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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.03 - Applicability

Current through Rules and Regulations filed through June 27, 2024
This regulation shall apply to all life insurance policies,
				  with or without nonforfeiture values, issued on or after the effective date of
				  this regulation, subject to the following exceptions and conditions.
(1) Exceptions
(a) This regulation shall not apply to any
				individual life insurance policy issued on or after the effective date of this
				regulation if the policy is issued in accordance with and as a result of the
				exercise of a reentry provision contained in the original life insurance policy
				of the same or greater face amount, issued before the effective date of this
				regulation, that guarantees the premium rates of the new policy. This
				regulation also shall not apply to subsequent policies issued as a result of
				the exercise of such a provision, or a derivation of the provision, in the new
				policy.
(b) This regulation shall
				not apply to any universal life policy that meets all the following
				requirements:
(1) Secondary guarantee period,
				if any, is five (5) years or less;
(2) Specified premium for the secondary
				guarantee period is not less than the net level reserve premium for the
				secondary guarantee period based on the CSO valuation tables as defined in
				Section 4F and the applicable valuation interest rate; and (c) The initial
				surrender charge is not less than 100 percent of the first year annualized
				specified premium for the secondary guarantee period.
(3) This regulation shall not apply to any
				variable life insurance policy that provides for life insurance, the amount or
				duration of which varies according to the investment experience of any separate
				account or accounts.
(4) This
				regulation shall not apply to any variable universal life insurance policy that
				provides for life insurance, the amount or duration of which varies according
				to the investment experience of any separate account or accounts.
(5) This regulation shall not apply to a
				group life insurance certificate unless the certificate provides for a stated
				or implied schedule of maximum gross premiums required in order to continue
				coverage in force for a period in excess of one year.
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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.04 - Definitions

Current through Rules and Regulations filed through June 27, 2024
For purposes of this regulation:
(1) "Basic reserves" means reserves
				calculated in accordance with O.C.G.A. §
									33-10-13.
(2) "Contract segmentation method" means the
				method of dividing the period from issue to mandatory expiration of a policy
				into successive segments, with the length of each segment being defined as the
				period from the end of the prior segment (from policy inception, for the first
				segment) to the end of the latest policy year as determined below. All
				calculations are made using the 1980 CSO valuation tables, as defined in
				Subsection (5) of this section, (or any other valuation mortality table adopted
				by the National Association of Insurance Commissioners (NAIC) after the
				effective date of this regulation and promulgated by regulation by the
				commissioner for this purpose), and, if elected, the optional minimum mortality
				standard for deficiency reserves stipulated in 120-2 -.05(2).
The length of a particular contract segment shall be set
				  equal to the minimum of the value
t
for which Gt is greater
				  than Rt (if Gt never exceeds Rt the segment length is deemed to be the number
				  of years from the beginning of the segment to the mandatory expiration date of
				  the policy), where Gt and Rt are defined as follows:
Click
				  here to view image
where:
x = original issue age;
k = the number of years from the date of issue to the
				  beginning of the segment;
t = 1, 2, ...;
t
is reset to 1 at the
				  beginning of each segment;
GPx+k+t-1 = Guaranteed gross premium per thousand of face
				  amount for year
t
of the segment, ignoring policy fees only if
				  level for the premium paying period of the policy.
qx+k+t
Rt = ___________, However, Rt may be increased or qx+k+t-1
				  decreased by one percent in any policy year, at the company's option, but Rt
				  shall not be less than one;
where:
x, k and t are as defined above, and
qx+k+t-1 = valuation mortality rate for deficiency reserves
				  in policy year k+t but using the mortality of Section 5B(2) if Section 5B(3) is
				  elected for deficiency reserves. However, if GPx+k+t is greater than 0 and
				  GPx+k+t-1 is equal to 0, Gt shall be deemed to be 1000. If GPx+k+t and
				  GPx+k+t-1 are both equal to 0, Gt shall be deemed to be 0.
(3) "Deficiency reserves" means the excess,
				if greater than zero, of
(a) Minimum reserves
				calculated in accordance with O.C.G.A. §
										33-10-13(l) Over
(b) Basic reserves.
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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.05 - General Calculation Requirements for Basic Reserves and Premium Deficiency Reserves

Current through Rules and Regulations filed through June 27, 2024
(1) At the election of the company for any
				one or more specified plans of life insurance, the minimum mortality standard
				for basic reserves may be calculated using the 1980 CSO valuation tables with
				select mortality factors (or any other valuation mortality table adopted by the
				NAIC after the effective date of this regulation and promulgated by regulation
				by the commissioner for this purpose). If select mortality factors are elected,
				they may be:
(a) The ten-year select
				mortality factors incorporated into the 1980 amendments to the NAIC Standard
				Valuation Law;
(b) The select
				mortality factors in the Appendix; or
(c) Any other table of select mortality
				factors adopted by the NAIC after the effective date of this regulation and
				promulgated by regulation by the commissioner for the purpose of calculating
				basic reserves.
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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.06 - Calculation of Minimum Valuation Standard for Policies with Guaranteed Nonlevel Gross Premiums or Guaranteed Nonlevel Benefits (Other than Universal Life Policies)

Current through Rules and Regulations filed through June 27, 2024
(1) Basic Reserves
Basic reserves shall be calculated as the greater of the
				  segmented reserves and the unitary reserves. Both the segmented reserves and
				  the unitary reserves for any policy shall use the same valuation mortality
				  table and selection factors. At the option of the insurer, in calculating
				  segmented reserves and net premiums, either of the adjustments described in
				  Paragraph (a) or (b) below may be made:
(a) Treat the unitary reserve, if greater
				than zero, applicable at the end of each segment as a pure endowment and
				subtract the unitary reserve, if greater than zero, applicable at the beginning
				of each segment from the present value of guaranteed life insurance and
				endowment benefits for each segment.
(b) Treat the guaranteed cash surrender
				value, if greater than zero, applicable at the end of each segment as a pure
				endowment; and subtract the guaranteed cash surrender value, if greater than
				zero, applicable at the beginning of each segment from the present value of
				guaranteed life insurance and endowment benefits for each segment.
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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.07 - Calculation of Minimum Valuation Standard for Flexible Premium and Fixed Premium Universal Life Insurance Policies That Contain Provisions Resulting in the Ability of a Policyowner to Keep a Policy in Force Over a Secondary Guarantee Period

Current through Rules and Regulations filed through June 27, 2024
(1) General
(a) Policies with a secondary guarantee
				include:
(1) A policy with a guarantee that
				the policy will remain in force at the original schedule of benefits, subject
				only to the payment of specified premiums;
(2) A policy in which the minimum premium at
				any duration is less than the corresponding one year valuation premium,
				calculated using the maximum valuation interest rate and the 1980 CSO valuation
				tables with or without ten-year select mortality factors, or any other table
				adopted after the effective date of this regulation by the NAIC and promulgated
				by regulation by the commissioner for this purpose; or
(3) A policy with any combination of
				Subparagraph (1) and (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 120-2-108 - VALUATION OF LIFE INSURANCE POLICIES › Rule 120-2-108-.08 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
This regulation shall become effective for policies issued on
				  or after January 1, 2000.
O.C.G.A. §§
											33-2-9,
				  33-10-13.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This regulation is issued under the authority granted by
				  O.C.G.A. §
									33-2-9 and O.C.G.A. §
									33-7-14(d)(2)(B).
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.02 - Purpose and Intent

Current through Rules and Regulations filed through June 27, 2024
The purpose and intent of this regulation is to establish
				  uniform, national standards governing reserve financing arrangements pertaining
				  to life insurance policies containing guaranteed nonlevel gross premiums,
				  guaranteed nonlevel benefits and universal life insurance policies with
				  secondary guarantees; and to ensure that, with respect to each such financing
				  arrangement, funds consisting of Primary Security and Other Security, as
				  defined in
				  120-2-109-.05, are held by or on
				  behalf of ceding insurers in the forms and amounts required herein. In general,
				  reinsurance ceded for reserve financing purposes has one or more of the
				  following characteristics: some or all of the assets used to secure the
				  reinsurance treaty or to capitalize the reinsurer (1) are issued by the ceding
				  insurer or its affiliates; or (2) are not unconditionally available to satisfy
				  the general account obligations of the ceding insurer; or (3) create a
				  reimbursement, indemnification or other similar obligation on the part of the
				  ceding insurer or any if its affiliates (other than a payment obligation under
				  a derivative contract acquired in the normal course and used to support and
				  hedge liabilities pertaining to the actual risks in the policies ceded pursuant
				  to the reinsurance treaty).
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.03 - Applicability

Current through Rules and Regulations filed through June 27, 2024
This regulation shall apply to reinsurance treaties that cede
				  liabilities pertaining to Covered Policies, as that term is defined in
				  120-2-109-.05(2),
				  issued by any life insurance company domiciled in this state. This regulation
				  and 120-2-78 shall both apply to such reinsurance treaties; provided, that in
				  the event of a direct conflict between the provisions of this regulation and
				  120-2-78, the provisions of this regulation shall apply, but only to the extent
				  of the conflict.
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.04 - Exemptions from this Regulation

Current through Rules and Regulations filed through June 27, 2024
This regulation does not apply to the situations described in
				  Sections (1) through (6).
(1)
				Reinsurance of:
(a) Policies that satisfy the
				criteria for exemption set forth in
				120-2-108-.06(6)
				or 120-2-108-.06(7);
				and which are issued before the later of:
(i)
				The effective date of this regulation, and
(ii) The date on which the ceding insurer
				begins to apply the provisions of VM-20 to establish the ceded policies'
				statutory reserves, but in no event later than Jan. 1, 2020;
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.05 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "Actuarial
				Method" means the methodology used to determine the Required Level of Primary
				Security, as described in
				120-2-109-.06.
(2) "Covered Policies" means the following:
				Subject to the exemptions described in
				120-2-109-.04, Covered Policies
				are those policies, other than Grandfathered Policies, of the following policy
				types:
(a) Life insurance policies with
				guaranteed nonlevel gross premiums and/or guaranteed nonlevel benefits, except
				for flexible premium universal life insurance policies; or,
(b) Flexible premium universal life insurance
				policies with provisions resulting in the ability of a policyholder to keep a
				policy in force over a secondary guarantee period.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.08 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this regulation is held invalid, the
				  remainder shall not be affected.
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.09 - Prohibition against Avoidance

Current through Rules and Regulations filed through June 27, 2024
No insurer that has Covered Policies as to which this
				  regulation applies (as set forth in
				  120-2-109-.03) shall take any
				  action or series of actions, or enter into any transaction or arrangement or
				  series of transactions or arrangements if the purpose of such action,
				  transaction or arrangement or series thereof is to avoid the requirements of
				  this regulation, or to circumvent its purpose and intent, as set forth in
				  120-2-109-.02.
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-109 - TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING REGULATION › Rule 120-2-109-.10 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
This regulation shall become effective [insert date] and
				  shall pertain to all Covered Policies in force as of and after that
				  date.
O.C.G.A. §§
											33-2-9,
				  33-7-14.
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 120-2-110 - RIGHT TO SHOP › Rule 120-2-110-.01 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) Pursuant to
				O.C.G.A. Section
				33-24-59.27(c)(4)
				 the Commissioner is responsible for
				promulgating rules and regulations which include definitions for the following
				terms:
a) Risk adjusted hospital readmission
				rates;
b) Absolute hospital
				readmission rates;
c) Admission
				volume;
d) Utilization
				volume;
e) Risk adjusted rates of
				adverse events;
f) Risk adjusted
				total cost of care; and
g) Absolute
				relative total cost of care.
We have researched the federal context of these programmatic
				  terms under 42 CFR Parts 412, 413 and 476 and Title XVIII of the Social
				  Security Act, Section 1801. We have determined that at the present time there
				  are no official federal definitions set out for these terms. It is the
				  intention of the Office of Commissioner of Insurance to establish definitions
				  for these terms in keeping with currently developing federal guidance. At such
				  time as federal guidance in this context develops, our Office will act to
				  officially promulgate rule definitions consistent with federal
				  guidance.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.01 - Applicability

Current through Rules and Regulations filed through June 27, 2024
These Rules shall apply to the applicants for certification
				  as independent review organizations, and all attendant procedures thereto; any
				  and all independent review organizations certified by the State Health Planning
				  Agency, or its successor Agency, the Department of Insurance, hereinafter known
				  as the Department, pursuant to the authority granted by O.C.G.A. §
									33-20A-30, which article shall be
				  known and cited as the "Patient's Right to Independent Review Act", and the
				  procedures for the request for independent review; and the procedures for
				  independent review of services previously rendered as well as concurrent or
				  prospective services by a managed care entity to an eligible enrollee as those
				  terms are defined herein. Any independent review organization that has been
				  certified by an independent national accrediting organization that has
				  developed standards for the purpose of bestowing certification or accreditation
				  upon entities of this type, and that can provide documentation to the
				  Department of such certification or accreditation, shall be deemed certified by
				  the Department and shall not have to apply for certification as an independent
				  review organization in Georgia in order to be added to the Department's list of
				  certified independent review organizations.
O.C.G.A. §§
											33-2-9,
				  33-20A-41.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.02 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "Act" means
				O.C.G.A. §
									33-20A-30
et seq.
,
				which shall be known and cited as the "Patient's Right to Independent Review
				Act."
(2) "Adverse Outcome" means a
				decision issued by a managed care entity to an eligible enrollee after the
				grievance procedure provided for in O.C.G.A. §
									33-20A-5, which was a denial of
				the claim in whole or in part of the eligible enrollee or a refusal to pay for
				a treatment sought.
(3) "Affiliate"
				means a person who directly or indirectly, through one or more intermediaries,
				controls, is controlled by, or is under common control with the person
				specified.
(4) "Applicant" means a
				party that seeks approval from the Department to be certified as an independent
				review organization, or to have a previous certification renewed.
(5) "Commissioner" means the Commissioner of
				the Georgia Department of Insurance.
(6) "Dental Plan" means an insurance policy
				or health benefit plan, including a policy written by a company subject to the
				provisions of O.C.G.A. §
									33-20A-1
et seq.
that provides coverage for expenses for dental services.
(7) "Dentist" means a licensed doctor of
				dentistry holding either a D.D.S. or a D.M.D. degree.
(8) "Department" means the Department of
				Insurance.
(9) "Eligible Enrollee"
				means a person who:
(a) Is an enrollee or an
				eligible dependent of an enrollee of a managed care plan or was an enrollee or
				an eligible dependent of an enrollee of such plan at the time of the request
				for treatment and,
(b) Seeks a
				treatment which reasonably appears to be a covered service or benefit under the
				enrollee's evidence of coverage; provided, however, that this subparagraph
				shall not apply if the notice from a managed care plan of the outcome of the
				grievance procedure was that a treatment is experimental.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.04 - Request for Independent Review

Current through Rules and Regulations filed through June 27, 2024
(1) An eligible enrollee shall be entitled to
				appeal to an independent review organization when:
(a) The eligible enrollee has received notice
				of an adverse outcome pursuant to a grievance procedure or the managed care
				entity has not complied with the requirements of Code Section
				33-20A-5 with regard to such
				procedures; or
(b) A managed care
				entity determines that a proposed treatment is excluded as experimental under
				the managed care plan, and all of the following criteria are met:
1. The eligible enrollee has a terminal
				condition that, according to the treating physician, has a substantial
				probability of causing death within two years from the date of the request for
				independent review or the eligible enrollee's ability to regain or maintain
				maximum function, as determined by the treating physician, would be impaired by
				withholding the experimental treatment;
2. After exhaustion of standard treatment as
				provided by the evidence of coverage or a finding that such treatment would be
				of substantially lesser or of no benefit, the eligible enrollee's treating
				physician certifies that the eligible enrollee has a condition for which
				standard treatment would not be medically indicated for the eligible enrollee
				or for which there is no standard treatment available under the evidence of
				coverage of the eligible enrollee more beneficial than the treatment
				proposed;
3. The eligible
				enrollee's treating physician has recommended and certified in writing
				treatment which is likely to be more beneficial to the eligible enrollee than
				any available standard treatment;
4. The eligible enrollee has requested a
				treatment as to which the eligible enrollee's treating physician, who is a
				licensed, board certified or board eligible physician qualified to practice in
				the area of medicine appropriate to treat the eligible enrollee's condition,
				has certified in writing that scientifically valid studies using accepted
				protocols, such as control group or double-blind testing, published in peer
				reviewed literature, demonstrate that the proposed treatment is likely to be
				more beneficial for the eligible enrollee than available standard treatment;
				and
5. A specific treatment
				recommended would otherwise be included within the eligible enrollee's
				certificate of coverage, except for the determination by the managed care
				entity that such treatment is experimental for a particular
				condition.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.05 - Procedure for Request for Independent Review

Current through Rules and Regulations filed through June 27, 2024
(1) In the event that the outcome of the
				grievance procedure under Code Section
				33-20A-5 is adverse to the eligible
				enrollee, the managed care entity shall include with the written notice of the
				outcome of the grievance procedure a statement specifying that any request for
				independent review must be made to the Department on forms made available by
				the Department in accordance with this Rule, and such forms must be included
				with the notification. Such statement shall be in simple, clear language in
				boldface type, which is larger and bolder than any other typeface that is in
				the notice and in at least 14-point typeface.
(2) An eligible enrollee must submit the
				written request for independent review to the Department. This request need not
				be in any required format, but may be a simple written request for an
				independent review of an adverse outcome of a grievance procedure of a managed
				care entity. The request must include the name and address of the eligible
				enrollee, and/or the name and address of the eligible enrollee's guardian in
				the case of a minor, the eligible enrollee's legal guardian in the case of an
				eligible enrollee's incapacity, and/or the eligible enrollee's representative.
				The written request must also include a copy of the notification to the
				eligible enrollee, or the eligible enrollee's applicable representative, of the
				adverse outcome determination of the grievance procedure of the managed care
				entity involved.
(3) Upon receipt
				of a written request by an eligible enrollee or the eligible enrollee's
				applicable representative made in accordance with these Rules as outlined
				above, the Department shall, no later than three (3) working days after
				receipt, notify the eligible enrollee, or the eligible enrollee's applicable
				representative, of receipt of the request and assign the request to an
				independent review organization on a rotating basis according to the date the
				request was received in accordance with these Rules as outlined
				below.
(4) Upon assignment of a
				request for independent review to an independent review organization, the
				Department shall provide written notification of the name and address of the
				assigned organization to both the requesting eligible enrollee, or the eligible
				enrollee's applicable representative, and the managed care entity.
O.C.G.A. §§
											33-2-9,
				  33-20A-41.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.06 - The Conduct of the Review by the Independent Review Organization

Current through Rules and Regulations filed through June 27, 2024
(1) Within three
				working days of receipt of notice from the Department of assignment of the
				request for independent review, the managed care entity shall submit to that
				organization the following:
(a) Any
				information submitted to the managed care entity by the eligible enrollee or
				his/her provider in support of the eligible enrollee's grievance procedure
				filing;
(b) A copy of the contract
				provisions or evidence of coverage of the managed care plan, including the
				entire contract or policy; and
(c)
				Any other relevant documents or information used by the managed care entity in
				determining the outcome of the eligible enrollee's
				grievance.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.07 - Independent Review Organization Decision

Current through Rules and Regulations filed through June 27, 2024
(1) The expert reviewer of the independent
				review organization shall make a determination as to whether a treatment is
				experimental based upon the following criteria:
(a) Whether such treatment has been approved
				by the federal Food and Drug Administration; or
(b) Whether medical and scientific evidence
				demonstrates that the expected benefits of the proposed treatment would be
				greater than the benefits of any available standard treatment and that the
				adverse risks of the proposed treatment will not be substantially increased
				over those of standard treatments.
(c) For either determination, the expert
				reviewer shall apply prudent professional practices and shall assure that at
				least two documents of medical and scientific evidence support the decision.
				The expert reviewer shall take into account evidence and opinions of
				practitioners in the field who are experts in the treatment proposed to be
				offered.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.08 - Independent Review Organization Telephone Access

Current through Rules and Regulations filed through June 27, 2024
(1) An independent review organization shall
				have appropriate personnel reasonably available by telephone, in accordance
				with Eastern Standard or Eastern Daylight time, whichever is applicable, at
				least forty (40) hours per week during normal business hours, to discuss
				eligible enrollee's care and to allow response to telephone questions. The
				independent review organization must also allow reasonable telephone access on
				evenings and weekends.
(2) An
				independent review organization must have a telephone system capable of
				accepting or recording or providing instructions to incoming calls during other
				than normal business hours and shall respond to such calls not later than two
				working days of the later of the date on which the call was received or the
				date the details necessary to respond have been received from the caller. The
				independent review organization shall request the specific information needed
				from the caller not later than two working days after initial receipt of the
				call in question. In the event of an emergency, the independent review
				organization shall respond within the time appropriate to circumstances
				relating to the delivery of the services and the condition of the eligible
				enrollee.
O.C.G.A.
				  §§
										33-2-9,
				  33-20A-41.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.10 - Complaints and Inquiries Regarding Conduct of Independent Review Organizations

Current through Rules and Regulations filed through June 27, 2024
(1) Complaints to the Department. Within a
				reasonable time period, upon receipt of a written complaint alleging a
				violation of these Rules or the Act by an independent review organization from
				an eligible enrollee's health care provider, a person acting on behalf of the
				eligible enrollee, the eligible enrollee, or a managed care entity, the
				Department shall investigate the complaint and furnish a written response to
				the complainant and the independent review organization named.
(2) Authority of the Department to make
				inquiries. In addition to the authority of the Department to respond to
				complaints described in subsection (a) of this section, the Department is
				authorized to address inquiries to any independent review organization in
				relation to the organization's business condition or any matter connected with
				its transactions which the Department may deem necessary for the public good or
				for a proper discharge of its duties. It shall be the duty of the independent
				review organization to promptly answer such inquiries in writing, and in all
				cases within thirty days of the request for response.
O.C.G.A. §§
											33-2-9,
				  33-20A-41.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.11 - On-Site Inspections by the Department

Current through Rules and Regulations filed through June 27, 2024
(1) The Department is authorized to make
				examinations concerning the quality, availability, accessibility, and
				performance of independent review services as often as is deemed
				necessary.
(2) A representative of
				the Department is authorized to visit the administrative offices or any branch
				office of each independent review organization annually, or as frequently as
				necessary, during normal business hours, to review the books and operations of
				the independent review organization.
(3) The independent review organization must
				make available during such on-site visits the following documents:
(a) the minutes of the applicant's
				organizational meetings, indicating the time of each meeting and the
				date;
(b) a list of and information
				regarding physicians and other providers to be used by the independent review
				organization as follows:
1. for physicians,
				indicate:
(i) medical specialty;
(ii) board certification, if any;
(iii) state license number;
(iv) business address; and
(v) any professional association or other
				medical group with whom physicians are affiliated;
2. for other providers, indicate:
(i) address; and
(ii) license or certification, if
				applicable;
(iii) any other records
				concerning the operation of the independent review organization.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.12 - Violations by Independent Review Organizations

Current through Rules and Regulations filed through June 27, 2024
(1) If the Department believes that any
				person conducting independent review is in violation of the Act, or these
				Rules, the Department shall notify the independent review organization of the
				alleged violation and may compel the production of any and all documents or
				other information as necessary to determine whether or not such violation has
				taken place.
(2) The Department may
				initiate appropriate proceedings in accordance with the Act and these
				Rules.
(3) The Department shall be
				the party bringing any action pursuant to these Rules.
(4) If the independent Hearing Officer
				determines that the independent review organization has violated or is
				violating any provision of the Act or these Rules, the Hearing Officer may:
(a) impose sanctions with regard to the
				assignment of review requests to the independent review organization;
(b) require the independent review
				organization to cease and desist from the action(s) found to be in violation of
				the Act or these Rules; and/or
(c)
				revoke or suspend the certification of an independent review
				organization.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.13 - Fees for Independent Review

Current through Rules and Regulations filed through June 27, 2024
(1) Any reviews which involve either a
				Medical Doctor or a Doctor of Osteopathy will be tier-one reviews with a flat
				fee of $ 1,500.
(2) All other type
				of reviews shall be tier-two reviews with a flat fee of $ 1,000.
(3) The fees referenced above shall be the
				flat rate for the applicable type of review, and the independent review
				organizations may also bill the managed care entities for their costs incurred
				in the review. Such costs are intended to include such items as photocopying,
				facsimile, postage, package delivery, and courier costs.
(4) Independent review organizations shall
				bill the managed care entity directly for the fees and costs of independent
				review.
(5) Managed Care Entities
				shall pay independent review organizations directly within 30 days of receipt
				of an invoice.
(6) Failure to Pay
				Invoice. Failure by a managed care entity to pay invoices from independent
				review organization within 30 days of receipt shall constitute a violation
				subject to the penalty referenced under the Act, and codified at O.C.G.A.
				§
									33-20A-35.
O.C.G.A. §§
											33-2-9,
				  33-20A-41.
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 120-2-111 - PATIENT'S RIGHT TO INDEPENDENT REVIEW › Rule 120-2-111-.14 - Assignment of Requests for Independent Review

Current through Rules and Regulations filed through June 27, 2024
(1) The Department shall assign each request
				for independent review to an independent review organization.
(2) Independent review organizations shall be
				added to the list from which assignments for independent review are made in
				order of the date of certification by the Department.
(3) Assignment shall be made chronologically
				from the list of independent review organizations with ultimate assignment
				being to the first in line with no apparent conflicts of interest.
(4) Non-selection for presence of conflicts
				of interest does not move the independent review organization to the bottom of
				the list. Such independent review organization retains its chronological
				position until selected for independent review.
O.C.G.A. §§
											33-2-9,
				  33-20A-41.
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 120-3 - RULES OF SAFETY FIRE COMMISSIONER › Subject 120-3-1 - ORGANIZATION OF THE OFFICE OF THE SAFETY FIRE COMMISSIONER. REPEALED

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Sec.
				25-2-4
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 120-3 - RULES OF SAFETY FIRE COMMISSIONER › Subject 120-3-2 - RULES OF PRACTICE AND PROCEDURE. REPEALED

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Sec.
				25-2-4
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 120-3 - RULES OF SAFETY FIRE COMMISSIONER › Subject 120-3-3 - RULES AND REGULATIONS FOR THE STATE MINIMUM FIRE SAFETY STANDARDS › Rule 120-3-3-.01 - Promulgation and Purpose

Current through Rules and Regulations filed through June 27, 2024
(1) These rules and regulations of the Safety
				Fire Commissioner entitled, "Rules and Regulations for the State Minimum Fire
				Safety Standards" are promulgated to establish the State's minimum fire safety
				standards as specified in the Official Code of Georgia Annotated, (O.C.G.A.)
				Section 25-2-4.
(2) A primary purpose of these rules and
				regulations is to establish the state minimum fire safety standards and
				requirements for the prevention of loss of life and property from fire, panic
				from fear of fire, explosions or related hazards in all buildings, structures
				and facilities with the exception of one- and two- family dwellings, one- and
				two-family row houses (townhouses) separated by a 2-hour fire wall and two-
				family townhouses separated by a 2-hour fire wall.
O.C.G.A.
				  §§
											25-2-4,
				  33-2-9,
				  50-13-21.
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 120-3 - RULES OF SAFETY FIRE COMMISSIONER › Subject 120-3-3 - RULES AND REGULATIONS FOR THE STATE MINIMUM FIRE SAFETY STANDARDS › Rule 120-3-3-.02 - Application

Current through Rules and Regulations filed through June 27, 2024
(1)
(a) Pursuant to O.C.G.A.
				25-2-4, rules and regulations
				adopted by the Safety Fire Commissioner shall have the force and effect of law
				and shall have statewide application as being the state minimum fire safety
				standards and shall not require adoption by a municipality or county. The
				governing authority of any municipality or county in this state is authorized
				to enforce the state minimum fire safety standards on all buildings and
				structures except one-family and two-family dwellings, one- and two-family row
				houses (townhouses) separated by a 2-hour fire wall and two-family townhouses
				separated by a 2-hour fire wall, and those buildings and structures listed in
				O.C.G.A. 25-2-13, except as may be required
				or permitted by O.C.G.A.
				25-2-12 and
				25-2-12.1.
(b) Pursuant to O.C.G.A.
				25-2-13(f), the
				municipal governing authority in any incorporated area or the county governing
				authority in any unincorporated area of the state shall have the authority to
				enact such ordinances as it deems necessary to perform fire safety inspections
				and related activities for those buildings and structures not covered by
				O.C.G.A. 25-2-13.
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 120-3 - RULES OF SAFETY FIRE COMMISSIONER › Subject 120-3-3 - RULES AND REGULATIONS FOR THE STATE MINIMUM FIRE SAFETY STANDARDS › Rule 120-3-3-.04 - State Minimum Fire Safety Standards with Modifications

Current through Rules and Regulations filed through June 27, 2024
(1) Unless
				otherwise stated in this chapter, the edition of the
International Fire
				Code (IFC)
, and the following editions of the codes, standards,
				recommended practices, guides and methods, as published in the
National
				Fire Codes (NFC)
by the National Fire Protection Association (NFPA),
				as adopted and modified in this Chapter, shall be the state minimum fire safety
				standards. Where any of the adopted publications of the NFPA references NFPA 1
				or NFPA 5000, or any fire code or building code, it shall be construed that
				such references apply to the
International Fire Code (IFC)
or
				the
International Building Code
(
IBC
)
				respectively, as adopted by this Chapter 120-3-3, and the Georgia Department of
				Community Affairs. Where the
IFC
or
IBC
does
				not specifically address the referenced issue, NFPA 1 or NFPA 5000 may be
				applied subject to the approval of the authority having jurisdiction.
(2) Hospitals, hospices, ambulatory surgical
				centers, nursing homes, assisted living communities, assisted living homes,
				memory care units or other health care type occupancies or facilities that are
				regulated by the federal Centers for Medicare and Medicaid Services (CMS) shall
				comply with the fire and life safety rules and regulations imposed by that
				agency even though the codes and standards or the editions of codes and
				standards adopted by that agency may not be specifically addressed or included
				in this chapter. The codes and standards adopted and modified herein shall also
				apply where applicable and shall be deemed to be the minimum state fire and
				life safety standards where they are at least as protective as the CMS rules
				and regulations.
(3)
International Fire Code (IFC)
, 2018 Edition
Modifications:
(a)
Modifications to Chapter 1:
1.
				Delete section 101.1 in its entirety and substitute in its place the following:
101.1 "
Title.
The
International Fire Code
, 2018 edition, published by the
International Code Council
, when used in conjunction with this
				Chapter, shall be known as a
Georgia State Minimum Fire Prevention
				Code
, hereafter referred to as 'this
Code'
."