Rule 120-2-75-.03. Definitions

Unless otherwise provided, terms referenced in this Regulation are used as defined in O.C.G.A. §§ 33-1-2 and 33-20-3. Other terms are used in accordance with the Georgia Insurance Code and the Rules and Regulations of the Office of Commissioner of Insurance.

1. (a) "Basic Rates" is defined as rates for various categories of individuals that are calculated by or certified by a qualified actuary using reasonable assumptions as to expected medical expenses, administrative expenses and margins for contingencies;
2. (b) "Commissioner" is defined as the Commissioner of Insurance;
3. (c) "Enrollee" is defined as an individual who has been enrolled in a health care plan;
4. (d) "Provider sponsored health care corporation" ("PSHCC") is defined as a corporation formed pursuant to O.C.G.A. § 33-20-5 and which provides medical services to enrollees or subscribers;
5. (e) "Subscriber" is defined as a person to whom a subscriber's certificate is issued by a health care corporation;
6. (f) "Subscriber's Certificate" is defined as the certificate issued to a subscriber which sets forth the kinds and extent of the health care services which may be all or part of the total health care services used by or provided to a subscriber for which the corporation is liable to make total or partial payment.

Authority: O.C.G.A. Secs. 33-2-9, 33-20-5.

History. Original Rules entitled "Definitions" adopted. F. Jul. 19, 1996; eff. Aug. 8, 1996.