(a) A health group cooperative shall contract only with a small employer insurer that demonstrates:

Terms Used In Tennessee Code 56-7-2211

  • Contract: A legal written agreement that becomes binding when signed.
  • cooperative: means a private purchasing cooperative composed of small employers formed under this part. See Tennessee Code 56-7-2203
  • Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
  • small employer: includes any person that, during the preceding year, employed no less than two (2) and no more than fifty (50) eligible employees and otherwise qualifies as a small employer pursuant to this subdivision (18). See Tennessee Code 56-7-2203
(1) That the insurer or health maintenance organization is licensed and in good standing with the department;
(2) The capacity to administer the group health insurance plans;
(3) The ability to monitor and evaluate the quality and cost effectiveness of care and applicable procedures;
(4) The ability to conduct utilization management and applicable procedures and policies;
(5) The ability to assure enrollees a sufficient number of health care providers, including specialty providers; and
(6) A satisfactory grievance procedure and the ability to respond to enrollees’ calls, questions, and complaints.
(b) A health group cooperative shall comply with federal laws applicable to cooperatives and group health insurance plans issued through cooperatives, to the extent required by federal law and this title or rules promulgated pursuant to this title.
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