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-.05 - Georgia Health Benefits Assignment System

Universal Citation: GA Rules and Regs r 120-2-81-.05

Current through Rules and Regulations filed through September 23, 2024

(1) The standard health benefit plans developed by the Commissioner in accordance with O.C.G.A. § 33-29A-5 shall be designated as Plan C and Plan D respectively. The model policy form template for Plans C and D are designated as Form GHBAS-1, and the schedule of benefits for Plans C and D is designated as Form GHBAS-S.

(2) A managed care organization who participates in the Georgia Health Benefits Assignment System (GHBAS) must file policy forms necessary for providing the coverage required by the GHBAS 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 managed care organization is subject to the provisions of O.C.G.A. § 33-29A-1et seq., whichever is later. Coverage provided pursuant to assignment by the GHBAS 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 managed care organization may file policy forms prepared in accordance with Form GHBAS-1 and the schedule of benefits in Form GHBAS-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 managed care organization 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 GHBAS-1 and GHBAS-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) A managed care organization 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 GHBAS. These materials include enrollment forms, forms describing or soliciting an election of benefit options, disclosures regarding coverage under standard and optional plans, and any other documentation issued to qualifying eligible individuals for enrollment in standard or optional plans offered by the managed care organization.

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

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