Definitions

  1. Law
  2. Georgia Code
  3. Insurance
  4. Health Maintenance Organizations
  5. Definitions

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As used in this chapter, the term:

  1. "Basic health care services" means health care services which an enrolled population might reasonably require in order to be maintained in good health, including as a minimum but not restricted to preventive care, emergency care, inpatient hospital and physician care, and outpatient medical services.
  2. "Enrollee" means an individual who has elected to contract for or participate in a health benefits plan for that individual or for that individual and that individual's eligible dependents.
  3. "Evidence of coverage" means any certificate, agreement, or contract issued to an enrollee setting out the coverage to which he is entitled.
  4. "Health benefits plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for, or reimburse any part of the cost of any health care services, at least part of which consists of arranging for or the provision of health care services, as distinguished from an arrangement which provides only for indemnification against the cost of such services on a prepaid basis through insurance or otherwise.
  5. "Health care services" means any services included in the furnishing to any individual of medical or dental care or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness or injury.
  6. "Health maintenance organization" means any person who undertakes to provide or arrange for one or more health benefits plans.
  7. "Insurer" means every insurer authorized under this title to issue contracts of accident and sickness insurance. Health care corporations and health maintenance organizations are included within such term.

    (7.1) "Patient" means a person who seeks or receives health care services fron a health maintenance organization.

  8. "Person" means any natural or artificial person including but not limited to individuals, partnerships, associations, trusts, or corporations.
  9. "Provider" means any physician, hospital, or other person who is licensed or otherwise authorized in this state to furnish health care services.

(Code 1933, § 56-3601, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 1; Ga. L. 1987, p. 3, § 33; Ga. L. 1995, p. 745, § 2.4; Ga. L. 1996, p. 485, §§ 1.2, 1.3; Ga. L. 2017, p. 164, § 12/HB 127.)

OPINIONS OF THE ATTORNEY GENERAL

Dental services alone do not constitute basic health care services.

- Plan offering only dental services may not be licensed as a health maintenance organization pursuant to O.C.G.A. T. 33, C. 21 since it does not provide basic health care services as defined in O.C.G.A. § 33-21-1. 1982 Op. Att'y Gen. No. 82-71.

RESEARCH REFERENCES

ALR.

- When is medical expense "incurred" under policy providing for payment of medical expenses incurred within fixed period of time from date of injury, 65 A.L.R.5th 649.


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