56-7-3002 - Part definitions. [Effective Until Various Dates. See the Compiler's Notes.]
56-7-3002. Part definitions. [Effective Until Various Dates. See the Compiler's Notes.]
[Effective Until Various Dates. See the Compiler's Notes.]
(a) As used in this part, unless the context otherwise requires:
(1) Advisory committee means the committee established pursuant to § 56-7-3004;
(2) Commissioner means the commissioner of finance and administration;
(3) Contractor means a health insurance carrier or third party administrator that enters into a contract with the department pursuant to § 56-7-3007 to offer a plan to eligible individuals; provided, however, that any such insurance carrier or administrator shall have at least a B+ rating by the A.M. Best Company, where available, or a rating determined by the commissioner to be equivalent, issued by an independent insurance company rating organization;
(4) Contributing employer means an employer that has, pursuant to § 56-7-3013, elected to contribute toward the premiums of one (1) or more of its employees who have enrolled in the program;
(5) Department means the department of finance and administration;
(6) Dependent means a dependent of an eligible individual, as defined by the department;
(7) Eligible individual means an individual who meets the eligibility criteria established by the department pursuant to § 56-7-3005;
(8) Enrollee means an eligible individual or a dependent who is enrolled in a plan;
(9) (A) Health benefits coverage includes medical insurance in force currently or in force during the past six (6) months that would make a participating employer or enrollee ineligible pursuant to § 56-7-3005. Health benefits coverage shall include, but not be limited to, basic medical coverage (hospitalization plans), major medical insurance, comprehensive medical insurance, short-term medical policies, limited-benefit plans, mini-medical plans and high deductible health plans with health savings accounts. Health benefits coverage shall not include catastrophic health insurance plans that only provide medical services after satisfying a deductible in excess of fifteen thousand dollars ($15,000). Additionally, health benefits coverage shall not include medical insurance that is available to an enrollee pursuant either to the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986, Pub. L. No. 99-272, compiled in 29 U.S.C. § 1161 et seq. and that the individual declined, or to § 56-7-2312 et seq. and that the individual declined.
(B) This subdivision (9) shall be repealed midnight June 30, 2012.
(10) Health insurance carrier means an entity that is authorized to provide health insurance coverage in this state in accordance with this title, including, but not limited to, an insurance company, a health maintenance organization, a nonprofit hospital and medical service corporation, and a preferred provider organization. For purposes of this part, health insurance carrier shall also include a plan described in § 56-2-121(a); provided, that nothing in this part shall be construed to modify or eliminate the exemption conferred on such plans by § 56-2-121(a);
(11) (A) Involuntary loss of coverage means the loss of health benefits coverage arising from, but not limited to, the following circumstances:
(i) A separation from employment, voluntary or involuntary;
(ii) A health insurance carrier's cancellation of group or individual health benefits coverage for reasons other than premium nonpayment, fraud or misrepresentation;
(iii) A health insurance carrier's decision to no longer sell small group health benefits coverage; or
(iv) The loss of eligibility for TennCare or CoverKids;
(B) Involuntary loss of coverage shall not include situations in which the primary insured dropped dependent spouse or dependent child or children from the health benefits coverage policy;
(C) This subdivision (11) shall be repealed midnight June 30, 2012;
(12) Low income employee means an employee whose income, as defined by the department, is less than two hundred fifty percent (250%) of the federal poverty level, or such other amount as the department may specify;
(13) Participating small employer means an employer with fifty (50) or fewer employees, a significant proportion of whom are low income employees, that meets the eligibility criteria established pursuant to § 56-7-3006(a);
(14) Plan means the health benefits coverage offered by a contractor to eligible individuals;
(15) Program means the Cover Tennessee program established pursuant to this part; and
(16) Third party administrator means an entity that, on behalf of a health insurance carrier, employer or other entity, provides health insurance coverage to individuals in this state, receives or collects charges, contributions or premiums for, or adjudicates, processes or settles claims in connection with, any type of health benefit provided in, or as an alternative to, health insurance coverage.
(b) The definitions of health benefits coverage and involuntary loss of coverage in subsection (a) shall be repealed midnight June 30, 2012. Pursuant to § 56-7-3028, the remaining definitions in subsection (a) shall be repealed on June 30, 2010.
[Acts 2006, ch. 867, §§ 5, 14(a); 2008, ch. 1093, §§ 1, 4.]