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2020 Tennessee Code
Title 56 - Insurance
Chapter 7 - Policies and Policyholders
Part 23 - Mandated Insurer or Plan Coverage
§ 56-7-2318. Optional Coverage
Universal Citation: TN Code § 56-7-2318 (2020)
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- Subject to the provisions and conditions of §§ 56-7-2312 — 56-7-2322, the employee or member shall be entitled to obtain a converted policy providing, at the option of the employee or member, coverage on an expense incurred basis under any one (1) of the plans meeting the following requirements:
- Plan A:
- Hospital room and board daily expense benefits in a maximum dollar amount approximately the average semiprivate rate charged in metropolitan areas of this state, for a maximum duration of seventy (70) days;
- Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
- Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of eight hundred dollars ($800);
- Plan B:
- Hospital room and board daily expense benefits in a maximum dollar amount equal to seventy-five percent (75%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days;
- Miscellaneous hospital expense benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
- Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of six hundred dollars ($600); or
- Plan C:
- Hospital room and board daily expense benefits in a maximum dollar amount equal to fifty percent (50%) of the maximum dollar amount determined for Plan A, for a maximum duration of seventy (70) days;
- Miscellaneous hospital benefits of a maximum amount of ten (10) times the hospital room and board daily expense benefits; and
- Surgical operation expense benefits according to a surgical schedule consistent with those customarily offered by the insurer under group or individual health insurance policies and providing a maximum benefit of four hundred dollars ($400).
- Plan A:
- The maximum dollar amounts in Plan A shall be determined by the commissioner and may be redetermined by the commissioner from time to time as to converted policies issued subsequent to the redetermination. The redetermination shall not be made more often than once in three (3) years. The maximum dollar amounts in Plans A, B, and C shall be rounded to the nearest multiple of ten dollars ($10.00).
- Subject to the provisions and conditions of §§ 56-7-2312 — 56-7-2322, the employee or member shall be entitled to obtain a converted policy providing, at the option of the employee or member, coverage on an expense incurred basis under any one (1) of the plans meeting the following requirements:
- The insurer may also, in lieu of the plans of benefits set forth in subsection (a), provide alternate plans with benefits exceeding those in Plan A, B, or C, with the approval of the commissioner.
- If the benefits level required in subsections (a) and (b) exceeds the benefits level provided under the group policy, the conversion policy may offer benefits that are substantially similar to those provided under the group policy in lieu of those required in subsections (a) and (b).
- The insurer may, at its option, also offer alternate plans of group health conversion in addition to those required by this part.
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