Rule 120-2-80-.01 - Scope(1) This Regulation Chapter shall apply to licensed insurers, including, but not limited to, health maintenance organizations and health care corporations offering managed care plans in this State.(2) Insurers with approved or proposed policy contracts containing preferred provider arrangements subject to O.C.G.A. Title 33, Chapter 30, Article Two, shall be subject to this Regulation Chapter and shall be considered managed care entities. Preferred Provider Organization plans shall be subject to the provisions of this Regulation Chapter as may be reasonably applied to covered benefits and services offered through a managed care entity's contracting, participating preferred providers.(3) Where enrollees of managed care plans choose to obtain covered benefits or services outside the panel of contracting or preferred providers, a managed care entity shall not be held responsible for access, credentialing, quality of care or other issues not under the insurer's control because of lack of provider contracting status. Managed care entities should disclose plan provisions and limitations regarding benefits, access and quality issues in these instances.(4) Nothing in this Regulation Chapter shall be construed to permit any person other than a licensed insurer to offer a managed care plan or other insurance product or allow an entity or person to transact insurance in this State without a Certificate of Authority as provided in O.C.G.A. Title 33, Chapter 3.(5) Nothing in this Regulation Chapter or O.C.G.A. Title 33, Chapter 20A shall be construed to create new classes of insurance pursuant to O.C.G.A. § 33-3-5 or new lines of insurance pursuant to Title 33, Chapter 7.Ga. Comp. R. & Regs. R. 120-2-80-.01
O.C.G.A. Secs. 33-2-9, 33-3-2, 33-3-5, 33-20A-3, 33-20A-4, 33-20A-5.
Original Rule entitled "Scope" adopted. F. Mar. 20, 1998; eff. Apr. 9, 1998.