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 120-2-95 - MILITARY SALES PRACTICES › Rule 120-2-95-.05 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "Active Duty"
				means full-time duty in the active military service of the United States and
				includes members of the reserve component (National Guard and Reserve) while
				serving under published orders for active duty or full-time training. The term
				does not include members of the reserve component who are performing active
				duty or active duty for training under military calls or orders specifying
				periods of less than 31 calendar days.
(2) "Department of Defense (DoD) Personnel"
				means all active duty service members and all civilian employees, including
				nonappropriated fund employees and special government employees, of the
				Department of Defense.
(3) "Door to
				Door" means a solicitation or sales method whereby an insurance producer
				proceeds randomly or selectively from household to household without prior
				specific appointment.
(4) "General
				Advertisement" means an advertisement having as its sole purpose the promotion
				of the reader's or viewer's interest in the concept of insurance, or the
				promotion of the insurer or the insurance producer.
(5) "Insurer" means an insurance company
				required to be licensed under the laws of this state to provide life insurance
				products, including annuities.
(6)
				"Insurance producer" means a person required to be licensed under the laws of
				this state to sell, solicit or negotiate life insurance, including
				annuities.
(7) "Known" or
				"Knowingly" means, depending on its use herein, the insurance producer or
				insurer had actual awareness, or in the exercise of ordinary care should have
				known, at the time of the act or practice complained of, that the person
				solicited:
(a) is a service member;
				or
(b) is a service member with a
				pay grade of E-4 or below.
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 120-2-95 - MILITARY SALES PRACTICES › Rule 120-2-95-.06 - Practices Declared Dishonest, Unfair, or Deceptive on a Military Installation

Current through Rules and Regulations filed through June 27, 2024
(1) The following acts or practices when
				committed on a military installation by an insurer or insurance producer with
				respect to the in-person, face-to-face solicitation of life insurance are
				declared to be dishonest, unfair, or deceptive:
(a) Knowingly soliciting the purchase of any
				life insurance product "door to door" or without first establishing a specific
				appointment for each meeting with the prospective purchaser.
(b) Soliciting service members in a group or
				"mass" audience or in a "captive" audience where attendance is not
				voluntary.
(c) Knowingly making
				appointments with or soliciting service members during their normally scheduled
				duty hours.
(d) Making appointments
				with or soliciting service members in barracks, day rooms, unit areas, or
				transient personnel housing or other areas where the installation commander has
				prohibited solicitation.
(e)
				Soliciting the sale of life insurance without first obtaining permission from
				the installation commander or the commander's designee.
(f) Posting unauthorized bulletins, notices
				or advertisements.
(g) Failing to
				present DD Form 2885,
Personal Commercial Solicitation
				Evaluation
, to service members solicited or encouraging service
				members solicited not to complete or submit a DD Form 2885.
(h) Knowingly accepting an application for
				life insurance or issuing a policy of life insurance on the life of an enlisted
				member of the United States Armed Forces without first obtaining for the
				insurer's files a completed copy of any required form which confirms that the
				applicant has received counseling or fulfilled any other similar requirement
				for the sale of life insurance established by regulations, directives or rules
				of the DoD or any branch of the Armed Forces.
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 120-2-95 - MILITARY SALES PRACTICES › Rule 120-2-95-.08 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of these sections or the application thereof
				  to any person or circumstance is held invalid for any reason, the invalidity
				  shall not affect the other provisions or any other application of these
				  sections which can be given effect without the invalid provisions or
				  application. To this end all provisions of these sections are declared to be
				  severable.
O.C.G.A. Secs.
				  33-2-9,
				  33-6-4,
				  33-6-12.
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 120-2-95 - MILITARY SALES PRACTICES › Rule 120-2-95-.09 - Effective Date

Current through Rules and Regulations filed through June 27, 2024
This regulation shall become effective September 1, 2007, and
				  shall apply to acts or practices committed on or after the effective
				  date.
O.C.G.A. Secs.
				  33-2-9,
				  33-6-4,
				  33-6-12.
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 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN › Rule 120-2-96-.01 - Authority and Purpose

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Section
				  33-51-2(1)
				   authorizes the Commissioner of Insurance to
				  "establish flexible guidelines" for HSA-High Deductible Health Plan filings
				  submitted in connection with products that incorporate health promotion and
				  wellness principles. Within the provisions of Chapter 33-51-4, it is stated
				  that to the extent wellness principles are applied within approved policy
				  contracts, that discounts, refunds, credits or other incentives shall not be
				  considered to be illegal inducements or rebating under applicable provisions of
				  the Georgia Insurance Code, including Unfair Trade Practice provisions. Other
				  provisions of the Act make changes to PPO allowable differentials between
				  classes of providers and product design potential changes. This Rule is
				  intended to amplify and promulgate practical guidelines to carry out the
				  Georgia Affordable HSA Eligible High Deductible Health Plan Act.
O.C.G.A. Secs.
				  33-2-9,
				  33-51-3.
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 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN › Rule 120-2-96-.02 - Categories of Products Allowed as High Deductible Health Plan in Wellness Program

Current through Rules and Regulations filed through June 27, 2024
Under this Rule, a health insurance policy, which satisfies
				  Internal Revenue Code requirements for a High Deductible Health Plan, may be
				  used by an insurer in connection with a Wellness Program and with a Health
				  Savings Account program.
Health insurance product categories include, without
				  limitation:
(1) Comprehensive or major
				medical health insurance products offered by Life, Accident and Sickness
				Insurers or Property and Casualty Insurers;
(2) Comprehensive or major medical health
				coverage products styled and appropriately disclosed as health maintenance
				organization coverage when offered by a licensed HMO;
(3) Preferred Provider Organization
				comprehensive or major medical health coverage products offered by insurers of
				any applicable licensure type;
(4)
				Point of Service comprehensive or major medical health insurance coverage
				products (when offered by licensed insurers in connection with approved HMO
				products); or
(5) Other
				comprehensive or major medical health insurance products which do not violate
				IRS Rules for High Deductible Health Plans under Section 223 of the Internal
				Revenue Code or related IRS Rules and Regulations.
Filings of product types described in (1) through (5) above
				  may be reviewed and considered for approval by the Commissioner. Such product
				  filings may also be considered for favorable treatment under Georgia provisions
				  relating to taxation and relief from unfair trade practice provisions regarding
				  rebating or illegal inducements with respect to wellness program benefits under
				  O.C.G.A. Sections
				  33-51-2 and
				  33-51-4.
O.C.G.A. Secs.
				  33-2-9,
				  33-8-8.2,
				  33-51-3,
				  33-51-4.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN › Rule 120-2-96-.03 - Special Provisions for Preferred Provider Organization Products Under O.C.G.A. Section 33-51-5, O.C.GA. Section 33-51-6 and This Rule

Current through Rules and Regulations filed through June 27, 2024
(1) Preferred
				Provider Organization ("PPO") products offered under O.C.G.A. Section
				33-51-5 may contain greater
				percentage differentials between preferred and non-preferred providers than the
				30% percentage differential limitations under Rule
				120-2-44-.04(5).
				Notwithstanding O.C.G.A. Section
				33-51-5 and Rule
				120-2-96-.03(1),
				plans may not have a coinsurance percentage applicable to benefit levels for
				services provided by non-preferred providers that is less than 60% of the
				benefit levels under the policy for such services. This means the maximum
				coinsurance percentage which may be required by insurers for the enrollee's
				responsibility for non-preferred provider benefits under PPO products remains
				at a maximum of 40%.
(2) O.C.G.A.
				Section 33-51-6 confirms the continuation
				of the historical requirement under Georgia Law that within PPO coverage,
				non-preferred dental and/or non-preferred pharmaceutical providers be
				reimbursed by insurers at the same level as preferred dental or pharmaceutical
				providers as stated in O.C.G.A. Section
				33-30-23 and O.C.G.A. Section
				33-51-6.
O.C.G.A. Secs.
				  33-2-9,
				  33-51-3.
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 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN › Rule 120-2-96-.04 - Categories of Products Not Qualified for Favorable Treatment in Wellness Program

Current through Rules and Regulations filed through June 27, 2024
Examples of plans that will not be allowable or approved
				  under O.C.G.A. Section
				  33-51-2 would include, but not be
				  limited to:
(1) limited benefit
				insurance products, as defined in O.C.G.A. Section
				33-30-12, where the term "limited
				benefit insurance" means accident and sickness insurance designed, advertised,
				and marketed to supplement major medical insurance. The term "limited benefit
				insurance" includes accident only, CHAMPUS supplement, dental, disability
				income, fixed indemnity, long term care, Medicare supplement, specified
				disease, vision, and any other accident and sickness insurance other than basic
				hospital expense, basic medical-surgical expense, or major medical
				insurance.
(2) limited duration
				health insurance products of terms of less than 12 months, regardless of the
				scope or limitations of benefits within the health insurance
				coverage.
O.C.G.A. Secs.
				  33-2-9,
				  33-51-3.
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 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN › Rule 120-2-96-.05 - Product Filing Standards and Procedures

Current through Rules and Regulations filed through June 27, 2024
(1) Insurers proposing products for
				consideration and potential approval under O.C.G.A. Chapter 33-51 and this Rule
				shall, in cover letters or their equivalent if filed electronically under
				SERFF, indicate their intent and shall:
(a)
				describe the type of comprehensive or major medical health insurance coverage
				being proposed,
(b) make a clear
				disclosure on the face page of the Master Policy, if group, and on face pages
				of Certificates, or on the face page of individual policies to this
				effect.
(c) include a clear and
				conspicuous disclosure that states, in effect, that the health insurer has
				designed and constructed the evidence of coverage with the intent of satisfying
				and qualifying the health insurance coverage as a High Deductible Health Plan
				under applicable provisions of Section 223 of the Internal Revenue Service laws
				and rules, but that neither the insurer nor the Office of Commissioner of
				Insurance of the State of Georgia provides federal tax advice, and that
				consumers should seek their own private tax advice with respect to federal tax
				treatment beyond the insurance coverage.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This Regulation is promulgated by the Commissioner of
				  Insurance pursuant to the authority set forth in O.C.G.A. §§
									33-2-9 and
				  33-64-1 et seq. All terms defined
				  in O.C.G.A. §
									33-64-1, hereinafter referred to
				  as the Pharmacy Benefits Managers Act, which are used in this Regulation, shall
				  have the same meaning as in the Act.
O.C.G.A.
				  §§
											33-2-9,
				  33-64-7.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.02 - Scope and purpose

Current through Rules and Regulations filed through June 27, 2024
(1) This Regulation applies to any pharmacy
				benefits manager as defined in O.C.G.A. §
									33-64-1.
(2) The purposes of this Regulation include:
(a) Providing the regulation and licensure of
				pharmacy benefits managers;
(b)
				Promoting the financial responsibility of pharmacy benefits managers;
(c) To protect the interests of the enrolled
				public;
(d) To provide means by
				which to govern, regulate, and monitor the conduct of pharmacy benefits
				managers;
(e) Subjecting those
				business entities defined in O.C.G.A. §
										33-64-1 to the jurisdiction of the
				Commissioner of Insurance; and
(f)
				Regulating pharmacy benefits managers' practices in conformity with the general
				purposes of the Georgia Insurance Code.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.03 - License; application; issuance; renewal; net worth; probationary license

Current through Rules and Regulations filed through June 27, 2024
(1) It is unlawful
				for any person, business entity, or other entity to act as or hold itself out
				to be a pharmacy benefits manager in this State without a valid license issued
				by the Commissioner of Insurance. To qualify for and hold a license to act as a
				pharmacy benefits manager in this State, a pharmacy benefits manager must
				otherwise be in compliance with Chapter 64 of Title 33 of the Official Code of
				Georgia Annotated and this Regulation.
(2) The pharmacy benefits manager shall file
				with the Commissioner an application for a license upon a form to be furnished
				by the Commissioner.
(3) An audited
				financial statement or such other information as the Commissioner may require
				that demonstrates that the applicant possesses a minimum net worth of $200,000.
				Letters of credit, backstop guarantees and special corporate structures will
				not be taken into consideration by the Commissioner in determining the net
				worth requirement.
(4) A Bond and
				proof of Errors and Omissions coverage must be included in the application and
				maintained by the pharmacy benefits manager.
(5) An application for a pharmacy benefits
				manager's license shall be accompanied by a fee of $2000.00.
(6) The Commissioner shall not issue a
				license or renew an existing license if he or she determines that the pharmacy
				benefits manager has:
(a) Misrepresented or
				concealed any material fact in the application for the license;
(b) Has obtained or attempted to obtain the
				license by misrepresentation, concealment, or other fraud;
(c) Has committed fraud;
(d) Has failed to obtain for initial
				licensure or retain for annual renewal a net worth of at least $200,000;
				or
(e) Has violated any provision
				of this chapter while on probation, if for license renewal.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.04 - Pharmacy benefits managers bond; and errors and omissions coverage

Current through Rules and Regulations filed through June 27, 2024
(1) Every pharmacy
				benefits manager shall file a bond with the Commissioner. The pharmacy benefits
				manager shall file a certificate of such bond, in a form acceptable by a
				corporate surety insurer authorized to transact insurance in this state in
				favor of Commissioner of Insurance of the state of Georgia, continuous in form
				and in an amount $100,000.
(2) The
				bond shall inure to the benefit of any person damaged by any fraudulent act or
				conduct of the pharmacy benefits manager and must be conditioned upon faithful
				accounting and application of all money coming into the pharmacy benefits
				manager's possession in connection with its activities as an pharmacy benefits
				manager.
(3) The bond remains in
				force until released by the Commissioner or canceled by the surety. Without
				prejudice to any liability previously incurred, the surety may cancel the bond
				upon thirty (30) days' advance notice to the pharmacy benefits manager and the
				Commissioner. A pharmacy benefits manager's license shall be suspended if it
				does not file with the Commissioner a replacement bond before the date of
				cancellation of the previous bond. A replacement bond must meet all
				requirements of this section for the initial bond.
(4) Each pharmacy benefits manager shall
				obtain errors and omissions coverage or other appropriate liability insurance,
				written by an insurer authorized to transact insurance in this state, in an
				amount of at least $250,000.
(5)
				Any policy written in accordance with paragraph (4) of this Rule shall be for a
				term of at least one year and shall contain provisions that:
(a) Cancellation or termination of the policy
				is not effective except upon sixty (60) days' written notice by registered or
				certified mail to the other party to the policy and to the Commissioner;
				and
(b) The policy is automatically
				renewable at the expiration of the policy period except upon sixty (60) days'
				written notice by registered or certified mail by the party not renewing the
				policy to the other party to the policy and to 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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.05 - Annual renewal

Current through Rules and Regulations filed through June 27, 2024
(1) Each authorized pharmacy benefits manager
				shall file with the Commissioner an annual renewal of its license on a form
				prescribed by the Commissioner. The statement shall be filed annually on or
				before May 1. The annual renewal shall be in such form and contain such matters
				as the Commissioner prescribes and shall be verified by at least one officer of
				the pharmacy benefits manager. For good cause shown the Commissioner may extend
				the time for filing of the annual renewal of the license conditioned upon
				payment of a late fee of $15.00 per day as prescribed by law at O.C.G.A. §
									33-8-1(W). In the
				event the pharmacy benefits manager does not timely renew its license prior to
				the expiration of its license, June 30, the pharmacy benefits manager will
				cease to have a valid license and will need to reapply for a new license prior
				to commencing its business or initiating new business in Georgia. If the
				pharmacy benefits manager fails to renew its license the Commissioner shall
				provide notice to the pharmacy benefits manager and the pharmacy benefits
				manager may invoke the right to a hearing.
(2) At the time of filing its annual renewal,
				the pharmacy benefits manager shall pay a filing fee of $1000.00.
(3) The pharmacy benefits manager shall at
				all times maintain a net worth of $200,000. If the pharmacy benefits manager
				fails to maintain a net worth of $200,000 the Commissioner, in his or her
				discretion, may enter any disciplinary order as he or she deems appropriate
				pursuant to Title 33. In order to verify the net worth of the pharmacy benefits
				manager, proof that the applicant possesses a minimum net worth of $200,000
				must be included in the annual renewal filing that represents the calendar year
				end or fiscal year end of the pharmacy benefits manager.
O.C.G.A.
				  §§
											33-2-9,
				  33-64-7.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.06 - Examination by Commissioner; on-site visits; access to records; and expenses

Current through Rules and Regulations filed through June 27, 2024
(1) The Commissioner or his or her designated
				representative is authorized to conduct financial examinations, compliance
				audits, and investigate complaints of the affairs of each pharmacy benefits
				manager as often as is deemed necessary. Whenever the Commissioner shall deem
				it expedient, he or she shall examine, either directly or by use of an examiner
				duly authorized by him or her, the affairs, transactions, accounts, records,
				documents, assets, liabilities, of a pharmacy benefits manager and any other
				facts relative to its business methods, management, and dealings with a health
				plan or covered entity.
(2) Any
				pharmacy benefits manager being examined shall provide to the Commissioner or
				his or her designee convenient and free access, at all reasonable hours at
				their offices, to all books, records, documents and other papers relating to
				such pharmacy benefits manager's business affairs. In addition to on-site
				access to records, a pharmacy benefit manager shall, upon written request, make
				its records available to the Commissioner or the Commissioner's designee,
				unless otherwise directed by the Commissioner.
(3) A pharmacy benefits manager shall pay the
				fees and expenses of the examination whether conducted by the Commissioner or
				contracted examiner designated by the Commissioner. A consolidated account for
				the examination shall be filed by the examiner with the Commissioner. When a
				pharmacy benefits manager is examined as a result of a complaint filed against
				it and the Commissioner determines that the complaint was not justified, the
				expenses incurred as a result of the examination shall not be levied against
				the pharmacy benefits manager.
(4)
				Nothing in this rule shall limit or abridge any other investigatory powers of
				the Commissioner vested in him or her by Title 33 of the Official Code of
				Georgia Annotated.
O.C.G.A.
				  §§
											33-2-9,
				  33-64-7.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.07 - Forms; reports; and required documentation

Current through Rules and Regulations filed through June 27, 2024
(1) Standard pharmacy benefits manager forms
				are required and will be supplied upon request by the Commissioner's office
				either in paper form or electronically over the internet. Applicants and
				licensed pharmacy benefits managers shall utilize all applicable forms in
				preparing applications, statements, notices of required information, and other
				required submissions required under Chapter 64 of Title 33 of the Official Code
				of Georgia Annotated.
(2) A
				pharmacy benefits manager shall file all methodologies utilized in determining
				multi-source generic drug pricing reimbursement to pharmacies in this state
				within 30 days of their use and upon receiving a notice of complaint by the
				Commissioner in connection with O.C.G.A. §
									33-64-9, a pharmacy benefits
				manager shall within 14 calendar days:
(a)
				Identify the methodology and source or sources used to determine the
				multi-source generic drug price for the drug which is the subject of the
				complaint; and
(b) Identify the
				reason for the denial of any pharmacy reimbursement appeal and produce relevant
				documentation in connection with the reimbursement price of the drug the day
				the claim at issue in the complaint was adjudicated and the preceding 5 days
				prior to the day the claim was adjudicated including source pricing records as
				well the national drug code of an equivalent drug product that could have been
				purchased by the complainant pharmacy at a price at or below the amount the
				pharmacy was reimbursed;
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.08 - Penalties; Commissioner actions; and reimbursements

Current through Rules and Regulations filed through June 27, 2024
(1) Any person,
				business entity, or other entity acting as a pharmacy benefits manager without
				a license shall be subject to a monetary penalty of up to $2000.00 for each and
				every transaction in violation of the chapter. Any person, business entity, or
				other entity willfully acting as a pharmacy benefits manager without a license
				shall be subject to a monetary penalty of up to $10,000.00 for each and every
				act in violation.
(2) In addition
				to all other penalties provided for under this title, the Commissioner shall
				have the authority to place any pharmacy benefits manager on probation for a
				period of time not to exceed one year for each and every act in violation of
				thee chapter and may subject such pharmacy benefits manager to a monetary
				penalty of up to $2000.00 for each and every act in violation of this chapter.
				If the pharmacy benefits manager willfully acted in violation of this chapter
				the monetary penalty may be increased up to $10,000.00 for each and every act
				in violation.
(3) In the event a
				pharmacy benefits manager is in violation of the chapter while on probation,
				the Commissioner may suspend the license.
(4) When a pharmacy benefits manager is
				taking or threatening to take action in violation of the chapter the
				Commissioner may issue a cease and desist order.
(5) When the action of a pharmacy benefits
				manager is in violation of the chapter the Commissioner may order reimbursement
				to an insured, pharmacy, or other dispenser for any monetary loss arising as a
				result of the violation or violations as well as order payment of a fine not to
				exceed $1,000.00 per violation to an insured, pharmacy, or other dispenser who
				has been aggrieved. Such a fine shall be in addition to and not to preclude any
				other penalties pursuant to the chapter.
O.C.G.A.
				  §§
											33-2-9,
				  33-64-7.
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 120-2-97 - PHARMACY BENEFITS MANAGERS REGULATION › Rule 120-2-97-.09 - 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, business entity, or other entity or
				  circumstance, is held invalid by a court of competent jurisdiction, the
				  remainder of the Regulation Chapter or the applicability of such provision to
				  other persons or circumstances shall not be affected.
O.C.G.A.
				  §§
											33-2-9,
				  33-64-7.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.01 - Purpose and Authority

Current through Rules and Regulations filed through June 27, 2024
Section 1003 of the Patient Protection and Affordable Care
				  Act directs the Secretary of the Department of Health and Human Services
				  ("HHS"), in conjunction with the States, to establish a process for the review
				  of unreasonable health insurance rate increases. The federal regulations
				  adopted by HHS at 45 C.F.R. Part 154 set forth criteria for an effective rate
				  review program and provide that, on and after September 1, 2011, HHS will defer
				  to a State review of certain health insurance rate filings only if that State
				  has been deemed to have an effective rate review program. HHS will assert the
				  authority to review certain health insurance rate filings in States without an
				  effective rate review program. Georgia has been deemed to be an effective rate
				  review State subject to the adoption of the federal rate review criteria on or
				  before September 1, 2011. This Emergency Regulation Chapter is necessary to
				  preserve the Commissioner of Insurance's ability to review certain health
				  insurance rates and preserve the public welfare as contemplated by O.C.G.A.
				  §
									33-9-1(a)  and
				  other applicable provisions of Title 33 cited herein.
This regulation is issued pursuant to the authority vested in
				  the Commissioner under Chapters 2 and 9 of Title 33 and O.C.G.A. §§
									33-21-13,
				  33-21-18, and
				  33-21-28.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.02 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "CMS" means the
				Centers for Medicare & Medicaid Services.
(2) "Health benefit plan" has the same
				meaning as O.C.G.A. §
									33-24-59.5(2)  as
				that term is modified by the provisions of O.C.G.A. §
									33-1-2(1.1) but does not include
				coverage offered by a person not subject to the jurisdiction of the
				Commissioner pursuant to O.C.G.A. §
									33-1-14.
(3) "Individual market" means the market for
				health benefit plans where the health benefit plan is issued directly to a
				natural person and not through coverage under a group, blanket or franchise
				health benefit plan.
(4) "Rate
				increase" means any increase of the rates for a health benefit plan offered in
				the individual or small group market.
(5) "Rate increase subject to review" means a
				rate increase that meets the criteria set forth in
				120-2-98-.03.
(6) "Secretary" means the Secretary of the
				Department of Health and Human Services.
(7) "Small group market" means the market
				within which small group coverage is sold as that term is defined in O.C.G.A.
				§
									33-30-12(a).
(8) "Unreasonable rate increase" means a rate
				increase subject to review that violates applicable laws, regulations, and
				rules.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.03 - Rate Increases Subject to Review

Current through Rules and Regulations filed through June 27, 2024
Only rate increases for health benefit plans that are equal
				  to or exceed 10% are subject to review under this regulation. The methodology
				  for determining the amount of a rate increase prescribed in
				  45 C.F.R. §
										154.200 shall be used to determine whether a
				  rate increase is equal to or exceeds 10%.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.04 - Rate Filing Requirements

Current through Rules and Regulations filed through June 27, 2024
In addition to other materials that are otherwise required to
				  be filed, each insurer is required to file the following material for a rate
				  increase subject to review:
(1) The
				preliminary justification required by
				45 C.F.R. §
										154.215(b);
(2) The documentary support for all
				assumptions used by the insurer to develop the proposed rate increase,
				including historical data underlying the assumptions;
(3) The documentary support demonstrating the
				insurer's consideration of the applicable factors set forth in
				120-2-98-.05;
(4) Any documentation requested by the
				Department to the extent that such documentation is pertinent to the filing
				under review.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.05 - Standards of Review

Current through Rules and Regulations filed through June 27, 2024
In addition to standards or criteria of review that are
				  otherwise applicable to a rate increase subject to review under this
				  regulation, the following standards will apply to the review of rates to the
				  extent applicable to the filing under review:
(1) The impact of medical trend changes by
				major service categories;
(2) The
				impact of utilization changes by major service categories;
(3) The impact of cost-sharing changes by
				major service categories;
(4) The
				impact of benefit changes;
(5) The
				impact of changes in enrollee risk profile;
(6) The impact of any overestimate or
				underestimate of medical trend for prior year periods related to the rate
				increase;
(7) The impact of changes
				in reserve needs;
(8) The impact of
				changes in administrative costs related to programs that improve health care
				quality;
(9) The impact of changes
				in other administrative costs;
(10)
				The impact of changes in applicable taxes, licensing or regulatory
				fees;
(11) Medical loss ratio;
				and
(12) The health insurance
				issuer's capital and surplus.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.06 - Access of Public to Rate Increase Process

Current through Rules and Regulations filed through June 27, 2024
The preliminary justification of a proposed rate increase
				  subject to review, filed pursuant to
				  120-2-98-.04(1),
				  will be published to the Department of Insurance website within five (5)
				  business days of receipt. In addition the Department will accept public
				  comments on any proposed rate increase.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.07 - Reporting Final Determination to CMS

Current through Rules and Regulations filed through June 27, 2024
The Department will report its final determination of whether
				  a rate increase subject to review is unreasonable in accordance with
				  45 C.F.R. §
										154.210(b)(2).
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.08 - Rate Filing Guidance

Current through Rules and Regulations filed through June 27, 2024
The Commissioner shall issue guidance for electronic filing
				  of rates subject to this regulation via bulletins. All rate filings subject to
				  this regulation must be filed in accordance with the relevant
				  bulletin.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.09 - Applicability of Other Regulations

Current through Rules and Regulations filed through June 27, 2024
These regulations apply in addition to other applicable
				  regulations.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-98 - REVIEW OF HEALTH BENEFIT PLAN RATE INCREASES › Rule 120-2-98-.10 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of these sections or the application thereof
				  to any person or circumstance is held invalid for any reason, the invalidity
				  shall not affect the other provisions or any other application of these
				  sections which can be given effect without the invalid provisions or
				  application. To this end all provisions of these sections are declared to be
				  severable.
O.C.G.A. Sections
				  33-2-9,
				  33-9-1
et seq.
,
				  33-21-13,
				  33-21-18(a),
				  33-21-28.
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 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES › Rule 120-2-99-.01 - Authority and Purpose

Current through Rules and Regulations filed through June 27, 2024
Article 3 of Chapter 29A of Title 33 directs the Commissioner
				  to adopt implementing rules and regulations governing the filing, approval, and
				  sale of individual health insurance products that have been approved for
				  issuance in other states. This regulation is issued pursuant to the authority
				  vested in the Commissioner under Chapter 2 of Title 33 and O.C.G.A. Sections
				  O.C.G.A. 33-29A-30
et
				  seq.
O.C.G.A. §§
										33-2-9 and
				  33-29A-30
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES › Rule 120-2-99-.02 - Individual Health Insurance Products Approved in Other States

Current through Rules and Regulations filed through June 27, 2024
(1) An insurer
				authorized to transact insurance in this state may file for approval and
				issuance in this state an individual health insurance product currently
				approved for issuance by the insurer or its affiliate in another state,
				provided that such product meets the requirements of Article 3 of Chapter 29A
				of Title 33, other applicable provisions of Title 33, and the regulations of
				the Commissioner.
(2) An insurer
				authorized to transact insurance in this state may offer an individual health
				insurance product with benefits equivalent to those in any individual health
				insurance product approved pursuant to Article 3 of Chapter 29A of Title
				33.
(3) Any individual health
				insurance product offered or sold pursuant to Article 3 of Chapter 29A of Title
				33 shall comply with O.C.G.A. §
									9-9-2(c)(3)  and
				shall not require the insured or his or her beneficiary to arbitrate disputes
				arising under the terms of the policy.
O.C.G.A. §§
										33-2-9 and
				  33-29A-30
et
				  seq.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES › Rule 120-2-99-.03 - Filing Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) All individual health insurance products
				offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall be filed
				for prior review and approval and subject to the applicable SERFF filing and
				policy form filing fees.
(2) Proof
				of current approval and product line authority in domicile state is required of
				foreign insurers.
(3) Proof of
				current state approval other than Georgia, if different from domicile state
				should be furnished and referenced in filing.
(4) Outlines of coverage must be prepared and
				filed for approval with the policy forms filing.
(5) Insurer filings shall conform to
				applicable actuarial standards set forth by the National Association of
				Insurance Commissioners or regulations promulgated by the Commissioner
				including, but not limited to:
(a) Assumptions
				and rating processes;
(b) Presumed
				loss ratio in the pricing of any such product; and
(c) Any other appropriate actuarial standards
				of practice under comprehensive major medical coverage for medical and surgical
				benefits, or for high deductible health plans sold under the applicable
				provisions of Section 223 of the Internal Revenue Code.
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 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES › Rule 120-2-99-.05 - Severability

Current through Rules and Regulations filed through June 27, 2024
If any provision of these sections or the application thereof
				  to any person or circumstance is held invalid for any reason, the invalidity
				  shall not affect the other provisions or any other application of these
				  sections which can be given effect without the invalid provisions or
				  application. To this end all provisions of these sections are declared to be
				  severable.
O.C.G.A. §
										33-2-9.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-100 - Limited Purpose Subsidiaries › Rule 120-2-100-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This regulation is promulgated by the Commissioner of
				  Insurance pursuant to the authority set forth in O.C.G.A. §§
									33-14-100
et
				  seq.
O.C.G.A. §§
										33-2-9,
				  33-14-100
et
				  seq.