As used in this chapter, the term: “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 hospital and physician care, and outpatient medical services. “Enrollee” means an individual […]
Every health maintenance organization shall be responsible for the assumption of full financial risk of providing basic health services to its members, except that the health maintenance organization may reinsure its risks with solvent reinsurers who qualify to transact reinsurance in this state under Code Section 33-7-14 and may enter into reinsurance treaties or agreements […]
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 of this state for the investment of assets constituting the legal […]
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.
Every enrollee residing in this state is entitled to evidence of coverage under a health benefits plan. The health maintenance organization shall issue the evidence of coverage. No evidence of coverage or amendment to the evidence of coverage shall be issued or delivered to any person in this state until a copy of the form […]
Every health maintenance organization shall annually provide to its enrollees: A description of services and information as to where and how to secure them; and A clear and understandable description of the health maintenance organization’s method for resolving enrollee complaints. History. Code 1933, § 56-3609, enacted by Ga. L. 1979, p. 1148, § 1; Ga. […]
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 of the preceding year and a copy of said report shall […]
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, reductions, abatements, and credits that life insurers are entitled […]
Whenever the Commissioner of Insurance shall deem it expedient, but not less than once every three years, he or his designee shall visit and examine the transactions, accounts, financial records, and documents of any health maintenance organization and of the providers with whom such organization has contracts, agreements, or other arrangements pursuant to its health […]
The Commissioner of Insurance shall adopt rules and regulations necessary for the implementation of this chapter with respect to all matters of organization, control of the matters relating to business, agents, examinations, and all other Code sections not exempted by this Code section. The commissioner of community health shall adopt rules and regulations for health […]
Every health benefits plan of every health maintenance organization shall include provisions that: 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 warranted by his or her evaluation, such emergency provider may initiate necessary intervention necessary […]
The Commissioner of Insurance may, after notice and hearing, promulgate any reasonable rules and regulations which are necessary to provide for the licensing of agents. “Agent” means a person directly or indirectly associated with a health benefits plan who engages in solicitation or enrollment. History. Code 1933, § 56-3614, enacted by Ga. L. 1979, p. […]
Any domestic stock, mutual, or nonprofit corporation whose charter powers include the business of a health maintenance organization may apply to the Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall establish or operate a health maintenance organization in this […]
Except as otherwise provided in this chapter, all hearings and proceedings held under this chapter shall be conducted in accordance with Chapter 2 of this title and the Commissioner of Insurance shall have all the powers granted to him in Chapter 2 of this title. The commissioner of community health, or his or her designated […]
All health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to regulation by the commissioner of community health. Upon the Commissioner’s determination that a health maintenance organization no longer meets the requirements of subsection (b.1) of Code Section 33-21-3, the Commissioner shall immediately notify the commissioner of […]
The commissioner of community health, in carrying out his obligations under subsection (b) of Code Section 33-21-3, paragraph (4) of subsection (a) of Code Section 33-21-5, and subsection (b) of Code Section 33-21-17, may contract with qualified persons to make recommendations concerning the determinations required to be made by him. Such recommendations may be accepted […]
All applications, filings, and reports required under this chapter shall be treated as public documents. History. Code 1933, § 56-3624, enacted by Ga. L. 1979, p. 1148, § 1.
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: To the extent that it may be necessary to carry out the […]
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 rehabilitation, liquidation, or conservation of insurance companies. The Commissioner may apply for an order directing him to rehabilitate, […]
Notwithstanding any other law which may be inconsistent with this Code section, an insurer or a health care corporation licensed in this state may directly or through a subsidiary or affiliate organize and operate a health maintenance organization. History. Code 1933, § 56-3615, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, […]
