(1) Availability of
any insurance contract shall not be denied to an insured or prospective insured
solely on the basis of sex or marital status of the insured or prospective
insured. The amount of benefits payable, or any term, conditions or type of
coverage shall not be restricted, modified, excluded, or reduced solely on the
basis of the sex or marital status of the insured or prospective insured except
to the extent the amount of benefits, term, conditions or type of coverage vary
as a result of the application of rate differentials permitted under the
Tennessee Insurance Code. However, nothing in this regulation shall prohibit an
insurer from taking marital status into account for the purpose of defining
persons eligible for dependents benefits. Specific examples of practices
prohibited by this regulationinclude but are not limited to the following:
(a) Denying coverage to females gainfully
employed at home, employed part-time or employed by relatives when coverage is
offered to males similarly employed.
(b) Denying policy riders to females when the
riders are available to males.
(c)
Denying maternity benefits to unmarried females covered under a contract if
maternity coverage is available to married females under such contract,
provided that this shall not be construed to require that benefits must be
payable for normal pregnancies under either group or individual insurance
contracts.
(d) Denying, under group
contracts, dependent coverage to husbands of female employees, when dependent
coverage is available to wives of male employees.
(e) Denying disability income contracts to
employed women when coverage is offered to men similarly employed.
(f) Treating complications of pregnancy
differently from any other illness or sickness under the contract.
Complications of pregnancy means:
1.
conditions, requiring hospital confinement (when the pregnancy is not
terminated), whose diagnoses are distinct from pregnancy but are adversely
affected by pregnancy or are caused by pregnancy, such as acute nephritis,
nephrosis, cardiac decompensation, missed abortion and similar medical and
surgical conditions of comparable severity, but shall not include false labor,
occasional spotting, physician-prescribed rest during the period of pregnancy,
morning sickness, hyperemesis gravidarum, and similar conditions associated
with the management of a difficult pregnancy not constituting a nosologically
distinct complication of pregnancy; and
2. non-elective cesarean section, ectopic
pregnancy which is terminated and spontaneous termination of pregnancy, which
occurs during a period of gestation in which a viable birth is not
possible.
(g)
Restricting, reducing, modifying, or excluding benefits payable for disorders
of the genital organs of only one sex.
(h) Offering lower maximum monthly benefits
to women than to men who are in the same classification under a disability
income contract.
(i) Offering more
restrictive benefit periods and more restrictive definitions of disability to
women than to men in the same classifications under a disability income
contract.
(j) Establishing
different conditions by sex under which the policyholder may renew a contract
or exercise benefit options contained in the contract.
(k) Limiting the amount of coverage an
insured or prospective insured may purchase based upon the insured's or
prospective insured's martial status unless such limitation is for the purpose
of defining persons eligible for dependents benefits.
(2) An insurer shall not refuse to insure, or
refuse to continue to insure, or limit the amount, extent or kind of coverage
available to an individual, or charge an individual a different rate for the
same coverage solely because of blindness or partial blindness; provided,
however, with respect to all other conditions, including the underlying cause
of the blindness or partial blindness, persons who are blind or partially blind
shall be subject to the same standards of sound actuarial principles or actual
or reasonably anticipated experience as are sighted persons.
(a) Refusal to insure includes denial by an
insurer of disability insurance coverage on the grounds that the policy defines
''disability'' as being presumed in the event that the insured loses his/her
eyesight. However, an insurer may exclude from coverage disabilities,
consisting solely of blindness or partial blindness when such condition existed
at the time the policy was issued.
