Healthcare (Insurance)

signed · Tennessee · House Apr 28, 2025

HB 37: Opioids - As enacted, authorizes an insurer, for purposes of group insurance plans offered to state employees, to adopt or amend a state preferred drug list (PDL); requires the insurer to ensure that a non-opioid drug approved by the U.S. food and drug administration for the treatment or management of pain is not disadvantaged or discouraged with respect to coverage relative to an opioid or narcotic drug for the treatment or management of pain on the PDL. - Amends TCA Title 8; Title 53; Title 56; Title 63; Title 68 and Title 71.

HB 37 requires insurers offering health plans to Tennessee state employees to treat FDA-approved non-opioid pain medications equally with opioids on their preferred drug lists (PDL). It prohibits insurers from discouraging coverage for non-opioid options used for pain management, though it allows insurers to prefer one opioid over another or one non-opioid over another. This applies specifically to state employee group insurance plans covered under Tennessee Code Annotated sections 56-7-3801 to 56-7-3803. The law, effective January 1, 2026, aims to expand access to non-opioid pain treatments without mandating their preference.

Topics ✓ HealthcareSupports HealthcareRequires insurers to treat FDA-approved non-opioid pain meds equally with opioids in state employee plans, improving patient access to alternatives and reducing opioid reliance.95% confidence

Sub-Topics Insurance Substance Abuse

in committee · Tennessee · House Mar 12, 2025

HB 595: Insurance, Health, Accident - As introduced, enacts the "Freedom to Grow Our Tennessee Families Act." - Amends TCA Title 56 and Title 71.

HB 595, the "Freedom to Grow Our Tennessee Families Act," requires Tennessee health insurers to cover specific fertility services starting January 1, 2026. It mandates coverage for fertility diagnostic care, treatment (to achieve pregnancy), and preservation services (like egg freezing), including at least three egg retrievals with unlimited embryo transfers. The law prohibits insurers from denying coverage based on medical history (e.g., cancer treatment), using donor gametes, or discriminating due to race, gender, or relationship status. It also bans waiting periods and requires insurers to base coverage limits solely on medical guidelines from established fertility organizations. This directly affects Tennessee residents with health insurance plans and the state’s health insurers.

Topics ✓ HealthcareSupports HealthcareMandates insurer coverage for fertility services including diagnostics, treatment, and preservation, prohibiting denial based on medical history. Expands access to reproductive healthcare services.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · Senate May 14, 2026

SB 435: 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.

SB 435 requires Tennessee health insurers and TennCare to cover biomarker testing for diagnosis, treatment, or monitoring of diseases starting January 1, 2026. Biomarker testing - medical tests analyzing genes, proteins, or other biological markers - must be covered when supported by FDA approvals, clinical guidelines, or evidence-based standards. Insurers must process prior authorization requests within 24 hours for urgent cases and 72 hours for non-urgent ones, while ensuring coverage avoids repeated biopsies. This affects all private health benefit plans and TennCare enrollees by mandating coverage for specific, evidence-based diagnostic and treatment tests.

Topics ✓ HealthcareSupports HealthcareMandates insurers and TennCare to cover biomarker testing for diagnosis/treatment per clinical guidelines, expanding patient access to essential diagnostics starting 2026.95% confidence

Sub-Topics Insurance

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passed · Tennessee · House Apr 6, 2026

HB 1061: Insurance, Health, Accident - As introduced, prohibits an out-of-network ambulance service provider from balance billing an enrollee in a health benefit plan for emergency ambulance services; establishes allowable billable costs for such services. - Amends TCA Title 56, Chapter 7 and Title 68, Chapter 140.

HB 1061 prohibits out-of-network ambulance providers from charging patients extra fees (balance billing) for emergency ambulance services covered under their health insurance plan. It directly affects patients using emergency ambulance services who are enrolled in health benefit plans, ensuring they pay no more than the lesser of their in-network copay, the ambulance bill, or 325% of the Medicare rate for similar services in their area. The bill requires health insurers to count patient payments toward their deductibles and out-of-pocket limits, and bans providers from asking patients to waive these protections. The law takes effect July 1, 2025, for health plans issued or renewed on or after that date.

Topics ✓ HealthcareSupports HealthcareProhibits out-of-network ambulance balance billing, limits patient costs to in-network copays or 325% Medicare rate, directly protects patient rights and improves access to emergency care.95% confidence

Sub-Topics Insurance Medicare

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signed · Tennessee · Senate Apr 30, 2025

SB 437: Insurance, Health, Accident - As enacted, revises certain protocols for mental health and substance abuse services. - Amends TCA Title 56 and Title 71.

SB 437 requires most health insurance plans in Tennessee to cover mental health and substance abuse services through a specific integrated care model called the Psychiatric Collaborative Care Model (PCCM), effective July 1, 2025. This model involves primary care providers, care managers, and psychiatric consultants working together to coordinate patient treatment using validated tools and regular assessments. Insurance plans may deny coverage only if they comply with existing state and federal mental health parity laws (including the MHPAEA) and medical necessity standards. The requirement applies to TennCare and CoverKids programs when services are deemed medically necessary by program guidelines.

Topics ✓ HealthcareSupports HealthcareMandates insurance coverage for mental health/substance abuse via PCCM, expanding access and support per bill requirements.95% confidence

Sub-Topics Insurance Mental Health Substance Abuse

in committee · Tennessee · House Mar 19, 2025

HB 651: Insurance, Health, Accident - As introduced, prohibits a health insurance entity or TennCare MCO from including an all-products clause in a network participation agreement with a healthcare provider, and makes certain other changes related to MCO network adequacy. - Amends TCA Title 56 and Title 71.

HB 651 prohibits health insurance companies and TennCare managed care organizations (MCOs) from including "all-products clauses" in contracts with healthcare providers. These clauses would force providers (like doctors, nurses, and physician assistants) to join multiple networks or offer services under other plans from the same insurer as a condition of participation. The bill makes such clauses void and imposes a $10,000 civil penalty per violation on insurers. It requires the insurance commissioner to create rules by July 2026 to enforce this prohibition, directly affecting provider contracts and network access.

Topics ✓ HealthcareSupports HealthcareBans restrictive 'all-products clauses' forcing providers into multiple insurer networks, improving provider choice and access to care.95% confidence

Sub-Topics Insurance

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in committee · Tennessee · House Jan 28, 2025

HB 70: TennCare - As introduced, requires a TennCare health benefit plan renewed or issued on or after July 1, 2025, by a health insurance carrier to provide coverage and reimbursement for biomarker testing for preeclampsia in pregnant women. - Amends TCA Title 56; Title 63; Title 68 and Title 71.

HB 70 requires TennCare health benefit plans (renewed or issued on or after July 1, 2025) to cover and reimburse biomarker testing for preeclampsia in pregnant women. This directly affects pregnant women enrolled in Tennessee's Medicaid program (TennCare) and the health insurance carriers providing their coverage. The bill mandates that testing must be ordered by a physician, conducted by the prenatal care provider using FDA-approved methods, and follow clinical guidelines. It also allows TennCare to create rules and seek federal approval to ensure Medicaid coverage for this testing.

Topics ✓ HealthcareSupports HealthcareMandates TennCare coverage for preeclampsia biomarker testing, expanding access to critical prenatal care for pregnant women.95% confidence

Sub-Topics Insurance Medicaid Women's Health

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introduced · Tennessee · House Feb 5, 2025

HB 508: Insurance, Health, Accident - As introduced, extends from 30 to 60 days the period of time following delivery of a medicare supplement policy or certificate during which an applicant may have the premium refunded, and about which each medicare supplement policy or certificate must have notice prominently printed on the first page of the policy or certificate. - Amends TCA Title 4, Chapter 3, Part 13; Title 8; Title 55, Chapter 12; Title 56 and Title 71.

HB 508 extends the refund period for Medicare supplement policies (Medigap) in Tennessee from 30 to 60 days after policy delivery. This change directly affects consumers who purchase these policies, giving them more time to review coverage and request a premium refund if unsatisfied. The bill requires all policies to include a clear notice about the 60-day refund window prominently on the first page. It will take effect January 1, 2026, for policies delivered on or after that date.

Topics ✓ HealthcareSupports HealthcareExtends Medigap refund window to 60 days, enhancing consumer protection and decision-making rights in healthcare insurance policies.85% confidence

Sub-Topics Insurance Medicare

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passed · Tennessee · House Mar 11, 2025

HB 27: Abortion - As introduced, enacts the "Reproductive Freedom Act." - Amends TCA Title 4; Title 5; Title 6; Title 7; Title 20; Title 29; Title 37; Title 39; Title 49; Title 53; Title 56; Title 63; Title 68 and Title 71.

HB 27, titled the "Reproductive Freedom Act," establishes a new legal framework protecting reproductive healthcare access in Tennessee. It defines "reproductive health care" to include abortion, contraception, prenatal care, and related services, and affirms individuals' fundamental rights to make decisions about their reproductive health without state interference. The bill requires health insurance plans to cover reproductive health care (Section 15) and repeals multiple existing state laws that restricted abortion access or imposed criminal penalties for reproductive care (Sections 2-22). This legislation directly affects all Tennesseans seeking reproductive healthcare by removing legal barriers and mandating coverage under state-regulated insurance plans.

Topics ✓ HealthcareSupports HealthcareRequires insurance coverage for reproductive health care (including abortion, contraception) and protects access without state interference, expanding coverage and protecting patient rights per bill summary.95% confidence

Sub-Topics Insurance Women's Health

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in committee · Tennessee · Senate Mar 25, 2025

SB 1372: Insurance, Health, Accident - As introduced, prohibits a health insurance entity or TennCare MCO from including an all-products clause in a network participation agreement with a healthcare provider, and makes certain other changes related to MCO network adequacy. - Amends TCA Title 56 and Title 71.

SB 1372 prohibits health insurers and TennCare managed care organizations (MCOs) from requiring healthcare providers (such as doctors, nurses, and physician assistants) to join multiple networks or offer services under different plans as a condition for participating in their provider networks. This "all-products clause" ban directly affects providers who previously faced pressure to accept bundled contracts. Violations carry a $10,000 civil penalty per occurrence, and the commissioner must create implementing rules by July 2026. The bill aims to improve provider network access, particularly in rural areas, by reducing restrictive contracting practices.

Topics ✓ HealthcareSupports HealthcareProhibits restrictive 'all-products clauses' forcing providers into multiple networks, improving provider access and network adequacy per bill summary.92% confidence

Sub-Topics Insurance

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