05 SB174/AP
Senate
Bill 174
By:
Senators Staton of the 18th, Seabaugh of the 28th, Hudgens of the 47th, Hill of
the 32nd, Johnson of the 1st and others
AS PASSED
AS PASSED
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 may offer certain employees and
consumers a choice between a health benefit plan containing all state mandated
health benefits and an alternative health benefit plan that does not contain all
state mandated health benefits; to allow for employees and individuals to choose
the plan best suited to such
employeés
and
individuaĺs
needs and budget including supplemental policies; to provide exceptions; to
provide for certain notices; 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 contain the limited selection of state mandated health benefits
set forth in Code Section 33-59-3; provided, however, that, on and after July 1,
2005, employees in group plans or individuals may choose pursuant to this
chapter among new health insurance plans offered by insurers that either include
all state mandated health benefits or include the limited state mandated health
benefits set forth in Code Section 33-59-3.
33-59-3.
As
used in this chapter, the term:
(1)
'Alternative health benefit plan' means a group or individual health benefit
plan that contains:
(A)
Major medical benefits;
(B)
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; and
coverage of newly born or adopted children in Code Section 33-24-22;
and
(C)
Coverage of testing for chlamydia in Code Section 31-17-4.1; coverage for
complications of pregnancy in Code Section 33-24-24; coverage for general
anesthesia and related hospital and outpatient facility charges for dental care
for persons who are developmentally disabled, seven or younger, neurologically
impaired, or suffering severe face or head trauma in Code Section 33-24-28.4;
surveillance tests for ovarian cancer in Code Section 33-24-56.2; colorectal
cancer screening and testing in Code Section 33-24-56.3; coverage for hospital
stays after delivery in Code Section 33-24-58.2; direct access to obstetricians
and gynecologists in Code Section 33-24-59; treatment of dependent children with
cancer in Code Section 33-24-59.1; coverage for equipment and self-management
training for individuals with diabetes in Code Section 33-24-59.2; coverage for
prescribed female contraceptive drugs or devices in Code Section 33-24-59.6,
provided that nothing contained in this paragraph shall be construed to require
any insurance company to provide coverage for abortion; coverage for
prescription inhalers in Code Section 33-24-59.8; coverage for autism in Code
Section 33-24-59.10; coverage for mastectomy and lymph node dissection in Code
Section 33-24-72; coverage for mammograms, pap smears, and screening for
prostate cancer in Code Sections 33-29-3.2 and 33-30-4.2; provisions concerning
mail-order pharmaceuticals in Code Section 33-30-4.3; and coverage for child
wellness exams in Code Sections 33-29-3.4 and 33-30-4.5.
(2)
'Group' means any employer group of 50 employees or less.
(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.
33-59-4.
(a)
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, a group health benefit plan that contains all state
mandated health benefits and may offer a group alternative health benefit plan
as defined in this chapter; 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, an individual health benefit plan that contains all
state mandated health benefits and may offer an individual alternative health
benefit plan as defined in this chapter.
(b)
On and after July 1, 2005, an employer who chooses to offer group health benefit
plans to its employees shall offer to each eligible employee a group health
benefit plan that contains all state mandated health benefits and may offer to
each eligible employee a group alternative health benefit plan as defined in
this chapter.
(c)
The provisions of Chapter 21 of this title shall not be deemed to prohibit
licensees thereunder from selling the policies provided for in this Code
section.
(d)
The purchase of an accident and sickness policy or contract under this Code
section shall not preclude the purchaser from purchasing additional limited
benefit insurance policies or contracts.
33-59-5.
(a)
In each sale of an alternative health benefit plan, the insurer shall provide to
each proposed individual group member or individual policyholder a notice and an
acknowledgment at the beginning of the application for the alternative health
benefit plan containing 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 all of the 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.'
(b)
An acknowledgment separate from the notice and application provided for in
subsection (a) of this Code section shall be provided to and completed by each
individual policyholder or individual group member. Such acknowledgment shall
contain a comparison of the benefits contained in each of the health benefit
plan options being offered to the individual policyholder or individual group
member. The Commissioner shall promulgate such rules and regulations as he or
she deems necessary to implement this subsection including rules and regulations
concerning the form and contents of such acknowledgment. In the case of group
health benefit plans being offered by an employer, a copy of the acknowledgment
for each individual group member shall be maintained by the
employer.
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.
All
laws and parts of laws in conflict with this Act are repealed.