(a) The local education insurance committee shall approve a group insurance plan for eligible employees of local education agencies that shall consist of the following:
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
Contract: A legal written agreement that becomes binding when signed.
Local education insurance committee: means the local education insurance committee created in subsection (a). See Tennessee Code 8-27-301
written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
(1) One (1) or more basic health plans as the local education insurance committee deems necessary and reasonable; and(2) Voluntary benefit plans as may be necessary and reasonable. The local education insurance committee may provide for voluntary benefits as part of the basic health plans or as separate plans.(b) The local education insurance committee is authorized to determine the premiums, benefits package, funding method, administrative procedures, eligibility provisions, and rules relating to the plans established by this section.(c) The basic health plans shall be offered to local education agencies; provided, that voluntary benefits are available only in local education agencies in which the local board votes to be responsible for the coverage costs provided for in § 8-27-303.(d) The basic health plans provided for in subsection (a) and the equal or superior benefit plans provided for in § 8-27-303 shall be the only state-supported insurance plans for local education employees.(e) If a local education agency participates in the basic health plans provided for in subsection (a), those plans shall be the only basic health plans that the local education agency may make available to its employees.(f) Nothing in this part shall require a local education agency to make available to its employees any insurance plan approved by the local education insurance committee.(g)(1) Except as otherwise provided in subdivision (g)(5), within thirty (30) days of receipt of a written request for claims data from a local education agency (LEA), the local education insurance committee shall provide claims data for the purpose of underwriting and premium rating as described in subdivision (g)(2) if:
(A) The LEA, as part of its written request for claims data, identifies the HIPAA covered entity the local education insurance committee should provide with the claims data, including contact information necessary for transmittal of the claims data; and(B) The LEA submits a confidentiality agreement from each proposed recipient along with the request, which includes the recipient’s certification that it is a HIPAA covered health plan as defined by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d et seq.).(2) Upon the covered entity’s receipt of the requested claims data, the LEA may request certification of the accuracy and completeness of the claims data by an outside independent consultant, selected and retained by the local education insurance committee. The LEA shall reimburse the state for the fees charged by the outside consultant for review and certification, pursuant to the hourly rates in the state’s consulting agreement.(3) No contract or memorandum of understanding may limit the local education agency’s access to claims data in a manner contrary to this subsection (g).(4) The release of claims data pursuant to this subsection (g) must meet the minimum standards established by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. § 1320d et seq.) and the rules and regulations promulgated by federal authorities in connection with HIPAA.(5)(A) Notwithstanding subdivision (g)(1), the thirty-day response requirement does not apply if more than ten (10) requests for claims data under this subsection (g) are pending.(B) Upon request by an LEA, the local education insurance committee shall provide information regarding pending requests and the response time.
