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Georgia Statutes, Title 33

Georgia/Statutes

← All Georgia coverage

Title 33

73 chapters · 1,492 sections in this title.

All chapters in Title 331,492 Ch 24, INSURANCE GENERALLY134 Ch 14, DOMESTIC STOCK AND MUTUAL INSURERS78 Ch 11, INVESTMENTS72 Ch 23, LICENSING62 Ch 37, INSURERS REHABILITATION AND LIQUIDATION59 Ch 9, REGULATION OF RATES, UNDERWRITING RU…49 Ch 15, FRATERNAL BENEFIT SOCIETIES38 Ch 5, REGULATION OF UNAUTHORIZED INSURERS37 Ch 41, CAPTIVE INSURANCE COMPANIES34 Ch 20, HEALTH CARE PLANS33 Ch 3, AUTHORIZATION AND GENERAL REQUIREMEN…32 Ch 2, DEPARTMENT AND COMMISSIONER31 Ch 17, RECIPROCAL INSURERS31 Ch 21, HEALTH MAINTENANCE ORGANIZATIONS31

1,492 sections·Filtered byTitle 33✕

O.C.G.A. § 33-17-30 Recordkeeping duties, §33-14-13
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Reinsurance of risks. Domestic stock insurers, §33-14-40. INDEX INSURANCE COMPANIES —Cont’d Domestic stock and mutual insurers —Cont’d Reinsurance of risks —Cont’d Limited purpose subsidiary life insurance companies, §§33-14-100 to 33-14-109. Mutual insurers, §33-14-72. Return of…
O.C.G.A. § 33-17-31 Exchange of contracts or indemnities by attorneys
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Any attorney who shall exchange any contract or indemnity of the kind and character speciﬁed in this chapter or who shall directly or indirectly solicit or negotiate any application for the contracts without ﬁrst complying with all the provisions of this chapter shall be guilty o…
O.C.G.A. § 33-17-4 Types of insurance in which reciprocal insurers authorized to transact business; reinsurance
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(a) A reciprocal insurer may, upon qualifying as a reciprocal insurer as provided for by this title, transact any kind or kinds of insurance deﬁned by this title other than life or title insurance. (b) A reciprocal insurer may purchase reinsurance upon the risk of any subscriber …
O.C.G.A. § 33-17-5 Requirements as to name; actions by and against insurers

Showing 551–600 of 1,492

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A reciprocal insurer shall: (1) Have and use a business name. The name shall include the word ‘‘reciprocal’’ or ‘‘interinsurer’’ or ‘‘interinsurance’’ or ‘‘exchange’’ or ‘‘underwriters’’ or ‘‘underwriting’’; and (2) Bring and defend actions in its own name. History. — Code 1933, …

O.C.G.A. § 33-17-6 Procedure for incorporation of domestic reciprocal insurer generally; application for certiﬁcate of authority; execution and ﬁling by attorney of declaration; contents of declaration

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(a) Twenty-ﬁve or more persons domiciled in this state may organize a domestic reciprocal insurer and make application to the Commissioner for a certiﬁcate of authority to transact insurance. (b) The proposed attorney shall fulﬁll the requirements of and shall execute and ﬁle wit…

O.C.G.A. § 33-17-7 Issuance of certiﬁcate of authority; refusal, suspension, or revocation of certiﬁcate of authority; renewal of certiﬁcate; payment of fees and taxes

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(a) The certiﬁcate of authority to transact business of a reciprocal insurer shall be issued to its attorney in the name of the insurer. (b) The Commissioner may refuse, suspend, or revoke the certiﬁcate of authority to transact business, in addition to other grounds for refusal,…

O.C.G.A. § 33-17-8 Filing of bond by attorney for insurer; amount of bond; cancellation of bond

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(a) Concurrently with the ﬁling of the declaration provided for in Code Section 33-17-6, the attorney of a domestic reciprocal insurer shall ﬁle with the Commissioner a bond in favor of the Commissioner for the beneﬁt of all persons damaged as a result of breach by the attorney o…

O.C.G.A. § 33-17-9 Maintenance by attorney of deposit in lieu of bond

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In lieu of the bond required under Code Section 33-17-8, the attorney may maintain on deposit with the state through the office of the Commissioner a like amount in cash or in value of securities qualiﬁed for deposit under Chapter 11 of this title, subject to the same conditions …

O.C.G.A. § 33-20A-1 Short title

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This article shall be known and may be cited as the ‘‘Patient Protection Act of 1996.’’ History. — Code 1981, § 33-20A-1, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 350, § 2.

O.C.G.A. § 33-20A-2 Legislative ﬁndings

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(a) The General Assembly ﬁnds and declares that it is a vital government concern that the citizens of the State of Georgia have access to quality health care services and that informed consumers will be better able to identify and select plans that offer quality health care servi…

O.C.G.A. § 33-20A-3 Deﬁnitions

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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…

O.C.G.A. § 33-20A-4 Certiﬁcation requirements; review and recertiﬁcation; sanctions for failure to meet requirements; alternative methods for certiﬁcation

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(a) In addition to other requirements of law, prior to offering a managed care plan to any resident in Georgia, a managed care entity must ﬁrst obtain a certiﬁcate from the Commissioner of Insurance indicating that such managed care plan meets the requirements of this article. Th…

O.C.G.A. § 33-20A-5 Standards for certiﬁcation

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The Commissioner shall establish standards for the certiﬁcation of qualiﬁed managed care plans that conduct business in this state. Such standards must include the following provisions: (1) Disclosure to enrollees and prospective enrollees. (A) A managed care entity shall disclos…

O.C.G.A. § 33-20A-6 Financial incentive programs prohibited; capitated payment arrangement allowed

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(a) A managed care plan may not use a ﬁnancial incentive or disincentive program that directly or indirectly compensates a health care provider or hospital for ordering or providing less than medically necessary and appropriate care to his or her patients or for denying, reducing…

O.C.G.A. § 33-20A-7 Penalizing provider for discussing necessary or appropriate care with patient prohibited; penalty for providing records and assistance prohibited; penalty for violations

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(a) No health care provider may be penalized for considering, studying, or discussing medically necessary or appropriate care with or on behalf of his or her patient. (b) No health care provider may be penalized by a managed care plan for providing testimony, evidence, records, o…

O.C.G.A. § 33-20A-7.1 Application; managed care plan’s liability following precertiﬁcation; availability of personnel for precertiﬁcation procedure

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(a)(1) The provisions of this chapter shall apply to any managed care plan offered pursuant to Article 1 of Chapter 18 of Title 45 and to any managed care plan offered by any managed care entity. (2) When an enrollee, provider, facility, or home health care provider calls during …

O.C.G.A. § 33-20A-8 Conﬁdentiality and accuracy of patient records

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Each managed care plan shall establish procedures to safeguard the privacy of individually identiﬁable patient information and to maintain accurate and timely records for patients. History. — Code 1981, § 33-20A-8, enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 350, § 2.

O.C.G.A. § 33-20A-9 Emergency services requirements; restrictive formulary requirements

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Every managed care plan shall include provisions that: (1)(A) In the event that a patient seeks emergency services and if necessary in the opinion of the emergency health care provider responsible for the patient’s emergency care and treatment and warranted by his or her evaluati…

O.C.G.A. § 33-20A-9.1 Legislative intent; consumer choice option; provisions; increased expenses; covered beneﬁts; forms

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(a) It is the intent of the General Assembly to allow citizens to have the right to choose their own health care providers and hospitals with as few mandates from government and business as possible. It is also the intent to allow these choices with minimal additional cost to any…

O.C.G.A. § 33-20A-30 Short title

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This article shall be known and may be cited as the ‘‘Patient’s Right to Independent Review Act.’’ History. — Code 1981, § 33-20A-30, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-31 Deﬁnitions

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As used in this article, the term: (1) ‘‘Department’’ means the Department of Community Health established under Chapter 2 of Title 31. (2) ‘‘Eligible enrollee’’ means a person who: (A) Is an enrollee or an eligible dependent of an enrollee of a managed care plan or was an enroll…

O.C.G.A. § 33-20A-32 Right to appeal

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An eligible enrollee shall be entitled to appeal to an independent review organization when: (1) The eligible enrollee has received notice of an adverse outcome pursuant to a grievance procedure or the managed care entity has not complied with the requirements of Code Section 33-…

O.C.G.A. § 33-20A-33 Minimum expense of treatment prior to review

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Except where required pursuant to Code Section 51-1-49, a proposed treatment must require the expenditure of a minimum of $500.00 to qualify for independent review. History. — Code 1981, § 33-20A-33, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-34 Representatives for enrollee; cost of review; cooperation

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(a) The parent or guardian of a minor who is an eligible enrollee may act on behalf of the minor in requesting independent review. The legal guardian or representative of an incapacitated eligible enrollee shall be authorized to act on behalf of the eligible enrollee in requestin…

O.C.G.A. § 33-20A-35 Request for independent review

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(a) In the event that the outcome of the grievance procedure under Code Section 33-20A-5 is adverse to the eligible enrollee, the managed care entity shall include with the written notice of the outcome of the grievance procedure a statement specifying that any request for indepe…

O.C.G.A. § 33-20A-36 Additional information required for independent review

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(a) Within three business days of receipt of notice from the department of assignment of the application for determination to an independent review organization, the managed care entity shall submit to that organization the following: (1) Any information submitted to the managed …

O.C.G.A. § 33-20A-37 Effect of favorable determinations

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(a) A decision of the independent review organization in favor of the eligible enrollee shall be ﬁnal and binding on the managed care entity and the appropriate relief shall be provided without delay. A managed care entity bound by such decision of an independent review organizat…

O.C.G.A. § 33-20A-38 Organizational and employee liability

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Neither an independent review organization nor its employees, agents, or contractors shall be liable for damages arising from determinations made pursuant to this article, unless an act or omission thereof is made in bad faith or through gross negligence, constitutes fraud or wil…

O.C.G.A. § 33-20A-39 Certiﬁcation of independent review organizations; conﬂict of interest; quality assurance mechanism; copies of nonproprietary information

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(a) The department shall certify independent review organizations that meet the requirements of this Code section and any regulations promulgated by the department consistent with this article. The department shall deem certiﬁed any independent review organization meeting standar…

O.C.G.A. § 33-20A-40 Determining medical necessity or whether a treatment is experimental

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(a) For the purposes of this article, in making a determination as to whether a treatment is medically necessary and appropriate, the expert reviewer shall use the deﬁnition provided in paragraph (7) of Code Section 33-20A-31. (b) For the purposes of this article, in making a det…

O.C.G.A. § 33-20A-41 Rules and regulations

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The department shall provide necessary rules and regulations for the implementation and operation of this article. History. — Code 1981, § 33-20A-41, enacted by Ga. L. 1999, p. 350, § 3; Ga. L. 2005, p. 1438, § 2/SB 140.

O.C.G.A. § 33-20A-42 Grievance procedures and hearings for Medicaid care management members

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Medicaid care management members shall, after ﬁrst exhausting the grievance procedure of the managed care plan providing health care beneﬁts pursuant to Article 7 of Chapter 4 of Title 49 or Article 13 of Chapter 5 of Title 49, be afforded the fair hearing rights provided pursuan…

O.C.G.A. § 33-20A-60 Deﬁnitions

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As used in this article, the term: (1) ‘‘Agent’’ shall not include an agent or agency as deﬁned in Code Section 33-23-1. (2) ‘‘Carrier’’ means an accident and sickness insurer, fraternal beneﬁt society, health care corporation, health maintenance organization, provider sponsored …

O.C.G.A. § 33-20A-61 Physician contracts

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(a) Every physician contract entered into, amended, extended, or renewed after July 1, 2002, by a carrier shall contain a speciﬁc provision which shall provide that, in the event that an insurance carrier, plan, network, panel, or any agent thereof should terminate a physician’s …

O.C.G.A. § 33-20A-62 Payment

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(a) No carrier, plan, network, panel, or any agent thereof may conduct a postpayment audit or impose a retroactive denial of payment on any claim by any claimant relating to the provision of health care services that was submitted within 90 days of the last date of service or dis…

O.C.G.A. § 33-20-1 Short title

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This chapter shall be known and may be cited as the ‘‘Health Care Plan Act.’’ History. — Code 1933, § 56-1700a, enacted by Ga. L. 1976, p. 1461, § 1.

O.C.G.A. § 33-20-10 Expiration, renewal, and amendment of certiﬁcate of authority

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(a) All certiﬁcates of authority shall expire at 12:00 Midnight on June 30 following the date of issuance or renewal. A health care corporation desiring renewal shall ﬁle on March 1 preceding expiration a copy of its annual statement as of December 31 of the preceding year in a f…

O.C.G.A. § 33-20-11 Refusal, revocation, or suspension of certiﬁcate of authority generally

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The Commissioner may refuse to issue, or after a hearing refuse to renew, or revoke or suspend a health care corporation’s certiﬁcate of authority in addition to other grounds provided for in this title if the corporation: (1) Violates any provision of this title other than the p…

O.C.G.A. § 33-20-12 Mandatory refusal, revocation, or suspension

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The Commissioner shall refuse to issue or to renew or shall revoke or suspend a health care corporation’s certiﬁcate of authority: (1) If such action is required by any provision of this title; or (2) If the health care corporation no longer meets the requirements for the authori…

O.C.G.A. § 33-20-13 Management of corporations; general powers; requirements as to reserves, minimum subscriber’s surpluses, and charges

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(a) Health care corporations shall be governed and conducted as corporations and the necessary expenses of administering the affairs of the corporations may be paid from the payments collected from subscribers. (b) A health care corporation may in its discretion limit the beneﬁts…

O.C.G.A. § 33-20-14 Acceptance of applications

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When organized, health care corporations shall be authorized to accept applicants individually or in groups who may become subscribers of the corporation furnishing health care services under a contract which shall entitle each subscriber, beneﬁciary, and covered dependent to the…

O.C.G.A. § 33-20-15 Issuance and contents of membership certiﬁcates

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(a) Every health care corporation shall issue to its subscribers a membership certiﬁcate which shall describe the health care plan under which the subscriber is enrolled and shall specify how the holder of such contract may obtain the name or names and addresses of participating …

O.C.G.A. § 33-20-16 Right to become participating physician or approved health care provider

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Every doctor of medicine, every doctor of dental surgery, every podiatrist, and every health care provider within a class approved by the health care corporation who is appropriately licensed to practice and who is reputable and in good standing shall have the right to become a p…

O.C.G.A. § 33-20-17 Powers of corporations to contract for provision of health care services; receipt of payments

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(a) Any health care corporation organized or operated under this chapter and engaged in the operation of a health care plan may contract with any agency, instrumentality, or political subdivision of the United States of America or of this state for the furnishing of health care s…

O.C.G.A. § 33-20-18 Sale of contracts providing for payment of speciﬁed charges made by participating physicians; right of subscribers to select physicians; liability of corporations for negligence of physicians

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(a) Health care corporations shall have the right to sell contracts providing for the payment of speciﬁed charges made by participating physicians furnishing medical or surgical care, or both, to the holders of such contracts, their beneﬁciaries, and covered dependents as provide…

O.C.G.A. § 33-20-19 Regulation and supervision of corporations by Commissioner generally; payment of fees and taxes by corporations generally

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Health care corporations shall be subject to regulation and supervision by the Commissioner and shall be required to pay any fees and taxes, including premium taxes, as are now or may hereafter be required of life insurers under this title in accordance with Chapters 2, 3, 8, and…

O.C.G.A. § 33-20-2 Purpose and construction of chapter

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It is the purpose and intent of this chapter and the policy of this state to promote and ﬁnance quality health care services of demonstrated need, efficiently provided and properly utilized at a reasonable cost, in order to maintain the standing and promote the progress of compre…

O.C.G.A. § 33-20-20 Submission to Commissioner of operating plan, schedule of rates, and amount of service; approval by Commissioner

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Except for corporations subject to this chapter which are surviving corporations, health care corporations shall before accepting applications from subscribers in a nonproﬁt health care plan submit to the Commissioner a plan of operating and overhead expenses, operation cost, and…

O.C.G.A. § 33-20-21 Approval of Commissioner of rates to be paid to providers of services

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Except for corporations subject to this chapter which are surviving corporations, the Commissioner shall ﬁrst approve the rates of payment to be made by health care corporations to providers of health care services on behalf of said corporation, its subscribers, beneﬁciaries, and…

O.C.G.A. § 33-20-22 Investment of funds of corporations

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Health care corporations shall invest in or lend their funds on security of and shall hold as invested assets only such assets as are authorized by Articles 1 and 3 of Chapter 11 of this title for the investments of assets of domestic insurance companies and such investments shal…