As used in this chapter, unless the context otherwise requires:

(1) “Applicant” means:

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Terms Used In Tennessee Code 56-42-103

  • Certificate: means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state. See Tennessee Code 56-42-103
  • Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
  • Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-42-103
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Group long-term care insurance: means a long-term care insurance policy that is delivered or issued for delivery in this state and issued to:
    (A) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination of employees or former employees, or for members or former members, or a combination of members or former members, of the labor organizations. See Tennessee Code 56-42-103
  • Long-term care insurance: includes group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care insurance. See Tennessee Code 56-42-103
  • Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
  • Policy: means any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan, health maintenance organization or any similar organization. See Tennessee Code 56-42-103
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
  • Trustee: A person or institution holding and administering property in trust.
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and
(B) In the case of a group long-term care insurance policy, the proposed certificate holder;
(2) “Certificate” means any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state;
(3) “Commissioner” means the commissioner of commerce and insurance;
(4) “Group long-term care insurance” means a long-term care insurance policy that is delivered or issued for delivery in this state and issued to:

(A) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees, or a combination of employees or former employees, or for members or former members, or a combination of members or former members, of the labor organizations;
(B) Any professional, trade or occupational association for its members or former or retired members, or combination of former or retired members, if the association:

(i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and
(ii) Has been maintained in good faith for purposes other than obtaining insurance;
(C)

(i) An association or a trust or the trustee or trustees of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering the policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance, have been in active existence for at least one (1) year and have a constitution and bylaws that provide that:

(a) The association or associations hold regular meetings not less than annually to further purposes of the members;
(b) Except for credit unions, the association or associations collect dues or solicit contributions from members; and
(c) The members have voting privileges and representation on the governing board and committees;
(ii) Thirty (30) days after the filing, the association or associations will be deemed to satisfy the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or
(D) A group other than as described in subdivisions (4)(A)-(C), subject to a finding by the commissioner that:

(i) The issuance of the group policy is not contrary to the best interest of the public;
(ii) The issuance of the group policy would result in economies of acquisition or administration; and
(iii) The benefits are reasonable in relation to the premiums charged;
(5) “Long-term care insurance” means any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis, for one (1) or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital. “Long-term care insurance” includes group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care insurance. “Long-term care insurance” also includes a policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity. “Long-term care insurance” includes group and individual policies or riders whether issued by insurers, fraternal benefit societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations or any similar organization. “Long-term care insurance” does not include any insurance policy that is offered primarily to provide basic medicare supplement coverage, basic hospital expense coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage;
(6) “Policy” means any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital or medical service corporation, prepaid health plan, health maintenance organization or any similar organization; and
(7)

(A) “Qualified long-term care insurance contract” or “federally tax-qualified long-term care insurance contract” means an individual or group insurance contract that meets the requirements of § 7702(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 7702(b)), as follows:

(i) The only insurance protection provided under the contract is coverage of qualified long-term care services. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(i) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;
(ii) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses are reimbursable under Title XVII of the Social Security Act (42 U.S.C. § 1391 et seq.), or would be so reimbursable but for the application of a deductible or coinsurance amount. The requirements of this subdivision (7)(A)(ii) do not apply to expenses that are reimbursable under Title XVII of the Social Security Act only as a secondary payor. A contract shall not fail to satisfy the requirements of this subdivision (7)(A)(ii) by reason of payments being made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate;
(iii) The contract is guaranteed renewable, within the meaning of § 7702B(b)(1)(C) of the Internal Revenue Code of 1986 (26 U.S.C § 7702B(b)(1)(C));
(iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed except as provided in subdivision (7)(A)(v);
(v) All refunds of premiums, and all policyholder dividends or similar amounts, under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund on the event of death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and
(vi) The contract meets the consumer protection provisions set forth in § 7702B(g) of the Internal Revenue Code of 1986 (26 U.S.C § 7702B(g)).
(B) “Qualified long-term care insurance contract” or “federally tax-qualified long term care insurance contract” also means the portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of § 7702B(b) and (e) of the Internal Revenue Code of 1986 (26 U.S.C § 7702B(b) and (e)).
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