(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.
