Rule 120-2-44-.05 - Prohibited Policy Provision(1) In no event may a health care insurer deny at least non-preferred level of covered benefit reimbursement to an insured for services provided by a nonpreferred provider on the grounds that the insured was not referred to a preferred provider by a person acting on behalf of or under an agreement with the health care insurer.(2) Preferred Provider Arrangements or Preferred provider insurance policies or certificates may not contain terms or conditions that would operate unreasonably to restrict the accessibility and availability of health care services for the insured.(3) A health care insurer may not issue policies in this State containing preferred provider arrangements that provide no reimbursement for expenses of health care services rendered by a non-preferred provider.(4) No health care plan utilizing a preferred provider arrangement shall be issued if the defined service area does not contain sufficient numbers of preferred providers to afford reasonable access to health care services by those persons covered under such plan.Ga. Comp. R. & Regs. R. 120-2-44-.05
O.C.G.A. Secs. 33-2-9, 33-30-27.
Original Rule entitled "Prohibited Policy Provision" 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Repealed: New Rule, same title, adopted.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.