Bill Text: GA HB1166 | 2011-2012 | Regular Session | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Enrolled.html

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12 LC 29 5196ERS

House Bill 1166 (COMMITTEE SUBSTITUTE)

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

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 policies; 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 policies.

(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 policies 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, insurers 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 policy' 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) 'Creditable coverage' means medical expense coverage under any of the following:

(A) Medicare or Medicaid;

(B) An employer based accident and sickness insurance or health benefit arrangement;

(C) An individual accident and sickness insurance policy, including coverage issued by a health maintenance organization, nonprofit hospital or nonprofit medical service corporation, health care corporation, or fraternal benefit society;

(D) A spouse's benefits or coverage under medicare or Medicaid or an employer based health insurance or health benefit arrangement;

(E) A conversion policy;

(F) A franchise policy issued on an individual basis to a member of a true association as defined in subsection (b) of Code Section 33-30-1;

(G) A health policy formed pursuant to 10 U.S.C. Chapter 55;

(H) A health policy provided through the Indian Health Service or a tribal organization program or both;

(I) A state health benefits risk pool;

(J) A health policy formed pursuant to 5 U.S.C. Chapter 89;

(K) A public health policy; or

(L) A Peace Corps Act health benefit policy.

(3) '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.

(4) '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 policy.

(5) 'Open enrollment period' means January 1, 2013, through January 31, 2013.

(6) 'Qualified individual' means a resident of this state who is less than 19 years of age.

(7) '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, an insurer shall ensure that at least one policy design issued pursuant to Code Section 33-29A-3 and this chapter shall be available to individuals applying for a child-only policy.

(b) Insurers shall offer guaranteed-issue coverage to primary subscribers under the age of 19 years during open enrollment periods during which insurers shall accept applications for child-only policies.

(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 policy 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 period, 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 policy 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 creditable coverage.

(f) Coverage under individual policies applied for during the open enrollment period 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. An insurer may impose a surcharge for up to 12 months if an individual enrolls in a child-only policy without prior creditable coverage in the 63 day period preceding the date of application. The amount of the surcharge may be up to an additional 50 percent of the premium rate that would be charged if an individual enrolls in a child-only policy with prior creditable coverage in the 63 day period preceding the date of application.

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 apply for child-only policies during the open enrollment period 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 policy 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 policy, but shall include current enrollment in a high-risk pool insurance policy.

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 insurer's website throughout the year.

33-29B-7.

Each insurer that participates in the individual market in Georgia shall submit to the Commissioner the following information at the time the insurer submits the information pertaining to 2013 that is required in Code Section 33-3-21:

(1) The number of applicants for a child-only policy during open enrollment period;

(2) The number of individuals who enrolled in a child-only policy during the open enrollment period; and

(3) The number of applicants denied enrollment in a child-only policy during the open enrollment period 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 January 1, 2013.

SECTION 3.

All laws and parts of laws in conflict with this Act are repealed.