(a) Any of the following acts are prohibited as unfairly discriminatory:

Terms Used In Tennessee Code 56-8-204

  • Abuse: means the occurrence of one (1) or more of the following acts:
    (A) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse. See Tennessee Code 56-8-202
  • Abuse status: means the fact or perception that a person is, has been, or may be a subject of abuse, regardless of whether the person has sustained abuse-related medical conditions or has incurred abuse-related claims. See Tennessee Code 56-8-202
  • Abuse-related medical condition: means a medical condition sustained by a subject of abuse that arises in whole or part out of an act or pattern of abuse. See Tennessee Code 56-8-202
  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Health benefit plan: includes accident only, credit health, dental, vision, medicare supplement, or long-term care coverage issued as a supplement to liability insurance, automobile medical payment insurance, short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis. See Tennessee Code 56-8-202
  • Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the cost of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or health services. See Tennessee Code 56-8-202
  • insured: includes a person who is a beneficiary covered by a group policy, certificate, or health benefit plan. See Tennessee Code 56-8-202
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
  • plan: means a policy, contract, certificate or agreement offered by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. See Tennessee Code 56-8-202
  • Subject of abuse: means a person to whom a family member, or a current or former household member, intimate partner, or caretaker, or a perpetrator of sexual assault, a stalker or a sex offender has directed an act as defined in subdivision (1). See Tennessee Code 56-8-202
(1) Denying, refusing to issue, renew or reissue, canceling or otherwise terminating a health benefit plan, or restricting or excluding health benefit plan coverage, or adding a premium differential to any health benefit plan on the basis of the applicant’s or insured‘s abuse status;
(2) Excluding or limiting coverage or denying a claim incurred by an insured as a result of abuse on the basis of the insured’s abuse status;
(3) Terminating group coverage for a subject of abuse on the basis of the insured’s abuse status where coverage was originally issued in the name of the abuser and the abuser has divorced, separated from, or lost custody of the subject of abuse, or the abuser’s coverage has terminated voluntarily or involuntarily. Nothing in this subdivision (3) prohibits the insurer or health carrier from requiring the subject of abuse to pay the full premium for the person‘s coverage under the health plan or from requiring the subject of abuse to reside or work within its service area. Nothing in this subdivision (3) gives a subject of abuse any greater rights than the subject would otherwise have had to continued coverage under Tennessee or federal law. The continuation coverage required by this section shall be satisfied by any COBRA coverage provided to a subject of abuse and is not intended to be in addition to any coverage provided under COBRA; or
(4) Disclosing or transferring any information, by a person employed by or contracting with a health carrier, relating to an applicant’s or insured’s abuse status or abuse-related medical condition, or the applicant’s or insured’s status as a family member, employer or associate of, or in a relationship with a subject of abuse, except:

(A) For purposes related to the provision of health care services;
(B) For the purpose of administering claims, utilization review or case management; or
(C) Where required by the commissioner or a court of competent jurisdiction.
(b) Nothing in this section shall be construed to prohibit a health carrier from asking an applicant or insured about a medical condition, even if the condition is abuse-related, or using information thereby obtained for the purpose of acts or practices permitted by this part. A subject of abuse, at the subject’s absolute discretion, may provide evidence of abuse to a health carrier for the limited purpose of facilitating treatment of an abuse-related condition or demonstrating that a medical condition is abuse-related, and nothing in this section shall be construed as authorizing the health carrier to disregard that information.
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