Online Provider Directories; Printed Directories by Request; Required Content; Accessibility

  1. Law
  2. Georgia Code
  3. Insurance
  4. Accurate Provider Directories
  5. Online Provider Directories; Printed Directories by Request; Required Content; Accessibility

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    1. An insurer shall post on its website a current and accurate electronic provider directory for each of its network plans with the information described in Code Section 33-20C-4. Such online provider directory shall be easily accessible in a standardized, downloadable, searchable, and machine readable format.
    2. In making the provider directory available online, the insurer shall ensure that the general public is able to view all of the current providers for a network plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract number.
    3. The insurer shall update each network plan on the online provider directory no less than every 30 days.
  2. An insurer shall provide a print copy of a current provider directory, or a print copy of the requested directory information, with the information described in Code Section 33-20C-5 upon request by a covered person or a prospective covered person.
  3. For each network plan, an insurer shall include in plain language, in both the online and print directory, the following general information:
    1. A description of the criteria the insurer has used to build its provider network;
    2. If applicable, a description of the criteria the insurer has used to tier providers;
    3. If applicable, how the insurer designates the different provider tiers or levels, such as by name, symbols, or grouping, in the network and for each specific provider in the network, which tier each is placed in order for a covered person or a prospective covered person to be able to identify the provider tier; and
    4. If applicable, a notice that authorization or referral may be required to access some providers.
  4. The insurer shall make clear for both its online and print directories the provider directory that applies to each network plan by identifying the specific name of the network plan as marketed and issued in this state.
  5. The insurer shall make available through its online and print directories the source of the information required pursuant to Code Sections 33-20C-4 and 33-20C-5 pertaining to each health care provider and any limitations, if applicable.
  6. Provider directories, whether in electronic or print format, shall be accessible to individuals with disabilities and individuals with limited English proficiency as defined in 45 C.F.R. Section 92.201 and 45 C.F.R. Section 155.205(c).

(Code 1981, §33-20C-2, enacted by Ga. L. 2016, p. 149, § 1/SB 302.)


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