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-.10 - Renewability and Modification of Coverage under Individual Health Insurance

Universal Citation: GA Rules and Regs r 120-2-67-.10

Current through Rules and Regulations filed through March 20, 2024

(a) On and after July 1, 1997, all insurers which issue, issue for delivery, deliver, or renew existing individual policies or contracts of health insurance in the State of Georgia shall renew or continue such coverage at the option of the insured.

(b) Notwithstanding paragraph (a), an insurer may cancel or nonrenew coverage only in the following instances:

(1) The insured has failed to pay premiums in accordance with the terms of the individual health insurance policy or contract, including any timeliness requirements, subject to applicable State law;

(2) The insured has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact in applying for or procuring coverage, subject to the time limit specified in O.C.G.A. § 33-29-3(b)(2)(A); or

(3) Subject to the Rules and Regulations of the Office of Commissioner of Insurance Rule 120-2-33-.06(6), the insured no longer lives, resides, or works in the service area of the network if the individual policy or contract is issued by a health maintenance organization or a provider-sponsored health care corporation, but only if coverage is canceled or non-renewed uniformly without regard to any health status related factor of the insureds.

(4) 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 discontinuance of the policy form to all insured and to the Commissioner;

(B) the insurer offers to such insured all other individual policies currently being offered or renewed by the insurer in this State for which the insured are otherwise eligible without regard to any health status related factor; and

(C) the insurer acts uniformly without regard to the claims experience or any health-status related factor of individuals insured or eligible to be insured.

(5) An insurer discontinues offering and terminates, cancels, or does not renew all coverage under all policy forms in the individual market, provided that:

(A) the insurer provides at least 180 days notice prior to the discontinuance or nonrenewal of a policy or contract to all insured under that policy or contract;

(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 (5)(C);

(C) the insurer does not issue coverage in such market for 5 years beginning with the date of the last health insurance policy or contract in that market not renewed; and

(D) the insurer acts uniformly without regard to the claims experience or any health status related factor of individuals insured or eligible to be insured.

(6) An insured 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, individuals insured under such association policies shall be guaranteed renewability by the insurer.

(1) such modifications to that policy are effective on a uniform basis among all individuals with that policy form; and

(2) such modifications are accepted and signed by the insured.

(d) The term "accident and sickness insurance" as used in O.C.G.A. § 33-29-21shall have the same meaning as the term "health insurance" used in this Regulation Chapter.

O.C.G.A. Sec. 33-2-9, 33-29-21, 33-30-15.

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