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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.03 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "Exceeded its
				Powers" means, including but not limited to, the following conditions:
(a) The insurer has refused to permit
				examination of its books, papers, accounts, records of affairs by the
				Commissioner;
(b) A domestic
				insurer has unlawfully removed from this State books, papers, accounts or
				records necessary for an examination of the insurer;
(c) The insurer has failed to promptly comply
				with the applicable financial reporting statutes or rules and departmental
				requests relating thereto;
(d) The
				insurer has neglected or refused to observe a requirement or order of the
				Commissioner to make good, within the time prescribed by law, any prohibited
				deficiency in its capital, capital stock, surplus.
(e) The insurer is continuing to transact
				insurance or write business after its license has been revoked or suspended by
				the Commissioner;
(f) The insurer,
				by contract or otherwise, has unlawfully or has in violation of a requirement
				or order of the Commissioner or has without first having obtained written
				approval of the Commissioner if approval is required by law:
1. Totally reinsured its entire outstanding
				business; or
2. Merged or
				consolidated substantially its entire property or business with another
				insurer.
(g) The insurer
				engaged in any transaction in which it is not authorized to engage under the
				laws of this State;
(h) The insurer
				has failed to comply with a lawful requirement or order of the
				Commissioner.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.04 - Applicability

Current through Rules and Regulations filed through June 27, 2024
This Regulation shall apply to all insurers doing business in
				  this State.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-1,
				  33-3-2,
				  33-3-17,
				  33-3-18,
				  33-14-6.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.05 - Requirements to Comply; Administrative Supervision

Current through Rules and Regulations filed through June 27, 2024
(1) If the Commissioner determines that any
				of the conditions exist as set forth in Section
				33-3-17 or
				33-3-18 of the Official Code of
				Georgia Annotated relating to administrative supervision, the Commissioner may
				proceed with the administrative supervision of the insurer.
(2) If placed under administrative
				supervision, the insurer shall have such period of time as deemed necessary by
				the Commissioner to comply with the requirements of the Commissioner subject to
				the provisions of this Regulation.
(3) If it is determined by the Commissioner
				that the conditions giving rise to the supervision still exist at the end of
				the supervision period specified above, the Commissioner may extend such
				period.
(4) If it is determined by
				the Commissioner that none of the conditions giving rise to the supervision
				exist, the Commissioner may release the insurer from supervision.
O.C.G.A. Secs.
				  33-2-9,
				  33-2-11,
				  33-2-12,
				  33-2-14,
				  33-3-1,
				  33-3-17,
				  33-3-18,
				  33-3-19.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.06 - Powers

Current through Rules and Regulations filed through June 27, 2024
The Commissioner may take such action as deemed necessary or
				  appropriate to reform the insurer under supervision and the expense for such
				  action shall be borne by the insurer. The Commissioner shall have all the
				  powers of the shareholders, policyholders, members, subscribers, directors,
				  committees of the board of directors, officers, managers, and attorneys-in-fact
				  whose authority shall be subordinate to him. He shall have full power to direct
				  and manage, to hire and discharge employees, officers and directors,
				  notwithstanding any by-laws of the insurer or any contracts that may exist. The
				  Commissioner may deal directly with the property and business affairs of the
				  insurer.
(a) Administrative
				supervision consists of supervision of the actions of the Board of Directors of
				the company and the employees of the company. Any resolutions by the board of
				Directors shall be subject to the approval of the Commissioner. All actions and
				transactions of the employees and officers of the company are subject to the
				approval of the Commissioner as the administrator.
(b) The Commissioner shall have control over
				the cash receipts and cash disbursements of the company. All company decisions
				shall be subject to the approval of the Commissioner.
(c) The Commissioner shall be able to act for
				the company in connection with any of its custodian agreements.
(d) The Commissioner may require the insurer
				to:
1. Reduce the total amount of present and
				potential liability for policy benefits by reinsurance;
2. Reduce, suspend or limit the volume of
				business being accepted or renewed;
3. Reduce general insurance and commission
				expenses by specified methods;
4.
				Increase the insurer's capital and surplus;
5. Suspend or limit the declaration and
				payment of dividend by an insurer to its stockholders or to its
				policyholders;
6. File reports in a
				form acceptable to the Commissioner concerning the market value of an insurer's
				assets;
7. Limit or withdraw from
				certain investments or discontinue certain investment practices to the extent
				the Commissioner deems necessary;
8. Document the adequacy of premium rates in
				relation to the risks insured; or
9. File, in addition to regular annual
				statements, interim financial reports on the form adopted by the National
				Association of Insurance Commissioners or on such format as promulgated by the
				Commissioner.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.07 - Prohibited Acts During Period of Supervision

Current through Rules and Regulations filed through June 27, 2024
During the period of supervision, the Commissioner or his
				  designated appointee shall serve as the Administrator. The Commissioner may
				  provide that the insurer is prohibited from doing any of the following things
				  during the period of supervision, without the prior approval of the
				  Commissioner or his appointed supervisor:
(a) Dispose of; convey or encumber any of its
				assets or its business in force;
(b) Withdraw any of its bank
				accounts;
(c) Lend any of its
				funds;
(d) Invest any of its
				funds;
(e) Transfer any of its
				property;
(f) Incur any debt,
				obligation or liability;
(g) Merge
				or consolidate with another company;
(h) Approve new premiums or renew any
				policies;
(i) Enter into any new
				reinsurance contract or treaty;
(j)
				Terminate, surrender, forfeit, convey or lapse any insurance policy,
				certificate or contract, except for nonpayment of premiums due;
(k) Release, pay or refund premium deposits,
				accrued cash or loan values, unearned premiums, or other reserves on any
				insurance policy, certificate or contract;
(l) Make any material change in
				management;
(m) Increase salaries
				and benefits of officers or directors or the preferential payment of bonuses,
				dividends or other payments deemed preferential; or
(n) Any other action the Commissioner deems
				may impair the safety or security of the insurer's policyholders or certificate
				holders, its creditors, or the public.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-1,
				  33-3-17,
				  33-3-18.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.08 - Administrative Election of Proceedings

Current through Rules and Regulations filed through June 27, 2024
Nothing contained in this Regulation shall preclude the
				  Commissioner from initiating proceedings to place an insurer in conservation,
				  rehabilitation or liquidation proceedings or other delinquency proceedings,
				  however designated under the laws of this State, regardless of whether the
				  Commissioner has previously initiated administrative supervision proceedings
				  under this Regulation against the insurer.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-17,
				  33-3-18,
				  33-37-7,
				  33-37-8.
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 120-2-55 - ADMINISTRATIVE SUPERVISION › Rule 120-2-55-.09 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of this Regulation or the application
				  thereof to any person or circumstance is held invalid by a court of competent
				  jurisdiction, the remainder of the Regulation or the applicability of such
				  provision to other persons or circumstances shall not be
				  affected.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-1,
				  33-13-8.
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 120-2-56 - WORKERS' COMPENSATION HEALTH BENEFITS PILOT PROJECTS › Rule 120-2-56-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This Regulation is adopted and promulgated by the
				  Commissioner of Insurance pursuant to the authority set forth in O.C.G.A.
				  Sections 33-2-9 and
				  34-9-122.1.
O.C.G.A. Secs.
				  33-2-9,
				  34-9-122.1.
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 120-2-56 - WORKERS' COMPENSATION HEALTH BENEFITS PILOT PROJECTS › Rule 120-2-56-.02 - Workers' Compensation Health Benefits Pilot Projects

Current through Rules and Regulations filed through June 27, 2024
The Commissioner of Insurance shall permit, but not require,
				  employers and employees to enter into agreements to provide the employees with
				  workers' compensation medical payments benefits through comprehensive health
				  insurance that covers workplace injury and illness. The Commissioner of
				  Insurance shall determine whether the medical benefits afforded under pilot
				  projects for injured employees are substantially similar to benefits available
				  under Title 34, Chapter 9, of the Official Code of Georgia Annotated, relating
				  to workers' compensation.
O.C.G.A. Secs.
				  33-2-9,
				  34-9-122.1.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.01 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The Purpose of this Chapter of the Rules and Regulations of
				  the Office of Commissioner of Insurance is to promote the delivery of quality
				  health care by cost-effective means, efficient communication, protection of
				  parties involved, accessible treatment done in a timely and effective manner,
				  maintaining confidentiality of information, and to provide minimum standards
				  for private review agents.
O.C.G.A. Secs.
				  33-2-9,
				  33-46-1,
				  33-46-11.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.03 - Application and Renewal Filing Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) Applications for certification shall be
				submitted to the Office of the Commissioner of Insurance on Forms GID-57,
				GID-65(UR) and GID-72, attached hereto and incorporated herein, along with the
				original license or certificate fee and application fee required for private
				review agents under O.C.G.A.
				33-8-1.
(2) Private review agents operating in
				Georgia prior to the effective date of this Chapter of the Rules and
				Regulations of the Office of Commissioner of Insurance and which have not
				applied for certification within sixty (60) days of such effective date shall
				be in violation of Chapter 46 of Title 33 of the Official Code of Georgia
				Annotated and this Chapter of the Rules and Regulations of the Office of
				Commissioner of Insurance and are prohibited from operating as a private review
				agent until such private review agent has applied for certification and has
				been certified.
(3)
(a) Any private review agent not operating in
				Georgia on the effective date of this Chapter of the Rules and Regulations of
				the Office of Commissioner of Insurance may apply for certification at any time
				prior to doing business in Georgia.
(b) A private review agent or utilization
				review entity may not conduct utilization review of healthcare services
				provided in this state unless the Commissioner has granted the private review
				agent or utilization review entity a certificate pursuant to this chapter.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.04 - Refusal, Suspension and Revocation

Current through Rules and Regulations filed through June 27, 2024
The Office of Commissioner of Insurance may refuse to issue
				  or renew and may suspend or revoke a certificate if a private review
				  agent:
(a) Violates any provision or
				otherwise fails to comply with any provision of Chapter 46 of Title 33 of the
				Official Code of Georgia Annotated or this Chapter of the Rules and Regulations
				of the Office of Commissioner of Insurance;
(b) Has intentionally misrepresented or
				concealed any material fact in any application for certification or on any form
				filed with the Commissioner of Insurance;
(c) Has obtained or attempted to obtain the
				certification by misrepresentation, concealment, or other fraud or uses a
				certification without proper authority; or
(d) Has failed to produce records in response
				to a written request by the Office of Commissioner of Insurance sent to the
				last known address of the private review agent.
O.C.G.A. Secs.
				  33-2-9,
				  33-46-1,
				  33-46-11.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.05 - Requirements for Utilization Review

Current through Rules and Regulations filed through June 27, 2024
(1) Private review agents shall have
				sufficient staff to facilitate review in accordance with review criteria and
				shall designate one or more individuals able to effectively communicate medical
				and clinical information.
(2)
				Private review agent shall provide access to its review staff by a toll free or
				collect call telephone line during normal business hours. A private review
				agent shall have an established procedure to review timely call backs from
				health care providers and shall establish written procedures for receiving
				after-hour calls, either in person or by recording.
(3) Private review agent shall collect only
				the information necessary to certify the admission, procedure or treatment,
				length of stay, frequency and duration of services. All requests for
				information shall be made during normal business hours.
(4) Private review agents shall identify
				themselves prior to collecting necessary information.
(5) Private review agents shall establish and
				follow procedures and rules for on-site medical facility review.
(6) In the event a private review agent
				questions the medical necessity or appropriateness of care, the following
				procedures will apply:
(a) The attending
				health care provider shall have the opportunity to discuss a utilization review
				determination promptly by telephone with a clinical peer, an identified health
				care provider representing the private review agent and trained in a related
				healthcare specialty. If the determination is made not to certify, an adverse
				determination exists.
(b)
				Reconsideration of an adverse determination occurs when any questions
				concerning medical necessity or appropriateness of care are not resolved under
				subparagraph (a) above. The right to appeal an adverse determination shall be
				available to the enrollee and the attending physician or other ordering health
				care provider. The enrollee or enrollee's representative shall be allowed a
				second review by another identified health care provider in an appropriate
				medical specialty who represents the private review agent.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.06 - Complaint Procedure

Current through Rules and Regulations filed through June 27, 2024
Private review agents shall establish and maintain a
				  complaint system which includes, at a minimum, the following:
(a) Establishes and maintains a complaint
				system which has been approved by the Commissioner and which provides
				reasonable procedures for the resolution of written complaints initiated by
				enrollees covered persons or health care healthcare providers concerning
				utilization review;
(b) Maintains
				records of such written complaints for five years from the time the complaints
				are filed and submits to the Commissioner a summary report at such times and in
				such format as the Commissioner may require; and
(c) Permits the Commissioner to examine the
				complaints at any time
(d) All
				complaints shall be directed to the private review agent; and
(e) The private review agent shall contact
				the complainant, gather all pertinent facts regarding the complaint, and
				attempt to resolve the complaint as soon as reasonably possible within the
				context of written policies and procedures.
O.C.G.A.
				  §§
											33-2-9,
				  33-46-1,
				  33-46-11.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.07 - Reporting Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) By March 1, 2023, and annually thereafter
				on or before the same date, each private review agent shall submit to the
				Office of the Commissioner of Insurance a list of all complaints by type and
				disposition, and an analysis of such complaints files against them during the
				past calendar year.
(2) By March 1,
				2023, and annually thereafter on or before the same date, the annual report
				information regarding utilization review activities for the preceding calendar
				year shall be submitted to the Office of Commissioner of Insurance on Form
				GID-73 which is attached hereto and incorporated herein.
(3) The Commissioner of Insurance shall
				require any other reporting requirements that are necessary to fully evaluate
				utilization review compliance with Chapter 46 of Title 33 of the Official Code
				of Georgia Annotated and this Chapter of the Rules and Regulations of the
				Office of Commissioner of Insurance and the impact of utilization review
				programs on patient access to care.
(4) Each private review agent shall notify
				the Office of Commissioner of Insurance in writing within sixty (60) days of
				any changes to information last filed with the Office of Commissioner of
				Insurance under Form GID-57.
O.C.G.A.
				  33-2-9,
				  33-46-1,
				  33-46-11.
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 120-2-58 - CERTIFICATION OF PRIVATE REVIEW AGENTS › Rule 120-2-58-.08 - Penalties

Current through Rules and Regulations filed through June 27, 2024
Any certified private review agent which violates or fails to
				  comply with any provision of Chapter 46 of Title 33 of the Official Code of
				  Georgia Annotated and this Chapter of the Rules and Regulations of the Office
				  of Commissioner of Insurance will be subject to fines and penalties applicable
				  to licensed insurers generally, including revocation of its certification or
				  right to do business in this state.
O.C.G.A. Secs.
				  33-2-9,
				  33-46-1,
				  33-46-11.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.01 - 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 by O.C.G.A. Sections
				  33-2-9 and
				  33-24-10.1.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.02 - Purpose

Current through Rules and Regulations filed through June 27, 2024
The purpose of this Regulation Chapter is to implement the
				  provisions of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,
				  provide for a standardized form to be used in the billing and reimbursement of
				  health care, reduce the number of forms utilized and increase efficiency in the
				  reimbursement of health care through standardization.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.03 - Applicability and Scope

Current through Rules and Regulations filed through June 27, 2024
(1) Except as otherwise specifically
				provided, this Regulation Chapter shall apply to all issuers, health care
				practitioners, and institutional care practitioners.
(2) Nothing in this Regulation Chapter shall
				prohibit an issuer, health care practitioner or institutional care practitioner
				from using alternative forms or procedures for filing claims as are specified
				in a written contract between the health care practitioner or institutional
				care practitioner and issuer.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.04 - Definitions

Current through Rules and Regulations filed through June 27, 2024
For the purposes of O.C.G.A.
				  33-24-10.1 and this Regulation
				  Chapter:
(a) "HCFA" means the Health
				Care Financing Administration of the United States Department of Health and
				Human Services.
(b) "HCFA Form
				1450" means the health insurance claim form maintained by HCFA for use by
				institutional care practitioners.
(c) "HCFA Form 1500" means the health
				insurance claim form maintained by HCFA for use by health care
				practitioners.
(d) "Health Care
				Practitioner" means a health care provider duly licensed by the Secretary of
				State of the State of Georgia pursuant to the Official Code of Georgia
				Annotated and the Rules and Regulations of the State of Georgia.
(e) "Institutional Care Practitioner" means a
				hospice, hospital, skilled nursing facility, extended care facility,
				intermediate care facility, convalescent nursing home, and personal care
				facility licensed pursuant to the Official Code of Georgia Annotated and the
				Rules and Regulations of the State of Georgia.
(f) "Insured" means an individual covered
				under a policy of insurance or the provider to which that individual has
				assigned benefits.
(g) "Issuer"
				means an insurance company, fraternal benefit society, health care service
				plan, health maintenance organization, third party administrator, and any other
				entity reimbursing the costs of health care expenses.
(h) "J512 Form" means the uniform dental
				claim form approved by the American Dental Association for use by
				dentists.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.05 - Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) Health care
				practitioners and institutional care practitioners shall use and accept the
				most current editions of the HCFA Form 1450, HCFA Form 1500, or J512 Form and
				most current instructions for these forms in the billing of patients or their
				representatives and filing claims with issuers.
(2) Issuers shall provide, upon request, to
				health care practitioners, institutional care practitioners and insureds, and
				accept the most current editions of the HCFA Form 1450, HCFA Form 1500, or J512
				Form for the processing of claims.
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-59 - STANDARD CLAIM FORM FOR ACCIDENT AND SICKNESS INSURANCE › Rule 120-2-59-.06 - 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, the remainder of the Regulation Chapter and the application of such
				  provision to other persons or circumstances shall not be affected
				  thereby.
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				  here to view
O.C.G.A. Secs.
				  33-2-9,
				  33-24-10.1.
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 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This rule is promulgated by the Commissioner of Insurance
				  pursuant to Sections
				  33-2-9 and
				  33-3-21 of the Georgia Insurance
				  Code.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.02 - Purpose and Scope

Current through Rules and Regulations filed through June 27, 2024
(1) The purpose of this rule is to improve
				the Georgia Insurance Department's surveillance of the financial condition of
				insurers by requiring an annual examination by independent certified public
				accountants of the financial statements reporting the financial position and
				the results of operations of insurers.
(2) Every insurer (as defined in
				120-2-60-.03) shall be subject to
				this rule. Insurers having direct premiums written in this state of less than
				$1,000,000 in any calendar year and less than 1,000 policyholders or
				certificate holders of directly written policies nationwide at the end of such
				calendar year shall be exempt from this rule for such year (unless the
				Commissioner makes a specific finding that compliance is necessary for the
				Commissioner to carry out statutory responsibilities) except that insurers
				having assumed premiums pursuant to contracts and/or treaties of reinsurance of
				$1,000,000 or more will not be so exempt.
(3) Foreign or alien insurers filing audited
				financial reports in another state, pursuant to such other state's requirement
				of audited financial reports which has been found by the Commissioner to be
				substantially similar to the requirements herein, are exempt from this rule if:
(a) A copy of the Audited Financial Report,
				Report on Significant Deficiencies in Internal Controls, and the Accountant's
				Letter of Qualifications which are filed with such other state are filed with
				the Commissioner in accordance with the filing dates specified in
				120-2-60-.04 and .11 and .12,
				respectively (Canadian insurers may submit accountants' reports as filed with
				the Canadian Dominion Department of Insurance); or
(b) A copy of any Notification of Adverse
				Financial Condition Report filed with such other state is filed with the
				Commissioner within the time specified in
				120-2-60-.10.
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 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.04 - Filing and Extensions for Filing of Annual Audited Financial Reports

Current through Rules and Regulations filed through June 27, 2024
(1) All insurers
				shall have an annual audit by an independent certified public accountant and
				shall file an Audited financial report with the Commissioner on or before June
				1 for the year ended December 31 immediately preceding. The Commissioner may
				require an insurer to file an audited financial report earlier than June 1 with
				ninety (90) days advance notice to the insurer.
(2) Extensions of the June 1 filing date may
				be granted by the Commissioner for thirty (30) day periods upon showing by the
				insurer and its independent certified public accountant the reasons for
				requesting such extension and determination by the Commissioner of good cause
				for an extension. The request for extension must be submitted in writing not
				less than ten (10) days prior to the due date in sufficient detail to permit
				the Commissioner to make an informed decision with respect to the requested
				extension.
(3) If an extension is
				granted in accordance with the provisions in paragraph 2, a similar extension
				of thirty (30) days is granted to the filing of Management's Report of Internal
				Control over Financial Reporting.
(4) Every insurer required to file an annual
				Audited financial report pursuant to this regulation shall designate a group of
				individuals as constituting its Audit committee, as defined in
				120-2-60-.03(3).
				The Audit committee of an entity that controls an insurer may be deemed to be
				the insurer's Audit committee for purposes of this regulation at the election
				of the controlling person.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.05 - Contents of Annual Audited Financial Report

Current through Rules and Regulations filed through June 27, 2024
(1) The annual Audited financial report shall
				report the financial position of the insurer as of the end of the most recent
				calendar year and the results of its operations, cash flows and changes in
				capital and surplus for the year then ended in conformity with statutory
				accounting practices prescribed, or otherwise permitted, by the Department of
				Insurance of the state of domicile.
(2) The annual Audited financial report shall
				include the following:
(a) Report of
				independent certified public accountant;
(b) Balance sheet reporting admitted assets,
				liabilities, capital and surplus;
(c) Statement of operations;
(d) Statement of cash flows;
(e) Statement of changes in capital and
				surplus;
(f) Notes to financial
				statements. These notes shall be those required by the appropriate NAIC Annual
				Statement Instructions and the NAIC Accounting Practices and Procedures Manual.
				In addition these notes shall also include:
1.A reconciliation of differences, if any,
				between the audited statutory financial statements and the Annual Statement
				filed pursuant to O.C.G.A. Section
				33-3-21 of the Georgia Insurance
				Code with a written description of the nature of these differences;
2.A summary of ownership and relationships of
				the insurer and all affiliated companies; and
(g) The financial statements included in the
				Audited Financial Report shall be prepared in a form and using language and
				groupings substantially the same as the relevant sections of the Annual
				Statement of the insurer filed with the Commissioner, and the financial
				statement shall be comparative, presenting the amounts as of December 31 of the
				current year and the amounts as of the immediately preceding December 31.
				(However, in the first year in which an insurer is required to file an audited
				financial report, the comparative data may be omitted.)
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 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.07 - Qualifications of Independent Certified Public Accountant

Current through Rules and Regulations filed through June 27, 2024
(1) The
				Commissioner shall not recognize any person or firm as a qualified independent
				certified public accountant if that person or firm:
(a) Is not in good standing with the AICPA
				and in all states in which the accountant is licensed to practice, or, for a
				Canadian or British company, that is not a chartered accountant; or
(b) Has either directly or indirectly entered
				into an agreement of indemnity or release from liability (collectively referred
				to as indemnification) with respect to the audit of the insurer.
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 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.08 - Consolidated or Combined Audits

Current through Rules and Regulations filed through June 27, 2024
An insurer may make written application to the Commissioner
				  for approval to file audited consolidated or combined financial statements in
				  lieu of separate annual audited financial statements if the insurer is part of
				  a group of insurance companies which utilizes a pooling or one hundred percent
				  reinsurance agreement that affects the solvency and integrity of the insurer's
				  reserves and such insurer cedes all of its direct and assumed business to the
				  pool. In such cases, a columnar consolidating or combining worksheet shall be
				  filed with the report, as follows:
(a)
				Amounts shown on the consolidated or combined Audited Financial Report shall be
				shown on the worksheet;
(b) Amounts
				for each insurer subject to this section shall be stated separately;
(c) Noninsurance operations may be shown on
				the worksheet on a combined or individual basis;
(d) Explanations of consolidating and
				eliminating entries shall be included; and
(e) A reconciliation shall be included of any
				differences between the amounts shown in the individual insurer columns of the
				worksheet and comparable amounts shown on the Annual Statements of the
				insurers.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.09 - Scope of Examination and Report of Independent Certified Public Accountant

Current through Rules and Regulations filed through June 27, 2024
Financial statements furnished pursuant to
				  120-2-60-.05 hereof shall be
				  audited by an independent certified public accountant. The audit of the
				  insurer's financial statements shall be conducted in accordance with generally
				  accepted auditing standards. In accordance with AU Section 319 of the
				  Professional Standards of the AICPA (Consideration of Internal Control in a
				  Financial Statement Audit), the independent certified public accountant should
				  obtain an understanding of internal control sufficient to plan the audit. To
				  the extent required by AU 319, for those insurers required to file a
				  Management's Report of Internal Control over Financial Reporting pursuant to
				  120-2-60-.17, the independent
				  certified public accountant should consider (as that term is defined in
				  Statement on Auditing Standards (SAS) No. 102, Defining Professional
				  Requirements in Statements on Auditing Standards or its replacement) the most
				  recently available report in planning and performing the audit of the statutory
				  financial statements. Consideration shall also be given to such other
				  procedures illustrated in the Financial Condition Examiner's Handbook
				  promulgated by the National Association of Insurance Commissioners as the
				  independent certified public accountant deems necessary.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.10 - Notification of Adverse Financial Condition

Current through Rules and Regulations filed through June 27, 2024
(1) The insurer required to furnish the
				annual Audited financial report shall require the independent certified public
				accountant to report, in writing, within five (5) business days to the board of
				directors or its Audit committee any determination by the independent certified
				public accountant that the insurer has materially misstated its financial
				condition as reported to the Commissioner as of the balance sheet date
				currently under audit or that the insurer does not meet the minimum capital and
				surplus requirement of the Georgia Insurance Code as of that date. An insurer
				who has received a report pursuant to this paragraph shall forward a copy of
				the report to the Commissioner within five (5) business days of receipt of such
				report and shall provide the independent certified public accountant making the
				report with evidence of the report being furnished to the Commissioner. If the
				independent certified public accountant fails to receive such evidence within
				the required five (5) business day period, the independent certified public
				accountant shall furnish to the Commissioner a copy of its report within the
				next five (5) business days.
(2) No
				independent certified public accountant shall be liable in any manner to any
				person for any statement made in connection with the above paragraph if the
				statement is made in good faith in compliance with paragraph 1.
(3) If the accountant, subsequent to the date
				of the Audited financial report filed pursuant to this rule, becomes aware of
				facts which might have affected his report, the Commissioner notes the
				obligation of the accountant to take such action as prescribed in Volume 1,
				Section AU 561 of the Professional Standards of the AICPA.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.11 - Communication of Internal Control Related Matters Noted in an Audit

Current through Rules and Regulations filed through June 27, 2024
(1) In addition to
				the annual audited financial Statements, each insurer shall furnish the
				Commissioner with a written communication as to any unremediated material
				weaknesses in its Internal control over financial reporting noted during the
				audit. Such communication shall be prepared by the accountant within sixty (60)
				days after the filing of the annual Audited financial report, and shall contain
				a description of any unremediated material weakness (as the term material
				weakness is defined by Statement on Auditing Standard 60, Communication of
				Internal Control Structure Matters Noted in an Audit, or its replacement) as of
				December 31 immediately preceding (so as to coincide with the Audited financial
				report discussed in
				120-2-60-.04(1))
				in the insurer's Internal control over financial reporting noted by the
				accountant during the course of their audit of the financial statements. If no
				unremediated material weaknesses were noted, the communication shall so
				state.
(2) The insurer is required
				to provide a description of remedial actions taken or proposed to correct
				unremediated material weaknesses, if the actions are not described in the
				accountant's communication.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.
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 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-60 - CPA ANNUAL AUDITED FINANCIAL REPORTS › Rule 120-2-60-.12 - Accountant's Letter of Qualifications

Current through Rules and Regulations filed through June 27, 2024
The accountant shall furnish the insurer in connection with,
				  and for inclusion in, the filing of the annual Audited financial report, a
				  letter stating:
(a) That the accountant
				is independent with respect to the insurer and conforms to the standards of his
				or her profession as contained in the Code of Professional Ethics and
				pronouncements of the AICPA and the Rules of Professional Conduct of the
				Georgia Board of Public Accountancy, or similar code;
(b) The background and experience in general,
				and the experience in audits of insurers of the staff assigned to the
				engagement and whether each is an independent certified public accountant.
				Nothing within this rule shall be construed as prohibiting the accountant from
				utilizing such staff as he or she deems appropriate where use is consistent
				with the standards prescribed by generally accepted auditing
				standards;
(c) That the accountant
				understands the annual Audited financial report and his or her opinion thereon
				will be filed in compliance with this rule and that the Commissioner will be
				relying on this information in the monitoring and regulation of the financial
				position of insurers;
(d) That the
				accountant consents to the requirements of
				120-2-60-.13 and that the
				accountant consents and agrees to make available for review by the
				Commissioner, or the Commissioner's designee or appointed agent, the workpapers
				as defined in
				120-2-60-.13;
(e) A representation that the accountant is
				properly licensed by an appropriate state licensing authority and is a member
				in good standing in the AICPA; and
(f) A representation that the accountant is
				in compliance with the requirements of
				120-2-60-.07 of this
				regulation.
O.C.G.A. Secs.
				  33-2-9,
				  33-3-21.