Subscription Contract and Certificate — Requirements — Terms and Conditions

  1. Law
  2. Tennessee Code
  3. Insurance
  4. Medical Service Plan Law, 1945
  5. Subscription Contract and Certificate — Requirements — Terms and Conditions

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Every contract entered into by a medical service plan corporation and a subscriber shall be in writing, and a certificate stating the terms and conditions of the contract shall be furnished the subscriber. No such subscription certificate shall be issued unless it contains the following provisions, and any other applicable provisions that may be required by this chapter or other applicable laws of this state:

  1. A statement of the amounts payable to the corporation by the subscribers and the times at which and manner in which the amounts shall be paid;
  2. A statement of the nature of the medical services to be paid for and the period during which the certificate is effective; and if there are any types of medical services to be excepted with the approval of the commissioner, a detailed statement of the exceptions printed as specified in this section;
  3. A statement of the terms or conditions, if any, upon which the certificate may be cancelled or otherwise terminated at the option of either party;
  4. A statement that the subscription and certificate constitute the contract between the corporation and the subscriber, and include the endorsements thereon and attached papers, if any, and contain the entire contract;
  5. A statement that no statement by the subscriber in the subscriber's application for a certificate shall void the contract or be used in any legal proceeding under the contract, unless the application or an exact copy of the application is included in or attached to the certificate, and that no agent or representative of the corporation, other than an officer or officers designated in the certificate, is authorized to change the contract or waive any of its provisions;
  6. A statement that if the subscriber defaults in making any payment under the certificate, the subsequent acceptance of a payment by the corporation or by one (1) of its duly authorized agents shall reinstate the certificate, but with respect to sickness and injury may cover only such sickness as may be first manifested more than a specified number of days, not exceeding ten (10) days, after the date of the acceptance;
  7. A statement of the period of grace that will be allowed a subscriber for making any payment due under the contract. The period shall not be less than ten (10) days during the first contract year, and thereafter shall be one (1) month, not less than thirty (30) days;
  8. A statement authorizing medical service by physicians other than participating physicians in cases of emergency or when consented to by the medical service corporation, or when the subscriber requires medical services outside the county or counties or area served by the medical service plan corporation, in which case money benefits shall be provided as optional and as specified in the subscriber's contract and approved as fair by the commissioner. Otherwise, a statement that indemnity in the form of cash will not be paid to any subscriber except in reimbursements paid by the subscriber to a physician and for which the corporation was liable at the time of the payment; and
  9. Any other statements that may be required by published regulations of the commissioner.


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