Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-104 - PREMIUM RATES AND PATIENT PROTECTION AND AFFORDABLE CARE ACT
Rule 120-2-104-.04 - Small Group Accident and Sickness Policies

Universal Citation: GA Rules and Regs r 120-2-104-.04

Current through Rules and Regulations filed through September 23, 2024

(a) Notice of the maximum amount of a group premium increase shall be mailed or delivered to the group policyholder and to each employer group or subgroup insured under the group policy not less than 60 days prior to the effective date of such increase.

(b) Concurrently with any notice of premium increase or offer of new coverage because of discontinuance or termination of an existing plan of coverage, an insurer shall provide an estimate as to the amount or percentage of any premium increase which is attributable to the Patient Protection and Affordable Care Act. Such notices shall include the following statement: "These increases are due to the federal Patient Protection and Affordable Care Act and not the enactment of any laws or regulations of the Governor of Georgia, the Georgia General Assembly, or the Georgia Department of Insurance."

(c) When determining estimates of the amount or percentage of premium increases which are attributable to PPACA, insurers must analyze the following but may analyze additional relevant factors:

(1) Policies being issued using modified community rating;

(2) The Essential Health Benefits;

(3) The effect of a 70 percent actuarial value; and

(4) Taxes and fees;

(d) Each insurer shall perform an analysis of rate impact upon comprehensive or major medical health coverage according to the following conditions:

(1) Each insurer shall estimate the average premium impact upon the average small group;

(2) When determining the average premium impact on each small group listed in subparagraph (1) of paragraph (d), an insurer may use as a basis:
(i) A product similar to the one owned by the recipient of the notice;

(ii) Each type of product sold by the company in the small group market; or

(iii) The company's most common policy sold in the small group market.

(e) Each disclosure shall be in a form compliant with the following conditions:

(1) An itemized estimate is not required for each factor listed in subparagraph (1) through (4) of paragraph (c). However, each estimate shall, at a minimum, incorporate the applicable factors listed in that section.

(2) Each estimate may be displayed in a range based upon the company's estimates; and

(3) A notice may use as a basis a product identified by items (i), (ii), or (iii) of subparagraph (2) of paragraph (d) provided that:
(i) If a notice uses as a basis the products identified by item (ii) of subparagraph (2) of paragraph (d), then an estimate must be provided for each of those products; and

(ii) If a notice uses as a basis the products identified by item (iii) of subparagraph (2) of paragraph (d), then such notice shall include a web address where the recipient can go to the insurer's website to view the disclosure information for each product listed in item (ii) subparagraph (2) of paragraph (d).

O.C.G.A. Sections 33-2-9 and 33-33-30-13.

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