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 120-2-67 - PORTABILITY AND RENEWABILITY
Rule 120-2-67-.08 - Special Enrollment
Universal Citation: GA Rules and Regs r 120-2-67-.08
Current through Rules and Regulations filed through March 20, 2024
(a) Individuals who decline group health insurance coverage when first eligible and satisfy subparagraphs (1) or (2) shall be considered newly eligible employees and not late enrollees, and must be offered coverage under the group policy or contract as newly eligible employees in accordance with paragraph (b), if such eligible individuals elect to enroll within the specified period in each subparagraph. Such individuals are:
(1) Existing employees or group members,
and existing dependents of such existing employees or group members, who
declines coverage when first eligible or when first offered because of coverage
under other creditable coverage, provided that:
(A) the employee or group member stated in
writing that existing creditable coverage was the reason for the employee,
group member, or dependent declining enrollment, but only if such statement is
required by the insurer, and the insurer has provided the employee or group
member notice of such a requirement at the time of declination and included in
such notice the consequences of not making a statement;
(B)
(i)
federal or state continuation coverage has been exhausted; or
(ii) other coverage unrelated to continuation
has terminated as a result of loss of eligibility for such other coverage under
the terms of that coverage or; (iii) contributions for such other coverage from
a former or current employer have terminated;
(C) such other creditable coverage was not
terminated in accordance with the Rules and Regulations of the Office of
Commissioner of Insurance Rule
120-2-67-.10(b)(2)
or for failure of the employee, group member, or dependent to pay premiums or
contributions on a timely basis in accordance with the terms of coverage and
the Georgia Insurance Code or the Rules and Regulations of the Office of
Commissioner of Insurance; and
(D)
the employee or group member requests enrollment for the employee or group
member and/or dependents not later than thirty (30) days after the effective
date of the event described in subparagraph (B).
(2) Any of the following as a result of
marriage, birth, adoption or placement for adoption:
(A) the employee or group member, if not
enrolled under the group policy as a result of declining coverage when first
eligible;
(B) the spouse of an
employee or group member, provided the employee or group member is covered or
elects coverage with the spouse; or
(C) the dependent or dependents of an
employee or group member, provided the employee or group member is covered or
elects coverage with the dependent or dependents.
(3) Coverage must be elected for any
individual or individuals specified in paragraph (2) no later than thirty (30)
days after the date of marriage, birth, adoption or placement for adoption, or,
only for newborns or adopted children, thirty-one (31) days after the date of
birth, adoption or placement for adoption if dependent or family coverage was
not previously elected or payment of additional specific premium is required to
provide coverage for such children.
(4) Coverage must be elected no later than
thirty (30) days after a group policy is modified to make dependent coverage
available for all employees or group members.
(b) Special enrollment date is to be determined as follows:
(1) In the event an
employee, group member, or dependent becomes eligible in accordance with
paragraph (a)(1) of this Rule, enrollment must become effective no later than
the first day of the first calendar month after the date the completed request
for enrollment is received by the insurer.
(2) In the event an employee, group member,
or dependent becomes eligible in accordance with subparagraph (a)(2) of this
Rule, enrollment must become effective on the date of birth, adoption or
placement for adoption, or in the case of marriage, no later than the first day
of the first calendar month after the date the completed request for enrollment
is received.
O.C.G.A. Sec. 33-2-9, 33-24-22, 33-30-15.
Disclaimer: These regulations may not be the most recent version. Georgia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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