Title 33

This chapter shall apply to policies of insurance, certificates evidencing coverage under a policy of insurance, or any other evidence of insurance, issued by an insurer, delivered, or issued for delivery in this state except for policies issued to an employer in another state whi…

The proceeds or avails of all group or blanket accident and sickness policies shall be exempt from all liability for debt to the same extent and under the same conditions as provided for in the case of individual accident and sickness insurance by Code Section 33-29-15. History. …

Chapter 29 of this title shall not apply to group accident and sickness or blanket accident and sickness insurance policies; but, except as otherwise provided in this chapter, no policy of group or blanket accident and sickness insurance shall contain any provision relative to no…

(a) As used in this Code section, the term ‘‘small group’’ means a group or subgroup of at least two and no more than 50 employees, members, or enrollees. (b) Except as otherwise provided in this Code section, the claims experience produced by small groups covered under accident …

(a) Notice of the maximum amount of a group premium increase shall be mailed or delivered to the group policyholder and to each employer group or subgroup insured under the group policy not less than 60 days prior to the effective date of the premium increase. (b) The commissione…

(a) As used in this Code section, the term ‘‘insurer’’ means an accident and sickness insurer, fraternal benefit society, health care corporation, provider sponsored health care corporation, health maintenance organization, or any similar entity. (b)(1) All insurers shall furnish,…

(a) As used in this Code section, the term: (1) ‘‘Functional deformity’’ means a deformity of the bone or joint structure of the maxilla or mandible such that the normal character and essential function of such bone structure is impeded. (2) ‘‘Policy’’ means any major medical ben…

(a) As used in this Code section, the term: (1) ‘‘Affiliation period’’ means a period, used by health maintenance organizations in lieu of a preexisting condition exclusion clause, beginning on the enrollment date, which must expire before health insurance coverage provided by a …

Nothing in this chapter validates any charge or practice illegal under any rule of law or regulation governing usury, small loans, retail installment sales, or the like or extends the application of any statute, rule, or regulation to any transaction not otherwise subject thereto…

‘‘Blanket accident and sickness insurance’’ is that form of group accident and sickness insurance covering the groups of persons listed in paragraphs (1) through (6) of this Code section and issued upon the following basis: (1) Under a group policy or contract issued to any commo…

Each group accident and sickness policy shall contain in substance the following provisions: (1) A provision that, in the absence of fraud or intentional misrepresentation of material fact in applying for or procuring coverage under the terms of the group policy or contract, all …

(a) Every insurer authorized to issue group accident and sickness insurance benefit plans, policies, or contracts shall be required to make available, either as a part of or as an optional endorsement to all such policies providing major medical insurance coverage which are issued…

(a) As used in this Code section, the term: (1) ‘‘Female at risk’’ means a woman: (A) Who has a personal history of breast cancer; (B) Who has a personal history of biopsy proven benign breast disease; (C) Whose grandmother, mother, sister, or daughter has had breast cancer; or (…

(a) For the purposes of this Code section, the term ‘‘health care insurer’’ means an insurer, including a fraternal benefit society, a health care plan, or a health maintenance organization authorized to sell accident and sickness insurance policies, subscriber certificates, or oth…

(a) Every insurer authorized to issue group accident and sickness insurance benefit plans, policies, or contracts shall be required to make available, either as a part of or as an optional endorsement to all such policies providing major medical insurance coverage which are issued…

(a) As used in this Code section, the term: (1) ‘‘Child wellness services’’ means the periodic review of a child’s physical and emotional status conducted by a physician or conducted pursuant to a physician’s supervision, but shall not include periodic dental examinations or othe…

Any group accident and sickness policy may provide that all or any portion of any indemnities provided by any policy on account of hospital, nursing, or medical or surgical services may, at the insurer’s option, be paid directly to the hospital or person rendering such services; …

(a) Any insurance company authorized to write accident and sickness insurance in this state shall have the power to issue blanket accident and sickness insurance. No blanket policy may be issued or delivered in this state unless a copy of the form of the blanket policy shall have…

(a) The benefits on account of medical or surgical services provided by a group or blanket policy of accident and sickness insurance may be limited by its terms to services performed by specifically defined professions, provided that in the absence of such definitions, the term ‘‘phy…

(a) All benefits under any group or blanket accident and sickness policy shall be payable to the person insured, to his designated beneficiary or beneficiaries, or to his estate, provided that if the person insured is a minor or mental incompetent, the benefits may be made payable to…

This article shall be known and may be cited as the ‘‘Preferred Provider Arrangements Act.’’ History. — Code 1981, § 33-30-20, enacted by Ga. L. 1988, p. 1483, § 1.

It is the intent of the General Assembly to encourage health care cost containment while preserving quality of care by allowing health care insurers to enter into preferred provider arrangements and by establishing minimum standards for preferred provider arrangements and the hea…

As used in this article, the term: (1) ‘‘Emergency services’’ or ‘‘emergency care’’ means those health care services that are provided for a condition of recent onset and sufficient severity, including, but not limited to, severe pain, that would lead a prudent layperson, possess…

(a) Notwithstanding any provisions of law to the contrary, any health care insurer may enter into preferred provider arrangements as provided in this article. Such arrangements shall: (1) Establish the amount and manner of payment to the preferred provider; (2) Include fair, reas…

Health care insurers may issue health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such policies or subscriber certificates shall contain at least the following provisions: (1) A provision that if a covered p…

Subject to the approval of the Commissioner under such procedures as he may develop, health care insurers may place reasonable limits on the number or classes of preferred providers which satisfy the standards set forth by the health care insurer, provided that there be no discri…

— Accident insurance: provisions regarding voluntary exposure to danger as applicable to dangers incident to automobiling, 4 A.L.R. 1244. Accident insurance: injury by insect, 9 A.L.R. 529. Accident insurance: taxicab as a public conveyance provided by a common carrier within pro…

PRESCRIPTIONS —Cont’d Health insurance —Cont’d Stage four metatastic cancer treatments. Limiting access to drugs conditioned on attempts with other drugs first, prohibition, §33-24-59.20. Step therapy protocols, §33-24-59.25. Insurance coverage. Off-label use, §33-24-59.11. Off-la…

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 pros…

As used in this chapter, the term: (1) ‘‘Agent’’ shall be defined as provided in Code Section 33-23-1. (2) ‘‘Carrier’’ means any entity that provides health insurance to employers in this state. For the purposes of this chapter, carrier includes an insurance company, hospital or m…

Insurance premium finance companies. Licenses, §33-22-3. Insurance private review agents. Certification, §§33-46-5, 33-46-6. Insurance rating organizations. Licensees. Annual fee, §33-9-15. Application fee, §33-9-12. Insurance title. Fees collected under title. Allowance of refunds…

Generally, §§33-29-1 to 33-29-22. Policies approved in other states, insurers offering, §§33-29A-30 to 33-29A-35. Long-term care insurance, §§33-42-1 to 33-42-6. Medicare supplement insurance, §§33-43-1 to 33-43-9. Preferred provider arrangements, §§33-30-20 to 33-30-27. Accurate…

(a) On and after July 1, 1997, the Commissioner is authorized to issue certificates of authority to nonprofit corporations to operate as health plan purchasing cooperatives to provide services to members located within particular geographic areas of the state in accordance with the…

(a) Each health plan purchasing cooperative shall serve a particular geographic area of the state that consists of either one entire county or more than one contiguous entire county. The Commissioner shall not authorize any purchasing cooperative to serve a geographic area which …

(a)(1) Membership in a health plan purchasing cooperative shall be voluntary. (2) A purchasing cooperative shall accept for membership in the cooperative any eligible small employer which agrees to pay the membership fee and a premium for coverage through the purchasing cooperati…

The department shall assist health plan purchasing cooperatives. To this end, the department is responsible for: (1) Initially and thereafter annually certifying that each cooperative complies with the provisions of this chapter and regulations adopted pursuant to Code Section 33…

(a) Each cooperative shall use appropriate, efficient, and standardized means to notify members of the availability of health benefit plan coverage offered through the cooperative. (b)(1) Each cooperative shall make available to its members marketing materials prepared by or for t…

(a)(1) Each purchasing cooperative shall be a nonprofit corporation, and the provisions of Chapter 3 of Title 14 shall apply to each purchasing cooperative; provided, however, that the provisions of this chapter shall control to the extent of any conflict with the provisions of Cha…

(a) Prior to authorization by the Commissioner to operate as a health plan purchasing cooperative, a nonprofit corporation shall, directly or through a contractor which provides administrative services to the corporation, file with the Commissioner a corporate surety bond in an amo…

The Commissioner shall issue regulations in accordance with Code Section 33-2-9 for the administration of this chapter. History. — Code 1981, § 33-30A-9, enacted by Ga. L. 1997, p. 1072, § 1.

This chapter shall be known and may be cited as the ‘‘Spending Account and Consumer Driven Health Plan Advancement Act.’’ History. — Code 1981, § 33-30B-1, enacted by Ga. L. 2003, p. 912, § 1.

The purposes of this chapter are to provide enabling provisions for spending accounts and consumer driven health plans, provide statutory authorization for the establishment of such plans, and facilitate the advancement of such plans as a response to escalating costs of health ca…

As used in this chapter, the term: (1) ‘‘Consumer driven health plan’’ means a plan for the provision or reimbursement of health care services that makes available to enrolled individuals information on health, health care, the pricing of health care, and the pricing of health ca…

(a) A spending account plan or consumer driven health plan may be written in this state for a group or for an individual. Such plan may contain a spending account feature which will provide the first-dollar payments for health care services up to a designated amount. Group plans m…

For any plan having a spending account feature, the amount of the spending account is not required to be the same as the attachment point for insurance reimbursements. If the attachment point for insurance reimbursements to the plan is higher than the amount contained in the spen…

The insurance contract providing reimbursements for expenditures for health care services incurred by the plan may be a stop-loss, specific excess and aggregate, or other similar contract. It may be written by an insurer licensed for life, accident, and sickness insurance under Co…