Tennessee Health Study Guide

Tennessee’s health law is easy to underestimate, because most of it tracks the national baseline. The parts that don’t are concentrated in two statutes — the prompt-pay rule at T.C.A. §56-7-109 and the group continuation rule at §56-7-2312 — and both are written in a way that punishes anyone who arrives carrying a number from another state.

State continuation counts in policy months, not eighteen

Forget 18 months. Tennessee’s continuation right is “the fractional policy month remaining at termination, plus three (3) additional policy months.” That is a genuinely different unit from the one COBRA uses: the clock is the policy month, and the entitlement is short.

Then the statute opens two much wider doors. Where coverage ends because of divorce or the death of the spouse, the person gets the fractional month remaining plus up to fifteen (15) additional policy months. And where coverage terminates during pregnancy, §56-7-2312(d)(1) gives the fractional month plus “not less than six (6) months after the pregnancy ends” — bounded at the end of the second three-month period following the three-month period in which it ends.

And it does not care how big the employer is

Federal COBRA starts at 20 employees. Tennessee’s continuation right attaches to the group policy regardless of headcount — small groups and large groups alike. So the familiar exam framing “a mini-COBRA for employers too small for federal COBRA” is only half right here: Tennessee’s rule reaches everybody, it is just much shorter.

Two conditions come with it. The person must have been continuously insured for at least three months before termination, and must pay the premium in advance.

And one exclusion outranks the rest, because it decides most real cases: there is no continuation where the group policy “was terminated in its entirety or was terminated with respect to an insured class of which the employee was a member.” Continuation carries an individual out of a group that still exists; when the group itself goes, what remains is a conversion right. Also excluded are those who failed to pay contributions, those eligible for Medicare, and those whose coverage was replaced within 31 days.

Prompt pay splits by how the claim arrived

Most states set one clean-claim deadline. Tennessee sets two, and keys them to the medium:

• Electronic submission — 21 calendar days to pay or act on the claim.
• Paper submission — 30 calendar days.
• Late either way, 1% interest per month accrues from the day after payment was due.

External review is binding on the carrier

Under the Tennessee Health Carrier Grievance and External Review Procedure Act, the independent review organisation’s decision is binding on the health carrier. Not advisory, not a recommendation the plan may weigh. If an answer choice has the insurer “considering” an adverse external review determination, it is wrong.

The Tennessee coverage landscape, as a set

Four facts that hang together, and getting one usually lets you reason to the rest:

• Marketplace: federally facilitated. Tennessee built no state-based exchange; individual coverage runs through HealthCare.gov.
• Medicaid: not expanded. Tennessee remains a non-expansion state.
• The Medicaid programme is TennCare, administered by the Division of TennCare.
• CHIP is CoverKids, administered within TennCare.

The practical consequence — a coverage gap for adults earning too much for TennCare and too little for a marketplace subsidy — is the kind of structural fact the Tennessee-specific half of the exam likes to test through a client scenario rather than a definition.

Long-term care carries its own gate, and it recurs

Selling long-term care in Tennessee requires a one-time eight-hour producer training course under §56-42-109(a)(1), completed before the sale — and TDCI adds ongoing training every twenty-four months thereafter, of no less than four hours. This sits alongside your 24 hours of continuing education, not inside them.

The policy itself carries a 30-day free look from delivery under §56-42-105(f)(1). Note the contrast with the ordinary health free look: §56-26-129 gives ten days on “every individual accident and health policy or contract.” Ten for health generally, thirty for long-term care — and Tennessee fixes no general free look at all on a new individual life policy or annuity.

Guaranty limits on the health side

If a health insurer fails, the Tennessee Life and Health Insurance Guaranty Association covers $500,000 “for health benefit plans” — the statute’s own phrase, not “major medical”; $300,000 for disability income and long-term care; and $100,000 for health coverages that are none of those. The aggregate per life is $300,000, rising to $500,000 where a health benefit plan is in the mix — and that hinge is where the questions live.