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Tennessee - Compensation & Benefit Legislation

TENNESSEE - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

TENNESSEE - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care coverage. Pediatric nursery care is an employer option.

 

Preventive care for children: No.

 

(Tennessee Code Ann. Sections 56-7-2301, 56-7-2302, 56-7-2304)

 

TENNESSEE - ALCOHOLISM & DRUG ABUSE

Employer option.

 

Minimum yearly inpatient coverage: Policy must provide coverage that is not less than the coverage it provides for physical illness.

 

Minimum yearly outpatient coverage: Policy must provide coverage that is no less than the coverage it provides for physical illness.

 

Minimum lifetime coverage: no statutory requirements.

 

(Tennessee Code Ann. Sections 56-7-1009, 56-7-2601, 56-7-2602)

 

TENNESSEE - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: Tennessee has no income tax on wages. For state Unemployment Insurance purposes, the total amount of employees' salary reductions and any cash that the employee has the option to receive (whether or not the employee chooses the cash option) is taxable.

 

TENNESSEE - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

TENNESSEE - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (Tennessee Admin. Code 780-1-53)

 

TENNESSEE - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

TENNESSEE - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: All employers.

 

Applicant Testing: Applicant testing is allowed.

 

Employee Testing: Employee testing is allowed if there is a reasonable suspicion of drug or alcohol abuse by such employee. Employees may also be tested after an accident and as part of a routine fitness-for-duty physical.

 

How Test Results are Used: Test results may be used for disciplinary action, including termination. Employer may not discipline, discharge, or refuse to hire on a basis of a positive test result that has not been verified by a confirmation test and a medical review officer.

 

Enforcement of Statutes: State has no statutory requirements.

 

Employee Remedies: State has no statutory requirements.

 

Employer Penalties: State has no statutory requirements.

 

Who Pays for Testing: Employer shall pay the cost of all drug tests that the employer requires of the employee.

 

Employee Assistance Benefits: Employer's Drug Policy Statement must include names and telephone numbers of EAP and drug and alcohol rehabilitation programs. Employer is not required to provide these programs.

 

Other Requirements: Prior to testing employer shall give all employees and job applicants a written policy statement on alcohol and drug testing.

 

(Tennessee Code Ann. Sections 50-9-101 thru 50-0-112.)

 

TENNESSEE - GROUP HEALTH CODE ADDITIONS (MANDATED)

Alcoholism, Drug Abuse, and Mental Health Treatment: Insurers must offer to policyholders coverage of expenses arising from psychiatric disorders, mental or nervous conditions, alcoholism, or drug dependency, allowing 30 outpatient visits per year. (Tennessee Code Ann. Sections 56-7-1003, 56-7-1009.)

 

Authorizations: Verbal authorizations which are given to group health care providers (HMOs and managed care organizations included) or to insured individuals must be confirmed by written authorizations, facsimile transmissions, or verbally by means of confirmation numbers or other confirmation codes. (S321, 1997) (Tennessee Code Ann. Section 56-2-1.)

 

Breast Reconstruction: Group health policies (HMOs included) which provide coverage for mastectomy must provide coverage for all stages of reconstructive breast surgery on the diseased breast following a mastectomy. Also, policies must cover surgery performed on a non-diseased breast to establish symmetry between the breasts in a manner agreed upon by a patient and an attending physician. Reconstructive surgery on a non-diseased breast must occur within five years of a mastectomy. (H697, 1997) (Tennessee Code Ann. Section 56-7-25.)

 

Coverage Continuation and Conversion: Group hospital, surgical, and medical policies must provide continuation rights of up to three months and subsequent conversion rights to employees whose coverage terminates for any reason but discontinuation of the policy, in which case conversion rights must be provided. Continuation rights of up to 15 months and subsequent conversion rights must be provided to spouses and dependents who cease to be eligible due to divorce or death of the insured. (Tennessee Code Ann. Section 56-7-1501.)

 

Dental Procedures: Health care insurers must provide minors age eight and younger with coverage for inpatient and outpatient hospital care, including anesthesia and physician services, for dental procedures which cannot be performed safely in an office setting. (S878, 1997) (Tennessee Code Ann. Section 56-7-1005.)

 

Dependents: Policies limiting coverage of dependents to a certain age group must cover dependent up to age 24 unless otherwise ineligible. (Tennessee Code Ann. Section 56-7-1005.)

 

Diabetes: Effective January 1, 1998, health care insurers (HMOs, PPOs, and managed care organizations included) must provide coverage for equipment, supplies, and outpatient self-management training and education as prescribed by a physician as medically necessary for the treatment of diabetes. Covered diabetes needs include blood glucose monitors and blood glucose monitors for the legally blind; test strips for blood glucose monitors; visual reading and urine test strips; insulin; injection aids; syringes; lancets, insulin pumps, infusion devices and appurtenances; oral hypoglycemic agents; podiatric appliances; and glucagon emergency kits. (S1573, 1997) (Tennessee Code Ann. Section 56-7-26.)

 

Disclosure of Information: Providers must not be prohibited from disclosing to patients the existence of financial arrangements with health plans in which the provider is rewarded when a plan reduces or limits the range and amount of medically necessary and appropriate services rendered to participants. (S629, 1997) (Tennessee Code Ann. Sections 56, 63, 68, 71.)

 

Domestic Violence: Health insurers must not unfairly discriminate against victims of domestic abuse on the basis of their abuse status by denying, refusing, limiting, excluding, canceling, or otherwise terminating coverage. Also, insurers must not assign premium differentials to victims of domestic violence, or disclose or transfer information relating to an individual's abuse status or abuse related medical condition, except for specified acceptable purposes. (H2925, 1996) (Tennessee Code Ann. Section 56.)

 

Emergency Services: Effective January 1, 1998, health care policies must not deny coverage to an individual or to a family member for emergency services if medical symptoms indicate that an emergency situation may have occurred. In emergency situation, services must be covered whether prior authorization for such services was obtained and whether an emergency care provider has a contractual agreement with the policy to provide such services. (H1066, 1997) (Tennessee Code Ann. Sections 56-7-23, 68-140-3.)

 

Genetic Information: Health insurers must not deny or cancel coverage for an individual or for a family member of an individual on the basis that genetic services have been requested or received. Insurers must not request a covered individual or prospective enrollee to submit to genetic testing or require an individual to disclose genetic testing results to a provider. Providers must not disclose genetic information without prior written authorization from individuals or from their legal representatives. (H413, 1997)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Tennessee Code Ann. Section 56-7-1005.)

 

Mammography Screening: Policies covering mastectomy must cover mammography screening as described. (Tennessee Code Ann. Section 56-7-1005.)

 

Maternity: Health care policies, including HMOs, which cover maternity care must provide inpatient hospitalization benefits for a mother and her newborn child for a minimum of 48 hours following a vaginal birth and for a minimum of 96 hours following a Caesarean section. (S2379, 1996) (Tennessee Code Ann. Section 56-7-25.) Disclosure of Information: Maternity care provisions must be supplied in writing to individuals covered under a health care plan in their next scheduled mailing or on a yearly basis. (S2379, 1996, H2364, 1996) (Tennessee Code Ann. Section 56-7-25.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury of sickness, including treatment of medically diagnosed congenital defects and birth abnormalities, in addition to coverage for infants placed in well child care. (Tennessee Code Ann. Section 56-7-1001.) Nursery care: Insurers must make available to group policyholders with maternity benefits coverage for pediatric nursery care for newborns. (Tennessee Code Ann. Section 56-7-1001.)

 

Osteoporosis. Group health insurance policies, including HMOs, which provide coverage for accident and health services must also provide individuals who are thought to be at risk of developing the disease with benefits for bone mass measurement (bone density testing) for the prevention, diagnosis, and treatment of osteoporosis. (S2833, H2484, 1996) (Tennessee Code Ann. Section 56-7-25.)

 

Phenylketonuria: Health care policies (including HMOs) must cover costs for treatment of children with phenylketonuria. Covered treatments for phenylketonuria, a rare inherited genetic disorder, include licensed professional medical services provided under the supervision of a physician and dietary formulas which are medically necessary (S165, H151, 1995) (Tennessee Code Ann. Section 56-7-25.)

 

Policies for Small Employers Small employer carriers who offer health coverage insurance under a basic or standard plan to small employers must offer such coverage to all eligible employees of the small employer and their dependents. Small employer carriers may not offer such coverage to only certain individuals in a small employer group or to only part of the group, except in the case of late enrollees. (Tennessee Code Ann. Section 56-7-2209(a).)

 

Prescription Drugs: Health care insurers which provide prescription drug benefits must not exclude coverage of drugs for particular indications on the basis that they have not been approved by the FDA for an indication. In order for such drugs to be covered, they must be recognized for treatment of such indication in one of the standard reference compendia, or in medical literature. Coverage also must include benefits for medically necessary services associated with the administration of a drug. Experimental drugs and those which the FDA has determined to have contraindications must not be covered. (S834, 1997) (Tennessee Code Ann. Section 56-7-23.)

 

Prostate Cancer Screening: Health care policies must provide benefits for prostate cancer screening for men aged 50 and over and for other men if determined to be medically necessary by a physician. (H570, 1997)

 

Providers: Optometrists, clinical psychologists, podiatrists, social workers, chiropractors, dentists, audiologists, and speech pathologists: Costs of services must be covered if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (Tennessee Code Ann. Sections 56-7-108, 56-7-116, 56-7-1011.) Psychiatric hospitals: Insurers must deny coverage solely because a psychiatric hospital has no surgical facilities if surgical services are provided under contract with another facility. (Tennessee Code Ann. Sections 56-7-1003, 56-7-1004.)

 

Sterilization: Policies covering sterilization cannot deny coverage based on the reason given for the sterilization. (Tennessee Code Ann. Section 56-7-1006.)

 

TENNESSEE - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

TENNESSEE - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: No.

 

Percent of employees who must elect coverage (if employees pay part of premium): No statutory requirements.

 

Percent of employees who must be covered if employer pays all of premium: No statutory requirements.

 

Minimum number of employees in group plan: No statutory requirements.

 

Employer prohibited as beneficiary: No statutory requirements.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(Tennessee Code Ann. Section 56-7-2305)

 

TENNESSEE - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving. Other: All days appointed by the Governor or President. If holiday falls on Sunday, following Monday is a holiday; if holiday falls on Saturday, preceding Friday is a holiday. (Tennessee Code Ann. Sections 15-1-101, 15-2-101 through 15-2-106, 15-2-108)

 

TENNESSEE - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

TENNESSEE - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes except for employer with fewer than 5 employees and any temporary employee who has worked less than 6 months.

 

Remedies and Penalties: Violator is guilty of a Class A misdemeanor. Employee may bring civil action for reinstatement, lost wages, and benefits.

 

Other Requirements: Employee must give employer prior notice the next working day after receiving a summons to report to jury duty. Employer is required to pay full compensation minus compensation employee receives for jury service. Railroad employees who are paid based on mileage will receive same mileage pay as if they had reported for work. (Tennessee Code Ann. 22-4-108.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

TENNESSEE - LEAVES OF ABSENCE

Employers Subject to Leave Laws: Employers with 100 or more employees.

 

Criteria for Eligibility: Mothers of newborn or adopted children who have been employed full time for 12 consecutive months prior to leave.

 

Maximum length of leave: 4 months; can be extended with paid time off.

 

Paid Leave: Employer discretion.

 

Acceptable Reasons for Leave: Birth/adoption of a child; pregnancy.

 

Employment Guarantees After Leave: Entitled to reinstatement in position held prior to leave or equivalent position if employee gives 3 months prior notice. Failure to reinstate position is acceptable if position previously held was so unique that employer could not fill position temporarily after reasonable efforts.

 

Use of Vacation or other Time-off Benefits: State reports no statutory requirements.

 

Certification Required: State reports no statutory requirements.

 

Effect Of Leave on Other Benefits: Employee's obligation to pay for benefits while on leave, unless employer pays benefits during other types of leave.

 

Effect of Seniority Accrual During Leave: Seniority does not accrue during leave.

 

Minimum Requirements for Notification to Employer: 3 months prior notice is required, plus declaration of intent to return to work.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Tennessee Code Ann. Section 4-21-408.)

 

See U.S. Federal Family and Medical Leave Act

 

TENNESSEE - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

TENNESSEE - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, social workers, and nurse midwives. Mandatory coverage for nurse practitioners, nurse anesthetists, clinical nursing specialists, audiologists and speech pathologists. (Tennessee Code Ann. Sections 56-7-2401-56-7-2405, 56-7-2407, 56-7-2408, 56-7-2603)

 

TENNESSEE - MENTAL HEALTH CARE

Mandatory coverage unless excluded or rejected.

 

Minimum yearly inpatient coverage: 20 days

 

Minimum yearly outpatient coverage: 24 visits

 

Minimum lifetime coverage: Policy must provide coverage that is not less than the coverage it provides for physical illness.

 

(Tennessee Code Ann. Sections 56-7-1003,56-7-2601)

 

TENNESSEE - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

State reports no statutory requirements.

 

See U.S. Minimum Wage

 

TENNESSEE - NEW HIRE REPORTING

Who is required to report: All Employers.

 

Who must be reported: All employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4, or at the option of the employer, an equivalent form containing the same data. Report may be transmitted by first class mail, magnetically, or electronically in a format approved by the State.

 

Filing deadline: Within 20 business days of hire.

 

Employer information to be included: Name, address, and EIN.

 

Employee information to be included: Name, address, and SSN.

 

Penalty for failure to report: After notice, fine of $20 may be imposed. $400 if failure is due to conspiracy between employer and employee.

 

(Tennessee Code Ann. Sections 36-5-1102)

 

TENNESSEE - NEWBORN CARE MANDATE

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury of sickness, including treatment of medically diagnosed congenital defects and birth abnormalities, in addition to coverage for infants placed in well child care. (Tennessee Code Ann. Section 56-7-1001.)

 

TENNESSEE - OVERTIME COMPENSATION REQUIREMENTS

State reports no statutory requirements.

 

TENNESSEE - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

TENNESSEE - PRE-EXISTING CONDITIONS

For insurance plans offered to small employers, pre-existing condition provision may not limit coverage beyond 12 months following the insured's effective date of coverage. (Tennessee Code Ann. Sections 56-7-2203, 56-7-2208, 56-7-2209)

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

TENNESSEE - PROTECTED CLASSIFICATIONS

Age:  Yes, age 40 and over.

Race:   Yes.

Color:   Yes.

National Origin:   Yes.

Ancestry:   Yes.

Religion:  Yes.

Sex:   Yes.

Pregnancy:  No specific law. State has expressed policy against discrimination.

Sexual Harassment:  No specific law. State has expressed policy against discrimination.

 

(Tenn. Code Ann. Sections 4-21-102, 4-21-301, 4-21-401, 4-21-407.)

 

TENNESSEE - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

TENNESSEE - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

TENNESSEE - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Under the general wage payment statute, on the 5th of the month, for work prior to 16th of previous month, or 20th of month for work prior to 1st of month.

 

Date due if employee resigns: : Under the general wage payment statute, on the 5th of the month, for work prior to 16th of previous month, or 20th of month for work prior to 1st of month.

 

Wages: Yes. (Wages or other compensation.)

 

Vacation Pay No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(Tennessee Code Ann. Section 50-2-103)

 

TENNESSEE - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: No.

 

(Tennessee Code Ann. Sections 50-7-402, 50-7-403, 50-7-701, 50-7-707.)

 

TENNESSEE - VACATION PAY

State reports no statutory requirements.

 

TENNESSEE - VOTING TIME OFF

Reasonable time not to exceed 3 hours as long as employee does not have 3 hours away from work while the polls are open. Employer may specify the hours during which employee may be absent. (Tennessee Code Ann. Sections 2-1-106, 2-19-134, 2-19-135.)

 

TENNESSEE - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employers of 5 or more employees. Corporate officers may reject coverage. Elective as to employer performing labor incidental to job.

 

Public Employers: Voluntary as to state and political sub-divisions.

 

Exceptions: Farm labor, domestic servants, casual employees, employees of interstate common carriers, and voluntary ski patrol persons.

 

Special Coverage Provisions: Voluntary as to employers of less than 5 employees.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)