Title 33, Chapter 21, Section 29
( 33-21-29)
(a) It is the intent of the General Assembly to allow citizens to
have the right to choose their own health care providers with as few
mandates from government and business as possible. It is also the
intent to allow these choices with no additional cost to any
business in this state. With these intentions, and the recognition
of necessary governmental involvement through various laws, the
General Assembly enacts this Code section. (b) As used in this Code section, the term: (1) "Employer" means an employer, association, or other private
group arrangement. (2) "Enrollee" means any person entitled to receive health care
services or reimbursement for such services pursuant to a contract
with a health maintenance organization, whether the contract is
with the person entitled to receive those services or
reimbursement or the contract is with an employer of which such
person is an employee or member. (3) "Point-of-service option" means a delivery system that permits
an enrollee of a health maintenance organization to receive
services outside the provider panel of the health maintenance
organization under the terms and conditions of the enrollee's
contract with the health maintenance organization. (4) "Provider" means a provider or a group of providers designated to provide health care services to the health maintenance organization's enrollees, as provider is defined in Code Section 33-21-1. (5) "Provider panel" means those providers with which a health
maintenance organization contracts to provide health care services
to the health maintenance organization's enrollees. (c) If the only type of insurance that an employer offers to
eligible employees or individuals is health benefit plan coverage
through a health maintenance organization, then the health
maintenance organization with which such employer contracts to
provide such coverage shall offer or make arrangements for the
offering of a point-of-service option to such employer for the
employer's eligible employees or individuals, and each such eligible
employee or individual shall have the right to accept or reject such
option. (d) An employer may require an employee or individual who accepts
the point-of-service option to be responsible for the payment of a
premium over the amount of the premium for the coverage offered by
the health maintenance organization or by an arrangement with
another entity in conjunction with the health maintenance
organization either directly to the health maintenance organization
or other entity or by payroll deduction. (e) A health maintenance organization may impose different
cost-sharing provisions for the point-of-service option based on
whether the service is provided through the provider panel of the
health maintenance organization or outside the provider panel of the
health maintenance organization.
(f) This Code section shall not apply to the Department of Community
Health with regard to any and all health benefits that the
department may provide pursuant to Article 7 of Chapter 4 of Title
49, the "Georgia Medical Assistance Act of 1977," nor shall this
Code section apply to Chapter 9 of Title 34, relating to workers'
compensation. (g) An employer may charge an employee or individual who accepts the
point-of-service option a reasonable administrative fee for costs
associated with the employer's reasonable administration of the
point-of-service option. |