Healthcare (Insurance)

in committee · Tennessee · House May 15, 2025

HB 296: Insurance Companies, Agents, Brokers, Policies - As enacted, requires TACIR to conduct a study on the feasibility of implementing and potential effects of enacting the insurance coverage requirements proposed in Senate Bill 231 of the 114th General Assembly, as originally filed; requires TACIR to publish a report of its findings and recommendations. - Amends TCA Title 8; Title 56; Title 63; Title 68 and Title 71.

HB 296 requires Tennessee health insurance plans to cover speech therapy for stuttering without annual limits, prior authorization, or restrictions based on the type of stuttering. It applies to all health benefit plans that renew or issue policies on or after July 1, 2025, directly affecting insurance companies and policyholders seeking speech therapy services. The law mandates coverage for both habilitative and rehabilitative speech therapy services, including telehealth options, without visit limits or medical necessity requirements. This implementation follows requirements originally proposed in Senate Bill 231 of the 114th General Assembly.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for speech therapy without limits/restrictions, expanding patient access to essential healthcare services for stuttering treatment.95% confidence

Sub-Topics Insurance Telehealth

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signed · Tennessee · House May 14, 2026

HB 484: Insurance, Health, Accident - As enacted, requires a health insurer that issues, amends, delivers, or renews a contract or agreement for a health benefit plan to take effect on or after January 1, 2027, to include coverage for biomarker testing; requires a TennCare health benefit plan that is issued, amended, or renewed on or after January 1, 2027, to provide coverage for biomarker testing when medically necessary. - Amends TCA Title 56 and Title 71.

HB 484 requires health insurers and TennCare to cover biomarker testing for diagnosis, treatment, or monitoring of diseases starting January 1, 2026. It applies to all health benefit plans (including private insurance) and TennCare plans, mandating coverage when tests are supported by FDA approvals, clinical guidelines, or evidence-based standards. The bill specifies that insurers must approve or deny prior authorization requests within 24-72 hours and provide clear appeal processes for patients. This policy directly affects patients needing biomarker tests (e.g., for cancer treatment) and insurers managing coverage for these tests.

Topics ✓ HealthcareSupports HealthcareMandates insurers and TennCare to cover biomarker testing for diagnosis/treatment, expanding patient access to essential medical services.95% confidence

Sub-Topics Insurance

in committee · Tennessee · Senate Apr 7, 2026

SB 420: Insurance, Health, Accident - As introduced, prohibits an insurer, pharmacy benefits manager, or third-party administrator from changing or conditioning the terms of health plan coverage based on availability of financial or other product assistance for a prescription drug; establishes certain procedures for calculating an enrollee's contribution to an applicable cost sharing requirement. - Amends TCA Title 4; Title 8; Title 10; Title 53; Title 56; Title 63; Title 68 and Title 71.

SB 420 prohibits insurers, pharmacy benefits managers, and third-party administrators in Tennessee from altering health plan coverage terms - such as cost-sharing or benefit design - based on whether a patient has access to prescription drug assistance programs (like manufacturer coupons or patient aid). This directly affects health plan enrollees who use such programs to lower drug costs. The bill requires insurers to calculate cost-sharing contributions based on actual patient payments, not external assistance, and applies to plans entered into or renewed on or after January 1, 2026. It aims to prevent insurers from penalizing patients for utilizing available drug cost-saving resources.

Topics ✓ HealthcareSupports HealthcarePrevents insurers from penalizing patients using drug assistance programs, ensuring cost-sharing reflects actual patient payments and improving access to affordable medications.95% confidence

Sub-Topics Insurance Prescription Drugs

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signed · Tennessee · Senate May 15, 2025

SB 231: Insurance Companies, Agents, Brokers, Policies - As enacted, requires TACIR to conduct a study on the feasibility of implementing and potential effects of enacting the insurance coverage requirements proposed in Senate Bill 231 of the 114th General Assembly, as originally filed; requires TACIR to publish a report of its findings and recommendations. - Amends TCA Title 8; Title 56; Title 63; Title 68 and Title 71.

SB 231 requires Tennessee health insurance plans to cover speech therapy specifically for stuttering, including both habilitative (helping learn or improve communication skills) and rehabilitative (helping restore lost skills) services. The law prohibits annual visit limits, prior authorization, restrictions based on the cause of stuttering, and excludes utilization review for these services, while mandating coverage for both in-person and telehealth options. This requirement applies to health benefit plans renewing or issuing policies on or after July 1, 2025. The bill directly affects insured individuals seeking speech therapy for stuttering and insurers offering health coverage in Tennessee.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for stuttering therapy without visit limits or prior authorization, expanding access to speech services per bill's explicit requirements.95% confidence

Sub-Topics Insurance Telehealth

signed · Tennessee · Senate May 15, 2025

SB 881: Insurance, Health, Accident - As enacted, removes the aggregate penalty limits for violations of law concerning pharmacy benefits managers; provides that a pharmacy benefits manager regulated under law relative to pharmacy benefits managers is subject to the insurance laws relative to timely reimbursement of health insurance claims and its requirements for timing of payments to pharmacists; provides that a violation of the prompt pay standards is governed by the penalties set out in insurance laws relative to timely reimbursement of health insurance claims. - Amends TCA Title 56.

SB 881 removes limits on penalties for pharmacy benefits managers (PBMs) that fail to pay pharmacies promptly under Tennessee law. It requires PBMs to pay "clean claims" (complete, error-free claims) within 30 days for paper submissions and 14 days for electronic submissions, with interest accruing for late payments. The bill establishes tiered penalties: failing to pay 95% of clean claims triggers up to $10,000 in fines, 85% triggers $10,000-$100,000, and 60% triggers $100,000-$200,000. This directly affects PBMs (like those managing prescription drug benefits) and pharmacies that rely on timely payments from them.

Topics ✓ HealthcareSupports HealthcareBill mandates timely payments to pharmacies with penalties for delays, protecting pharmacists and ensuring uninterrupted healthcare services.95% confidence

Sub-Topics Insurance Prescription Drugs

in committee · Tennessee · House May 2, 2025

HB 329: Insurance Companies, Agents, Brokers, Policies - As enacted, authorizes categorizing certain foreign multiple employer welfare arrangements as domestic multiple employer welfare arrangements if specific conditions are met. - Amends TCA Title 56, Chapter 26.

HB 329 allows certain bank-run health insurance arrangements (called "multiple employer welfare arrangements" or MEWAs) operating across state lines to be treated as domestic Tennessee arrangements if they meet specific conditions. It affects bank-based MEWAs that are licensed in a neighboring state, serve no more than 2,500 Tennessee employees, and comply with regulatory oversight similar to Tennessee standards. Key provisions require these arrangements to be exclusively for banks, avoid health-based enrollment restrictions, and obtain approval from Tennessee's insurance commissioner. The bill aims to simplify regulatory compliance for these arrangements while ensuring they meet solvency and oversight standards. This change took effect after becoming law in May 2025 (Public Chapter 161).

Topics ✓ HealthcareSupports HealthcareEnables bank MEWAs to operate under TN rules, expanding health insurance access options for employers and employees while maintaining regulatory compliance.85% confidence

Sub-Topics Insurance

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in committee · Tennessee · House Apr 28, 2026

HB 427: Employees, Employers - As enacted, allows for eligible employees to be absent four weeks from work following a living organ donation surgery; requires the department of health to create living organ donor informational material and make such material available on the department's website. - Amends TCA Title 4; Title 8; Title 50; Title 56 and Title 68.

HB 427 provides 12 weeks of job-protected leave for eligible employees recovering from living organ donation surgery, including state workers with 12+ months of service and private-sector employees covered under federal FMLA rules. It prohibits insurers from denying or altering life, disability, or long-term care insurance coverage based solely on someone being a living organ donor. The bill also requires Tennessee's Department of Health to create and post public educational materials about living donation benefits, risks, and insurance impacts by July 2025. These provisions directly affect living organ donors, their employers, and insurance providers across Tennessee.

Topics ✓ HealthcareSupports HealthcareProhibits insurance denial based on donor status, mandates job-protected leave for organ donation recovery, and requires health department educational materials - directly advancing patient access and rights in healthcare.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentProvides 12 weeks job-protected leave for organ donation recovery and prohibits insurance discrimination based on donor status, directly advancing worker benefits and protections under employment standards.95% confidence

Sub-Topics Insurance Long-Term Care Paid Leave

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introduced · Tennessee · House Feb 5, 2025

HB 511: Insurance, Health, Accident - As introduced, requires a healthcare provider, healthcare group, practice, or clinic, healthcare facility, or other entity to provide notice to each health insurance entity with which it is under contract as soon as practicable if the healthcare provider, healthcare group, practice, or clinic, healthcare facility, or other entity is the subject of a cyber-attack. - Amends TCA Title 33; Title 56; Title 63; Title 68, Chapter 11 and Title 71.

HB 511 requires healthcare providers, clinics, facilities, and other entities that contract with health insurance companies for patient care reimbursement to notify those insurers "as soon as practicable" if they experience a cyber-attack. This applies to all Tennessee entities billing insurers for healthcare services, directly affecting providers and insurers. The key provision mandates timely notification to help insurers protect patient data and manage claims during incidents. The bill amends Tennessee insurance and health codes (Titles 33, 56, 63, 68, and 71) to establish this requirement.

Topics ✓ HealthcareSupports HealthcareMandates cyber-attack notifications to protect patient data, aligning with patient data security and rights in healthcare systems.90% confidence ✓ TechnologySupports TechnologyMandates cyber-attack notification to protect patient data, enhancing healthcare cybersecurity protocols per bill's core requirement.85% confidence

Sub-Topics Insurance Primary Care

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failed · Tennessee · Senate Mar 11, 2025

SB 190: Employees, Employers - As introduced, requires an employer that terminates the employment of an employee who the employer knows to be pregnant and who is covered under an employer-sponsored health benefit plan to continue to provide coverage under the plan until the employee’s pregnancy ends. - Amends TCA Title 8, Chapter 27; Title 50; Title 56 and Title 71.

SB 190 requires employers to continue providing health insurance coverage under an employer-sponsored plan to employees terminated while pregnant, until the pregnancy ends. It directly affects pregnant employees covered by such plans who lose their jobs and employers offering those plans. Key provisions mandate employers to keep paying their share of premiums and prevent insurers from dropping coverage without written proof the pregnancy ended, while requiring employees to notify employers in writing within 30 days after pregnancy concludes. The law takes effect July 1, 2025.

Topics ✓ HealthcareSupports HealthcareMandates continued employer-sponsored health coverage for terminated pregnant employees until pregnancy ends, preventing loss of access to healthcare services and protecting patient rights during vulnerable period.95% confidence ✓ Labor & EmploymentSupports Labor & EmploymentPrevents loss of health coverage for pregnant employees terminated due to pregnancy, protecting a key benefit during a vulnerable period per bill's explicit mandate.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · Senate Feb 12, 2025

SB 1261: Insurance Companies, Agents, Brokers, Policies - As introduced, imposes requirements for health insurance issuers using artificial intelligence, algorithms, or other software for utilization review or utilization management functions. - Amends TCA Title 8, Chapter 27; Title 56 and Title 71.

SB 1261 requires Tennessee health insurance companies, including TennCare and pharmacy benefits managers, to follow strict rules when using artificial intelligence (AI) for healthcare decisions like approving treatments. It mandates that AI tools must base decisions on individual patient medical history and provider recommendations - not just group data - and cannot replace licensed doctors in determining medical necessity. Insurers must disclose AI use in their policies, regularly review AI performance, and ensure patient data is handled securely under HIPAA. The law prohibits AI from discriminating or causing harm and treats violations as unfair claims practices, allowing patients to sue for damages.

Topics ✓ HealthcareSupports HealthcareRequires insurers to use AI based on individual patient data, disclose AI use, and maintain doctor involvement in medical necessity decisions - protecting patient rights and access to care.85% confidence ✓ TechnologySupports TechnologyMandates transparency, prohibits group-data reliance, and requires individualized AI decisions in healthcare to protect patient privacy and prevent biased outcomes, aligning with consumer protection regulations.95% confidence

Sub-Topics Insurance Prescription Drugs Artificial Intelligence

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