05 LC 28
1892
Senate
Bill 16 - Prefile
By: Senator Golden of the 8th
By: Senator Golden of the 8th
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 "Georgia Consumer Choice of Benefits Health Insurance Plan
Act"; to provide a short title; to provide for legislative intent; to provide
definitions; to provide that Georgia Consumer Choice of Benefits Health
Insurance Plan policies or contracts not subject to state mandated health
benefits may be offered by insurers to group or individual policyholders; to
provide exceptions; 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 may be known and may be cited as the 'Georgia Consumer 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 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 in no way prevent insurers from offering any coverages that
are offered or mandated under this title; provided, however, that, on and after
July 1, 2005, it is explicitly intended that employers or individuals may choose
pursuant to this chapter new health insurance plans offered by insurers that may
exclude in whole or in part state mandated health benefits.
33_59_3.
As
used in this chapter, the term:
(1)
'Group' means any employer group of 50 employees or less.
(2)
'Health benefits plan' means the Georgia Consumer 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 from and after July 1, 2005:
(1)
In addition to offering within this state group accident and sickness policies
or contracts that must contain state mandated health benefits, any insurer
authorized to transact business in this state shall be authorized to offer
through a licensed agent or agency, as an option, one or more group health
benefit plans which, either in whole or in part, do not provide state mandated
health benefits; and
(2)
In addition to offering within this state individual accident and sickness
policies or contracts that must contain state mandated health benefits, any
insurer authorized to transact business in this state shall be authorized to
offer through a licensed agent or agency, as an option, one or more individual
health benefit plans which, either in whole or in part, 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, either
in whole or in part, does not provide state mandated health benefits, the
insurer shall:
(1)
Provide to the proposed group or individual policyholder a written notice at the
beginning of the written application for the health benefits plan the following
language in bold type:
'You
have the option to choose this Consumer Choice of Benefits Health Insurance Plan
which, either in whole or in part, 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 plans that include state mandated health
benefits. If you choose this option, please consult with your insurance agent
to discover which state mandated health benefits are excluded from this
policy.';
(2)
Provide a form to be signed by the proposed group or individual policyholder
acknowledging that the health benefits plan being purchased by the group 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."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.