Administrator: means : (A) An individual, either employed by, or contracted with, the sponsor or the plan to provide administrative services on behalf of the plan. See Tennessee Code 8-27-901
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.
Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
Insured: means any individual, other than the primary insured, who receives benefits under the plan. See Tennessee Code 8-27-901
plan: includes those to which the primary insured pays to the plan a nominal fee for the primary insured and any insureds whose relationship to the primary insured allows them to receive benefits under the plan. See Tennessee Code 8-27-901
Sponsor: means a county, municipality, municipal corporation, or special school district in this state that establishes and funds a plan. See Tennessee Code 8-27-901
TPA: means an organization with which the plan contracts to process claims or manage certain other aspects of the plan, including, but not limited to, customer service, plan design, benefits notification, subrogation services, general plan administration, and appeals review. See Tennessee Code 8-27-901
(1) The name of the plan administrator and the designation of any named fiduciaries other than the plan administrator under the claims procedure for deciding benefit appeals;(2) A description of the benefits provided;(3) The standard of review for benefit decisions;(4) Who is eligible to participate, which includes designating classes of employees, establishing an employment waiting period prior to eligibility for plan participation, designating the hours per week an employee must work in order to be eligible for plan participation, and establishing tiers of coverage;(5) How much the primary insured must pay towards the cost of each tier of coverage;(6) The plan sponsor‘s amendment and termination rights and procedures and how plan assets will be distributed if the plan is terminated;(7) Rules restricting and regulating the use of personal health information (PHI), if the plan sponsor uses PHI;(8) Subrogation, reimbursement, coordination of benefits, and offset provisions;(9) Procedures for allocating and designating administrative duties to a TPA or committee;(10) To the extent the plan has assets, the manner in which it is funded;(11) Information regarding COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985 (42 U.S.C. § 300bb-1 et seq.)), HIPAA (Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. § 1320d et seq.)), and other federal mandates;(12) Preexisting condition exclusions;(13) Special enrollment rules;(14) Mental health parity;(15) Coverage for adopted children and domestic partners;(16) Qualified medical support orders; and(17) Minimum hospital stays following childbirth.(b) The summary plan description must include, at a minimum:
(1) A summary description of all benefits and costs to insureds under the plan, including co-pays, deductibles, and premiums for different tiers of coverage, if applicable;(2) A list of eligible plan participants;(3) Contact information for the administrator;(4) Contact information for the sponsor;(5) A mailing address for each type of notice required by this part; and(6) A copy of any forms required by the plan or by this part.
