Title 33 — Title 33
0 chapters · 1,218 sections in this title.
O.C.G.A. § 33-20E-2 Application to insurers; definitions
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(a) This chapter shall apply to all insurers providing a healthcare plan that pays for the provision of healthcare services to covered persons. (b) As used in this chapter, the term: (1) ‘‘Balance bill’’ means the amount that a nonparticipating provider charges for services provi…
O.C.G.A. § 33-20E-20 Annual reporting by Commissioner
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On or before July 1, 2022, and each July 1 thereafter, the Commissioner shall provide a written report to the House Committee on Insurance and the Senate Insurance and Labor Committee, or their successor committees, and shall post the report on the department’s website summarizin…
O.C.G.A. § 33-20E-21 Insurance companies
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Captive insurance companies. Inapplicability of inconsistent provisions, §33-41-26. Life settlements act. Multiple owners, §33-59-12. Medicaid care management organizations, §33-21A-12. Pharmacy benefits managers. Federal law controlling, §33-64-13. 1120 INDEX CONFUSION. Captive i…
O.C.G.A. § 33-20E-22 Reporting to credit reporting agencies
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No nonparticipating provider shall report to any credit reporting agency any covered person who receives a surprise bill for the receipt of healthcare services from such provider and does not pay such provider any copay, coinsurance, deductible, or other cost-sharing amount beyon…
O.C.G.A. § 33-20E-23 Accurate provider directories
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Disclosure of health benefit plan surprise bill rating in advertisement, §33-20C-7. Ambulance services. Financial responsibilities for ground ambulance services, §33-20E-23. Applicability to insurers, §33-20E-2. Exemptions, §33-20E-3. 1180 INDEX HEALTH INSURANCE —Cont’d Surprise b…
O.C.G.A. § 33-20E-3 Exemption
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(a) Nothing in this chapter shall be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001, et seq. (b) This chapter shall be applicable only to healthcare plans and state healthc…
O.C.G.A. § 33-20E-4 Payment for emergency medical services
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(a) An insurer that provides any benefits to covered persons with respect to emergency medical services shall pay for such emergency medical services regardless of whether the healthcare provider or facility furnishing emergency medical services is a participating provider or faci…
O.C.G.A. § 33-20E-5 Payment for nonemergency medical services
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(a) In accordance with Code Section 33-20E-7 and this chapter, an insurer that provides any benefits to covered persons with respect to nonemergency medical services shall pay for such services in the event that such services resulted in a surprise bill regardless of whether the h…
O.C.G.A. § 33-20E-6 Denying or restricting benefits based on balance billing; notice to insured
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No healthcare plan shall deny or restrict the provision of covered benefits from a participating provider to a covered person solely because the covered person obtained treatment from a nonparticipating provider leading to a balance bill. Notice of such protection shall be provide…
O.C.G.A. § 33-20E-7 Surprise bill exclusion; requirements
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(a) Nothing in this chapter shall reduce a covered person’s financial responsibilities in the event that such covered person chose to receive nonemergency medical services from an out-of-network provider. Such services shall not be considered a surprise bill for purposes of this c…
O.C.G.A. § 33-20E-9 Arbitration of payment issues
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(a) If an out-of-network provider concludes that payment received from an insurer pursuant to Code Section 33-20E-4 or 33-20E-5 or if an out-of-network facility concludes that payment received from an insurer pursuant to Code Section 33-20E-4 is not sufficient given the complexit…
O.C.G.A. § 33-21-1 Definitions
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As used in this chapter, the term: (1) ‘‘Basic health care services’’ means health care services which an enrolled population might reasonably require in order to be maintained in good health, including as a minimum but not restricted to preventive care, emergency care, inpatient…
O.C.G.A. § 33-21-10 Genetic testing
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Confidentiality. Purpose of provisions, §33-54-1. Governing body. Composition, §33-21-6. Fiduciary responsibilities of directors, officers, etc., §33-21-7. Filing of notice of exercise of powers, etc., §33-21-8. Matters of policy and operation. Duty to establish mechanism for part…
O.C.G.A. § 33-21-11 Investment of funds of organizations
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With the exception of investments made in accordance with paragraphs (1) and (2) of subsection (a) and subsection (b) of Code Section 33-21-8, the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws…
O.C.G.A. § 33-21-12 Participation in organizations by members of associations
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No employer, union, trade organization, or any other association shall force its members, either by payroll deduction or other means, to join a health maintenance organization. History. — Code 1933, § 56-3628, enacted by Ga. L. 1979, p. 1148, § 1. 871 33-21-13 33-21-13. Evidence …
O.C.G.A. § 33-21-14 Annual information to enrollees
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Every health maintenance organization shall annually provide to its enrollees: (1) A description of services and information as to where and how to secure them; and (2) A clear and understandable description of the health maintenance organization’s method for resolving enrollee c…
O.C.G.A. § 33-21-15 Filing of annual reports; contents
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(a) Every health maintenance organization shall annually, on or before March 1, file with the Commissioner of Insurance, on forms to be designated by him and certified by at least two principal officers of said health maintenance organization, an annual statement as of December 31 …
O.C.G.A. § 33-21-16 Fees and taxes
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The same fees and taxes provided for in Chapter 8 of this title applicable to life insurers shall apply to and shall be imposed upon each health maintenance organization provided for in this chapter; and the organizations shall also be entitled to the same tax deductions, reducti…
O.C.G.A. § 33-21-17 Reports of examinations, §33-21-17
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Long-term health care. Continuing care providers and facilities. Reporting requirements, §33-45-6. Vehicle product protection warranties. Warrantors’ books, records and accounts, §§33-34A-10, 33-34A-11. 1105 INDEX ACKNOWLEDGMENTS. Health insurance. Small business employee choice …
O.C.G.A. § 33-21-18 Adoption of rules and regulations generally
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33-21-18.1. Emergency services requirements; restrictive formulary requirements. 33-21-19. Promulgation of rules and regulations for licensing of agents. 33-21-20. Conduct of hearings generally; participation in hearings by commissioner of community health; judicial review. 33-21…
O.C.G.A. § 33-21-18.1 Emergency services requirements; restrictive formulary requirements
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Every health benefits plan of every health maintenance organization shall include provisions that: (1) In the event a patient seeks emergency services and if necessary in the opinion of the health care provider responsible for the patient’s emergency care and treatment and warrant…
O.C.G.A. § 33-21-19 Promulgation generally, §33-21-18
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Taxation. Imposition of taxes, §33-21-16. Terminal illness. Coverage not to be restricted due to, §33-24-59.18. HEALTH PLAN PURCHASING COOPERATIVES, §§33-30A-1 to 33-30A-11. Areas of service, §33-30A-3.
O.C.G.A. § 33-21-20 Recommendations required by chapter
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Authority of commissioner to contract for making of, §33-21-21. Regulation by commissioner, §33-21-20.1. COMPACTS.
O.C.G.A. § 33-21-20.1 COMPACTS
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Insurance. Interstate insurance product regulation compact, §§33-59A-1, 33-59A-2. COMPROMISE AND SETTLEMENT.
O.C.G.A. § 33-21-22 Complaint system
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Maintenance of records of complaints, §33-21-9. 1297 INDEX RECORDS —Cont’d Insurance. Health insurance. Health care plans. Maintenance and examination of books and records, §33-20-23. Hearings, §33-2-21. Legal insurance. Prepaid legal services plans. Sponsors, §33-35-15. Insuranc…
O.C.G.A. § 33-21-23 Confidentiality of medical information; claim of privileges by organizations
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(a) Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from the person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except: (1) To the e…
O.C.G.A. § 33-21-24 Rehabilitation, liquidation, or conservation of organizations
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Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Commissioner pursuant to the law governing the rehabilitatio…
O.C.G.A. § 33-21-25 Interest
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Benefits, §33-24-59.5. Investment of funds, §33-21-11. Life and health insurance guaranty association, §§33-38-1 to 33-38-22. Liquidation of organizations, §33-21-24. 1183 INDEX HEALTH MAINTENANCE ORGANIZATIONS —Cont’d Managed care, §§33-29A-1 to 33-29A-9. Managed health care plan…
O.C.G.A. § 33-21-26 Insurance administrators
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Bond, §33-23-102. Insurance contracts. Coverage of uninsurable subjects, §33-24-12. Insurance policies generally, §§33-24-44, 33-24-44.1. Notice required, §33-24-47. Underwriting and rate risking. Credit information as basis for cancellation, etc., §33-24-91. Vehicle protection p…
O.C.G.A. § 33-21-27 Insurance
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False statements by officers, agents, etc., §33-1-8. Fraud, §33-1-9. Staging a collision, filing related fraudulent claim, §33-1-9.1. Issuance or delivery of policy in violation of title, §33-1-7. Legal insurance. Prepaid legal services plans. Institution of criminal proceedings, …
O.C.G.A. § 33-21-29 Policy
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Automobile or motorcycle insurance, §33-24-45. Cancellation of certain property insurance policies, §33-24-46. DEFINED TERMS —Cont’d Policy —Cont’d Child wellness insurance coverage, §33-29-3.4. Child wellness services, §33-30-4.5. Group or blanket accident and sickness insurance…
O.C.G.A. § 33-21-3 Contents, §33-21-2
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Denial. Grounds and procedure, §33-21-3. Hearing requirement, §33-21-20. Execution, §33-21-2. Filing requirements, §33-21-2. Issuance. Grounds and procedure, §33-21-3. License fee, §33-21-4. Revocation, §33-21-5. Hearing requirement, §33-21-20. Suspension, §33-21-5. Hearing requi…
O.C.G.A. § 33-21-4 Annual license fee
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Every health maintenance organization subject to this chapter shall pay to the Commissioner of Insurance the annual license fee provided in Code Section 33-8-3. History. — Code 1933, § 56-3621, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 5. 33-21-5. Suspension or…
O.C.G.A. § 33-21-5 Suspension or revocation of certificate of authority
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(a) The Commissioner of Insurance may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if he finds that any of the following conditions exist: (1) The health maintenance organization is operating significantly in contraven…
O.C.G.A. § 33-21-7 Fiduciary responsibilities of directors, officers, or partners
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Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the organization shall be responsible for the funds in a fiduciary relationship to the health maintenance organization. H…
O.C.G.A. § 33-21-8 Emergency services
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Requirements, §33-21-18.1. Enforcement of chapter, §33-21-27. Essential rural health care provider access. Expansion into rural areas, §33-20B-3.1. Qualifications for participating providers. When health maintenance organization not required to comply, §33-20B-3. Establishment. Pr…
O.C.G.A. § 33-21A-1 Short title
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This chapter shall be known and may be cited as the ‘‘Medicaid Care Management Organizations Act.’’ History. — Code 1981, § 33-21A-1, enacted by Ga. L. 2008, p. 704, § 1/HB 1234. 33-21A-2. Definitions.
O.C.G.A. § 33-21A-11 Medical malpractice judgments
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Payment by insurer, §33-3-27. Pharmacy benefits managers. Differences between reimbursed amounts and amounts charged to health plan, §33-64-10. Imposing certain fees or engaging in practice of steering, §33-64-12. REPUDIATION. Insurance contracts. Minors, §33-24-5. RESCISSION. Lif…
O.C.G.A. § 33-21A-12 Rural health care providers
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Essential rural health care provider access, §§33-20B-1 to 33-20B-6. HEALTH BENEFIT PLANS. Health insurance navigators. Compensation from insurers, health benefit plans, businesses, etc. Restrictions, §33-23-203. HEALTH CARE CORPORATIONS. Health maintenance organizations. Organiza…
O.C.G.A. § 33-21A-2 Definitions
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As used in this chapter, the term: (1) ‘‘Care management organization’’ means an entity that is organized for the purpose of providing or arranging health care, which has been granted a certificate of authority by the Commissioner of Insurance as a health maintenance organization …
O.C.G.A. § 33-21A-4 Reimbursement for emergency health care services
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(a) In particular, but without limitation, a care management organization shall not: (1) Deny or inappropriately reduce payment to a provider of emergency health care services for any evaluation, diagnostic testing, or treatment provided to a recipient of medical assistance for a…
O.C.G.A. § 33-21A-5 Requirements relating to critical access hospitals
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(a) A critical access hospital must provide notice to a care management organization and the Department of Community Health of any alleged breaches in its contract by such care management organization. (b) If a critical access hospital satisfies the requirement of subsection (a) o…
O.C.G.A. § 33-21A-7 Bundling of provider complaints and appeals
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(a) In reviewing provider complaints or appeals related to denial of claims, a care management organization shall allow providers to consolidate complaints or appeals of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of indiv…
O.C.G.A. § 33-21A-8 Participation by dentists
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(a) Except as provided in subsection (b) of this Code section, no care management organization or agent of such care management organization shall deny any dentist from participating in the Medicaid and PeachCare for Kids dental program administered by such care management organi…
O.C.G.A. § 33-21A-9 Submission and payment of claims
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(a) If a provider submits a claim to a responsible health organization for services rendered within 72 hours after the provider verifies the eligibility of the patient with that responsible health organization, the responsible health organization shall reimburse the provider in an…
O.C.G.A. § 33-22-1 Short title
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This chapter shall be known and may be cited as the ‘‘Insurance Premium Finance Company Act.’’ History. — Ga. L. 1969, p. 561, § 1. 33-22-2. Definitions.
O.C.G.A. § 33-22-10 Delinquency charges; returned check fees
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(a) A premium finance agreement may provide for the payment by the insured of a delinquency charge ranging in amount from $1.50 to a maximum of 5 percent of the delinquent payment on any payment which is in default for a period of five days or more. If the default results in the ca…
O.C.G.A. § 33-22-11 Necessity of filing of premium finance agreement
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No filing of the premium finance agreement shall be necessary to perfect the validity of the agreement as a secured transaction as against creditors, subsequent purchasers, pledgees, encumbrancers, successors, or assigns. History. — Ga. L. 1969, p. 561, § 14. 907 33-22-12.1 33-22-1…
O.C.G.A. § 33-22-12.1 Filing requirements, §33-22-11
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Form, contents, execution and delivery, §33-22-8. Notification of existence, §33-22-12. Applicability of chapter, §33-22-16. Banks and trust companies. Applicability of chapter to, §33-22-16. Bonds, surety, §33-22-5. Cancellation of contract. Disposition of unearned premiums, §33-…
O.C.G.A. § 33-22-13 Definitions, §33-22-2
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Commercial insurance premium finance agreement, §33-22-9. Consumer insurance premium finance agreement, §33-22-9. Delinquency charges, §33-22-10. Delivery of agreements, §33-22-8. Deposits of securities acceptable to commissioner. Amount, §33-22-5. Disposition of unearned premiums …