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-.09 - Renewability and Modification of Coverage under Group Health Insurance
Universal Citation: GA Rules and Regs r 120-2-67-.09
Current through Rules and Regulations filed through September 23, 2024
(a) On and after July 1, 1997, all insurers which issue, issue for delivery, deliver, or renew existing group policies, certificates, or contracts of health insurance in the State of Georgia shall renew or continue such coverage at the option of the policyholders.
(b) Notwithstanding paragraph (a), an insurer may cancel or nonrenew coverage in the following instances:
(1) The policyholder has failed to pay premiums or contributions in accordance with the terms of the group health insurance policy or contract, including any timeliness requirements, subject to applicable State law;
(2) The policyholder has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact in applying for or procuring coverage under the terms of the group health insurance policy or contract;
(3) The policyholder has violated an insurer's minimum employer contribution or group participation rules, provided that the insurer submits written notice to each affected policyholder and provides each policyholder sixty (60) days in which to bring the group into compliance prior to cancellation;
(4) None of the policyholder's employees, group members, or enrollees live, reside, or work in the service area of the provider network, only if the group policy or contract is issued by a health maintenance organization or a provider-sponsored health care corporation, unless there is at least one insured employee, group member, or enrollee who has agreed to return to the service area of a health maintenance organization in accordance with the Rules and Regulations of the Office of Commissioner of Insurance 120-2-33-.06(5).
(5) An insurer terminates, cancels, or does not renew all coverage under a particular policy form, provided that:
(A) the insurer provides at least ninety (90) days notice prior to the termination of the policy form to all policyholders and certificate holders;
(B) for a policy form used by small employers, the insurer offers to such small employer policyholders the option to purchase all other group policies from the insurer currently being offered to or renewed by small employers in this State for which the small employer policyholders would otherwise be eligible;
(C) for a policy form used by large employers, the insurer offers to such large employer policyholders the option to purchase any other group policy from the insurer currently being offered to or renewed by a large employer in this State; and
(D) the insurer acts uniformly without regard to the claims experience of any or all policyholders, covered employers, or any healthstatus related factor relating to any enrollees or other eligibles covered by or eligible for coverage under the policy.
(6) An insurer discontinues offering and terminates, cancels, or does not renew all coverage in either the small employer market or the large employer market, or both, provided that:
(A) the insurer provides at least 180 days notice prior to the discontinuance or nonrenewal of a policy or contract to all policyholders and certificate holders,
(B) the insurer provides at least 180 days notice to the Commissioner prior to the earliest date of termination or non-renewal related to the discontinuation in the market and indicates in such notice the date described in subparagraph (6)(C), and
(C) the insurer does not issue coverage in such market for five (5) years beginning with the date of the last health insurance policy or contract in that market not renewed.
(7) An employer ceases membership in an association through which health insurance coverage is issued, provided that the insurer was still issuing coverage through that association, or the association was still making such coverage available, and the coverage cancellation or non-renewal is uniform without regard to any health status related factor relating to any insured. If the association ceases to make coverage available under any health insurance policy or contract, or ceases to exist, employers covered under such association policies shall be considered policyholders and shall be guaranteed renewability by the insurer.
(c) Insurers may modify group policies only at the time of renewal, provided that, for all small employers covered under a policy, such modifications to that policy are effective on a uniform basis among all small employers with that policy.
(d) Notwithstanding paragraph (c), an insurer may modify a group policy other than at renewal only if a policyholder elects to modify its coverage at such other time.
(e) For the purposes of this section "large employer" shall mean all employers or other groups not meeting the definition of "small employer" as set forth in this Regulation Chapter.
O.C.G.A. Sec. 33-2-9, 33-30-15.
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