Ga. Comp. R. & Regs. R. 120-2-83-.03 - Notification and Disclosure

(a) Notification of the option's availability and explanatory materials regarding the option shall be provided to enrollees at least annually at open enrollment, renewal, time of solicitation or by direct mail advertising, or upon request. Such information shall be provided to prospective enrollees upon request. Such information shall also be provided to newly eligible employees. Information shall include, but shall not be limited to:

(1) A one page form to be completed and signed by the enrollee and the nominated provider containing the enrollee's name, identification number, group number, address, date of birth, and telephone number. The form shall also include the provider's name, group name (if applicable), State of Georgia license number, tax identification number, address, identity of the hospital(s) where the provider has privileges, telephone number, and facsimile number;

(2) Pricing (including information that allows the enrollee to compare pricing with and without the option so that the enrollee may make an informed choice);

(3) The nomination process in accordance with Rule 120-2-83-.04; and

(4) The credentialing process in accordance with Rule 120-2-83-.05.

(b) Only the enrollee may elect the option on behalf of him/herself and his/her eligible dependents.

(c) The Commissioner may create a disclosure form for managed care entities to provide to each prospective enrollee or enrollee with the information required in paragraphs (a) and (b) of this Rule. Said form may be changed from time to time as the Commissioner deems necessary.

(d) Enrollees shall have the right to withdraw from the option in limited situations where their nominated provider is rejected, deselected or declines to participate, effective the first day of the month following written notice to the managed care entity. In the event of withdrawal, the managed care entity shall provide the enrollee with a commensurate decrease in premium for the remainder of the plan year. However, due to federal taxation consequences, the enrollee's right to withdraw shall not apply to cafeteria benefit plans qualified under § 125 of the Internal Revenue Code.

Notes

Ga. Comp. R. & Regs. R. 120-2-83-.03

O.C.G.A. Secs. 33-2-9, 33-20A-9.1.

Original Rule entitled "Notification and Diclosure" was f. as ER 120-2-83-0.10-.03. F. and eff. on November 24, 1999, the date of adoption, to remain in effect for 120 days or until the effective date of a permanent Rule covering the same subject matter is adopted, as specified by the Agency. Amended: Permanent Rule of same title adopted. F. Mar. 3, 2000; eff. Mar. 23, 2000.