reglab/statecodes huggingface dataset:
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.10 - Eligibility for Benefits; Time Limit for Application

Current through Rules and Regulations filed through June 27, 2024
(1) Coverage issued
				through the assignment system shall cover the qualifying eligible individual
				and any eligible dependents if coverage for all such individuals is elected
				pursuant to application as provided for in this Regulation Chapter.
(2) A qualifying eligible individual or a
				spouse or former spouse who is an eligible dependent shall have a choice of
				individual coverage or family coverage to include any or all eligible
				dependents.
(3) An election of
				assignment system coverage by a qualifying eligible individual shall be deemed
				to be an election on behalf of any eligible dependents covered under the
				qualifying eligible individual's continuation coverage, unless the application
				indicates an election of the qualifying eligible individual otherwise. Election
				shall not be contingent on identical election of any other family member with
				regard to individual or family coverage.
(4) The Commissioner or administrator may at
				any time request additional information from the applicant for initial review
				of eligibility, and may delegate any part of the eligibility review and
				solicitation of additional information to health insurers and managed care
				organizations participating in GHIAS or GHBAS. The qualifying eligible
				individual must comply with a request for additional information and
				verification of eligibility to the fullest extent possible. Health insurers and
				managed care organizations are subject to the provisions of the Rules and
				Regulations of the Office of Commissioner of Insurance §
									120-2-67-.12 with regard to
				accepting attestations and other evidence of coverage during verification if a
				certification of creditable coverage is not available.
(5) A substantially completed application for
				coverage under the assignment system shall be filed with the Commissioner or
				the delegated administrator not later than sixty-three (63) consecutive days
				after a qualifying event. Such filing shall toll the sixty-three (63)
				consecutive day election period for the qualifying eligible individual and all
				other eligible dependents for whom coverage is elected, provided that
				eligibility is ultimately verified and initial premium is paid.
(6) Notwithstanding paragraph (5), qualified
				eligible individuals with qualifying events on or after October 30, 1997, but
				before January 1, 1998, may file a substantially completed application no later
				than March 3, 1998.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.11 - Effective Date of Coverage

Current through Rules and Regulations filed through June 27, 2024
All coverage issued through the assignment system, upon
				  application and payment of premium, shall become effective on the date of a
				  qualifying event. In no case shall a participating health insurer or managed
				  care organization be required to make such coverage effective prior to January
				  1, 1998.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.12 - Initial Premium

Current through Rules and Regulations filed through June 27, 2024
A participating health insurer or managed care organization
				  may require payment for any retroactive periods of coverage commencing with the
				  date of a qualifying event as part of the initial premium in order to
				  effectuate coverage. However, such initial premium shall not exceed the sum
				  total of such retroactive payment, a pro-rated premium for the remaining month,
				  and the next full calendar month if a monthly payment mode is
				  selected.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.13 - Preexisting Conditions and Health Status

Current through Rules and Regulations filed through June 27, 2024
(1) All policies or plans issued through the
				assignment system shall not exclude any preexisting condition or maintain any
				preexisting condition limitation.
(2) Health insurers or managed care
				organizations participating in the assignment system may not take into account
				health status related factors, claims experience, or evidence of insurability
				with regard to eligibility for coverage or benefit choices in the assignment
				system.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.14 - Reduction of Coverage

Current through Rules and Regulations filed through June 27, 2024
(1) Any assignment system policy or plan may
				provide for a reduction or coordination of coverage on any person upon
				eligibility for coverage under Medicare.
(2) No assignment system policy or plan may
				provide for a reduction or coordination of coverage based upon a person's
				eligibility for coverage under the Medicaid program of the State of
				Georgia.
(3) The benefits under the
				assignment system policy or plan shall be secondary to any group or blanket
				accident and sickness contract covering any person insured under the assignment
				system policy.
(4) The assignment
				system policy or plan may provide that any hospital, surgical or medical
				benefits payable thereunder may be reduced by the amount of any such benefits
				payable under the continuation coverage after the termination of the
				individual's insurance thereunder.
(5) A health insurer or managed care
				organization may request information in advance of any premium due date of such
				policy or plan of any person covered thereunder only as to whether:
(a) The insured is covered for similar
				benefits under any arrangement of coverage for individuals in a group, whether
				on an insured or uninsured basis; or
(b) Similar benefits are provided for or
				available to such person, pursuant to or in accordance with the requirements of
				Medicare.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.15 - Renewability

Current through Rules and Regulations filed through June 27, 2024
(1) All assignment
				system policies and plans must provide that the health insurer or managed care
				organization may refuse to renew the coverage of any person insured thereunder
				only as permitted in the Rules and Regulations of the Office of Commissioner of
				Insurance §
									120-2-67-.10(b)(1), (2), (3), and
				(5) with regard to renewability of individual
				health insurance policies or contracts.
(2) Any refusal to renew shall be without
				prejudice to any valid claim commencing while the policy or plan is in
				force.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.16 - Notification

Current through Rules and Regulations filed through June 27, 2024
All insurers issuing accident and sickness insurance coverage
				  in this state, managed care organizations, and third party administrators
				  licensed by the Commissioner and engaged in the business of health insurance in
				  this state may issue any notices or other information regarding coverage under
				  the assignment system produced by the Commissioner for Georgia citizens to
				  employers and employer sponsored health benefit arrangements for whom
				  administrative services are rendered. The Commissioner may require any or all
				  such insurers, managed care organizations, or third party administrators to
				  distribute such notices or information to agents and other individuals for
				  dissemination to potential eligible individuals.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.17 - Maintenance

Current through Rules and Regulations filed through June 27, 2024
(1) As deemed
				necessary, the Commissioner may survey all insurers and managed care
				organizations issuing or renewing accident and sickness coverage in this state
				to determine the health insurers and managed care organizations eligible to
				participate in GHIAS and GHBAS, the pro-rata volume of business in the
				individual health insurance market issued by each health insurer and managed
				care organization for the purpose of making fair and equitable assignments, and
				for any other purpose necessary for the continued implementation and
				maintenance of GHIAS and GHBAS. The Commissioner may use all authority granted
				to him or her by law to enforce disclosure of information solicited by this
				survey. The survey may require disclosure of information pertaining to the
				following:
(a) Premium volume under individual
				health insurance coverage issued in this state;
(b) Premium rates charged;
(c) Information regarding the marketing
				activity of insurers and managed care organizations in the individual health
				insurance market in this state;
(d)
				Policy form, benefit, and enrollment data for individual health insurance
				coverage sold or renewed in this state; and
(e) Any other information deemed appropriate
				by the Commissioner for the continued implementation and maintenance of
				O.C.G.A. §
										33-29A-1
et
				seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.18 - Subsequent Optional Choices

Current through Rules and Regulations filed through June 27, 2024
(1) Any qualifying eligible individual shall
				have the option of switching from Plan B to Plan A, or from Plan D to Plan C,
				or to any other optional policy or plan offered by the participating health
				insurer or managed care organization after enrolling and purchasing coverage
				under Plan B or Plan D in the assignment system. The participating health
				insurer or managed care organization shall also permit the privilege of
				switching form Plan A or Plan C to any other optional policy or plan offer
				under this Rule after the qualifying eligible individual enrolls for coverage.
				The participating health insurer or managed care organization may limit such
				choice to the following events:
(a) Once a
				year within 31 days of the policy anniversary date, with coverage becoming
				effective on the policy anniversary date;
(b) Upon notification of premium increase,
				with coverage becoming effective on the effective date of the premium increase;
				and
(c) Within 31 days of divorce
				or marriage, with coverage becoming effective on the first day of the following
				calendar month.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.19 - Penalties

Current through Rules and Regulations filed through June 27, 2024
Any health insurer or managed care organization failing to
				  comply with the requirements of this Regulation Chapter shall be subject to
				  penalties and other enforcement actions as may by appropriate under the
				  insurance laws of this State.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS › Rule 120-2-81-.20 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this Regulation Chapter or the
				  application thereof to any person or circumstance is for any reason held to be
				  invalid by a court of competent jurisdiction, the remainder of the Regulation
				  Chapter or the applicability of such provision to other persons or
				  circumstances shall not be affected.
O.C.G.A. Secs.
				  33-2-9,
				  33-29A-1,
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This Regulation Chapter is issued pursuant to the authority
				  vested in the Commissioner of Insurance by O.C.G.A. §§
									33-2-9 and
				  33-24-59.2.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.02 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The purpose of this Regulation Chapter is to implement
				  O.C.G.A. Section
				  33-24-59.2 regarding minimum
				  coverage provisions for medically necessary diabetes related equipment,
				  supplies, pharmacologic agents, and outpatient self-management training and
				  education including medical nutrition therapy, for individuals with
				  insulin-dependent diabetes, insulin-using diabetes, gestational diabetes and
				  non-insulin using diabetes.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.03 - Applicability and Scope

Current through Rules and Regulations filed through June 27, 2024
On or after July 1, 2002 health insurance policies and plans,
				  except limited benefit insurance policies, shall provide coverage for medically
				  necessary equipment, supplies, pharmacologic agents, and outpatient
				  self-management training and education including medical nutrition therapy for
				  individuals with insulin-dependent diabetes, insulin-using diabetes,
				  gestational diabetes, and non-insulin-diabetes who adhere to the prognosis and
				  treatment regimen prescribed by a physician licensed to practice medicine
				  pursuant to Title 43.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.04 - Definitions

Current through Rules and Regulations filed through June 27, 2024
For the purposes of this Regulation Chapter, the following
				  definitions shall apply:
(1) "ADA"
				means the American Diabetes Association;
(2) "Certification" means the review,
				approval and assignment of a program site number of an outpatient diabetes
				education program that meets minimum standards;
(3) "Certified Diabetes Educator" means a
				person currently certified by the National Certification Board of Diabetes
				Educators;
(4) "Certified,
				Registered, or Licensed Health Care Professional" means those individuals who
				make up an interdisciplinary team, including professionals with skills specific
				to each content area. This team may include any individual of any health care
				profession, but must include at least:
(a) a
				licensed Dietitian; and
(b) a
				Registered Nurse or other health care professional who is a Certified Diabetes
				Educator.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.05 - Pharmacologic Agent Coverage Defined

Current through Rules and Regulations filed through June 27, 2024
Health insurance policies and plans, except limited benefit
				  insurance policies, shall provide coverage for the following pharmacologic
				  agents when prescribed by a physician licensed to practice medicine pursuant to
				  Title 43:
(1) Insulin of each class
				approved by the federal Food and Drug Administration (FDA) including
				formulations available either in a vial or cartridge;
(2) Prescription insulin of each class
				approved by the federal Food and Drug Administration (FDA) including
				formulations available either in a vial or cartridge formulation;
(3) Prescription oral medications of each
				class approved by the federal Food and Drug Adminstration (FDA) for the
				management of diabetes;
(4) Oral
				products approved by the federal Food and Drug Administration (FDA) for the
				management of diabetes;
(5)
				Glucagon kits;
(6) Pharmacologic
				agents approved by the federal Food and Drug Administration (FDA) for the
				management of diabetes and its complications.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.06 - Minimum Standards for Equipment Coverage Defined

Current through Rules and Regulations filed through June 27, 2024
Health insurance policies and plans, except limited benefit
				  insurance policies, shall provide coverage for the following medical equipment,
				  non-disposable and durable medical equipment when prescribed by a physician
				  licensed to practice medicine pursuant to Title 43:
(1) Blood glucose monitors and glucose
				monitors, including commercially available blood glucose monitors designed for
				patients' use and for persons who have been diagnosed with diabetes;
(2) Blood glucose monitors and glucose
				monitors for the legally blind or visually impaired due to diabetes which
				includes commercially available blood glucose monitors designed for patient use
				with adaptive devices and for persons who are legally blind and have been
				diagnosed with diabetes, or are visually impaired due to diagnosed
				diabetes;
(3) Injection aids,
				including those adaptable to meet the needs of the legally blind, to assist
				with insulin injection;
(4) Insulin
				pumps, which includes insulin infusion pumps;
(5) Medical supplies for use with or without
				insulin pumps and insulin infusion pumps to include durable devices to assist
				with the injection of insulin and infusion sets;
(6) Therapeutic shoes, custom fitted inserts
				and related orthopedic footwear associated with the prevention and treatment of
				diabetes and diabetes related complications;
(7) Pen-like insulin injection devices
				designed for multiple use;
(8)
				Lancing devices associated with the drawing of blood samples for use with blood
				glucose monitors; and
(9) Such
				other medical equipment, non-disposable and durable medical equipment that is
				medically necessary and consistent with the current standards of care of the
				American Diabetes Association.
Education, Training, and Medical Nutrition Therapy" adopted.
				  F. Nov. 12, 1999; eff. Dec. 2, 1999.
Repealed:
New Rule entitled
				  "Minimum Standards for Equipment Coverage Defined" adopted. F. Oct. 8, 2002;
				  eff. Oct. 28,
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.07 - Minimum Standards for Single-Use Medical Supply Coverage Defined

Current through Rules and Regulations filed through June 27, 2024
Health insurance policies and plans, except limited benefit
				  insurance policies, shall provide coverage for the following single-use medical
				  supplies when prescribed by a physician licensed to practice medicine pursuant
				  to Title 43:
(1) Test strips for
				glucose monitors, which include test strips whose performance achieved
				clearance by the federal Food and Drug Administration (FDA) for
				marketing;
(2) Visual reading and
				urine testing strips, which includes visual reading strips for glucose, urine
				testing strips for ketones, or urine test strips for both glucose and ketones.
				Using urine test strips for glucose only is not acceptable as the sole method
				of monitoring blood glucose levels;
(3) Lancets and single use lancing devices
				used in conjunction with the monitoring of glycemic control;
(4) Syringes, which includes insulin
				syringes, insulin injection needles for use with pen-like insulin injection
				devices and other disposable parts required for insulin injection
				aids;
(5) Medical supplies for use
				with insulin pumps and insulin infusion pumps to include infusion sets,
				cartridges, syringes, skin preparation, batteries and other disposable supplies
				needed to maintain insulin pump therapy;
(6) Medical supplies for use with or without
				syringes, insulin pumps and insulin infusion pumps to include disposable
				devices to assist with the injection of insulin and infusion sets, alcohol
				swabs and related preparations and other similar compounds associated with the
				cleansing of injection sites prior to the administration of insulin;
				and
(7) Such other single-use
				medical supplies that are medically necessary and consistent with the current
				standards of care of the American Diabetes Association.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.08 - Minimum Standards for Diabetes Self-Management Training Defined

Current through Rules and Regulations filed through June 27, 2024
Health insurance policies and plans, except limited benefit
				  insurance policies, shall provide coverage for diabetes self-management
				  training and medical nutrition therapy when prescribed by a physician licensed
				  to practice medicine pursuant to Title 43. Minimum standards for diabetes
				  self-management training and medical nutrition therapy shall conform to the
				  following:
(1) Diabetes
				self-management training and medical nutrition therapy services must be
				provided by a diabetes self-management training program that meets the
				following criteria:
(a) The program has been
				recognized by the federal Centers for Medicare & Medicaid Services (CMS),
				or
(b) Obtains or receives
				approval, accreditation or certification by a national organization assessing
				standards of quality in the provision of diabetes self-managment
				education.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.09 - Penalties

Current through Rules and Regulations filed through June 27, 2024
Any insurer failing to comply with the requirements of this
				  Regulation Chapter shall be subject to penalties and enforcement actions as may
				  be appropriate under the insurance laws of the state of
				  Georgia.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-82 - COVERAGE FOR MANAGEMENT AND TREATMENT OF DIABETES › Rule 120-2-82-.10 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this Regulation Chapter or the
				  application thereof to any person or circumstance is for any reason held to be
				  invalid by a court of competent jurisdiction, the remainder of the Regulation
				  Chapter or the applicability of such provision to other persons or
				  circumstances shall not be affected.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-59.2.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.01 - Authority and Purpose

Current through Rules and Regulations filed through June 27, 2024
This Regulation Chapter is adopted and promulgated pursuant
				  to the authority granted to the Commissioner of Insurance pursuant to O.C.G.A.
				  §§
									33-2-9 and
				  33-20A-9.1. The purpose and intent
				  of this Regulation Chapter is to provide for the implementation of the consumer
				  choice option as defined in O.C.G.A. §
									33-20A-9.1(b).
O.C.G.A. Secs.
				  33-2-9,
				  33-20A-9.1.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.02 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(a) For purposes of
				this Regulation Chapter and O.C.G.A. § 33- 20A-9.1:
(1) "Accepted provider" shall mean a provider
				that has been nominated by an enrollee and either accepted by a managed care
				entity which has chosen not to credential nominated providers or accepted by a
				managed care entity following credentialing in accordance with Rule
				120-2-83-.05.
(2) "Deselected provider" shall mean a
				provider that has been nominated by an enrollee and provisionally accepted by
				the managed care entity, but later disapproved for reimbursement because the
				provider fails to meet one of the criteria for participation set forth in
				O.C.G.A. §
										33-20A-9.1(c).
(3) "Enrollee" shall mean an enrollee of a
				managed care entity required to offer the consumer choice option pursuant to
				O.C.G.A. § 33- 20A-9.1(b).
(4)
				"Nominated provider" shall mean an out of network provider nominated by an
				enrollee.
(5) "Option" shall mean
				the consumer choice option as defined in O.C.G.A. §
										33-20A-9.1(b).
(6) "Managed Care Entity" shall mean any
				entity identified pursuant to O.C.G.A. §
										33-20A-3(6)  and
				required to offer the option pursuant to O.C.G.A. §
										33-20A-9.1(c).
(7) "Provider" shall mean a health care
				provider as defined in O.C.G.A. §
										33-20A-3(3)  or a
				hospital.
(8) "Provisionally
				accepted provider" shall mean a provider that has been nominated by an enrollee
				and provisionally accepted by the managed care entity upon receipt of the
				nominating form.
(9) "Rejected
				provider" shall mean a provider that has been nominated by an enrollee and
				disapproved because the provider fails to meet one of the criteria for
				participation set forth in O.C.G.A. § 33- 20A-9.1(c) by a managed care
				entity which has chosen not to credential nominated providers.
(10) "Similarly situated provider" shall mean
				an in network provider located in the same geographic area and providing the
				same or similar services as the nominated provider.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.03 - Notification and Disclosure

Current through Rules and Regulations filed through June 27, 2024
(a) Notification of the option's availability
				and explanatory materials regarding the option shall be provided to enrollees
				at least annually at open enrollment, renewal, time of solicitation or by
				direct mail advertising, or upon request. Such information shall be provided to
				prospective enrollees upon request. Such information shall also be provided to
				newly eligible employees. Information shall include, but shall not be limited
				to:
(1) A one page form to be completed and
				signed by the enrollee and the nominated provider containing the enrollee's
				name, identification number, group number, address, date of birth, and
				telephone number. The form shall also include the provider's name, group name
				(if applicable), State of Georgia license number, tax identification number,
				address, identity of the hospital(s) where the provider has privileges,
				telephone number, and facsimile number;
(2) Pricing (including information that
				allows the enrollee to compare pricing with and without the option so that the
				enrollee may make an informed choice);
(3) The nomination process in accordance with
				Rule 120-2-83-.04;
				and
(4) The credentialing process
				in accordance with Rule
				120-2-83-.05.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.04 - Provider Nomination

Current through Rules and Regulations filed through June 27, 2024
(a) Managed care entities shall create, and
				make readily available to nominated providers, a nomination package which shall
				include, if applicable:
(1) Information
				regarding credentialing procedures pursuant to Rule
				120-2-83-.05. This includes, but is
				not limited to, all forms required to be completed by the provider for the
				purpose of credentialing; and
(2) A
				compensation schedule specific to the nominated provider's area of
				practice.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.05 - Credentialing

Current through Rules and Regulations filed through June 27, 2024
(a) Nothing in this
				Regulation Chapter shall require managed care entities to credential as to
				nominated providers.
(b) As
				provided for in O.C.G.A. §
									33-20A-9.1(c)(1)(C),
				managed care entities are permitted to implement credentialing procedures that
				meet minimum requirements set forth by recognized credentialing
				bodies.
(c) Within ninety (90) days
				of receipt of all necessary information as required by the managed care entity
				and provided with the nomination form in accordance with Rule
				120-2-83-.04(a)(l),
				the managed care entity shall provide notice in writing, to the provider and
				the enrollee, of the credentialing decision.
(d) For deselected providers, this notice
				shall contain the specific statutory, medical, professional or ethical reasons
				for deselection.
O.C.G.A. Secs.
				  33-2-9,
				  33-20A-9.1.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.06 - Form Filings; Examination Authority

Current through Rules and Regulations filed through June 27, 2024
(a) Rate and form filings for the option
				shall be deemed original filings.
(b) Managed care entities may seek approval
				of acceptable group master contract language which describes administrative
				procedures and limits changes to or withdrawals from the option election by an
				enrollee, consistent with Rule
				120-2-83-.03(d).
(c) The requirements for offering the option
				pursuant to this Regulation Chapter shall be satisfied if a managed care entity
				meets all requirements set forth in O.C.G.A. §
									33-20A-9.1(d)(2)(C).
				Compliance with this paragraph shall be applicable on a product and option
				specific basis, including different cost sharing levels.
(d) Nothing in this Regulation Chapter shall
				affect the Commissioner's examination authority pursuant to Title 33 of the
				Official Code of Georgia Annotated.
O.C.G.A. Secs.
				  33-2-9,
				  33-20A-9.1.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.07 - Penalties

Current through Rules and Regulations filed through June 27, 2024
Any insurer, or any agent, counselor, representative,
				  officer, or employee of such insurer failing to comply with the requirements of
				  this Regulation Chapter shall be subject to such penalties as may be
				  appropriate under the insurance laws of this State.
O.C.G.A. Secs.
				  33-2-9,
				  33-20A-9.1.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-83 - CONSUMER CHOICE OPTION › Rule 120-2-83-.08 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this Regulation Chapter or the
				  application of it to any person or circumstance is held invalid, such
				  invalidity shall not affect the provisions or applications of the rules herein
				  which can be given effect without the invalid portion. To that end, the
				  provisions of this Rule are declared to be severable.
O.C.G.A. Secs.
				  33-2-9,
				  33-20A-9.1.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.01 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The purpose of this regulation is to implement the provisions
				  of Chapter 39 of Title 33 of the Official Code of Georgia Annotated and to
				  provide an interpretive ruling to carry out the responsibilities of the Office
				  of the Commissioner concerning the collection, use, and disclosure of personal
				  information in connection with insurance transactions in Georgia pursuant to
				  Title V of the Gramm-Leach-Bliley Act (15 U.S.C. 6801
et
				  seq.
).
O.C.G.A. Sec.
				  33-2-9,
				  15 U.S.C. Sec.
				  6805.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.02 - Applicability

Current through Rules and Regulations filed through June 27, 2024
This regulation applies to all insurance institutions,
				  agents, insurance support organizations, producers, unauthorized insurers who
				  place business through a licensed excess line broker in this state pursuant to
				  Chapter 5 of Title 33, and other persons or entities licensed or required to be
				  licensed, authorized or required to be authorized, registered or required to be
				  registered pursuant to the Georgia Insurance Code.
O.C.G.A. Sec.
				  33-2-9,
				  15 U.S.C. Sec.
				  6805.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.03 - Authority

Current through Rules and Regulations filed through June 27, 2024
This regulation is issued pursuant to the authority vested in
				  the Commissioner of Insurance under O.C.G.A. §
									33-2-9 to implement Chapter 39 of
				  Title 33 and to provide an interpretive ruling to carry out the
				  responsibilities of his office under Sections 505 and 507 of Subtitle A of
				  Title V of the Gramm-Leach-Bliley Act. Section 505 of the Gramm-Leach-Bliley
				  Act specifically reserves functional regulation of all insurance activities to
				  the States and directs State insurance authorities to enforce Title V privacy
				  standards, and Section 507 permits the enforcement of any State provisions that
				  offer greater protections and standards than may be set forth in Title V of the
				  Gramm-Leach-Bliley Act.
O.C.G.A. Sec.
				  33-2-9,
				  15 U.S.C. Secs.
				  6805,
				  6807.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.04 - Requirements

Current through Rules and Regulations filed through June 27, 2024
Any person or entity subject to this regulation shall comply
				  with Chapter 39 of Title 33 and all other applicable Georgia laws; and shall
				  further comply with Title V of the Gramm-Leach-Bliley Act (15 U.S.C.
				  6801
et seq.
) and other
				  applicable federal laws to the extent said federal laws set forth standards
				  that are either in addition to, or stricter than, the consumer protections in
				  Georgia law.
O.C.G.A. Sec.
				  33-2-9,
				  15 U.S.C. Secs.
				  6805,
				  6807.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.05 - Enforcement

Current through Rules and Regulations filed through June 27, 2024
The Commissioner of Insurance has the authority to enforce
				  Title V of the Gramm-Leach-Bliley Act (15 U.S.C. §
										6801
et
				  seq.
) and has all of the enforcement powers otherwise available to the
				  Commissioner under Chapter 39 of Title 33 and all other applicable Georgia
				  laws.
O.C.G.A. Sec.
				  33-2-9,
				  15 U.S.C. Sec.
				  6805.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-87 - REGULATIONS GOVERNING THE COLLECTION, USE, AND DISCLOSURE OF INFORMATION GATHERED IN CONNECTION WITH INSURANCE TRANSACTIONS › Rule 120-2-87-.06 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any regulation or portion thereof contained in this
				  Chapter is held invalid by a court of competent jurisdiction, the remainder of
				  the regulation herein and the applicability of such provisions to other
				  circumstances shall not be affected thereby.
O.C.G.A. Sec.
				  33-2-9.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-89 - SURPLUS LINES INSURANCE REGULATION › Rule 120-2-89-.01 - Statutory Authority

Current through Rules and Regulations filed through June 27, 2024
This Regulation is made and promulgated by the Insurance
				  Commissioner pursuant to the authority set forth in Section
				  33-2-9 and Section
				  33-5-26 of the Georgia Insurance
				  Code.
O.C.G.A. Secs.
				  33-2-9,
				  33-5-26.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-89 - SURPLUS LINES INSURANCE REGULATION › Rule 120-2-89-.02 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The purpose of this Regulation is to establish rules for the
				  delivery of a standard disclosure form or brochure explaining surplus lines
				  coverage, which shall be attached to or made a part of any surplus line policy
				  in which the policy premium is $5,000.00 per annum or less.
O.C.G.A. Secs.
				  33-2-9,
				  33-5-26.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-89 - SURPLUS LINES INSURANCE REGULATION › Rule 120-2-89-.03 - Delivery of Standard Disclosure Brochure

Current through Rules and Regulations filed through June 27, 2024
Pursuant to Code Section
				  33-5-26(b), no
				  surplus lines policy or certificate with an annual premium of $5,000.00 per
				  annum or less, shall be delivered in this state without being accompanied by a
				  standard form explaining surplus lines insurance.
(a) The standard form referred to in this
				Section shall be identical in format and content to the document attached
				hereto as Appendix A.
(b) It shall
				be the responsibility of the licensed surplus lines broker to ensure that a
				copy of the standard disclosure brochure is delivered to the policyholder with
				the policyholder's copy of the policy.
O.C.G.A. Secs.
				  33-2-9,
				  33-5-26.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-89 - SURPLUS LINES INSURANCE REGULATION › Rule 120-2-89-.04 - Penalties

Current through Rules and Regulations filed through June 27, 2024
Any insurer or surplus lines broker failing to comply with
				  the requirements of this Regulation Chapter shall be subject to such penalties
				  as may be appropriate under the insurance laws of this State.
O.C.G.A. Secs.
				  33-2-9,
				  33-5-26.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-89 - SURPLUS LINES INSURANCE REGULATION › Rule 120-2-89-.05 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this Regulation Chapter or the
				  application of it to any person or circumstance is held invalid, such
				  invalidity shall not affect the provisions or applications of the rules herein
				  which can be given effect without the invalid portion. To that end, the
				  provisions of this Rule are declared to be severable.
O.C.G.A. Secs.
				  33-2-9,
				  33-5-26.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-90 - STANDARD NONFORFEITURE AND VALUATION FOR USE IN DETERMINING MINIMUM RESERVE LIABILITIES AND NONFORFEITURE BENEFITS REGULATION › Rule 120-2-90-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This regulation is promulgated by the Commissioner of
				  Insurance pursuant to O.C.G.A. §§
									33-2-9,
				  33-10-13(b.1)(2),
				  33-10-13(d)(1)(B)(iii) and 33-25-4(e)(8)(F).
O.C.G.A. Secs.
				  33-2-9,
				  33-10-13,
				  33-25-4.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-90 - STANDARD NONFORFEITURE AND VALUATION FOR USE IN DETERMINING MINIMUM RESERVE LIABILITIES AND NONFORFEITURE BENEFITS REGULATION › Rule 120-2-90-.02 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The purpose of this regulation is to recognize, permit and
				  prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality
				  Table in accordance with O.C.G.A. §§
									33-10-13(d)(1)(B)(iii)
				   and
				  33-25-4(e)(8)(F) 
				  and Georgia Insurance Department Regulation Chapter 120-2-90 and to recognize
				  and permit the use of mortality tables that reflect differences in mortality
				  between Preferred and Standard lives in determining minimum reserve liabilities
				  for life insurance pursuant to O.C.G.A. §
									33-10-13(d)(1)(B)(iii)
				   and Georgia Insurance Department Regulation
				  Chapter 120-2-90.
O.C.G.A. Secs.
				  33-2-9,
				  33-10-13,
				  33-25-4.