Claims data: means : (A) A general claims data set aggregated by month and year, for the most recent thirty-six (36) months of available data, and describing the claims experience with the following information: (i) Number of enrolled employees, including whether the individual is active or a retiree. See Tennessee Code 8-27-301
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 any person in office as a member of the public service commission, as prescribed by title 65, chapter 1, prior to June 30, 1996. See Tennessee Code 8-34-101
Local education insurance committee: means the local education insurance committee created in subsection (a). See Tennessee Code 8-27-301
Member: means any person included in the membership of the retirement system, as provided in chapter 35, part 1 of this title. See Tennessee Code 8-34-101
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
(1) There is created a local education insurance committee to be composed of the governor, who may designate the commissioner of education to attend in place of the governor as a full voting member, a representative of local school boards to be selected by the Tennessee School Boards Association, the state treasurer, the commissioner of commerce and insurance, the comptroller of the treasury, the commissioner of finance and administration, and three (3) teachers appointed to represent the three (3) grand divisions under the procedure contained in § 8-34-302(a)(9).(2) The state treasurer, the commissioner of commerce and insurance, the comptroller of the treasury, and the commissioner of finance and administration are authorized to designate an alternate representative to attend, participate, and vote at meetings of the local education insurance committee when that respective member is unable to attend. The commissioner of education also has the authority to designate an alternate representative if the commissioner of education is designated by the governor, pursuant to this subsection (a), to serve on the local education insurance committee. The designation of an alternate representative shall be made in writing to the chair of the local education insurance committee.(b) As used in this part:
(1) “Claims data” means:
(A) A general claims data set aggregated by month and year, for the most recent thirty-six (36) months of available data, and describing the claims experience with the following information:
(i) Number of enrolled employees, including whether the individual is active or a retiree;(ii) Number of members;(iii) Charges submitted;(iv) Allowed amount;(v) Deductible amount;(vi) Copayments;(vii) Coinsurance amounts;(viii) Third-party amounts; and(ix) Net payment; and(B) A large claims data set aggregated by month and year, for the most recent thirty-six (36) months of available data, and describing the net or allowed payments for individuals exceeding twenty-five thousand dollars ($25,000), and describing the claims experience with the following information:
(i) Fund code designating whether the individual is active or a retiree;(ii)Year of birth;(iii) Principal diagnosis code;(iv) The net or allowed amount paid on behalf of the individual; and(v) A sequential member reference number rather than the individual’s name;(2) “Instructional employee” means those persons employed by a local education agency as teachers, as defined in § 8-34-101, and who are not eligible for insurance coverage under § 8-27-202;(3) “Local education agency” or “LEA” has the same definition as used in § 49-3-104 and includes educational cooperatives created pursuant to the Educational Cooperation Act, compiled in title 49, chapter 2, part 13;(4) “Local education insurance committee” means the local education insurance committee created in subsection (a); and(5) “Support staff employees” means those persons employed by a local education agency who are not instructional employees.
