Tennessee § 56-7-2409 Employer-based plans to offer at least one plan option providing copayment amounts for office visits with chiropractic physicians, physical or occupational therapists no greater than those for primary care physician visits

Tennessee Statutes

§ 56-7-2409 — Employer-based plans to offer at least one plan option providing copayment amounts for office visits with chiropractic physicians, physical or occupational therapists no greater than those for primary care physician visits

(a)As used in this section:

(1)"Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan;

(2)"Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan;

(3)"Covered person" has the same meaning as set forth in § 56-7-110(a) ; and (4) "Health insurance entity" has the same meaning as set forth in § 56-7-109 , but does not include government insurance plans created by title 8, chapter 27.

(b)A health insurance entity offering employer-based plans must

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(a) As used in this section: (1) "Coinsurance" means a percentage of the contractual fee schedule applicable to a particular health care provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan; (2) "Copayment" means the specified dollar amount that a covered person must pay for covered services during a visit to a health care provider under the terms of a particular health insurance policy or plan; (3) "Covered person" has the same meaning as set forth in § 56-7-110(a) ; and (4) "Health insurance entity" has the same meaning as set forth in § 56-7-109 , but does not include government insurance plans created by title 8, chapter 27. (b) A health insurance entity offering employer-based plans must offer to employers no less than one (1) plan option in which the copayment and coinsurance amounts for services rendered during an office visit to a chiropractic physician licensed under title 63, chapter 4, or to a physical therapist or occupational therapist licensed under title 63, chapter 13, are no greater than the copayment and coinsurance amounts for the services rendered during an office visit to a primary care physician licensed under title 63, chapter 6 or title 63, chapter 9. (c) Compliance with this section shall not be required with respect to a particular insurance plan if it is determined that compliance would cause that plan to lose its status as a grandfathered health plan within the meaning of § 1251 of the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended, and § 2301 of the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152, as amended, both compiled in 42 U.S.C. § 18011 . (d) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies, and any employer plan exempt from regulation under this title due to § 514 of the federal Employee Retirement Income Security Act of 1974 (ERISA) ( 29 U.S.C. § 1144 ).

Tennessee § 56-7-2409 (Employer-based plans to offer at least one plan option providing copayment amounts for office visits with chiropractic physicians, physical or occupational therapists no greater than those for primary care physician visits) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.