Powers of Organizations Generally; Filing of Notice of Exercise of Powers

  1. Law
  2. Georgia Code
  3. Insurance
  4. Health Maintenance Organizations
  5. Powers of Organizations Generally; Filing of Notice of Exercise of Powers

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  1. The powers of a health maintenance organization include, but are not limited to, the following:
    1. The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, their ancillary equipment, and such property as may reasonably be required for the organization's principal office or for such other purposes as may be necessary in the transaction of the business of the organization;
    2. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;
    3. The furnishing of health care services through providers which are under contract with or employed by the organization;
    4. The contracting with any person for the performance on its behalf of certain functions such as marketing and enrollment;
    5. The contracting with another insurer licensed in this state for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the organization;
    6. The offering, in addition to basic health care services, of:
      1. Additional health care services;
      2. Indemnity benefits covering out-of-area or emergency services; and
      3. Indemnity benefits, in addition to those relating to out-of-area and emergency services, provided through insurers; and
    7. The extension of malpractice insurance to a medical group with which it has a mutually exclusive contract to provide medical services to the enrollees of the health maintenance organization; provided, however, that coverage only protects against liability arising from medical care provided to enrollees of the health maintenance organization who receive medical care at a facility under contract with or owned or operated by the health maintenance organization.
    1. A health maintenance organization shall file notice, with adequate supporting information, with the Commissioner prior to the exercise of any power granted in paragraph (1) or (2) of subsection (a) of this Code section. The Commissioner shall disapprove the exercise of power if in his opinion it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the Commissioner does not disapprove within 90 days of the filing, it shall be deemed approved.
    2. The Commissioner may promulgate rules and regulations exempting from the filing requirement of paragraph (1) of this subsection those activities having a de minimis effect.

(Code 1933, § 56-3604, enacted by Ga. L. 1979, p. 1148, § 1; Ga. L. 1986, p. 676, § 6; Ga. L. 2013, p. 802, § 2/HB 312.)

OPINIONS OF THE ATTORNEY GENERAL

Offering dental services.

- A licensed health maintenance organization may offer additional services such as a dental plan, and may offer such service as a "stand-alone" plan. 1986 Op. Att'y Gen. No. 86-49, distinguishing 1982 Op. Att'y Gen. No. 82-71.

RESEARCH REFERENCES

ALR.

- Validity and construction of prescription drug insurance plans, 42 A.L.R.3d 897.


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