§ 56-32-101 Short Title
§ 56-32-102 Chapter Definitions
§ 56-32-103 Certificate of Authority — Applications — Applicants — Exemptions — Excess or Aggregate Insurance
§ 56-32-104 Issuance of Certificate of Authority
§ 56-32-105 Powers — Limitations — Hold Harmless Clause
§ 56-32-106 Fiduciaries — Bonds
§ 56-32-107 Evidence of Coverage
§ 56-32-108 Reports
§ 56-32-109 Notice of Change in Operation
§ 56-32-111 Investments
§ 56-32-112 Capital Requirements — Required Deposits
§ 56-32-113 Prohibited Practices
§ 56-32-114 Licensing of Agents
§ 56-32-115 Regulation by Commissioner — Examination of Books and Records
§ 56-32-116 Revocation or Suspension of Certificates
§ 56-32-117 Rehabilitation, Liquidation, Conservation or Supervision of Hmos
§ 56-32-118 Rules and Regulations — Notice of Hearing for Denial, Revocation or Suspension of Certificates — Administrative Procedure
§ 56-32-119 Fees
§ 56-32-120 Administrative Penalty — Cease and Desist Orders — Injunctions
§ 56-32-121 Applicability of Other Laws — Construction
§ 56-32-122 Acquisition of Control of or Merger of an Hmo
§ 56-32-123 Bidding
§ 56-32-124 Taxation
§ 56-32-125 Confidentiality of Information
§ 56-32-126 Prompt Payment Requirements
§ 56-32-128 Point of Service Option or Preferred Provider Organization Plan
§ 56-32-129 Prohibited Discrimination
§ 56-32-130 Prohibited Retaliatory Action
§ 56-32-131 Verification of Health Benefit Delivery — Annual Review — Survey of Persons Disenrolled by the Tenncare Program
§ 56-32-132 Investigatory Powers of the Department of Commerce and Insurance
§ 56-32-134 Required Information for Verification and Audit Purposes
§ 56-32-135 Confidentiality
§ 56-32-136 Violation and Penalty
§ 56-32-137 Discrimination Prohibited — Coverage Not Created
§ 56-32-138 Payment of Authorized Pharmacy Claims — Corrections by Pharmacy

Terms Used In Tennessee Code > Title 56 > Chapter 32 - Health Maintenance Organization Act of 1986

  • Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
  • 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 entity that exercises control over or is controlled by the HMO, directly or indirectly through:

    1. Equity ownership of voting securities. See Tennessee Code 56-32-102
    2. 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.
    3. Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
    4. Appraisal: A determination of property value.
    5. Arrears: means any child support or spousal support associated with a child support order owed under a court or administrative order that is delinquent pursuant to §. See Tennessee Code 36-5-701
    6. Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
    7. Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
    8. 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
    9. 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.
    10. basic health care services: includes , but is not limited to, services made necessary as the result of Title XIX federal programs or waivers for which TennCare is primarily responsible for implementation or enforcement. See Tennessee Code 56-32-102
    11. 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
    12. Child: means an individual, whether over or under the age of majority, who is or is alleged to be owed a duty of support by the individual's parent or who is or is alleged to be the beneficiary of a support order directed to the parent. See Tennessee Code 36-5-2101
    13. Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
    14. Coinsurance: means an enrollee's share of covered medical expenses when an enrollee and the HMO share in a specific ratio of the covered medical expenses. See Tennessee Code 56-32-102
    15. Commissioner: means the commissioner of commerce and insurance. See Tennessee Code 56-32-102
    16. Commissioner: means the commissioner of human services. See Tennessee Code 36-5-701
    17. Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
    18. Contract: A legal written agreement that becomes binding when signed.
    19. Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
    20. Credit bureau: An agency that collects individual credit information and sells it for a fee to creditors so they can make a decision on granting loans. Typical clients include banks, mortgage lenders, credit card companies, and other financing companies. (Also commonly referred to as consumer-reporting agency or credit-reporting agency.) Source: OCC
    21. Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
    22. Deed: The legal instrument used to transfer title in real property from one person to another.
    23. Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
    24. Department: means the department of human services. See Tennessee Code 36-5-701
    25. Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
    26. Enrollee: means an individual who is enrolled in an HMO. See Tennessee Code 56-32-102
    27. Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
    28. Escrow: Money given to a third party to be held for payment until certain conditions are met.
    29. 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.
    30. Evidence of coverage: means any certificate, agreement or contract issued to an enrollee setting out the coverage to which the enrollee is entitled. See Tennessee Code 56-32-102
    31. Fiduciary: A trustee, executor, or administrator.
    32. financial institution: means :

      1. A depository institution, as defined in Section 3(c) of the Federal Deposit Insurance Act (12 U. See Tennessee Code 36-5-814
      2. financial institution: shall mean :

        1. A depository institution, as defined in Section 3(c) of the Federal Deposit Insurance Act (12 U. See Tennessee Code 36-5-910
        2. Foreign: when used without limitation, includes all companies formed by authority of any other state or government. See Tennessee Code 56-1-102
        3. Fraud: Intentional deception resulting in injury to another.
        4. Health care services: means any services included in the furnishing to any individual of medical or dental care, or hospitalization, or incidental to the furnishing of the care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability. See Tennessee Code 56-32-102
        5. Income: includes earnings or other periodic entitlements to money from any source and any other property subject to withholding for support under the law of this state. See Tennessee Code 36-5-2101
        6. 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
        7. Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
        8. Law: includes decisional and statutory law and rules and regulations having the force of law. See Tennessee Code 36-5-2101
        9. Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
        10. Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
        11. License: means a license, certification, registration, permit, approval or other similar document issued to an individual evidencing admission to or granting authority to engage in a profession, trade, occupation, business, or industry, to hunt or fish, or to operate any motor vehicle or other conveyance, but does not include a license to practice law unless the supreme court establishes guidelines pursuant to §. See Tennessee Code 36-5-701
        12. Licensee: means any individual holding a license, certification, registration, permit, approval, or other similar document evidencing admission to, or granting authority to engage in a profession, trade, occupation, business, or industry, to hunt or fish, or to operate any motor vehicle or other conveyance, but "licensee" does not include an attorney only with respect to the attorney's license to practice law unless the supreme court establishes guidelines pursuant to §. See Tennessee Code 36-5-701
        13. Licensing authority: means the board, commission, or agency, including the department of safety, that has been established by statute or state regulation to oversee the issuance and regulation of any license. See Tennessee Code 36-5-701
        14. Lien: A claim against real or personal property in satisfaction of a debt.
        15. Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
        16. 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
        17. Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
        18. Month: means a calendar month. See Tennessee Code 1-3-105
        19. Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
        20. Net worth: means the excess of total admitted assets over total admitted liabilities, but the liabilities shall not include fully subordinated debt approved by the commissioner. See Tennessee Code 56-32-112
        21. Not in compliance with an order of support: means that the obligor is five hundred dollars ($500) or more in arrears and the arrears are ninety (90) days or more past due. See Tennessee Code 36-5-701
        22. 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.
        23. Obligee: means :

          1. An individual to whom a duty of support is or is alleged to be owed or in whose favor a support order or a judgment determining parentage of a child has been issued. See Tennessee Code 36-5-2101
          2. Obligor: means an individual, or the estate of a decedent that:

            1. Owes or is alleged to owe a duty of support. See Tennessee Code 36-5-2101
            2. Obligor: means any individual owing a duty of support. See Tennessee Code 36-5-701
            3. Oversight: Committee review of the activities of a Federal agency or program.
            4. Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
            5. Person: means an individual, corporation, business trust, estate, trust, partnership, limited liability company, association, joint venture, public corporation, government, or governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. See Tennessee Code 36-5-2101
            6. person: includes an individual, insurer, company, association, organization, Lloyds, society, reciprocal insurer or interinsurance exchange, partnership, syndicate, business trust, corporation, agent, general agent, broker, solicitor, service representative, adjuster, and every legal entity. See Tennessee Code 56-32-102
            7. Personal property: All property that is not real property.
            8. Personal property: includes money, goods, chattels, things in action, and evidences of debt. See Tennessee Code 1-3-105
            9. 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
            10. Physician-hospital organization: means an organization formed to allow hospitals and physicians to jointly obtain provider contracts with HMOs and other payers of health care benefits. See Tennessee Code 56-32-102
            11. 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
            12. premiums: as used in this chapter includes, but is not limited to, any and all payments made by the state to any entity providing health care services pursuant to any federal waiver received by the state that waives any or all of Title XIX of the federal Social Security Act, compiled in 42 U. See Tennessee Code 56-32-112
            13. Property: includes both personal and real property. See Tennessee Code 1-3-105
            14. Provider: means any physician, hospital or other person that is licensed or otherwise authorized in this state to furnish health care services. See Tennessee Code 56-32-102
            15. Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
            16. 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
            17. Reciprocal: means the aggregation of subscribers under a common name. See Tennessee Code 56-16-102
            18. Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in perceivable form. See Tennessee Code 36-5-2101
            19. Register: means to file in a tribunal of this state a support order or judgment determining parentage of a child issued in another state or a foreign country. See Tennessee Code 36-5-2101
            20. 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
            21. Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
            22. Restricted license: means a license that allows a person to operate a motor vehicle for the limited purposes of going to and from and working at the person's regular place of employment and going to and from the person's school and does not include a commercial driver license of any kind. See Tennessee Code 36-5-701
            23. Right of offset: Banks' legal right to seize funds that a guarantor or debtor may have on deposit to cover a loan in default. It is also known as the right of set-off. Source: OCC
            24. Service of process: The service of writs or summonses to the appropriate party.
            25. 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.
            26. Spousal support: as used in this part , means a legally enforceable obligation assessed against an individual for the support of a spouse or former spouse who is living with a child or children for whom the individual also owes support. See Tennessee Code 36-5-1002
            27. State: means a state of the United States, the District of Columbia, Puerto Rico, the United States Virgin Islands, or any territory or insular possession under the jurisdiction of the United States. See Tennessee Code 36-5-2101
            28. State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
            29. Statute: A law passed by a legislature.
            30. Subpoena: A command to a witness to appear and give testimony.
            31. Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
            32. Subscription: includes a mark, the name being written near the mark and witnessed. See Tennessee Code 1-3-105
            33. Support enforcement agency: means a public official, governmental entity, or private agency authorized to:

              1. Seek enforcement of support orders or laws relating to the duty of support. See Tennessee Code 36-5-2101
              2. Support order: means a judgment, decree, order, decision, or directive, whether temporary, final, or subject to modification, issued in a state or foreign country for the benefit of a child, a spouse, or a former spouse, which provides for monetary support, health care, arrearages, retroactive support, or reimbursement for financial assistance provided to an individual obligee in place of child support. See Tennessee Code 36-5-2101
              3. Testimony: Evidence presented orally by witnesses during trials or before grand juries.
              4. Tribunal: means a court, administrative agency, or quasi-judicial entity authorized to establish, enforce, or modify support orders or to determine parentage of a child. See Tennessee Code 36-5-2101
              5. Trustee: A person or institution holding and administering property in trust.
              6. 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
              7. United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
              8. Venue: The geographical location in which a case is tried.
              9. working capital: means current assets, including admitted stocks and admitted bonds, minus current liabilities. See Tennessee Code 56-32-112
              10. written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
              11. Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105