SB 620 - Health Insur. - mental disorders under small group policies

First Reader Summary

A bill to amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to general provisions relative to insurance, so as to change certain provisions relating to coverage of treatment of mental disorders; to provide for available coverage of treatment of mental disorders under certain small group policies; to provide for available coverage of treatment of mental disorders under certain large group policies.

Page Numbers - 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10

Code Sections - 33-24-29/ 33-24-29/ 33-24-29.1

SB 620 98                                            SB620/AP 
 
      SENATE BILL 620 
 
      By:  Senators Stokes of the 43rd, Walker of the 22nd 
           and Oliver of the 42nd 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Article 1 of Chapter 24 of Title 33 of the Official 
  1- 2  Code of Georgia Annotated, relating to general provisions 
  1- 3  relative to insurance, so as to change certain provisions 
  1- 4  relating to coverage of treatment of mental disorders; to 
  1- 5  provide for available coverage of treatment of mental 
  1- 6  disorders under certain small group policies; to provide for 
  1- 7  available coverage of treatment of mental disorders under 
  1- 8  certain large group policies; to provide for legislative 
  1- 9  intent; to provide for related matters; to provide for 
  1-10  contingent repeal of certain provisions; to repeal 
  1-11  conflicting laws; and for other purposes. 
 
  1-12       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1-13                           SECTION 1. 
 
  1-14  Article 1 of Chapter 24 of Title 33 of the Official Code of 
  1-15  Georgia Annotated, relating to general provisions relative 
  1-16  to insurance, is amended by striking Code Section 
  1-17  33-24-28.1, relating to coverage of treatment of mental 
  1-18  disorders, and inserting in lieu thereof the following: 
 
  1-19    "(a) As used in this Code section, the term: 
 
  1-20      (1) 'Accident and sickness insurance benefit plan, 
  1-21      policy, or contract' means: 
 
  1-22        (A) An individual accident and sickness insurance 
  1-23        policy or contract, as defined in Chapter 29 of this 
  1-24        title;  
 
  1-25        (B) A group or blanket accident and sickness insurance 
  1-26        policy or contract, as defined in Chapter 30 of this 
  1-27        title;  
 
  1-28        (C) A group contract of the type issued by a nonprofit 
  1-29        hospital service corporation established under Chapter 
  1-30        19 of this title;  
 
  1-31        (D) A group contract of the type issued by a health 
  1-32        care plan established under Chapter 20 of this title;  
 
 
 
                                 -1- 
 
 
 
  2- 1        (E) A group contract of the type issued by a nonprofit 
  2- 2        medical service corporation established under Chapter 
  2- 3        18 of this title;  
 
  2- 4        (F) A group contract of the type issued by a health 
  2- 5        maintenance organization established under Chapter 21 
  2- 6        of this title; or 
 
  2- 7        (G)(B) Any similar individual accident and sickness 
  2- 8        benefit plan, policy, or contract. 
 
  2- 9      (2) 'Mental disorder' shall have the same meaning as 
  2-10      defined by The Diagnostic and Statistical Manual of 
  2-11      Mental Disorders (American Psychiatric Association) or 
  2-12      The International Classification of Diseases (World 
  2-13      Health Organization) as of January 1, 1981, or as the 
  2-14      Commissioner may further define such term by rule and 
  2-15      regulation. 
 
  2-16    (b) Every insurer authorized to issue accident and 
  2-17    sickness insurance benefit plans, policies, or contracts 
  2-18    shall be required to make available, either as a part of 
  2-19    or as an optional endorsement to all such policies 
  2-20    providing major medical insurance coverage which are 
  2-21    issued, delivered, issued for delivery, or renewed on or 
  2-22    after July 1, 1984, coverage for the treatment of mental 
  2-23    disorders, which coverage shall be at least as extensive 
  2-24    and provide at least the same degree of coverage as that 
  2-25    provided by the respective plan, policy, or contract for 
  2-26    the treatment of other types of physical illnesses. Such 
  2-27    an optional endorsement shall also provide that the 
  2-28    coverage required to be made available pursuant to this 
  2-29    Code section shall also cover the spouse and the 
  2-30    dependents of the insured if the insured's spouse and 
  2-31    dependents are covered under such benefit plan, policy, or 
  2-32    contract.  In no event shall such an insurer be required 
  2-33    to cover inpatient treatment for more than a maximum of 30 
  2-34    days per policy year or outpatient treatment for more than 
  2-35    a maximum of 48 visits per policy year under individual 
  2-36    policies or to cover inpatient treatment for more than a 
  2-37    maximum of 60 days per policy year or outpatient treatment 
  2-38    for more than a maximum of 50 visits per policy year under 
  2-39    group policies. 
 
  2-40    (c) The optional endorsement required to be made available 
  2-41    under subsection (b) of this Code section shall not 
  2-42    contain any exclusions, reductions, or other limitations 
  2-43    as to coverages, deductibles, or coinsurance provisions 
 
 
 
                                 -2- 
 
 
 
  3- 1    which apply to the treatment of mental disorders unless 
  3- 2    such provisions apply generally to other similar benefits 
  3- 3    provided or paid for under the accident and sickness 
  3- 4    insurance benefit plan, policy, or contract. 
 
  3- 5    (d) Nothing in this Code section shall be construed to 
  3- 6    prohibit an insurer, nonprofit corporation, health care 
  3- 7    plan, health maintenance organization, or other person 
  3- 8    issuing any similar accident and sickness insurance 
  3- 9    benefit plan, policy, or contract from issuing or 
  3-10    continuing to issue an accident and sickness insurance 
  3-11    benefit plan, policy, or contract which provides benefits 
  3-12    greater than the minimum benefits required to be made 
  3-13    available under this Code section or from issuing any such 
  3-14    plans, policies, or contracts which provide benefits which 
  3-15    are generally more favorable to the insured than those 
  3-16    required to be made available under this Code section. 
 
  3-17    (e) The requirements of this Code section with respect to 
  3-18    a group or blanket accident and sickness insurance benefit 
  3-19    plan, policy, or contract shall be satisfied if the 
  3-20    coverage specified in subsections (b) and (c) of this Code 
  3-21    section is made available to the master policyholder of 
  3-22    such plan, policy, or contract. Nothing in this Code 
  3-23    section shall be construed to require the group insurer, 
  3-24    nonprofit corporation, health care plan, health 
  3-25    maintenance organization, or master policyholder to 
  3-26    provide or to make available such coverage to any insured 
  3-27    under such group or blanket plan, policy, or contract. 
 
  3-28    (f) Nothing in this Code section shall be construed to 
  3-29    prohibit the inclusion of coverage for the treatment of 
  3-30    mental disorders that differs from the coverage provided 
  3-31    in the same insurance plan, policy, or contract for 
  3-32    physical illnesses if the policyholder does not purchase 
  3-33    the optional coverage made available pursuant to this Code 
  3-34    section." 
 
  3-35                           SECTION 2. 
 
  3-36  Said article is further amended by striking Code Section 
  3-37  33-24-29, relating to medicare supplement health insurance, 
  3-38  which reads as follows: 
 
  3-39    "33-24-29. 
 
  3-40    Reserved." 
 
  3-41  and inserting in lieu thereof the following: 
 
 
 
                                 -3- 
 
 
 
  4- 1    "33-24-29. 
 
  4- 2    (a) As used in this Code section, the term: 
 
  4- 3      (1) 'Accident and sickness insurance benefit plan, 
  4- 4      policy, or contract' means: 
 
  4- 5        (A) A group or blanket accident and sickness insurance 
  4- 6        policy or contract, as defined in Chapter 30 of this 
  4- 7        title; 
 
  4- 8        (B) A group contract of the type issued by a nonprofit 
  4- 9        hospital service corporation established under Chapter 
  4-10        19 of this title; 
 
  4-11        (C) A group contract of the type issued by a health 
  4-12        care plan established under Chapter 20 of this title; 
 
  4-13        (D) A group contract of the type issued by a nonprofit 
  4-14        medical service corporation established under Chapter 
  4-15        18 of this title; 
 
  4-16        (E) A group contract of the type issued by a health 
  4-17        maintenance organization established under Chapter 21 
  4-18        of this title; or 
 
  4-19        (F) Any similar group accident and sickness benefit 
  4-20        plan, policy, or contract. 
 
  4-21      (2) 'Mental disorder' shall have the same meaning as 
  4-22      defined by The Diagnostic and Statistical Manual of 
  4-23      Mental Disorders (American Psychiatric Association) or 
  4-24      The International Classification of Diseases (World 
  4-25      Health Organization) as of January 1, 1981, or as the 
  4-26      Commissioner may further define such term by rule and 
  4-27      regulation. 
 
  4-28    (b) This Code section shall apply only to accident and 
  4-29    sickness insurance benefit plans, policies, or contracts, 
  4-30    certificates evidencing coverage under a policy of 
  4-31    insurance, or any other evidence of insurance issued by an 
  4-32    insurer, delivered, or issued for delivery in this state, 
  4-33    except for policies issued to an employer in another state 
  4-34    which provide coverage for employees in this state who are 
  4-35    employed by such employer policyholder, providing major 
  4-36    medical benefits covering small groups as defined in 
  4-37    subsection (a) of Code Section 33-30-12. 
 
  4-38    (c) Every insurer authorized to issue accident and 
  4-39    sickness insurance benefit plans, policies, or contracts 
  4-40    shall be required to make available, either as a part of 
 
 
 
                                 -4- 
 
 
 
  5- 1    or as an optional endorsement to all such policies 
  5- 2    providing major medical insurance coverage which are 
  5- 3    issued, delivered, issued for delivery, or renewed on or 
  5- 4    after July 1, 1998, coverage for the treatment of mental 
  5- 5    disorders, which coverage shall be at least as extensive 
  5- 6    and provide at least the same degree of coverage and the 
  5- 7    same annual and lifetime dollar limits, but which may 
  5- 8    provide for different limits on the number of inpatient 
  5- 9    treatment days and outpatient treatment visits, as that 
  5-10    provided by the respective plan, policy, or contract for 
  5-11    the treatment of other types of physical illnesses. Such 
  5-12    an optional endorsement shall also provide that the 
  5-13    coverage required to be made available pursuant to this 
  5-14    Code section shall also cover the spouse and the 
  5-15    dependents of the insured if the insured's spouse and 
  5-16    dependents are covered under such benefit plan, policy, or 
  5-17    contract. 
 
  5-18      (d)(1) The optional endorsement required to be made 
  5-19      available under subsection (c) of this Code section 
  5-20      shall not contain any exclusions, reductions, or other 
  5-21      limitations as to coverages which apply to the treatment 
  5-22      of mental disorders unless such provisions apply 
  5-23      generally to other similar benefits provided or paid for 
  5-24      under the accident and sickness insurance benefit plan, 
  5-25      policy, or contract, except for any differing limits on 
  5-26      inpatient treatment days and outpatient treatment visits 
  5-27      as provided under subsection (c) of this Code section 
  5-28      and as otherwise provided in paragraph (2) of this 
  5-29      subsection. 
 
  5-30      (2) The optional endorsement required to be made 
  5-31      available under subsection (c) of this Code section may 
  5-32      contain deductibles or coinsurance provisions which 
  5-33      apply to the treatment of mental disorders, and such 
  5-34      deductibles or coinsurance provisions need not apply 
  5-35      generally to other similar benefits provided or paid for 
  5-36      under the accident and sickness insurance benefit plan, 
  5-37      policy, or contract; provided, however, that if a 
  5-38      separate deductible applies to the treatment of mental 
  5-39      disorders, it shall not exceed the deductible for 
  5-40      medical or surgical coverages.  A separate out-of-pocket 
  5-41      limit may be applied to the treatment of mental 
  5-42      disorders, which limit, in the case of an indemnity type 
  5-43      plan, shall not exceed the maximum out-of-pocket limit 
  5-44      for medical or surgical coverages and which, in the case 
  5-45      of a health maintenance organization plan, shall not 
 
 
                                 -5- 
 
 
 
  6- 1      exceed the maximum out-of-pocket limit for medical or 
  6- 2      surgical coverages or the amount of $2,000.00 in 1998 
  6- 3      and as annually adjusted thereafter according to the 
  6- 4      Consumer Price Index for health care, whichever is 
  6- 5      greater. 
 
  6- 6      (e)(1) Nothing in this Code section shall be construed 
  6- 7      to prohibit an insurer, nonprofit corporation, health 
  6- 8      care plan, health maintenance organization, or other 
  6- 9      person issuing any similar accident and sickness 
  6-10      insurance benefit plan, policy, or contract from issuing 
  6-11      or continuing to issue an accident and sickness 
  6-12      insurance benefit plan, policy, or contract which 
  6-13      provides benefits greater than the minimum benefits 
  6-14      required to be made available under this Code section or 
  6-15      from issuing any such plans, policies, or contracts 
  6-16      which provide benefits which are generally more 
  6-17      favorable to the insured than those required to be made 
  6-18      available under this Code section. 
 
  6-19      (2) Nothing in this Code section shall be construed to 
  6-20      prohibit any person issuing an accident and sickness 
  6-21      insurance benefit plan, policy, or contract from 
  6-22      providing the coverage required to be made available 
  6-23      under subsection (c) of this Code section through an 
  6-24      indemnity plan with or without designating preferred 
  6-25      providers of services or from arranging for or providing 
  6-26      services instead of indemnifying against the cost of 
  6-27      such services, without regard to whether such method of 
  6-28      providing coverage for treatment of mental disorders 
  6-29      applies generally to other similar benefits provided or 
  6-30      paid for under the accident and sickness insurance 
  6-31      benefit plan, policy, or contract. 
 
  6-32    (f) The requirements of this Code section with respect to 
  6-33    a group or blanket accident and sickness insurance benefit 
  6-34    plan, policy, or contract shall be satisfied if the 
  6-35    coverage specified in subsections (c) and (d) of this Code 
  6-36    section is made available to the master policyholder of 
  6-37    such plan, policy, or contract. Nothing in this Code 
  6-38    section shall be construed to require the group insurer, 
  6-39    nonprofit corporation, health care plan, health 
  6-40    maintenance organization, or master policyholder to 
  6-41    provide or make available such coverage to any insured 
  6-42    under such group or blanket plan, policy, or contract. 
 
  6-43    (g) The Commissioner shall collect such data and perform 
  6-44    such studies as are necessary to determine the effect, if 
 
 
                                 -6- 
 
 
 
  7- 1    any, of the coverage provided by the optional endorsement 
  7- 2    required to be made available under this Code section on 
  7- 3    premiums for blanket accident and sickness benefit plans, 
  7- 4    policies, or contracts for the period July 1, 1998, 
  7- 5    through October 1, 1999, and shall submit a written report 
  7- 6    of his or her findings regarding the same to the General 
  7- 7    Assembly not later than December 1, 1999.  If the 
  7- 8    Commissioner finds and reports that as an effect of such 
  7- 9    coverage such premiums increased on average at an annual 
  7-10    rate exceeding two percent for such period, this Code 
  7-11    section shall stand repealed on January 1, 2000. 
 
  7-12    (h) This Code section is neither enacted pursuant to nor 
  7-13    intended to implement the provisions of any federal law." 
 
  7-14                           SECTION 3. 
 
  7-15  Said article is further amended by adding a new Code Section 
  7-16  33-24-29.1 to read as follows: 
 
  7-17    "33-24-29.1. 
 
  7-18    (a) As used in this Code section, the term: 
 
  7-19      (1) 'Accident and sickness insurance benefit plan, 
  7-20      policy, or contract' means: 
 
  7-21        (A) A group or blanket accident and sickness insurance 
  7-22        policy or contract, as defined in Chapter 30 of this 
  7-23        title; 
 
  7-24        (B) A group contract of the type issued by a nonprofit 
  7-25        hospital service corporation established under Chapter 
  7-26        19 of this title; 
 
  7-27        (C) A group contract of the type issued by a health 
  7-28        care plan established under Chapter 20 of this title; 
 
  7-29        (D) A group contract of the type issued by a nonprofit 
  7-30        medical service corporation established under Chapter 
  7-31        18 of this title; 
 
  7-32        (E) A group contract of the type issued by a health 
  7-33        maintenance organization established under Chapter 21 
  7-34        of this title; or 
 
  7-35        (F) Any similar group accident and sickness benefit 
  7-36        plan, policy, or contract. 
 
  7-37      (2) 'Mental disorder' shall have the same meaning as 
  7-38      defined by The Diagnostic and Statistical Manual of 
  7-39      Mental Disorders (American Psychiatric Association) or 
 
 
 
                                 -7- 
 
 
 
  8- 1      The International Classification of Diseases (World 
  8- 2      Health Organization) as of January 1, 1981, or as the 
  8- 3      Commissioner may further define such term by rule and 
  8- 4      regulation. 
 
  8- 5    (b) This Code section shall apply only to accident and 
  8- 6    sickness insurance benefit plans, policies, or contracts, 
  8- 7    certificates evidencing coverage under a policy of 
  8- 8    insurance, or any other evidence of insurance issued by an 
  8- 9    insurer, delivered, or issued for delivery in this state, 
  8-10    except for policies issued to an employer in another state 
  8-11    which provide coverage for employees in this state who are 
  8-12    employed by such employer policyholder, providing major 
  8-13    medical benefits covering all groups except small groups 
  8-14    as defined in subsection (a) of Code Section 33-30-12. 
 
  8-15    (c) Every insurer authorized to issue accident and 
  8-16    sickness insurance benefit plans, policies, or contracts 
  8-17    shall be required to make available, either as a part of 
  8-18    or as an optional endorsement to all such policies 
  8-19    providing major medical insurance coverage which are 
  8-20    issued, delivered, issued for delivery, or renewed on or 
  8-21    after July 1, 1998, coverage for the treatment of mental 
  8-22    disorders, which coverage shall be at least as extensive 
  8-23    and provide at least the same degree of coverage and the 
  8-24    same annual and lifetime dollar limits as that provided by 
  8-25    the respective plan, policy, or contract for the treatment 
  8-26    of other types of physical illnesses. Such an optional 
  8-27    endorsement shall also provide that the coverage required 
  8-28    to be made available pursuant to this Code section shall 
  8-29    also cover the spouse and the dependents of the insured if 
  8-30    the insured's spouse and dependents are covered under such 
  8-31    benefit plan, policy, or contract. 
 
  8-32      (d)(1) The optional endorsement required to be made 
  8-33      available under subsection (c) of this Code section 
  8-34      shall not contain any exclusions, reductions, or other 
  8-35      limitations as to coverages, including without 
  8-36      limitation limits on the number of inpatient treatment 
  8-37      days and outpatient treatment visits, which apply to the 
  8-38      treatment of mental disorders unless such provisions 
  8-39      apply generally to other similar benefits provided or 
  8-40      paid for under the accident and sickness insurance 
  8-41      benefit plan, policy, or contract, except as otherwise 
  8-42      provided in paragraph (2) of this subsection. 
 
  8-43      (2) The optional endorsement required to be made 
  8-44      available under subsection (c) of this Code section may 
 
 
                                 -8- 
 
 
 
  9- 1      contain deductibles or coinsurance provisions which 
  9- 2      apply to the treatment of mental disorders, and such 
  9- 3      deductibles or coinsurance provisions need not apply 
  9- 4      generally to other similar benefits provided or paid for 
  9- 5      under the accident and sickness insurance benefit plan, 
  9- 6      policy, or contract; provided, however, that if a 
  9- 7      separate deductible applies to the treatment of mental 
  9- 8      disorders, it shall not exceed the deductible for 
  9- 9      medical or surgical coverages.  A separate out-of-pocket 
  9-10      limit may be applied to the treatment of mental 
  9-11      disorders, which limit, in the case of an indemnity type 
  9-12      plan, shall not exceed the maximum out-of-pocket limit 
  9-13      for medical or surgical coverages and which, in the case 
  9-14      of a health maintenance organization plan, shall not 
  9-15      exceed the maximum out-of-pocket limit for medical or 
  9-16      surgical coverages or the amount of $2,000.00 in 1998 
  9-17      and as annually adjusted thereafter according to the 
  9-18      Consumer Price Index for health care, whichever is 
  9-19      greater. 
 
  9-20      (e)(1) Nothing in this Code section shall be construed 
  9-21      to prohibit an insurer, nonprofit corporation, health 
  9-22      care plan, health maintenance organization, or other 
  9-23      person issuing any similar accident and sickness 
  9-24      insurance benefit plan, policy, or contract from issuing 
  9-25      or continuing to issue an accident and sickness 
  9-26      insurance benefit plan, policy, or contract which 
  9-27      provides benefits greater than the minimum benefits 
  9-28      required to be made available under this Code section or 
  9-29      from issuing any such plans, policies, or contracts 
  9-30      which provide benefits which are generally more 
  9-31      favorable to the insured than those required to be made 
  9-32      available under this Code section. 
 
  9-33      (2) Nothing in this Code section shall be construed to 
  9-34      prohibit any person issuing an accident and sickness 
  9-35      insurance benefit plan, policy, or contract from 
  9-36      providing the coverage required to be made available 
  9-37      under subsection (c) of this Code section through an 
  9-38      indemnity plan with or without designating preferred 
  9-39      providers of services or from arranging for or providing 
  9-40      services instead of indemnifying against the cost of 
  9-41      such services, without regard to whether such method of 
  9-42      providing coverage for treatment of mental disorders 
  9-43      applies generally to other similar benefits provided or 
  9-44      paid for under the accident and sickness insurance 
  9-45      benefit plan, policy, or contract. 
 
 
                                 -9- 
 
 
 
 10- 1    (f) The requirements of this Code section with respect to 
 10- 2    a group or blanket accident and sickness insurance benefit 
 10- 3    plan, policy, or contract shall be satisfied if the 
 10- 4    coverage specified in subsections (c) and (d) of this Code 
 10- 5    section is made available to the master policyholder of 
 10- 6    such plan, policy, or contract. Nothing in this Code 
 10- 7    section shall be construed to require the group insurer, 
 10- 8    nonprofit corporation, health care plan, health 
 10- 9    maintenance organization, or master policyholder to 
 10-10    provide or make available such coverage to any insured 
 10-11    under such group or blanket plan, policy, or contract. 
 
 10-12    (g) The Commissioner shall collect such data and perform 
 10-13    such studies as are necessary to determine the effect, if 
 10-14    any, of the coverage provided by the optional endorsement 
 10-15    required to be made available under this Code section on 
 10-16    premiums for blanket accident and sickness benefit plans, 
 10-17    policies, or contracts for the period July 1, 1998, 
 10-18    through October 1, 1999, and shall submit a written report 
 10-19    of his or her findings regarding the same to the General 
 10-20    Assembly not later than December 1, 1999.  If the 
 10-21    Commissioner finds and reports that as an effect of such 
 10-22    coverage such premiums increased on average at an annual 
 10-23    rate exceeding two percent for such period, this Code 
 10-24    section shall stand repealed on January 1, 2000." 
 
 10-25                           SECTION 4. 
 
 10-26  All laws and parts of laws in conflict with this Act are 
 10-27  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 -10-