reglab/statecodes huggingface dataset:
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 1 - GENERAL PROVISIONS (§§ 33-41-1 — 33-41-26) › Section 33-41-23 - Certificate of dormancy

(a)
A captive insurance company that meets the definition of a dormant captive insurance company set forth in this chapter may apply to the Commissioner for a certificate of dormancy on a form or forms as may be prescribed by the Commissioner.
(b)
A dormant captive insurance company that has been issued a certificate of dormancy pursuant to this Code section shall:
(1)
Possess and thereafter maintain unimpaired, paid-in-capital and surplus of at least $25,000.00;
(2)
Submit to the Commissioner a report of its financial condition on or before March 1 of each year on a form or in a manner as prescribed by the Commissioner;
(3)
Renew such certificate every five years by submitting documentation as prescribed by the Commissioner and paying a renewal fee of $500.00; and
(4)
Be subject to an examination pursuant to Code Section
33-41-16
in the discretion of the Commissioner.
(c)
A dormant captive insurance company that has been issued a certificate of dormancy pursuant to this Code section shall not:
(1)
Be subject to or liable for the payment of any tax pursuant to Code Section
33-41-22
; or
(2)
Be required to submit any annual forms, fees, or documents that are otherwise required by this chapter, other than those required pursuant to this Code section.
(d)
The Commissioner may, upon written request, declare a captive insurance company to be dormant for purposes of this Code section even if such captive insurance company retains liabilities associated with policies written or assumed, provided that such captive insurance company has otherwise ceased the transaction of insurance business. However, in this case, the Commissioner may, in his or her discretion, require such captive insurance company to possess and maintain unimpaired, paid-in-capital and surplus and reserves greater than that required by this Code section.
(e)
A certificate of dormancy shall be revoked if a captive insurance company no longer meets the definition of a dormant captive insurance company or fails to meet the requirements as set forth in this Code section.
(f)
A dormant captive insurance company shall apply to the Commissioner for approval and shall be granted such approval to surrender its certificate of dormancy and resume conducting the business of insurance prior to issuing any insurance policies and shall pay an application fee as prescribed by the Commissioner.
(g)
Any provisions of this title which are inconsistent with the provisions of this Code section shall not apply to dormant captive insurance companies.
Amended by 2019 Ga. Laws 186,§ 2-11, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 1 - GENERAL PROVISIONS (§§ 33-41-1 — 33-41-26) › Section 33-41-24 - Rule making authority

The Commissioner may adopt rules establishing standards to ensure that a pure captive insurance company's parent or any of its affiliated companies is able to exercise control of the risk management function of any controlled unaffiliated business to be insured by the pure captive insurance company; provided, however, that, until such time as rules under this Code section are adopted, the Commissioner may approve or deny the coverage of such risks by a pure captive insurance company on a case by case basis.
Amended by 2019 Ga. Laws 186,§ 2-12, eff. 7/1/2019.
Amended by 2016 Ga. Laws 611,§ 1, eff. 7/1/2016.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 1 - GENERAL PROVISIONS (§§ 33-41-1 — 33-41-26) › Section 33-41-25 - Regulatory authority

The Commissioner may establish such rules and regulations and issue such interpretive rulings as may be necessary to carry out the provisions of this chapter.
Added by 2019 Ga. Laws 186,§ 2-13, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 1 - GENERAL PROVISIONS (§§ 33-41-1 — 33-41-26) › Section 33-41-26 - Inconsistent provisions not applicable to captive insurance companies

Any provisions of this title which are inconsistent with the provisions of this chapter shall not apply to captive insurance companies; provided, however, that pure and agency captive insurance companies shall not be subject to the requirements of Chapter 13 of this title.
Added by 2019 Ga. Laws 186,§ 2-13, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 2 - PROTECTED CELLS (§§ 33-41-100 — 33-41-106) › Section 33-41-100 - Application

In addition to the general provisions of Article 1 of this chapter, the provisions of this article shall apply to sponsored captive insurance companies.
Added by 2019 Ga. Laws 186,§ 2-14, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 2 - PROTECTED CELLS (§§ 33-41-100 — 33-41-106) › Section 33-41-102 - Protected cells; prior written approval; annual filing of financial reports; notification upon insolvency

(a)
A sponsored captive insurance company may establish one or more protected cells if the Commissioner has approved in writing a business plan, or an amendment to such plan, with respect to each protected cell that includes information about the participant, the associated participant contract or contracts, and any other information requested by the Commissioner.
(b)
No participant contract shall take effect without the Commissioner's prior written approval. The addition of each new protected cell, the withdrawal of any current participant, or the termination of any existing protected cell shall constitute a change in the business plan of the sponsored captive insurance company and shall require the Commissioner's prior written approval.
(c)
Each sponsored captive insurance company shall annually file with the Commissioner such financial reports as he or she shall require. Any such financial report shall include, without limitation, accounting statements detailing the financial experience of each protected cell.
(d)
Each sponsored captive insurance company shall notify the Commissioner in writing within ten business days of any protected cell becoming insolvent or otherwise unable to meet its claim, expense, insurance, or reinsurance obligations.
Added by 2019 Ga. Laws 186,§ 2-14, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 2 - PROTECTED CELLS (§§ 33-41-100 — 33-41-106) › Section 33-41-103 - Incorporated protected cells; legal entity status; requirements for formation; naming; rights and authority

(a)
A sponsored captive insurance company licensed under this chapter may establish and maintain one or more protected cells to insure or reinsure risks subject to the provisions, terms, and conditions set forth in this chapter, and it is the intent of the General Assembly to provide sponsored captive insurance companies with the option to establish one or more protected cells as incorporated protected cells without limiting any rights or protections applicable to unincorporated protected cells.
(b)
The creation of a protected cell pursuant to this chapter does not create, with respect to such protected cell, a legal person separate from the sponsored captive insurance company of which it is a part unless such protected cell is an incorporated protected cell.
(c)
In addition to the provisions required by subparagraphs (c)(1)(B) and (c)(1)(C) of Code Section
33-41-5
, an incorporated protected cell must also include the following in its formation documents:
(1)
A reference to the sponsored captive insurance company of which it will be a part; and
(2)
A statement that the entity is a protected cell incorporated for the limited purposes authorized by the sponsored captive insurance company's certificate of authority.
(d)
An incorporated protected cell shall not use any name that is either similar, misleading, or confusing with respect to any other name already in use by any other entity doing business in this state.
(e)
An incorporated protected cell shall be entitled to enter into contracts and undertake obligations in its own name and for its own account unless prohibited by an applicable participant contract. In the case of a contract or obligation undertaken directly by an incorporated protected cell to which the sponsored captive insurance company is not a party, either in its own name and for its own account or on behalf of a protected cell, the counterparts to the contract or obligation shall have no right or recourse against the sponsored captive insurance company, any other protected cell not a party to such contract or obligation or any assets other than against assets properly attributable to the incorporated protected cell that is a party to the contract or obligation.
Amended by 2020 Ga. Laws 521,§ 33, eff. 7/29/2020.
Added by 2019 Ga. Laws 186,§ 2-14, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 2 - PROTECTED CELLS (§§ 33-41-100 — 33-41-106) › Section 33-41-105 - Commingling of assets prohibited; separation of cells

(a)
In connection with the conservation, rehabilitation, or liquidation of captive insurance companies set forth in Code Section
33-41-21
, including sponsored captive insurance companies, the assets and liabilities of a protected cell shall at all times be kept separate from, and shall not be commingled with, those of other protected cells and the sponsored captive insurance company except to the extent that the assets and liabilities of any one or more protected cells are determined to have not been allocated, segregated, and separated pursuant to the business plan and participant contracts approved by the Commissioner, and which are subject to the tracing provisions set forth in this article.
(b)
Notwithstanding the provisions of this title, in the event of the insolvency of a sponsored captive insurance company where the Commissioner determines that one or more protected cells remain solvent, the Commissioner may separate such cells from the sponsored captive insurance company and may allow, on application of the sponsored captive insurance company or participant, for the conversion of such protected cells into one or more new or existing other captive insurance companies.
Added by 2019 Ga. Laws 186,§ 2-14, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 41 - CAPTIVE INSURANCE COMPANIES (§§ 33-41-1 — 33-41-106) › Article 2 - PROTECTED CELLS (§§ 33-41-100 — 33-41-106) › Section 33-41-106 - Application of Code Section 33-41-16 to sponsored captive insurance companies

All provisions set forth in subsection (c) of Code Section
33-41-16
shall also apply to sponsored captive insurance companies in the same manner.
Added by 2019 Ga. Laws 186,§ 2-14, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 42 - LONG-TERM CARE INSURANCE (§§ 33-42-1 — 33-42-7) › Section 33-42-2 - Purpose of chapter

The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance as defined from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 42 - LONG-TERM CARE INSURANCE (§§ 33-42-1 — 33-42-7) › Section 33-42-3 - Applicability of chapter

The requirements of this chapter shall apply to long-term care insurance policies issued, delivered, or issued for delivery in this state. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable provisions of this title insofar as they do not conflict with this chapter, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance. A policy which is not advertised, marketed, or offered as long-term care insurance need not meet the requirements of this chapter.
Amended by 2019 Ga. Laws 186,§ 1-3, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 42 - LONG-TERM CARE INSURANCE (§§ 33-42-1 — 33-42-7) › Section 33-42-5 - Group policy issued in another state

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in subparagraph (B) of paragraph (3) of Code Section
33-42-4
unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
Amended by 2019 Ga. Laws 186,§ 1-5, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 42 - LONG-TERM CARE INSURANCE (§§ 33-42-1 — 33-42-7) › Section 33-42-7 - [Repealed]

Amended by 2020 Ga. Laws 521,§ 33, eff. 7/29/2020.
Amended by 2019 Ga. Laws 186,§ 1-6, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-2 - Applicability of chapter

(a)
Except as otherwise specifically provided, this chapter shall apply to:
(1)
All medicare supplement policies delivered or issued for delivery in this state; and
(2)
All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this state.
(b)
This chapter shall not apply to a policy of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations or a combination thereof, for employees or former employees or a combination thereof, or for members or former members or a combination thereof of the labor organizations.
(c)
Except as provided under subsection (d) of Code Section
33-43-5
, the provisions of this chapter shall not be construed to prohibit or apply to insurance policies or health care benefit plans, including group conversion policies, provided to medicare eligible persons, which policies are not marketed or held to be medicare supplement policies or benefit plans.
Amended by 2019 Ga. Laws 186,§ 1-7, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-4 - Reasonable return of benefits required; minimum standards for loss ratios

Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The Commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-5 - Outline of coverage; informational brochures; captions or notice requirements; disclosure of information regarding replacement of policies, contracts, or certificates

(a)
In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered in this state unless an outline of coverage is delivered to the applicant at the time application is made.
(b)
The Commissioner shall prescribe the format and content of the outline of coverage required by subsection (a) of this Code section. For purposes of this Code section, "format" means style, arrangements, and overall appearance, including such items as the size, color, and prominence of type and arrangement of text and captions. Such outline of coverage shall include:
(1)
A description of the principal benefits and coverage provided in the policy;
(2)
A statement of the exceptions, reductions, and limitations contained in the policy;
(3)
A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and
(4)
A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c)
The Commissioner may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies, the Commissioner may require by regulation that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the Commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare, but in no event shall the brochure be provided later than the time of policy delivery.
(d)
The Commissioner may prescribe by regulation for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages for all accident and sickness insurance policies sold to persons eligible for medicare, other than:
(1)
Medicare supplement policies; or
(2)
Disability income policies.
(e)
The Commissioner may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts, or certificates by persons eligible for medicare.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-6 - Notice of right to return policy and of right to refund

Medicare supplement policies or certificates shall have a notice prominently printed on the first page of the policy or certificate stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this Code section shall be paid directly to the applicant by the issuer in a timely manner.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-7 - Review and approval of Medicare supplement advertisements

Every issuer of medicare supplement insurance in this state shall provide a copy of any medicare supplement advertisement intended for use in this state whether through written, radio, or television medium to the Commissioner for review and approval by the Commissioner.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-8 - Regulations

Regulations adopted pursuant to this chapter shall be subject to the provisions of this chapter and Code Section
33-2-9
.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 43 - MEDICARE SUPPLEMENT INSURANCE (§§ 33-43-1 — 33-43-9) › Section 33-43-9 - Enforcement

In addition to any other applicable penalties for violations of this title, the Commissioner may require issuers violating any provision of this chapter or regulations promulgated pursuant to this chapter to cease marketing any medicare supplement policy or certificate in this state which is related directly or indirectly to a violation or may require such issuer to take such actions as are necessary to comply with the provisions of this chapter, or both.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 44 - HIGH RISK HEALTH INSURANCE PLAN (§ 33-44-1) › Section 33-44-1 - through 33-44-10 - [Reserved]

Reserved. Repealed by Ga. L. 2019, p. 533, § 1-9/HB 99, effective July 1, 2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-2 - Use of powers; providers or facilities charging an entrance fee

(a)
For the purpose of enforcing the requirements of this chapter, the Commissioner and the department shall be authorized to use the powers granted in Chapters 1 and 2 of this title.
(b)
A provider or facility which charges a resident an entrance fee for lodging in a residential unit and provides limited continuing care shall not call itself nor be considered a provider of continuing care, but such provider or facility shall otherwise be subject to the requirements imposed upon the providers and facilities regulated by this chapter; provided, however, that a facility that has received a certificate of authority and has been in conformance with the provisions of this chapter prior to July 1, 2011, may continue to call and present itself to the public as a provider of continuing care.
Amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-3 - Certificate of authority required for operation of life plan communities

(a)
Nothing in this title or chapter shall be deemed to authorize any provider to transact any insurance business other than that of continuing care insurance or limited continuing care insurance or otherwise to engage in any other type of insurance unless it is authorized under a certificate of authority issued by the department under this title. Nothing in this chapter shall be construed so as to interfere with the jurisdiction of the Department of Community Health or any other regulatory body exercising authority over providers regulated by this chapter or real property law related to the purchase and sale of resident owned living units.
(b)
Nothing in this chapter shall be construed so as to modify or limit in any way:
(1)
Provisions of Article 3 of Chapter 6 of Title 31 and any rules and regulations promulgated by the Department of Community Health pursuant to such article relating to certificates of need for life plan communities or home health agencies, as such terms are defined in Code Section
31-6-2
; or
(2)
Provisions of Chapter 7 of Title 31 relating to licensure or permit requirements and any rules and regulations promulgated by the Department of Community Health pursuant to such chapter, including, without limitation, licensure or permit requirements for nursing home care, assisted living care, personal care home services, home health services, and private home care services.
(c)
Nothing in this chapter shall be construed so as to allow private home care services to be provided by any person or entity other than a licensed private home care provider.
(d)
A provider of continuing care at home may contract with a licensed home health agency to provide home health services to a resident. In order to provide home health services directly, a provider of continuing care at home shall obtain a certificate of need for a home health agency, as such term is defined in Code Section
31-6-2
, pursuant to the same criteria and rules as are applicable to freestanding home health agencies that are not components of life plan communities.
Amended by 2019 Ga. Laws 303,§ 5, eff. 7/1/2019.
Amended by 2015 Ga. Laws 79,§ 2, eff. 7/1/2015.
Amended by 2014 Ga. Laws 555,§ 2, eff. 7/1/2014.
Amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
Amended by 2009 Ga. Laws 102,§ 1-43, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-4 - Administration by Insurance Department

The administration of this chapter is vested in the department, which shall:
(1)
Prepare and furnish all forms necessary under the provisions of this chapter;
(2)
Collect in advance, and the applicant shall pay in advance at the time of filing, a fee for an application for a certificate of authority or a renewal of a certificate of authority, both as provided in Code Section
33-8-1
, and a late fee to be determined by the department. The department may also levy a fine not to exceed $50.00 a day for each day of noncompliance; and
(3)
Adopt rules, within the standards of this chapter, necessary to effect the purposes of this chapter. Specific provisions in this chapter relating to any subject shall not preclude the department from adopting rules concerning such subject if such rules are within the standards and purposes of this chapter.
Amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
Amended by 2005 Ga. Laws 19,§ 33, eff. 4/7/2005.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-5 - Application for approval or renewal of certificate of authority

No person may engage in the business of providing continuing care or limited continuing care or issuing continuing care agreements in this state without a certificate of authority therefor obtained from the department as provided in this chapter. For purposes of this Code section, the term "engage in the business of" shall include the development or construction of a facility subject to regulation under this chapter or the holding of oneself out to the public as a provider. The application for approval or renewal of a certificate of authority shall be on such forms as provided by the department. The department shall issue such certificate of authority if the applicant pays the required fees, and the continuing care agreement for the applicant meets the requirements of Code Section
33-45-7
. The department shall renew a certificate of authority if the provider pays the required fees and furnishes the annual disclosure statement required by Code Section
33-45-6
and is otherwise not in violation of this chapter.
Amended by 2012 Ga. Laws 684,§ 33, eff. 5/1/2012.
Amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-6 - Annual revised disclosure statement; statement to be made available to all residents of facility; submission of other necessary information as determined by Commissioner

(a)
Annually, on or before June 1, the provider shall file a revised disclosure statement and such other information and data showing its condition as of the last day of the preceding calendar year or fiscal year of the provider. If the department does not receive the required information on or before June 1, a late fee may be charged. The department may approve an extension of up to 30 days.
(b)
(1)
The provider shall also make the revised disclosure statement available to all the residents of the facility.
(2)
A provider shall also revise its disclosure statement and have the revised disclosure statement recorded at any other time if revision is necessary to prevent an otherwise current disclosure statement from containing a material misstatement of fact or omitting a material fact required to be stated therein. Only the most recently recorded disclosure statement, with respect to a facility, and in any event, only a disclosure statement dated within one year plus 120 days prior to the due date of the time of renewal of a certificate of authority required by this chapter, shall be considered current.
(c)
Notwithstanding the provisions of Code Section
33-45-9
, the Commissioner may require a provider to submit such other information as he or she deems necessary to enforce this chapter.
Amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-7.1 - Provider authorized to offer continuing care when resident purchases resident owned living unit

A provider which has obtained a certificate of authority pursuant to Code Section
33-45-5
and the written approval of the Commissioner is authorized to offer, as a part of the continuing care agreement, continuing care at home or continuing care in which the resident purchases a resident owned living unit, subject to the provisions of Chapters 6 and 7 of Title 31 and rules and regulations promulgated by the Department of Community Health pursuant to such chapters relating to certificate of need and licensure requirements.
Amended by 2019 Ga. Laws 186,§ 1-10, eff. 7/1/2019.
Amended by 2015 Ga. Laws 79,§ 3, eff. 7/1/2015.
Added by 2014 Ga. Laws 555,§ 4, eff. 7/1/2014.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-9 - Provisions of this chapter not subject to waiver

No act, agreement, or statement of any resident, or of an individual purchasing continuing care or limited continuing care for a resident, under any continuing care agreement to furnish care to the resident shall constitute a valid waiver of any provision of this chapter intended for the benefit or protection of the resident or the individual purchasing care for the resident; provided, however, that nothing in this Code section shall be construed to prohibit a continuing care agreement from providing for a resident or prospective resident to agree to arbitration prior to bringing any action pursuant to Code Section
33-45-12
.
Redesignated and mended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-12 - Actions for recovery of damages and attorney's fees

Any resident injured by a violation of this chapter may bring an action for the recovery of damages plus reasonable attorney's fees.
Redesignated by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-13 - Penalties for violation of chapter provisions; department authorized to take remedial action, including suspension and revocation of certificate of authority

(a)
Any person who knowingly maintains, enters into, performs, or, as manager or officer or in any other administrative capacity, assists in entering into, maintaining, or performing any continuing care agreement subject to this chapter without a valid certificate of authority or renewal thereof, as contemplated by or provided in this chapter, or who otherwise violates any provision of this chapter, is guilty of a misdemeanor. Each violation of this chapter constitutes a separate offense.
(b)
In addition to the powers granted pursuant to Chapters 1 and 2 of this title, the department may bring an action to enjoin a violation, threatened violation, or continued violation of this chapter in the superior court of the county in which the violation occurred, is occurring, or is about to occur.
(c)
If, after a period of 180 days, or such additional time as the department shall deem appropriate, the corrective action plan required by paragraph (1) of subsection (d) of Code Section
33-45-11
has been submitted and approved by the department and the department deems the facility or provider to be unable to achieve the necessary financial reserves or is not making substantial progress toward achieving the required financial reserves, the department shall be authorized to take immediate action against the facility or provider's certificate of authority, including suspension or revocation of the certificate of authority; provided, however, that before the Commissioner suspends or revokes a certificate of authority, the Commissioner shall conduct a hearing in accordance with Chapter 2 of this title.
(d)
Any action brought by the department against a provider shall not abate by reason of a sale or other transfer of ownership of the facility used to provide care, which provider is a party to the action, except with the express written consent of the Commissioner.
Redesignated and amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 45 - CONTINUING CARE PROVIDERS AND FACILITIES (§§ 33-45-1 — 33-45-14) › Section 33-45-14 - Period of applicability of chapter

Any contract or continuing care agreement executed before July 1, 1991, which is amended or renewed subsequent to July 1, 1991, and any contract or continuing care agreement executed on or after July 1, 1991, shall be subject to this chapter.
Redesignated and amended by 2011 Ga. Laws 77,§ 1, eff. 5/11/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-1 - Construction

This chapter shall be construed liberally to promote consumer protection.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-3
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-2 - Application

(a)
This chapter applies to:
(1)
Private review agents;
(2)
Utilization review entities;
(3)
All health insurers and stand-alone dental plans that provide accident and sickness insurance products whether on an individual, group, or blanket basis as provided in this title;
(4)
All administrators of such products licensed in accordance with Article 2 of Chapter 23 of this title;
(5)
All pharmacy benefits managers;
(6)
All contracts entered into or renewed by the Department of Community Health with a contracted entity to provide healthcare coverage or services pursuant to the state health benefit plan; and
(7)
All contracts entered into or renewed by the Department of Community Health and care management organizations to provide or arrange for healthcare coverage or services on a prepaid, capitated basis to members.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-4
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-3 - Legislative purposes and intent

(a)
The purpose of this chapter is to promote the delivery of quality healthcare in Georgia. Furthermore, it is to foster the delivery of such care in a cost-effective manner through greater coordination between healthcare providers, claim administrators, insurers, employers, patients, private review agents, and utilization review entities; to improve communication and knowledge of healthcare benefits among all parties; to protect patients, claim administrators, insurers, private review agents, employers, and healthcare providers by ensuring that utilization review activities are based upon accepted standards of treatment and patient care; to ensure that such treatment is accessible and done in a timely and effective manner; and to ensure that private review agents and utilization review entities maintain confidentiality of information obtained in the course of utilization review.
(b)
In order to carry out the intent and purposes of this chapter, it is declared to be the policy of this chapter to protect Georgia residents by imposing minimum standards on private review agents and utilization review entities who engage in utilization review with respect to healthcare services provided in Georgia, such standards to include regulations concerning certification of private review agents and utilization review entities, disclosure of utilization review standards and appeal procedures, minimum qualifications for utilization review personnel, minimum standards governing accessibility of utilization review, and such other standards, requirements, and rules or regulations promulgated by the Commissioner which are not inconsistent with the foregoing. Notwithstanding the foregoing, it is neither the policy nor the intent of the General Assembly to regulate the terms of self-insured employee welfare benefit plans as defined in Section 31(I) of the Employee Retirement Income Security Act of 1974, as amended, and therefore any regulations promulgated pursuant to this chapter shall relate only to persons subject to this chapter.
Renumbered from §
33-46-1
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-5
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-5 - Certification of private review agents; exemption

(a)
A private review agent or utilization review entity may not conduct utilization review of healthcare provided in this state unless the Commissioner has granted the private review agent or utilization review entity a certificate pursuant to this chapter. No individual conducting utilization review shall require certification if such utilization review is performed within the scope of such person's employment with an entity already certified pursuant to this Code section.
(b)
The Commissioner shall issue a certificate to an applicant that has met all the requirements of this chapter and all applicable regulations of the Commissioner.
(c)
A certificate issued under this chapter is not transferable without the prior approval of the Commissioner.
Renumbered from §
33-46-3
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-7
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-7 - Certificate application fees; information to be submitted with application

(a)
An applicant for a certificate shall submit an application on a form prescribed by the Commissioner and pay an application fee and a certificate fee as provided in Code Section
33-8-1
. The application shall be signed and verified by the applicant.
(b)
In conjunction with the application, the private review agent or utilization review entity shall submit such information that the Commissioner requires, including but not limited to:
(1)
A utilization review plan;
(2)
The type and qualifications of the personnel either employed or under contract to perform the utilization review;
(3)
A copy of the materials designed to inform applicable patients and healthcare providers of the requirements of the utilization review plan; and
(4)
A signed attestation by the chief medical officer or chief executive officer of the applicant that such entity's utilization review activities comply with the standards required by this chapter.
The information provided must demonstrate to the satisfaction of the Commissioner that the applicant will comply with the requirements of this chapter.
Renumbered from §
33-46-5
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-9
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-8 - Expiration and renewal of certificate

(a)
A certificate shall expire on the second anniversary of its effective date unless the certificate is renewed for a two-year term as provided in this Code section.
(b)
Before the certificate expires but no sooner than 90 days prior to such expiration, a certificate may be renewed for an additional two-year term if the applicant:
(1)
Otherwise is entitled to the certificate;
(2)
Pays to the Commissioner the renewal fee as provided in Code Section
33-8-1
;
(3)
Submits to the Commissioner:
(A)
A renewal application on the form that the Commissioner requires; and
(B)
Satisfactory evidence of compliance with any requirements established by the Commissioner for certificate renewal; and
(4)
(A)
Establishes and maintains a complaint system which has been approved by the Commissioner and which provides reasonable procedures for the resolution of written complaints initiated by covered persons or healthcare providers concerning utilization review;
(B)
Maintains records of such written complaints for five years from the time the complaints are filed and submits to the Commissioner a summary report at such times and in such format as the Commissioner may require; and
(C)
Permits the Commissioner to examine the complaints at any time.
Renumbered from §
33-46-6
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-10
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-9 - Jurisdiction of Commissioner over private review agents and utilization review entities

Private review agents and utilization review entities shall be subject to the jurisdiction of the Commissioner in all matters regulated by this chapter and the Commissioner shall have such powers and authority with regard to private review agents and utilization review entities as provided in Code Sections
33-2-9
through
33-2-28
with regard to insurers.
Renumbered from §
33-46-7
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-11
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-10 - Applicability of Chapter 39 of Title 33

Private review agents and utilization review entities shall be subject to the provisions of Chapter 39 of this title.
Renumbered from §
33-46-8
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-12
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-11 - Listings of certificate holders

The Commissioner shall periodically, not less than once a year, provide a list of private review agents and utilization review entities issued certificates and the renewal date for those certificates to all hospitals and to any other individual or organization requesting such list.
Renumbered from §
33-46-9
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-13
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-12 - Reporting requirements

The Commissioner shall establish such reporting requirements upon private review agents and utilization review entities as are necessary to determine if the utilization review programs are in compliance with the provisions of this chapter and applicable rules and regulations.
Renumbered from §
33-46-10
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-14
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-13 - Adoption of rules and regulations

The Commissioner shall adopt rules and regulations to implement the provisions of this chapter.
Renumbered from §
33-46-11
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
Renumbered as §
33-46-15
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-14 - Exemptions from certificate requirements

No certificate is required for utilization review by any Georgia licensed pharmacist or pharmacy while engaged in the practice of pharmacy, including but not limited to review of the dispensing of drugs, participation in drug utilization review, and monitoring patient drug therapy.
Renumbered from §
33-46-12
by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-15 - Exemptions from applicability of chapter

(a)
This chapter shall not apply to any contract with the federal government for utilization and review of patients eligible for hospital services under Title XVIII or XIX of the Social Security Act.
(b)
This chapter shall not apply to any private review agent or utilization review entity when such private review agent or utilization review entity is working under contract, or an extension or renewal thereof, with a licensed insurer operating under an agreement, providing administrative services pursuant to the provisions of subsection (b) of Code Section
33-20-17
to a healthcare benefit plan negotiated through collective bargaining as that term is defined in the federal National Labor Relations Act, as amended, if the original agreement was executed and in effect prior to January 1, 1990.
(c)
This chapter shall not apply to audits of the medical record for the purposes of verifying that healthcare services were ordered and delivered.
Renumbered from §
33-46-13
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 1 - GENERAL PROVISIONS (§§ 33-46-1 — 33-46-16) › Section 33-46-16 - Commissioner to issue annual report

The Commissioner shall issue an annual report to the Governor and the General Assembly concerning the conduct of utilization review in this state. Such report shall include a description of utilization review programs and the services they provide, an analysis of complaints filed against private review agents and utilization review entities by patients or providers, and an evaluation of the impact of utilization review programs on patient access to care. The Commissioner shall not be required to distribute copies of the annual report to legislators in the General Assembly but shall notify such legislators of the availability of the report in the manner which he or she deems to be most effective and efficient.
Renumbered from §
33-46-14
and amended by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.