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2023 Tennessee Code
Title 56 - INSURANCE (§§ 56-1-101 — 56-61-125)
Chapter 7 - POLICIES AND POLICYHOLDERS 33|373 (§§ 56-7-NEW — 56-7-3722)
Part 23 - MANDATED INSURER OR PLAN COVERAGE (§§ 56-7-NEW — 56-7-2369)
Section 56-7-2357 - Section definitions - Health insurance issuer limitations - Actions not prohibited
Universal Citation:
TN Code § 56-7-2357 (2023)
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- (a) As used in this section:
- (1) "Managed health insurance issuer" has the same meaning as defined in § 56-32-128(a); and
- (2) "Medical laboratory" has the same meaning as defined in § 68-29-103.
- (b) A health insurance issuer or a managed health insurance issuer shall not:
- (1) Deny a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan; provided, that this subdivision (b)(1) does not prohibit a managed health insurance issuer or health insurance issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where a managed health insurance issuer or health insurance issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care needs; and
- (2) Prevent a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan; provided, that the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory.
- (c) Each health insurance issuer or managed health insurance issuer shall apply the same coinsurance, co-payment, deductible, and quantity limit factors within the same employee group and other plan-sponsored groups to all medical laboratory services provided by a licensed medical laboratory; provided, that all medical laboratories comply with the same terms and conditions.
- (d) This section does not prohibit:
- (1) A health insurance issuer or managed health insurance issuer from applying different coinsurance, co-payment, and deductible factors within the same employer group and other plan-sponsored groups; or
- (2) An employer or other plan-sponsored group from offering multiple options or choices of health insurance benefit plans, including, but not limited to, cafeteria benefit plans.
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