Rule 120-2-44-.03 - Definitions(1) "Co-pay" means a discrete, specified dollar amount an insured must pay for specified covered services at the time of service.(2) "Preferred Benefits" means services and/or benefits due or payable when the insured seeks covered health care services from a Preferred Provider in accordance with policy provisions.(3) "Preferred Provider Insurance Policy" means an individual accident and sickness insurance policy, group accident and sickness insurance master policy or certificate, by whatever name called, other than:(c) health insurance policy written as part of Workers' Compensation equivalent coverage; or(d) a credit accident and sickness insurance policy which provides for differentials in the level of benefits because of preferred provider arrangements, or participation contracts between the insurer and health care providers through which insurers attempt to effect cost savings by employing financial and/or managed care principles in a health insurance policy or certificate.(4) "Gatekeeper" means a primary care physician or other appropriate health care provider who is a preferred provider, as described in the preferred provider insurance policy or certificate, and who acts as a required initial point of contact for the insured and through whom covered health benefits may be required to be accessed or permission to seek covered care may be required by the insurer in order to receive preferred benefits.(5) "Non-Preferred Benefits" means benefits payable on an indemnity basis when the insured seeks covered health care services from a non-preferred provider in accordance with policy provisions.(6) Other terms used in this Chapter shall be defined to have the same meaning as the meaning ascribed to the particular terms by O.C.G.A. § 33-30-22 or by O.C.G.A. Title 33, whichever is applicable.Ga. Comp. R. & Regs. R. 120-2-44-.03
O.C.G.A. Secs. 33-2-9, 33-30-27.
Original Rule entitled "Definitions" f. Feb. 9, 1989; eff. Mar. 1, 1989, as specified by the Agency.Repealed: New Rule, same title, adopted. F. Jan. 21, 1997; eff. Feb. 10, 1997.