Terms Used In Tennessee Code > Title 56 > Chapter 7 > Part 22 - Tennessee Small Employer Group Health Coverage Reform Act

• 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
• 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
• Board: means the board of directors of the pool. See Tennessee Code 56-7-2203
• 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
• 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
• 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
• Contract: A legal written agreement that becomes binding when signed.
• cooperative: means a private purchasing cooperative composed of small employers formed under this part. See Tennessee Code 56-7-2203
• 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.
• Department: means the department of commerce and insurance. See Tennessee Code 56-1-102
• 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
• 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
• Fraud: Intentional deception resulting in injury to another.
• Health benefit plan: means :
  (i) Any accident and health insurance policy or certificate. See Tennessee Code 56-7-2203
• 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
• 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.
• 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
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Minor: means any person who has not attained eighteen (18) years of age. See Tennessee Code 1-3-105
• 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
• 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: 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
• 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
• 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
• 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
• 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 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
• 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
• Subscriber: means a person obligated under a reciprocal insurance agreement. See Tennessee Code 56-16-102
• 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