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 120-2-81 - INDIVIDUAL HEALTH INSURANCE ASSIGNMENT SYSTEMS
Rule 120-2-81-.04 - Georgia Health Insurance Assignment System

Universal Citation: GA Rules and Regs r 120-2-81-.04

Current through Rules and Regulations filed through September 23, 2024

(1) The standard benefit schedules developed by the Commissioner in accordance with O.C.G.A. § 33-29A-4 shall be designated as Plan A and Plan B respectively. The model policy form template for Plans A and B is designated as Form GHIAS-1, and schedule of benefits for Plans A and B is designated as Form GHIAS-S.

(2) A health insurer who participates in the Georgia Health Insurance Assignment System (GHIAS) must file policy forms necessary for providing the coverage required by the GHIAS no later than thirty (30) days following either the effective date of this Regulation Chapter, or the date of notice from the Commissioner that the health insurer is subject to the provisions of O.C.G.A. § 33-29A-1et seq., whichever is later. Coverage provided pursuant to assignment by the GHIAS that is effective prior to the approval of the policy form shall be subject to the requirements of this Regulation Chapter and shall be amended pursuant to any modifications required by the Commissioner for approval of the filing. Such coverage made effective prior to approval of filing shall not be in violation if the policy form is filed within thirty (30) days as required.

(3) Methods of Filing.

(a) A participating health insurer may file policy forms prepared in accordance with Form GHIAS-1 and the schedule of benefits in Form GHIAS-S . Such policy forms shall be deemed approved upon the date the Commissioner receives the filing, provided they conform to the template form; or

(b) A participating health insurer may file policy forms with contractual language substantially similar to the model policy form template for approval, but must include the same benefits prescribed in the model policy form template and the same schedule of benefits prescribed in Forms GHIAS-1 and GHIAS-S . Such filings must include a description which specifically outlines the variances in language between the model policy form template and the filed form. A policy form filing with variances from the model policy form template prescribed in Form GHIAS-1 may not contain any provisions which are less beneficial than the relevant template provisions with regard to qualifying eligible individuals or eligible dependents.

(4) Special Rules for Preferred Provider Arrangements.

(a)

(a) A participating health insurer which issues health insurance policies with preferred provider arrangements in this state as approved by the Commissioner may offer standard policies with preferred provider arrangements. The out-of-network benefit levels must be at least as comprehensive as the schedule of benefits prescribed in Form GHIAS-S for Plans A and B.

(b)

(b) Health insurers may offer preferred provider arrangements with gatekeeper provisions if such provisions are typically included in health insurance policies approved by the Commissioner and issued by the health insurer in this state outside of the assignment system.

(c)

(c) Policy forms including preferred provider arrangements may be filed utilizing the model policy form template for preferred provider arrangements described in Form GHIAS-2. Such policy forms shall be deemed approved upon the date the Commissioner receives the filings, provided they conform to the template form. Otherwise, the health insurer must file for approval a policy form that is substantially similar to the preferred provider model policy form template. The health insurer may submit a revised schedule of benefits for approval which reflects in-network and out-of-network benefit levels for Plans A and B.

(d)

(d) A policy form filing with variances from the model policy form template prescribed in Form GHIAS-1 may not contain any provisions which are less beneficial than the relevant template provisions with regard to qualifying eligible individuals or eligible dependents.

(5) A health insurer shall file with the Commissioner for approval any and all materials used to offer coverage to a qualifying eligible individual and eligible dependents through the GHIAS. These materials include enrollment forms, forms describing or soliciting an election of benefit options, disclosures regarding coverage under standard and optional policies, and any other documentation issued to qualifying eligible individuals for enrollment in standard or optional policies offered by the health insurer.

O.C.G.A. Secs. 33-2-9, 33-29A-1, et seq.

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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