Terms Used In Tennessee Code > Title 33 > Chapter 2 - Services and Facilities

• Abuse: means the knowing infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish. See Tennessee Code 33-2-402
• Abuse: means the occurrence of one (1) or more of the following acts:
  (A) Attempting to cause or intentionally, knowingly or recklessly causing another person, including a minor child, bodily injury, physical harm, severe emotional distress, psychological trauma, rape, sexual assault or involuntary sexual intercourse. See Tennessee Code 56-8-202
• Abuse status: means the fact or perception that a person is, has been, or may be a subject of abuse, regardless of whether the person has sustained abuse-related medical conditions or has incurred abuse-related claims. See Tennessee Code 56-8-202
• Abuse-related medical condition: means a medical condition sustained by a subject of abuse that arises in whole or part out of an act or pattern of abuse. See Tennessee Code 56-8-202
• Acceptable collateral: means :
  (A) As to securities lending transactions, and for the purpose of calculating counterparty exposure amount, cash, cash equivalents, letters of credit, direct obligations of, or securities that are fully guaranteed as to principal and interest by, the government of the United States, or by the Federal National Mortgage Association or the Federal Home Loan Mortgage Corporation, and as to lending foreign securities, sovereign debt rated NAIC-SVO 1. See Tennessee Code 56-3-302
• Access Tennessee: means the nonprofit entity created pursuant to §. See Tennessee Code 56-7-2902
• Account owner: means the owner of a retained asset account who is a resident of this state. See Tennessee Code 56-7-3403
• Accumulated contributions: means the sum of all the amounts deducted from the compensation of a member, together with any amount transferred to the account of the member established pursuant to chapters 34-37 of this title from the respective account of the member under one (1) or more of the superseded systems, with interest thereon, as provided in §. See Tennessee Code 8-34-101
• Actual reimbursement: means the total amount that a covered entity or pharmacy benefits manager determines that a pharmacy or other dispenser will receive consistent with the provider agreement, and is the sum of the amount the covered entity or pharmacy benefits manager will pay directly to the pharmacy or other dispenser plus any applicable patient out-of-pocket cost paid directly by the patient to the pharmacy or other dispenser, for dispensing of a particular prescription or providing a covered service. See Tennessee Code 56-7-3201
• Actuarial certification: means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer carrier is in compliance with §. See Tennessee Code 56-7-2203
• Actuary: means a person who is a member in good standing of the American Academy of Actuaries. See Tennessee Code 56-6-502
• Actuary: means a person who is a member in good standing of the American Academy of Actuaries. See Tennessee Code 56-6-802
• administrator: means any person, company, corporation, partnership, association or other legal entity that collects charges or premiums from, or that adjusts or settles claims on, residents of this state in connection with life or health insurance coverage or annuities other than:
  (1) An employer on behalf of its employees or the employees of one (1) or more subsidiary or affiliated corporations of the employer. See Tennessee Code 56-6-401
• Admitted assets: means assets permitted to be reported as admitted assets on the statutory financial statement of the insurer most recently required to be filed with the commissioner, but:
  (A) Excluding the assets of separate accounts, the investments of which are not subject to this part. See Tennessee Code 56-3-302
• ADTF: means an institution, treatment resource, group residence (boarding home, sheltered workshop, activity center), rehabilitation center, hospital, community mental health center, nonresidential office-based opiate treatment facility, nonresidential substitution-based treatment center for opiate addiction, DUI school, counseling center, clinic, halfway house, recovery residence, or other entity, by these or other names, providing alcohol and drug services. See Tennessee Code 33-2-1401
• Adverse action: means a denial or cancellation of, an increase in any charge for, or a reduction or other adverse or unfavorable change in the terms of coverage or amount of, any insurance, existing or applied for, in connection with the underwriting of personal insurance. See Tennessee Code 56-5-201
• Advisory organization: means any person or organization, other than a rate service organization, that assists insurers as authorized by §. See Tennessee Code 56-5-102
• Advisory prospective loss costs: means historical aggregate losses and loss adjustment expenses projected through development to their ultimate value and through trending to a future point in time. See Tennessee Code 56-5-102
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Affiliate: means any company that controls, is controlled by, or is under common control with another company. See Tennessee Code 56-5-201
• Affiliate: means any insurance company that controls, is controlled by, or is under common control with the insurer writing the policies. See Tennessee Code 56-4-210
• Affiliate: means , as to any person, another person that, directly or indirectly through one (1) or more intermediaries, controls, is controlled by, or is under common control with the person. See Tennessee Code 56-3-302
• Affirmed: In the practice of the appellate courts, the decree or order is declared valid and will stand as rendered in the lower court.
• Alcohol and drug services: includes evaluation, treatment, residential personal care, habilitation, rehabilitation, counseling, or supervision of persons with substance use disorder, or services to persons designed to prevent substance use disorder that either receive funds from the department of health or assess fees for services provided. See Tennessee Code 33-2-402
• Alcohol and drug services: includes evaluation, treatment, residential personal care, habilitation, rehabilitation, counseling, or supervision of persons with substance use disorder, or services to persons designed to prevent substance use disorder that either receive funds from the department of health or assess fees for services provided. See Tennessee Code 33-2-1401
• Allegation: something that someone says happened.
• Allowed amount: means the contractually agreed upon payment amount between a carrier and a healthcare entity participating in the carrier's network, excluding any member deductible, co-pay, or other obligation. See Tennessee Code 56-7-602
• Amortization: Paying off a loan by regular installments.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Annuity: means any active annuity contract issued in this state other than an annuity used to fund an employment-based retirement plan or program where the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants or that is used to fund a pre-need funeral contract as defined in §. See Tennessee Code 56-7-3403
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Applicant: means :
  (A) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits. See Tennessee Code 56-7-1501
• Arraignment: A proceeding in which an individual who is accused of committing a crime is brought into court, told of the charges, and asked to plead guilty or not guilty.
• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• Asymmetric conduct: means an insurer's use of the DMF prior to July 1, 2015, in connection with searching for information regarding whether annuitants under the insurer's annuities might be deceased, but not in connection with whether the insureds under its policies might be deceased. See Tennessee Code 56-7-3403
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Attorney: means the person designated and authorized by subscribers as the attorney-in-fact having authority to obligate them on reciprocal insurance contracts. See Tennessee Code 56-16-102
• Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
• Bail: Security given for the release of a criminal defendant or witness from legal custody (usually in the form of money) to secure his/her appearance on the day and time appointed.
• Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
• Base premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business, by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage. See Tennessee Code 56-7-2203
• Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Beneficiary: has the meaning given such term under §. See Tennessee Code 56-7-2802
• Beneficiary: means any person, persons or institution receiving a retirement allowance or other benefit as provided in chapters 34-37 of this title. See Tennessee Code 8-34-101
• Beneficiary: means an individual or other entity entitled to benefits under a policy or annuity. See Tennessee Code 56-7-3403
• Board: means the board of directors of the pool. See Tennessee Code 56-7-2203
• board: means the board provided for in part 3 of this chapter. See Tennessee Code 8-34-101
• Board: means the Access Tennessee board of directors established pursuant to §. See Tennessee Code 56-7-2902
• Bona fide association: means an association that satisfies the requirements of §. See Tennessee Code 56-7-2802
• Business entity: means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity. See Tennessee Code 56-6-102
• Business entity: includes a sole proprietorship, corporation, limited liability company, association, general or limited partnership, joint stock company, joint venture, mutual fund, bank, trust, real estate investment trust, joint tenancy or other similar form of business organization, whether organized for-profit or not-for-profit. See Tennessee Code 56-3-302
• Cap: means an agreement obligating the seller to make payments to the buyer with each payment based on the amount by which a reference price or level or the performance or value of one (1) or more underlying interests exceeds a predetermined number, sometimes called the strike rate or strike price. See Tennessee Code 56-3-302
• Capital and surplus: means the sum of the capital and surplus of the insurer required to be shown on the statutory financial statement of the insurer most recently required to be filed with the commissioner. See Tennessee Code 56-3-302
• carrier: means a health insurance entity as defined in §. See Tennessee Code 56-7-602
• Carrier: means any person that provides one (1) or more health benefit plans in this state, including a licensed insurance company, a prepaid hospital or medical service plan, a health maintenance organization (HMO) and a multiple employer welfare arrangement (MEWA). See Tennessee Code 56-7-2203
• Case characteristics: means demographic or other objective characteristics of a small employer, as determined by a small employer carrier, that are considered by the small employer carrier in the determination of premium rates for the small employer, but does not mean claim experience, health status and duration of coverage since issue. See Tennessee Code 56-7-2203
• Cash equivalents: means highly rated, highly liquid and readily marketable investments or securities with a remaining term to maturity of one (1) year or less, which includes money market funds as defined in §. See Tennessee Code 56-3-302
• Catastrophic disaster: means an event that results in large numbers of deaths and injuries, causes extensive damage or destruction of facilities that provide and sustain human needs, produces an overwhelming demand on state and local response resources and mechanisms, causes a severe long-term effect on general economic activity, and severely affects state, local and private sector capabilities to begin and sustain response activities. See Tennessee Code 56-6-902
• Certificate: means , any certificate delivered or issued for delivery in this state under a group medicare supplement policy. See Tennessee Code 56-7-1501
• CGAD: means a confidential report filed by the insurer or insurance group in accordance with this part. See Tennessee Code 56-2-903
• Chambers: A judge's office.
• Chief officer: means the person with overall authority for a public or private hospital, developmental center, treatment resource, or developmental disabilities service or facility, or the person's designee. See Tennessee Code 33-1-101
• Church plan: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Church plan: has the meaning given the term under ERISA, in 29 U. See Tennessee Code 56-7-2902
• Class of business: means all or a distinct grouping of small employers as shown on the records of a small employer carrier. See Tennessee Code 56-7-2203
• Clearing corporation: means :
  (i) A corporation as defined in §. See Tennessee Code 56-3-902
• Clinical criteria: means the written policies, screening procedures, decision rules, decision abstracts, clinical protocols, practice guidelines, and medical protocols used by the utilization review agent to determine the necessity and appropriateness of health care services. See Tennessee Code 56-6-703
• COBRA continuation coverage: refers to continuation of coverage offered pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985 ( 42 U. See Tennessee Code 56-7-2902
• COBRA continuation provision: means any of the following:
  (A) Section 4980B of the Internal Revenue Code of 1986 (26 U. See Tennessee Code 56-7-2802
• Commercial risk insurance: means insurance within the scope of this part that is not personal risk insurance. See Tennessee Code 56-5-102
• Commercial risk insurance: means insurance within the scope of this part that is not "personal risk insurance" as defined in §. See Tennessee Code 56-7-1802
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-5-102
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-6-102
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-6-703
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-6-902
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-6-1001
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-6-1402
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-7-602
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-9-103
• Commissioner: means the commissioner of mental health and substance abuse services, or, when applicable, the commissioner of intellectual and developmental disabilities, the commissioner's authorized representative, or in the event of the commissioner's absence or a vacancy in the office of commissioner, the deputy commissioner of mental health and substance abuse services, or, when applicable, the deputy commissioner of intellectual and developmental disabilities. See Tennessee Code 33-2-402
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-2-903
• Commissioner: means the commissioner of environment and conservation or the commissioner's designated representative. See Tennessee Code 68-202-401
• Commissioner: means the commissioner of commerce and insurance, or the commissioner's designee. See Tennessee Code 56-2-1003
• Commissioner: means the commissioner of finance and administration. See Tennessee Code 56-7-2902
• Commissioner: means the commissioner of mental health and substance abuse services when the statute at issue relates to mental illness or serious emotional disturbance and means the commissioner of intellectual and developmental disabilities when the statute at issue relates to intellectual and developmental disabilities. See Tennessee Code 33-1-101
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-3-902
• Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-9-501
• commodity contract: means :
  (i) A contract for the purchase or sale of a commodity for future delivery on, or subject to the rules of, a board of trade or contract market under the Commodity Exchange Act ( 7 U. See Tennessee Code 56-9-103
• Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
• Community mental health center: includes any parent or corporate affiliate of a community mental health center as defined in §. See Tennessee Code 33-2-703
• Community mental health center: includes for profit corporations and private entities qualified as tax exempt organizations under Internal Revenue Code, §. See Tennessee Code 33-1-101
• Comparable healthcare service: includes , but is not limited to:
  (A) Physical and occupational therapy services. See Tennessee Code 56-7-602
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Consent: means voluntary agreement to what is reasonably well understood regardless of how the agreement is expressed. See Tennessee Code 33-1-101
• Consent: means agreement to administrative supervision by the insurer. See Tennessee Code 56-9-501
• Consumer: means an insured whose credit information is used or whose insurance score is calculated in the underwriting or rating of a personal insurance policy or an applicant for the policy. See Tennessee Code 56-5-201
• Consumer: means an individual, including an applicant, policyholder, insured, beneficiary, claimant, or certificate holder, who is a resident of this state and whose nonpublic information is in a licensee's possession, custody, or control. See Tennessee Code 56-2-1003
• Consumer direction: means a model of service delivery for certain medicaid home and community-based services in which the person receiving the services, family member, or other representative employs and supervises the individual who provides the services. See Tennessee Code 33-2-402
• Consumer reporting agency: means any entity that, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties. See Tennessee Code 56-5-201
• Continuance: Putting off of a hearing ot trial until a later time.
• Control: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a company. See Tennessee Code 56-4-210
• controlled: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a contract for goods or nonmanagement services, or otherwise. See Tennessee Code 56-6-602
• Controlling person: means any person, firm, association or corporation who directly or indirectly has the power to direct, or cause to be directed, the management, control or activities of the reinsurance intermediary. See Tennessee Code 56-6-802
• cooperative: means a private purchasing cooperative composed of small employers formed under this part. See Tennessee Code 56-7-2203
• Cooperative agreement: means an agreement among two (2) or more community mental health centers for the offering, provision, operation, coordination, planning, funding, pricing, contracting, utilization review, or management of mental health and related services under programs funded or administered by departments or agencies of state government, including, but not limited to, the TennCare program, or the sharing, allocation, or referral of service recipients, personnel, instructional programs, support services, ancillary services, and facilities, or other services traditionally offered by community mental health centers for the programs. See Tennessee Code 33-2-703
• Cost sharing requirement: means a copayment, coinsurance, deductible, or annual limitation on cost sharing, including, but not limited to, a limitation subject to 42 U. See Tennessee Code 56-7-3201
• Counterclaim: A claim that a defendant makes against a plaintiff.
• Counterparty exposure amount: means :
  (A) For an over-the-counter derivative instrument not entered into pursuant to a written master agreement which provides for netting of payments owed by the respective parties:

  (i) The market value of the over-the-counter derivative instrument if the liquidation of the derivative instrument would result in a final cash payment to the insurer. See Tennessee Code 56-3-302
• Covered entity: means a covered entity as defined in §. See Tennessee Code 56-7-3201
• Covered person: means a person on whose behalf a health insurance entity offering health insurance coverage is obligated to pay benefits or provide services. See Tennessee Code 56-7-110
• Credit information: means any credit-related information derived from a credit report, found on a credit report itself, or provided on an application for personal insurance. See Tennessee Code 56-5-201
• Credit report: means any written, oral, or other communication of information by a consumer reporting agency bearing on a consumer's creditworthiness, credit standing or credit capacity that is used or expected to be used or collected in whole or in part for the purpose of serving as a factor to determine personal insurance premiums, eligibility for coverage, or tier placement. See Tennessee Code 56-5-201
• Credit report: A detailed report of an individual's credit history prepared by a credit bureau and used by a lender in determining a loan applicant's creditworthiness. ^{Source: OCC}
• Credit Score: A number, roughly between 300 and 800, that measures an individual's credit worthiness. The most well-known type of credit score is the FICO score. This score represents the answer from a mathematical formula that assigns numerical values to various pieces of information in your credit report. ^{Source: OCC}
• Creditable coverage: means , with respect to an individual, coverage of the individual under any of the following:
  (i) A group health plan. See Tennessee Code 56-7-2802
• Creditable coverage: means , with respect to an individual, coverage of the individual that provides the minimum essential coverage required under 26 U. See Tennessee Code 56-7-2902
• Creditable service: means prior service plus membership service, as provided in part 6 of this chapter. See Tennessee Code 8-34-101
• Creditor: is a person having any claim, whether matured or unmatured, liquidated or unliquidated, secured or unsecured, absolute, fixed or contingent. See Tennessee Code 56-9-103
• Crop: means and includes any agricultural product, including livestock, nursery product, tree and product from a tree, as well as anything insured by the Federal Crop Insurance Corporation under a crop insurance program. See Tennessee Code 56-6-1001
• Crop insurance: means insurance providing protection against damage to crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation, disease, or other yield-reducing conditions or perils provided by the private insurance market, or that is subsidized by the Federal Crop Insurance Corporation, including multi-peril crop insurance. See Tennessee Code 56-6-102
• Custodian: means a national bank, state bank, federal home loan bank, trust company or broker/dealer that participates in a clearing corporation. See Tennessee Code 56-3-902
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• Decedent: A deceased person.
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Delinquency proceeding: means any proceeding instituted against an insurer for the purpose of liquidating, rehabilitating, reorganizing or conserving the insurer, and any summary proceeding under §. See Tennessee Code 56-9-103
• Department: means the department of commerce and insurance. See Tennessee Code 56-6-102
• Department: means the department of commerce and insurance. See Tennessee Code 56-6-1001
• Department: means the department of commerce and insurance. See Tennessee Code 56-7-602
• Department: means the department of mental health and substance abuse services, or, when applicable, the department of intellectual and developmental disabilities. See Tennessee Code 33-2-402
• Department: means the department of environment and conservation. See Tennessee Code 68-202-401
• Department: means the department of commerce and insurance. See Tennessee Code 56-2-903
• Department: means the department of commerce and insurance. See Tennessee Code 56-2-1003
• Department: means the department of finance and administration. See Tennessee Code 56-7-2902
• Department: means the department of mental health and substance abuse services when the statute at issue deals with mental illness or serious emotional disturbance and means the department of intellectual and developmental disabilities when the statute at issue deals with intellectual and developmental disabilities. See Tennessee Code 33-1-101
• Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
• Department: means the department of commerce and insurance. See Tennessee Code 56-9-501
• Dependent: A person dependent for support upon another.
• Dependent: means the spouse or child of an eligible employee, subject to applicable terms of the health care plan covering the employee. See Tennessee Code 56-7-2203
• Derivative instrument: means any agreement, option or instrument, or any series or combinations of an agreement, option or instrument:
  (i) To make or take delivery of, or assume or relinquish, a specified amount of one (1) or more underlying interests, or to make a cash settlement in lieu thereof. See Tennessee Code 56-3-302
• Derivative instruments: includes options, warrants (not attached to another financial instrument purchased by the insurer), caps, floors, collars, swaps, swaptions, forwards, futures and any other agreements, options or instruments substantially similar thereto, or any series or combinations thereof. See Tennessee Code 56-3-302
• Derivative transaction: means a transaction involving the use of one (1) or more derivative instruments. See Tennessee Code 56-3-302
• Developmental center: means a department of intellectual and developmental disabilities facility or part of it that provides residential and habilitation services to persons with intellectual disabilities. See Tennessee Code 33-1-101
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• DMF: means the death master file from the United States social security administration or any other database or service that an insurer may determine is substantially as inclusive as the death master file for determining that a person has reportedly died. See Tennessee Code 56-7-3403
• DMF match: means a search of a DMF that results in a match of a person's social security number or name and date of birth. See Tennessee Code 56-7-3403
• Docket: A log containing brief entries of court proceedings.
• Doing business: includes any of the following acts, whether effected by mail or otherwise:
  (A) The issuance or delivery of contracts of insurance to persons resident in this state. See Tennessee Code 56-9-103
• Dollar roll transaction: means two (2) simultaneous transactions with settlement dates no more than ninety-six (96) days apart so that in one (1) transaction an insurer sells to a business entity, and in the other transaction the insurer is obligated to purchase from the same business entity, substantially similar securities of the following types:
  (A) Mortgage-backed securities issued, assumed or guaranteed by the Government National Mortgage Association, the Federal National Mortgage Association or the Federal Home Loan Mortgage Corporation or their respective successors. See Tennessee Code 56-3-302
• Domestic insurance company: means an insurance company, other than life and fraternal insurance companies, nonprofit hospital and medical service corporations, nonprofit dental service corporations, nonprofit vision service corporations and title insurance companies, incorporated under the laws of this state. See Tennessee Code 56-3-401
• Domiciliary state: means the state in which an insurer is incorporated or organized, or, in the case of an alien insurer, its state of entry. See Tennessee Code 56-9-103
• Donor: The person who makes a gift.
• DRP: means a person designated by a travel insurance supervising entity pursuant to §. See Tennessee Code 56-6-1402
• Drug abuse: means a condition characterized by the continuous or episodic use of a drug or drugs resulting in social impairment, vocational impairment, psychological dependence or pathological patterns of use. See Tennessee Code 33-1-101
• Earnable compensation: includes , but is not limited to, any bonus or incentive payment. See Tennessee Code 8-34-101
• Eligible employee: means an employee who works for a small employer on a full-time basis, with a normal work week of thirty (30) or more hours, including a sole proprietor, a partner or a partnership, or an independent contractor, if included as an employee under a health care plan of a small employer. See Tennessee Code 56-7-2203
• Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. ^{Source: OCC}
• Employee: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Employer: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Employer: means :
  (A) The state or any department, commission, institution, board or agency of the state government by which a member is paid, with respect to members in its employ. See Tennessee Code 8-34-101
• Encrypted: means the transformation of data into a form that results in a low probability that its meaning is discernible without the use of a protective process or key. See Tennessee Code 56-2-1003
• Enrollee: means an individual who has contracted for or who participates in coverage under an insurance policy, a health maintenance organization contract, a health service corporation contract, an employee welfare benefit plan, a hospital or medical services plan, or any other benefit program providing payment, reimbursement, or indemnification for health care costs for the individual or the individual's eligible dependents. See Tennessee Code 56-6-703
• Enrollment date: means , with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment. See Tennessee Code 56-7-2802
• Equity interests: includes common stock, an equity investment in an investment company, other than a money market mutual fund described in §. See Tennessee Code 56-3-302
• equity security: means any stock or similar security, or any security convertible, with or without consideration, into a stock or similar security, or carrying a warrant or right to subscribe or to purchase a stock or similar security. See Tennessee Code 56-3-701
• ERISA: means the Employee Retirement Income Security Act of 1974 ( 29 U. See Tennessee Code 56-7-2902
• Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. ^{Source: OCC}
• Escrow: Money given to a third party to be held for payment until certain conditions are met.
• Exceeded its powers: means the following conditions:
  (A) The insurer has refused to permit examination of its books, papers, accounts, records or affairs by the commissioner, the commissioner's deputies, employees or duly commissioned examiners. See Tennessee Code 56-9-501
• Excepted benefits: means benefits under one (1) or more, or any combination, of the following:
  (A) Benefits not subject to requirements:

  (i) Coverage only for accident or disability income insurance, or any combination of accident and disability income insurance. See Tennessee Code 56-7-2802
• Facility: means a developmental center, treatment resource, group residence, boarding home, sheltered workshop, activity center, rehabilitation center, hospital, community mental health center, counseling center, clinic, group home, halfway house or any other entity that provides a mental health, intellectual or developmental disability service or an alcohol and drug abuse prevention and/or treatment facility. See Tennessee Code 33-2-402
• Fair Credit Reporting Act: A federal law, established in 1971 and revised in 1997, that gives consumers the right to see their credit records and correct any mistakes. ^{Source: OCC}
• Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
• Family member: means with respect to an individual, another individual related by blood to that individual. See Tennessee Code 56-7-2702
• Federal governmental plan: means a governmental plan established or maintained for its employees by the federal government or by any agency or instrumentality of the federal government. See Tennessee Code 56-7-2802
• Federal home loan bank: means an institution chartered under the Federal Home Loan Bank Act ( 12 U. See Tennessee Code 56-9-103
• Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. ^{Source: OCC}
• Federally defined eligible individual: means an individual:
  (A) For whom, as of the date on which the individual seeks coverage under this part, the aggregate of the periods of creditable coverage is eighteen (18) or more months. See Tennessee Code 56-7-2902
• Fee simple: Absolute title to property with no limitations or restrictions regarding the person who may inherit it.
• Fiduciary: A trustee, executor, or administrator.
• Fingerprints: means an impression of the lines on the finger taken for purpose of identification. See Tennessee Code 56-6-902
• Fixed charges: includes interest on all obligations and amortization of debt discount and expenses. See Tennessee Code 56-3-302
• Fixed charges: includes interest on all bonds and other evidence of indebtedness, and amortization of debt discount and expenses. See Tennessee Code 56-3-401
• Floor: means an agreement obligating the seller to make payments to the buyer in which each payment is based on the amount by which a predetermined number, sometimes called the floor rate or price, exceeds a reference price, level, performance or value of one (1) or more underlying interests. See Tennessee Code 56-3-302
• Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. ^{Source: OCC}
• Foreign: when used without limitation, includes all companies formed by authority of any other state or government. See Tennessee Code 56-1-102
• Foreign country: means any other jurisdiction not in any state. See Tennessee Code 56-9-103
• Foreign decree: means any decree or order in equity of a court located in a reciprocal state, including a court of the United States located in the reciprocal state, against any insurer incorporated or authorized to do business in this state. See Tennessee Code 56-2-702
• Foreign guaranty association: means any entities similar to a guaranty association now in existence in or hereafter created by the legislature of any other state. See Tennessee Code 56-9-103
• Foreign jurisdiction: means :
  (A) A jurisdiction other than a domestic jurisdiction. See Tennessee Code 56-3-302
• Forgery: The fraudulent signing or alteration of another's name to an instrument such as a deed, mortgage, or check. The intent of the forgery is to deceive or defraud. ^{Source: OCC}
• Formal delinquency proceeding: means any liquidation or rehabilitation proceeding. See Tennessee Code 56-9-103
• Fund: means the Access Tennessee health insurance program fund established by §. See Tennessee Code 56-7-2902
• Future: means an agreement, traded on a futures exchange, to make or take delivery of, or effect a cash settlement based on the actual or expected price, level, performance or value of, one (1) or more underlying interests. See Tennessee Code 56-3-302
• Futures exchange: means a foreign or domestic exchange, contract market or board of trade on which trading in futures is conducted and, in the United States, that has been authorized for such trading by the commodities futures trading commission or any successor of the commodities futures trading commission. See Tennessee Code 56-3-302
• Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
• general assets: includes all the property or its proceeds in excess of the amount necessary to discharge the sum or sums secured thereby. See Tennessee Code 56-9-103
• Generic alternative: means a drug that is designated to be therapeutically equivalent by the United States food and drug administration's Approved Drug Products with Therapeutic Equivalence Evaluations. See Tennessee Code 56-7-3201
• Genetic information: means information derived from genetic testing to determine the presence or absence of variations or mutations, including carrier status, in an individual's genetic material or genes that are scientifically or medically believed to cause a disease, disorder or syndrome, or are associated with a statistically increased risk of developing a disease, disorder or syndrome, that is asymptomatic at the time of testing. See Tennessee Code 56-7-2702
• Genetic services: means health services to obtain, assess, and interpret genetic information for diagnostic and therapeutic purposes, and for genetic education and counseling. See Tennessee Code 56-7-2702
• Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
• Governmental plan: has the meaning given the term under ERISA, §. See Tennessee Code 56-7-2802
• Governmental plan: has the meaning under ERISA, in 29 U. See Tennessee Code 56-7-2902
• Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. ^{Source: Federal Reserve}
• gross premiums: means maximum gross premiums as provided in the policy contracts, new and renewal, including policy or membership fees, whether paid in part or in whole by cash, automatic premium loans, dividends applied in any manner whatsoever, and without deduction or exclusion of dividends in any manner. See Tennessee Code 56-4-204
• Gross profits or income: as used in this part , means gross income from all sources, except as provided in subsection (b), including income on tax exempt securities, loans, dividends and interest on stocks, bonds or other investments, plus net rentals on real estate, less the net amount of tax paid by the investment company on its tangible assets wherever located. See Tennessee Code 56-4-305
• Group health insurance coverage: means , in connection with a group health plan, health insurance coverage offered in connection with the plan. See Tennessee Code 56-7-2802
• Group health plan: means an employee welfare benefit plan, as defined in ERISA, §. See Tennessee Code 56-7-2802
• Group health plan: means an employee welfare benefit plan as defined in ERISA, in 29 U. See Tennessee Code 56-7-2902
• Guarantor: A party who agrees to be responsible for the payment of another party's debts should that party default. ^{Source: OCC}
• Guaranty association: means the Tennessee insurance guaranty association created by chapter 12, part 1 of this title, the life and health insurance guaranty association created by chapter 12, part 2 of this title, and any other similar entity now or hereafter created by the general assembly of this state for the payment of claims of insolvent insurers. See Tennessee Code 56-9-103
• Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
• Health benefit plan: means :
  (i) Any accident and health insurance policy or certificate. See Tennessee Code 56-7-2203
• Health benefit plan: includes accident only, credit health, dental, vision, medicare supplement, or long-term care coverage issued as a supplement to liability insurance, automobile medical payment insurance, short-term and catastrophic health insurance policies, and a policy that pays on a cost-incurred basis. See Tennessee Code 56-8-202
• Health care provider: means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11. See Tennessee Code 56-7-110
• Health care service: means health care procedures, treatments, or services provided by a facility licensed in this state or provided by a doctor of medicine, a doctor of osteopathy, or a health care professional licensed in this state. See Tennessee Code 56-6-703
• Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the cost of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits or health services. See Tennessee Code 56-8-202
• Health insurance coverage: means a contractual arrangement for the provision of a payment for health care, including:
  (A) A group health plan. See Tennessee Code 56-7-2702
• Health insurance coverage: means benefits consisting of medical care, provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care, under any policy, certificate, or agreement offered by a health insurance issuer. See Tennessee Code 56-7-2802
• Health insurance coverage: means any hospital and medical expense incurred policy, nonprofit health care service plan contract, health maintenance organization subscriber contract, or any other health care plan or arrangement that pays for or furnishes medical or health care services, whether by insurance or otherwise. See Tennessee Code 56-7-2902
• Health insurance issuer: means an entity subject to the insurance laws of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide health insurance coverage, including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation. See Tennessee Code 56-7-2802
• Health maintenance organization: means :
  (A) A federally qualified health maintenance organization, as defined under federal law. See Tennessee Code 56-7-2802
• Health maintenance organization: means an organization as defined in §. See Tennessee Code 56-7-2902
• Health plan: means health insurance coverage as defined in §. See Tennessee Code 56-7-602
• Health status-related factor: means any of the following factors:
  (A) Health status. See Tennessee Code 56-7-2802
• Healthcare entity: means :
  (A) Any healthcare facility licensed under title 33 or 68. See Tennessee Code 56-7-602
• Healthcare facility: means an institution, place, or building providing healthcare services that is required to be licensed under title 68, chapter 11, or title 33. See Tennessee Code 56-6-703
• Hedging transaction: means a derivative transaction that is entered into and maintained to manage:
  (A) The risk of a change in the value, yield, price, cash flow or quantity of assets or liabilities, or a portfolio of assets and/or liabilities, that the insurer has acquired or incurred or anticipates acquiring or incurring. See Tennessee Code 56-3-302
• highly rated: means an investment rated "P-1" by Moody's Investors Service, Inc. See Tennessee Code 56-3-302
• Home state: means any state or territory of the United States and the District of Columbia in which an insurance producer maintains a principal place of residence or principal place of business and is licensed to act as an insurance producer. See Tennessee Code 56-6-102
• Home state: means the District of Columbia and any state or territory of the United States in which the public adjuster's principal place of residence or principal place of business is located. See Tennessee Code 56-6-902
• Hospital: means a licensed public or private institution as defined in §. See Tennessee Code 56-7-2902
• Hospital: means a public or private hospital or facility or part of a hospital or facility equipped to provide inpatient care and treatment for persons with mental illness or serious emotional disturbance. See Tennessee Code 33-1-101
• Immediate family: means a spouse. See Tennessee Code 56-2-1003
• Income generation transaction: means a derivative transaction which is entered into to generate income. See Tennessee Code 56-3-302
• Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. ^{Source: FDIC}
• Independent casualty actuary: means a casualty actuary who is a member of the American Academy of Actuaries and who is not affiliated with, nor an employee, principal, nor the direct or indirect owner of, or in any way controlled by, the insurer or producer. See Tennessee Code 56-6-602
• Index rate: means , for each class of business as to a rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate. See Tennessee Code 56-7-2203
• Individual: means a natural person. See Tennessee Code 56-6-902
• Individual health insurance coverage: means health insurance coverage offered to individuals in the individual market, but does not include short-term limited duration insurance. See Tennessee Code 56-7-2802
• Individual market: means the market for health insurance coverage offered to individuals other than in connection with a group health plan. See Tennessee Code 56-7-2802
• Information security program: means the administrative, technical, and physical safeguards that a licensee uses to access, collect, distribute, process, protect, store, use, transmit, dispose of, or otherwise handle nonpublic information. See Tennessee Code 56-2-1003
• Information system: means :
  (A) A discrete set of electronic information resources organized for the collection, processing, maintenance, use, sharing, dissemination, or disposition of electronic nonpublic information. See Tennessee Code 56-2-1003
• Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
• Insane: includes all persons of unsound mind. See Tennessee Code 1-3-105
• insolvent: means :
  (A) For an insurer issuing only assessable fire insurance policies:

  (i) The inability to pay any obligation within thirty (30) days after it becomes payable. See Tennessee Code 56-9-103
• Institution: includes a corporation, a joint-stock association and a business trust. See Tennessee Code 56-3-401
• Insurance: means any of the lines of authority in §. See Tennessee Code 56-6-102
• Insurance arrangement: means , to the extent permitted by ERISA, any plan, program, contract or other arrangement under which one (1) or more employers, unions or other organizations provide to their employees or members, either directly or indirectly through a trust or third party administration, health care services or benefits other than through an insurer, and shall include any plan described in §. See Tennessee Code 56-7-2902
• insurance company: includes all corporations, associations, partnerships, or individuals engaged as principals in the business of insurance. See Tennessee Code 56-1-102
• insurance company: means any insurance, fidelity or surety company, including any corporation, company, partnership, association, society, order, fraternal or otherwise, individual or aggregation of individuals engaging in, or proposing or attempting to engage in, any kind of insurance or surety business, including the exchanging of reciprocal or interinsurance contracts between individuals, partnerships and corporations. See Tennessee Code 56-4-201
• Insurance group: means those insurers and affiliates included within an insurance holding company system as defined in §. See Tennessee Code 56-2-903
• Insurance producer: means a person required to be licensed under the laws of this state to sell, solicit or negotiate insurance. See Tennessee Code 56-6-102
• Insurance provider: means an insurer or other entity providing health insurance coverage. See Tennessee Code 56-7-2702
• Insurance score: means a number or rating that is derived from an algorithm, computer application, model, or other process that is based in whole or in part on credit information for the purposes of predicting the future insurance loss exposure of an individual applicant or insured. See Tennessee Code 56-5-201
• insured: includes a person who is a beneficiary covered by a group policy, certificate, or health benefit plan. See Tennessee Code 56-8-202
• Insurer: means and includes every person engaged as indemnitor, surety or contractor in the business of entering into contracts of insurance or of annuities, as limited to:
  (A) Any insurer who is doing an insurer business, or has transacted insurance in this state, and against whom claims arising from that transaction may exist now or in the future. See Tennessee Code 56-9-501
• Insurer: means any insurance company authorized to transact insurance business in this state. See Tennessee Code 56-6-102
• Insurer: means any person, firm, association or corporation duly licensed in this state as an insurance company pursuant to §. See Tennessee Code 56-6-502
• insurer: means a person, firm, association or corporation duly licensed to transact a property/casualty insurance business in this state. See Tennessee Code 56-6-602
• Insurer: means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer. See Tennessee Code 56-6-802
• insurer: means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations. See Tennessee Code 56-7-1603
• Insurer: means any person who has done, purports to do, is doing or is licensed to do an insurance business, and is or has been subject to the authority of, or to liquidation, rehabilitation, reorganization, supervision, or conservation by, any insurance commissioner. See Tennessee Code 56-9-103
• Insurer: means any entity that provides health insurance coverage in this state. See Tennessee Code 56-7-2902
• Insurer: means any insurance company authorized to transact life insurance business in this state. See Tennessee Code 56-7-3403
• Intellectual disability: means , for the purposes of the general functions of the department as set forth in §. See Tennessee Code 33-1-101
• Interchangeable biological product: means a biological product licensed by the federal food and drug administration and determined to meet the safety standards for determining interchangeability pursuant to 42 U. See Tennessee Code 56-7-3501
• Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. ^{Source: OCC}
• Internal Revenue Code: means the Internal Revenue Code of 1986, codified in United States Code, title 26, as amended. See Tennessee Code 8-34-101
• Intervenor: means any hospital, physician, allied health professional, health care provider or other person furnishing goods or services to, or in competition with, community mental health center, insurer, hospital service corporation, medical service corporation, hospital and medical services corporation, preferred provider organization, health maintenance organization, behavioral health organization, or any employer or association that directly or indirectly provides health care benefits to its employees or members. See Tennessee Code 33-2-703
• Intestate: Dying without leaving a will.
• Investment practices: means transactions of the types described in §. See Tennessee Code 56-3-302
• Issuer: includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this state medicare supplement policies or certificates. See Tennessee Code 56-7-1501
• Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
• Joint tenancy: A form of property ownership in which two or more parties hold an undivided interest in the same property that was conveyed under the same instrument at the same time. A joint tenant can sell his (her) interest but not dispose of it by will. Upon the death of a joint tenant, his (her) undivided interest is distributed among the surviving joint tenants.
• Joint underwriting: means a voluntary arrangement established on an ad hoc basis to provide insurance coverage for a commercial risk pursuant to which two (2) or more insurers separately contract with the insured at a price and under policy terms agreed upon between the insurers. See Tennessee Code 56-5-102
• Lands: includes lands, tenements and hereditaments, and all rights thereto and interests therein, equitable as well as legal. See Tennessee Code 1-3-105
• Large employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employed an average of at least fifty-one (51) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Tennessee Code 56-7-2802
• Large group market: means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a large employer. See Tennessee Code 56-7-2802
• Late enrollee: means an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period provided under the terms of the health benefit plan. See Tennessee Code 56-7-2203
• Late enrollee: means , with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:
  (A) The first period in which the individual is eligible to enroll under the plan. See Tennessee Code 56-7-2802
• Levels of care: means the continuum of support ranging from nonclinical recovery housing to clinical and licensed treatment. See Tennessee Code 33-2-1401
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• liabilities: include , but are not limited to, reserves required by statute or by department general regulations or specific requirements imposed by the commissioner upon a subject company at the time of admission or subsequent thereto. See Tennessee Code 56-9-103
• License: means a document issued by this state's commissioner authorizing a person to act as an insurance producer for the lines of authority specified in the document. See Tennessee Code 56-6-102
• Licensed producer: means an agent, broker or reinsurance intermediary licensed pursuant to the applicable provisions of this title. See Tennessee Code 56-6-802
• Licensee: means a proprietorship, a partnership, an association, a governmental agency, or corporation, that operates a facility or a service and has obtained a license under this part. See Tennessee Code 33-2-402
• Lien: A claim against real or personal property in satisfaction of a debt.
• Limited line credit insurance: includes credit life, credit disability, credit property, credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage disability, guaranteed automobile protection (gap) insurance, and any other form of insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation that the commissioner determines should be designated a form of limited line credit insurance. See Tennessee Code 56-6-102
• Limited lines insurance: means those lines of insurance defined in §. See Tennessee Code 56-6-102
• Limited lines producer: means a person authorized by the commissioner to sell, solicit or negotiate limited lines insurance. See Tennessee Code 56-6-102
• Limited lines travel insurance producer: means an individual or business entity that has met the requirements of §. See Tennessee Code 56-6-1402
• Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
• Livestock: means all equine as well as animals that are being raised primarily for use as food or fiber for human utilization or consumption including, but not limited to, cattle, sheep, swine, goats, and poultry. See Tennessee Code 1-3-105
• Market value: means the price for the security or derivative instrument obtained from a generally recognized source or the most recent quotation from the source or, to the extent no generally recognized source exists, the price for the security or derivative instrument as determined pursuant to the terms of the instrument or in good faith by the insurer as can be reasonably demonstrated to the commissioner upon request, plus accrued but unpaid income on the security or derivative instrument to the extent not included in the price as of the date. See Tennessee Code 56-3-302
• Markup: The process by which congressional committees and subcommittees debate, amend, and rewrite proposed legislation.
• Maximum allowable cost: means the maximum amount that a pharmacy benefits manager or covered entity will reimburse a pharmacy for the cost of a drug or a medical product or device. See Tennessee Code 56-7-3102
• Maximum allowable cost list: means a list of drugs, medical products or devices, or both medical products and devices, for which a maximum allowable cost has been established by a pharmacy benefits manager or covered entity. See Tennessee Code 56-7-3102
• Medicaid: means the federal- and state-financed, state-run program of medical assistance established pursuant to Title XIX of the Social Security Act ( 42 U. See Tennessee Code 56-7-2902
• Medical care: means amounts paid for:
  (A) The diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body. See Tennessee Code 56-7-2802
• Medical care: means :
  (A) The diagnosis, care, mitigation, treatment, or prevention of disease. See Tennessee Code 56-7-2902
• Medicare: means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965. See Tennessee Code 56-7-1501
• Medicare: means coverage under Parts A and/or B of Title XVIII of the Social Security Act ( 42 U. See Tennessee Code 56-7-2902
• Medicare supplement policy: means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations other than a policy issued pursuant to a contract under §. See Tennessee Code 56-7-1501
• 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
• Membership service: means service rendered while a member of the retirement system. See Tennessee Code 8-34-101
• Mental illness: means a psychiatric disorder, alcohol dependence, or drug dependence, but does not include intellectual disability or other developmental disabilities. See Tennessee Code 33-1-101
• MGA: means any person who:
  (i) Manages all or part of the insurance business of an insurer, including the management of a separate division, department, or underwriting office. See Tennessee Code 56-6-502
• Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
• Misappropriation of property: means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of belongings or money without consent. See Tennessee Code 33-2-402
• Mortgage loan: A loan made by a lender to a borrower for the financing of real property. ^{Source: OCC}
• Mortgagee: The person to whom property is mortgaged and who has loaned the money.
• Mortgagor: The person who pledges property to a creditor as collateral for a loan and who receives the money.
• Multi-factor authentication: means authentication through verification of at least two (2) of the following types of authentication factors:
  (A) Knowledge factors, such as by a password. See Tennessee Code 56-2-1003
• Multiplier: means a workers' compensation insurance company's determination of the profits and expenses, other than loss expense and loss adjustment expense, all other applicable rating factors, including, but not limited to, schedule rating, experience rating and small deductible credits, and deviation from advisory prospective loss costs associated with writing workers' compensation insurance, which shall be expressed as a single multiplicative factor to be applied equally and uniformly to the advisory prospective loss costs approved by the commissioner in making rates for all classification of risks utilized by the company. See Tennessee Code 56-5-102
• NAIC: means the National Association of Insurance Commissioners. See Tennessee Code 56-6-102
• NAIC: means the National Association of Insurance Commissioners. See Tennessee Code 56-6-902
• NAIC: means the National Association of Insurance Commissioners. See Tennessee Code 56-2-903
• NAIC: means the National Association of Insurance Commissioners. See Tennessee Code 56-3-302
• NAIC-SVO: means the securities valuation office of the National Association of Insurance Commissioners. See Tennessee Code 56-3-302
• National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. ^{Source: OCC}
• Neglect: means failure to provide goods or services necessary to avoid physical harm, mental anguish, or mental illness, which results in injury or probable risk of serious harm. See Tennessee Code 33-2-402
• Negotiate: means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms or conditions of the contract. See Tennessee Code 56-6-102
• Net earnings available for fixed charges: means net income determined on either a consolidated or an unconsolidated basis after allowance for operating and maintenance expenses, depreciation and depletion, and taxes, other than federal and state income taxes, but excluding extraordinary nonrecurring items of income or expense appearing in the regular financial statements of the issuing, assuming or guaranteeing business entity. See Tennessee Code 56-3-302
• Netting agreement: means :
  (A) A contract or agreement, including terms and conditions incorporated by reference in it, including a master agreement, which master agreement, together with all schedules, confirmations, definitions, and addenda to it and transactions under any of them, shall be treated as one (1) netting agreement, that documents one (1) or more transactions between the parties to the agreement for or involving one (1) or more qualified financial contracts and that provides for the netting, liquidation, setoff, termination, acceleration, or close-out, under or in connection with one (1) or more qualified financial contracts or present or future payment or delivery obligations or payment or delivery entitlements under one (1) or more qualified financial contracts, including liquidation or close-out values relating to those obligations or entitlements, among the parties to the netting agreement. See Tennessee Code 56-9-103
• Network plan: means health insurance coverage of a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer. See Tennessee Code 56-7-2802
• New business premium rate: means , for each class of business as to a rating period, the lowest premium rate charged, offered or that could have been charged by a small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage. See Tennessee Code 56-7-2203
• Nonfederal governmental plan: means a governmental plan that is not a federal governmental plan. See Tennessee Code 56-7-2802
• Nonpayment of premium: means failure of the named insured to discharge when due any obligations in connection with the payment of premiums on a policy of automobile liability insurance or any installment of the premium, whether the premium is payable directly to the insurer or its agent or indirectly under any premium finance plan or extension of credit. See Tennessee Code 56-7-1301
• Nonpayment of premium: means failure of the named insured to discharge when due any of its obligations in connection with the payment of premiums on a policy of commercial risk insurance or any installment of the premium, whether the premium is payable directly to the insurer or its agents or indirectly under any premium finance plan or extension of credit. See Tennessee Code 56-7-1802
• Nonpublic information: means information that is not publicly available and that is:
  (A) Business-related information of a licensee, in which the tampering with, unauthorized disclosure of, access to, or use of, would cause a material adverse impact to the business, operations, or security of the licensee. See Tennessee Code 56-2-1003
• Nonresidential office-based opiate treatment facility: includes , but is not limited to, stand-alone clinics, treatment resources, individual physical locations occupied as the professional practice of a prescriber or prescribers licensed pursuant to title 63, or other entities prescribing products containing buprenorphine, or products containing any other controlled substance designed to treat opiate addiction by preventing symptoms of withdrawal to twenty-five percent (25%) or more of its patients or to one hundred fifty (150) or more patients. See Tennessee Code 33-2-402
• Oath: includes affirmation. See Tennessee Code 1-3-105
• Oath: A promise to tell the truth.
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• Obligation: means a note, bond, debenture, trust certificate, equipment trust certificate, production payment, negotiable bank certificate of deposit, bankers' acceptance, asset-backed security, NAIC-SVO credit tenant loan, loan secured by financing a net lease or net leases, and other evidence of indebtedness for the payment of money, or participations, certificates or other evidences of an interest in any of the obligations listed in this subdivision (29), whether constituting a general obligation of the issuer or payable only out of certain revenues or certain funds pledged or otherwise dedicated for payment. See Tennessee Code 56-3-302
• Offer and disseminate: means providing general information, including a description of the coverage and price, as well as processing the application, collecting premiums, and performing other lawful nonlicensable activities. See Tennessee Code 56-6-1402
• Option: means an agreement giving the buyer the right to buy or receive, known as a "call option" sell or deliver, known as a "put option" enter into, extend or terminate or effect a cash settlement based on the actual or expected price, spread, level, performance or value of one (1) or more underlying interests. See Tennessee Code 56-3-302
• Organization: means any nationally recognized recovery residence standards organization, any affiliate of any nationally recognized recovery residence standards organization, or grantees of any state or federal department or agency. See Tennessee Code 33-2-1401
• Over-the-counter derivative instrument: means a derivative instrument entered into with a business entity, other than through a securities exchange, futures exchange, or cleared through a qualified clearinghouse. See Tennessee Code 56-3-302
• Participant: has the meaning given the term under ERISA, §. See Tennessee Code 56-7-2802
• Peer: means an individual with lived experience in recovery and the appropriate skills to support a recovery community. See Tennessee Code 33-2-1401
• Person: means any association, aggregate of individuals, business, company, corporation, individual, joint-stock company, Lloyds-type organization, organization, partnership, receiver, reciprocal or interinsurance exchange, trustee or society. See Tennessee Code 56-16-102
• Person: means an individual or a business entity. See Tennessee Code 56-6-102
• Person: means an individual or a business entity. See Tennessee Code 56-6-902
• Person: means a natural person. See Tennessee Code 56-6-1001
• Person: means a business entity or a natural person. See Tennessee Code 56-6-1402
• Person: includes a corporation, company, association, firm, partnership, society, and joint stock company, as well as an individual. See Tennessee Code 56-7-2702
• Person: means an individual, trust, firm, joint stock company, corporation (including a government corporation), partnership, association, state, municipality, commission, political subdivision of a state, any interstate body, any governmental agency of this state and any department, agency or instrumentality of the federal government. See Tennessee Code 68-202-401
• Person: means an individual or non-governmental entity, including a sole proprietorship, corporation, limited liability company, partnership, trust, religious organization, association, nonprofit organization described in §. See Tennessee Code 56-2-1003
• Person: means an individual, a business entity, a multilateral development bank or a government or quasi-governmental body, such as a political subdivision or a government sponsored enterprise. See Tennessee Code 56-3-302
• Person: means the policy insured, annuity owner, annuitant, or account owner, as applicable under the policy, annuity, or retained asset account subject to this part. See Tennessee Code 56-7-3403
• Personal property: All property that is not real property.
• Personal property: includes money, goods, chattels, things in action, and evidences of debt. See Tennessee Code 1-3-105
• Personal 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
• Personal risk insurance: means property and casualty insurance that provides:
  (A) Insurance on one (1) to four (4) family dwelling units, including mobile homes. See Tennessee Code 56-5-102
• Personal support services: means nursing consultation, education services, and other personal assistance services as defined by rule, which are provided to individuals with substantial limitation in two (2) or more major life activities in either their regular or temporary residences, but does not mean direct nursing services provided in connection with an acute episode of illness or injury. See Tennessee Code 33-2-402
• Pharmacy benefits manager: includes , but is not limited to, a health insurance issuer, managed health insurance issuer as defined in §. See Tennessee Code 56-7-3102
• Pharmacy benefits manager: means a pharmacy benefits manager as defined in §. See Tennessee Code 56-7-3201
• Pharmacy services administrative organization: means an entity that provides contracting and other administrative services to pharmacies to assist them in their interaction with third-party payers, pharmacy benefits managers, drug wholesalers, and other entities. See Tennessee Code 56-7-3102
• Plaintiff: The person who files the complaint in a civil lawsuit.
• plan: means a policy, contract, certificate or agreement offered by a carrier to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. See Tennessee Code 56-8-202
• Plan of operation: means the articles, bylaws, and operating rules and procedures adopted by the board pursuant to §. See Tennessee Code 56-7-2902
• Plan sponsor: has the meaning given the term under §. See Tennessee Code 56-7-2802
• Pleadings: Written statements of the parties in a civil case of their positions. In the federal courts, the principal pleadings are the complaint and the answer.
• Policy: means any policy or certificate of life insurance issued in this state, but does not include any policy or certificate of life insurance that provides a death benefit under:
  (A) An employee benefit plan subject to the Employee Retirement Income Security Act of 1974, as periodically amended, compiled at 29 U. See Tennessee Code 56-7-3403
• Policy: means a contract of insurance, certificate, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by an insurer, including endorsements or riders to an insurance policy or contract. See Tennessee Code 56-8-202
• policy form: means :
  (A) Any policy, contract, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this part. See Tennessee Code 56-7-1603
• Pool: means a voluntary arrangement other than a residual market mechanism, established on an ongoing basis, pursuant to which two (2) or more insurers participate in the sharing of risks on a predetermined basis. See Tennessee Code 56-5-102
• Potential exposure: means :
  (A) As to a futures position, the amount of initial margin required for that position. See Tennessee Code 56-3-302
• Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. ^{Source: OCC}
• Preauthorization: means the process by which the utilization review agent determines the medical necessity of otherwise covered health care services prior to the rendering of such health care services including, but not limited to, preadmission review, pretreatment review, utilization, and case management. See Tennessee Code 56-6-703
• Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
• Preexisting condition exclusion: means , with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that date. See Tennessee Code 56-7-2802
• Preexisting conditions provision: means a policy provision that limits or excludes coverage for charges or expenses incurred during a specified period following the insured's effective date of coverage, for a condition that, during a specified period immediately preceding the effective date of coverage, had manifested itself in a manner that would cause an ordinarily prudent person to seek diagnosis, care or treatment, or for which medical advice, diagnosis, care or treatment was recommended or received as to that condition or as to pregnancy existing on the effective date of coverage. See Tennessee Code 56-7-2203
• Preferred dividend requirements: means dividends at the maximum prescribed rate on all preferred stock of the same class as that being acquired by the insurance company and on all stock ranking as to dividends on a parity with the dividends or prior to the dividends, whether or not the dividends are cumulative. See Tennessee Code 56-3-302
• Preferred dividend requirements: means dividends at the maximum prescribed rate on all preferred stock of the same class as that being acquired by the insurance company and on all stock ranking as to dividends on a parity with the dividends or prior to the dividends, whether or not the dividends are cumulative. See Tennessee Code 56-3-401
• Premium: includes insurance premiums or other fees charged for a health benefit plan, including the costs of benefits paid or reimbursements made to or on behalf of persons covered by the plan. See Tennessee Code 56-7-2203
• Prescription drug: means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs. See Tennessee Code 56-7-3201
• Prescription drug: means a drug that under federal or state law is required to be dispensed only pursuant to a prescription order or is restricted to use by individuals authorized by law to prescribe drugs. See Tennessee Code 56-7-3501
• Prior service: means service rendered prior to the date of membership in the retirement system for which credit was given under the terms of one (1) or more of the superseded systems as provided in part 6 of this chapter. See Tennessee Code 8-34-101
• Private passenger automobile liability insurance policy: means a policy delivered or issued for delivery in this state, insuring a natural person as named insured, or one (1) or more related individuals resident of the same household, and under which the insured vehicles therein designated are of the following types only:
  (A) A motor vehicle of the private passenger or station wagon type that is not used as a public or livery conveyance for passengers, nor rented to others. See Tennessee Code 56-7-1301
• Probable cause: A reasonable ground for belief that the offender violated a specific law.
• Probation: A sentencing alternative to imprisonment in which the court releases convicted defendants under supervision as long as certain conditions are observed.
• Producer: means an insurance broker or brokers or any other person, firm, association or corporation, when, for any compensation, commission or other thing of value, the person, firm, association or corporation acts or aids in any manner in soliciting, negotiating or procuring the making of any insurance contract on behalf of an insured other than the person, firm, association or corporation. See Tennessee Code 56-6-602
• production credit association: means a corporation organized and chartered pursuant to §. See Tennessee Code 56-4-401
• Program: means the Access Tennessee health insurance program, created in §. See Tennessee Code 56-7-2902
• Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
• provider: means any person or entity performing services regulated pursuant to title 63 or title 68, chapter 11, with whom the health insurance entity has an express and valid network provider agreement or contract. See Tennessee Code 56-7-3301
• Provider of record: means the physician or other licensed practitioner identified to the utilization review agent as having primary responsibility for the care, treatment, and services rendered to an individual. See Tennessee Code 56-6-703
• Public adjuster: means any person, other than someone who is employed by an insurance carrier, who, for compensation or any other thing of value, on behalf of the insured:
  (i) Acts or aids, solely in relation to first party claims arising under insurance contracts that insure the real or personal property of the insured on behalf of an insured, in investigating, verifying, substaining, estimating, appraising, determining, presenting, and discussing the value of the claim, and effectuating the resolution of a claim for loss or damage covered by an insurance contract. See Tennessee Code 56-6-902
• Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
• Qualified clearinghouse: means a clearinghouse subject to the rules of a securities exchange or a futures exchange that provides clearing services, including acting as a counterparty to each of the parties to a transaction such that the parties no longer have credit risk to each other. See Tennessee Code 56-3-302
• Qualified financial contract: means any commodity contract, forward contract, repurchase agreement, securities contract, swap agreement, and any similar agreement that the commissioner determines to be a qualified financial contract for the purposes of this chapter. See Tennessee Code 56-9-103
• Qualified primary credit source: means the credit source to which an insurer looks for payment as to an investment and against which an insurer has a direct claim for full and timely payment, evidenced by a contractual right for which an enforcement action can be brought in a domestic jurisdiction. See Tennessee Code 56-3-302
• Radiation: includes all ionizing electromagnetic waves and corpuscular emissions such as, but not necessarily limited to, gamma rays and X-rays. See Tennessee Code 68-202-401
• Radioactive material: refers to any material, solid, liquid or gas, which emits radiation spontaneously. See Tennessee Code 68-202-401
• Rate: includes advisory prospective loss costs. See Tennessee Code 56-5-102
• Rate service organization: means any person or organization that assists insurers in ratemaking or filing as authorized by §. See Tennessee Code 56-5-102
• Rating period: means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect, as determined by the small employer carrier. See Tennessee Code 56-7-2203
• Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
• real property: include lands, tenements and hereditaments, and all rights thereto and interests therein, equitable as well as legal. See Tennessee Code 1-3-105
• Reasonably accurate: means information determined through application by the health insurance entity of contract rates, fee schedules and reimbursement rules and policies in effect as of the date inquiry is made by the provider. See Tennessee Code 56-7-3301
• Receiver: means receiver, liquidator, rehabilitator or conservator as the context requires. See Tennessee Code 56-9-103
• Reciprocal: means the aggregation of subscribers under a common name. See Tennessee Code 56-16-102
• Reciprocal state: means any state other than this state in which in substance and effect §. See Tennessee Code 56-9-103
• Reciprocal state: means any state or territory of the United States, the laws of which contain procedures substantially similar to those specified in this part for the enforcement of decrees or orders in equity issued by courts located in other states or territories of the United States, against any insurer incorporated or authorized to do business in the state or territory. See Tennessee Code 56-2-702
• Record keeping services: means those circumstances under which the insurer has agreed with a group life insurance policyholder to be responsible for obtaining, maintaining, and administering in its own systems information about each individual insured under the policyholder's group life insurance contract at least the following information:
  (A) Individual insured's social security number or name and date of birth. See Tennessee Code 56-7-3403
• Recoupment: means the action by a health insurance entity to recover amounts previously paid to a health care provider by withholding or setting off the amounts against current payments to the health care provider. See Tennessee Code 56-7-110
• Recovery residence: means any ADTF, including any residence classified as a single family residence under §. See Tennessee Code 33-2-1401
• Reinsurance intermediary: means a reinsurance intermediary broker, or a reinsurance intermediary manager. See Tennessee Code 56-6-802
• Reinsurer: means any person, firm, association or corporation duly licensed in this state pursuant to the applicable provisions of this title as an insurer with the authority to assume reinsurance. See Tennessee Code 56-6-802
• Replication transaction: means a derivative transaction or combination of derivative transactions effected either separately or in conjunction with cash market investments included in the insurer's investment portfolio in order to replicate the risks and returns of another authorized transaction, investment or instrument and/or operate as a substitute for cash market transactions. See Tennessee Code 56-3-302
• Repurchase transaction: means a transaction in which an insurer purchases securities from a business entity that is obligated to repurchase the purchased securities or equivalent securities from the insurer at a specified price, either within a specified period of time or upon demand. See Tennessee Code 56-3-302
• Reputable and responsible character: means that the applicant or licensee can be trusted with responsibility for persons who are particularly vulnerable to abuse, neglect, and financial or sexual exploitation. See Tennessee Code 33-2-402
• Required prescription drug: means a medication that is required as part of a step therapy protocol. See Tennessee Code 56-7-3501
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• Resident: means an individual who is legally domiciled in Tennessee. See Tennessee Code 56-7-2902
• Residual market mechanism: means an arrangement, either voluntary or mandated by law, involving participation by insurers in the equitable apportionment among them of insurance that may be afforded applicants who are unable to obtain insurance through ordinary methods. See Tennessee Code 56-5-102
• Responsible relative: means the parent of an unemancipated child with mental illness, serious emotional disturbance, alcohol dependence, drug dependence, or developmental disabilities who is receiving service in programs of the department or any relative who accepts financial responsibility for the care and service of a service recipient. See Tennessee Code 33-1-101
• Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
• Retirement: means withdrawal from membership with a retirement allowance granted under chapters 34-37 of this title. See Tennessee Code 8-34-101
• Retirement allowance: means the sum of the member annuity and the state annuity. See Tennessee Code 8-34-101
• Retirement system: means the Tennessee consolidated retirement system as defined in §. See Tennessee Code 8-34-101
• Revocable trust: A trust agreement that can be canceled, rescinded, revoked, or repealed by the grantor (person who establishes the trust).
• Risk assessment: means the risk assessment that each licensee must conduct under §. See Tennessee Code 56-2-1003
• Savings and loan association: includes a building and loan association, a federal or state savings and loan association, a federal savings bank, and any other financial institution, the accounts of which are insured by the federal savings and loan insurance corporation (FSLIC) or any successor of such corporation. See Tennessee Code 1-3-105
• Secured claim: means any claim secured by mortgage, trust deed, pledge, deposit as security, escrow, or otherwise, but not including special deposit claims or claims against general assets. See Tennessee Code 56-9-103
• Securities: means instruments as defined in §. See Tennessee Code 56-3-902
• Securities exchange: means :
  (A) An exchange registered as a national securities exchange or a securities market registered under the Securities Exchange Act of 1934 (15 U. See Tennessee Code 56-3-302
• Securities lending transaction: means a transaction in which securities are loaned by an insurer to a business entity that is obligated to return the loaned securities or equivalent securities to the insurer, either within a specified period of time or upon demand. See Tennessee Code 56-3-302
• Sell: means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company. See Tennessee Code 56-6-102
• Serious emotional disturbance: means a condition in a child who currently or at any time during the past year has had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet psychiatric diagnostic criteria that results in functional impairment that substantially interferes with or limits the child's role or functioning in family, school, or community activities and includes any mental disorder, regardless of whether it is of biological etiology. See Tennessee Code 33-1-101
• Service: includes any activity to prevent, treat, or ameliorate mental illness, serious emotional disturbance, alcohol and drug use, intellectual or developmental disabilities, which includes diagnosis, evaluation, residential assistance, training, habilitation, rehabilitation, prevention, treatment, counseling, case coordination, or supervision of persons with mental illness, alcohol and drug abuse issues, serious emotional disturbances, and intellectual or developmental disabilities. See Tennessee Code 33-2-402
• Service: means service as a general employee, a teacher, a state police officer, a wildlife officer, a firefighter, a police officer, a state judge, a county judge, an attorney general, a commissioner or a county official which is paid for by an employer, and also includes service for which a former member of the general assembly is entitled to under former §. See Tennessee Code 8-34-101
• Service of process: The service of writs or summonses to the appropriate party.
• Service recipient: means a person who is receiving service, has applied for service, or for whom someone has applied for or proposed service because the person has mental illness, serious emotional disturbance, or a developmental disability. See Tennessee Code 33-1-101
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Shell business entity: means a business entity having no economic substance, except as a vehicle for owning interests in assets issued, owned or previously owned by a person domiciled in a foreign jurisdiction. See Tennessee Code 56-3-302
• Shopping and decision support program: means the program established by a carrier pursuant to this part. See Tennessee Code 56-7-602
• Significant break in coverage: means a period of sixty-three (63) consecutive days during all of which the individual does not have any creditable coverage, except that neither a waiting period nor an affiliation period is taken into account in determining a significant break in coverage. See Tennessee Code 56-7-2902
• small employer: includes any person that, during the preceding year, employed no less than two (2) and no more than fifty (50) eligible employees and otherwise qualifies as a small employer pursuant to this subdivision (18). See Tennessee Code 56-7-2203
• Small employer: means , in connection with a group health plan with respect to a calendar year and a plan year, an employer who employs an average of at least two (2) but no more than fifty (50) employees on business days during the preceding calendar year and who employs at least two (2) employees on the first day of the plan year. See Tennessee Code 56-7-2802
• Small employer carrier: means any carrier that offers health benefit plans covering eligible employees of one (1) or more small employers. See Tennessee Code 56-7-2203
• Small group market: means the health insurance market under which individuals obtain health insurance coverage, directly or through any arrangement, on behalf of themselves and their dependents, through a group health plan maintained by a small employer. See Tennessee Code 56-7-2802
• Solicit: means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular company. See Tennessee Code 56-6-102
• Specific license: means a license issued by the department which allows the use, storage, handling, and possession of radioactive sources under specified conditions of the license. See Tennessee Code 68-202-401
• Specific licensee: means a holder of a specific license issued by the department. See Tennessee Code 68-202-401
• State: means any state, district or territory of the United States and the Panama Canal Zone. See Tennessee Code 56-9-103
• State: includes the several states, the District of Columbia, the Commonwealth of Puerto Rico and the possessions of the United States. See Tennessee Code 56-3-302
• State: means the state of Tennessee. See Tennessee Code 8-34-101
• State: includes the several states, the District of Columbia, the Commonwealth of Puerto Rico and the possessions of the United States. See Tennessee Code 56-3-401
• Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
• Step therapy protocol: means a protocol, policy, or program that establishes a specific sequence in which prescription drugs for a specified medical condition, and medically appropriate for a particular patient, are covered by a health carrier or health benefit plan. See Tennessee Code 56-7-3501
• Subject of abuse: means a person to whom a family member, or a current or former household member, intimate partner, or caretaker, or a perpetrator of sexual assault, a stalker or a sex offender has directed an act as defined in subdivision (1). See Tennessee Code 56-8-202
• Subpoena: A command to a witness to appear and give testimony.
• Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
• Subscription: includes a mark, the name being written near the mark and witnessed. See Tennessee Code 1-3-105
• suitable available accommodations: means that a state-owned or operated hospital or treatment resource has the capacity, as reasonably determined by the commissioner, and the medical capability, equipment and staffing to provide an appropriate level of care, treatment and physical security to an individual in an unoccupied and unassigned bed. See Tennessee Code 33-1-101
• Superseded system: means , where applicable, the Tennessee state retirement system, the Tennessee teachers' retirement system, the Tennessee judges' retirement system, the retirement system for county paid judges of Tennessee, the attorneys general retirement system of Tennessee, the public service commissioners' retirement system, and the Tennessee retirement system for county officials, any one (1) of them, or any combination thereof. See Tennessee Code 8-34-101
• Supplementary rate information: includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, loss adjustment expense, including defense costs incurred for any reason under the policy, and any other similar information needed to determine the applicable rate in effect or to be in effect. See Tennessee Code 56-5-102
• Support: means any activity or resource that enables a service recipient to participate in a service for mental illness, serious emotional disturbance, or developmental disabilities or in community life. See Tennessee Code 33-1-101
• Supporting information: means :
  (A) The experience and judgment of the filer and the experience or data of other insurers or organizations relied upon by the filer. See Tennessee Code 56-5-102
• Surplus lines producer: means a person authorized by the commissioner to sell, solicit or negotiate surplus lines insurance pursuant to the Surplus Lines Insurance Act, compiled in chapter 14 of this title. See Tennessee Code 56-6-102
• SVO Rating: means the numerical ranking designation of one (1) through six (6) assigned to securities as determined by the NAIC-SVO. See Tennessee Code 56-3-302
• Swap: means an agreement to exchange or to net payments at one (1) or more times based on the actual or expected price, yield, level, performance or value of one (1) or more underlying interests. See Tennessee Code 56-3-302
• Swaption: means an option to purchase or sell a swap at a given price and time or at a series of prices and times. See Tennessee Code 56-3-302
• Tennessee securities: means real estate owned by an insurance company described in subdivision (b)(1) in this state. See Tennessee Code 56-4-210
• Testate: To die leaving a will.
• Testify: Answer questions in court.
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• Third party administrator: means any entity that, on behalf of an insurer or insurance arrangement, 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. See Tennessee Code 56-7-2902
• Third-party service provider: means a person, not otherwise defined as a licensee, that contracts with a licensee to maintain, process, or store, or is otherwise permitted access to maintain, process, or store, nonpublic information through its provision of services to the licensee. See Tennessee Code 56-2-1003
• To be in violation: means that the reinsurance intermediary, insurer, or reinsurer for whom the reinsurance intermediary was acting failed to substantially comply with this part. See Tennessee Code 56-6-802
• Tort: A civil wrong or breach of a duty to another person, as outlined by law. A very common tort is negligent operation of a motor vehicle that results in property damage and personal injury in an automobile accident.
• Transfer: includes the sale and every other and different mode, direct or indirect, of disposing of or of parting with property or with an interest therein, or with the possession thereof or of fixing a lien upon property or upon an interest therein, absolutely or conditionally, voluntarily, by or without judicial proceedings. See Tennessee Code 56-9-103
• Travel insurance supervising entity: means a person that receives a license pursuant to §. See Tennessee Code 56-6-1402
• Travel retailer: means a business entity that makes, arranges, or offers travel services and may offer and disseminate travel insurance as a service to its customers on behalf of and under the direction of a travel insurance supervising entity. See Tennessee Code 56-6-1402
• Treatment resource: means any public or private facility, service, or program providing treatment or rehabilitation services for mental illness or serious emotional disturbance, including, but not limited to, detoxification centers, hospitals, community mental health centers, clinics or programs, halfway houses, and rehabilitation centers. See Tennessee Code 33-1-101
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. ^{Source: OCC}
• Trustee: A person or institution holding and administering property in trust.
• Underlying interest: means the assets, liabilities or other interests, or a combination of assets, liabilities or other interests, underlying a derivative instrument, such as any one (1) or more securities, currencies, rates, indices, commodities or derivative instruments. See Tennessee Code 56-3-302
• Uniform application: means the current version of the NAIC uniform application for resident and nonresident producer licensing. See Tennessee Code 56-6-102
• Uniform business entity application: means the current version of the NAIC uniform business entity application for resident and nonresident business entities. See Tennessee Code 56-6-102
• Uniform business entity application: means the current version of the NAIC uniform business entity application for resident and nonresident business entities. See Tennessee Code 56-6-902
• Uniform Commercial Code: A set of statutes enacted by the various states to provide consistency among the states' commercial laws. It includes negotiable instruments, sales, stock transfers, trust and warehouse receipts, and bills of lading. ^{Source: OCC}
• Uniform individual application: means the current version of the NAIC uniform individual application for resident and nonresident individuals. See Tennessee Code 56-6-902
• Uphold: The decision of an appellate court not to reverse a lower court decision.
• Usury: Charging an illegally high interest rate on a loan. ^{Source: OCC}
• Utilization review: means a system for prospective and concurrent review of the necessity and appropriateness in the allocation of health care resources and services given or proposed to be given to an individual within this state. See Tennessee Code 56-6-703
• Utilization review agent: means any person or entity, including the state, performing utilization review, except:
  (A) An agency of the federal government. See Tennessee Code 56-6-703
• Utilization review organization: means an entity that conducts utilization review, as defined in §. See Tennessee Code 56-7-3501
• Verdict: The decision of a petit jury or a judge.
• Waiting period: means , with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. See Tennessee Code 56-7-2802
• Warrant: means an instrument that gives the holder the right to purchase or sell the underlying interest at a given price and time or at a series of prices and times outlined in the warrant agreement. See Tennessee Code 56-3-302
• Writ: A formal written command, issued from the court, requiring the performance of a specific act.
• Writ of certiorari: An order issued by the Supreme Court directing the lower court to transmit records for a case for which it will hear on appeal.