(a) A health insurance issuer that provides individual health insurance coverage to an individual shall renew or continue in force the coverage at the option of the individual for all such coverage in effect on or after July 1, 1997, except as provided in this section.
Fraud: Intentional deception resulting in injury to another.
Health insurance coverage: means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer. See Tennessee Code 56-7-2802
Health insurance issuer: 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, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. See Tennessee Code 56-7-2802
Health status-related factor: means any of the following factors: (A) Health status. See Tennessee Code 56-7-2802
Individual health insurance coverage: means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance. See Tennessee Code 56-7-2802
Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See Tennessee Code 56-7-2802
Network plan: means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer. See Tennessee Code 56-7-2802
State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(b) A health insurance issuer may nonrenew or discontinue health insurance coverage of an individual in the individual market based only on one (1) or more of the following:
(1) The individual has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage or the issuer has not received timely premium payments;(2) The individual has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact under the terms of the coverage;(3) The issuer is ceasing to offer coverage in the individual market in accordance with subsection (c) and other applicable insurance law;(4) In the case of a health insurance issuer that offers health insurance coverage in the market through a network plan, the individual no longer resides, lives, or works in the service area, or in an area for which the issuer is authorized to do business, but only if the coverage is terminated under this subdivision (b)(4) uniformly without regard to any health status-related factor of covered individuals; and(5) In the case of health insurance coverage that is made available in the individual market only through one (1) or more bona fide associations, the membership of the individual in the association, on the basis of which the coverage is provided, ceases, but only if the coverage is terminated under this subdivision (b)(5) uniformly without regard to any health status-related factor of covered individuals.(c) In any case in which an issuer decides to discontinue offering a particular type of health insurance coverage offered in the individual market, coverage of the type may be discontinued by the issuer only if:
(1) The issuer provides notice to each covered individual provided coverage of this type in the market of the discontinuation at least ninety (90) days prior to the date of the discontinuation of the coverage;(2) The issuer offers to each individual in the individual market provided coverage of this type, the option to purchase any other individual health insurance coverage currently being offered by the issuer for individuals in the market; and(3) In exercising the option to discontinue coverage of this type and in offering the option of coverage under subdivision (c)(2), the issuer acts uniformly without regard to any health status-related factor of enrolled individuals or individuals who may become eligible for the coverage.(d)(1) Subject to subdivision (d)(2), in any case in which a health insurance issuer elects to discontinue offering all health insurance coverage in the individual market in this state, health insurance coverage may be discontinued by the issuer only if:
(A) The issuer provides notice to the commissioner and to each individual of the discontinuation at least one hundred eighty (180) days prior to the date of the expiration of the coverage; and(B) All health insurance issued or delivered for issuance in this state in the market is discontinued and coverage under the health insurance coverage in the market is not renewed.(2) In the case of a discontinuation under subdivision (d)(1)(A) in the individual market, the issuer may not provide for the issuance of any health insurance coverage in the individual market in the state during the five-year period beginning on this date of the discontinuation of the last health insurance coverage not so renewed.(3) The commissioner may waive subdivision (d)(2) upon written request by a health insurance issuer that demonstrates to the satisfaction of the commissioner that a waiver would benefit insurance consumers in this state and would strengthen the individual market.(e) At the time of coverage renewal, a health insurance issuer may modify the health insurance coverage for a policy form offered to individuals in the individual market so long as the modification is consistent with state law and effective on a uniform basis among all individuals with that policy form.(f) In applying this section in the case of health insurance coverage that is made available by a health insurance issuer in the individual market to individuals only through one (1) or more associations, a reference to an “individual” is deemed to include a reference to the association of which the individual is a member.
