(a) Except as modified in this section, this part shall apply with respect to group health plans, and health insurance coverage offered in connection with group health plans, for plan years beginning after June 30, 1997.
Terms Used In Tennessee Code 56-7-2808
Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
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
Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
Group health plan: means an employee welfare benefit plan, as defined in ERISA, §. See Tennessee Code 56-7-2802
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 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
(b)Determination of creditable coverage.(1)Period of coverage.(A) Subject to subdivision (b)(1)(B), no period before July 1, 1996, shall be taken into account in determining creditable coverage.(B) The commissioner shall provide for a process whereby individuals who need to establish creditable coverage for periods before July 1, 1996, and who would have coverage credited, but for subdivision (b)(1)(A) may be given credit for creditable coverage for the periods through the presentation of documents or other means.(2)Certifications.(A) Subject to subdivisions (b)(2)(B) and (C), the provisions regarding certification shall apply to events occurring after June 30, 1996.(B) In no case is a certification required to be provided under this subdivision (b)(2) before June 1, 1997.(C) In the case of an event occurring after June 30, 1996, and before October 1, 1996, a certification is not required to be provided unless an individual, with respect to whom the certification is otherwise required to be made, requests the certification in writing.(3)Transitional Rule. In the case of an individual who seeks to establish creditable coverage for any period for which certification is not required because it relates to an event occurring before June 30, 1996:
(A) The individual may present other credible evidence of coverage in order to establish the period of creditable coverage; and(B) A group health plan and a health insurance issuer shall not be subject to any penalty or enforcement action with respect to the plan’s or issuer’s crediting or not crediting coverage if the plan or issuer has sought to comply in good faith with the applicable requirements under this section.(c)(1) Except as provided in subdivision (b)(2), in the case of a group health plan maintained pursuant to one (1) or more collective bargaining agreements between employee representatives and one (1) or more employers ratified before April 30, 1997, this part shall not apply to plan years beginning before the later of the date on which the last of the collective bargaining agreements relating to the plan terminates, determined without regard to any extension of the collective bargaining agreements agreed to after April 30, 1997, or July 1, 1997.(2) Any plan amendment made pursuant to a collective bargaining agreement relating to the plan that amends the plan solely to conform to any requirement of this part shall not be treated as a termination of the collective bargaining agreement.
