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 120-2-96 - GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN
Rule 120-2-96-.05 - Product Filing Standards and Procedures

Universal Citation: GA Rules and Regs r 120-2-96-.05

Current through Rules and Regulations filed through September 23, 2024

(1) Insurers proposing products for consideration and potential approval under O.C.G.A. Chapter 33-51 and this Rule shall, in cover letters or their equivalent if filed electronically under SERFF, indicate their intent and shall:

(a) describe the type of comprehensive or major medical health insurance coverage being proposed,

(b) make a clear disclosure on the face page of the Master Policy, if group, and on face pages of Certificates, or on the face page of individual policies to this effect.

(c) include a clear and conspicuous disclosure that states, in effect, that the health insurer has designed and constructed the evidence of coverage with the intent of satisfying and qualifying the health insurance coverage as a High Deductible Health Plan under applicable provisions of Section 223 of the Internal Revenue Service laws and rules, but that neither the insurer nor the Office of Commissioner of Insurance of the State of Georgia provides federal tax advice, and that consumers should seek their own private tax advice with respect to federal tax treatment beyond the insurance coverage.

(2) High Deductible Health Plan Policies which contain the appropriate disclosures should receive an expedited review with respect to those coverage issues and the overall filing. All otherwise applicable requirements regarding mandated benefits, limitations, disclosures, notices and other requirements remain in effect to the extent they do not violate IRS Rules for High Deductible Health Plans under Section 223 of the Internal Revenue Code or related IRS Rules and Regulations.

(3) The Commissioner will consider and may accept a statement from the insurer in a cover letter or its electronic equivalent in the case of SERFF or other electronic filing submission modes accompanying a filing for High Deductible Health Plan coverage, signed by an officer of the company, that indicates the insurer has sought and obtained appropriate advice of counsel familiar with Internal Revenue Service Laws and Rules and that to the best of the company's knowledge and belief, the proposed product qualifies as High Deductible Health Plan coverage under all applicable IRS laws and rules.

(4) The Commissioner may accept, but is not required to accept, a statement from an officer of the Insurer that the product is similar to a previously approved health insurance product, if so identified by exact form number, date of original or most recent approval, and if accompanied by documentation of differences from any such prior approved form. Such documentation may take the form of a redline version, markup, summary of differences or other clearly designed instrument which helps the reviewer isolate and identify substantive differences from previously approved versions of similar coverage.

(5)

(a) Wellness or Health Promotion Programs should be adequately disclosed by an insurer, either as an integral component of the health insurance product itself, or by attachment of such wellness or health promotion product as a rider to be sold or offered in connection with allowable high deductible health insurance products under Rule 120-2-96-.02. Insurers shall be required to clearly disclose the relationship between any proposed health promotion or wellness program and the high deductible health product within application materials, within any advertisement or other solicitation materials and within the evidence of coverage, if applicable. Health Promotion or Wellness Programs shall disclose any and all applicable costs in terms of premium, contribution or other costs, as well as clearly and accurately disclose potential incentives, rewards, discounts or other benefits and how enrollees may claim or otherwise earn and receive any such incentives, rewards or discounts. Such disclosures must be provided by the insurer to any interested party on request.

(b) Health Promotion or Wellness programs that are not designed, controlled, operated by and offered by insurers within their health insurance policies must be filed by insurers wishing to use them in connection with High Deductible Health Plan products seeking protection from rebates, illegal inducements or other unfair trade practices under O.C.G.A. Section 33-51-4.

(6) The Commissioner may post enhanced instructions for insurers to use in making formalized SERFF or other electronic or other expedited filings under O.C.G.A. Section 33-51-2 on Office of Commissioner of Insurance website materials. The Commissioner will continue to apply applicable policy form filing fees on any such expedited filing methods, but insurers are encouraged to utilize such methods of filing and any such methods of Electronic Funds Transfer to pay applicable policy form and rate filing fees whenever possible or as required in the future for all other SERFF filings.

O.C.G.A. Secs. 33-2-9, 33-51-3.

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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