reglab/housing_qa huggingface dataset:
GA Code § 33-20E-22 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-22. Reporting to Credit Reporting Agencies

 No nonparticipating provider shall report to any credit reporting agency any covered person who receives a surprise bill for the receipt of healthcare services from such provider and does not pay such provider any copay, coinsurance, deductible, or other cost-sharing amount beyond what such covered person would pay if such nonparticipating provider had been a participating provider.    (Code 1981, §33-20E-22, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20E-23 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20E - Surprise Billing Consumer Protection Act|§ 33-20E-23. Financial Responsibilities for Ground Ambulance Transportation

 Nothing in this chapter shall reduce a covered person's financial responsibilities with regard to ground ambulance transportation.    (Code 1981, §33-20E-23, enacted by Ga. L. 2020, p. 210, § 1/HB 888.)
GA Code § 33-20F-1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20F - Self-Funded Healthcare Plans|§ 33-20F-1. Definitions

 As used in this chapter, the term:    "ERISA” means the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.   "Insurer” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including those of an accident and sickness insurance company, a health maintenance organization, a healthcare plan, a managed care plan, or any other entity providing a health insurance plan, a health benefit plan, or healthcare services.   "Self-funded healthcare plan” means an arrangement whereby an employer assumes the financial risk for providing healthcare benefits to its employees and such arrangement is subject to the exclusive jurisdiction of ERISA.     (Code 1981, §33-20F-1, enacted by Ga. L. 2021, p. 113, § 3/HB 234.)
GA Code § 33-20F-2 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20F - Self-Funded Healthcare Plans|§ 33-20F-2. Election to Participate in Surprise Billing Consumer Protection Act; Notices

  Notwithstanding any provision of law in Chapter 20E of this title, the "Surprise Billing Consumer Protection Act,” a self-funded healthcare plan may elect on an annual basis to participate in and be bound by such Act.   A self-funded healthcare plan that elects to participate in the Surprise Billing Consumer Protection Act shall provide notice to the Commissioner of its election decision on a form prescribed by the Commissioner.The completed form shall include an attestation that the self-funded healthcare plan has elected to participate in and be bound by the Surprise Billing Consumer Protection Act to the extent that insurers are similarly bound.Such form shall be posted on the Commissioner's website for use by self-funded healthcare plans choosing to opt in.   A self-funded healthcare plan may elect to initiate its participation on either January 1 of any year or on the first day of the self-funded healthcare plan's plan year of any year.   On its election form, the plan must indicate whether it chooses to affirmatively renew its election on an annual basis or whether it should be presumed to have renewed on an annual basis until the Commissioner receives advance notice from the plan that it is terminating its election as of either December 31 of a calendar year or the last day of its plan year. Notices under this subsection shall be submitted to the Commissioner at least 30 days in advance of the effective date of the election to initiate participation and 30 days in advance of the effective date of the termination of participation.   Self-funded healthcare plans opting in shall develop processes to address employee notifications or other responsibilities under ERISA that may arise from electing to participate in the Surprise Billing Consumer Protection Act.     (Code 1981, §33-20F-2, enacted by Ga. L. 2021, p. 113, § 3/HB 234.)
GA Code § 33-20F-3 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20F - Self-Funded Healthcare Plans|§ 33-20F-3. Website Listing of Participants

 The department shall maintain on its website a list of all self-funded healthcare plans that have chosen to participate in and comply with the Surprise Billing Consumer Protection Act.    (Code 1981, §33-20F-3, enacted by Ga. L. 2021, p. 113, § 3/HB 234.)
GA Code § 33-20F-4 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20F - Self-Funded Healthcare Plans|§ 33-20F-4. Applicability

 Nothing in this chapter shall be applicable to healthcare plans which are subject to the exclusive jurisdiction of ERISA, unless such plan elects to participate in and agrees to comply with the Surprise Billing Consumer Protection Act.    (Code 1981, §33-20F-4, enacted by Ga. L. 2021, p. 113, § 3/HB 234.)
GA Code § 33-20F-5 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 20F - Self-Funded Healthcare Plans|§ 33-20F-5. Removal From Participation by Commissioner; Hearing

 Notwithstanding any provision of law in the Surprise Billing Consumer Protection Act, in the event that a self-funded healthcare plan has chosen to participate in and comply with such Act, the Commissioner shall allow such participation. The Commissioner shall retain the authority, however, to remove or refuse to readmit such participant if the Commissioner determines that the self-funded healthcare plan is failing or previously failed to comply with the Surprise Billing Consumer Protection Act.Any self-funded healthcare plan shall have the opportunity to request a hearing pursuant to Code Section 33-2-17 prior to the effective date of such removal or denial.    (Code 1981, §33-20F-5, enacted by Ga. L. 2021, p. 113, § 3/HB 234.)
GA Code § 33-21-1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-1. Definitions

 As used in this chapter, the term:    "Basic health care services" means health care services which an enrolled population might reasonably require in order to be maintained in good health, including as a minimum but not restricted to preventive care, emergency care, inpatient hospital and physician care, and outpatient medical services.   "Enrollee" means an individual who has elected to contract for or participate in a health benefits plan for that individual or for that individual and that individual's eligible dependents.   "Evidence of coverage" means any certificate, agreement, or contract issued to an enrollee setting out the coverage to which he is entitled.   "Health benefits plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services, at least part of which consists of arranging for or the provision of health care services, as distinguished from an arrangement which provides only for indemnification against the cost of such services on a prepaid basis through insurance or otherwise.   "Health care services" means any services included in the furnishing to any individual of medical or dental care or hospitalization or incident to the furnishing of such 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 or injury.   "Health maintenance organization" means any person who undertakes to provide or arrange for one or more health benefits plans.   "Insurer" means every insurer authorized under this title to issue contracts of accident and sickness insurance. Health care corporations and health maintenance organizations are included within such term.  (7.1) "Patient" means a person who seeks or receives health care services fron a health maintenance organization.    "Person" means any natural or artificial person including but not limited to individuals, partnerships, associations, trusts, or corporations.   "Provider" means any physician, hospital, or other person who is licensed or otherwise authorized in this state to furnish health care services.    (Code 1933, § 56-3601, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 1; Ga. L. 1987, p. 3, § 33; Ga. L. 1995, p. 745, § 2.4; Ga. L. 1996, p. 485, §§ 1.2, 1.3; Ga. L. 2017, p. 164, § 12/HB 127.)   OPINIONS OF THE ATTORNEY GENERAL   Dental services alone do not constitute basic health care services.    - Plan offering only dental services may not be licensed as a health maintenance organization pursuant to O.C.G.A. T. 33, C. 21 since it does not provide basic health care services as defined in O.C.G.A. § 33-21-1. 1982 Op. Att'y Gen. No. 82-71.   RESEARCH REFERENCES   ALR.   - When is medical expense "incurred" under policy providing for payment of medical expenses incurred within fixed period of time from date of injury, 65 A.L.R.5th 649.
GA Code § 33-21-4 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-4. Annual License Fee

 Every health maintenance organization subject to this chapter shall pay to the Commissioner of Insurance the annual license fee provided in Code Section 33-8-3.   (Code 1933, § 56-3621, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 5.)
GA Code § 33-21-6 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-6. Composition of Governing Body; Duty to Establish Mechanism for Participation by Enrollees in Matters of Policy and Operation

  The governing body of any health maintenance organization shall include providers and other individuals, provided that at least one-third of the members of the governing body shall be public members.   The governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referendums on major policy decisions, or through the use of other mechanisms.    (Code 1933, § 56-3605, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 2000, p. 136, § 33.)
GA Code § 33-21-7 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-7. Fiduciary Responsibilities of Directors, Officers, or Partners

 Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization shall be responsible for the funds in a fiduciary relationship to the health maintenance organization.   (Code 1933, § 56-3606, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-9 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-9. Establishment and Maintenance of Complaint System; Maintenance of Records of Complaints; Summary Reports; Examination of System

  Every health maintenance organization shall establish and maintain a complaint system which has been approved by the Commissioner of Insurance to provide reasonable procedures for the resolution of written complaints initiated by enrollees or providers concerning health care services.   The health maintenance organization shall maintain records of written complaints concerning health care services for five years from the time the complaints are filed and shall submit to the Commissioner of Insurance a summary report at such times and in such format as the Commissioner of Insurance may require.   The Commissioner of Insurance may examine the complaint system at any time.    (Code 1933, § 56-3610, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 7; Ga. L. 2004, p. 493, § 3.)
GA Code § 33-21-10 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-10. Responsibility of Organizations for Financial Risks of Providing Services Generally; Reinsurance of Risks; Deposit of Cash or Securities With Commissioner

  Every health maintenance organization shall be responsible for the assumption of full financial risk of providing basic health services to its members, except that the health maintenance organization may reinsure its risks with solvent reinsurers who qualify to transact reinsurance in this state under Code Section 33-7-14 and may enter into reinsurance treaties or agreements with such reinsurers in order to obtain reinsurance for:   The cost of providing basic health services which exceeds in the aggregate $5,000.00 per member per year;   The cost of providing basic health services to members when they are outside the health maintenance organization's service area; and   Not more than 90 percent of the amount of which the health maintenance organization's costs for any fiscal year exceed 115 percent of its income for that fiscal year, provided that all reinsurance treaties and agreements entered into by health maintenance organizations shall under this Code section also be required to meet the same standards as would be required by this title for reinsurance treaties or agreements made by a property and casualty insurer as a ceding insurer.     Each health maintenance organization shall deposit with the Commissioner cash or securities acceptable to the Commissioner in the amount of $100,000.00, provided that the Commissioner shall also have the authority to require such additional amounts of deposits as he may deem necessary to protect the enrollees of the health maintenance organization. The deposits shall be administered by the Commissioner pursuant to Chapter 12 of this title. The Commissioner shall also have the authority to waive, modify, or authorize accumulation and incremental adjustments of such deposits as he deems necessary to protect the enrollees of the health maintenance organization.    (Code 1933, § 56-3612, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-11 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-11. Investment of Funds of Organizations

 With the exception of investments made in accordance with paragraphs (1) and (2) of subsection (a) and subsection (b) of Code Section 33-21-8, the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies or such other securities or investments as the Commissioner may permit. The investments shall be subject to the same terms, conditions, and limitations which apply to life insurance companies.   (Code 1933, § 56-3611, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-12 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-12. Participation in Organizations by Members of Associations

 No employer, union, trade organization, or any other association shall force its members, either by payroll deduction or other means, to join a health maintenance organization.   (Code 1933, § 56-3628, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-14 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-14. Annual Information to Enrollees

 Every health maintenance organization shall annually provide to its enrollees:    A description of services and information as to where and how to secure them; and   A clear and understandable description of the health maintenance organization's method for resolving enrollee complaints.    (Code 1933, § 56-3609, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 9.)
GA Code § 33-21-15 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-15. Filing of Annual Reports; Contents

  Every health maintenance organization shall annually, on or before March 1, file with the Commissioner of Insurance, on forms to be designated by him and certified by at least two principal officers of said health maintenance organization, an annual statement as of December 31 of the preceding year and a copy of said report shall also be delivered to the commissioner of community health.   Such report shall be on forms prescribed by the Commissioner of Insurance and shall include:   A financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding year certified by an independent public accountant;   Any material changes in the information submitted pursuant to subsection (b) of Code Section 33-21-2;   The number of persons enrolled during the year, the number of enrollees as of the end of the year, and the number of enrollments terminated during the year;   A summary of information compiled pursuant to paragraph (3) of subsection (b) of Code Section 33-21-3 in such form as required by the commissioner of community health; and   Any other information relating to the financial condition or performance of the health maintenance organization as is necessary to enable the Commissioner of Insurance and the commissioner of community health to carry out their duties under this chapter.      (Code 1933, § 56-3608, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1992, p. 6, § 33; Ga. L. 2009, p. 453, § 1-6/HB 228.)
GA Code § 33-21-16 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-16. Fees and Taxes

 The same fees and taxes provided for in Chapter 8 of this title applicable to life insurers shall apply to and shall be imposed upon each health maintenance organization provided for in this chapter; and the organizations shall also be entitled to the same tax deductions, reductions, abatements, and credits that life insurers are entitled to receive.   (Code 1933, § 56-3627, enacted by Ga. L. 1979, p. 1148, § 1.)
GA Code § 33-21-18 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-18. Adoption of Rules and Regulations Generally

  The Commissioner of Insurance shall adopt rules and regulations necessary for the implementation of this chapter with respect to all matters of organization, control of the matters relating to business, agents, examinations, and all other Code sections not exempted by this Code section.   The commissioner of community health shall adopt rules and regulations for health maintenance organizations subject to his or her jurisdiction which are not inconsistent with this chapter and which are necessary to establish and control the standards of health care which a health maintenance organization shall maintain. Health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to the jurisdiction of the commissioner of community health.    (Code 1933, § 56-3619, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1992, p. 6, § 33; Ga. L. 2004, p. 493, § 5; Ga. L. 2009, p. 453, § 1-6/HB 228.)
GA Code § 33-21-18.1 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-18.1. Emergency Services Requirements; Restrictive Formulary Requirements

 Every health benefits plan of every health maintenance organization shall include provisions that:    In the event a patient seeks emergency services and if necessary in the opinion of the health care provider responsible for the patient's emergency care and treatment and warranted by his or her evaluation, such emergency provider may initiate necessary intervention necessary to stabilize the condition of the patient without seeking or receiving prospective authorization by the health maintenance organization or health benefits plan. If in the opinion of the emergency health care provider a patient's condition has stabilized and the emergency health care provider certifies that the patient can be transported to another facility without suffering detrimental consequences or aggravating the patient's condition, the patient may be relocated to another facility which will provide continued care and treatment as necessary; and   When a health maintenance organization uses a restrictive formulary for prescription drugs, such use shall include a written procedure whereby patients can obtain, without penalty and in a timely fashion, specific drugs and medications not included in the formulary when:   The formulary's equivalent has been ineffective in the treatment of the patient's disease or condition; or   The formulary's drug causes or is reasonably expected to cause adverse or harmful reactions in the patient.       (Code 1981, §33-21-18.1, enacted by Ga. L. 1996, p. 485, § 3.)
GA Code § 33-21-19 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-19. Promulgation of Rules and Regulations for Licensing of Agents

 The Commissioner of Insurance may, after notice and hearing, promulgate any reasonable rules and regulations which are necessary to provide for the licensing of agents. "Agent" means a person directly or indirectly associated with a health benefits plan who engages in solicitation or enrollment.   (Code 1933, § 56-3614, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1992, p. 6, § 33.)
GA Code § 33-21-20 (2021)
2021 Georgia Code|Title 33 - Insurance|Chapter 21 - Health Maintenance Organizations|§ 33-21-20. Conduct of Hearings Generally; Participation in Hearings by Commissioner of Community Health; Judicial Review

  Except as otherwise provided in this chapter, all hearings and proceedings held under this chapter shall be conducted in accordance with Chapter 2 of this title and the Commissioner of Insurance shall have all the powers granted to him in Chapter 2 of this title.   The commissioner of community health, or his or her designated representative, shall be in attendance at the hearings and shall participate in the proceedings. The recommendation and findings of the commissioner of community health with respect to matters regarding health maintenance organizations under his or her jurisdiction relating to the quality of health care services provided in connection with any decision regarding denial, suspension, or revocation of a certificate of authority shall be conclusive and binding upon the Commissioner of Insurance. Health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to the jurisdiction of the commissioner of community health. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the Commissioner of Insurance shall take action as is deemed advisable on written findings which shall be mailed to the health maintenance organization with a copy of the findings mailed to the commissioner of community health. The action of the Commissioner of Insurance and the recommendation and findings of the commissioner of community health shall be subject to review by the superior court having jurisdiction. The court may, in disposing of the issue before it, modify, affirm, or reverse the order of the Commissioner of Insurance in whole or in part.   Chapter 13 of Title 50, the "Georgia Administrative Procedure Act," shall apply to proceedings under this Code section to the extent that they are not in conflict with subsections (a) and (b) of this Code section.    (Code 1933, § 56-3620, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1992, p. 6, § 33; Ga. L. 2004, p. 493, § 6; Ga. L. 2009, p. 453, § 1-6/HB 228.)