§ 8-27-904 — Plan participant rights and duties

(a) By accepting payment of benefits pursuant to a plan authorized by this part, a plan participant has assigned to the plan the right of third-party insurance benefits or other recovery rights to which the plan participant may be entitled, which must be noted in plain language in the SPD. (b) By accepting payment of benefits pursuant to a plan authorized by this part, a plan participant acknowledges the plan's right to reimbursement, which must be noted in plain language in the SPD. (c) A plan under this part may deem a plan participant ineligible for continued or future coverage under the plan, if the plan participant: (1) Receives payment from a third-party tortfeasor, third-party insurer, third party for medical payments, or other individual or entity originally paid by the plan for the benefit of, or on behalf of, the plan participant; and (2) Fails or refuses to promptly reimburse the plan for the amounts paid by the plan. (d) A plan shall not remove a plan participant under a plan pursuant to subsection (c) unless the plan or administrator provides the primary insured with written notice of intent to remove the plan participant. The plan or administrator shall send the notice at least ninety (90) days prior to the date the plan participant will lose benefits under the plan by certified mail with signed or electronic receipt. To be effective the notice must at a minimum include: (1) The name of the plan participant to be removed from the plan; (2) The date the plan participant will cease to be covered under the plan; (3) The reason for removal from the plan; (4) The name, title, phone number, mailing address, and email address of an individual with the authority to cancel or change the plan participant's removal, if the removal violates the terms of the plan, or as the sponsor permits. (e) The plan shall not prevent a provider from receiving payment for services already rendered to a provider even if the plan participant is removed from participation in a plan pursuant to subsection (c). However, this subsection (e) does not require the plan to pay benefits to medical services providers if the benefits have already been paid to a plan participant.

Legislative History

Added by 2021 Tenn. Acts, ch. 360, s 3, eff. 7/1/2021.