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56-8-102 - Part definitions Preemption.

56-8-102. Part definitions Preemption.

(a)  For the purposes of this part:

     (1)  “Adjuster” means any person that is adjusting claims;

     (2)  “Affiliate of a depository institution” means any company that controls, is controlled by, or is under common control with a depository institution;

     (3)  (A)  “Claim” means:

                (i)  An oral, written, or electronic submission for payment that is filed by an insured, on behalf of an insured, or by a third party where the insurer accepts such claims, in accordance with the insurer's reasonable submission standards; and

                (ii)  Is sufficient to reasonably establish contractual liability for payment on the part of an insurer;

          (B)  For the purposes of § 56-8-105, a “claim” does not mean an inquiry by an insured as to the existence of coverage or how a potential claim may affect future premiums or renewability of coverage;

     (4)  “Commissioner” means the commissioner of commerce and insurance;

     (5)  “Customer”, for purposes of § 56-8-106, means an individual who purchases, applies to purchase or is solicited to purchase insurance products;

     (6)  “Depository institution” means a bank or savings association. “Depository institution” does not include an insurance company;

     (7)  “Fictitious grouping” means any grouping by way of membership, nonmembership, license, franchise, employment, contract, agreement or any other method or means;

     (8)  “Insured” means the party named on a policy or certificate as the individual with legal rights to the benefits provided by the policy;

     (9)  “Insurer” means any person, reciprocal exchange, interinsurer, Lloyd's insurer, fraternal benefit society, and any other legal entity engaged in the business of insurance. Insurer shall also mean medical service plans, hospital service plans, health maintenance organizations, prepaid limited health care service plans, hospital medical service corporations, dental, optometric and other similar health service plans. For purposes of this part, these entities shall be deemed to be engaged in the business of insurance;

     (10)  “Person” means a natural or artificial entity, including, but not limited to, individuals, partnerships, associations, trusts, corporations, insurance producers, adjusters, any employer to the extent that the employer self-insures its workers' compensation liabilities pursuant to § 50-6-405(b) or a group of employers qualifying as self-insurers pursuant to § 50-6-405(c), or third party administrators;

     (11)  “Policy” or “certificate” means a contract of insurance, indemnity, medical, health or hospital service, suretyship, or annuity issued, proposed for issuance or intended for issuance by any insurer;

     (12)  “Producer” means a person required to be licensed under the laws of this state to sell, solicit, or negotiate insurance under chapter 6, part 1 of this title; and

     (13)  “Third party administrator” means any person that collects charges or premiums from, or who adjusts or settles claims on, residents of this state on behalf of an insurer, and shall include any person currently defined as an administrator by § 56-6-401, any person currently defined as an administrator by Tenn. Comp. R. & Regs. 0780-1-54, or any person currently defined as a third-party administrator by Tenn. Comp. R. & Regs. 0780-1-81.

(b)  The Federal Employee Retirement Income Security Act (ERISA), compiled in 29 U.S.C. § 1001, preempts certain entities and some activities of those entities from the application of state laws. The purpose of the definitions in subsection (a) is to include within this part and rules promulgated pursuant to this part, all entities and activities to the extent not preempted by ERISA.

[Acts 2008, ch. 1079, §§ 1, 3.]