§ 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

  • 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.
  • affiliate: means any entity that exercises control over or is controlled by the HMO, directly or indirectly through:

    • (A) Equity ownership of voting securities. See Tennessee Code 56-32-102

    • Alcohol abuse: means a condition characterized by the continuous or episodic use of alcohol that results in social impairment, vocational impairment, psychological dependence or pathological patterns of use. See Tennessee Code 33-10-102
    • Alcohol dependence: means alcohol abuse that results in the development of tolerance or manifestations of alcohol abstinence syndrome upon cessation of use. See Tennessee Code 33-1-101
    • Alcoholism: means alcohol abuse that results in the development of tolerance or manifestation of alcohol abstinence syndrome upon cessation of use. See Tennessee Code 33-10-102
    • Arrest: Taking physical custody of a person by lawful authority.
    • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
    • 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
    • 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
    • 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
    • Child: means a person who is under eighteen (18) years of age. See Tennessee Code 33-1-101
    • 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
    • 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 56-32-102
    • Commissioner: means the commissioner of mental health and substance abuse services. See Tennessee Code 33-10-502
    • 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.
    • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
    • Conservatorship: is a proceeding in which a court removes the decision-making powers and duties, in whole or in part, in a least restrictive manner, from a person with a disability who lacks capacity to make decisions in one or more important areas and places responsibility for one or more of those decisions in a conservator or co-conservators. See Tennessee Code 34-1-101
    • Court: means any court having jurisdiction to hear matters concerning guardians or conservators. See Tennessee Code 34-1-101
    • Custodial health officer: means an employee of the county health department trained in detecting intoxication or incapacitation, or both, of persons due to the consumption of alcohol or drugs, or both, and also trained in the proper handling and transport of those persons. See Tennessee Code 33-10-404
    • 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 health department of any county to which this part applies. See Tennessee Code 33-10-404
    • Department: means the department of mental health and substance abuse services. See Tennessee Code 33-10-502
    • Dependent: A person dependent for support upon another.
    • Director: means the director of the health department of any county to which this part applies. See Tennessee Code 33-10-404
    • Drug abuse: means a condition characterized by the continuous or episodic use of a drug or drugs that results in social impairment, vocational impairment, psychological dependence or pathological patterns of use. See Tennessee Code 33-10-102
    • Drug dependence: means drug abuse that results in the development of tolerance or manifestations of drug abstinence syndrome upon cessation of use. See Tennessee Code 33-1-101
    • Drug dependence: means drug abuse that results in the development of tolerance or manifestations of drug abstinence syndrome upon cessation of use. See Tennessee Code 33-10-102
    • Enrollee: means an individual who is enrolled in an HMO. See Tennessee Code 56-32-102
    • 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
    • Fiduciary: means a guardian, coguardian, conservator, co-conservator, or qualified trustee as defined in §. See Tennessee Code 34-1-101
    • Foreign: when used without limitation, includes all companies formed by authority of any other state or government. See Tennessee Code 56-1-102
    • Fraud: Intentional deception resulting in injury to another.
    • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
    • 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
    • Health professional: means a person trained and licensed in the health sciences, including medical doctors, registered nurses and licensed practical nurses. See Tennessee Code 33-10-404
    • Highway: includes public bridges and may be held equivalent to the words "county way" "county road" or "state road". See Tennessee Code 1-3-105
    • 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
    • Incapacitated by alcohol: means that a person, as a result of the use of alcohol, is unconscious or that the person's judgment is otherwise so impaired that the person is incapable of realizing and making a rational decision with respect to the person's need for treatment, is unable to take care of the person's basic personal needs or safety or lacks sufficient understanding or capacity to make or communicate rational decisions concerning the person's welfare. See Tennessee Code 33-10-404
    • insurance company: includes all corporations, associations, partnerships, or individuals engaged as principals in the business of insurance. See Tennessee Code 56-1-102
    • judicial commissioner: means those officials as defined by §. See Tennessee Code 33-10-404
    • 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.
    • 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
    • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
    • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
    • 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
    • Month: means a calendar month. See Tennessee Code 1-3-105
    • 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
    • Oversight: Committee review of the activities of a Federal agency or program.
    • 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
    • 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
    • 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
    • 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
    • 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.
    • 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
    • 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
    • Reciprocal: means the aggregation of subscribers under a common name. See Tennessee Code 56-16-102
    • 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
    • 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
    • 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.
    • Statute: A law passed by a legislature.
    • 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
    • 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
    • Treatment: means the broad range of emergency, outpatient, intermediate and inpatient services and care, including diagnostic evaluation, medical, psychiatric, psychological care or social service care, or both, vocational rehabilitation or career counseling, or both, that may be extended to alcoholics and intoxicated persons. See Tennessee Code 33-10-404
    • Treatment resource: means any public or private facility, service, or program providing treatment or rehabilitation services for alcohol and drug dependence, mental illness or serious emotional disturbance, including, but not limited to, detoxification centers, licensed hospitals, community mental health centers, clinics or programs, halfway houses and rehabilitation centers. See Tennessee Code 33-10-102
    • Venue: The geographical location in which a case is tried.
    • working capital: means current assets, including admitted stocks and admitted bonds, minus current liabilities. See Tennessee Code 56-32-112
    • written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105