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GEORGIA CODE (Last Updated: August 20, 2013) |
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Title 33. INSURANCE |
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Chapter 21. HEALTH MAINTENANCE ORGANIZATIONS |
| § 33-21-1. Definitions |
| § 33-21-2. Procedure for establishment of health maintenance organizations generally; notice of modification; exemption of item from filing requirements |
| § 33-21-3. Grounds and procedure for issuance or denial of certificate of authority; endorsement of change of address upon certificate of authority |
| § 33-21-4. Annual license fee |
| § 33-21-5. Suspension or revocation of certificate of authority |
| § 33-21-6. Composition of governing body; duty to establish mechanism for participation by enrollees in matters of policy and operation |
| § 33-21-7. Fiduciary responsibilities of directors, officers, or partners |
| § 33-21-8. Powers of organizations generally; filing of notice of exercise of powers |
| § 33-21-9. Establishment and maintenance of complaint system; maintenance of records of complaints; summary reports; examination of system |
| § 33-21-10. Responsibility of organizations for financial risks of providing services generally; reinsurance of risks; deposit of cash or securities with Commissioner |
| § 33-21-11. Investment of funds of organizations |
| § 33-21-12. Participation in organizations by members of associations |
| § 33-21-13. Evidence of coverage; filing and approval of basic rates and method of computation of coverage |
| § 33-21-14. Annual information to enrollees |
| § 33-21-15. Filing of annual reports; contents |
| § 33-21-16. Fees and taxes |
| § 33-21-17. Examinations of organizations and providers; reports of examinations; payment of expenses of examinations |
| § 33-21-18. Adoption of rules and regulations generally |
| § 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 |
| § 33-21-20.1. Regulation of HMOs by commissioner of community health |
| § 33-21-21. Authority of commissioner of community health to contract for making of recommendations required by chapter; acceptance of recommendations |
| § 33-21-22. Applications, filings, and reports to be treated as public documents |
| § 33-21-23. Confidentiality of medical information; claim of privileges by organizations |
| § 33-21-24. Rehabilitation, liquidation, or conservation of organizations |
| § 33-21-25. Organization and operation of health maintenance organizations by insurers or corporations |
| § 33-21-26. Untrue or misleading statements; deceptive evidence of coverage; cancellation or nonrenewal of enrollees |
| § 33-21-27. Enforcement of chapter; penalties for violations of chapter |
| § 33-21-28. Applicability of provisions of title and of other laws to health maintenance organizations and representatives |
| § 33-21-29. Point-of-service option for persons offered health care coverage through health maintenance organization |
REFS & ANNOS
TITLE 33 Chapter 21 NOTE
CROSS REFERENCES. --State health planning and development, Ch. 6, T. 31. Public assistance for medical care, § 49-4-140 et seq.
LAW REVIEWS. --For article surveying recent legislative and judicial developments regarding Georgia's insurance laws, see 31 Mercer L. Rev. 117 (1979).
For note, "Paying the Piper: Third-party Payor Liability for Medical Treatment Decisions," see 25 Ga. L. Rev. 861 (1991).
OPINIONS OF THE ATTORNEY GENERAL
STATE PERSONNEL BOARD MAY OFFER MEMBERSHIP IN QUALIFIED HMO PLAN. --Since health maintenance organizations (HMO) may operate and contract with an insurer in Georgia, the State Personnel Board may include in its self-insurance plan the option of membership in a qualified HMO to provide the benefits under the plan of health insurance determined in accordance with §§ 20-2-880 through 20-2-895 and §§ 45-18-1 through 45-18-17 by contracting through its insurer administrator. Since the State Personnel Board may contract with its insurer administrator to offer this HMO membership option, logically it is the organization best able to provide this option. 1980 Op. Att'y Gen. No. 80-8.
A LIMITED PARTNERSHIP MAY ESTABLISH AND OPERATE A HEALTH MAINTENANCE ORGANIZATION since a limited partnership is a partnership and a partnership is a person within the meaning of the health maintenance organization chapter. 1984 Op. Att'y Gen. No. 84-87.
HEALTH MAINTENANCE ORGANIZATION IS NOT AUTOMATICALLY CONSIDERED TO BE CONDUCTING BUSINESS OF INSURANCE. 1984 Op. Att'y Gen. No. 84-87.
PROSPECTIVE EFFECT OF "INSURER" DEFINITION. --A limited partnership which has been operating a health maintenance organization since 1981 may continue to do so notwithstanding § 33-1-2(4), which defines "insurer" for purposes of the Georgia Insurance Code, since even if the 1982 revision of that section could effect the right of a limited partnership to operate a health maintenance organization, the effect of the revision, if any, is prospective only. 1984 Op. Att'y Gen. No. 84-87.
RESEARCH REFERENCES
Am. Jur. Proof of Facts. --Liability of Health Maintenance Organizations, 66 POF3d 1.
ALR. --Health insurance: provisions excluding or limiting liability in case of chronic diseases, 4 ALR 875; 15 ALR 1239.
Criterion of health for purposes of warranty or condition in insurance contract, 40 ALR 662; 100 ALR 362.
Validity and nature of group medical and hospital service plans, 167 ALR 322.
Scope of provision in group health or accident insurance policy excluding from coverage sickness or accidents arising out of, or in the course of, employment, 47 ALR2d 1240.
Provision of accident or health insurance policy that insured shall be under care of physician or surgeon, 84 ALR2d 375.
When is medical expense "incurred" under policy providing for payment of medical expenses incurred within fixed period of time from date of injury, 10 ALR3d 468.
Medical care insurance: right of insured under individual policy to coverage afforded by group policy from which he directly transferred on termination of his employment, 66 ALR3d 1192.
Elimination of particular coverage, or termination, of health hospitalization, or medical care insurance policy as affecting insurer's liability for insured's continuing hospitalization or medical expenses relating to previously covered illness, 66 ALR3d 1205.
Admissibility of opinion evidence as to employability on issue of disability in health and accident insurance and workers' compensation cases, 89 ALR3d 783.
Construction and application of provision in health or hospitalization policy excluding or postponing coverage of illness originating prior to issuance of policy or within stated time, 94 ALR3d 990.
Construction and application of provision in health or hospitalization policy excluding or postponing coverage of illness for which medical care or treatment was received within stated time preceding or following issuance of policy, 95 ALR3d 1290.
What services, equipment, or supplies are "medically necessary" for purposes of coverage under medical insurance, 75 ALR4th 763.
Coverage under medical and health insurance plans for services performed by dentists, oral surgeons, and orthodontists, 43 ALR5th 657.
Liability of health maintenance organizations (HMOs) for negligence of member physicians, 51 ALR5th 271.
LAW REVIEWS. --For article surveying recent legislative and judicial developments regarding Georgia's insurance laws, see 31 Mercer L. Rev. 117 (1979).
For note, "Paying the Piper: Third-party Payor Liability for Medical Treatment Decisions," see 25 Ga. L. Rev. 861 (1991).
OPINIONS OF THE ATTORNEY GENERAL
STATE PERSONNEL BOARD MAY OFFER MEMBERSHIP IN QUALIFIED HMO PLAN. --Since health maintenance organizations (HMO) may operate and contract with an insurer in Georgia, the State Personnel Board may include in its self-insurance plan the option of membership in a qualified HMO to provide the benefits under the plan of health insurance determined in accordance with §§ 20-2-880 through 20-2-895 and §§ 45-18-1 through 45-18-17 by contracting through its insurer administrator. Since the State Personnel Board may contract with its insurer administrator to offer this HMO membership option, logically it is the organization best able to provide this option. 1980 Op. Att'y Gen. No. 80-8.
A LIMITED PARTNERSHIP MAY ESTABLISH AND OPERATE A HEALTH MAINTENANCE ORGANIZATION since a limited partnership is a partnership and a partnership is a person within the meaning of the health maintenance organization chapter. 1984 Op. Att'y Gen. No. 84-87.
HEALTH MAINTENANCE ORGANIZATION IS NOT AUTOMATICALLY CONSIDERED TO BE CONDUCTING BUSINESS OF INSURANCE. 1984 Op. Att'y Gen. No. 84-87.
PROSPECTIVE EFFECT OF "INSURER" DEFINITION. --A limited partnership which has been operating a health maintenance organization since 1981 may continue to do so notwithstanding § 33-1-2(4), which defines "insurer" for purposes of the Georgia Insurance Code, since even if the 1982 revision of that section could effect the right of a limited partnership to operate a health maintenance organization, the effect of the revision, if any, is prospective only. 1984 Op. Att'y Gen. No. 84-87.
RESEARCH REFERENCES
Am. Jur. Proof of Facts. --Liability of Health Maintenance Organizations, 66 POF3d 1.
ALR. --Health insurance: provisions excluding or limiting liability in case of chronic diseases, 4 ALR 875; 15 ALR 1239.
Criterion of health for purposes of warranty or condition in insurance contract, 40 ALR 662; 100 ALR 362.
Validity and nature of group medical and hospital service plans, 167 ALR 322.
Scope of provision in group health or accident insurance policy excluding from coverage sickness or accidents arising out of, or in the course of, employment, 47 ALR2d 1240.
Provision of accident or health insurance policy that insured shall be under care of physician or surgeon, 84 ALR2d 375.
When is medical expense "incurred" under policy providing for payment of medical expenses incurred within fixed period of time from date of injury, 10 ALR3d 468.
Medical care insurance: right of insured under individual policy to coverage afforded by group policy from which he directly transferred on termination of his employment, 66 ALR3d 1192.
Elimination of particular coverage, or termination, of health hospitalization, or medical care insurance policy as affecting insurer's liability for insured's continuing hospitalization or medical expenses relating to previously covered illness, 66 ALR3d 1205.
Admissibility of opinion evidence as to employability on issue of disability in health and accident insurance and workers' compensation cases, 89 ALR3d 783.
Construction and application of provision in health or hospitalization policy excluding or postponing coverage of illness originating prior to issuance of policy or within stated time, 94 ALR3d 990.
Construction and application of provision in health or hospitalization policy excluding or postponing coverage of illness for which medical care or treatment was received within stated time preceding or following issuance of policy, 95 ALR3d 1290.
What services, equipment, or supplies are "medically necessary" for purposes of coverage under medical insurance, 75 ALR4th 763.
Coverage under medical and health insurance plans for services performed by dentists, oral surgeons, and orthodontists, 43 ALR5th 657.
Liability of health maintenance organizations (HMOs) for negligence of member physicians, 51 ALR5th 271.