05 LC 28
1950
House
Bill 83
By:
Representatives Lunsford of the
110th,
Harbin of the
118th,
Lord of the
142nd,
Burmeister of the
119th,
Keen of the
179th,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 33 of the Official Code of Georgia Annotated, relating to insurance,
so as to enact the "Small Business Employee Choice of Benefits Health Insurance
Plan Act"; to provide a short title; to provide for legislative intent; to
provide definitions; to provide that insurers must offer certain employees and
consumers a choice between Small Business Employee Choice of Benefits Health
Insurance Plan hospitalization policies or contracts not subject to state
mandated health benefits and other policies or contracts subject to state
mandated health benefits; to provide exceptions; to provide an effective date;
to repeal conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Title
33 of the Official Code of Georgia Annotated, relating to insurance, is amended
by adding a new Chapter 59 to read as follows:
"CHAPTER
59
33-59-1.
This
chapter shall be known and may be cited as the 'Small Business Employee Choice
of Benefits Health Insurance Plan Act.'
33-59-2.
The
General Assembly recognizes the need for employers and individuals in this state
to have the opportunity to choose among group and individual health insurance
plans that are more affordable and flexible than standard market policies of
accident and sickness insurance and the need to increase the availability of
health insurance coverage by authorizing the transaction of this type of plan or
policy by accident and sickness insurers licensed to transact business in this
state. This chapter shall require insurers which provide major medical coverage
to offer policies that contain all state mandated health benefits as well as
policies that do not contain any state mandated health benefits; provided,
however, that, on and after July 1, 2005, it is explicitly intended that
employees in group plans or individuals may choose pursuant to this chapter
among new health insurance plans offered by insurers that may include or exclude
state mandated health benefits.
33-59-3.
As
used in this chapter, the term:
(1)
'Group' means any employer group of 15 employees or less.
(2)
'Health benefits plan' means the Small Business Employee Choice of Benefits
Health Insurance Plan.
(3)
'Insurer' means any insurer or nonprofit organization authorized to sell
accident and sickness policies, subscriber contracts, certificates, or
agreements of any form under Chapters 15, 18, 19, 20, 21, 29, and 30 of this
title.
(4)(A)
'State mandated health benefits' means coverages for health care services or
benefits, required by state law or state regulations, requiring the
reimbursement or utilization related to specific health illnesses, injuries, or
conditions of the covered person or inclusion of a specific category of licensed
health care practitioner to be provided to the covered person in an individual,
blanket, or group policy or contract for a health related condition of a covered
person including, but not limited to, those contained in Code Sections
31-17-4.1, 33-24-24, 33-24-27, 33-24-27.1, 33-24-27.2, 33-24-28.3, 33-24-28.4,
33-24-56, 33-24-56.2, 33-24-56.3, 33-24-58.2, 33-24-59, 33-24-59.1, 33-24-59.2,
33-24-59.6, 33-24-59.8, 33-24-59.9, 33-24-59.10, 33-24-72, 33-29-3.2, 33-29-3.4,
33-29-6, 33-29-20, 33-30-4.2, 33-30-4.3, 33-30-4.5, 33-30-7, 33-30-14, and
33-53-2.
(B)
'State mandated health benefits' does not mean standard provisions or rights
required to be present in an individual, blanket, or group policy or contract
for accident and sickness insurance pursuant to state law or regulations
unrelated to specific health illnesses, injuries, or conditions of the insured,
including, but not limited to, those related to continuation of coverage in Code
Section 33-24-21.1, Code Section 33-24-21.2, paragraph (4) of Code Section
33-30-4, and paragraph (8) of subsection (b) of Code Section 33-30-6;
entitlement to conversion privileges in Code Section 33-24-21.1; termination of
coverage in Code Sections 33-24-21 and 33-24-28; or coverage of newly born or
adopted children in Code Section 33-24-22.
33-59-4.
Notwithstanding
any other provision of law and on and after July 1, 2005:
(1)
Any insurer authorized to transact business in this state offering group
accident and sickness policies or contracts shall be required to offer, through
a licensed agent or agency, individual members of the group a choice between a
group health benefit plan that contains all state mandated health benefits and
one or more group health benefit plans that provide hospitalization health
benefits and do not provide state mandated health benefits; and
(2)
Any insurer authorized to transact business in this state offering individual
accident and sickness policies or contracts shall be required to offer, through
a licensed agent or agency, individuals a choice between an individual health
benefit plan that contains all state mandated health benefits and one or more
individual health benefit plans that provide hospitalization health benefits and
do not provide state mandated health benefits.
33-59-5.
In
each sale of accident and sickness policies or contracts in which the proposed
group or individual policyholder has chosen a health benefits plan which does
not provide state mandated health benefits, the insurer shall:
(1)
Provide to each proposed individual group member or individual policyholder a
written notice at the beginning of the written application for the health
benefits plan the following language in boldface type:
'You
have the option to choose this Small Business Employee Choice of Benefits Health
Insurance Plan which does not provide state mandated health benefits normally
required in accident and sickness insurance policies in Georgia. This health
benefits plan may provide a more affordable health insurance policy for you,
although, at the same time, it may provide you with fewer health benefits than
those normally included as state mandated health benefits in policies in
Georgia. If you choose this option, please consult with your insurance agent to
discover which state mandated health benefits are excluded in this
policy.';
(2)
Provide a form to be signed by each proposed individual group member or
individual policyholder acknowledging that the health benefits plan being
purchased by the individual group member or individual policyholder does not
provide the state mandated health benefits listed on the form; and
(3)
Maintain the signed acknowledgment forms to provide information as may be needed
by the Commissioner of Insurance.
33-59-6.
The
Commissioner of Insurance may promulgate rules and regulations as necessary to
implement the provisions of this chapter and specify the information to be
contained on the forms supplied by insurers of these policies and contracts to
individual group members and
policyholders."
SECTION
2.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval.
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.