioner or the insurer may initiate an informal conference between the parties to seek additional information or responsive material from the other in order to resolve any outstanding matters related to the filing. In no event shall such period of conference extend beyond sixty (60) days of the commissioner's receipt of the insurer's original filing. At a date no later than sixty (60) days from the receipt of the insurer's original filing the commissioner shall issue either a notice of approval or disapproval regarding the insurer's filing unless the insurer and the commissioner mutually agree in writing to an extension not to exceed one hundred twenty (120) days from the receipt of the insurer's original filing.
(4) No policy, endorsement, rider, certificate or application shall be issued until the filing has been approved by the commissioner as provided in this section. The commissioner shall notify, in writing, the filer if the form or rates do not comply with this chapter and are therefore disapproved, specifying the reasons for the commissioner's determination. After such notice, it is unlawful for the filer to issue the form or rates in this state.
(5) In a notice issued under subdivision (a)(4), the commissioner shall state that a hearing shall be granted upon written request by the insurer. The insurer has thirty (30) days to submit a written request for a hearing. If a hearing is requested, then such hearing shall be held within thirty (30) days of receipt by the commissioner of the written request. Any hearing conducted shall be conducted in accordance with the Uniform Administrative Procedures Act, compiled in title 4, chapter 5.
(b) In accordance with regulations issued by the commissioner, medical loss ratio information shall be provided for each medical loss ratio reporting year by all accident and sickness insurers. If, pursuant to federal or state law, the accident and sickness insurer is required to provide a rebate based upon medical loss ratio requirements, the insurer shall notify the commissioner within ten (10) days of becoming aware of such rebate. The commissioner at that time shall evaluate the solvency and financial impact of such rebate. The commissioner retains the right to intervene with the secretary of the United States department of health and human services on behalf of an insurer deemed to be financially unsound to request that the secretary of the United States department of health and human services defer all or a portion of the rebate payments owed by the insurer.
(c) Subsequent to January 1, 2012, all filings submitted pursuant to this section shall be filed electronically; provided, however, that the commissioner may in certain circumstances, in the commissioner's own discretion, waive the electronic filing requirement. The commissioner may designate an entity to receive the electronic filings submitted pursuant to this section.
(d) The requirements of this section shall supersede and replace all other requirements related to the filing, approval and disapproval of major medical health insurance premium rates. As used in this section, "major medical health insurance premium rates" shall include any individual or small employer coverage as offered by an issuer of accident and sickness insurance, a nonprofit hospital and medical service corporation, medical service corporation, a hospital service corporation, and a health maintenance organization. As used in this section, "major medical health insurance" shall not include any policy as described by § 2791(c) of the Public Health Service Act, codified in 42 U.S.C. § 300gg-91(c). In the event that conflicts exist between this section and another provision in this title, this section shall govern.
(e) The provisions of this chapter are severable. If any provision of this chapter or its application to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application.
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