§ 56-7-2357 — Section definitions - Health insurance issuer limitations - Actions not prohibited

Tennessee § 56-7-2357

• Jurisdiction: Tennessee
• Title: 56

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(a) As used in this section: (1) "Managed health insurance issuer" has the same meaning as defined in § 56-32-128(a) ; and (2) "Medical laboratory" has the same meaning as defined in § 68-29-103 . (b) A health insurance issuer or a managed health insurance issuer shall not: (1) Deny a licensed medical laboratory the right to participate as a participating provider in a policy, contract, or plan on the same terms and conditions as are offered to another medical laboratory under the policy, contract, or plan; provided, that this subdivision (b)(1) does not prohibit a managed health insurance issuer or health insurance issuer from establishing rates or fees that may be higher in nonurban areas, or in specific instances where a managed health insurance issuer or health insurance issuer determines it necessary to contract with a particular provider in order to meet network adequacy standards or patient care needs; and (2) Prevent a person who is a party to or beneficiary of a policy, contract, or plan from selecting a licensed medical laboratory of the person's choice to furnish the medical laboratory services offered under the contract, policy, or plan; provided, that the medical laboratory is a participating provider under the same terms and conditions of the contract, policy, or plan as those offered to another medical laboratory. (c) Each health insurance issuer or managed health insurance issuer shall apply the same coinsurance, co-payment, deductible, and quantity limit factors within the same employee group and other plan-sponsored groups to all medical laboratory services provided by a licensed medical laboratory; provided, that all medical laboratories comply with the same terms and conditions. (d) This section does not prohibit: (1) A health insurance issuer or managed health insurance issuer from applying different coinsurance, co-payment, and deductible factors within the same employer group and other plan-sponsored groups; or (2) An employer or other plan-sponsored group from offering multiple options or choices of health insurance benefit plans, including, but not limited to, cafeteria benefit plans.