08 LC 37
0588
House
Bill 923
By:
Representatives Rogers of the
26th,
Harbin of the
118th,
Burkhalter of the
50th,
and Shaw of the
176th
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 provide for filing requirements for health insurance rates; to change
the minimum definitional limits of small groups; to add requirements for kinds
of insurance which insurers may transact; to expand requirements under accident
and sickness policies to require companies active in the group health insurance
market to offer plans of individual health insurance coverage; to change
additional requirements of insurers to participate and accept potential
reassignees in the assignment systems; to provide for statutory construction; to
provide for rule making and enforcement by the Commissioner of Insurance; to
provide for related matters; to provide for 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 revising Code Section 33-3-4, relating to kinds of insurance in which
insurers may transact, as follows:
"33-3-4.
(a)
An insurer which otherwise qualifies to transact insurance in Georgia may be
authorized to transact any one kind or combination of kinds of insurance as
defined in Chapter 7 of this title except:
(1)
A reciprocal insurer shall not transact life insurance;
(2)
A Lloyd´s insurer shall not transact life insurance; and
(3)
A title insurer shall be a stock insurer and shall not be authorized to transact
any other class of insurance, except that, if immediately prior to January 1,
1961, any title insurer lawfully held a subsisting certificate of authority
granting it the right to transact in Georgia additional classes of insurance
other than title insurance, so long as the insurer is otherwise in compliance
with this title, the Commissioner shall continue to authorize such insurer to
transact the same classes of insurance as those specified in such prior
certificate of authority.
(b)
Any insurer that offers, renews, or continues offering comprehensive accident
and sickness insurance products in the group insurance market in Georgia as
defined in subsection (a) of Code Section 33-7-2 must offer Georgia individual
health insurance consumers a choice from a set of at least two approved
comprehensive accident and sickness insurance individual products.
(c)
Insurers subject to subsection (b) of this Code section shall be required to
offer at least one plan that is a high-deductible consumer driven individual
health insurance plan. Insurers subject to subsection (b) of this Code section
shall also be required to offer at least one plan that is an individual
comprehensive accident and sickness insurance coverage plan. The Commissioner
may promulgate regulations to specify product design, benefits, and limitations
for such individual high-deductible consumer driven health insurance plans and
individual comprehensive accident and sickness insurance coverage
plans.
(d)
An insurer may file a written appeal to the Commissioner to be exempted from the
provisions of subsections (b) and (c) of this Code section if the insurer
believes that such requirement would place the insurer in a hazardous financial
condition or would place an undue hardship or burden on the insurer or if the
insurer does not have surplus, administrative, or market capacity to meet these
requirements. The Commissioner may consider insurer appeals and require such
other information from an insurer as he or she deems necessary to evaluate a
request for exemption or relief from one or more of the requirements of this
Code section."
SECTION
2.
Said
title is further amended by revising Code Section 33-7-2, relating to accident
and sickness insurance, as follows:
"33-7-2.
(a)
Accident and sickness insurance is insurance against bodily injury, disablement,
or death by accident or accidental means, or the expense thereof, or against
disablement or expense resulting from sickness and every insurance appertaining
thereto.
(b)
Comprehensive accident and sickness insurance is major medical accident and
sickness insurance taking the form of indemnity or managed care health
maintenance organization, preferred provider organization, provider sponsored
health care corporation, or other form of accident and sickness coverage with a
lifetime benefit level of at least $1 million and at least 70 percent
coinsurance for preferred provider organization preferred benefits or 75 percent
coverage of reasonable and customary charges for medical care, including
hospitalization, in the case of nonmanaged care or indemnity
coverages."
SECTION
3.
Said
title is further amended in Article 1 of Chapter 24, relating to general
provisions regarding insurance, by adding a new Code section to read as
follows:
"33-24-9.1.
(a)
In addition to any other specific requirements applicable to insurers for
specific health insurance products under this title, an insurer shall not
deliver or issue for delivery or renew in this state any health insurance policy
form until it has filed with the Commissioner a copy of every applicable rating
manual, rating schedule, change in rating manual, and change in rating schedule;
if rating manuals and rating schedules are not applicable, the insurer must file
with the Commissioner applicable premium rates and any change in applicable
premium rates.
(b)
Rates shall not be excessive, inadequate, or unfairly discriminatory. The
Commissioner may establish by rule, for each type of health insurance form,
procedures to be used in ascertaining the reasonableness of benefits in relation
to premium rates and may, by rule, exempt from any requirement of subsection (a)
of this Code section any health insurance policy form or type thereof as
specified in such rule to which form or type such requirements may not be
practically applied or to which form or type the application of such
requirements is not desirable or necessary for the protection of the public.
With respect to any health insurance policy form or type thereof which is
exempted by rule from any requirement of subsection (a) of this Code section,
premium rates filed pursuant to those rules shall be for informational
purposes.
(c)
Every filing must be made not less than 90 days in advance of any such use or
delivery. At the expiration of such 90 days, the rate filing will be deemed
approved unless prior thereto it has been affirmatively approved or disapproved
by order of the Commissioner. The approval of any such rate filing by the
Commissioner constitutes a waiver of any unexpired portion of such waiting
period. The Commissioner may extend by not more than an additional 90 days the
period within which he or she may so affirmatively approve or disapprove any
such rate filing by giving notice of such extension before expiration of the
initial 90 day period. At the expiration of any such period as so extended, and
in the absence of such prior affirmative approval or disapproval, any such rate
filing shall be deemed approved.
(d)
The Commissioner may order an examination of any filing required by this Code
section to determine the accuracy or reasonableness of the claims data,
assumptions, trend, development, expense, or other factor used to derive rates.
Such examination shall be conducted in accordance with the provisions of Chapter
2 of this title. Upon notification by the Commissioner of his or her intent to
conduct such examination, the insurer shall be prohibited from placing the rates
so filed in effect until such examination has been reviewed and certified by the
Commissioner as being complete. Such examination, if conducted by the
Commissioner, shall be reviewed and certified within 90 days of the date such
rate, rating plan, or rating system is filed; provided, however, if the
Commissioner makes an affirmative finding that the examination may not be
completed within the 90 day period, he or she may extend such time for one or
more additional 90 day periods as deemed necessary to complete the
examination.
(e)
The Commissioner may promulgate specific rules to encourage insurers and
consumers to implement programs encouraging healthy lifestyles for group and
individual health insurance products. Insurers may be allowed to give premium
discounts for successful completion of approved or accredited programs which
have documented success in improving the health of populations and lowering
overall health costs. Any such applicable premium discounts shall not be
considered as illegal inducements, rebates, or unfairly discriminatory programs
based on financial, physical, or mental limitations of any participating
individual when such programs are approved by the Commissioner and are conducted
in accordance with rules promulgated pursuant to this Code
section."
SECTION
4.
Said
title is further amended by revising subsection (f) of Code Section 33-24-21.1,
relating to group accident and sickness contracts conversion privilege and
continuation right provisions, as follows:
"(f)
Every group contract or group plan, other than a group accident and sickness
insurance policy, contract, or plan issued in connection with an extension of
credit, which provides hospital, surgical, or major medical expense insurance,
or any combination of these coverages, on an expense incurred or service basis,
excluding policies which provide benefits for specific diseases or for
accidental injuries only, shall contain a conversion privilege provision.
Insurers
active in the comprehensive group accident and health market as described in
subsection (b) of Code Section 33-7-2 shall, in addition to being required to
offer the coverage described in subsection (c) of Code Section 33-3-4 and
conversion policies to group members or qualifying eligible individuals under
this Code section, also be required to offer comprehensive individual accident
and sickness coverage in the general individual market in Georgia as a condition
of continued licensure and ability to operate in the comprehensive group
accident and sickness market in
Georgia."
SECTION
5.
Said
title is further amended by revising Code Section 33-29A-3, relating to
condition to licensure individual health insurance coverage, as
follows:
"33-29A-3.
Each
health insurer and managed care corporation which is licensed to and does offer
health insurance coverage in the individual market in this state shall as a
condition of such licensure agree to participation in its respective assignment
system provided by this chapter.
Participation
under this chapter shall include the potential for an insurer to be required to
accept the timely reassignment of individuals whose Georgia assignment system
coverage has terminated because the insurer covering them under assignment
withdraws from the Georgia individual health market, either voluntarily or
involuntarily, as the result of the insurer´s liquidation, suspension, or
rehabilitation. This Code section shall
not apply to an entity which offers only excepted benefits as specified in
Section 2791(c) of the federal Public Health Service Act, 42 U.S.C.A. Section
300gg-91(c)."
SECTION
6.
Said
title is further amended by revising Code Section 33-30-2, relating to the
effect of the chapter upon other provisions, as follows:
"33-30-2.
(a)
Nothing in this chapter validates any charge or practice illegal under any rule
of law or regulation governing usury, small loans, retail installment sales, or
the like or extends the application of any statute, rule, or regulation to any
transaction not otherwise subject thereto.
(b)
Insurers operating in the comprehensive accident and sickness group market in
Georgia on and after July 1, 2008, are required to comply with Code Section
33-3-4 with respect to requirements to offer comprehensive individual accident
and sickness coverages under subsection (a) of Code Section 33-7-2, paragraphs
(1) and (2) of subsection (f) of Code Section 33-24-21.1, and such rules and
regulations as the Commissioner may
promulgate."
SECTION
7.
Said
title is further amended by revising subsection (a) of Code Section 33-30-12,
relating to standards and requirements for rating of small groups under accident
and sickness insurance, as follows:
"(a)(1)
As used in this Code section, the term 'small group' means a group or subgroup
of at least
two
one employee,
member, or enrollee and no more than
50
99
employees, members, or enrollees.
(2)
In the case of a small group of a sole proprietor, the insurer may request
documentation from a sole proprietor that verifies that the sole proprietor in
fact is established as a valid business through state or federal tax
records.
(3)
An insurer may impose up to 18 months´ preexisting condition limitations
upon any sole proprietor small group if such sole proprietor cannot furnish
evidence of prior creditable coverage from prior group or individual health
insurance coverage or prior employer group self-funded coverage.
(4)
For purposes of this Code section, notwithstanding the gap in coverage limiting
provisions of paragraph (2) of subsection (a) of Code Section 33-30-15 under the
definition of 'creditable coverage,' sole proprietors making application for
small group health insurance coverage in Georgia may satisfy portability
requirements if their prior creditable coverage has no greater than a 120 day
gap in coverage between any of the applicable coverage types found in
subparagraphs (a)(2)(A) through (a)(2)(L) of Code Section
33-30-15."
SECTION
8.
This
Act shall become effective on July 1, 2008.
SECTION
9.
All
laws and parts of laws in conflict with this Act are repealed.