Title 33

(a) The Commissioner may after a hearing impose upon a health care corporation an administrative fine if he finds that the corporation through the acts of its officers, employees, agents, or representatives has with such frequency as to indicate its general business practice in thi…

Whenever the Commissioner finds after investigation that an organizer, agent, or solicitor of a health care corporation has unfairly or improperly solicited subscription certificates by misrepresenting the terms of the certificates or has engaged in any other unfair or deceptive pra…

It shall be unlawful for any person except a health care corporation established in accordance with this chapter and operating in accordance with authority from the Commissioner to establish, maintain, or operate a health care plan or to solicit subscribers to or enter into contr…

As used in this chapter, the term: (1) ‘‘Beneficiary’’ or ‘‘covered dependent’’ means a person designated in the subscription certificate or application therefor of a subscriber as entitled to health care service with respect to whom appropriate periodic payments are made, all subj…

Any dispute arising within the purview of this chapter with reference to the regulation and supervision of any health care corporation shall within 30 days after such dispute arises be submitted by the aggrieved person to the Commissioner for his decision with reference thereto, …

Except for corporations subject to this chapter which are surviving corporations, this chapter shall not apply to nor govern any corporation which is organized for profit or which contemplates any pecuniary gain to its shareholders or members. A corporation subject to this chapter…

Except where the context otherwise requires, the applicable provisions of Title 14 shall govern a health care corporation. A health care corporation shall not be considered to be a corporation described in paragraph (2) of subsection (a) of Code Section 14-3-1302. All of the prov…

(a) No reserved funds as defined in subsection (b) of this Code section or surplus of such nonprofit health care corporation as increased pursuant to the charge required in subsection (e) of Code Section 33-20-13 shall be distributed or paid to any person as a part of any plan of c…

(a)(1) Any health care corporation which is governed generally by Chapter 3 of Title 14, the ‘‘Georgia Nonprofit Corporation Code,’’ and authorized under this chapter may merge with, or amend its articles of incorporation to become, a corporation governed by Chapter 2 of Title 14,…

Health care corporations may be incorporated for the purpose of establishing, maintaining, and operating one or more health care plans, providing administrative or other services to employers or others that offer plans furnishing or reimbursing for health care services, including…

(a) Any five or more persons, all of whom shall be residents of this state, upon filing a petition with the Secretary of State for a corporate charter as provided in Chapter 3 of Title 14, the ‘‘Georgia Nonprofit Corporation Code,’’ or, if the resulting health care corporation is to…

The treasurer of a health care corporation shall be required to give a fidelity bond with corporate surety in such sum as may be determined by the directors of the corporation and all funds collected from the subscribers of the corporation shall be deposited to the account of the …

(a) Except for corporations subject to this chapter which are surviving corporations, a health care corporation may issue contracts only after the Commissioner has authorized it to do so. (b) Every application for a certificate of authority shall be accompanied by copies of the fo…

(a) The Commissioner shall be authorized to issue a certificate of authority in accordance with this chapter and other proper requirements of the Commissioner if the Commissioner is satisfied that: (1) All items required to be filed are in proper form and meet his approval; (2) The …

PERMITS. Insurance representatives. Transferability of permits, §33-23-24. PATIENT PROTECTION AND AFFORDABLE CARE ACT. Waiver of provisions, request by governor, §33-1-26. PERSONAL INJURY PROTECTION. Motor vehicle insurance. Accident reparations, §§33-34-1 to

Joint committee to study, §33-20A-70. GENERIC DRUGS. Pharmacy benefits managers. Multi-source generic drug pricing,

This chapter shall be known and may be cited as the ‘‘Essential Rural Health Care Provider Access Act.’’ History. — Code 1981, § 33-20B-1, enacted by Ga. L. 1998, p. 900, § 2.

As used in this chapter, the term: (1) ‘‘Essential rural health care provider’’ means any hospital, federally qualified health center, or rural health clinic, as such terms are defined in this Code section, which is located in a rural area and which complies with the provisions of …

(a) Any essential rural health care provider shall have the opportunity to become a participating provider of health care services in a health benefit plan if such provider meets all of the following conditions: (1) Participates in the medicare and Medicaid programs; (2) Adopts an…

When reviewing a health maintenance organization’s request to originate or expand an area of service into a rural area, the commissioner of community health shall consider whether the health maintenance organization has demonstrated its willingness to grant reasonable considerati…

To deny, reject, or terminate an essential rural health care provider from serving as a participating provider in a health benefit plan, the health care insurer shall: (1) Inform the essential rural health care provider in writing of the basis for such rejection or termination, in…

Any essential rural health care provider which is denied, rejected, or terminated from serving as a participating provider in a health benefit plan shall have the right of hearing and appeal before the Commissioner, or his or her designee, if that provider believes there has been …

Hearing and appeal rights of denied providers. Administration. viders are being arbitrarily excluded from participating in certain health benefit plans and that, should such practice continue, these providers will be harmed and forced either to discontinue their services or reloca…

As used in this chapter, the term: (1) ‘‘Covered person’’ means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan. (2) ‘‘Facility’’ means an institution providing physical, mental, or behavioral health care services or a healthcare se…

(a)(1) An insurer shall post on its website a current and accurate electronic provider directory for each of its network plans with the information described in Code Section 33-20C-4. Such online provider directory shall be easily accessible in a standardized, downloadable, searc…

(a) The insurer shall include in both its online and print directories a clearly identifiable telephone number and either a dedicated e-mail address or a link to a dedicated webpage that covered persons or the general public may use to report to the insurer inaccurate information …

(a) The insurer shall make available through an online provider directory, for each network plan, the following information, in a searchable format: (1) For healthcare professionals: (A) Name; (B) Gender; (C) Contact information; (D) Participating office location or locations; (E…

(a) The insurer shall make available in print, upon request, the following provider directory information for the applicable network plan: (1) For healthcare professionals: (A) Name; (B) Contact information; (C) Participating office location or locations; (D) Specialty, if applic…

This chapter shall not apply to the provision of health care services pursuant to a contract entered into by an insurer and the Department of Community Health for recipients of Medicaid or PeachCare for Kids and the state health benefit plan under Article 1 of Chapter 18 of Title …

(a) Each insurer that advertises or designates any hospital as in-network shall be required to disclose the relevant health benefit plan surprise bill rating within such advertisement, notwithstanding the type or form of such advertisement. (b) If a health benefit plan surprise bil…

As used in this chapter, the term: (1) ‘‘Affiliate’’ means an entity owned or controlled, either directly or through a parent or subsidiary entity, by a contracting entity that accesses the rates, terms, or conditions of health care services. (2) ‘‘Contracting entity’’ means any …

(a) Any person who commences business as a rental preferred provider network shall register with the Commissioner within 30 days of commencing business in this state unless such person is licensed by the Commissioner as a health insurer. Each rental preferred provider network not…

(a) A rental preferred provider network shall not: (1) Knowingly access or utilize a network provider’s contractual discount pursuant to a provider network contract without a contractual relationship with the network provider, rental preferred provider network, or third party; or…

(a) A third party, having itself been granted access to a network provider’s health care services and contractual discounts pursuant to a provider network contract, that subsequently grants access to another third party shall be obligated to comply with the rights and responsibil…

This chapter shall not apply to: (1) Provider network contracts for services provided to Medicaid, medicare, the state health benefit plan under Article 1 of Chapter 18 of Title 45, or State Children’s Health Insurance Program (SCHIP) beneficiaries; (2) Employers, church plans, or …

Any person or entity that is not duly licensed or that should be licensed by the department or that is not duly registered or that should be registered with the department pursuant to Code Section 33-20D-2 and acts as a rental preferred provider network, as defined in paragraph (7…

This chapter shall be known and may be cited as the ‘‘Surprise Billing Consumer Protection Act.’’ History. — Code 1981, § 33-20E-1, enacted by Ga. L. 2020, p. 210, § 1/HB 888.

The Commissioner shall dismiss certain requests for arbitration if the disputed claim is: (1) Related to a healthcare plan that is not regulated by the state; (2) The basis for an action pending in state or federal court at the time of the request for arbitration; (3) Subject to …

Within 30 days of the insurer’s receipt of the provider’s or facility’s request for arbitration, the insurer shall submit to the Commissioner all data necessary for the Commissioner to determine whether such insurer’s payment to such provider or facility was in compliance with Co…

The Commissioner shall promulgate rules implementing an arbitration process requiring the Commissioner to select one or more resolution organizations to arbitrate certain claim disputes between insurers and out-of-network providers or facilities. Prior to proceeding with such arb…

Upon the Commissioner’s referral of a dispute to a resolution organization, the parties shall have five days to select an arbitrator by mutual agreement. If the parties have not notified the resolution organization of their mutual selection before the fifth day, the resolution organ…

The parties shall have ten days after the selection of the arbitrator to submit in writing to the resolution organization each party’s final offer and each party’s argument in support of such offer. The parties’ initial arguments shall be limited to written form and shall consist …

Each party shall submit one proposed payment amount to the arbitrator. The arbitrator shall pick one of the two amounts submitted and shall reveal that amount in the arbitrator’s final decision. The arbitrator may not modify such selected amount. In making such a decision, the arb…

The party whose final offer amount is not selected by the arbitrator shall pay the amount of the verdict, the arbitrator’s expenses and fees, and any other fees assessed by the resolution organization, directly to such resolution organization. In the event of default, the defaulti…

Following the resolution of arbitration, the Commissioner may refer the decision of the arbitrator to the appropriate state agency or the governing entity with governing authority over such provider or facility if the Commissioner concludes that a provider or facility has either …

Once a request for arbitration has been filed with the Commissioner by a provider or facility under this chapter, neither such provider nor such facility nor the insurer in such dispute shall file a lawsuit in court regarding the same out-of-network claim. History. — Code 1981, § 3…