Free Tennessee Accident & Health practice questions

Answer: B. It may not be issued or renewed in Tennessee while it contains that reduction clause.

Tenn. Code Ann. Sec. 56-7-2323 bars an insurer, hospital service corporation or medical service corporation from issuing or renewing a group accident and sickness policy whose terms exclude or reduce benefits because the insured has been paid, or is also payable, under a blanket group or franchise school accident policy. The bar applies regardless of who makes the premium contribution, so it does not matter whether the school or the family paid for the school coverage. The section offers no exception for wording the commissioner approves and none for benefits above actual expenses.

Answer: A. The originating site

The statute defines the originating site as the place where the patient is located that starts the telehealth service to another qualified site, so the clinic where the patient sits is the originating site. Distant site is not the statutory label for the patient's location. A telehealth provider is a healthcare services provider delivering care through telehealth, which is a person rather than a location, and store-and-forward describes asynchronous transmission of data rather than a real-time video visit.

Answer: C. Yes, because the benefit reduction restriction does not reach a policy fully paid by the school.

Tenn. Code Ann. Sec. 56-7-2324 generally forbids a student accident policy, whatever its contract form, from reducing benefits because the student has group or individual health coverage. The section then carves out student accident coverage where the school or institution is the policyholder and pays 100 percent of the premium with no contribution from any insured, parent or guardian. The district here is the policyholder and pays everything, so the restriction does not apply. The exception turns on the school paying the whole premium, not the parents, and the restriction treats group and individual health contracts alike, so the type of other coverage is not the test.

Answer: D. They have a common employer for clinical practice

The statute defines a practice group as two or more healthcare services providers who share a common employer for purposes of their clinical practice. A shared specialty, a shared building or participation in the same insurer's network does not create a common employer, so none of those meets the definition.

Answer: D. A maximum of $50,000 in total benefits paid for a member in any twelve-month period

Tenn. Code Ann. Sec. 56-7-2360(a)(1)(B) defines an annual limit as a dollar limitation on the total benefits that may be paid in a twelve-month period for an individual or other coverage unit, which describes the $50,000 maximum. A yearly cap on the number of visits is a treatment limitation under the same section, because it limits visits rather than dollars paid. A deductible is a financial requirement, a term the section defines to include deductibles while excluding annual limits. Refusing a costlier therapy until a lower-cost one is shown ineffective is a fail-first protocol, which the section lists among non-quantitative treatment limitations.

Answer: B. Starting at the very moment the child is born

Tennessee requires individual and group health policies that pay on an expense-incurred basis, and nonprofit service or indemnity contracts, to extend any child benefits they provide to a newborn child of the insured or subscriber from the moment of birth. Coverage therefore does not wait until the insurer is notified of the birth, until 31 days have passed, or until the infant goes home from the hospital. Each of those choices names a later starting point, and the statute sets the start at birth.

Answer: A. A dollar cap on the total amount a health plan may pay in benefits for an individual or other coverage unit

Under Tenn. Code Ann. Sec. 56-7-2360(a)(1)(A), an aggregate lifetime limit is a dollar limitation on the total amount payable in benefits under a health plan for an individual or other coverage unit. A dollar cap measured over a twelve-month period is a separate defined term in the same section, the annual limit. A cap on visits or days of treatment is a treatment limitation, which the section defines by frequency, visits, days or similar limits rather than by dollars. Deductibles, copayments, coinsurance and out-of-pocket expenses are financial requirements, and the section's definition of that term expressly excludes aggregate lifetime and annual limits.

Answer: A. Preventive care benefits

Sec. 56-7-2360(a)(1)(C)(i) defines the classifications of benefits as six categories: inpatient in-network, inpatient out-of-network, outpatient in-network, outpatient out-of-network, prescription drug, and emergency care benefits. Inpatient out-of-network, prescription drug, and emergency care benefits each appear on that list. Preventive care is not one of the six.

Answer: C. Encourage use of basic group benefits for dependency care while preserving the consumer's choice of coverage

Tenn. Code Ann. Sec. 56-7-2602(a) states that the section aims to encourage consumers to take advantage of basic group health benefits for treating alcohol and other drug dependency, and to protect the consumer's right to choose coverage that fits his or her medical-economic needs. The clause speaks of group coverage and of the consumer's freedom to choose, which a compulsory mandate on every individual policy would contradict. Nothing in the purpose clause describes holding dependency benefits below physical illness benefits or moving the cost to a program run by the department.

Answer: B. Yes, because such a contract is an alternative to shared ownership

The statute defines a healthcare system as two or more healthcare organizations affiliated either through shared ownership or through a contractual relationship that controls payment terms and service delivery. Either form of affiliation is enough, so a qualifying contract makes A and B a healthcare system without a common owner. Two organizations meet the numerical requirement, and the definition says nothing about membership in an insurer's network.