reglab/statecodes huggingface dataset:
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-52 - Direct response insurance business

(a)
For the purposes of this Code section, "direct response insurance business" means the solicitation, delivery, and servicing of group or individual life or accident and sickness insurance policies in this state, other than franchise insurance policies or other policies sold through a third party, travel life or accident insurance policies, or life or accident and sickness insurance policies sold or issued in connection with an extension of credit, under a general mode of business in which there is no face-to-face contact between the insured and an agent or other representative of the insurer.
(b)
Any foreign or alien insurer who conducts a direct response insurance business in this state shall:
(1)
Maintain a registered agent for service of process who is a resident of this state; and
(2)
Maintain an office within this state, accept collect telephone calls from its direct response insurance policyholders, or provide toll free telephone service to such policyholders in order to provide information and assistance to such policyholders and their beneficiaries.
(c)
Any insurer providing collect or toll free telephone service pursuant to this Code section shall notify its direct response insurance policyholders in writing of the applicable telephone number or numbers and of any subsequent changes in the telephone number or numbers within 90 days of such change.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-54 - Payments to nonparticipating or nonpreferred providers of health care services

(a)
Notwithstanding any provisions of Code Sections
33-1-3
,
33-1-5
, and
33-24-17
and Chapter 20 of this title or any other provisions of this title which might be construed to the contrary, whenever an accident and sickness insurance policy, subscriber contract, or self-insured health benefit plan, by whatever name called, which is issued or administered by a person licensed under this title provides that any of its benefits are payable to a participating or preferred provider of health care services licensed under the provisions of Chapter 4 of Title 26 or of Chapter 9, 11, 30, 34, 35, or 39 of Title 43 or of Chapter 11 of Title 31 for services rendered, the person licensed under this title shall be required to pay such benefits either directly to any similarly licensed nonparticipating or nonpreferred provider who has rendered such services, has a written assignment of benefits, and has caused written notice of such assignment to be given to the person licensed under this title or jointly to such nonparticipating or nonpreferred provider and to the insured, subscriber, or other covered person; provided, however, that in either case the person licensed under this title shall be required to send such benefit payments directly to the provider who has the written assignment. When payment is made directly to a provider of health care services as authorized by this Code section, the person licensed under this title shall give written notice of such payment to the insured, subscriber, or other covered person.
(b)
Nothing contained in this Code section shall be deemed to prohibit the payment of different levels of benefits or from having differences in coinsurance percentages applicable to benefit levels for services provided by participating or preferred providers and nonparticipating or nonpreferred providers as otherwise authorized under the provisions of Code Sections
33-30-20
through
33-30-27
.
(c)
Payments made by a person licensed under this title under subsection (a) of this Code section to a nonparticipating or nonpreferred provider or jointly to the provider and the insured, subscriber, or other covered person shall discharge such person's obligation with respect to the amount so paid.
(d)
The provisions of this Code section shall not apply to credit insurance, disability income insurance, or limited accident and sickness policies such as hospital indemnity policies, specified disease policies, limited accident policies, or similar limited policies.
Amended by 2006 Ga. Laws 667,§ 4, eff. 7/1/2006.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-56 - Prohibition against requiring referral from primary care physician to dermatologist

(a)
It is the intent of the General Assembly to encourage health care cost containment while preserving the quality of care offered to citizens of this state. The General Assembly finds that there is an increasing number of health insurance benefit providers which require a referral from a primary care physician to a dermatologist as a condition of the payment of benefits to an insured patient. The General Assembly finds that such a requirement as it relates to dermatological services may block unfairly a patient's choice of direct access to providers of health care services and may not be in the public interest.
(b)
As used in this Code section, the term:
(1)
"Dermatological services" means services ordinarily and customarily rendered by a physician specializing in the practice of dermatology.
(2)
"Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care corporation, health maintenance organization, accident and sickness insurer, fraternal benefit society, or similar entity.
(c)
No health benefit policy which is issued, delivered, issued for delivery, or renewed in this state shall require as a condition to the coverage of dermatological services that an enrollee, subscriber, or insured first obtain a referral from a primary care physician, as such term is defined by the group plan, policy, or contract for health care services.
Amended by 2019 Ga. Laws 140,§ 53, eff. 7/1/2019.
Amended by 2017 Ga. Laws 52,§ 28, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-56.2 - Surveillance tests for ovarian cancer

(a)
As used in this Code section, the term:
(1)
"At risk for ovarian cancer" means:
(A)
Having a family history:
(i)
With one or more first or second-degree relatives with ovarian cancer;
(ii)
Of clusters of women relatives with breast cancer;
(iii)
Of nonpolyposis colorectal cancer; or
(B)
Testing positive for BRCA1 or BRCA2 mutations.
(2)
"Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, those contracts executed by the state on behalf of state employees under Article 1 of Chapter 18 of Title 45, by an insurer.
(3)
"Insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, preferred provider organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.
(4)
"Surveillance tests" means annual screening using:
(A)
CA-125 serum tumor marker testing;
(B)
Transvaginal ultrasound; and
(C)
Pelvic examination.
(b)
Every health benefit policy that is delivered, issued, issued for delivery, executed, or renewed in this state or approved for issuance or renewal in this state by the Commissioner shall provide coverage for surveillance tests for women age 35 and over at risk for ovarian cancer.
(c)
The benefits provided in this Code section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given health benefit policy.
(d)
A physician who assesses a patient for ovarian cancer and such patient is at risk for ovarian cancer is encouraged to advise such patient of the availability of surveillance tests in accordance with the practices of the profession generally under similar conditions and like surrounding circumstances.
Amended by 2019 Ga. Laws 140,§ 54, eff. 7/1/2019.
Added by 2001 Ga. Laws 18, § 1, eff. 7/1/2001.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-56.3 - Colorectal cancer screening and testing

(a)
As used in this Code section, the term:
(1)
"Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed by an insurer in this state, including, but not limited to, those contracts executed by the Department of Community Health pursuant to paragraph (1) of subsection (d) of Code Section
31-2-4
. The term "health benefit policy" does not include the following limited benefit insurance policies: accident only, CHAMPUS supplement, dental, disability income, fixed indemnity, long-term care, medicare supplement, specified disease, vision, and nonrenewable individual policies written for a period of less than six months.
(2)
"Insurer" means any person, corporation, or other entity authorized to provide health benefit policies under this title.
(b)
Every health benefit policy shall provide coverage for colorectal cancer screening, examinations, and laboratory tests in accordance with guidelines and recommendations established by the American Cancer Society, in consultation with the American College of Gastroenterology and the American College of Radiology, for the ages, family histories, and frequencies referenced in such guidelines and recommendations and deemed appropriate by the attending physician after conferring with the patient.
(c)
The benefits provided in this Code section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given health benefit policy.
Amended by 2020 Ga. Laws 521,§ 33, eff. 7/29/2020.
Amended by 2019 Ga. Laws 140,§ 55, eff. 7/1/2019.
Amended by 2009 Ga. Laws 102,§ 1-41, eff. 7/1/2009.
Added by 2002 Ga. Laws 908, § 1, eff. 7/1/2002.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-56.5 - Health benefit policy to provide coverage for orally administered chemotherapy for the treatment of cancer; definitions

(a)
As used in this Code section, the term:
(1)
"Cost sharing requirements" includes co-payments, coinsurance, deductibles, and any other amounts paid by the covered person for a prescription dispensed by a licensed retail pharmacy.
(2)
"Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed by an insurer in this state. The term "health benefit policy" does not include the following limited benefit insurance policies: accident only, CHAMPUS supplement, dental, disability income, fixed indemnity, long-term care, Medicaid, medicare supplement, specified disease, vision, self-insured plans, and nonrenewable individual policies written for a period of less than six months.
(3)
"Insurer" means any person, corporation, or other entity authorized to provide health benefit policies under this title.
(b)
A health benefit policy that provides coverage for intravenously administered or injected chemotherapy for the treatment of cancer shall provide coverage for orally administered chemotherapy for the treatment of cancer on a basis no less favorable than the intravenously administered or injected chemotherapy regardless of the formulation or benefit category determination by the insurer.
(c)
An insurer providing a health benefit policy and any participating entity through which the insurer offers health services shall not:
(1)
Vary the terms of any health benefit policy, to avoid compliance with this Code section;
(2)
Provide any incentive, including, but not limited to, a monetary incentive, or impose treatment limitations to encourage a covered person to accept less than the minimum protections available under this Code section;
(3)
Penalize a health care practitioner or reduce or limit the compensation of a health care practitioner for recommending or providing services or care to a covered person as required under this Code section;
(4)
Provide any incentive, including, but not limited to, a monetary incentive, to induce a health care practitioner to provide care or services that do not comply with this Code section; or
(5)
Change the classification of any intravenously administered or injected chemotherapy treatment or increase the amount of cost sharing applicable to any intravenously administered or injected chemotherapy, in order to achieve compliance with this Code section.
(d)
An insurer that limits the total amount paid by a covered person through all cost sharing requirements to no more than $200.00 per filled prescription for any orally administered chemotherapy shall be deemed to be in compliance with this Code section.
Amended by 2019 Ga. Laws 140,§ 57, eff. 7/1/2019.
Added by 2014 Ga. Laws 529,§ 2-2, eff. 1/1/2015.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-57 - Health insurance; provision that coverage cannot be terminated due to individual claims experience required

(a)
As used in this Code section, the term:
(1)
"Insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, or any similar entity and any self-insured health care plan not subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974,
29 U.S.C. Section 1001
, et seq.
(2)
"Policy" means any health care plan, subscriber contract, or accident and sickness plan, contract, or policy by whatever name called other than a disability income policy, a long-term care insurance policy, a medicare supplement policy, a health insurance policy written as a part of workers' compensation equivalent coverage, a specified disease policy, a credit insurance policy, a hospital indemnity policy, a limited accident policy, or other type of limited accident and sickness policy.
(b)
Notwithstanding any provisions of this title which might be construed to the contrary, all individual basic hospital or medical expense, major medical, or comprehensive medical expense insurance policies issued, delivered, issued for delivery, or renewed in this state shall provide that once an individual has been accepted for coverage, his or her coverage cannot be terminated by the insurer due solely to his or her individual claims experience.
(c)
The Commissioner shall promulgate appropriate procedures and guidelines by rules and regulations to implement the provisions of this Code section after notification and review of such regulation by the appropriate standing committees of the House of Representatives and Senate in accordance with the requirements of applicable law. Nothing in this Code section shall be construed to prohibit the Commissioner and any insurers with a desire to do so from mutually agreeing on procedures, rules, regulations, and guidelines and from implementing the provisions of this Code section on a voluntary basis before April 1, 1996.
Amended by 2020 Ga. Laws 521,§ 33, eff. 7/29/2020.
Amended by 2019 Ga. Laws 140,§ 58, eff. 7/1/2019.
Amended by 2017 Ga. Laws 52,§ 29, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-58 - Newborn Baby and Mother Protection Act; short title

This Code section and Code Sections
33-24-58.1
and
33-24-58.2
shall be known and may be cited as the "Newborn Baby and Mother Protection Act."
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-58.1 - Newborn Baby and Mother Protection Act; legislative findings and declaration

The General Assembly finds and declares that:
(1)
Whereas, until recently health care insurers covered costs of hospital stays of a mother and a newborn until they were discharged by a physician after a consultation with the mother. Now many insurers are refusing payment for a hospital stay that extends beyond 24 hours after an uncomplicated vaginal delivery and 48 hours after a cesarean delivery;
(2)
There is sufficient scientific data to question the safety and appropriateness of such early releases from the hospital following delivery, particularly as it relates to the detection of many problems which if undiagnosed may pose life-threatening and costly complications and may require a longer period of observation by skilled personnel;
(3)
Guidelines developed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend as a minimum that mothers and infants meet certain medical criteria and conditions prior to discharge, and it is unlikely that these criteria and conditions can be met in less than 48 hours following a normal vaginal delivery and 96 hours following a cesarean delivery;
(4)
The length of postdelivery inpatient stay should be a clinical decision made by a physician based on the unique characteristics of each mother and her infant, taking into consideration the health of the mother, the health and stability of the baby, the ability and confidence of the mother to care for her baby, the adequacy of support systems at home, and access to appropriate follow-up care; and
(5)
Requiring insurers to cover minimum postdelivery inpatient stays will allow identification of early problems with the newborn, prevent disability through appropriate use of metabolic screening, and help ensure that the family is able and prepared to care for the baby at home.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59 - Women's access to health care; health insurance; provision disclosing insured's right to direct access to obstetricians and gynecologists required

(a)
The General Assembly finds and declares that the specialty of obstetrics and gynecology is devoted to health care of women throughout their lifetimes.
(b)
(1)
As used in this Code section, the term "health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care corporation, health maintenance organization, accident and sickness insurer, fraternal benefit society, or similar entity.
(2)
Any accident and sickness policies, plans, or contracts which contain no provisions which require referrals from another physician for coverage of the services of an obstetrician or gynecologist shall not be required to give the notice required in subsection (d) of this Code section.
(c)
No health benefit policy which is issued, delivered, issued for delivery, or renewed in this state shall require as a condition to the coverage of services of an obstetrician or gynecologist who is within the health benefit policy network of health care providers that an enrollee, subscriber, or insured first obtain a referral from another physician; provided, however, that the services covered by this subsection shall be limited to those services defined by the published recommendations of the Accreditation Council for Graduate Medical Education for training as an obstetrician or gynecologist, including, but not limited to, diagnosis, treatment, and referral.
(d)
Each health benefit policy which is issued, delivered, issued for delivery, or renewed in this state shall disclose to enrollees, subscribers, or insureds, in clear, accurate language, such person's right to direct access to obstetricians and gynecologists as provided in this Code section. Such information shall be disclosed to each such person at the time of enrollment or otherwise first becoming an enrollee, subscriber, or insured, and at least annually thereafter.
Amended by 2019 Ga. Laws 140,§ 61, eff. 7/1/2019.
Amended by 2017 Ga. Laws 52,§ 30, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.2 - Coverage for equipment and self-management training for individuals with diabetes; enforcement

(a)
Every individual major medical and group health insurance policy, group health insurance plan or policy, and any other form of managed or capitated care plans or policies shall provide coverage for medically necessary equipment, supplies, pharmacologic agents, and outpatient self-management training and education, including medical nutrition therapy, for individuals with insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes who adhere to the prognosis and treatment regimen prescribed by a physician licensed to practice medicine pursuant to Title 43.
(b)
(1)
Diabetes outpatient self-management training and education as provided for in subsection (a) of this Code section shall be provided by a certified, registered, or licensed health care professional with expertise in diabetes.
(2)
The Commissioner shall promulgate rules and regulations after consultation with the Department of Public Health which conform to the standards for diabetes outpatient self-management training and educational services established by the American Diabetes Association for purposes of this Code section.
(3)
The Commissioner shall promulgate rules and regulations, relating to standards of diabetes care, after consultation with the Department of Public Health, the American Diabetes Association, and the National Institutes of Health. Such rules and regulations shall be adopted in accordance with the provisions of Code Section
33-2-9
.
(c)
The benefits provided in this Code section shall be subject to the same annual deductibles or coinsurance established for all other covered benefits within a given policy.
(d)
Private third-party payors may not reduce or eliminate coverage due to the requirements of this Code section.
(e)
Enforcement of the provisions of this Code section shall be performed by the Commissioner of Insurance.
Amended by 2019 Ga. Laws 140,§ 63, eff. 7/1/2019.
Amended by 2011 Ga. Laws 244,§ 6-3, eff. 7/1/2011.
Amended by 2009 Ga. Laws 102,§ 1-42, eff. 7/1/2009.
Amended by 2002 Ga. Laws 782, § 1, eff. 7/1/2002.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.3 - Payments sent directly to health care provider by insurer

(a)
As used in this Code section, the term "health care insurer" means any insurer which issues, delivers, issues for delivery, or renews an individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, or renewed in this state by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, or other insurer or similar entity. It shall not, however, include a policy of insurance designed, advertised, and marketed to supplement basic health care coverage for hospital, medical-surgical, or major medical expenses so long as said supplemental insurance contract provides for payment directly to the insured.
(b)
Any other provision of law to the contrary notwithstanding, if a covered person provides in writing to a health care provider, whether the health care provider is a preferred provider or not, that payment for health care services shall be made solely to the health care provider and be sent directly to the health care provider by the health care insurer, and the health care provider certifies to same upon filing a claim for the delivery of health care services, the health care insurer shall make payment solely to the health care provider and shall send said payment directly to the health care provider. This subsection shall not be construed to extend coverages or to require payment for services not otherwise covered.
Amended by 2019 Ga. Laws 140,§ 65, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.4 - Confidentiality of medical information obtained from pharmacies; restrictions on release of information; penalty for violation

(a)
As used in this Code section, the term "insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, provider sponsored health care corporation, or the plan administrator of any health benefit plan established pursuant to Article 1 of Chapter 18 of Title 45 and includes any entity which administers or processes claims on behalf of any of the foregoing.
(b)
Any medical information concerning a patient that was obtained by or released to an insurer from a pharmacy or pharmacist shall be confidential and privileged and may be released by such insurer to a third party for consideration only if such release is specifically authorized by such patient or a person otherwise authorized to act therefor. Any insurer possessing patient medical information which was obtained from a pharmacy or pharmacist shall not release such information to any third party for consideration without the explicit written consent of the patient or a person otherwise authorized to act therefor, which consent was obtained after written notice by the insurer to such patient or person otherwise authorized to act therefor of the purpose of such release, the party or parties to whom the information will be released, and any consideration paid or to be paid to the insurer for such information.
(c)
The provisions of subsection (b) of this Code section shall not prohibit the release of medical information by an insurer to a third party for purposes of appropriate medical research without notice to or the written consent of a patient or person authorized to act therefor, provided that such release does not provide any information that identifies a patient, prescriber, pharmacy, or pharmacist, including without limitation any name, address, or telephone number of a patient, prescriber, pharmacy, or pharmacist. Information released in accordance with the provisions of this subsection may be used for appropriate medical research.
(d)
Violation of this Code section by any insurer to which any license or certificate of authority has been issued under this title shall constitute an unfair trade practice punishable under Article 1 of Chapter 6 of this title.
Amended by 2019 Ga. Laws 140,§ 66, eff. 7/1/2019.
Amended by 2017 Ga. Laws 52,§ 32, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.8 - Coverage for prescription inhalers; no restriction on the number of days before obtaining a refill as prescribed

No individual major medical or group health insurance policy, group health insurance plan or policy, or any other form of managed or capitated health care plans or policies issued, delivered, issued for delivery, or renewed containing coverage for prescription drugs and pharmaceuticals shall deny or limit coverage for prescription inhalants required to enable persons to breathe when suffering from asthma or other life-threatening bronchial ailments based upon any restriction on the number of days before an inhaler refill may be obtained if, contrary to such restrictions, such inhalants have been ordered or prescribed by the treating physician.
Amended by 2019 Ga. Laws 140,§ 70, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.13 - Exemptions from certain unfair trade practices for certain wellness and health improvement programs; incentives

(a)
An insurer issuing life, comprehensive, major medical group, or individual health insurance benefit plans may, in keeping with federal requirements, offer wellness or health improvement programs, including voluntary wellness or health improvement programs that provide for rewards or incentives, including, but not limited to, merchandise, gift cards, debit cards, premium discounts, credits or rebates, contributions towards a member's health savings account, modifications to copayment, deductible, or coinsurance amounts, cash value, or any combination of these incentives, to encourage participation in such wellness or health improvement programs and to reward insureds for participation in such programs.
(b)
The offering of such rewards or incentives to insureds under such wellness or health improvement programs shall not be considered an unfair trade practice under Code Section
33-6-4
if such programs are filed with the Commissioner and made a part of the life or health insurance master policy and certificates or the individual life or health insurance evidence of coverage as a policy amendment, endorsement, rider, or other form of policy material as agreed upon by the Commissioner. The Commissioner shall be authorized to develop an automatic or expedited approval process for review of such wellness or health improvement programs, including those programs already approved under the laws and regulations of other states.
Amended by 2012 Ga. Laws 736,§ 1, eff. 7/1/2012.
Added by 2010 Ga. Laws 548,§ 2, eff. 7/1/2010.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.15 - Definitions; dental insurance

(a)
As used in this Code section:
(1)
"Covered dental services" means dental care services for which a reimbursement is available under a covered person's dental benefit plan, or for which a reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.
(2)
"Covered person" means any subscriber, enrollee, member, beneficiary, or participant, or his or her dependent, for whom benefits are payable when that covered person receives dental care services rendered or authorized by a dentist licensed under Chapter 11 of Title 43.
(3)
"Dental benefit plan" means any individual or group plan, policy, contract, or subscription agreement which includes or is for dental care services that is issued, delivered, issued for delivery, or renewed in this state whether by a health care insurer, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, health care plan, or any other person, firm, corporation, joint venture, or other similar business entity that pays for, purchases, or furnishes dental care services to patients, insureds, beneficiaries, or covered dependents in this state.
(4)
"Dental insurer" means any person, firm, corporation, joint venture, or other similar business entity that offers dental benefit plans in consideration of periodic payments.
(b)
No contract between a dental insurer and a dentist shall require a dentist to accept an amount set by the dental insurer as payment for dental care services that are not covered dental services under the covered person's dental benefit plan.
(c)
A dental insurer or other person or entity providing third-party administrator services shall not make available any providers in its dentist network to a plan that sets dental fees for any services except covered services.
(d)
A dental insurer shall not draft, publish, disseminate, or circulate explanation of benefit forms that include language which directly or indirectly implies that a dentist may or should extend discounts to patients for noncovered dental services. Statements by a dental insurer which are prohibited by this Code section include but are not limited to, "Our members value the services you provide and we encourage you to continue extending the discount on noncovered services."
Amended by 2017 Ga. Laws 52,§ 36, eff. 7/1/2017.
Added by 2011 Ga. Laws 198,§ 2, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.16 - Equal access to child's health insurance information; exceptions

(a)
As used in this Code section, the term:
(1)
"Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, those contracts executed by the State of Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by an insurer.
(2)
"Insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, preferred provider organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.
(b)
An insurer shall provide a parent of a child the right to inspect, review, or attain copies of health insurance records relating to his or her own child; provided, however, that if the parent making such request is not the named insured or owner of such policy, he or she shall provide the insurer a certified copy of his or her divorce decree, a parenting plan pursuant to Code Section
19-9-1
, or other court document establishing that the parent may have access to such records.
(c)
Health insurance records and information pertaining to the child shall not be withheld from the custodial parent or from the noncustodial parent unless a court order has specifically removed the right of the noncustodial parent to such information or unless parental rights have been terminated.
(d)
In the absence of fraud or bad faith, the insurer shall not be subject to liability for furnishing information and records requested pursuant to subsection (b) of this Code section.
Amended by 2019 Ga. Laws 140,§ 75, eff. 7/1/2019.
Added by 2013 Ga. Laws 171,§ 1, eff. 7/1/2013.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.17 - Coverage of certain abortions through certain qualified health plans prohibited; definitions

(a)
No abortion coverage shall be provided by a qualified health plan offered within the State of Georgia through a state law, a federal law, or regulation or exchange created by the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and regulations or guidance issued under those acts, except in the case of medical emergency.
(b)
For the purposes of this Code section, the term "abortion" has the same meaning as provided in Code Section
31-9A-2
.
(c)
For the purposes of this Code section, the term "medical emergency" has the same meaning as provided in Code Section
31-9A-2
.
(d)
Nothing in this Code section shall be construed as creating or recognizing a right to an abortion.
(e)
It is not the intention of this Code section to make lawful an abortion that is unlawful.
Amended by 2019 Ga. Laws 140,§ 76, eff. 7/1/2019.
Added by 2014 Ga. Laws 547,§ 1, eff. 4/21/2014.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.18 - Coverage for treatment of a terminal condition

(a)
As used in this Code section, the term:
(1)
"Health benefit plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization, subscriber contract or agreement, preferred provider organization, accident and sickness insurance benefit plan, or other insurance contract under any other name. The term shall include any health insurance plan established under Article 1 of Chapter 18 of Title 45 and under Chapter 4 of Title 49, the "Georgia Medical Assistance Act of 1977."
(2)
"Terminal condition" means any disease, illness, or health condition that a physician has diagnosed as expected to result in death in 24 months or less.
(3)
"Treatment" does not include any medication or medical procedure, regardless of where actually prescribed, dispensed, or administered, which if prescribed, dispensed, or administered in this state would constitute assisted suicide in violation of Code Section
16-5-5
.
(b)
No health benefit plan shall restrict coverage for treatment of a terminal condition when such treatment has been prescribed by a physician as medically appropriate and such treatment has been agreed to by an insured patient or by a person to whom the insured patient has legally delegated such authority or to whom otherwise has the legal authority to consent on behalf of the insured patient. The health benefit plan shall not refuse to pay or otherwise reimburse for the treatment diagnosed under this subsection, including any drug or device, so long as such end of life care is consistent with best practices for the treatment of the terminal condition and such treatment is supported by peer reviewed medical literature.
(c)
A denial or a refusal to pay for treatment prescribed under subsection (b) of this Code section shall be a violation of this Code section.
(d)
A violation of this Code section shall be a per se violation of Chapter 6 of this title, and the penalties, procedures, and remedies applicable to violations of Chapter 6 of this title shall be applicable to a violation of this Code section.
Added by 2015 Ga. Laws 31,§ 1, eff. 7/1/2015.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.19 - Coverage for treatment of burns with skin substitutes utilizing cryopreserved cadaver derived skin tissue

No health benefit policy issued, delivered, or renewed in this state that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment and management of burns shall limit or exclude coverage for such treatment on the basis that the use of cryopreserved cadaver derived skin tissue is an experimental or investigational medical treatment.
Added by 2015 Ga. Laws 207,§ 1, eff. 7/1/2015.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.20 - Access to stage four advanced, metastatic cancer treatments in health benefit plans

(a)
As used in this Code section, the term:
(1)
"Health benefit plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization, subscriber contract or agreement, preferred provider organization, accident and sickness insurance benefit plan, or other insurance contract under any other name. The term shall include any health insurance plan established under Article 1 of Chapter 18 of Title 45 and under Article 7 of Chapter 4 of Title 49, the "Georgia Medical Assistance Act of 1977."
(2)
"Stage four advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body.
(b)
No health benefit plan issued, delivered, or renewed in this state that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment of stage four advanced, metastatic cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such drug or drugs; provided, however, that the use of such drug or drugs is consistent with best practices for the treatment of stage four advanced, metastatic cancer and is supported by peer reviewed medical literature.
Added by 2016 Ga. Laws 489,§ 3, eff. 7/1/2016.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.22 - Prescription drug program defined; cost sharing; denial of coverage; dispensing fees

(a)
As used in this Code section, the term "prescription drug program" means any individual or group plan, policy, or contract for prescription drug services issued, delivered, issued for delivery, executed, or renewed by an insurer in this state on or after July 1, 2017.
(b)
A prescription drug program providing prescription drug coverage in this state shall permit and apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a pharmacy for less than a 30 day supply if the prescriber or pharmacist indicates the fill or refill could be in the best interest of the insured patient or is for the purpose of synchronizing the insured patient's medications.
(c)
No prescription drug program providing prescription drug coverage shall deny coverage for the dispensing of any drug prescribed for the treatment of an illness that is made in accordance with a plan among the insured, a practitioner, and a pharmacist to synchronize the refilling of multiple prescriptions for the insured.
(d)
No prescription drug program providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees determined by calculation of the days' supply of medication dispensed. Dispensing fees shall be determined exclusively on the total number of prescriptions dispensed.
Amended by 2019 Ga. Laws 321,§ 33, eff. 5/12/2019.
Added by 2017 Ga. Laws 272,§ 1, eff. 7/1/2017.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.23 - Carrier issuing health benefit plans to pay insurance agent's commissions; regulation

(a)
As used in this Code section, the term:
(1)
"Agent" shall have the same meaning as in Code Section
33-23-1
.
(2)
"Carrier" means any entity licensed to provide health insurance in this state and which is subject to state insurance regulation.
(3)
"Health benefit plan" means any hospital or medical insurance policy or certificate, health care plan contract or certificate, qualified higher deductible health plan, or health maintenance organization subscriber contract. Health benefit plan does not include policies issued in accordance with Chapter 31 of this title; disability income policies; policies issued in accordance with Code Section
34-9-14
or
34-9-122.1
; limited accident and sickness insurance policies such as credit, dental, vision, medicare supplement, long-term care, hospital indemnity, or specified disease insurance; coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; or automobile medical payment insurance.
(4)
"Premium" means the consideration paid in exchange for coverage under a health benefit plan.
(b)
Any carrier that issues a health benefit plan in this state through an agent shall pay a commission to such agent. Such carrier shall file with the department its proposed commission rates relevant to all such agents. The commission paid to such agents shall be consistent with the amount proposed in the rates filed with the department, as required by the Commissioner. Such commission shall be structured to compensate the agent for the first term and for each renewal term thereafter, so long as such agent reviews coverage and provides ongoing customer service for such plan; provided, however, that no such first term compensation to such agent shall be required for any individual health benefit plan sold during a special enrollment period. Notwithstanding the above, any carrier that does not provide such first term commission during a special enrollment period shall, upon policy renewal, provide the agent with the renewal commission and any first term commission that was not paid because such policy was sold during a special enrollment period. Nothing in this Code section is intended or shall be construed to require a carrier to pay a commission to an agent who is employed by such carrier.
(c)
The Commissioner shall adopt such rules and regulations he or she deems necessary for the administration of this Code section.
Amended by 2020 Ga. Laws 565,§ 1, eff. 1/1/2021.
Amended by 2019 Ga. Laws 140,§ 77, eff. 7/1/2019.
Added by 2018 Ga. Laws 549,§ 2, eff. 7/1/2018.
See 2018 Ga. Laws 549, § 3.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 24 - INSURANCE GENERALLY (§§ 33-24-1 — 33-24-98) › Article 1 - GENERAL PROVISIONS (§§ 33-24-1 — 33-24-59.33) › Section 33-24-59.26 - Limitation on definition of "preexisting condition"

(a)
As used in this Code section, the term:
(1)
"Preventive services" means screening tests, counseling, and preventive medicines, or treatments provided or conducted to prevent medical illness or condition prior to symptoms or physical manifestations of such medical illness or condition.
(2)
"Short-term health benefit policy or certificate" means any individual or group plan, policy, or contract for health care services for a coverage period of less than one year issued, delivered, issued for delivery, or renewed in this state which provides major medical benefits by a health care corporation, health maintenance organization, preferred provider organization, accident and sickness insurer, fraternal benefit society, or any similar entity and any self-insured plan not subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974,
29 U.S.C. Section 1101
, et seq.
(b)
No short-term health benefit policy or certificate shall contain a provision defining "preexisting condition" which is more restrictive than the following:
(1)
Preexisting condition means the existence of symptoms which would cause an ordinary prudent person to seek diagnosis, care, or treatment; or
(2)
A condition for which medical advice or treatment was recommended by or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person. The condition at issue must be the ultimate condition for which medical advice or treatment was recommended by or received from a provider of health care services and excludes any preventive services.
Added by 2019 Ga. Laws 140,§ 64, eff. 7/1/2019.