What State Law Requires a Group Plan to Cover in Tennessee

The honest answer to this question is that we could not read Tennessee’s codified insurance compilation, and we are therefore not going to tell you what it does or does not require a group plan to cover. What we can do is show you exactly what was sought and what came back, then build the page on the sources that are readable: the federal floor every small group plan in Tennessee sits on, the federal mechanism by which any state adds something on top of that floor, and Tennessee’s own enacted acts, published by the Secretary of State and readable in full.

That is a smaller answer than most pages on this question give you. It is also the only one we can stand behind.

What was sought, at which address, and what came back

The Tennessee Department of Commerce and Insurance maintains a Rules and Laws page, and that page tells visitors, in its own words, to “review Tennessee insurance statutes, use the Laws link and search under Tenn. Code Ann. Title 56, Insurance.” That is the correct starting point, published by the regulator itself, and it is the one we used.

The Laws link redirects to a subscription legal research container. The response comes back at 3,702 bytes of HTML. What is inside it is a cookie test and a browser-fingerprinting routine that ends by redirecting the visitor onward. Searching the returned document for the things a statute page would contain — a Title 56 section number, the phrase “Tenn. Code,” the word “Chapter,” the word “coverage,” even the word “insurance” — returns nothing at all. There is no statutory text in the document at any point.

That is not an error page and it is not an empty result. It is a shell that expects a subscription session, and an ordinary reader following the Department’s own instructions does not get law out of it. So the operative Tennessee insurance code was sought, at the address the regulator publishes for it, and it could not be read.

Tennessee’s rules and Tennessee’s acts are a different matter entirely

This is the distinction that gets collapsed, and collapsing it produces a false and rather insulting claim about Tennessee.

Tennessee’s administrative rules are published by the Secretary of State in the Official Compilation of Rules and Regulations. The insurance chapters download as ordinary documents carrying real text, and they are substantive — the chapter governing form and rate filings for health coverage subject to the Affordable Care Act is right there, readable, with its scope provision, its filing requirements and its administrative history intact.

Tennessee’s enacted acts are published the same way. The Secretary of State posts enrolled acts as primary-source documents, which means a specific Tennessee enactment can be read as passed rather than as somebody later described it. We read one in full for this page.

So the accurate statement is narrow and specific: Tennessee’s codified compilation is not readable by an ordinary visitor through the route the Department publishes. Tennessee’s rules and Tennessee’s session laws are. Those are different claims about different documents, and only the first one is a limit on this page.

The federal floor is fully readable, and it is where to start

Whatever Tennessee does or does not add, every fully-insured small group plan sold in Tennessee sits on a federal floor, and that floor is readable end to end.

45 CFR 147.150 does the work of applying it: an issuer offering coverage in the individual or small group market “must ensure that such coverage includes the essential health benefits package,” effective for plan or policy years beginning on or after January 1, 2014.

45 CFR 156.110(a) then sets out what that package is built from. An EHB-benchmark plan must “provide coverage of at least the following categories of benefits”:

• ambulatory patient services
• emergency services
• hospitalization
• maternity and newborn care
• mental health and substance use disorder services, including behavioral health treatment
• prescription drugs
• rehabilitative and habilitative services and devices
• laboratory services
• preventive and wellness services and chronic disease management
• pediatric services, including oral and vision care

Further provisions of the same section are worth knowing. Paragraph (e) requires an issuer to “ensure an appropriate balance among the EHB categories to ensure that benefits are not unduly weighted toward any category,” which is the rule that stops a plan from nodding at a category while gutting it. And paragraph (f) is a small, clean example of state discretion operating inside the federal floor rather than on top of it: “If the base-benchmark plan does not include coverage for habilitative services, the State may determine which services are included in that category.”

How a state adds a benefit on top, and who has to pay for it

Now the mechanism the question is really about. When people ask what state law requires a plan to cover, they are asking about benefits a state has added above the federal floor. There is a federal rule describing how that works, it governs qualified health plans, and it is readable.

45 CFR 155.170(a)(1) opens with the permission: “A State may require a QHP to offer benefits in addition to the essential health benefits.” It then sorts those additions by when the state acted. For plan years beginning before January 1, 2028, a benefit required by state action taking place on or before December 31, 2011, a benefit required by state action for purposes of compliance with federal requirements, or a benefit covered in the state’s benchmark plan is considered an EHB. A benefit required by state action taking place on or after January 1, 2012, other than for federal-compliance purposes, that is not covered in the state’s benchmark plan is considered in addition to the essential health benefits.

Then comes the part almost nobody explains. Paragraph (a)(3): “A State must make payments in accordance with paragraph (b) of this section to defray the cost of any State-required benefits in addition to the EHB.” Paragraph (b) says those payments go either “To an enrollee, as defined in § 155.20 of this subchapter” or “Directly to the QHP issuer on behalf of the individual described in paragraph (b)(1).” And paragraph (a)(4) puts the sorting duty on the state too: “The State will identify which State-required benefits are in addition to the EHB.”

Read together, that is the whole shape of the thing. A state may add. What it adds after the cut-off is classified as additional rather than essential. The state — not the employer, not the employee, not the issuer — must defray the cost of the additions. And the state, not you, is the party responsible for identifying which requirements fall on which side of the line.

The December 31, 2011 test is not permanent

One scoping point, because it is the kind of thing that quietly ages a page into being wrong.

That 2011 cut-off applies to plan years beginning before January 1, 2028. The section was amended in 2026, and a new test takes effect for plan years beginning on or after January 1, 2028, under which a benefit is in addition to the essential health benefits if it is “(i) Required by a State action taking place after December 31, 2011; (ii) Applicable to the small group and/or individual markets; (iii) Specific to required care, treatment, or services; and (iv) Not required by State action for purposes of compliance with Federal requirements.”

If you are reading this before that changeover, the 2011 line is the operative one. If you are reading it after, it is not. We would rather write the date down than let the sentence quietly expire.

One Tennessee coverage requirement, read at the Secretary of State

Because Tennessee’s enacted acts are readable, a specific Tennessee coverage requirement can be shown here at primary source. This one is reported descriptively, as an example of how such a requirement is structured, and nothing is generalized from it.

2026 Public Chapter 932, § 2 adds a new section to Tenn. Code Ann. Title 56, Chapter 7, Part 23. Its operative subsection, § 2(b)(1), reads: “If an insurance policy that is offered outside of the marketplace exchange and that is issued, renewed, or amended in this state on or after the effective date of this act, includes coverage for gender transition procedures, then the policy must also include coverage for detransition procedures.” Section 5 provides that the act “takes effect upon becoming a law, the public welfare requiring it, and applies to contracts for insurance entered into, amended, or renewed on or after that date.” The General Assembly’s own bill record for the measure gives an effective date of 05/07/2026.

Note what it is, structurally:

It is conditional, not free-standing. It does not require any policy to cover anything outright. It is an if-you-cover-this-then-you-must-also-cover-that requirement, which is a genuinely different shape from a mandate that a benefit be included, and describing it as Tennessee requiring coverage of a particular procedure would misstate what the act does.

Its exchange half is not yet operative. A parallel subsection applies the same rule to policies offered on the marketplace exchange, but only “Upon approval and implementation of the waiver sought in subsection (i).” Subsection (i) directs the Department of Commerce and Insurance to apply to CMS, within ninety (90) days of the effective date, for a waiver under 45 CFR § 156.111 to add the procedures to Tennessee’s essential health benefits for qualified health plans on the exchange. We did not seek and do not report whether that waiver has been received or approved, so treat that half as pending.

And it proves nothing about the rest. One enacted act is one enacted act. It does not establish that Tennessee has other coverage requirements, and it does not establish that Tennessee has none. It is simply the one we were able to read.

Why no third-party summary was substituted

There is an obvious shortcut here and we did not take it. When a state’s code is unreadable, the tempting move is to reach for a published compilation of state benefit mandates and print what it says about Tennessee.

We declined, for one reason and one demonstration of it. The reason: a compilation carries its own vintage, and a reader has no way of knowing from the page whether the compilation was refreshed after the state last acted. The demonstration: the federal compilation that names Tennessee carries a Year of Enactment column reading “Before 2012”, and Tennessee enacted the act quoted in the previous section with an effective date of 05/07/2026. So we can show, not merely suspect, that a consolidated summary of Tennessee benefit requirements sits behind Tennessee’s own enactments. Reprinting it here as current law would have been the single most confident-sounding and least defensible paragraph on this page.

What a Tennessee employer should actually do with this

Work from what can be verified, and ask the right party for the rest.

The federal floor above applies to your fully-insured small group coverage in Tennessee, and it is checkable line by line against the sections cited. If a proposal in front of you is level-funded rather than fully-insured, the floor may not reach it at all, and that is worth a direct question to whoever put the proposal together. For the Tennessee layer, the Insurance Division of the Tennessee Department of Commerce and Insurance is the party that can speak to what Tennessee currently requires, and it publishes its bulletins, interpretive opinions and attorney general opinions on its own site.

And if a page, a broker or a carrier summary tells you confidently what Tennessee does or does not require a group plan to cover, the fair question is the one we had to ask ourselves: which document did you read that in, and can I read it too?