Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-33 - HEALTH MAINTENANCE ORGANIZATIONS
Rule 120-2-33-.03 - Definitions

Universal Citation: GA Rules and Regs r 120-2-33-.03

Current through Rules and Regulations filed through September 23, 2024

(1) All terms defined in Acts 1979, p. 1148 (O.C.G.A. Chapter 33-21), as amended, hereinafter referred to as the Health Maintenance Organization Act or Act, which are used in this Regulation, shall have the same meaning as in the Act.

(2) The following words and terms, when used in this Regulation, shall have the following meanings:

(a) "Basic Rates" means rates for various categories of individuals that are calculated by or certified by a qualified actuary using reasonable assumptions as to expected medical expenses, administrative expenses and margins for contingencies.

(b) "Commissioner" means the Commissioner of Insurance of the State of Georgia.

(c) "Complaint" means a written expression of concern or displeasure by an enrollee regarding any aspect of the HMO relative to the enrollee which is delivered to the HMO, Department of Insurance or the Department of Human Resources.

(d) "Department" means the Department of Insurance, State of Georgia.

(e) "Governing body" means the Board of Directors, or if otherwise designated in the Charter or Bylaws, those individuals vested with the ultimate responsibility for the management of a corporation which has been issued or is applying for a certificate of authority to operate as a Health Maintenance Organization.

(f) "Public Member" means an individual who has no vested interest, financial or otherwise, in the operations of the HMO by reason of his relationship with the HMO as an employee, provider, stockholder or director.

O.C.G.A. Secs. 33-2-9, Ch. 33-21.

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