08 LC 33
2360
Senate
Bill 404
By:
Senators Williams of the 19th, Goggans of the 7th, Hudgens of the 47th, Rogers
of the 21st, Seabaugh of the 28th 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 "Georgia Health Marketplace Act"; to establish the Georgia
Health Marketplace to provide access to health care products for Georgia
consumers; to provide for definitions; to establish the Georgia Health
Marketplace Authority; to provide for its membership and powers; to provide for
health care products and programs in the Georgia Health Marketplace; to create a
marketing trust fund; to provide for limited liability; to provide for consumer
complaints; to provide for catastrophic coverage products; to provide for rules
and regulations; 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 adding a new chapter to read as follows:
"CHAPTER
62
33-62-1.
This
chapter shall be known and may be cited as the "Georgia Health Marketplace
Act."
33-62-2.
For
purposes of this chapter, the term:
(1)
'Authority' means the Georgia Health Marketplace Authority established pursuant
to Code Section 33-62-3.
(2)
'Board' means the board of directors of the Georgia Health Marketplace
Authority.
(3)
'Commissioner' means the Commissioner of Insurance.
(4)
'Fund' means the GHM Marketing Trust Fund, as established in Code Section
33-62-6.
(5)
'GHM' means the Georgia Health Marketplace established pursuant to Code Section
33-62-5.
(6)
'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.
33-62-3.
(a)
There is established the Georgia Health Marketplace Authority as a body
corporate and politic, an instrumentality of the state, and a public
corporation; and by that name the authority may contract and be contracted with
and bring and defend actions. The authority shall have perpetual
existence.
(b)
The authority shall be governed by a board of directors composed of ten members
as follows:
(1)
The executive director of the Georgia Technology Authority;
(2)
The Commissioner of the Department of Community Health;
(3)
The Commissioner of Insurance;
(4)
A physician who is licensed under Chapter 34 of Title 43, appointed by the
Governor;
(5)
A representative of a health insurance company licensed to offer health
insurance policies in this state, appointed by the Lieutenant
Governor;
(6)
A consumer representative, appointed by the Lieutenant Governor;
(7)
A marketing expert, appointed by the Lieutenant Governor;
(8)
An agent licensed to offer health insurance policies in this state, appointed by
the Speaker of the House of Representatives;
(9)
A consumer representative, appointed by the Speaker of the House of
Representatives; and
(10)
A hospital administrator, appointed by the Speaker of the House of
Representatives.
The
initial members of the board shall be appointed to terms of office beginning
July 1, 2008. All members shall serve for terms of three years; provided,
however, that for the purpose of providing for staggered terms, of the
Lieutenant Governor´s and Speaker´s initial appointments, one each
shall be appointed for a term of one year, two years, and three years,
respectively. Any vacancy on the board shall be filled in the same manner as
the original appointment, and any member appointed to fill a vacancy occurring
because of death, resignation, or ineligibility for membership shall serve only
for the unexpired term of the member´s predecessor. A member shall be
eligible for reappointment.
(c)
The board shall at its initial meeting and the first meeting of each calendar
year thereafter select from among its members a chairperson and a vice
chairperson. Meetings shall be held at the call of the chairperson or whenever
any two members so request.
(d)
The members of the board who are not public officers shall be entitled to an
expense allowance and reimbursement from funds of the authority for their actual
travel expenses necessarily incurred in the performance of their duties and for
each day actually spent in performance of their duties in the same manner as
provided in Code Section 45-7-21.
(e)
A majority of the members of the board shall constitute a quorum for the
transaction of business of the authority. The vote of at least a majority of
the members present at any meeting at which a quorum is present is necessary for
any action to be taken by the board. No vacancy in the membership of the board
shall impair the right of a quorum to exercise all rights and perform all duties
of the board.
(f)
No member or employer of a member shall be eligible to bid on, or enter into,
any contract let by the authority or receive payment from the authority as an
employee, contractor, consultant, or vendor; provided, however, that this
subsection shall not be construed to prohibit a member of the authority or
employee of such member from submitting health care products for inclusion on
the GHM in accordance with established policies and procedures of the
authority.
(g)
The authority is assigned to the Department of Community Health for
administrative purposes only, as prescribed in Code Section 50-4-3.
33-62-4.
The
authority shall have the following powers:
(1)
To hire officers, agents, and employees, including an executive director, as
necessary to perform the duties and carry out the powers conferred by this
chapter;
(2)
To have a seal and alter the same at its pleasure;
(3)
To make and execute contracts, lease agreements, and all other instruments
necessary or convenient to exercise the powers of the authority or to further
the public purpose for which the authority is created;
(4)
To acquire by purchase, lease, or otherwise and to hold, lease, and dispose of
real or personal property of every kind and character, or any interest therein,
in furtherance of the public purpose of the authority;
(5)
To apply for and to accept any gifts or grants or loan guarantees or loans of
funds or property or financial or other aid in any form from the federal
government or any agency or instrumentality thereof, or from the state or any
agency or instrumentality thereof, or from any other source for any or all of
the purposes specified in this chapter and to comply, subject to the provisions
of this chapter, with the terms and conditions thereof;
(6)
To solicit, receive, and review proposals from technology vendors for the
development and implementation of technology to operate and maintain the GHM,
including an Internet website accessible to all Georgians;
(7)
To identify health care products which fall under the categories set out in
paragraphs (2) through (6) of subsection (b) of Code Section 33-62-5 for
inclusion in the GHM;
(8)
To suspend, at its sole discretion, products from inclusion in the GHM and
companies and entities from submitting products for inclusion based on evidence
of fraud, provided such suspension or any reinstatement shall occur only upon
the written request of the Commissioner or federal law enforcement
authorities;
(9)
To develop and approve specific measurement tools for consumers to use in
comparing health care products, including brief summaries of deductibles,
copayment requirements, covered providers, benefits, premiums, and coverage
limits. To the maximum extent possible, the authority shall utilize cost and
quality measurements established by the Georgia Health Information Technology
and Transparency Advisory Board;
(10)
To develop a brief questionnaire of not more than ten questions to enable
visitors to the GHM website to obtain instant approximate price quotes
consisting of either specific prices or price ranges for products they may wish
to purchase. Approximate rates provided by insurers pursuant to such
questionnaire shall be used only for informational purposes and shall create no
contractual obligation on the part of an insurer to offer an individual a policy
at such rate prior to completion of medical underwriting by such insurer.
Information provided by consumers through the GHM for purposes of obtaining
price quotes on products shall not be transferred outside the GHM or recorded in
written or electronic form by the GHM;
(11)
To develop a common battery of medical underwriting questions that can be
uniformly utilized by health insurance companies to medically underwrite
policies;
(12)
To fix and collect fees and charges associated with the operation of the GHM,
including but not limited to listing charges for health insurance companies and
licensed insurance agents to register on the GHM; provided, however, that any
fees and charges collected shall be used only for purposes of promoting the GHM
to Georgia consumers and shall not be used for general administrative expenses
associated with the GHM;
(13)
To administer the GHM Marketing Trust Fund, as established in Code Section
33-62-6;
(14)
To deposit or invest funds held by it in any state depository or in any
investment which is authorized for the investment of proceeds of state general
obligation bonds and to use for its corporate purposes or redeposit or reinvest
interest earned on such funds;
(15)
To exercise any power granted by the laws of this state to public or private
corporations which is not in conflict with the public purpose of the authority;
and
(16)
To do all things necessary or convenient to carry out the powers conferred by
this chapter.
33-62-5.
(a)
The authority shall establish, operate, and maintain the Georgia Health
Marketplace, which shall serve as an Internet portal for access to health care
products which fall under the categories set out in paragraphs (2) through (6)
of subsection (b) of this Code section and to the PeachCare for Kids Program.
The GHM shall also include specific measurement tools for consumers to use in
comparing health care products, including brief summaries of deductibles,
copayment requirements, covered providers, benefits, premiums, financial
soundness ratings, and coverage limits.
(b)
The health care products and programs included in the GHM shall be in one of the
following categories:
(1)
PeachCare for Kids Program created by Code Section 49-5-273;
(2)
Initiatives or programs established by the Department of Community Health aimed
at providing accessible health insurance coverage to employees of small
businesses in this state, such as the Health Insurance Partnership;
(3)
Traditional small group or individual health insurance products sold by licensed
Georgia insurers;
(4)
Health care savings accounts, including any health care plan offering medical
savings accounts or health reimbursement arrangement accounts;
(5)
Health care services provided directly from a physician which do not require a
health care provider to manage any risk, such as, but not limited to, a set
number of office visits, annual checkups, a set range of imaging services,
immunizations, and services provided on a regular schedule for chronic diseases.
Prior to receiving health care services directly from a physician pursuant to
this paragraph, a consumer shall be required to sign an acknowledgment and
understanding of the following statement:
'I
understand I am purchasing a prepaid package of medical services. This package
of services is not health insurance and provides only prepaid services at a
discounted rate. Purchasing this package without also purchasing catastrophic
coverage insurance may leave me without coverage for many major medical
problems.'
These
services shall not be treated as insurance products under Georgia law. The
Composite State Board of Medical Examiners shall be responsible for disciplining
any physician for unprofessional conduct in offering or providing such services;
and
(6)
Catastrophic coverage products only as authorized pursuant to Code Section
33-62-8.
(c)
The GHM shall provide consumers who identify health care products on the GHM the
option of contacting a health insurance company or a licensed insurance agent by
telephone or direct electronic referral to the agent or company website when he
or she is ready to purchase a product. For consumers choosing the licensed
insurance agent option, licensed agents selling the selected plan shall be
listed in the order directed by the authority, with that order being determined
by professional qualifications of the agent and the agent´s geographical
proximity to the address given by the consumer; provided, however, that the
authority may take into consideration a licensed insurance agent´s history
of consumer complaints against such agent in the listed order. The authority
shall include on the GHM a description of the important role of licensed agents
in educating consumers on health insurance products.
(d)
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.
(e)
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.
33-62-6.
(a)
There is created the GHM Marketing Trust Fund as a separate fund in the state
treasury. The trust fund shall be administered by the authority.
(b)
The trust fund shall consist of such moneys as appropriated by the General
Assembly, fees and charges determined and collected by the authority for the
operation of the Georgia Health Marketplace, which shall be limited to initial
listing charges for health insurance companies and licensed insurance agents to
register on the GHM, and private contributions from any source.
(c)
State funds received by the authority through appropriations by the General
Assembly shall not be expended by the authority unless the authority collects or
receives matching private funds at a ratio of 1:1 to the state funds through
fees, charges, or contributions from health insurance companies, licensed
insurance agents, or other private sources. State funds not matched within two
years shall be returned from the trust fund to the general fund.
(d)
Funds from the trust fund shall be expended only for the purpose of entering
into competitively bid contracts for private sector marketing, advertising, and
public relations to promote the GHM to Georgia consumers. Funds shall not be
expended for general administrative expenses associated with the
GHM.
33-62-7.
(a)
The authority shall not be liable for any acts or omissions of an insurer
related to its participation in the GHM.
(b)
Consumer complaints relating to health care products and programs purchased or
enrolled in through the GHM shall be handled in the same manner as would be
applicable if the consumer purchased or enrolled in the health care product or
program through other means.
33-62-8.
(a)
Notwithstanding any other provision of law and on and after the effective date
of this Code section, catastrophic coverage products may be offered by an
insurer for purposes of this chapter only. Such products shall:
(1)
Have deductibles in at least a minimum amount as established by the authority;
provided, however, that an insurer may set a higher deductible. Such minimum
amount shall be equal to the amount established by the United States Department
of Treasury as the minimum deductible for high deductible health plans, as it
exists on the effective date of this Code section. The authority shall
establish and maintain rules governing the adjustments of this figure for
purposes of inflation which may be based on the method of adjustment for high
deductible health plans established by the United States Department of Treasury
or on the Consumer Price Index;
(2)
Provide coverage for services or treatment based solely upon a contractual
agreement between the insurer and the consumer;
(3)
Be offered only through the GHM; and
(4)
Be available for purchase only by individuals:
(A)
Between the ages of 18 and 25; or
(B)
Who certify in writing that they will open, within 60 days of purchase of the
catastrophic coverage product, and maintain an active health care savings
account capitalized to an amount equal to or greater than the annual deductible
of the catastrophic coverage product the individual intends to purchase through
the GHM.
Products
offered pursuant to this Code section shall not be subject to other Title 33
provisions including but not limited to provisions which require specific state
mandated health benefits, which regulate premiums, or which regulate the
issuance or cancellation of policies.
(b)
Prior to purchasing a catastrophic coverage product pursuant to this chapter, a
consumer shall be required to sign an acknowledgment and understanding of the
following statement:
'I
understand that the catastrophic coverage product I am purchasing or enrolling
in is not subject to any of the coverage requirements that state law mandates of
standard health insurance plans. I understand that in exchange for paying a
lower premium, I may be responsible for higher out of pocket expenses if I get
sick or am in an accident.'
(c)
An insurer that offers one or more catastrophic coverage products through the
GHM shall also make available for purchase on the GHM at least one individual
accident and sickness insurance policy that contains all state mandated health
benefits.
(d)
The Commissioner may promulgate rules and regulations as necessary to implement
the provisions of this Code section.
33-62-9.
The
authority and the Commissioner, as appropriate, shall be authorized to adopt
rules and regulations to effect the implementation of this
chapter."
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.