(a)

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Terms Used In Tennessee Code 56-7-2804

  • Dependent: A person dependent for support upon another.
  • Employer: has the meaning given the term under §. See Tennessee Code 56-7-2802
  • 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.
  • Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with the plan. See Tennessee Code 56-7-2802
  • Group health plan: means an employee welfare benefit plan, as defined in ERISA, §. See Tennessee Code 56-7-2802
  • Health insurance coverage: means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer. See Tennessee Code 56-7-2802
  • Health insurance issuer: means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. See Tennessee Code 56-7-2802
  • Health status-related factor: means any of the following factors:
    (A) Health status. See Tennessee Code 56-7-2802
(1) Subject to subdivision (a)(2), a group health plan, and a health insurance issuer offering group health insurance coverage in connection with a group health plan, may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

(A) Health status;
(B) Medical condition, including both physical and mental illnesses;
(C) Claims experience;
(D) Receipt of health care;
(E) Medical history;
(F) Genetic information;
(G) Evidence of insurability, including conditions arising out of acts of domestic violence; or
(H) Disability.
(2) To the extent consistent with other sections of this part, subdivision (a)(1) shall not be construed to:

(A) Require a group health plan, or group health insurance coverage, to provide particular benefits other than those provided under the terms of the plan or coverage; or
(B) Prevent the plan or coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage.
(3) For purposes of subdivision (a)(1), rules for eligibility to enroll under a plan include rules defining any applicable waiting periods for enrollment.
(b)

(1) A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
(2) Nothing in subdivision (b)(1) shall be construed to:

(A) Restrict the amount that an employer may be charged for coverage under a group health plan; or
(B) Prevent a group health plan, and a health insurance issuer offering group health insurance coverage, from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
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