reglab/statecodes huggingface dataset:
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-20 - Prior authorization requirements posted on website; statistical reporting

(a)
An insurer shall make any current prior authorization requirements readily accessible on its website to healthcare providers. Clinical criteria on which an adverse determination is based shall be provided to the healthcare provider at the time of the notification.
(b)
If an insurer intends either to implement a new prior authorization requirement or to amend an existing requirement, such insurer shall ensure that the new or amended requirement is not implemented unless such insurer's website has been updated to reflect such addition or change.
(c)
An insurer using prior authorization shall make aggregate statistics available per such insurer and per its plans regarding prior authorization approvals and denials on its website in a readily accessible format. The Commissioner shall determine the statistics required in order to comply with this Code section in accordance with applicable state and federal privacy laws. Such statistics shall include, but not be limited to, the following:
(1)
Approved or denied on initial request;
(2)
Reason for denial;
(3)
Whether appealed;
(4)
Whether approved or denied on appeal; and
(5)
Time between submission and response.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-21 - Insurer responsibility for compliance; periodic reviews; evaluation of adverse determinations

(a)
An insurer shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the insurer and for ensuring that all requirements of this chapter and applicable rules and regulations are met. The insurer also shall ensure that appropriate personnel have operational responsibility for the conduct of the insurer's utilization review program.
(b)
Whenever an insurer contracts with a private review agent or utilization review entity to perform services subject to this chapter or applicable rules and regulations, the Commissioner shall hold the insurer responsible for monitoring the activities of such private review agent or utilization review entity and for ensuring that the requirements of this chapter and applicable rules and regulations are met.
(c)
A private review agent or utilization review entity shall use documented clinical criteria that are based on sound clinical evidence and which are evaluated periodically to assure ongoing efficacy.
(d)
Qualified healthcare professionals shall administer the utilization review program and oversee utilization review decisions. An initial screening of prior authorization requests may be completed without providing the treating provider or other qualified healthcare professional with the opportunity to speak with a clinical peer of the private review agent or utilization review entity. Such an opportunity shall be provided, however, before an appeal. If a private review agent or utilization review entity questions the medical necessity of a healthcare service, such agent or entity shall notify the covered person's treating provider, or such provider's appropriately qualified designee familiar with the patient's case, that medical necessity is being questioned in accordance with the provisions of paragraph (5) of subsection (a) of Code Section
33-46-6
.
(e)
An insurer shall provide covered persons and participating providers with access to its utilization review staff by telephone or through synchronous digital text or voice messaging or similar technology in accordance with state and federal privacy laws. A clinical peer shall evaluate the clinical appropriateness of adverse determinations.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-22 - Review of appeals by appropriate healthcare provider

A private review agent or utilization review entity shall ensure that all appeals are reviewed by an appropriate healthcare provider who shall:
(1)
Possess a current and valid nonrestricted license or maintain other appropriate legal authorization;
(2)
Be currently in active practice in the same or similar specialty and who typically manages the medical condition or disease;
(3)
Be knowledgeable of, and have experience providing, the healthcare service under appeal;
(4)
Not have been directly involved in making the adverse determination; and
(5)
Consider all known clinical aspects of the healthcare service under review, including, but not limited to, a review of all pertinent medical or other records provided to the private review agent or utilization review entity by the covered person's healthcare provider, any relevant records provided to such agent or entity by a facility, and any medical or other literature provided to such agent or entity by the healthcare provider.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-23 - Restrictions on authorizations when service timely rendered

If initial healthcare services are performed within 45 business days of approval of prior authorization, the insurer shall not revoke, limit, condition, or restrict such authorization, unless such prior authorization is for a Schedule II controlled substance or there is a billing error, fraud, material misrepresentation, or loss of coverage.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-23.1 - Prior authorization of prescription medications for chronic conditions

(a)
As used in this Code section, the term:
(1)
"Chronic condition" means a serious, long-term, physical, mental, or developmental disability or disease.
(2)
"Ongoing medication therapy" means a clinical and evidence-based treatment that uses a prescribed medicine to prevent, diagnose, treat, or relieve the symptoms of a chronic condition and is continuing or expected to continue for at least a year.
(b)
Unless otherwise provided in subsection (c) of this Code section or prohibited by state or federal law, if a healthcare provider receives a prior authorization for a medication prescribed to a covered person with a chronic condition that requires ongoing medication therapy, and the provider continues to prescribe the medication, and the medication is used for a condition that is within the scope of use approved by the United States Food and Drug Administration or has been proven to be a safe and effective form of treatment for the patient's specific underlying condition based on clinical practice guidelines that are developed from peer-reviewed publications, the prior authorization received shall:
(1)
Be valid for the lesser of:
(A)
One year from the date the healthcare provider receives the prior authorization; or
(B)
Until the last day of coverage under the covered person's healthcare plan; and
(2)
Cover any change in dosage prescribed by the healthcare provider during the period of authorization.
(c)
(1)
This Code section shall not apply to:
(A)
Medications that are prescribed for a nonmaintenance condition;
(B)
Medications that have a typical treatment period of less than 12 months;
(C)
Medications for which medical or scientific evidence does not support a 12 month approval, including medications where an initial shorter duration approval is necessary to demonstrate appropriate response to therapy; or
(D)
Medications that are opioid analgesics or benzodiazepines.
(2)
Nothing in this Code section prevents the prior authorization of a medication for more than a year if permissible by the covered person's healthcare plan.
Added by 2022 Ga. Laws 830,§ 1, eff. 1/1/2023.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-24 - Medically necessary unanticipated emergency or urgent healthcare services

Prior authorization shall not be required for unanticipated emergency healthcare services, urgent healthcare services, or covered healthcare services which are incidental to the primary covered healthcare service and determined by the covered person's physician or dentist to be medically necessary.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-25 - Prior authorization for ambulance transportation or emergency healthcare services prohibited

An insurer cannot require prior authorization for emergency prehospital ambulance transportation or for the provision of emergency healthcare services.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-26 - Timely notification of prior authorization or adverse determination

Effective January 1, 2022, until December 31, 2022, if an insurer requires prior authorization of a healthcare service, a private review agent or utilization review entity shall notify the covered person's healthcare provider, or such provider's appropriately qualified designee, of any prior authorization or adverse determination within 15 calendar days of obtaining all necessary information to make such authorization or adverse determination. Effective January 1, 2023, if an insurer requires prior authorization of a healthcare service, a private review agent or utilization review entity shall notify the covered person's healthcare provider, or such provider's appropriately qualified designee, of any prior authorization or adverse determination within 7 calendar days of obtaining all necessary information to make such authorization or adverse determination.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-27 - Notification time for prior authorization or adverse determination

A private review agent or utilization review entity shall render a prior authorization or adverse determination concerning urgent healthcare services and notify such person's healthcare provider, or such provider's appropriately qualified designee, of that prior authorization or adverse determination no later than 72 hours after receiving all information needed to complete the review of the requested healthcare services.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-28 - Honoring of prior authorizations

(a)
Upon receipt of information documenting a prior authorization from a covered person or from a covered person's healthcare provider, a private review agent or utilization review entity, for at least the initial 30 days of such person's new coverage, shall honor a prior authorization for a covered healthcare service granted to him or her from a previous private review agent or utilization review entity even if approval criteria or products of a healthcare plan have changed or such person is covered under a new healthcare plan, so long as the former criteria, products, or plans are not binding upon a new insurer.
(b)
During the time period described in subsection (a) of this Code section, a private review agent or utilization review entity may perform its own review to grant a prior authorization.
(c)
If there is a change in coverage of, or approval criteria for, a previously authorized healthcare service, the change in coverage or approval criteria shall not affect a covered person who received prior authorization before the effective date of such change for the remainder of the covered person's plan year so long as such person remains covered by the same insurer.
(d)
A private review agent or utilization review entity shall continue to honor a prior authorization it has granted to a covered person in accordance with this Code section.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-29 - Noncompliance resulting in automatic authorization

Each violation by a private review agent or utilization review entity of deadline or other requirements specified in this chapter shall result in the automatic authorization of healthcare services under review by such private review agent or utilization review entity if such noncompliance is related to such services. Notwithstanding the foregoing, noncompliance based on a de minimis violation that does not cause, or is not likely to cause, prejudice or harm to the covered person shall not result in the automatic authorization of such healthcare services, so long as the insurer demonstrates that the violation occurred due to good cause or due to matters beyond the control of the insurer and that such violation occurred in the context of an ongoing good faith exchange of information between the insurer and the covered person, or, if applicable, the covered person's healthcare provider or authorized representative.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-30 - Mandatory compliance

With regard to the provision of healthcare services, each contract entered into or renewed by a managed care organization, each contract entered into or renewed by the Department of Community Health with a care management organization, and each contract entered into by the board of such organization with a contracted entity pursuant to the state health benefit plan shall comply with this chapter.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-31 - Role of Commissioner; compliance enforced by Department of Community Health

The Commissioner shall not have the authority to approve, disapprove, or modify any plan offered by a care management organization or any contract between a care management organization and the Department of Community Health. Compliance with this chapter by care management organizations shall be enforced by the Department of Community Health.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 46 - CERTIFICATION OF PRIVATE REVIEW AGENTS (§§ 33-46-1 — 33-46-32) › Article 2 - PRIOR AUTHORIZATIONS (§§ 33-46-20 — 33-46-32) › Section 33-46-32 - Commissioner's authority not reduced

Nothing in this chapter shall be construed as reducing the authority of the commissioner of community health.
Added by 2021 Ga. Laws 266,§ 2, eff. 1/1/2022.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-2 - Definitions

As used in this chapter, the term:
(1)
"Actuary" means a person who is a member in good standing of the American Academy of Actuaries.
(2)
"Insurer" means an insurer as defined in Code Section
33-1-2
.
(3)
(A)
"Managing general agent" means any person, firm, association, or corporation who negotiates and binds ceding reinsurance contracts on behalf of an insurer or manages all or part of the insurance business of an insurer, including the management of a separate division, department, or underwriting office and acts as an agent for such insurer whether known as a managing general agent, general agent, manager, or other similar term, who, with or without the authority, either separately or together with affiliates, produces, directly or indirectly, and underwrites an amount of gross direct written premium equal to or more than 5 percent of the policyholder surplus as reported in the last annual statement of the insurer in any one quarter or year together with one or more of the following:
(i)
Adjusts or pays claims in excess of an amount determined by the Commissioner; or
(ii)
Negotiates reinsurance on behalf of the insurer.
(B)
Notwithstanding the provisions of subparagraph (A) of this paragraph, the following persons shall not be considered as managing general agents for the purposes of this chapter:
(i)
An employee of the insurer;
(ii)
A United States manager of the United States branch of an alien insurer; or
(iii)
An underwriting manager which provides underwriting services only, pursuant to contract, manages any of the insurance underwriting operations of the insurer, is under common control with the insurer, subject to Chapter 13 of this title, and whose compensation is not based on the volume of premiums written.
(4)
"Producer" means an agent or subagent as defined in Chapter 23 of this title.
(5)
"Underwrite" means the authority to accept or reject risk on behalf of the insurer.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-3 - License required; surety bond; errors and omissions policy

(a)
No person, firm, association, or corporation shall act in the capacity of a managing general agent with respect to risks located in this state for an insurer licensed in this state unless such person is a licensed producer in this state.
(b)
No person, firm, association, or corporation shall act in the capacity of a managing general agent representing an insurer domiciled in this state with respect to risks located outside this state unless such person is licensed as a producer in this state pursuant to the provisions of this chapter.
(c)
The Commissioner may require the managing general agent to maintain a surety bond in an amount acceptable to him for the protection of the insurer. The Commissioner may require the managing general agent to maintain an errors and omissions policy.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-4.1 - Fully earned policy fees

No licensed managing general agent may charge a fully earned policy fee in connection with the issuance of an insurance policy unless such fee shall be a component of the insurer's rate filing. No fully earned policy fee may exceed $25.00.
Added by 2009 Ga. Laws 107,§ 3, eff. 7/1/2009.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-5 - Insurer's oversight responsibilities; notice to Commissioner of relationship with managing general agent; conflict of interest

(a)
The insurer shall have on file an independent financial examination, in a form acceptable to the Commissioner, of each managing general agent with which it has done business.
(b)
If a managing general agent establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the managing general agent. This is in addition to any other required loss reserve certification.
(c)
The insurer shall periodically and at least semiannually conduct an on-site review of the underwriting and claims processing operations of the managing general agent.
(d)
Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates shall rest with an officer of the insurer, who shall not be affiliated with the managing general agent.
(e)
Within 30 days of entering into or termination of a contract with a managing general agent, the insurer shall provide written notification of such appointment or termination to the Commissioner. Notices of appointment of a managing general agent shall include a statement of duties which the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the Commissioner may request.
(f)
An insurer shall review its books and records each quarter to determine if any producer has become, by operation of paragraph (3) of Code Section
33-47-2
, a managing general agent. If the insurer determines that a producer has become a managing general agent, the insurer shall promptly notify the producer and the Commissioner of such determination and the insurer and producer must fully comply with the provisions of this chapter within 30 days of such determination.
(g)
An insurer shall not appoint to its board of directors an officer, director, employee, subproducer, or controlling shareholder of its managing general agents. This subsection shall not apply to relationships governed by Chapter 13 of this title or, if applicable, Chapter 48 of this title.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-6 - Principal and agent relationship created

The acts of the managing general agent are considered to be the acts of the insurer on whose behalf it is acting. A managing general agent may be examined as if it were the insurer.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 47 - MANAGING GENERAL AGENTS (§§ 33-47-1 — 33-47-7) › Section 33-47-7 - Violation of chapter; penalties

(a)
If the Commissioner finds, after a hearing conducted in accordance with Chapter 2 of this title, that any person has violated any provision of this chapter, the Commissioner may order:
(1)
For each separate violation, a penalty in an amount not to exceed $10,000.00;
(2)
Revocation or suspension of the producer's license; and
(3)
The managing general agent to reimburse the insurer or the rehabilitator or liquidator of the insurer for any losses incurred by the insurer caused by a violation of this chapter committed by the managing general agent.
(b)
The decision, determination, or order of the Commissioner pursuant to subsection (a) of this Code section shall be subject to judicial review as provided in Chapter 2 of this title.
(c)
Nothing contained in this Code section shall affect the right of the Commissioner to impose any other penalties provided for in this title.
(d)
Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, and auditors.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 48 - PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS (§§ 33-48-1 — 33-48-4) › Section 33-48-1 - Short title

This chapter shall be known and may be cited as the "Business Transacted with Producer Controlled Property and Casualty Insurer Act."
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 48 - PRODUCER CONTROLLED PROPERTY AND CASUALTY INSURERS (§§ 33-48-1 — 33-48-4) › Section 33-48-4 - Proceedings upon violation of chapter; burden of proof; penalties

(a)
(1)
If the Commissioner has reason to believe that a controlling producer has committed or is committing an act which could be determined to be a violation, as defined in paragraph (6) of Code Section
33-48-2
, he shall serve upon the controlling producer a statement of the charges and notice of a hearing to be conducted in accordance with Chapter 2 of this title at a time not less than 30 days after the service of the notice and at a place fixed in the notice.
(2)
At such hearing, the Commissioner must establish that the controlling producer engaged in a violation, as defined in paragraph (6) of Code Section
33-48-2
. The controlling producer shall have an opportunity to be heard and to present evidence rebutting the charges and to establish that the insolvency of the controlled insurer arose out of events not attributable to the violation. The decision, determination, or order of the Commissioner shall be subject to judicial review pursuant to Chapter 2 of this title.
(3)
Upon the finding, pursuant to the proceeding set forth in this subsection that the controlling producer committed a violation, as defined in paragraph (6) of Code Section
33-48-2
, and the controlling producer failed to establish that such violation did not substantially contribute to the insolvency, the controlling producer shall reimburse the Georgia Insurers Insolvency Pool or the Georgia Life and Health Insurance Guaranty Association for all payments made for losses, loss adjustment, and administrative expenses on the business placed by such producer in excess of gross earned premiums and investment income earned on premiums and loss reserves for such business.
(4)
Nothing contained in this Code section shall affect the right of the Commissioner to impose any other penalties provided for in this title.
(b)
Nothing contained in this chapter is intended to or shall in any manner alter or affect the rights of policyholders, claimants, creditors, or other third parties.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-4 - Written authorization of relationship required; contents

Transactions between a broker and the insurer it represents in such capacity shall only be entered into pursuant to a written authorization specifying the responsibilities of each party. The authorization shall, at a minimum, provide that:
(1)
The insurer may terminate the broker's authority at any time;
(2)
The broker will render accounts to the insurer accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by or owing to the broker, and remit all funds due to the insurer within 30 days of receipt;
(3)
All funds collected for the insurer's account will be held by the broker in a fiduciary capacity in a bank which is a qualified United States financial institution;
(4)
The broker will comply with Code Section
33-49-5
;
(5)
The broker will comply with the written standards established by the insurer for the cession or retrocession of all risks; and
(6)
The broker will disclose to the insurer any relationship with any reinsurer to which business will be ceded or retroceded.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-5 - Retention of records

(a)
For at least ten years after expiration of each contract of reinsurance transacted by the broker, the broker will keep a complete record for each transaction showing:
(1)
The type of contract, limits, underwriting restrictions, classes or risks, and territory;
(2)
The period of coverage, including effective and expiration dates, cancellation provisions, and notice required of cancellation;
(3)
Reporting and settlement requirements of balances;
(4)
The rate used to compute the reinsurance premium;
(5)
The names and addresses of assuming reinsurers;
(6)
Rates of all reinsurance commissions, including the commissions on any retrocessions handled by the broker;
(7)
Related correspondence and memoranda;
(8)
Proof of placement;
(9)
Details regarding retrocessions handled by the broker including the identity of retrocessionaires and the percentage of each contract assumed or ceded;
(10)
Financial records, including, but not limited to, premium and loss accounts; and
(11)
When the broker procures a reinsurance contract on behalf of a licensed ceding insurer:
(A)
Directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or
(B)
If placed through a representative of the assuming reinsurer, other than an employee, written evidence that such reinsurer has delegated binding authority to the representative.
(b)
The insurer will have access and the right to copy and audit all accounts and records maintained by the broker related to its business in a form usable by the insurer.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-6 - Prohibition against employing unlicensed broker or individual employed by broker; annual statement of broker's financial condition required

(a)
An insurer shall not engage the services of any person, firm, association, or corporation to act as a broker on its behalf unless such person is licensed as required by subsection (a) of Code Section
33-49-3
.
(b)
An insurer may not employ an individual who is employed by a broker with which it transacts business unless such broker is under common control with the insurer and subject to Chapter 13 of this title.
(c)
The insurer shall annually obtain a copy of statements of the financial condition of each broker with which it transacts business.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-8 - Restrictions on manager's operations

The manager shall not:
(1)
Cede retrocessions on behalf of the reinsurer, except that the manager may cede facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for such retrocessions. Such guidelines shall include a list of reinsurers with which such automatic agreements are in effect, and for each such reinsurer, the coverages and amounts or percentages that may be reinsured, and commission schedules;
(2)
Commit the reinsurer to participate in reinsurance syndicates;
(3)
Appoint any producer without assuring that the producer is lawfully licensed to transact the type of reinsurance for which he is appointed;
(4)
Without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or 1 percent of the reinsurer's policyholder's surplus as of December 31 of the last complete calendar year;
(5)
Collect any payment from a retrocessionaire or commit the reinsurer to any claim settlement with a retrocessionaire, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer;
(6)
Jointly employ an individual who is employed by the reinsurer unless such manager is under common control with the reinsurer subject to Chapter 13 of this title; or
(7)
Appoint a submanager.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-9 - Restrictions on reinsurer's operations

(a)
A reinsurer shall not engage the services of any person, firm, association, or corporation to act as a manager on its behalf unless such person is licensed as required by subsection (b) of Code Section
33-49-3
.
(b)
The reinsurer shall annually obtain a copy of statements of the financial condition of each manager which such reinsurer has engaged prepared by an independent certified accountant in a form acceptable to the Commissioner.
(c)
If a manager establishes loss reserves, the reinsurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the manager. This opinion shall be in addition to any other required loss reserve certification.
(d)
Binding authority for all retrocessional contracts or participation in reinsurance syndicates shall rest with an officer of the reinsurer who shall not be affiliated with the manager.
(e)
Within 30 days of termination of a contract with a manager, the reinsurer shall provide written notification of such termination to the Commissioner.
(f)
A reinsurer shall not appoint to its board of directors any officer, director, employee, controlling shareholder, or subproducer of its manager. This subsection shall not apply to relationships governed by Chapter 13 or Chapter 48 of this title.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-10 - Examination of reinsurance intermediaries and managers by Commissioner

(a)
A reinsurance intermediary shall be subject to examination by the Commissioner. The Commissioner shall have access to all books, bank accounts, and records of the reinsurance intermediary in a form usable to the Commissioner.
(b)
A manager may be examined as if it were the reinsurer.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 49 - REINSURANCE INTERMEDIARIES (§§ 33-49-1 — 33-49-11) › Section 33-49-11 - Violations; penalties

(a)
A reinsurance intermediary, insurer, or reinsurer found by the Commissioner, after a hearing conducted in accordance with Chapter 2 of this title, to be in violation of any provision of this chapter, shall:
(1)
For each separate violation, pay a penalty in an amount not exceeding $10,000.00;
(2)
Be subject to revocation or suspension of its license; and
(3)
If a violation was committed by the reinsurance intermediary, such reinsurance intermediary shall make restitution to the insurer, reinsurer, rehabilitator, or liquidator of the insurer or reinsurer for the net losses incurred by the insurer or reinsurer attributable to such violation.
(b)
The decision, determination, or order of the Commissioner pursuant to subsection (a) of this Code section shall be subject to judicial review pursuant to Chapter 2 of this title.
(c)
Nothing contained in this Code section shall affect the right of the Commissioner to impose any other penalties provided in this title.
(d)
Nothing contained in this chapter is intended to or shall in any manner limit or restrict the rights of policyholders, claimants, creditors, or other third parties or confer any rights to such persons.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-1 - Definition of multiple employer self-insured health plan

As used in this chapter, the term "multiple employer self-insured health plan" means any plan or arrangement which is established or maintained for the purpose of offering or providing health, dental, or short-term disability benefits to employees of two or more employers but which is not fully insured. A plan or arrangement is considered fully insured only if all benefits payable are guaranteed under a contract or policy of insurance issued by an insurer authorized to transact business in this state.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-3 - Application for license; payment of fees; payment of premium taxes

(a)
Application for a license shall be made on forms prescribed by the Commissioner.
(b)
Every multiple employer self-insured health plan shall pay to the Commissioner annual license fees, as established by rule or regulation of the Commissioner.
(c)
Every multiple employer self-insured health plan shall be exempt from the payment of premium taxes on the plan's net premium.
Amended by 2016 Ga. Laws 461,§ 1, eff. 4/27/2016.
Amended by 2011 Ga. Laws 245,§ 33, eff. 5/13/2011.
Amended by 2010 Ga. Laws 549,§ 2, eff. 7/1/2010.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-4 - Filing of bylaws, schedules of benefits, and management, administration, and trust agreements

At the time application for a license is made, the multiple employer self-insured health plan shall file with the Commissioner a copy of the plan's bylaws, all schedules of benefits, and all management, administration, and trust agreements which the plan had made or proposes to make for the conduct of its business and affairs. Any proposed changes or amendments to the foregoing must also be filed with the Commissioner.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-6 - Requirements for holding of funds collected

Funds collected from the participating employers under multiple employer self-insured health plans shall be held in trust subject to the following requirements:
(1)
A board of trustees elected by participating employers shall serve as fund managers on behalf of participants. Trustees shall be plan participants or be an employee or owner of a participating employer or an employee of a sponsoring association. No participating employer shall be represented by more than one trustee. A minimum of three and a maximum of seven trustees may be elected. Trustees shall not receive remuneration but they may be reimbursed for actual and reasonable expenses incurred in connection with duties as trustee;
(2)
Trustees shall be bonded in an amount not less than $150,000.00 from a licensed surety company or covered under a directors and officers liability policy issued to the multiple employer self-insured health plan;
(3)
Investment of plan funds shall be subject to the same restrictions which are applicable to insurers as provided in Chapter 11 of this title; and
(4)
A multiple employer self-insured health plan shall maintain a minimum loss ratio of at least 70 percent. Compliance with such minimum loss ratio standard shall be evaluated annually by a multiple employer self-insured health plan. Failure to comply with minimum loss ratio standards shall result in a premium refund to participating employers.
Amended by 2010 Ga. Laws 549,§ 4, eff. 7/1/2010.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-7 - Required disclosure statements

Every application for benefits and every benefit plan issued by a multiple employer self-insured health plan shall contain in contrasting color, in not less than ten-point type, the following statements:
(1)
The plan is a self-insured plan, and benefits are not guaranteed by a licensed insurer;
(2)
The plan is not covered by the Georgia Life and Health Guaranty Association;
(3)
This is a fully assessable benefit plan. In the event that the multiple employer self-insured health plan is unable to pay its obligations, participating employers shall be required to contribute on a joint and several basis the funds necessary to meet any unpaid obligations; and
(4)
Certain other major protections offered to Georgia residents under the Georgia Insurance Code and Rules and Regulations, such as conversion rights and certain mandated or required benefits, may not be available through the multiple employer self-insured plan.
Amended by 2010 Ga. Laws 549,§ 5, eff. 7/1/2010.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-8 - Health plans subject to examinations

Every multiple employer self-insured health plan shall be subject to examination in accordance with Chapter 2 of this title.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-9 - Dissolution of plan

(a)
A plan that desires to cease existence shall apply to the Commissioner for authority to dissolve. Applications to dissolve must be on forms prescribed by the Commissioner and must be approved or disapproved by the Commissioner within 60 days of receipt. Dissolution without authorization is prohibited and does not absolve a plan or its participants from fulfilling the plan's continuing obligations. An application to dissolve must be granted if either of the following conditions is met:
(1)
The plan demonstrates that it has no outstanding liabilities, including incurred but not reported liabilities; or
(2)
The plan has obtained an irrevocable commitment from a licensed insurer which provides for payment of all outstanding liabilities and for providing all related services, including payment of claims, preparation of reports, and administration of transactions associated with the period when the plan provided coverage.
(b)
Upon dissolution, after payment of all outstanding liabilities and indebtedness, the assets of the plan must be distributed to all employers participating in the plan during the last five years immediately preceding dissolution. The distributive share of each employer must be in the proportion that all contributions made by the employer during such five-year period bear to the total contributions made by all participating employers during such five-year period.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-10 - Rules and regulations promulgated by Commissioner

The Commissioner may promulgate rules or regulations which are necessary to implement the provisions of this chapter and to ensure the safe and proper operation of multiple employer self-insured health plans in this state.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-11 - Power of Commissioner to suspend license

(a)
If the Commissioner is of the opinion that a multiple employer self-insured health plan is in an unsound condition, that it has failed to comply with the law or any applicable rule or regulations or orders issued by the Commissioner, or that it is in a condition which renders its proceedings hazardous to the public or to persons covered under the plan, the Commissioner may, after a hearing, revoke or suspend the license of the plan or, in lieu thereof, impose a monetary penalty in accordance with Chapter 2 of this title.
(b)
If the Commissioner is of the opinion that any of the grounds set forth in subsection (a) of this Code section exists, the Commissioner may commence delinquency proceedings against the plan and supervise, rehabilitate, or liquidate the plan in accordance with the procedures set forth in Chapter 37 of this title.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-12 - Legislative intent

It is the intent of the General Assembly that a multiple employer self-insured health plan be created and maintained by and for the benefit of participating employers and operated under their exclusive management and control. This chapter is not intended to permit third-party administrators or other entrepreneurial promoters to establish a trust or plan and then proceed to solicit employers as participants. It is specifically intended that the impetus for the creation of the plan must come from the employers themselves, and the employers must at all times exercise absolute control over the management and conduct of the plan's business and affairs.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-13 - Multiple employer self-insured plans to make necessary filings

All multiple employer self-insured health plans who have member employees in this state shall make all filings necessary to comply with this chapter.
Amended by 2019 Ga. Laws 186,§ 1-13, eff. 7/1/2019.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 50 - MULTIPLE EMPLOYER SELF-INSURED HEALTH PLANS (§§ 33-50-1 — 33-50-14) › Section 33-50-14 - Commissioner approval of plans offering coverage in other states

A multiple employer self-insured health plan which covers lives in other states may cover lives in this state only if the Commissioner deems the plan to be in compliance with the requirements of this chapter.
Amended by 2011 Ga. Laws 245,§ 33, eff. 5/13/2011.
Added by 2010 Ga. Laws 549,§ 6, eff. 7/1/2010.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 51 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN (§§ 33-51-1 — 33-51-7) › Section 33-51-1 - Short title

This chapter shall be known and may be cited as the "Georgia Affordable HSA Eligible High Deductible Health Plan."
Added by 2008 Ga. Laws 463,§ 3, eff. 5/7/2008; exp. 1/1/2015.
Added by 2008 Ga. Laws 462,§ 2, eff. 5/7/2008.
2023 CODE OF GEORGIA › Title 33 - INSURANCE (§§ 33-1-1 — 33-66-8) › Chapter 51 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN (§§ 33-51-1 — 33-51-7) › Section 33-51-2 - Legislative intent

It is the intent of the General Assembly:
(1)
To authorize the Commissioner to establish flexible guidelines for health savings account eligible high deductible plan designs which will be affordable to Georgians and to increase the availability of these types of plans by accident and sickness insurers licensed to transact such insurance in this state;
(2)
To encourage the offering of affordable health savings account eligible high deductible plans, as required under the rules of the federal Internal Revenue Service related to the establishment of health savings accounts, with the specific intent of reaching many otherwise uninsured Georgians and the general intent of creating affordable comprehensive health insurance for all Georgians; and
(3)
To enhance the affordability of insurance with the flexible health savings account eligible high deductible plans allowed under this chapter by allowing rewards and incentives for participation in and adherence to health behaviors that recognize the value of the personal responsibility of each citizen to maintain good health, seek preventive care services, and comply with approved treatments.
Amended by 2013 Ga. Laws 33,§ 33, eff. 4/24/2013.
Added by 2008 Ga. Laws 463,§ 3, eff. 5/7/2008; exp. 1/1/2015.
Added by 2008 Ga. Laws 462,§ 2, eff. 5/7/2008.