Restrictions on Payment Methods Prohibited; Waiver of Provisions Prohibited; Enforcement

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Restrictions on Payment Methods Prohibited; Waiver of Provisions Prohibited; Enforcement

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  1. As used in this chapter, the term:
    1. "Care management organization" means an entity that is organized for the purpose of providing or arranging health care, which has been granted a certificate of authority by the Commissioner as a health maintenance organization pursuant to Chapter 21 of this title, and which has entered into a contract with the Department of Community Health to provide or arrange health care services on a prepaid, capitated basis to members.
    2. "Credit card payment" means a type of electronic funds transfer in which a health insurance plan or health insurer or its contracted vendor issues a single-use series of numbers associated with the payment of health care services performed by a health care provider and chargeable to a predetermined dollar amount, whereby the health care provider is responsible for processing the payment by a credit card terminal or Internet portal. Such term shall include virtual or online credit card payments, whereby no physical credit card is presented to the health care provider and the single-use credit card expires upon payment processing.
    3. "Electronic funds transfer" means an electronic funds transfer through the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, standard automated clearing-house network.
    4. "Health care provider" means any physician, dentist, podiatrist, pharmacist, optometrist, psychologist, registered optician, licensed professional counselor, physical therapist, chiropractor, hospital, or other entity or person that is licensed or otherwise authorized in this state to furnish health care services.
    5. "Health care services" means the examination or treatment of persons for the prevention of illness or the correction or treatment of any physical or mental condition resulting from illness, injury, or other human physical problem and includes, but is not limited to:
      1. Hospital services which include the general and usual services and care, supplies, and equipment furnished by hospitals;
      2. Medical services which include the general and usual services and care rendered and administered by doctors of medicine, doctors of dental surgery, and doctors of podiatry; and
      3. Other health care services which include appliances and supplies; nursing care by a registered nurse or a licensed practical nurse; care furnished by such other licensed practitioners; institutional services including the general and usual care, services, supplies, and equipment furnished by health care institutions and agencies or entities other than hospitals; physiotherapy; ambulance services; drugs and medications; therapeutic services and equipment including oxygen and the rental of oxygen equipment; hospital beds; iron lungs; orthopedic services and appliances including wheelchairs, trusses, braces, crutches, and prosthetic devices including artificial limbs and eyes; and any other appliance, supply, or service related to health care.
    6. "Health insurance plan" means any hospital or medical insurance policy or certificate; health plan contract or certificate; qualified higher deductible health plan; health maintenance organization subscriber contract; any contract providing benefits for dental care whether such contract is pursuant to a medical insurance policy or certificate; stand-alone dental plan, health maintenance provider contract, managed health care plan, self-insured plan, or otherwise; or any health insurance plan established pursuant to Article 1 of Chapter 18 of Title 45.
    7. "Health insurer" means any entity or person engaged as an indemnitor, surety, or contractor that issues insurance, annuity or endowment contracts, subscriber certificates, or other contracts of insurance by whatever name called. Health care plans under Chapter 20A of this title and health maintenance organizations are health insurers within the meaning of this chapter.
  2. Any health insurance plan issued, amended, or renewed on or after January 1, 2019, between a health insurer or its contracted vendor or a care management organization and a health care provider for the provision of health care services to a plan enrollee shall not contain restrictions on methods of payment from the health insurer or its vendor or the care management organization to the health care provider in which the only acceptable payment method is a credit card payment.
  3. If initiating or changing payments to a health care provider using electronic funds transfer payments, including virtual credit card payments, a health insurance plan, health insurer or its contracted vendor, or care management organization shall:
    1. Notify the health care provider if any fees are associated with a particular payment method; and
    2. Advise the provider of the available methods of payment and provide clear instructions to the health care provider as to how to select an alternative payment method.
  4. The provisions of this Code section shall not be waived by contract, and any contractual clause in conflict with the provisions of this Code section or that purport to waive any requirements of this Code section are void.
  5. Violations of this Code section shall be subject to enforcement by the Commissioner.

(Code 1981, §33-24-59.24, enacted by Ga. L. 2018, p. 1078, § 1/HB 818.)

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2018, Code Section 33-24-59.23, as enacted by Ga. L. 2018, p. 1078, § 1/HB 818, was redesignated as Code Section 33-24-59.24.


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