Definitions

For purposes of this article, the term ‘‘individual accident and sickness insurance policy’’ means any policy insuring against loss resulting from sickness or from bodily injury or death by accident, or both, or any contract to furnish ambulance service in the future but does not include limited benefit insurance policies exempted from the definition of the term ‘‘health benefit policy’’ in Code Section 33-1-2. The term ‘‘individual accident and sickness insurance policy’’ shall also include comprehensive major medical coverage for medical and surgical benefits, and also includes ‘‘high deductible health plans’’ sold or maintained under the applicable provisions of Section 223 of the Internal Revenue Code. History. — Code 1981, § 33-29A-31, enacted by Ga. L. 2011, p. 789, § 1/HB 47; Ga. L. 2019, p. 337, § 1-92/SB 132. The 2019 amendment, effective July 1, 2019, in this Code section, deleted ‘‘paragraph (1.1) of ’’ preceding ‘‘Code Sec- tion 33-1-2’’ near the end of the first sentence, and substituted ‘‘ ‘high deductible health plans’ ’’ for ‘‘ ‘High Deductible Health Plans’ ’’ in the middle of the second sentence. 33-29A-32. Commissioner to authorize insurers to offer individual accident and sickness insurance policies in Georgia that have been approved for issuance in other states. The Commissioner shall approve for sale in Georgia any individual accident and sickness insurance policy that is currently approved for issuance in another state where the insurer or the insurer’s affiliate or subsidiary is authorized to transact insurance so long as the insurer or the insurer’s affiliate or subsidiary filing and issuance such policy in Georgia is also authorized to transact insurance in this state pursuant to Chapter 3 of this title and provided that any such policy meets the requirements set forth in this article. Additionally, any insurer authorized to transact insurance in this state can offer an individual accident and sickness insurance policy with benefits equivalent to those in any policy approved for sale in Georgia under this article, provided that any such offered policy meets the requirements set forth in this article. History. — Code 1981, § 33-29A-32, enacted by Ga. L. 2011, p. 789, § 1/HB 47. 532 33-29A-34 33-29A-33. Satisfaction of actuarial standards set by National Association of Insurance Commissioners (NAIC); policies must comply with regulations and requirements promulgated by Commissioner; authority of Commissioner. (a) Any insurer selling an insurance policy pursuant to this article, and any policy approved pursuant to this article, shall satisfy actuarial standards set forth by the National Association of Insurance Commissioners (NAIC) and any regulation promulgated by the Commissioner that is not inconsistent with such NAIC standards. Any insurer selling an insurance policy pursuant to this article, and any policy approved pursuant to this article, shall, except as otherwise provided in this article, comply with the requirements of this title and the regulations promulgated by the Commissioner. (b) The Commissioner shall have the authority to determine whether an insurer satisfies the standards required by this Code section and may not approve a plan that he or she finds lacks compliance with this Code section. The Commissioner shall have the authority to determine whether the plan sold pursuant to this article continues to satisfy the requirements set forth in this Code section in the same manner as he or she does with an individual accident and sickness insurance policy approved pursuant to another applicable chapter in this title. (c) Any policy sold pursuant to this article shall comply with paragraph (3) of subsection (c) of Code Section 9-9-2 and shall not require the insured or his or her beneficiary to arbitrate disputes arising under the policy. History. — Code 1981, § 33-29A-33, enacted by Ga. L. 2011, p. 789, § 1/HB 47. 33-29A-34. Certain language required in policies and policy applications. (a) Each written application for a policy sold pursuant to this article shall contain the following language in boldface type at the beginning of the document: ‘‘The benefits of this policy may primarily be governed by the laws of a state other than Georgia; therefore, all of the laws applicable to policies filed in this state may not apply to this policy. Any purchase of individual health insurance should be considered carefully since future medical conditions may make it impossible to qualify for another individual health insurance policy.’’ (b) Each policy sold pursuant to this article shall contain the following language in boldface type at the beginning of the document: 533 33-29A-35 ‘‘The benefits of this policy providing your coverage may be governed primarily by the laws of a state other than Georgia. The benefits covered may be different from other policies you can purchase. Please consult your insurance agent or insurer to determine which health benefits are covered under this policy.’’ (c) Each individual accident and sickness policy sold pursuant to this article shall contain a side-by-side chart that compares the definitions of each benefit covered by the policy that has been sold in the other state with the definitions of the benefits covered under current Georgia laws and regulations where the specified benefit is similarly termed but defined differently. History. — Code 1981, § 33-29A-34, enacted by Ga. L. 2011, p. 789, § 1/HB 47. 33-29A-35. Adoption of rules and regulations by Commissioner; application of dispute resolution mechanism or provision. (a) The Commissioner shall adopt rules and regulations necessary to implement this article, which shall include, but shall not be limited to, standard forms for the disclosure of benefits, and preserve the intent and effect of Code Sections 33-24-27, 33-24-27.1, and 33-24-59.12 and subsection (c) of Code Section 33-29-6. (b) Any dispute resolution mechanism or provision for notice and hearing in this title shall apply to insurers issuing and delivering policies pursuant to this article. History. — Code 1981, § 33-29A-35, enacted by Ga. L. 2011, p. 789, § 1/HB 47; Ga. L. 2012, p. 775, § 33/HB 942. 534 T.33, C.29B HEALTH CARE COVERAGE FOR CHILDREN 33-29B-8 CHAPTER 29B HEALTH CARE COVERAGE FOR CHILDREN Sec. 33-29B-1 through 33-29B-8 [Repealed]. 33-29B-1 through 33-29B-8. Repealed by Ga. L. 2012, p. 617, § 1/HB 1166, effective January 1, 2014. Editor’s notes. — This chapter consisted of Code Sections 33-29B-1 through 33-29B-8, relating to health care coverage for children, and was based on Code 1981, §§ 33-29B-1 through 33-29B-8, enacted by Ga. L. 2012, p. 617, § 1/HB 1166. 535 T.33, C.30 T.33, C.30 INSURANCE CHAPTER 30 GROUP OR BLANKET ACCIDENT AND SICKNESS INSURANCE Sec. Article 1 General Provisions Sec. 33-30-1. 33-30-1.1. 33-30-2. 33-30-3. 33-30-4. 33-30-4.1. 33-30-4.2. 33-30-4.3. 33-30-4.4. 33-30-4.5. 33-30-5. 33-30-6. 33-30-7. 33-30-8. ‘‘Group accident and sickness insurance’’ defined; ‘‘true association’’ defined. Applicability. Effect of chapter upon other provisions. ‘‘Blanket accident and sickness insurance’’ defined. Required provisions generally. Coverage for human heart transplants; optional endorsement; requirements; guidelines. Insurance coverage for mammograms, Pap smears, and prostate-specific antigen tests. Utilization of mail-order pharmaceutical distributors in policies, plans, contracts, or funds; utilization of other providers of pharmaceutical services under same terms and conditions. Coverage for bone marrow transplants for the treatment of breast cancer and Hodgkin’s disease; optional endorsement; requirements; guidelines; applicability. Coverage for child wellness services. Direct payment for hospital or medical services. Authority to issue blanket accident and sickness policies; filing of form; required provisions; applicability of Code section to similar entities. Provision in group or blanket policies for medical or surgical services generally. Requirement of application for policy and issuance of cer- tificate for blanket accident and sickness insurance. 33-30-9. Payment of benefits under blanket accident and sickness policies. 33-30-10. Exemption of group and blanket policy proceeds from liability for debts of insured and beneficiary. 33-30-11. Applicability of Chapter 29 of title to group or blanket policies. 33-30-12. Standards and requirements for rating of small groups under accident and sickness insurance; exemptions. 33-30-13. Notices of premium increases to be mailed or delivered to group policyholder; notification of impact of federal Patient Protection and Affordable Care Act. 33-30-13.1. Furnishing claims experience to policyholders. 33-30-14. Insurance coverage for treatment of temporomandibular joint dysfunction or surgery for deformities of maxilla or mandible. 33-30-15. Continuation of similar coverage; preexisting conditions; procedures and guidelines. Article 2 Preferred Provider Arrangements 33-30-20. 33-30-21. 33-30-22. 33-30-23. 33-30-24. 536 Short title. Legislative intent. Definitions. Standards; payments or reimbursement for noncontracting provider of covered services; filing requirements for unlicensed entities; provision for payment solely to provider. Health benefit plans providing incentives to use services T.33, C.30 GROUP ACCIDENT AND SICKNESS INSURANCE T.33, C.30 Sec. Sec. of preferred providers; minimum requirements. Reasonable limits on number or classes of preferred providers. Applicability of Title 33 and related rules and regulations to health care insurers. 33-30-27. Promulgation of rules and regulations. 33-30-28 and 33-30-29. Redesignated.