Limitation on Copayments or Coinsurance Amount Imposed for Primary Care Services Rendered During Visit to Physician Assistant

  1. Law
  2. Tennessee Code
  3. Insurance
  4. Policies and Policyholders
  5. Mandated Scope of Practice
  6. Limitation on Copayments or Coinsurance Amount Imposed for Primary Care Services Rendered During Visit to Physician Assistant

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  1. As used in this section:
    1. “Coinsurance” means a percentage of the contractual fee schedule applicable to a particular healthcare provider that a covered person must pay for covered services rendered by that provider under the terms of a particular health insurance policy or plan;
    2. “Copayment” means the specified dollar amount that a covered person must pay for covered services during a visit to a healthcare provider under the terms of a particular health insurance policy or plan;
    3. “Covered person” has the same meaning as set forth in § 56-7-110(a); and
    4. “Health insurance entity” has the same meaning as set forth in § 56-7-109(a), but does not include the government insurance plans created pursuant to title 8, chapter 27, and title 71, chapter 5.
  2. No health insurance entity shall impose on a covered person any copayment or coinsurance amount for services rendered during an office visit to a physician assistant licensed under title 63, chapter 19, and contracted or authorized as a primary care practitioner by that health insurance entity, that is greater than the copayment or coinsurance amount imposed on a covered person by that health insurance entity for the services rendered during an office visit to a physician licensed under title 63, chapter 6 or 9, and contracted or authorized by that health insurance entity as a primary care practitioner.
  3. Nothing in this section shall prevent a health insurance entity from instituting measures designed to maintain quality and to control costs, including, but not limited to, imposing lower copayment or coinsurance amounts for services rendered by providers with proven clinical outcomes.
  4. Nothing in this section shall apply to plans described in Section 1251 of the federal Patient Protection and Affordable Care Act (42 U.S.C. § 18011) and Section 2301 of the federal Health Care and Education Reconciliation Act.


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