Terms Used In Tennessee Code > Title 56 > Chapter 7 > Part 28 - Health Insurance Portability, Availability and Renewability Act

• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Beneficiary: has the meaning given such term under §. See Tennessee Code 56-7-2802
• Bona fide association: means an association that satisfies the requirements of §. See Tennessee Code 56-7-2802
• Church plan: has the meaning given the term under §. See Tennessee Code 56-7-2802
• COBRA continuation provision: means any of the following:
  (A) Section 4980B of the Internal Revenue Code of 1986 (26 U. See Tennessee Code 56-7-2802
• 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 56-1-102
• 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.
• Creditable coverage: means , with respect to an individual, coverage of the individual under any of the following:
  (i) A group health plan. See Tennessee Code 56-7-2802
• Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
• Dependent: A person dependent for support upon another.
• Employee: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Employer: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Enrollment date: means , with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment. See Tennessee Code 56-7-2802
• 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.
• Excepted benefits: means benefits under one (1) or more, or any combination, of the following:
  (A) Benefits not subject to requirements:

  (i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance. See Tennessee Code 56-7-2802
• Federal governmental plan: means a governmental plan established or maintained for its employees by the federal government or by any agency or instrumentality of the federal government. See Tennessee Code 56-7-2802
• Fraud: Intentional deception resulting in injury to another.
• Governmental plan: has the meaning given the term under ERISA, §. See Tennessee Code 56-7-2802
• Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with the plan. See Tennessee Code 56-7-2802
• Group health plan: means an employee welfare benefit plan, as defined in ERISA, §. See Tennessee Code 56-7-2802
• Health insurance coverage: means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer. See Tennessee Code 56-7-2802
• Health insurance issuer: means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. See Tennessee Code 56-7-2802
• Health maintenance organization: means :
  (A) A federally qualified health maintenance organization, as defined under federal law. See Tennessee Code 56-7-2802
• Health status-related factor: means any of the following factors:
  (A) Health status. See Tennessee Code 56-7-2802
• Individual health insurance coverage: means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance. See Tennessee Code 56-7-2802
• Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See Tennessee Code 56-7-2802
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• Large employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Tennessee Code 56-7-2802
• Large group market: means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a large employer. See Tennessee Code 56-7-2802
• Late enrollee: means , with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:
  (A) The first period in which the individual is eligible to enroll under the plan. See Tennessee Code 56-7-2802
• Medical care: means amounts paid for:
  (A) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body. See Tennessee Code 56-7-2802
• Month: means a calendar month. See Tennessee Code 1-3-105
• Network plan: means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer. See Tennessee Code 56-7-2802
• Nonfederal governmental plan: means a governmental plan that is not a federal governmental plan. See Tennessee Code 56-7-2802
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Participant: has the meaning given the term under ERISA, §. See Tennessee Code 56-7-2802
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• 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
• Plan sponsor: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Preexisting condition exclusion: means , with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. See Tennessee Code 56-7-2802
• Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
• Small employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employs an average of at least two (2) but no more than fifty (50) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Tennessee Code 56-7-2802
• Small group market: means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a small employer. See Tennessee Code 56-7-2802
• 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
• United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
• Waiting period: means , with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. See Tennessee Code 56-7-2802
• written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
• Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105