Tennessee 2025-2026 Regular Session

Tennessee House Bill HB1304 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2	SENATE BILL 1270
3	3	By Johnson
4	4
5	5	HOUSE BILL 1304
6	6	By Lamberth
7	7
8	8
9	9	HB1304
10	10	001434
11	11	- 1 -
12	12
13	13	AN ACT to amend Tennessee Code Annotated, Title 56
14	14	and Section 68-1-115, relative to insurance.
15	15
16	16	BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
17	17	SECTION 1. Tennessee Code Annotated, Title 56, Chapter 2, Part 1, is amended by
18	18	adding the following as a new section:
19	19	56-2-1__. Claims experience report.
20	20	(a) As used in this section, unless the context otherwise requires:
21	21	(1) "Group health plan" or "plan" means an employee welfare benefit
22	22	plan, as that term is defined in § 3(1) of the Employee Retirement Income and
23	23	Security Act of 1974 (ERISA), 29 U.S.C. § 1002(1), including insured and self-
24	24	insured plans, to the extent that the plan provides medical care, as that term is
25	25	defined in § 2791(a)(2) of the Public Health Service Act (PHS Act), 42 U.S.C.
26	26	300gg–91(a)(2), including items and services paid for as medical care, to
27	27	employees or their dependents directly or through insurance, reimbursement, or
28	28	otherwise, that:
29	29	(A) Has twenty-five (25) or more participants as defined in section
30	30	3(7) of ERISA, 29 U.S.C. § 1002(7); or
31	31	(B) Is administered by an entity other than the employer that
32	32	established and maintains the plan;
33	33	(2) "Health benefit plan issuer" means a company or insurance company,
34	34	as those terms are defined in § 56-1-102, or a health maintenance organization,
35	35
36	36
37	37	- 2 - 001434
38	38
39	39	as that term is defined in § 56-32-102, that qualifies as a health insurance entity
40	40	as that term is defined in § 56-7-109;
41	41	(3) "Plan administrator" means an administrator, as that term is defined in
42	42	29 U.S.C. § 1002(16)(A); and
43	43	(4) "Plan sponsor" has the same meaning as defined in 29 U.S.C. §
44	44	1002(16)(B).
45	45	(b) No later than thirty (30) days after a health benefit plan issuer receives a
46	46	written request for a claims experience report from a plan, plan sponsor, or plan
47	47	administrator, the health benefit plan issuer shall provide the report to the requesting
48	48	party.
49	49	(c) To the extent such information is available to the health benefit plan issuer
50	50	and is relevant to the request made under subsection (b), a report provided pursuant to
51	51	subsection (b) must include the following information for the thirty-six-month period
52	52	preceding the date of the request or for the entire period of coverage, whichever is
53	53	shorter:
54	54	(1) Aggregate paid claims experience by month, including claims
55	55	experience for medical, dental, and pharmacy benefits, as applicable;
56	56	(2) Total premiums paid by month;
57	57	(3) Total number of covered employees on a monthly basis by coverage
58	58	tier, including whether coverage was for:
59	59	(A) An employee only;
60	60	(B) An employee with dependents only;
61	61	(C) An employee with a spouse only; or
62	62	(D) An employee with spouse and dependents;
63	63
64	64
65	65	- 3 - 001434
66	66
67	67	(4) An aggregate report of all claims exceeding ten thousand dollars
68	68	($10,000); and
69	69	(5) Total dollar amount of claims pending as of the date of the request for
70	70	the report.
71	71	(d) In the case of a request made under subsection (b) after the date of
72	72	termination of coverage, the report provided under subsection (b) must contain the
73	73	information outlined in subsection (c) that is available to the health benefit plan issuer as
74	74	of the date of the request and is relevant to the request for the thirty-six-month period
75	75	preceding the date of termination of coverage or for the entire policy period, whichever
76	76	period is shorter.
77	77	(e) No later than thirty (30) days after the date of termination of coverage under
78	78	a group health plan, a health benefit plan issuer shall provide to a plan, plan sponsor, or
79	79	plan administrator who made a request under subsection (b) before the date of
80	80	termination of coverage a supplemental written report of the information described in
81	81	subsection (c) to update the claims experience report with information that was not
82	82	included in the original report.
83	83	(f) A plan, plan sponsor, or plan administrator may use information in a written
84	84	claims experience report provided under this section only as necessary to perform
85	85	treatment, payment, or health care operations as those activities are described by 45
86	86	C.F.R. § 164.501.
87	87	(g) Except where the release of information is otherwise prohibited by law, a
88	88	health benefit plan issuer that releases information in accordance with this section has
89	89	not violated a standard of care and is not liable for civil damages resulting from, and is
90	90	not subject to criminal prosecution for, releasing such information.
91	91
92	92
93	93	- 4 - 001434
94	94
95	95	SECTION 2. Tennessee Code Annotated, Section 56-2-208(b)(6)(F)(vi)(c), is amended
96	96	by deleting the language "active" and substituting "inactive".
97	97	SECTION 3. Tennessee Code Annotated, Section 56-2-208(b)(8)(C)(iii), is amended by
98	98	adding the language "; provided, that the commissioner shall not remove from the list a
99	99	reciprocal jurisdiction as defined under subdivisions (b)(8)(A)(ii)(a) or (b)" immediately preceding
100	100	the period of the first sentence.
101	101	SECTION 4. Tennessee Code Annotated, Section 56-2-208(b)(8)(D), is amended by
102	102	deleting the language "subdivision (b)(8)(B)(iv)" and substituting "subdivision (b)(8)(B)(i)(d)".
103	103	SECTION 5. Tennessee Code Annotated, Section 56-2-208(b)(10), is amended by
104	104	deleting the language "subdivision (b)(2), (b)(3), or (b)(4)" and substituting "subdivision (b)(2),
105	105	(b)(3), (b)(4), or (b)(8)".
106	106	SECTION 6. Tennessee Code Annotated, Section 56-2-208(b)(11)(B)(ii), is amended by
107	107	deleting "subdivision (b)(6)(F)" and substituting "subdivision (b)(6)(G)".
108	108	SECTION 7. Tennessee Code Annotated, Section 56-2-208(b)(11)(C), is amended by
109	109	deleting "subdivision (b)(6)(E)" and substituting "subdivision (b)(6)(F)".
110	110	SECTION 8. Tennessee Code Annotated, Section 56-2-209(a)(2), is amended by
111	111	adding the language ", as defined in subsection (d)" immediately preceding the period of the first
112	112	sentence.
113	113	SECTION 9. Tennessee Code Annotated, Section 56-2-209(a)(2)(C), is amended by
114	114	deleting the subdivision and substituting:
115	115	(C) Clean, irrevocable, unconditional letters of credit, issued or confirmed by a
116	116	qualified United States financial institution no later than December 31 of the year for
117	117	which filing is being made, and in the possession of, or in trust for, the ceding company
118	118	on or before the filing date of its annual statement; or
119	119
120	120
121	121	- 5 - 001434
122	122
123	123	SECTION 10. Tennessee Code Annotated, Section 56-2-209(b), is amended by
124	124	deleting the subsection and substituting:
125	125	(b) Letters of credit meeting applicable standards of issuer acceptability as of the
126	126	dates of their issuance, or confirmation, must, notwithstanding the issuing or confirming
127	127	qualified United States financial institution's subsequent failure to meet applicable
128	128	standards of issuer acceptability, continue to be acceptable as security until their
129	129	expiration, extension, renewal, modification, or amendment, whichever first occurs.
130	130	SECTION 11. Tennessee Code Annotated, Section 56-2-209(c), is amended by
131	131	deleting the language "subdivision (a)(3)" and substituting "subdivision (a)(2)(C) and subsection
132	132	(b)".
133	133	SECTION 12. Tennessee Code Annotated, Section 56-2-209(g)(4), is amended by
134	134	adding the following as a new subdivision (A) and redesignating the existing subdivisions
135	135	accordingly:
136	136	(A) Meets the conditions set forth in § 56-2-208(b)(8);
137	137	SECTION 13. Tennessee Code Annotated, Section 56-5-102(7), is amended by
138	138	deleting the subdivision and substituting:
139	139	(7) "Personal risk insurance" means property and casualty insurance that
140	140	provides:
141	141	(A) Insurance on one (1) to four (4) family dwelling units, including mobile
142	142	homes;
143	143	(B) Individual insurance on household goods in dwellings, mobile homes,
144	144	apartments, or other residential facilities;
145	145	(C) Insurance on private passenger nonfleet motor-driven vehicles, not
146	146	used for hire, that are used for personal or family needs, including pickups,
147	147	station wagons, vans, and vehicles with fewer than four (4) wheels;
148	148
149	149
150	150	- 6 - 001434
151	151
152	152	(D) Insurance on pleasure watercraft that are used for personal or family
153	153	needs; and
154	154	(E) Insurance sold in connection with and incidental to rental agreements
155	155	for a period not to exceed ninety (90) days;
156	156	SECTION 14. Tennessee Code Annotated, Title 56, Chapter 5, Part 1, is amended by
157	157	adding the following new section:
158	158	56-5-1__. Coverage of farm risks and property used in farming.
159	159	Coverage by a commercial risk insurance policy of farm risks or real or personal
160	160	property used in farming must not be considered in determining whether property is
161	161	classified as farm or agricultural property under another law or rule in this state.
162	162	SECTION 15. Tennessee Code Annotated, Section 56-7-1605(a), is amended by
163	163	deleting the subsection and substituting:
164	164	(a) In addition to any other requirements of law, policy forms, except as stated in
165	165	§ 56-7-1604, must not be delivered or issued for delivery in this state on or after the
166	166	dates the forms are subject to this part, unless:
167	167	(1) The text achieves a minimum score of forty (40) on the Flesch
168	168	reading ease test or an equivalent score on another comparable test as provided
169	169	in subsection (d);
170	170	(2) The style, arrangement, and overall appearance of the policy give no
171	171	undue prominence to any portion of the text of the policy or to any endorsements
172	172	or riders; and
173	173	(3) The policy form contains a table of contents or an index of the
174	174	principal sections of the policy, if the policy has more than three thousand (3,000)
175	175	words.
176	176
177	177
178	178	- 7 - 001434
179	179
180	180	SECTION 16. Tennessee Code Annotated, Section 56-7-1605(b)(1), is amended by
181	181	deleting the language "printed".
182	182	SECTION 17. Tennessee Code Annotated, Section 56-7-1605(c), is amended by
183	183	deleting the subsection and substituting:
184	184	(c) As used in this section, "text" includes all matter contained in a policy form
185	185	except the following:
186	186	(1) The name and address of the insurer; the name, number, or title of
187	187	the policy; the table of contents or index; captions and subcaptions; specification
188	188	pages, schedules, or tables; and
189	189	(2) Any policy language that is drafted to conform to the requirements of
190	190	any federal law, regulation, or agency interpretation; any policy language
191	191	required by any collectively bargained agreement; any medical terminology; any
192	192	words which are defined in the policy; and any policy language required by law
193	193	or regulation; provided, that the insurer identifies the language or terminology
194	194	excepted by this subsection (c) and certifies, in writing, that the language or
195	195	terminology is entitled to be excepted by this subsection (c).
196	196	SECTION 18. Tennessee Code Annotated, Title 56, Chapter 7, Part 23, is amended by
197	197	deleting Sections 56-7-2312 – 56-7-2322.
198	198	SECTION 19. Tennessee Code Annotated, Section 68-1-115, is amended by deleting
199	199	the language ", § 56-7-2312,".
200	200	SECTION 20. The headings in this act are for reference purposes only and do not
201	201	constitute a part of the law enacted by this act. However, the Tennessee Code Commission is
202	202	requested to include the headings in any compilation or publication containing this act.
203	203	SECTION 21. Section 1 and Sections 15 through 19 take effect upon becoming law, the
204	204	public welfare requiring it. Sections 2 through 12 take effect July 1, 2025, the public welfare
205	205
206	206
207	207	- 8 - 001434
208	208
209	209	requiring it. Sections 13 and 14 take effect January 1, 2026, and apply to plans, policies, and
210	210	agreements issued, delivered, amended, or renewed to take effect on or after January 1, 2026,
211	211	the public welfare requiring it.