Ga. Comp. R. & Regs. R. 120-2-33-.06 - Termination of Coverage or Service
(1) No HMO may cancel or refuse to renew the
coverage of an enrollee for any reason which is not related to nonpayment of
premium except as provided by the Rules and Regulations of the Office of
Commissioner of Insurance Chapter 120-2-67.
(2) No HMO may cease offering a service or
terminate a service within a contract period, unless approved arrangements
equitable to enrollees are made providing for a rate adjustment or substitution
of an equivalent service, and prior approval of the Commissioner is
obtained.
(3) When an HMO
terminates all or a portion of an enrollee's coverage, or the enrollee, access
must be provided to the complaint system set forth in Rule
120-2-33-.09. No such termination
shall be effective until the enrollee, if he so desires, and in accordance with
the Act and Rule
120-2-33-.09, has exhausted the
complaint system.
(4)
Notwithstanding paragraphs (5) and (6), an HMO offering a point of service
policy form may not terminate coverage under that policy form for a group or
individual because no member of that group lives, resides, or works in the
approved service area, or, in the case of individual policy coverage, the
insured no longer lives, resides, or works in the approved service
area.
(5) The HMO shall not
terminate the coverage of an enrollee under a group contract or group policy
because the enrollee moves out of the approved service area, provided the
enrollee continues to be an eligible enrollee of the insured group and agrees
in writing to return to the approved service area for covered medical
care.
(6) The HMO shall not
terminate the coverage of an enrollee under an individual contract because the
enrollee moves out of the approved service area, provided the enrollee agrees
in writing to return to the approved service area for covered medical
care.
Notes
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