Underwriting in accordance with the standards set forth in this section shall be deemed not to be a violation of this part. Upon request of the commissioner, a health carrier or insurer of an individual or group policy that has taken an action that adversely affects a subject of abuse on the basis of an abuse-related medical condition must explain the reason for its action to the commissioner in writing and must be able to demonstrate that its action:

(1) Does not have the purpose or effect of treating abuse status as a medical condition or underwriting criterion;

Terms Used In Tennessee Code 56-8-205

  • 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
  • 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
  • Policy: means a contract of insurance, certificate, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract. See Tennessee Code 56-8-202
(2) Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition without regard to whether the condition or claim is abuse-related; and
(3) Is based on a determination, made in conformance with actual or reasonably anticipated actuarial experience.
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