State Law

Self-funded Healthcare Plan Opt-in to the Surprise Billing Consumer Protection Act

08/02/2023 Georgia Sections 33-20F-1 through 33-20F-5

Definitions; Opt-in by ERISA self-funded plans; Departmental website; exemption; Powers of Commissioner

OON-Payment Issues

Section 33-20F-1

As used in this chapter, the term:

(1) ‘ERISA’ means the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.

(2) ‘Insurer’ means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract, or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of healthcare services, including those of an accident and sickness insurance company, a health maintenance organization, a healthcare plan, a managed care plan, or any other entity providing a health insurance plan, a health benefit plan, or healthcare services.

(3) ‘Self-funded healthcare plan’ means an arrangement whereby an employer assumes the financial risk for providing healthcare benefits to its employees and such arrangement is subject to the exclusive jurisdiction of ERISA.

Section 33-20F-2.

(a) Notwithstanding any provision of law in Chapter 20E of this title, the ‘Surprise Billing Consumer Protection Act,’ a self-funded healthcare plan may elect on an annual basis to participate in and be bound by such Act.

(b) A self-funded healthcare plan that elects to participate in the Surprise Billing Consumer Protection Act shall provide notice to the Commissioner of its election decision on a form prescribed by the Commissioner. The completed form shall include an attestation that the self-funded healthcare plan has elected to participate in and be bound by the Surprise Billing Consumer Protection Act to the extent that insurers are similarly
bound. Such form shall be posted on the Commissioner’s website for use by self-funded healthcare plans choosing to opt in.

(c) A self-funded healthcare plan may elect to initiate its participation on either January 1 of any year or on the first day of the self-funded healthcare plan’s plan year of any year.

(d) On its election form, the plan must indicate whether it chooses to affirmatively renew its election on an annual basis or whether it should be presumed to have renewed on an annual basis until the Commissioner receives advance notice from the plan that it is terminating its election as of either December 31 of a calendar year or the last day of its plan year. Notices under this subsection shall be submitted to the Commissioner at least 30 days in advance of the effective date of the election to initiate participation and 30 days in advance of the effective date of the termination of participation.

(e) Self-funded healthcare plans opting in shall develop processes to address employee notifications or other responsibilities under ERISA that may arise from electing to participate in the Surprise Billing Consumer Protection Act.

Section 33-20F-3.

The department shall maintain on its website a list of all self-funded healthcare plans that have chosen to participate in and comply with the Surprise Billing Consumer Protection Act.

Section 33-20F-4.

Nothing in this chapter shall be applicable to healthcare plans which are subject to the exclusive jurisdiction of ERISA, unless such plan elects to participate in and agrees to comply with the Surprise Billing Consumer Protection Act.

Section 33-20F-5.

Notwithstanding any provision of law in the Surprise Billing Consumer Protection Act, in the event that a self-funded healthcare plan has chosen to participate in and comply with such Act, the Commissioner shall allow such participation. The Commissioner shall retain the authority, however, to remove or refuse to readmit such participant if the Commissioner determines that the self-funded healthcare plan is failing or previously failed to comply with the Surprise Billing Consumer Protection Act. Any self-funded healthcare plan shall have the opportunity to request a hearing pursuant to Code Section 33-2-17 prior to the effective date of such removal or denial.

See https://law.justia.com/codes/georgia/2022/title-33/chapter-20f/