Bill Text: GA HB1166 | 2011-2012 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Insurance; individual health insurance coverage to children through child-only health plans; provide
Spectrum: Partisan Bill (Republican 7-0)
Status: (Passed) 2013-01-01 - Effective Date [HB1166 Detail]
Download: Georgia-2011-HB1166-Introduced.html
Bill Title: Insurance; individual health insurance coverage to children through child-only health plans; provide
Spectrum: Partisan Bill (Republican 7-0)
Status: (Passed) 2013-01-01 - Effective Date [HB1166 Detail]
Download: Georgia-2011-HB1166-Introduced.html
12 LC
29 5142ER
House
Bill 1166
By:
Representatives Atwood of the
179th,
Smith of the
131st,
Meadows of the
5th,
Maxwell of the
17th,
Williams of the
113th,
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 provide for individual health insurance coverage to children through
child-only health plans; to provide for legislative intent; to establish a
mandatory, uniform open enrollment period; to provide for definitions; to
provide for guaranteed-issue coverage regardless of health status; to provide
for special enrollment periods for loss of coverage because of a qualifying
event; to provide for a list of qualifying events; to provide effective dates
for coverage purchased during an open enrollment period or after a qualifying
event; to provide notice and marketing requirements; to provide for rules and
regulations; to provide for an automatic repealer; 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
29B
33-29B-1.
(a)
It is the intention of this chapter to restore access to creditable health care
coverage for Georgia's children, and that in order to do so, it is important to
bring insurance providers into the market to offer individual health insurance
coverage to children through child-only health plans.
(b)
For the protection of the public, particularly children and families, and for
the protection of insurers required by federal law to guarantee the issue of
individual health plans to children who are less than 19 years of age without
imposing any preexisting condition exclusions, it is the intent of the General
Assembly to accomplish this goal by establishing that as a condition of issuing
health insurance coverage in the individual market until January 1, 2014,
carriers offer child-only policies during open enrollment periods specified by
this chapter.
33-29B-2.
(a)
As used in this chapter, the term:
(1)
'Child-only plan' means individual health insurance coverage for a qualified
individual who is less than 19 years of age. Such term shall not include
dependent health insurance for a qualified individual under another person's
health insurance.
(2)
'Health insurance' has the same meaning as accident and sickness policy as
defined in Code Section 33-29-1. Such term shall not include:
(A)
Any policy of workers' compensation insurance or any policy of workers'
insurance or any policy of liability insurance with or without supplementary
expense coverage on the policy;
(B)
Any policy or contract of reinsurance;
(C)
Any policy, the renewal of which is subject to continuation of employment with a
specified employer, any blanket or group policy of insurance, or any policy
issued pursuant to the exercise of conversion privileges provided for in group
insurance policies;
(D)
Life insurance, endowment or annuity contracts, or contracts supplemental
thereto which contain only such provisions relating to accident and sickness
insurance which provide additional benefits in case of death or dismemberment or
loss of sight by accident, or which operate to safeguard such contracts against
lapse or give a special surrender value or special benefit or an annuity in the
event that the insured or annuitant becomes totally and permanently disabled as
defined by the contract or supplemental contract;
(E)
Companies, organizations, or associations provided for in Chapters 18 and 19 of
this title; or
(F)
Any policy of accident, sickness, or hospitalization insurance issued prior to
January 1, 1961; long-term care, disability income, short-term, accident,
dental-only, vision-only, fixed indemnity, limited-benefit, or credit insurance;
coverage issued as a supplement to liability insurance; insurance arising out of
workers' compensation or similar law; automobile medical payment insurance; or
insurance under which benefits are payable with or without regard to fault and
that is statutorily required to be contained in any liability insurance policy
or equivalent self-insurance.
(3)
'Insurer' means an insurance company, insurance service, or insurance
organization licensed to engage in the business of insurance in Georgia and
which is subject to this title. Such term shall not include a group health
plan.
(4)
'Qualified individual' means a resident of this state who is less than 19 years
of age. Such term shall not include a person who is not a United States citizen
or who is present in the United States illegally.
(5)
'Qualifying event' means the loss of employer sponsored health insurance or the
involuntary loss of other existing health insurance for any reason other than
fraud, misrepresentation, or failure to pay a premium if the applicant is a
qualified individual when the qualifying event occurs.
33-29B-3.
(a)
All insurers that deliver or issue for delivery individual health insurance in
this state shall be subject to the provisions of this chapter. As a condition
of issuing coverage in the individual health market, a carrier shall have an
approved child-only policy available to be issued pursuant to Code Section
33-29A-3 and this chapter.
(b)
Insurers shall offer guaranteed-issue coverage to primary subscribers under the
age of 19 years during open enrollment periods. There shall be two annual open
enrollment periods during which insurers shall accept applications for
child-only coverage. The first open enrollment period for child-only applicants
shall commence on July 1, 2012, and end on July 31, 2012. Insurers shall
provide for subsequent open enrollment periods for child-only applicants during
the entire months of January, 2013, and July, 2013.
(c)
During the open enrollment period set forth in subsection (b) of this Code
section and within 30 days of a qualifying event, an insurer shall accept and
grant an application to insure a qualified individual for a child-only plan on a
guaranteed-issue basis without any limitations or exclusions of policy benefits
based upon the applicant's health status pursuant to federal law.
(d)
Insurers shall not offer child-only policies outside of the open enrollment
periods set forth in subsection (b) of this Code section, except insurers shall
permit a child under the age of 19 years to apply and enroll for coverage during
a special enrollment period under the terms of the health benefit plan if the
child has experienced a qualifying event.
(e)
A special enrollment period shall last 30 days from the date the insurer
receives notice of loss of coverage if:
(1)
Such notice is provided to the insurer no later than the sixtieth day after the
loss of coverage;
(2)
The loss of other coverage results from:
(A)
Birth;
(B)
Adoption;
(C)
Marriage;
(D)
Dissolution of marriage;
(E)
Loss of employer sponsored insurance;
(F)
Loss of eligibility under Code Section 49-4-1 or 49-5-273;
(G)
Entry of a valid court or administrative order mandating the child be covered;
or
(H)
Involuntary loss of other existing coverage for any reason other than fraud,
misrepresentation, or failure to pay premium; or
(3)
The person under 19 years of age is not eligible for group
coverage.
(f)
Coverage under individual policies applied for during the open enrollment period
set forth in subsection (b) of this Code section shall become effective within
30 days following the end of such period. Coverage under individual policies
applied for during a special enrollment period shall become effective within 30
days following the end of the special enrollment period.
(g)
Nothing in this Code section shall prohibit an insurer from setting a premium
rate for individuals based upon medical underwriting so long as such rate is in
compliance with the applicable product's rate filing on record with the
department.
33-29B-4.
In
the event that an individual under the age of 19 years is a dependent on a
policy with a primary subscriber who is over the age of 19 years and such
primary subscriber drops the policy, all dependents shall lose coverage as a
result of the termination of coverage of the primary subscriber. Such
individuals under the age of 19 years may reenroll with the insurer during the
next open enrollment period set forth in subsection (b) of this Code section or,
in the case of a qualifying event, during a special enrollment
period.
33-29B-5.
An
insurance carrier may deny coverage to an applicant for enrollment in a
child-only plan if other creditable coverage is available. For purposes of this
Code section, the term 'creditable coverage' shall not include eligibility for a
high-risk pool insurance plan, but shall include current enrollment in a
high-risk pool insurance plan.
33-29B-6.
(a)
Insurers currently covering subscribers or dependents under the age of 19 years
on individual policies shall continue to renew such policies in accordance with
Code Section 33-29-21.
(b)
Notice of the open enrollment opportunity, open enrollment dates for new
applicants, the opportunity to enroll due to a qualifying event, and
instructions on how to enroll a child in a child-only policy shall be displayed
continuously and prominently on the insurance carrier's website throughout the
year. Each carrier shall also provide a link to public programs administered by
the Department of Community Health.
33-29B-7.
Each
carrier that participates in the individual market in Georgia shall submit to
the Commissioner the following information at the time the carrier submits the
information required in Code Section 33-3-21:
(1)
The number of applicants for a child-only plan;
(2)
The number of individuals enrolled in a child-only plan; and
(3)
The number of applicants denied enrollment in a child-only plan and the reasons
for the denials.
33-29B-8.
(a)
The Commissioner shall adopt rules to implement and administer this
chapter.
(b)
This chapter and the rules adopted by the Commissioner to administer this
chapter shall stand repealed on January 1,
2014."
SECTION
2.
This
Act shall become effective on July 1, 2012.
SECTION
3.
All
laws and parts of laws in conflict with this Act are repealed.