Georgia Code
Article 1 - Patient Protection
§ 33-20A-3. Definitions

As used in this article, the term:
History. Code 1981, § 33-20A-3 , enacted by Ga. L. 1996, p. 485, § 1; Ga. L. 1999, p. 327, § 1; Ga. L. 1999, p. 350, § 2; Ga. L. 2002, p. 441, § 4; Ga. L. 2009, p. 859, § 3/HB 509; Ga. L. 2012, p. 775, § 33/HB 942; Ga. L. 2013, p. 141, § 33/HB 79; Ga. L. 2019, p. 337, § 1-88/SB 132; Ga. L. 2022, p. 598, § 4/HB 1324.
The 2019 amendment, effective July 1, 2019, deleted former paragraph (1), which read: “ ‘Commissioner’ means the Commissioner of Insurance.” and redesignated former paragraphs (2) through (17) as present paragraphs (1) through (16), respectively.
The 2022 amendment, effective July 1, 2022, inserted “physical or mental” and “regardless of the initial, interim, final, or other diagnoses that are given,” in the introductory language of paragraph (1).
Code Commission notes.
Pursuant to Code Section 28-9-5, in 1996, “refers” was substituted for “refer” in paragraph (8) (now paragraph (12)).
Pursuant to Code Section 28-9-5, in 2002, “Nonurgent” was substituted for “Non-urgent” in paragraph (12) (now paragraph (11)).
Editor’s notes.
Ga. L. 2002, p. 441, § 1, not codified by the General Assembly, provides that: “This Act shall be known and may be cited as the ‘Consumers’ Health Insurance Protection Act.’ ”
Ga. L. 2002, p. 441, § 11, not codified by the General Assembly, provides that: “This Act shall apply only to health benefit plan contracts issued, delivered, issued for delivery, or renewed in this state on or after October 1, 2002; provided, however, that Section 8 of this Act shall apply to all claims relating to health care services provided on or after July 1, 2002. Any carrier, plan, network, panel, or agent thereof conducting a post-payment audit or imposing a retroactive denial on any claim initially submitted prior to July 1, 2002, shall, no later than June 30, 2003, provide written notice to the claimant of the intent to conduct such an audit or impose such a retroactive denial of any such claim or part thereof, including the specific reason for the audit or denial and shall complete the audit or retroactive denial and provide notice to the claimant of any payment or refund due prior to January 1, 2004.” The reference to Section 8 of the Act apparently should be to Section 9 of the Act, which enacted Article 3 of this chapter.
Ga. L. 2022, p. 598, § 1/HB 1324, not codified by the General Assembly, provides: “The General Assembly finds that: (1) This state recognizes a ‘prudent layperson’ standard with regard to the need for emergency care;
“(2) Insurance companies operating in this state are required to adhere to that standard;
“(3) Patients in this state have had emergency medical claims denied due to insurers’ failure to adhere to the prudent layperson standard as intended;
“(4) The federal court system has recognized that this standard is not intended to look to the diagnosis that a patient receives. Rather, the only relevant considerations are the patient’s symptoms and whether a prudent layperson would think that emergency medical attention is necessary based on those symptoms;
“(5) This legislative body has intended and continues to intend that the prudent layperson standard be applied in the same manner;
“(6) In order to better protect Georgians seeking emergency care, legislation is needed not to change the meaning but to clarify the intended application of the prudent layperson standard in this state; and
“(7) Nothing in this Act is intended to be applicable to healthcare plans which are subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.”
Law reviews.
For note on the 2002 amendment of this Code section, see 19 Ga. St. U.L. Rev. 220 (2002).