2018 Georgia Code
Title 33 - Insurance
Chapter 20D - Rental Provider Network
§ 33-20D-1. Definitions

Universal Citation: GA Code § 33-20D-1 (2018)
    As used in this chapter, the term:
  • (1) "Affiliate" means an entity owned or controlled, either directly or through a parent or subsidiary entity, by a contracting entity that accesses the rates, terms, or conditions of health care services.

  • (2) "Contracting entity" means any person or entity that enters into direct contracts with health care providers for the delivery of health care services in the ordinary course of business, including a health care organization or hospital organization when leasing or renting the health care organization's or hospital organization's network to a third party.

  • (3) "Covered person" means an individual who is covered under a health insurance plan.

  • (4) "Health care services" means the examination or treatment of persons for the prevention of illness or the correction or treatment of any physical or mental condition resulting from illness, injury, or other human physical problem.

  • (5) "Health insurer" means an accident and sickness insurer, health care corporation, health maintenance organization, provider sponsored health care corporation, or any similar entity regulated by the Commissioner.

  • (6) "Provider network contract" means a contract between a contracting entity and a provider specifying the rights and responsibilities of the contracting entity and provider for the delivery of and payment for health care services to covered persons.

  • (7) "Rental preferred provider network" means a preferred provider network that contracts with a health insurer or other payor or with another preferred provider network to grant access to the terms and conditions of its contract with providers of health care services. Such contracts are often referred to as "renting" or "leasing" the network. The term "rental preferred provider network" does not refer to a proprietary network of a licensed insurer or to arrangements providing for access to the proprietary network of a licensed insurer by affiliates of the licensed insurer or by entities receiving administrative services from the licensed insurer or its affiliates.

  • (8) "Third party" means an organization that enters into a contract with a contracting entity or with another third party to gain access to a provider network contract.

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