The insurer shall not be required to issue a converted policy covering any person if the person is or could be covered by medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.); furthermore, the insurer shall not be required to issue a converted policy covering any person if:

(1)

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Terms Used In Tennessee Code 56-7-2314

  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
  • Contract: A legal written agreement that becomes binding when signed.
  • 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
  • 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
  • Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
(A) The person is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy or hospital or medical service subscriber contract or medical practice or other prepayment plan or by any other plan or program;
(B) The person is eligible for similar benefits, whether or not covered for the benefits, under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(C) Similar benefits are provided for or are available to the person, pursuant to or in accordance with the requirements of any state or federal law; and
(2) The benefit provided under the sources referred to in subdivision (1)(A) for the person or benefits provided or available under the sources referred to in subdivisions (1)(B) and (C) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer’s standards. The insurer’s standards must bear some reasonable relationship to actual health care costs in the area in which the insured lives at the time of conversion and must be filed with the commissioner prior to their use in denying coverage.
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