{"data":{"id":"us-tn/tenn.-code-ann.-56-7-2354","jurisdiction":"us-tn","citation":"Tenn. Code Ann. § 56-7-2354","heading":"Coverage for early detection of prostrate cancer","body":"(a) As used in this section: (1) \"Cost sharing requirement\" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense; (2) \"Health benefit plan\": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and (3) \"Men with a family history of prostate cancer\" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer. (b) A health benefit plan shall provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for: (1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (2) Men fifty (50) years of age and older; and (3) Other men, if a physician determines that early detection for prostate cancer is medically necessary. (c) (1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee. (2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code. (d) Notwithstanding subsection (b), a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 . Amended by 2024 Tenn. Acts, ch. 1003,s 2, eff. 7/1/2024. Acts 1997 , ch. 443, § 1.\nage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 . Amended by 2024 Tenn. Acts, ch. 1003,s 2, eff. 7/1/2024. Acts 1997 , ch. 443, § 1.\n(a) As used in this section: (1) \"Cost sharing requirement\" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense; (2) \"Health benefit plan\": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and (3) \"Men with a family history of prostate cancer\" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.\n(1) \"Cost sharing requirement\" means a deductible, coinsurance, copayment, or a maximum limitation on the application of a deductible, coinsurance, copayment, or other out-of-pocket expense;\n(2) \"Health benefit plan\": (A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer; (B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C\nle 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and (C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and\n(A) Means a hospital or medical expense policy; health, hospital, or medical service corporation contract; policy or agreement entered into by a health insurer; or health maintenance organization contract offered by an employer;\n(B) Includes a state insurance plan set out in title 8, chapter 27; a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5; and a policy or contract for health insurance coverage provided under the CoverKids program or a successor program provided for in title 71, chapter 3; and\n(C) Does not include policies or certificates covering only accident, credit, dental, disability income, long-term care, hospital indemnity, medicare supplement, as defined in § 1882(g)(1) of the Social Security Act ( 42 U.S.C. § 1395ss(g)(1) ), specified disease, or vision care; other limited benefit health insurance; coverage issued as a supplement to liability insurance; workers' compensation insurance; automobile medical payment insurance; or insurance that is statutorily required to be contained in any liability insurance policy or equivalent self insurance; and\n(3) \"Men with a family history of prostate cancer\" means men who have a first-degree relative: (A) Who was diagnosed with prostate cancer; (B) Who developed prostate cancer; (C) Whose death was a result of prostate cancer; (D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or (E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.\n(A) Who was diagnosed with prostate cancer;\n(B) Who developed prostate cancer;\n(C) Whose death was a result of prostate cancer;\n(D) Who has been diagnosed with a cancer known to be associated with an increased risk of prostate cancer; or\n(E) Who has a genetic alteration known to be associated with an increased risk of prostate cancer.\n(b) A health benefit plan shall provide, upon the recommendation of a physician, coverage for the early detection of prostate cancer for: (1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer; (2) Men fifty (50) years of age and older; and (3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.\n(1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer;\n(2) Men fifty (50) years of age and older; and\n(3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.\nt early detection for prostate cancer is medically necessary.\n(1) Men forty (40) to forty-nine (49) years of age who are at a high risk of developing prostate cancer, including African-American men and men with a family history of prostate cancer;\n(2) Men fifty (50) years of age and older; and\n(3) Other men, if a physician determines that early detection for prostate cancer is medically necessary.\n(c) (1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee. (2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code.\n(1) Except as provided in subdivision (c)(2), a health benefit plan that provides coverage for the early detection of prostate cancer must provide such coverage without imposing a cost sharing requirement on the enrollee.\n(2) If compliance with subdivision (c)(1) would result in a high deductible health benefit plan with a health savings account becoming ineligible under § 223 of the Internal Revenue Code ( 26 U.S.C. § 223 ), then subdivision (c)(1) applies to such plans only after the plan enrollee has satisfied the minimum deductible required under § 223 of the Internal Revenue Code, except with respect to items or services that are deemed preventive care pursuant to § 223(c)(2)(C) of the Internal Revenue Code.\n(d) Notwithstanding subsection (b), a policy or contract for health insurance coverage provided under the TennCare medical assistance program or a successor program provided for in title 71, chapter 5, or the CoverKids program or a successor program provided for in title 71, chapter 3, must provide coverage pursuant to this section when determined to be medically necessary pursuant to § 71-5-144 .","path":["TN Code","Title 56","Chapter 7"],"source_url":"https://oss-data-us.vaquill.ai/v2026.08/us_tn_statutes.parquet","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:26Z","sha256":"7970c3c561e948b43d19a38443e35a15785f77e9607e3426cbc2be97294449cd","source_id":"us-tn","stale":false,"prev":"us-tn/tenn.-code-ann.-56-7-2353","next":"us-tn/tenn.-code-ann.-56-7-2355"},"notice":"GroundRules: Original legal text. Not legal advice."}