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 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES
Rule 120-2-99-.04 - Required Disclosures
Current through Rules and Regulations filed through March 20, 2024
(1) Each policy application for a product offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall contain the following language in boldface type at the beginning of the document:
"The benefits of this policy may primarily be governed by the laws of a state other than Georgia; therefore, all of the laws applicable to policies filed in this state may not apply to this policy. Any purchase of individual health insurance should be considered carefully since future medical conditions may make it impossible to qualify for another individual health insurance policy."
(2) Each delivered policy must contain the following language in boldface type at the beginning of the document:
"The benefits of this policy providing your coverage may be governed primarily by the laws of a state other than Georgia. The benefits covered may be different from other policies you can purchase. Please consult your insurance agent or insurer to determine which health benefits are covered under this policy."
(3) Each policy offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall also contain the following standard forms for the disclosure and comparison of benefits.
[INSURER NAME AND ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section 33-29A-35)
Georgia Benefits Definitions vs. Non-Georgia Based Product Definitions
|
Georgia Defined Term and Definition |
[Non-Georgia Product] Defined Term and Definition |
[INSURER NAME, ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section 33-29A-35)
Georgia Benefits Definitions vs. This Non-Georgia based Product Definitions
|
Georgia Mandated Benefit |
Georgia Citation |
Mandate or Mandated Offer or Qualifications |
[Non-Georgia Product] Does This Individual Policy Cover this benefit? (reference page and section in policy) |
|
Asthma; Prescription Inhalers |
33-24-59.8 |
Mandated behavior in RX plans |
|
|
Autism; non-discrimination in products covering neurological disorders |
33-24-59.10 |
Mandate (subject to policy benefits, limitations consistent with other neurological disorders) |
|
|
Bone Marrow Transplants for treatment of breast cancer, Hodgkins Disease |
33-29-3.3 |
Mandated Offer in Major Medical Plans |
|
|
Bone Mass Measurement |
31-15A |
Mandated Offer (availability) |
|
|
Breast Cancer Patient Care; Mastectomies |
33-24-70-72 |
Mandate for policies covering surgery, mastectomies |
|
|
Child Cancer Clinical Trials |
33-24-59.1 |
Mandate |
|
|
Child Deliveries (48 / 96 hour hospital stay) |
33-24-58.2 |
Mandated Benefit for policies covering maternity benefits; Notice requirement on insurers 30 days after insurer learns covered person is pregnant, added in 2002. |
|
|
Child Wellness to age 5 |
33-29-3.4 |
Mandate |
|
|
Chlamydia Screening to certain females, ages |
31-14-4.1 |
Mandate |
|
|
Colorectal Cancer Screening Colorectal Cancer Screening (continued) |
33-24-56.3 |
Mandates coverage for Colorectal Cancer Screening, exams, lab tests, along guidelines of American Cancer Society, American College of Gastroenterology & American College of Radiology. Exceptions are limited policies. |
|
|
Dental; General Anesthesia |
33-24-28.4 |
Mandate |
|
|
Dermatologist Direct Access |
33-24-56 |
Mandates Access (subject to policy benefits) |
|
|
Diabetes Outpatient Self Management Training, Equipment |
33-24-59.2 |
Mandate for Major Medical Policies, Managed, Capitated plans |
|
|
Human Heart Transplants |
33-29-3.1 |
Mandated Offer (make available on major med plans) |
|
|
Mammograms, PAP Smears, PSA Test |
33-29-3.2 |
Mandate |
|
|
Mental Disorders |
33-24-28.1 |
Mandated Offer (make available) |
|
|
Morbid Obesity |
33-24-59.7 |
Mandated Offer (Georgia policy "may" cover) |
|
|
OB / GYN Direct Access |
33-24-59 |
Mandates Access (subject to policy benefits) |
|
|
Off-Label Prescription Drugs for insureds with life-threatening or chronic and disabling conditions |
33-24-59.11 |
Mandate (subject to certain conditions and prior authorization of insurer) |
|
|
Ovarian Cancer; Surveillance Tests for women at risk |
33-24-56.2 |
Mandates Coverage for certain women over age 35 (subject to same deductibles, coinsurance as other benefits) |
|
|
Pregnancy, Complications of |
33-24-24 |
Mandate for Major Medical |
|
|
Prescription Contraceptives |
33-24-59.6 |
Mandate for RX plans |
|
|
TMJ |
33-29-20 |
Mandate |
O.C.G.A. §§ 33-2-9 and 33-29A-30et seq.
