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:
  (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
• 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.
• 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.
• 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}
• 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
• 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 commerce and insurance. 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
• 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
• Contract: A legal written agreement that becomes binding when signed.
• 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.
• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• 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
• Dependent: A person dependent for support upon another.
• Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
• 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 33-10-102
• 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
• Enrollee: means an individual who is enrolled in an HMO. See Tennessee Code 56-32-102
• 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.
• 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: A trustee, executor, or administrator.
• 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.
• 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 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
• 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
• 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}
• insurance company: includes all corporations, associations, partnerships, or individuals engaged as principals in the business of insurance. See Tennessee Code 56-1-102
• 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
• 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.
• Oversight: Committee review of the activities of a Federal agency or program.
• 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.
• 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
• Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
• 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
• Property: includes both personal and real property. See Tennessee Code 1-3-105
• 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
• Reciprocal: means the aggregation of subscribers under a common name. See Tennessee Code 56-16-102
• Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• 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
• Service of process: The service of writs or summonses to the appropriate party.
• 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.
• State: includes states, territories, districts and insular and other possessions of the United States. See Tennessee Code 33-9-101
• 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
• 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
• Testimony: Evidence presented orally by witnesses during trials or before grand juries.
• 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
• 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
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• Trustee: A person or institution holding and administering property in trust.
• United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
• 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
• Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105