Georgia Code, Title 33, Chapter 21 - Health Maintenance Organizations

• § 33-21-1 - Definitions
  As used in this chapter, the term: (1) "Basic health care services" means health care services which an enrolled population might reasonably require in...
• § 33-21-2 - Procedure for Establishment of Health Maintenance Organizations Generally; Notice of Modification; Exemption of Item From Filing Requirements
  (a) Any domestic stock, mutual, or nonprofit corporation whose charter powers include the business of a health maintenance organization may apply to the Commissioner...
• § 33-21-3 - Grounds and Procedure for Issuance or Denial of Certificate of Authority; Endorsement of Change of Address Upon Certificate of Authority
  (a) Upon receipt of an application for issuance of a certificate of authority, the Commissioner of Insurance shall forthwith transmit copies of such application...
• § 33-21-4 - Annual License Fee
  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.
• § 33-21-5 - Suspension or Revocation of Certificate of Authority
  (a) The Commissioner of Insurance may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if he...
• § 33-21-6 - Composition of Governing Body; Duty to Establish Mechanism for Participation by Enrollees in Matters of Policy and Operation
  (a) The governing body of any health maintenance organization shall include providers and other individuals, provided that at least one-third of the members of...
• § 33-21-7 - Fiduciary Responsibilities of Directors, Officers, or Partners
  Any director, officer, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the...
• § 33-21-8 - Powers of Organizations Generally; Filing of Notice of Exercise of Powers
  (a) The powers of a health maintenance organization include, but are not limited to, the following: (1) The purchase, lease, construction, renovation, operation, or...
• § 33-21-9 - Establishment and Maintenance of Complaint System; Maintenance of Records of Complaints; Summary Reports; Examination of System
  (a) Every health maintenance organization shall establish and maintain a complaint system which has been approved by the Commissioner of Insurance to provide reasonable...
• § 33-21-10 - Responsibility of Organizations for Financial Risks of Providing Services Generally; Reinsurance of Risks; Deposit of Cash or Securities With Commissioner
  (a) Every health maintenance organization shall be responsible for the assumption of full financial risk of providing basic health services to its members, except...
• § 33-21-11 - Investment of Funds of Organizations
  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...
• § 33-21-12 - Participation in Organizations by Members of Associations
  No employer, union, trade organization, or any other association shall force its members, either by payroll deduction or other means, to join a health...
• § 33-21-13 - Evidence of Coverage; Filing and Approval of Basic Rates and Method of Computation of Coverage
  (a) Every enrollee residing in this state is entitled to evidence of coverage under a health benefits plan. The health maintenance organization shall issue...
• § 33-21-14 - Annual Information to Enrollees
  Every health maintenance organization shall annually provide to its enrollees: (1) A description of services and information as to where and how to secure...
• § 33-21-15 - Filing of Annual Reports; Contents
  (a) Every health maintenance organization shall annually, on or before March 1, file with the Commissioner of Insurance, on forms to be designated by...
• § 33-21-16 - Fees and Taxes
  The same fees and taxes provided for in Chapter 8 of this title applicable to life insurers shall apply to and shall be imposed...
• § 33-21-17 - Examinations of Organizations and Providers; Reports of Examinations; Payment of Expenses of Examinations
  (a) Whenever the Commissioner of Insurance shall deem it expedient, but not less than once every three years, he or his designee shall visit...
• § 33-21-18 - Adoption of Rules and Regulations Generally
  (a) The Commissioner of Insurance shall adopt rules and regulations necessary for the implementation of this chapter with respect to all matters of organization,...
• § 33-21-18.1 - Emergency Services Requirements; Restrictive Formulary Requirements
  Every health benefits plan of every health maintenance organization shall include provisions that: (1) In the event a patient seeks emergency services and if...
• § 33-21-19 - Promulgation of Rules and Regulations for Licensing of Agents
  The Commissioner of Insurance may, after notice and hearing, promulgate any reasonable rules and regulations which are necessary to provide for the licensing of...
• § 33-21-20 - Conduct of Hearings Generally; Participation in Hearings by Commissioner of Community Health; Judicial Review
  (a) Except as otherwise provided in this chapter, all hearings and proceedings held under this chapter shall be conducted in accordance with Chapter 2...
• § 33-21-20.1 - Regulation of Hmos by Commissioner of Community Health
  On May 13, 2004, all health maintenance organizations meeting the requirements of subsection (b.1) of Code Section 33-21-3 shall not be subject to regulation...
• § 33-21-21 - Authority of Commissioner of Community Health to Contract for Making of Recommendations Required by Chapter; Acceptance of Recommendations
  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...
• § 33-21-22 - Applications, Filings, and Reports to Be Treated As Public Documents
  All applications, filings, and reports required under this chapter shall be treated as public documents.
• § 33-21-23 - Confidentiality of Medical Information; Claim of Privileges by Organizations
  (a) Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from the person or from any...
• § 33-21-24 - Rehabilitation, Liquidation, or Conservation of Organizations
  Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be the rehabilitation, liquidation, or conservation of an insurance company and shall be...
• § 33-21-25 - Organization and Operation of Health Maintenance Organizations by Insurers or Corporations
  Notwithstanding any other law which may be inconsistent with this Code section, an insurer, a hospital service nonprofit corporation, a nonprofit medical service corporation,...
• § 33-21-26 - Untrue or Misleading Statements; Deceptive Evidence of Coverage; Cancellation or Nonrenewal of Enrollees
  (a) No health maintenance organization or representative of a health maintenance organization may cause or knowingly permit the use of advertising which is untrue...
• § 33-21-27 - Enforcement of Chapter; Penalties for Violations of Chapter
  (a) (1) In lieu of suspension or revocation of a certificate of authority for any of the causes enumerated in Code Section 33-21-5, the...
• § 33-21-28 - Applicability of Provisions of Title and of Other Laws to Health Maintenance Organizations and Representatives
  (a) Except as otherwise provided by law, all provisions of this title which are not in conflict with this chapter shall apply to health...
• § 33-21-29 - Point-Of-service Option for Persons Offered Health Care Coverage Through Health Maintenance Organization
  (a) It is the intent of the General Assembly to allow citizens to have the right to choose their own health care providers with...

Last modified: October 14, 2016