reglab/statecodes huggingface dataset:
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 1 - AVAILABILITY AND ASSIGNMENT SYSTEM (§§ 33-29A-1 — 33-29A-9) › Section 33-29A-7 - Moratorium on required issuance of coverage

The Commissioner may impose a moratorium upon the required issuance of coverage by a health insurer or managed care organization, if the Commissioner determines after public notice and hearing that the continuation of such required issuance by that entity will endanger the solvency of that entity.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 1 - AVAILABILITY AND ASSIGNMENT SYSTEM (§§ 33-29A-1 — 33-29A-9) › Section 33-29A-8 - Rules and regulations; compensation to licensed insurance agents

(a)
The Commissioner shall adopt rules and regulations for the implementation of this chapter. Notwithstanding any provision of Chapter 2 of this title or any other law to the contrary, such rules and regulations shall be adopted in exact compliance with the procedures specified in Article 1 of Chapter 13 of Title 50, the "Georgia Administrative Procedure Act." In addition to any other materials submitted under subsection (e) of Code Section
50-13-4
, there shall be so submitted the full text of the Georgia Health Insurance Assignment System, the Georgia Health Benefits Assignment System, the standard health insurance policies provided for in Code Section
33-29A-4
, and the standard health benefit plans provided for in Code Section
33-29A-5
.
(b)
The rules and regulations developed by the Commissioner shall include provisions for applications for GHIAS and GHBAS to be submitted by licensed insurance agents and for such agents to be compensated at a commission rate of not less than 3 percent from the premiums received by the issuing health insurer or managed care organization. For purposes of applications for GHIAS and GHBAS, licensed agents shall not be subject to the certificate of authority requirements of Code Section
33-23-26
.
Amended by 2001 Ga. Laws 293, § 5, eff. 7/1/2002.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 1 - AVAILABILITY AND ASSIGNMENT SYSTEM (§§ 33-29A-1 — 33-29A-9) › Section 33-29A-9 - Discontinuance of state assignment system benefit plans

(a)
Upon the effective date whereupon guaranteed issue coverage is available pursuant to the federal Patient Protection and Affordable Care Act, a health insurer or managed care organization shall not be required to offer health care policies under the Georgia Health Insurance Assignment System and Georgia Health Benefits Assignment System.
(b)
Each health insurer or managed care organization that has offered health care policies under the Georgia Health Insurance Assignment System and the Georgia Health Benefits Assignment System may terminate, cancel, or nonrenew such existing policies as of the date upon which guaranteed issue coverage is available pursuant to the federal Patient Protection and Affordable Care Act, provided that the health insurer or managed care organization provides at least 90 days' notice prior to the termination of the coverage to all policyholders and to the Commissioner.
(c)
An insurer may not terminate, cancel, or nonrenew any policy under this subsection if, at the end of the 90 day cancellation period, the insured would not have at least 90 days of remaining open enrollment to obtain insurance coverage through an exchange created pursuant to the federal Patient Protection and Affordable Care Act.
Amended by 2014 Ga. Laws 669,§ 33, eff. 4/29/2014.
Added by 2013 Ga. Laws 278,§ 3, eff. 7/1/2013.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 2 - COMMISSION ON THE GEORGIA HEALTH INSURANCE RISK POOL (§ 33-29A-20) › Section 33-29A-20 - through 33-29A-22 - [Reserved]

Reserved. Repealed by Ga. L. 2019, p. 337, § 2-1/SB 132, effective July 1, 2019 and by Ga. L. 2019, p. 919, § 14-1/HB 553, effective July 1, 2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-30 - Legislative findings and purpose; increasing availability of health insurance for uninsured individuals

The General Assembly recognizes the high level of uninsured individuals in this state and the need for individuals or other purchasers of health insurance coverage in this state to have the opportunity to choose health insurance plans that are more affordable and flexible than existing market policies offering accident and sickness insurance coverage. Therefore, the General Assembly seeks to increase the availability of health insurance coverage by allowing insurers authorized to transact insurance in Georgia to issue individual accident and sickness policies in Georgia that are currently approved for issuance in another state.
Amended by 2012 Ga. Laws 684,§ 33, eff. 5/1/2012.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-31 - Definitions

For purposes of this article, the term "individual accident and sickness insurance policy" means any policy insuring against loss resulting from sickness or from bodily injury or death by accident, or both, or any contract to furnish ambulance service in the future but does not include limited benefit insurance policies exempted from the definition of the term "health benefit policy" in Code Section
33-1-2
. The term "individual accident and sickness insurance policy" shall also include comprehensive major medical coverage for medical and surgical benefits, and also includes "high deductible health plans" sold or maintained under the applicable provisions of Section 223 of the Internal Revenue Code.
Amended by 2019 Ga. Laws 139,§ 1-92, eff. 7/1/2019.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-32 - Commissioner to authorize insurers to offer individual accident and sickness insurance policies in Georgia that have been approved for issuance in other states

The Commissioner shall approve for sale in Georgia any individual accident and sickness insurance policy that is currently approved for issuance in another state where the insurer or the insurer's affiliate or subsidiary is authorized to transact insurance so long as the insurer or the insurer's affiliate or subsidiary filing and issuing such policy in Georgia is also authorized to transact insurance in this state pursuant to Chapter 3 of this title and provided that any such policy meets the requirements set forth in this article. Additionally, any insurer authorized to transact insurance in this state can offer an individual accident and sickness insurance policy with benefits equivalent to those in any policy approved for sale in Georgia under this article, provided that any such offered policy meets the requirements set forth in this article.
Amended by 2021 Ga. Laws 307,§ 33, eff. 5/10/2021.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-33 - Satisfaction of actuarial standards set by National Association of Insurance Commissioners (NAIC)

(a)
Any insurer selling an insurance policy pursuant to this article, and any policy approved pursuant to this article, shall satisfy actuarial standards set forth by the National Association of Insurance Commissioners (NAIC) and any regulation promulgated by the Commissioner that is not inconsistent with such NAIC standards. Any insurer selling an insurance policy pursuant to this article, and any policy approved pursuant to this article, shall, except as otherwise provided in this article, comply with the requirements of this title and the regulations promulgated by the Commissioner.
(b)
The Commissioner shall have the authority to determine whether an insurer satisfies the standards required by this Code section and may not approve a plan that he or she finds lacks compliance with this Code section. The Commissioner shall have the authority to determine whether the plan sold pursuant to this article continues to satisfy the requirements set forth in this Code section in the same manner as he or she does with an individual accident and sickness insurance policy approved pursuant to another applicable chapter in this title.
(c)
Any policy sold pursuant to this article shall comply with paragraph (3) of subsection (c) of Code Section
9-9-2
and shall not require the insured or his or her beneficiary to arbitrate disputes arising under the policy.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-34 - Certain language required in policies and policy applications

(a)
Each written application for a policy sold pursuant to this article shall contain the following language in boldface type at the beginning of the document:
"The benefits of this policy may primarily be governed by the laws of a state other than Georgia; therefore, all of the laws applicable to policies filed in this state may not apply to this policy. Any purchase of individual health insurance should be considered carefully since future medical conditions may make it impossible to qualify for another individual health insurance policy."
(b)
Each policy sold pursuant to this article shall contain the following language in boldface type at the beginning of the document:
"The benefits of this policy providing your coverage may be governed primarily by the laws of a state other than Georgia. The benefits covered may be different from other policies you can purchase. Please consult your insurance agent or insurer to determine which health benefits are covered under this policy."
(c)
Each individual accident and sickness policy sold pursuant to this article shall contain a side-by-side chart that compares the definitions of each benefit covered by the policy that has been sold in the other state with the definitions of the benefits covered under current Georgia laws and regulations where the specified benefit is similarly termed but defined differently.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29A - INDIVIDUAL HEALTH INSURANCE COVERAGE AVAILABILITY AND ASSIGNMENT SYSTEMS (§§ 33-29A-1 — 33-29A-35) › Article 3 - INDIVIDUAL ACCIDENT AND SICKNESS INSURANCE (§§ 33-29A-30 — 33-29A-35) › Section 33-29A-35 - Adoption of rules and regulations by Commissioner; application of dispute resolution mechanism or provision

(a)
The Commissioner shall adopt rules and regulations necessary to implement this article, which shall include, but shall not be limited to, standard forms for the disclosure of benefits, and preserve the intent and effect of Code Sections
33-24-27
,
33-24-27.1
, and
33-24-59.12
and subsection (c) of Code Section
33-29-6
.
(b)
Any dispute resolution mechanism or provision for notice and hearing in this title shall apply to insurers issuing and delivering policies pursuant to this article.
Amended by 2012 Ga. Laws 684,§ 33, eff. 5/1/2012.
Amended by 2011 Ga. Laws 249,§ 1, eff. 7/1/2011.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 29B - INDIVIDUAL HEALTH INSURANCE COVERAGE TO CHILDREN THROUGH CHILD-ONLY HEALTH POLICIES (§ 33-29B-1) › Section 33-29B-1 - through 33-29B-8 - [Repealed]

Added by 2012 Ga. Laws 634,§ 1, eff. 1/1/2013.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-1.1 - Applicability

This chapter shall apply to policies of insurance, certificates evidencing coverage under a policy of insurance, or any other evidence of insurance, issued by an insurer, delivered, or issued for delivery in this state except for policies issued to an employer in another state which provides coverage for employees of this state employed by such employer policyholder.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-2 - Effect of chapter upon other provisions

Nothing in this chapter validates any charge or practice illegal under any rule of law or regulation governing usury, small loans, retail installment sales, or the like or extends the application of any statute, rule, or regulation to any transaction not otherwise subject thereto.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-3 - "Blanket accident and sickness insurance" defined

"Blanket accident and sickness insurance" is that form of group accident and sickness insurance covering the groups of persons listed in paragraphs (1) through (6) of this Code section and issued upon the following basis:
(1)
Under a group policy or contract issued to any common carrier or to any operator, owner, or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group defined as all persons or all persons of a class who may become passengers on such common carrier or such means of transportation;
(2)
Under a group policy or contract issued to an employer, who shall be deemed the policyholder, covering all employees, dependents, or guests defined by reference to specified hazards incident to the activities or operations of the employer or any class of employees, dependents, or guests similarly defined;
(3)
Under a group policy or contract issued to a school or other institution of learning, a camp, the sponsor of the institution of learning or camp, or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or campers; and supervisors and employees may be included;
(4)
Under a group policy or contract issued in the name of any religious, charitable, recreational, educational, or civic organization, which shall be deemed the policyholder, covering participants in activities sponsored by the organization;
(5)
Under a group policy or contract issued to a sports team or sponsors thereof, which shall be deemed the policyholder, covering members, officials, and supervisors; or
(6)
Under a group policy or contract issued to cover any other risk or class of risks which in the discretion of the Commissioner may be properly eligible for blanket accident and sickness insurance. The discretion of the Commissioner may be exercised on an individual risk basis or class of risks, or both.
Amended by 2005 Ga. Laws 82,§ 10, eff. 7/1/2005.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-4 - Required provisions generally

Each group accident and sickness policy shall contain in substance the following provisions:
(1)
A provision that, in the absence of fraud or intentional misrepresentation of material fact in applying for or procuring coverage under the terms of the group policy or contract, all statements made by the policyholder shall be deemed representations and not warranties, and that no statement made for the purpose of effecting insurance shall avoid the insurance or reduce benefits unless contained in a written instrument signed by the policyholder, a copy of which has been furnished to the policyholder;
(2)
A provision that the insurer will furnish to the policyholder, for delivery to each employee or member of the insured group, an individual certificate setting forth in summary form a statement of the essential features of the insurance coverage of the employee or member and to whom benefits are payable. If dependents or family members are included in the coverage, additional certificates need not be issued for delivery to the dependents or family members;
(3)
A provision that from time to time eligible new employees or members or dependents, in accordance with the terms of the policy, may be added to the group originally insured;
(4)
A provision that, with respect to termination of benefits for, or coverage of, any person who is a dependent child of an insured, the child shall continue to be insured up to and including age 25 so long as the coverage of the member continues in effect, the child remains a dependent of the insured parent or guardian, and the child, in each calendar year since reaching any age specified for termination of benefits as a dependent, has been enrolled for five calendar months or more as a full-time student at a postsecondary institution of higher learning or, if not so enrolled, would have been eligible to be so enrolled and was prevented from being so enrolled due to illness or injury. This paragraph shall not apply to group policies under which an employer provides coverage for dependents of its employees and pays the entire cost of the coverage without any charge to the employee or dependents; and
(5)
A provision that the policyholder is entitled to a grace period of not less than 31 days for the payment of any premium due except the first, during which grace period the policy shall continue in force unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.
Amended by 2005 Ga. Laws 82,§ 11, eff. 7/1/2005.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-5 - Direct payment for hospital or medical services

Any group accident and sickness policy may provide that all or any portion of any indemnities provided by any policy on account of hospital, nursing, or medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services; but the policy shall not require that the service be rendered by a particular hospital or person. Payments so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-7 - Provision in group or blanket policies for medical or surgical services generally

(a)
The benefits on account of medical or surgical services provided by a group or blanket policy of accident and sickness insurance may be limited by its terms to services performed by specifically defined professions, provided that in the absence of such definitions, the term "physician" or "surgeon," as used in such a policy, shall not be deemed limited solely to medical practitioners licensed under Chapter 34 of Title 43.
(b)
When a group or blanket policy of accident and sickness insurance, except policies providing special coverage for limited diseases, accident protection only, or dental policies, provides for hospital care, there may be included within the scope of coverage hospital care rendered on account of mental illnesses and hospital care rendered by any psychiatric hospital duly licensed by this state. If the coverage is not included in the policy, a statement that the policy does not cover mental illnesses shall be printed in the policy in boldface type or stamped on the face of the policy and printed or stamped on any identification card issued pursuant to the policy.
(c)
Any other laws to the contrary notwithstanding, whenever the term "physician" or "surgeon" is used in any policy of health or accident insurance issued in this state or in any contract for the provision of health care, services, or benefits issued by any health, medical, or other service corporation existing under, and by virtue of, any laws of this state, said term shall include, within its meaning, medical practitioners licensed under and in accordance with Chapter 11 of Title 43, relating to dentists, in respect to any care, services, procedures, or benefits covered by said policy of insurance or health care contract which the said persons are licensed to perform, any provisions in any such policy of insurance or health care contract to the contrary notwithstanding. This subsection shall be applicable to all policies in this state regardless of date of issue.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-8 - Requirement of application for policy and issuance of certificate for blanket accident and sickness insurance

An individual application shall not be required for a person to be covered under a blanket accident and sickness policy or contract, nor shall it be necessary for the insurer to furnish each person so insured a certificate.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-9 - Payment of benefits under blanket accident and sickness policies

(a)
All benefits under any group or blanket accident and sickness policy shall be payable to the person insured, to his designated beneficiary or beneficiaries, or to his estate, provided that if the person insured is a minor or mental incompetent, the benefits may be made payable to his parent, guardian, or other person actually supporting him or, if the entire cost of the insurance has been borne by the employer, the benefits may be made payable to the employer.
(b)
The policy may provide that all or any portion of any indemnities provided by any policy on account of hospital, nursing, and medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering the services; but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.
Amended by 2005 Ga. Laws 82,§ 13, eff. 7/1/2005.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-10 - Exemption of group and blanket policy proceeds from liability for debts of insured and beneficiary

The proceeds or avails of all group or blanket accident and sickness policies shall be exempt from all liability for debt to the same extent and under the same conditions as provided for in the case of individual accident and sickness insurance by Code Section
33-29-15
.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-11 - Applicability of Chapter 29 of title to group or blanket policies

Chapter 29 of this title shall not apply to group accident and sickness or blanket accident and sickness insurance policies; but, except as otherwise provided in this chapter, no policy of group or blanket accident and sickness insurance shall contain any provision relative to notice or proof of loss, to the time for paying benefits, or to the time within which an action may be brought on the policy, which provision is less favorable to the individuals insured than would be permitted by the comparable provisions required for individual accident and sickness insurance policies.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-13.1 - Furnishing claims experience to policyholders

(a)
As used in this Code section, the term "insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, provider sponsored health care corporation, health maintenance organization, or any similar entity.
(b)
(1)
All insurers shall furnish, regardless of the rating methodology used, claims experience to group policyholders within 30 days of any policyholder's request unless such information has been furnished to the group policyholder within the preceding six months. Such claims experience shall be furnished for all groups of 20 or more covered employees, members, or enrollees, not including dependents, and shall include, but shall not be limited to:
(A)
Earned premiums separated by policy year for at least the last two policy years, if applicable;
(B)
Total paid claims and total incurred claims, inclusive of any high amount or pooled claims, including both capitated and noncapitated expenses set forth in the same manner as premiums; and
(C)
Any amounts in excess of the individual pooling or stop-loss point applicable to the group.
(2)
Insurers that utilize provider contracting methods including financial devices such as global fee arrangements to cover all medical expenses or other methods used to calculate premiums may make application to the Commissioner for approval of the use of an alternative form of claims experience reporting. The insurer must still provide Georgia experience on a group-specific basis or on such other reasonable basis as the Commissioner may approve for such insurer, in advance, based upon a submission of an explanation and supporting documentation. Any insurer that received approval for an alternative form of group claims experience reporting to policyholders shall be required to seek the Commissioner's advance approval of a proposed response letter to group policyholders who request experience reporting. Such letter should describe the insurer's reasons for seeking an alternative reporting process and describe the alternative form of reporting approved by the Commissioner.
(3)
Insurers may charge a reasonable fee for providing this information to group policyholders. The schedule or amount of fees to be charged group policyholders for providing this information shall be filed by each insurer with the Commissioner.
(4)
In providing claims experience to group policyholders under this Code section, insurers shall adhere to all state and federal laws regarding disclosure of protected health or personal information.
Amended by 2024 Ga. Laws 387,§ 1, eff. 7/1/2024, app. to all policies or contracts issued, delivered, issued for delivery, or renewed in this state on or after 7/1/2024.
Amended by 2017 Ga. Laws 52,§ 48, eff. 7/1/2017.
Added by 2002 Ga. Laws 407, § 4, eff. 3/11/2002.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-13 - Notices of premium increases to be mailed or delivered to group policyholder; notification of impact of federal Patient Protection and Affordable Care Act

(a)
Notice of the maximum amount of a group premium increase shall be mailed or delivered to the group policyholder and to each employer group or subgroup insured under the group policy not less than 60 days prior to the effective date of the premium increase.
(b)
The commissioner of community health shall also provide notice to each person covered under the health insurance plans established pursuant to Article 1 of Chapter 18 of Title 45 when any premium increase occurs of how much of such increase is attributable to the federal Patient Protection and Affordable Care Act.
Amended by 2015 Ga. Laws 9,§ 33, eff. 3/13/2015.
Amended by 2014 Ga. Laws 669,§ 33, eff. 4/29/2014.
Amended by 2013 Ga. Laws 338,§ 2, eff. 7/1/2013.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-14 - Insurance coverage for treatment of temporomandibular joint dysfunction or surgery for deformities of maxilla or mandible

(a)
As used in this Code section, the term:
(1)
"Functional deformity" means a deformity of the bone or joint structure of the maxilla or mandible such that the normal character and essential function of such bone structure is impeded.
(2)
"Policy" means any major medical benefit plan, contract, or policy except the Georgia Basic Health Plan, a credit insurance policy, disability income policy, specified disease policy, hospital indemnity policy, limited accident policy, or other similarly limited accident and sickness policy.
(3)
"Temporomandibular joint" means the connection of the mandible and the temporal bone through the articular disc surrounded by the joint capsule and associated ligaments and tendons.
(4)
"Temporomandibular joint dysfunction" means congenital or developed anomalies of the temporomandibular joint.
(b)
No policy may be issued or issued for delivery in this state which:
(1)
Excludes medically necessary surgical or nonsurgical treatment for the correction of temporomandibular joint dysfunction by physicians or dentists professionally qualified by training and experience; or
(2)
Excludes medically necessary surgery for the correction of functional deformities of the maxilla and mandible.
(c)
The provisions of this Code section shall not cover cosmetic or elective orthodontic or periodontic care or general dental care.
(d)
(1)
The coverage under paragraph (1) of subsection (b) of this Code section may contain such types of exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to other benefits under the accident and sickness insurance benefit plan, policy, or contract.
(2)
Basic coverage for the nonsurgical treatment of temporomandibular joint dysfunction under paragraph (1) of subsection (b) of this Code section may be limited to history and examination; radiographs, which must be diagnostic for temporomandibular joint dysfunction; splint therapy with necessary adjustments, provided that removable appliances designed for orthodontic purposes would not be reimbursable under a major medical plan; and diagnostic or therapeutic masticatory muscle and temporomandibular joint injections.
(e)
Except as provided in paragraph (1) of subsection (c) of Code Section
33-30-23
for policies limited only to dental coverage, 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 preferred and nonpreferred providers as otherwise authorized under the provisions of Article 2 of this chapter, relating to preferred provider arrangements.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 1 - GENERAL PROVISIONS (§§ 33-30-1 — 33-30-16) › Section 33-30-16 - Definitions; requirement to offer reasonably priced comprehensive major medical health insurance policy

(a)
As used in this Code section, the term:
(1)
"Operative date" means the date on which either of the following occurs:
(A)
A federal law is enacted which expressly repeals
42 U.S.C. Section 300gg
-
3
or
42 U.S.C. Section 300gg-4
of the PPACA; or
(B)
42 U.S.C. Section 300gg
-
3
or
42 U.S.C. Section 300gg-4
of the PPACA is invalidated by the United States Supreme Court.
(2)
"PPACA" means the Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law 111-152.
(3)
"Preexisting medical condition" means a condition that was present before the effective date of coverage under a policy, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the effective date of coverage. Such term includes a condition identified as a result of a preenrollment questionnaire or physical examination given to the individual or a review of medical records relating to the preenrollment period.
(b)
(1)
Not later than 30 days after the operative date, and notwithstanding any other law to the contrary, every insurer issuing, delivering, or issuing for delivery comprehensive individual major medical health insurance policies in this state shall make at least one reasonably priced comprehensive major medical health insurance policy available to residents in the insurer's approved service areas of this state, and such insurer may not exclude, limit, deny, or delay coverage under such policy due to one or more preexisting medical conditions.
(2)
Such insurer may not limit or exclude benefits under such policy, including a denial of coverage applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage, or if coverage is denied, before the date of the denial.
(c)
The comprehensive major medical health insurance policy that the insurer is required to offer under this Code section shall be a policy that had been actively marketed in this state by the insurer as of the operative date and that was also actively marketed in this state during the year immediately preceding the operative date.
Added by 2021 Ga. Laws 235,§ 1, eff. 7/1/2021.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-20 - Short title

This article shall be known and may be cited as the "Preferred Provider Arrangements Act."
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-21 - Legislative intent

It is the intent of the General Assembly to encourage health care cost containment while preserving quality of care by allowing health care insurers to enter into preferred provider arrangements and by establishing minimum standards for preferred provider arrangements and the health benefit plans associated with those arrangements.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-22 - Definitions

As used in this article, the term:
(1)
"Emergency services" or "emergency care" means those physical or mental health care services that are provided for a condition, including but not limited to a mental health condition or substance use disorder, in which a person is exhibiting acute symptoms of sufficient severity, including, but not limited to, severe pain, regardless of the initial, interim, final, or other diagnoses that are given, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in:
(A)
Placing the patient's health in serious jeopardy;
(B)
Serious impairment to bodily functions; or
(C)
Serious dysfunction of any bodily organ or part.
"Emergency services" or "emergency care" includes medical services rendered after such person is stabilized and as part of outpatient observation or an inpatient or outpatient stay with respect to the visit in which such services are furnished, unless each of the conditions of subdivision (a)(3)(C)(ii)(II) of the federal Public Health Service Act,
42 U.S.C. Section 300gg-111
are met.
(2)
"Health benefit plan" means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer which defines the covered services and benefit levels available.
(3)
"Health care insurer" means an insurer, a fraternal benefit society, a health care plan, or a health maintenance organization authorized to sell accident and sickness insurance policies, subscriber certificates, or other contracts of insurance by whatever name called under this title.
(4)
"Health care provider" means any person duly licensed or legally authorized to provide health care services.
(5)
"Health care services" means services rendered or products sold by a health care provider within the scope of the provider's license or legal authorization. The term includes, but is not limited to, hospital, medical, surgical, dental, vision, chiropractic, psychological, and pharmaceutical services or products.
(6)
"Preferred provider" means a health care provider or group of providers who have contracted to provide specified covered services.
(7)
"Preferred provider arrangement" means a contract between or on behalf of the health care insurer and a preferred provider which complies with all the requirements of this article.
Amended by 2022 Ga. Laws 867,§ 3, eff. 7/1/2022, app. to all policies or contracts issued, delivered, issued for delivery, or renewed in this state on or after 7/1/2022.
Amended by 2022 Ga. Laws 833,§ 8, eff. 7/1/2022.
Amended by 2017 Ga. Laws 52,§ 50, eff. 7/1/2017.
Amended by 2005 Ga. Laws 82,§ 15, eff. 7/1/2005.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-24 - Health benefit plans providing incentives to use services of preferred providers; minimum requirements

Health care insurers may issue health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such policies or subscriber certificates shall contain at least the following provisions:
(1)
A provision that if a covered person receives emergency care for services specified in the preferred provider arrangement and cannot reasonably reach a preferred provider, that emergency care rendered during the course of the emergency will be paid for in accordance with the terms of the health benefit plan, at benefit levels at least equal to those applicable to treatment by preferred providers for emergency care in an amount based on the usual, customary, and reasonable charges in the area where the treatment is provided; and
(2)
A provision which clearly identifies the differences in benefit levels for health care services of preferred providers and benefit levels for health care services of nonpreferred providers.
For purposes of this Code section, when a request for emergency care is made through the emergency 9-1-1 system on behalf of a covered person and the ambulance service licensed under Chapter 11 of Title 31 that was dispatched in response to the request is not a preferred provider, for purposes of payment under paragraph (1) of this Code section, it shall be presumed that the covered person could not reasonably reach a preferred provider.
Amended by 2006 Ga. Laws 667,§ 5, eff. 7/1/2006.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-25 - Reasonable limits on number or classes of preferred providers

Subject to the approval of the Commissioner under such procedures as he may develop, health care insurers may place reasonable limits on the number or classes of preferred providers which satisfy the standards set forth by the health care insurer, provided that there be no discrimination against providers on the basis of religion, race, color, national origin, age, sex, or marital or corporate status, and provided, further, that all health care providers within any defined service area who are licensed and qualified to render the services covered by the preferred provider arrangement and who satisfy the standards set forth by the health care insurer shall be given the opportunity to apply and to become a preferred provider.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-26 - Applicability of Title 33 and related rules and regulations to health care insurers

Health care insurers as defined in this article shall be subject to and shall be required to comply with all other applicable provisions of this title and rules and regulations promulgated pursuant to this title.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-27 - Promulgation of rules and regulations

The Commissioner shall promulgate all rules and regulations necessary or appropriate to the administration and enforcement of this article.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30 - GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE (§§ 33-30-1 — 33-30-28) › Article 2 - PREFERRED PROVIDER ARRANGEMENTS (§§ 33-30-20 — 33-30-28) › Section 33-30-28 - and 33-30-29 - Redesignated

Redesignated as Code Sections 33-30-12 and 33-30-13 by Ga. L. 1991, p. 94, § 33, effective March 14, 1991.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30A - HEALTH PLAN PURCHASING COOPERATIVES (§§ 33-30A-1 — 33-30A-11) › Section 33-30A-2 - Certificates of authority authorized and required

(a)
On and after July 1, 1997, the Commissioner is authorized to issue certificates of authority to nonprofit corporations to operate as health plan purchasing cooperatives to provide services to members located within particular geographic areas of the state in accordance with the provisions of this chapter.
(b)
A health plan purchasing cooperative authorized by the Commissioner pursuant to subsection (a) of this Code section may also offer other related employee benefits and services to its members, including continuation coverage administration and purchasing services for limited accident and sickness insurance coverages such as dental, vision, and long-term care; provided, however, that a purchasing cooperative offering such related benefits or services must provide separate and explicitly identified rate or fee schedules for such benefits and services to distinguish them from health benefit plan premiums and membership fees.
(c)
(1)
Any health benefit plan, limited accident and sickness policy, or other insurance offered through a cooperative must be provided by a carrier.
(2)
A cooperative may not directly provide insurance or bear any risk associated with any health benefit plan or other insurance offered through the cooperative.
(d)
No entity shall hold itself out as a health plan purchasing cooperative without a certificate of authority granted by the Commissioner. Any entity not authorized as a health plan purchasing cooperative by the Commissioner shall not use as part of its advertising or marketing any self-descriptive term which is confusingly similar to a health plan purchasing cooperative. Any entity not authorized as a health plan purchasing cooperative by the Commissioner and providing services substantially similar to those of a purchasing cooperative shall clearly indicate in its advertising and marketing materials that such entity is not a health plan purchasing cooperative. Failure to comply with this subsection shall be an unfair and deceptive act or practice in the business of insurance within the meaning of paragraph (1) of subsection (b) of Code Section
33-6-4
.
(e)
Nothing in this chapter shall be deemed to permit a health plan purchasing cooperative to act as an insurer as defined in Code Section
33-1-2
or as an agent as defined in Code Section
33-23-1
.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 30A - HEALTH PLAN PURCHASING COOPERATIVES (§§ 33-30A-1 — 33-30A-11) › Section 33-30A-3 - Areas of service

(a)
Each health plan purchasing cooperative shall serve a particular geographic area of the state that consists of either one entire county or more than one contiguous entire county. The Commissioner shall not authorize any purchasing cooperative to serve a geographic area which divides any county or contains noncontiguous counties.
(b)
Any purchasing cooperative which serves any portion of a metropolitan statistical area shall not serve less than all of that metropolitan statistical area. The Commissioner shall not authorize any purchasing cooperative to serve a geographic area which divides any metropolitan statistical area.
(c)
The authority granted by the Commissioner to a purchasing cooperative to serve a particular geographic area shall be nonexclusive, and there shall be no limit upon the number of purchasing cooperatives which may be authorized to serve any particular geographic area.
(d)
The Commissioner shall authorize service for any geographic service area as proposed by the applicant nonprofit corporation if such proposed service area meets the requirements of this Code section.
(e)
Except as provided elsewhere in this Code section, nothing in this chapter shall restrict the geographic area served by a purchasing cooperative having less than 100,000 enrolled member subscribers. For purposes of this subsection, the purchasing cooperative shall report to the Commissioner, in a manner prescribed by the Commissioner, the number of member subscribers enrolled in the purchasing cooperative on an annual basis. For purchasing cooperatives having greater than 100,000 enrolled member subscribers, the purchasing cooperative shall demonstrate annually, to the satisfaction of the Commissioner, that permission to continue to enroll additional member subscribers will not have an adverse effect on the availability of private health benefit plan coverage offered outside the purchasing cooperative's geographic service area. Failure to provide satisfactory evidence shall result in the suspension of the purchasing cooperative's authority to enroll additional member subscribers in all or part of the purchasing cooperative's geographic service area, until such time as the Commissioner shall conclude that the requirements of this subsection have been satisfied.
(f)
Officers, directors, or employees of a health plan purchasing cooperative shall not serve as officers, directors, or employees of another health plan purchasing cooperative.
(g)
A geographic area may include one or more contiguous counties in an adjoining state.