Coverage for Treatment of a Terminal Condition

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Coverage for Treatment of a Terminal Condition

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  1. As used in this Code section, the term:
    1. "Health benefit plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization, subscriber contract or agreement, preferred provider organization, accident and sickness insurance benefit plan, or other insurance contract under any other name. The term shall include any health insurance plan established under Article 1 of Chapter 18 of Title 45 and under Chapter 4 of Title 49, the "Georgia Medical Assistance Act of 1977."
    2. "Terminal condition" means any disease, illness, or health condition that a physician has diagnosed as expected to result in death in 24 months or less.
    3. "Treatment" does not include any medication or medical procedure, regardless of where actually prescribed, dispensed, or administered, which if prescribed, dispensed, or administered in this state would constitute assisted suicide in violation of Code Section 16-5-5.
  2. No health benefit plan shall restrict coverage for treatment of a terminal condition when such treatment has been prescribed by a physician as medically appropriate and such treatment has been agreed to by an insured patient or by a person to whom the insured patient has legally delegated such authority or to whom otherwise has the legal authority to consent on behalf of the insured patient. The health benefit plan shall not refuse to pay or otherwise reimburse for the treatment diagnosed under this subsection, including any drug or device, so long as such end of life care is consistent with best practices for the treatment of the terminal condition and such treatment is supported by peer reviewed medical literature.
  3. A denial or a refusal to pay for treatment prescribed under subsection (b) of this Code section shall be a violation of this Code section.
  4. A violation of this Code section shall be a per se violation of Chapter 6 of this title, and the penalties, procedures, and remedies applicable to violations of Chapter 6 of this title shall be applicable to a violation of this Code section.

(Code 1981, §33-24-59.18, enacted by Ga. L. 2015, p. 111, § 1/HB 429.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2015, Code Section 33-24-59.18, as enacted by Ga. L. 2015, p. 1317, § 1/HB 409, was redesignated as Code Section 33-24-59.19.

Law reviews.

- For article on the 2015 enactment of this Code section, see 32 Ga. St. U. L. Rev. 193 (2015).


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