Georgia House of Representatives - 1995/1996 Sessions

HB 1687 - Health insurance; certain coverage; prohibit point-of-service options

Page Numbers - 1/ 2

Code Sections - 33-24-58

1. Lord  121st


House Comm: Ins        /                Senate Comm:            /                                   
House Vote: Yeas       Nays             Senate Vote: Yeas     Nays                                  
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               House          Action         Senate                                                 
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              2/13/96  Read 1st Time                                                                
              2/14/96  Read 2nd Time                                                                
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Code Sections amended:                                                                              


HB 1687                                            LC 25 0270






                        A BILL TO BE ENTITLED
                               AN ACT


  1- 1  To amend Article 1 of Chapter 24 of Title 33 of the Official
  1- 2  Code of Georgia Annotated, relating to general provisions
  1- 3  relating to insurance generally, so as to prohibit
  1- 4  point-of-service options for health insurance coverage
  1- 5  offered through a health maintenance organization or other
  1- 6  health benefit plan; to repeal conflicting laws; and for
  1- 7  other purposes.

  1- 8       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

                         SECTION 1.

  1- 9  Article 1 of Chapter 24 of Title 33 of the Official Code of
  1-10  Georgia Annotated, relating to general provisions relating
  1-11  to insurance generally, is amended by adding at the end a
  1-12  new Code section to read as follows:

  1-13    "33-24-58. (Index)

  1-14    (a) For the purposes of this Code section,

  1-15      (1) 'Carrier' means an insurer, a nonprofit health
  1-16      service plan, a health maintenance organization, a
  1-17      preferred provider organization, or another person or
  1-18      organization that provides health benefit plans subject
  1-19      to state regulations.  Carrier includes an entity that
  1-20      arranges a provider panel for a carrier.

  1-21      (2) 'Enrollee' means any person entitled to health care
  1-22      benefits from a carrier.

  1-23      (3) 'Point-of-service option' means a delivery system
  1-24      that permits a member or enrollee of a health
  1-25      maintenance organization or other health benefit plan to
  1-26      receive services outside the provider panel of the
  1-27      health maintenance organization or other health benefit
  1-28      plan under the terms and conditions of the member's or
  1-29      enrollee's contract with the health maintenance
  1-30      organization or other health benefit plan.




                                 -1- (Index)

                                                  LC 25 0270

  2- 1      (4) 'Provider' means a health care practitioner or a
  2- 2      group of health care practitioners licensed or otherwise
  2- 3      authorized by law to provide health care services.

  2- 4      (5) 'Provider panel' means those providers:

  2- 5        (A) With which a health maintenance organization
  2- 6        contracts to provide health care services to the
  2- 7        health maintenance organization's members or enrollees
  2- 8        under the carrier's health benefit plan; or

  2- 9        (B) Which participate in an arrangement between a
  2-10        carrier and providers in which any provider may
  2-11        participate solely on the basis of the provider's
  2-12        contracting with the carrier to provide services at a
  2-13        discounted fee-for-service rate.

  2-14    (b) No carrier shall offer, or contract with another
  2-15    carrier to offer, any point-of-service option in
  2-16    conjunction with a health maintenance organization or
  2-17    other health benefit plan."

                         SECTION 2.

  2-18  All laws and parts of laws in conflict with this Act are
  2-19  repealed.

























                                 -2- (Index)