Section 30. Group or Blanket Accident and Sickness Insurance, 33-30-1 through 33-30-29.
ARTICLE 2
PREFERRED PROVIDER ARRANGEMENTS
33-30-22. Definitions.
As used in this article, the term:
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"Emergency services" or "emergency care" means those health care services that are provided for a condition of recent onset and sufficient severity, including, but not limited to, severe pain, that would lead a prudent layperson, possessing an average knowledge of medicine and health, to believe that his or her condition, sickness, or injury is of such a nature that failure to obtain immediate medical care could result in:
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Placing the patient's health in serious jeopardy;
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Serious impairment to bodily functions; or
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Serious dysfunction of any bodily organ or part.
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"Health benefit plan" means the health insurance policy or subscriber agreement between the covered person or the policyholder and the health care insurer which defines the covered services and benefit levels available.
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"Health care insurer" means an insurer, a fraternal benefit society, a health care plan, or a health maintenance organization authorized to sell accident and sickness insurance policies, subscriber certificates, or other contracts of insurance by whatever name called under this title.
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"Health care provider" means any person duly licensed or legally authorized to provide health care services.
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"Health care services" means services rendered or products sold by a health care provider within the scope of the provider's license or legal authorization. The term includes, but is not limited to, hospital, medical, surgical, dental, vision, chiropractic, psychological, and pharmaceutical services or products.
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"Preferred provider" means a health care provider or group of providers who have contracted to provide specified covered services.
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"Preferred provider arrangement" means a contract between or on behalf of the health care insurer and a preferred provider which complies with all the requirements of this article.
(Code 1981, §33-30-22, enacted by Ga. L. 1988, p. 1483, § 1; Ga. L. 2005, p. 481, § 15/HB 291; Ga. L. 2017, p. 164, § 50/HB 127.)
The 2017 amendment,
effective July 1, 2017, deleted "a nonprofit medical service corporation, nonprofit hospital service corporation," preceding "or a health" near the middle of paragraph (3).
