TITLE 33 INSURANCE

Section 30. Group or Blanket Accident and Sickness Insurance, 33-30-1 through 33-30-29.

ARTICLE 2 PREFERRED PROVIDER ARRANGEMENTS

33-30-24. Health benefit plans providing incentives to use services of preferred providers; minimum requirements.

Health care insurers may issue health benefit plans which provide for incentives for covered persons to use the health care services of preferred providers. Such policies or subscriber certificates shall contain at least the following provisions:

1. A provision that if a covered person receives emergency care for services specified in the preferred provider arrangement and cannot reasonably reach a preferred provider, that emergency care rendered during the course of the emergency will be paid for in accordance with the terms of the health benefit plan, at benefit levels at least equal to those applicable to treatment by preferred providers for emergency care in an amount based on the usual, customary, and reasonable charges in the area where the treatment is provided; and
2. A provision which clearly identifies the differences in benefit levels for health care services of preferred providers and benefit levels for health care services of nonpreferred providers.

   For purposes of this Code section, when a request for emergency care is made through the emergency 9-1-1 system on behalf of a covered person and the ambulance service licensed under Chapter 11 of Title 31 that was dispatched in response to the request is not a preferred provider, for purposes of payment under paragraph (1) of this Code section, it shall be presumed that the covered person could not reasonably reach a preferred provider.

(Code 1981, §33-30-24, enacted by Ga. L. 1988, p. 1483, § 1; Ga. L. 2006, p. 652, § 5/HB 1257.)