§ 33-24-59-30 — Requirements for health insurance issuer for anatomical gifts or organ transplants; medically inappropriate organ transplants

Georgia § 33-24-59-30

• Jurisdiction: Georgia
• Title: 33

Text

(a) As used in this Code section, the term: (1) "Attending health care provider" means the attending physician and any other person administering health care services at the time of reference who is licensed, certified, or otherwise authorized or permitted by law to administer health care services in the ordinary course of business or the practice of a profession, including any person employed by or acting for any such authorized person. (2) "Covered person" means a policyholder, subscriber, enrollee, member, or individual covered by a health benefit plan. (3) "Health benefit plan" means a policy, contract, certificate, or agreement entered into, offered, or issued by a health insurance issuer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. Such term shall not include a plan providing coverage for only excepted benefits as specified in Section 2791(c) of the federal Public Health Service Act, 42 U.S.C.A. Section 300gg-91(c) and short-term policies that have a term of less than 12 months. (4) "Health insurance issuer" means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including through a health benefit plan as defined in this subsection, and shall include a sickness and accident insurance company, a health maintenance organization, a preferred provider organization, or any similar entity, or any other entity providing a plan of health insurance or health benefits. (b) A health insurance issuer that provides coverage for anatomical gifts, organ transplants, or related treatment and services shall not: (1) Deny coverage to a covered person solely on the basis of the individual's disability; (2) Deny to a patient eligibility, or continued eligibility, to enroll or to renew coverage under the terms of a health benefit plan, solely for the purpose of avoiding the requirements of this subsection; (3) Penalize or otherwise reduce or limit the reimbursement of an attending health care provider, or provide monetary or nonmonetary incentives to such a provider, to induce such provider to provide care to a covered person in a manner inconsistent with this Code section; or (4) Reduce or limit coverage benefits to a patient for the medical or other health care services related to organ transplantation performed pursuant to this Code section as determined in consultation with the attending health care provider and patient. (c) In the case of a health benefit plan maintained pursuant to one or more collective bargaining agreements between employee representatives and one or more employers, any plan amendment made pursuant to a collective bargaining agreement relating to the plan which amends the plan solely to conform to any requirement imposed pursuant to this Code section shall not be treated as a termination of the collective bargaining agreement. (d) Nothing in this Code section shall be deemed to require a health insurance issuer to provide coverage for a medically inappropriate organ transplant.

Legislative History

Added by 2021 Ga. Laws 244,§ 1-4, eff. 7/1/2021.