07 LC 28
3531
Senate
Bill 241
By:
Senator Hill of the 32nd
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 comprehensively revise the laws of Georgia concerning the provision of
health insurance; to provide that preferred provider arrangements shall not have
differences in coinsurance percentages applicable to benefit levels for services
provided by preferred and nonpreferred providers which differ by more than 40
percentage points; to provide that preferred provider arrangements shall not
have a coinsurance percentage applicable to benefit levels for services provided
by nonpreferred providers which exceeds 50 percent of the benefit levels under
the policy for such services; to provide that an insured under a group accident
and sickness policy may include dependents up to age 25 or until two years after
ceasing to be a dependent, whichever is earlier; to provide that employers who
employ persons who also work for other employers may enter into arrangements to
contribute to the employees´ health care coverage under such other
employers; to provide for the promulgation of rules and regulations; to
authorize selected out-of-state insurers to offer health insurance plans in
Georgia; to provide for certain notices; to authorize the Commissioner of
Insurance to adopt certain rules and regulations; to provide for related
matters; 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 subsection (b) of Code Section 33-30-23, relating to standards for
preferred provider arrangements, as follows:
"(b)
Such arrangements shall not:
(1)
Unfairly deny health benefits for medically necessary covered
services;
(2)
Have differences in benefit levels payable to preferred providers compared to
other providers which unfairly deny benefits for covered services;
(3)
Have differences in coinsurance percentages applicable to benefit levels for
services provided by preferred and nonpreferred providers which differ by more
than
30
40
percentage points;
(4)
Have a coinsurance percentage applicable to benefit levels for services provided
by nonpreferred providers which exceeds
40
50
percent of the benefit levels under the policy for such services;
(5)
Have an adverse effect on the availability or the quality of services;
and
(6)
Be a result of a negotiation with a primary care physician to become a preferred
provider unless that physician shall be furnished, beginning on and after
January 1, 2001, with a schedule showing common office based fees payable for
services under that arrangement."
SECTION
2.
Said
title is further amended by revising paragraph (4) of Code Section 33-30-4,
relating to required provisions of group accident and sickness policies
generally, as follows:
"(4)
A provision that, with respect to termination of benefits for, or coverage of,
any person who is a dependent child of an insured, the child shall continue to
be insured up to and including age 25
or until two
years after such child´s status as a dependent ends, whichever is
earlier, so long as the coverage of the
member continues in
effect,
and
the child remains a dependent of the insured parent or
guardian,
and the child, in each calendar year since reaching any age specified for
termination of benefits as a dependent, has been enrolled for five calendar
months or more as a full-time student at a postsecondary institution of higher
learning or, if not so enrolled, would have been eligible to be so enrolled and
was prevented from being so enrolled due to illness or
injury. This paragraph shall not apply to
group policies under which an employer provides coverage for dependents of its
employees and pays the entire cost of the coverage without any charge to the
employee or dependents; and".
SECTION
3.
Said
title is further amended by revising paragraph (8) of subsection (b) of Code
Section 33-30-6, relating to required provisions of blanket accident and
sickness policies, as follows:
"(8)
A provision that, with respect to termination of benefits for, or coverage of,
any person who is a dependent child of an insured, the child shall continue to
be insured up to and including age 25
or until two
years after such child´s status as a dependent ends, whichever is
earlier, so long as the coverage of the
insured parent or guardian continues in
effect,
and
the child remains a dependent of the parent or
guardian,
and the child, in each calendar year since reaching any age specified for
termination of benefits as a dependent, has been enrolled for five months or
more as a full-time student at a postsecondary institution of higher learning
or, if not so enrolled, would have been eligible to be so enrolled and was
prevented from being so enrolled due to illness or
injury."
SECTION
4.
Said
title is further amended by adding a new Code Section 33-30-16 to read as
follows:
"33-30-16.
(a)
Employers who employ persons who are also employed by other employers shall be
authorized to enter into arrangements with such other employers to provide group
health insurance coverage for such employees by contributing to the cost of such
health care insurance provided by such other employers.
(b)
The commissioner shall promulgate such rules and regulations as necessary to
regulate and enable such contributions to group health care insurance coverage
by additional employers of an insured."
SECTION
5.
Said
title is further amended by adding a new Chapter 62 to read as
follows:
"CHAPTER
62
33-62-1.
The
General Assembly recognizes the need for individuals, employers, and other
purchasers of health insurance coverage in this state to have the opportunity to
choose health insurance plans that are more affordable and flexible than
existing market policies offering accident and sickness insurance coverage.
Therefore, the General Assembly seeks to increase the availability of health
insurance coverage by allowing insurers authorized to engage in the business of
insurance in this state who are also authorized to engage in the business of
insurance in selected other states to issue accident and sickness policies in
Georgia.
33-62-2.
An
insurer who is authorized to engage in the business of insurance in this state
who is also authorized to engage in the business of insurance in other states
may offer to Georgia residents those policies offered by the insurer in other
states, provided that the policies are approved by the
Commissioner.
33-62-3.
(a)
Each written application for participation in an out-of-state health benefit
plan shall contain the following language in boldface type at the beginning of
the document:
'This
policy is primarily governed by the laws of
(insert state
where the master policy is filed);
therefore, all of the rating laws applicable to policies filed in this state do
not apply to this policy, which may result in increases in your premium at
renewal that would not be permissible in a Georgia-approved policy. Any
purchase of individual health insurance should be considered carefully since
future medical conditions may make it impossible to qualify for another
individual health policy. For information concerning individual health coverage
under a Georgia-approved policy, please consult your insurance agent or the
Georgia Department of Insurance.'
(b)
Each out-of-state health benefit plan shall contain the following language in
boldface type at the beginning of the document:
'The
benefits of this policy providing your coverage are governed primarily by the
laws of a state other than Georgia. While this health benefit plan may provide
you a more affordable health insurance policy, it may also provide fewer health
benefits than those normally included as state mandated health benefits in
policies in Georgia. Please consult your insurance agent to determine which
state mandated health benefits are excluded under this policy.'
33-62-4.
The
Commissioner shall be authorized to conduct market conduct and solvency
examinations of all insurers seeking to offer in this state the health benefit
plans that such insurers offer in other states or who have been given approval
to offer such health benefit plans. Such examinations shall be conducted in the
same manner and under the same terms and conditions as for companies located in
this state.
33-62-5.
The
Commissioner shall adopt rules and regulations necessary to implement this
chapter, including, but not limited to, determining which health benefit plans
offered in other states by insurers authorized to offer plans in Georgia shall
be offered in this state and determining the manner of approving the health
benefit plans offered by such companies."
SECTION
6.
All
laws and parts of laws in conflict with this Act are repealed.