(a) A converted policy may include a provision whereby the insurer may request information in advance of any premium due date of the policy of any person covered under the policy as to whether:

lawyer at desk

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Tennessee Code 56-7-2315

  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-1-102
  • Contract: A legal written agreement that becomes binding when signed.
  • Fraud: Intentional deception resulting in injury to another.
  • 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
(1) 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;
(2) The person is covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(3) Similar benefits are provided for or available to the person, pursuant to or in accordance with the requirements of any state or federal law.
(b) The converted policy may provide that the insurer may refuse to renew the policy or the coverage of any person insured under the policy for the following reasons only:

(1) Either the benefits provided under the sources referred to in subdivisions (a)(1) and (2) for the person or benefits provided or available under the sources referred to in subdivision (a)(3) for the person, together with the benefits provided by the converted policy, would result in overinsurance according to the insurer’s standards on file with the commissioner, or the converted policyholder fails to provide the requested information;
(2) Fraud or material misrepresentation in applying for any benefits under the converted policy;
(3) Eligibility of the insured person for coverage under medicare under Title XVIII of the federal Social Security Act ( 42 U.S.C. § 1395 et seq.), or under any other state or federal law providing for benefits similar to those provided by the converted policy; or
(4) Other reasons approved by the commissioner.
  Previous section
Next section  
 Part 23 Contents