Rules and Regulations of the State of Georgia
 

JavaScript Is Not Enabled alert

You need to have JavaScript enabled in your browser to utilise the full functionality of this website.

How to enable JavaScript in your browser






firefox Mozilla Firefox

  1. In the address bar, type about:config and press Enter.
  2. Click "I'll be careful, I promise" if a warning message appears.
  3. In the search box, search for javascript.enabled
  4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  5. Click on the "Reload current page" button of the web browser to refresh the page.
  • 1. In the address bar, type about:config and press Enter.
  • 2. Click "I'll be careful, I promise" if a warning message appears.
  • 3. In the search box, search for javascript.enabled
  • 4. Toggle the "javascript.enabled" preference (right-click and select "Toggle" or double-click the preference) to change the value from "false" to "true".
  • 5. Click on the "Reload current page" button of the web browser to refresh the page.




ie Internet Explorer

  1. On web browser menu click "Tools" icon and select "Internet Options".
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
  • 1. ie9 01
  • 2. ie9 02
  • 3. ie9 03
  • 4. ie9 04
  • 5. ie9 05
  • 6. ie9 06
  • 7. ie9 07
  • 8. ie9 08
 Internet Explorer < 9
  1. On web browser menu click "Tools" and select "Internet Options"
  2. In the "Internet Options" window select the "Security" tab.
  3. On the "Security" tab click on the "Custom level..." button.
  4. When the "Security Settings - Internet Zone" dialog window opens, look for the "Scripting" section.
  5. In the "Active Scripting" item select "Enable".
  6. When the "Warning!" window pops out asking "Are you sure you want to change the settings for this zone?" select "Yes".
  7. In the "Internet Options" window click on the "OK" button to close it.
  8. Click on the "Refresh" button of the web browser to refresh the page.
  • 1. ie 01
  • 2. ie 02
  • 3. ie 03
  • 4. ie 04
  • 5. ie 05
  • 6. ie 06
  • 7. ie 07
  • 8. ie 08




chrome Google Chrome

  1. On the web browser menu click on the "Customize and control Google Chrome" and select "Settings".
  2. In the "Settings" section click on the "Show advanced settings..."
  3. Under the the "Privacy" click on the "Content settings...".
  4. When the dialog window opens, look for the "JavaScript" section and select "Allow all sites to run JavaScript (recommended)".
  5. Click on the "OK" button to close it.
  6. Close the "Settings" tab.
  7. Click on the "Reload this page" button of the web browser to refresh the page.
  • 1. chrome 01
  • 2. chrome 02
  • 3. chrome 03
  • 4. chrome 04
  • 5. chrome 05
  • 6. chrome 06
  • 7. chrome 07




opera Opera

  • 1. a) Click on "Menu", hover mouse on the "Settings" then hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
  • 1. b) If "Menu bar" is shown click on the "Tools", hover mouse on the "Quick preferences" and mark the "Enable Javascript" checkbox.
1. a) opera10 a 1. b) opera10 b




safari Apple Safari

  1. On the web browser menu click on the "Edit" and select "Preferences".
  2. In the "Preferences" window select the "Security" tab.
  3. In the "Security" tab section "Web content" mark the "Enable JavaScript" checkbox.
  4. Click on the "Reload the current page" button of the web browser to refresh the page.
  • 1. safari 01
  • 2. safari 02
  • 3. safari 03
  • 4. safari 04
<xmp>.</xmp> <form name="form1" method="post" action="120-2-67?urlRedirected=yes&amp;data=admin&amp;lookingfor=120-2-67" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIFFgJmD2QWAgIFDw8WAh4EVGV4dAUFMiArIDNkZGTGBYGye9IS1glDoIP2QprsF9BWwA==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAK/9/+WBwLniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0M5IMD6RDObwnJzQnh7d7Zx9dNsv4=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> If you accept these terms enter the information below and click “I AGREE”.</p> </div> <table border="0" style="width: 810px"> <tr> </tr> <tr> <td style="vertical-align: text-top; width: 243px;"> Full Name:</td> <td style="width: 532px; vertical-align:super;"> <input name="firstName" type="text" id="firstName" class="txt" /> <span id="lbl_fname"><font color="Red"></font></span> </td> </tr> <tr><td style="width: 243px"> Human verification: <b> <span id="lblStopSpam">2 + 3</span>&nbsp;= </b></td><td style="width: 532px"> <input name="captcha" type="text" id="captcha" class="txt" /> <span id="lbl_captcha"><font color="Red"></font></span> &nbsp; <input name="sum" type="hidden" id="sum" value="5" /> </td></tr> </table> <input type="submit" name="Button1" value="I AGREE" id="Button1" disabled="disabled" /> <span id="alrtmsg"><font color="Red"></font></span> <input name="v1" type="hidden" id="v1" /> <input name="v2" type="hidden" id="v2" /> <input name="v3" type="hidden" id="v3" /> <p>Privacy Policy: the above information is for internal use only as related to this agreement and will not be sold or distributed.</p> </div> </div> </form> <html> <head runat="server"> <title>GA - GAC</title> <link href="_files/main.css" media="all" rel="Stylesheet" type="text/css" /> <link href="_files/treeview_old.css" media="all" rel="Stylesheet" type="text/css" /> <link href="/_files/popup.css" media="all" rel="stylesheet" type="text/css" /> <script type="text/javascript" src="/_files/treeview.js"></script> <script type="text/javascript" src="/_files/jquery-1.8.0.min.js"></script> <script type="text/javascript" src="/_files/jquery-1.10.2.js"></script> <script type="text/javascript" src="/_files/popup.js"></script> <script type="text/javascript" src="http://code.jquery.com/jquery-1.8.2.js"></script> <script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1.8/jquery.min.js" /> <script type="text/javascript" src="/_files/jquery.popup.js"></script> <script type="text/javascript" src="/_files/jquery.popup.min.js"></script> <script type="text/javascript" src="/_files/ValidateForm.js"></script> <script src="https://code.jquery.com/jquery-1.11.3.js"></script> <link href="/_files/enablejs.css" rel="Stylesheet" type="text/css" /> <link href="/_files/forJavascript.css" rel="Stylesheet" type="text/css" /> <style type="text/css"> .collapse{background-image:url('/images/expcoll_right.png');} .expand{background-image:url('/images/expcoll_down.png');} </style> <script type="text/javascript"> $(document).ready(function(){ $("#History-parent").click(function(){ $("#History-Childs").toggle(); if ($('#History-parent img').hasClass('expand')) { $('#History-parent img').addClass('collapse'); $('#History-parent img').removeClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_right.png'); } else { $('#History-parent img').removeClass('collapse'); $('#History-parent img').addClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_down.png'); } }); $("#History-Childs").hide(); var tocnode=document.getElementById('toc-children'); if (tocnode != null) { if(tocnode.childNodes.length != 0) { document.getElementById("doc-content").style.width="72%"; document.getElementById("toc").style.width="21%"; document.getElementById("toc").style.padding="10px"; } else { document.getElementById('toc').style.display="none"; } } }); function fnsetRDVal(id) { if (id=="y") { document.getElementById("y").value="yes" document.getElementById("n").value="" } else { document.getElementById("n").value="no" document.getElementById("y").value="" } } </script> <script type="text/javascript"> function TermsCon() { var overlay = $('<div id="overlay"></div>'); overlay.show(); overlay.appendTo(document.body); $('.popup2').show(); $('#btnAgree').click(function () { $('.popup2').hide(); $("#overlay").hide(); overlay.appendTo(document.body).remove(); }); $("#btnprint").click(function () { var contents = $("#popupterms").html(); var frame1 = $('<iframe />'); frame1[0].name = "frame1"; frame1.css({ "position": "absolute", "top": "-1000000px" }); $("body").append(frame1); var frameDoc = frame1[0].contentWindow ? frame1[0].contentWindow : frame1[0].contentDocument.document ? frame1[0].contentDocument.document : frame1[0].contentDocument; frameDoc.document.open(); //Create a new HTML document. frameDoc.document.write('<html><head>'); frameDoc.document.write('</head><body>'); //Append the external CSS file. frameDoc.document.write('<link href="_files/popup.css" rel="stylesheet" type="text/css" />'); //Append the DIV contents. frameDoc.document.write(contents); frameDoc.document.write('</body></html>'); frameDoc.document.close(); setTimeout(function () { window.frames["frame1"].focus(); window.frames["frame1"].print(); frame1.remove(); }, 500); }); // alert("Because you do not agree to the Terms and Conditions for Access, you must cease accessing and/or using this website and destroy all material obtained from this website without your agreement."); // $('.popup2').show(); } </script> </head> <body> <div class="popup2"> <div class='cnt2231' id="popupterms"> <div style="margin-bottom: 6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif" /> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll" style="height:100%;"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> By accessing and/or using this website, you agree to the terms and conditions above. If you do not agree to the terms and conditions above, you must cease accessing and/or using this website and destroy all material obtained from this website without your agreement. </p> </div> </div> <div class="modal-footer"> <input type="button" name="btnAgree" value="Close" id="btnAgree" class="btn-blue noprint" /> <input type="button" name="btnprint" value="Print" id="btnprint" class="btn-blue noprint" /> </div> </div> </div> <div id="main" class="noprint"> <!--class="noprint"--> <div id="header" class="noprint"> <div class="container"> <div class="terms"> NOTICE OF TERMS OF USE OF THIS WEBSITE. By accessing and/or using this website, you agree to the following <a onclick="javascript:TermsCon();" style="text-decoration: underline">terms and conditions.</a> </div> <div class="content"> <div id="logo"> <!--<a href="../" title="Home"><img alt="Rules and Regulations of the State of Georgia" src="/images/garr_logo.gif" /></a>--> <!--<span id="georgia"><a href="/">Rules and Regulations of the State of Georgia</a></span>--> <a href="../" title="Home"><img alt="Rules and Regulations of the State of Georgia" src="/images/ga_rulesreg.gif" /></a> </div> <div id="links"> <a href="../home.aspx" class="constant" title="home">Home</a> | <a href="../gac/" class="constant" title="home">Browse</a> | <a href="../help.aspx" class="constant" title="help">Help</a> | <a href="http://sos.ga.gov/index.php/General/rules_and_regulations" target="_blank" onclick="void(0);" class="constant" title="Georgia SOS">Go to Georgia SOS</a> </div> </div> </div> <div class="sidebar"> <div id="full-text-search"> <form class="searchform" action="../search.aspx" method="get" onsubmit="javascript:return fncheckqts();"> <span class="searchHierarchy" style="margin-right:10px;" > <em class="mnemonic">H</em>ierarchy Search:&nbsp; <input onclick="fnsetRDVal(id);" id="y" checked="checked" type="radio" name="hierarchysearch" value="yes" />&nbsp;Y <input onclick="fnsetRDVal(id);" id="n" type="radio" name="hierarchysearch" value="" />&nbsp;N </span> <input id="query" name="query" class="searchfield" value="Search GA R&R...." onfocus="if (this.value == 'Search GA R&R....') {this.value = '';}" onblur="if (this.value == '') {this.value = 'Search GA R&R....';}" type="text" /> <input class="searchbutton" value="Go" type="submit" /> <input type="hidden" name="searchvalue" value="Subject 120-2-67 PORTABILITY AND RENEWABILITY" /> <input type="hidden" id="msg" value="REPLACE_MESSAGE" /> <input type="hidden" name="from" value="gac" /> </form> </div> <!--<div id="full-text-search"> <form id="search" action="../search.aspx" method="get" onsubmit="javascript:return fncheckqts();"> <span class="searchHierarchy" style="margin-right:10px;" > <em class="mnemonic">H</em>ierarchy Search:&nbsp; <input onclick="fnsetRDVal(id);" id="y" checked="checked" type="radio" name="hierarchysearch" value="yes" />&nbsp;Y <input onclick="fnsetRDVal(id);" id="n" type="radio" name="hierarchysearch" value="" />&nbsp;N </span> <label for="query" accesskey="s"> <em class="mnemonic">S</em>earch GA R&R: </label><input type="hidden" name="from" value="gac" /> <input id="query" name="query" type="text" /> <input class="submit" value="Go" type="submit" /> <input type="hidden" id="msg" value="REPLACE_MESSAGE" /> <input type="hidden" name="searchlevel" value="REPLACE_SEARCHLEVEL" /> <input type="hidden" name="searchvalue" value="Subject 120-2-67 PORTABILITY AND RENEWABILITY" /> </form> </div>--> <div id="searchcitation"> <form class="searchform" action="../search.aspx" method="get" onsubmit="javascript:return fnchecks();"> <div> <input id="section" name="section" class="searchfield" value="Go to Citation...." onfocus="if (this.value == 'Go to Citation....') {this.value = '';}" onblur="if (this.value == '') {this.value = 'Go to Citation....';}" type="text" /> <input class="searchbutton" value="Go" type="submit" /> <input type="hidden" name="from" value="gac" /> </div> </form> </div> </div> <HTML xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:msxsl="urn:schemas-microsoft-com:xslt" xmlns:nll="uuid:{D3B28627-934D-41bc-8B7A-0549A8802FE4}"> <HEAD> <META http-equiv="Content-Type" content="text/html; charset=UTF-16"> </HEAD> <div id="infobar"><a href="javascript:;" accesskey="r" Name="Route" title="Route" class="quickkey"><em class="mnemonic">R</em>oute </a>:<div class="searchtips" style="float:right;margin-right:10px;color: rgb(47, 79, 79);"> <a style="text-decoration:none;color: rgb(47, 79, 79);" title="search tips" name="searchtip" href="../help.aspx#searching" target="_blank"><em class="mnemonic">S</em>earch tips</a></div><ul class="breadcrumb"> <li><a href="/GAC" name="GAC" title="GAC">GA R&amp;R</a></li> <li>&raquo; <a href="/GAC/120" title="120">Department 120</a></li> <li>&raquo; <a href="/GAC/120-2" title="120-2">Chapter 120-2</a></li> <li>&raquo; Subject 120-2-67</li> </ul> </div> </div><div id="doc" class="container"> <div id="doc-content" class="content"> <h1><nllsubject>Subject 120-2-67 PORTABILITY AND RENEWABILITY</nllsubject></h1> <h2><a href="/GAC/120-2-67-.01" name="120-2-67-.01" title="120-2-67-.01">Rule 120-2-67-.01 Authority</a></h2> <P>This Regulation Chapter is issued pursuant to the authority vested in the Commissioner of Insurance pursuant to O.C.G.A. §§ <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-9&amp;title=33#" target="_newtab">33-2-9</a> and <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#" target="_newtab">33-30-15</a>.</P> <h2><a href="/GAC/120-2-67-.02" name="120-2-67-.02" title="120-2-67-.02">Rule 120-2-67-.02 Purpose</a></h2> <P>The purpose of this Regulation Chapter is to implement O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#" target="_newtab">33-30-15</a> with respect to portability of group health insurance, and other insurance provisions related to the Health Insurance Portability and Accountability Act of 1996 including renewability of group and individual health insurance coverage.</P> <h2><a href="/GAC/120-2-67-.03" name="120-2-67-.03" title="120-2-67-.03">Rule 120-2-67-.03 Definitions</a></h2> <P>For the purpose of this Regulation Chapter, the following definitions shall apply:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Association" shall mean an organization as defined in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-1&amp;title=33#33-30-1(b)" target="_newtab">33-30-1(b)</a> and the Rules and Regulations of the Office of Commissioner of Insurance.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Creditable Coverage" shall mean any hospital, surgical, or medical expense coverage, or any combination of these coverages, as defined in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#33-30-15(a)(2)" target="_newtab">33-30-15(a)(2)</a>, regardless of exclusions or waivers related to such coverage, other than coverage under a disability income policy, a long-term care insurance policy, a medicare supplement policy, a health insurance policy written as part of workers' compensation equivalent coverage or supplemental to a liability policy, a specified disease policy, a credit insurance policy, a dental or vision benefit policy which is not an integral part of creditable coverage, a fixed indemnity policy, or a limited accident policy. Creditable coverage shall include coverage under a short-term, limited duration policy or a blanket accident and sickness policy which includes basic or comprehensive hospital, surgical, or medical expense coverage, or any combination of these coverages, which is (are) not exclusively contingent on accident or injury resulting from particular activities or limited to liability arising from such activities.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Employer based accident and sickness insurance or health benefit arrangement," as used in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#33-30-15(a)(2)(B)" target="_newtab">33-30-15(a)(2)(B)</a> and in this Regulation Chapter, shall mean any insured plan or self-funded plan, regardless of whether such plan is, or claims to be, subject to the Employee Retirement Income Security Act of 1974, <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1001&amp;title=29#" target="_newtab">29 U.S.C. Section 1001</a>, <I>et seq.</I></td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Group Member" shall mean any individual in a group eligible for coverage under a group health insurance policy or contract.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Health Insurance" shall mean, for purposes of this Regulation Chapter, any creditable coverage as defined in paragraph (b) issued by an insurer on a group or individual basis, other than a blanket accident and sickness policy or a short-term, limited duration policy which limits coverage to a maximum of twelve month. Such blanket or short-term policies which constitute creditable coverage shall be considered health insurance in this Regulation Chapter only for the purposes of Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a> .</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Health Status Related Factor" shall mean any of the factors described in Rule <a title="120-2-67-.13(a)(1)" href="120-2-67-.13#120-2-67-.13(a)(1)">120-2-67-.13(a)(1)</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> ''Insured'' shall mean: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(g)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> with regard to group health insurance coverage, any employee, group member, subscriber, enrollee or dependent covered under a group health insurance policy or contract; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(g)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> with regard to individual health insurance coverage, any covered person.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Late Enrollee" shall mean an employee, group member, or enrollee who enrolls other than: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(h)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> when first eligible under the terms of the group health insurance policy or contract, taking into account eligibility only during the most recent continuous period of employment or group coverage; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(h)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> when eligible for special enrollment.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Placement for adoption" shall mean the assumption and retention by an employee, member or enrollee covered or eligible for coverage under a group health insurance policy or contract of a legal obligation for total or partial support of a child in anticipation of adoption of such child. The child's placement with such employee, member or enrollee terminates upon the termination of such legal obligation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Policyholder" shall mean, with respect to group health insurance coverage, the entity to which a group health insurance policy or contract is issued in accordance with O.C.G.A.§ <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-1&amp;title=33#" target="_newtab">33-30-1</a>, including, but not limited to, an employer, an association, or employer members issued certificates of coverage through a trust.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(k)">(k)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Portability" shall mean that any employee, group member, subscriber, enrollee, or dependent who was enrolled under prior "creditable coverage" and who meets the eligibility requirements under Rule <a title="120-2-67-.04" href="120-2-67-.04">120-2-67-.04</a> shall be eligible immediately, subject to applicable waiting or affiliation periods, for the same coverage provided other employees, group members, subscribers, enrollees, or dependents under a new group insurance health benefit plan without limitations for preexisting conditions, subject to the requirements of O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#" target="_newtab">33-30-15</a> and this Regulation Chapter.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(l)">(l)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Preexisting Condition" shall mean any physical or mental condition, sickness, impairment, or ailment, regardless of cause, for which medical advice, diagnosis, care, or treatment was received within the six month period ending on the effective date of coverage under a group health plan, the date of enrollment under a group health insurance plan, or the first date of a waiting period for a group health insurance plan, whichever is earliest. In no case shall any of the following be considered a preexisting condition: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(l)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> pregnancy, or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(l)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> genetic information in the absence of a diagnosis related to such information.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(m)">(m)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Small Employer" shall mean any employer that employed an average of at least two but not more than 50 employees on business days during the preceding calendar year and that employs at least two employees on the first day of the rating period. All employers treated as a single employer under subsection (b), (c), (m), or (o) of Section 414 of the Internal Revenue Code of 1986 shall be treated as one employer. In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether or not an employer is a small employer shall be based on the average number of employees that it is reasonably expected that the employer will employ on business days in the current calendar year.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.03(n)">(n)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Waiting Period" shall mean any period of time which must pass before a newly eligible employee, group member, or enrollee is first covered by a group health insurance policy or contract, provided an employee or group member elects coverage when first eligible under the terms of the group health insurance plan. With regard to coverage under an individual health insurance policy or contract, the waiting period shall mean the period of time beginning with the date a substantially completed application for coverage is received by an insurer, and ending with the effective date of coverage; however, such a waiting period exists only if the application results in the actual purchase of an individual health insurance policy or contract. A waiting period shall not constitute a gap in coverage for the purposes of determining any previous creditable coverage.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.04" name="120-2-67-.04" title="120-2-67-.04">Rule 120-2-67-.04 Portability Eligibility</a></h2> <P>The requirements for an insured to be eligible for portability under a group health insurance benefit plan as required in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#" target="_newtab">33-30-15</a> are as follows:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.04(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The newly eligible insured was enrolled under similar coverage within the previous 90 days and is a "newly eligible employee" as defined in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#33-30-15(a)(4)(A) and (B)" target="_newtab">33-30-15(a)(4)(A) and (B)</a>, or a late enrollee subject to all provisions of this Regulation Chapter which apply to late enrollees and subject to the terms of coverage; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.04(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insured was subject to an exclusion or waiver for a preexisting condition under the group health insurance policy or contract prior to the effective date of the Rule for that policy or contract.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.05" name="120-2-67-.05" title="120-2-67-.05">Rule 120-2-67-.05 Preexisting Conditions</a></h2> <P>Group health insurance policies subject to O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#" target="_newtab">33-30-15</a> and this Regulation Chapter shall not include a limitation for preexisting conditions for individuals without previous creditable coverage in excess of twelve (12) months following the eligibility date of a newly eligible insured's coverage or the first day of any applicable waiting period, whichever is earlier, and eighteen (18) months following the effective date of coverage for late enrollees. Limitations on coverage include any form of exclusion rider or waiver for preexisting conditions. Conditions pertaining to preexisting limitations are as follows:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.05(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The time period applicable to preexisting condition limitations under the new group health insurance benefit plan shall be reduced by the amount of time any newly eligible insured was previously covered by creditable coverage, or a combination of creditable coverages not separated by any gap in coverage greater than 90 days;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.05(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If an insured was covered under prior creditable coverage, or a combination of creditable coverages, for twelve (12) months when first eligible, or eighteen (18) months if a late enrollee, no preexisting conditions limitation or exclusion period shall be applicable to any preexisting condition under the group health insurance benefit plan;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.05(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may provide a maximum limitation of less than twelve months for preexisting conditions;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.05(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any preexisting exclusion or limitation must run concurrently with any applicable waiting period; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.05(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No preexisting condition exclusion or limitation may be placed on a newborn child or newly adopted child, if that child is enrolled within thirty (30) days following the date of birth, adoption, placement for adoption, or within thirty-one (31) days following such dates if dependent or family coverage was not previously elected or payment of additional specific premium is required to provide coverage for the child.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.06" name="120-2-67-.06" title="120-2-67-.06">Rule 120-2-67-.06 Affiliation Periods</a></h2> <P>A group health insurance policy offered by a health maintenance organization may impose an affiliation period to employees, enrollees, or group members in lieu of any and all pre-existing condition exclusions or limitations only if the following are satisfied:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.06(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The affiliation period is applied uniformly to all employees, enrollees, or members of the group, without regard to any health status related factor;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.06(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The affiliation period does not exceed two months for newly eligible employees, group members and dependents, or three months for late enrollees;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.06(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The affiliation period begins on the first day of any waiting period, or on the first day of employment, whichever is earlier, and runs concurrently with any waiting period;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.06(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No premium is charged for the affiliation period; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.06(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A health maintenance organization electing to use an affiliation period in their group health policies or contracts must fully disclose the terms of such affiliation period in all policies or contracts and certificates.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.07" name="120-2-67-.07" title="120-2-67-.07">Rule 120-2-67-.07 Alternative Method of Crediting Coverage</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Pursuant to O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#33-30-15(c)(2)" target="_newtab">33-30-15(c)(2)</a>, insurers offering group health insurance coverage may apply the preexisting condition exclusion crediting method described in this Rule within any category of benefits described in paragraph (b) and not based on coverage for any other benefits. Insurers may elect to use all or any of the categories in counting certain benefits within a category against a preexisting condition exclusion related to such benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The alternative method for counting creditable coverage may be used for the following categories of benefits: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> mental health;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> substance abuse treatment;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> prescription drugs;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> dental care; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(b)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> vision care.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All other benefits, and all associated conditions, not related to the categories of benefits outlined in paragraph (b) are subject to the preexisting condition exclusion and limitation provisions of Rule <a title="120-2-67-.05" href="120-2-67-.05">120-2-67-.05</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The time period applicable to a preexisting condition exclusion within a particular category under the new group health insurance plan shall be reduced by the amount of time any newly eligible insured was previously covered by creditable coverage, or a combination of creditable coverages, which included any level of benefits within that category maintained under such previous creditable coverage or coverages. A lapse of coverage for benefits within a category shall not be treated as a significant break in coverage if, during such a lapse, creditable coverage was maintained except for coverage in a category, or a break of 90 days or less occurred in which no creditable coverage was maintained.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If an insured was covered for benefits within a particular category under prior creditable coverage, or a combination of coverages, for twelve (12) months, no preexisting condition exclusion period for benefits within that category shall be applicable to any preexisting condition under the new group health insurance benefit plan.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may provide a maximum exclusion of less than twelve months for benefits within a category because of preexisting conditions related to that category of benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If an insurer uses the alternative method with a particular policy, the insurer must state prominently in any disclosure statement concerning the coverage, and to each employer at the time of the offer or sale of the coverage, that the insurer is using the alternative method, and include in such statements a description of the effect of using the alternative method. This applies separately to each type of coverage offered by the insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may require an eligible employee, group member, or enrollee to document previous creditable coverage within a category or categories and to cooperate in obtaining such documentation. An insurer may also request information on categories of benefits included in previous creditable coverage from any previous insurer, administrator, employer, or employer health benefit arrangement and solicit corroboration documentation for the purposes of crediting coverage under the alternative method.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.07(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer, upon the request of another insurer, administrator, employer, or employer health benefit arrangement providing coverage to a former insured, must promptly disclose specific information needed by the other insurer, administrator, employer, or employer health benefit arrangement in order to determine an insured's or former insured's previous creditable coverage with respect to any category or categories of benefits creditable coverage with respect to any category or categories of benefits permitted for consideration under the alternative method. An insurer furnishing this information may charge the reasonable cost of disclosing such information.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.08" name="120-2-67-.08" title="120-2-67-.08">Rule 120-2-67-.08 Special Enrollment</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Individuals who decline group health insurance coverage when first eligible and satisfy subparagraphs (1) or (2) shall be considered newly eligible employees and not late enrollees, and must be offered coverage under the group policy or contract as newly eligible employees in accordance with paragraph (b), if such eligible individuals elect to enroll within the specified period in each subparagraph. Such individuals are: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Existing employees or group members, and existing dependents of such existing employees or group members, who declines coverage when first eligible or when first offered because of coverage under other creditable coverage, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the employee or group member stated in writing that existing creditable coverage was the reason for the employee, group member, or dependent declining enrollment, but only if such statement is required by the insurer, and the insurer has provided the employee or group member notice of such a requirement at the time of declination and included in such notice the consequences of not making a statement;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(B)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> federal or state continuation coverage has been exhausted; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(B)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> other coverage unrelated to continuation has terminated as a result of loss of eligibility for such other coverage under the terms of that coverage or; (iii) contributions for such other coverage from a former or current employer have terminated;</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> such other creditable coverage was not terminated in accordance with the Rules and Regulations of the Office of Commissioner of Insurance Rule <a title="120-2-67-.10(b)(2)" href="120-2-67-.10#120-2-67-.10(b)(2)">120-2-67-.10(b)(2)</a> or for failure of the employee, group member, or dependent to pay premiums or contributions on a timely basis in accordance with the terms of coverage and the Georgia Insurance Code or the Rules and Regulations of the Office of Commissioner of Insurance; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(1)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the employee or group member requests enrollment for the employee or group member and/or dependents not later than thirty (30) days after the effective date of the event described in subparagraph (B).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any of the following as a result of marriage, birth, adoption or placement for adoption: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(2)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the employee or group member, if not enrolled under the group policy as a result of declining coverage when first eligible;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(2)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the spouse of an employee or group member, provided the employee or group member is covered or elects coverage with the spouse; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(2)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the dependent or dependents of an employee or group member, provided the employee or group member is covered or elects coverage with the dependent or dependents.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Coverage must be elected for any individual or individuals specified in paragraph (2) no later than thirty (30) days after the date of marriage, birth, adoption or placement for adoption, or, only for newborns or adopted children, thirty-one (31) days after the date of birth, adoption or placement for adoption if dependent or family coverage was not previously elected or payment of additional specific premium is required to provide coverage for such children.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(a)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Coverage must be elected no later than thirty (30) days after a group policy is modified to make dependent coverage available for all employees or group members.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Special enrollment date is to be determined as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event an employee, group member, or dependent becomes eligible in accordance with paragraph (a)(1) of this Rule, enrollment must become effective no later than the first day of the first calendar month after the date the completed request for enrollment is received by the insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.08(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event an employee, group member, or dependent becomes eligible in accordance with subparagraph (a)(2) of this Rule, enrollment must become effective on the date of birth, adoption or placement for adoption, or in the case of marriage, no later than the first day of the first calendar month after the date the completed request for enrollment is received.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-67-.09" name="120-2-67-.09" title="120-2-67-.09">Rule 120-2-67-.09 Renewability and Modification of Coverage under Group Health Insurance</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> On and after July 1, 1997, all insurers which issue, issue for delivery, deliver, or renew existing group policies, certificates, or contracts of health insurance in the State of Georgia shall renew or continue such coverage at the option of the policyholders.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding paragraph (a), an insurer may cancel or nonrenew coverage in the following instances: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policyholder has failed to pay premiums or contributions in accordance with the terms of the group health insurance policy or contract, including any timeliness requirements, subject to applicable State law;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policyholder has performed an act or practice that constitutes fraud or intentional misrepresentation of material fact in applying for or procuring coverage under the terms of the group health insurance policy or contract;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policyholder has violated an insurer's minimum employer contribution or group participation rules, provided that the insurer submits written notice to each affected policyholder and provides each policyholder sixty (60) days in which to bring the group into compliance prior to cancellation;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> None of the policyholder's employees, group members, or enrollees live, reside, or work in the service area of the provider network, only if the group policy or contract is issued by a health maintenance organization or a provider-sponsored health care corporation, unless there is at least one insured employee, group member, or enrollee who has agreed to return to the service area of a health maintenance organization in accordance with the Rules and Regulations of the Office of Commissioner of Insurance <a title="120-2-33-.06" href="120-2-33-.06">120-2-33-.06</a> (5).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer terminates, cancels, or does not renew all coverage under a particular policy form, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(5)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer provides at least ninety (90) days notice prior to the termination of the policy form to all policyholders and certificate holders;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(5)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> for a policy form used by small employers, the insurer offers to such small employer policyholders the option to purchase all other group policies from the insurer currently being offered to or renewed by small employers in this State for which the small employer policyholders would otherwise be eligible;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(5)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> for a policy form used by large employers, the insurer offers to such large employer policyholders the option to purchase any other group policy from the insurer currently being offered to or renewed by a large employer in this State; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(5)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer acts uniformly without regard to the claims experience of any or all policyholders, covered employers, or any healthstatus related factor relating to any enrollees or other eligibles covered by or eligible for coverage under the policy.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer discontinues offering and terminates, cancels, or does not renew all coverage in either the small employer market or the large employer market, or both, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(6)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer provides at least 180 days notice prior to the discontinuance or nonrenewal of a policy or contract to all policyholders and certificate holders,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(6)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 (6)(C), and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(6)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer does not issue coverage in such market for five (5) years beginning with the date of the last health insurance policy or contract in that market not renewed.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(b)(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An employer 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, employers covered under such association policies shall be considered policyholders and shall be guaranteed renewability by the insurer.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers may modify group policies only at the time of renewal, provided that, for all small employers covered under a policy, such modifications to that policy are effective on a uniform basis among all small employers with that policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding paragraph (c), an insurer may modify a group policy other than at renewal only if a policyholder elects to modify its coverage at such other time.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.09(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of this section "large employer" shall mean all employers or other groups not meeting the definition of "small employer" as set forth in this Regulation Chapter.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.10" name="120-2-67-.10" title="120-2-67-.10">Rule 120-2-67-.10 Renewability and Modification of Coverage under Individual Health Insurance</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding paragraph (a), an insurer may cancel or nonrenew coverage only in the following instances: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-29-3&amp;title=33#33-29-3(b)(2)(A)" target="_newtab">33-29-3(b)(2)(A)</a>; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subject to the Rules and Regulations of the Office of Commissioner of Insurance Rule <a title="120-2-33-.06(6)" href="120-2-33-.06#120-2-33-.06(6)">120-2-33-.06(6)</a>, 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer terminates, cancels, or does not renew all coverage under a particular policy form, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(4)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer provides at least ninety (90) days notice prior to the discontinuance of the policy form to all insured and to the Commissioner;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(4)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(4)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer acts uniformly without regard to the claims experience or any health-status related factor of individuals insured or eligible to be insured.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer discontinues offering and terminates, cancels, or does not renew all coverage under all policy forms in the individual market, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(5)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(5)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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);</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(5)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(5)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the insurer acts uniformly without regard to the claims experience or any health status related factor of individuals insured or eligible to be insured.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(b)(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers may modify individual policies at the time of renewal, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(c)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> such modifications to that policy are effective on a uniform basis among all individuals with that policy form; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(c)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> such modifications are accepted and signed by the insured.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.10(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The term "accident and sickness insurance" as used in O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-29-21&amp;title=33#" target="_newtab">33-29-21</a> shall have the same meaning as the term "health insurance" used in this Regulation Chapter.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.11" name="120-2-67-.11" title="120-2-67-.11">Rule 120-2-67-.11 Liabilities and Duties of Prior Insurers</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.11(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A prior insurer shall remain liable only to the extent of its accrued liabilities and extensions of benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.11(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In accordance with O.C.G.A. § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-30-15&amp;title=33#33-30-15(b)(2)" target="_newtab">33-30-15(b)(2)</a>, an insurer must offer a conversion policy to any insured whose group health insurance coverage terminates, including termination of such group health insurance coverage after any period of continuation required under § <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-24-21.1&amp;title=33#" target="_newtab">33-24-21.1</a> or the provisions of the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) Section 601, <I>et seq. </I>of the Employee Retirement Income Security Act of 1974, as amended, <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1611&amp;title=29&amp;getbrowsepage=yes#" target="_newtab">29 U.S.C. Section 1611</a><I>et seq.</I></td> </tr> </table> <h2><a href="/GAC/120-2-67-.12" name="120-2-67-.12" title="120-2-67-.12">Rule 120-2-67-.12 Certification of Creditable Coverage</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any insurer issuing a group health insurance policy or contract or individual insurance policy or contract must furnish a certification of creditable coverage described in subparagraph (1) in accordance with subparagraphs (2) through (6) of this paragraph. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The certification of creditable coverage must be in writing and include the following information: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the date the certification is issued;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the name of the insurer that provided the coverage described in the certification;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the name of the insured (including any covered dependents) with respect to whom the certification applies, and any other information necessary for the insurer providing the coverage specified in the certification to identify the insured, such as the insured's insurance indentification number and the name of the employee or group member under group health insurance coverage, or the policyholder under individual health insurance coverage, if the certification is for (or includes) a dependent;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the name, address, and telephone number of the insurer or plan administrator required to provide the certification;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(E)">(E)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the telephone number to call for further information regarding the certification;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(F)">(F)</a></td> <td valign="top" style="text-align:left" class="leftalign"> either; <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(F)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> a statement that an insured has at least eighteen (18) months of creditable coverage, or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(F)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the date any applicable waiting or affiliation period began, and the date creditable coverage began; and</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(1)(G)">(G)</a></td> <td valign="top" style="text-align:left" class="leftalign"> the date creditable coverage ended, unless the certification indicates that creditable coverage is continuing as of the date of the certification.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer issuing a group health insurance policy or contract must provide a written certification for (i) the most recent period of continuous creditable coverage ending with events described in (A) and (B) of this subparagraph, or (ii) each period of continuous coverage as permitted in (C) of this subparagraph without charge, to insureds or former insureds, or any other person designated by an insured or former insured, or any other individual, insurer, employer health benefit arrangement, or administrator requesting on behalf of an insured or former insured. An insurer must issue such certification within fourteen (14) days after receipt of notice that any of the following events have occurred: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(2)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Coverage for an insured has ceased or terminated for any reason; </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(2)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insured has terminated or exhausted federal or state continuation of benefits; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(2)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A request has been made within twenty-four (24) months after coverage ceased, regardless of whether the former insured has previously received a certification from the insurer. An insurer must make reasonable efforts to ascertain whether any of the above events have occurred.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer issuing an individual health insurance policy or contract must provide a written certification for (i) the most recent period of continuous creditable coverage ending with an event described in (A) of this subparagraph, or (ii) each period of continuous coverage as permitted in (B) of this subparagraph without charge, to insureds or former insureds, or any other person designated by an insured or former insured, or any other individual, insurer, employer health benefit arrangement, or administrator requesting on behalf of an insured or former insured. An insurer must issue such certification within fourteen (14) days after receipt of notice that any of the following events have occurred: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(3)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Coverage for an insured has ceased or terminated for any reason; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(3)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A request has been made within twenty-four (24) months after coverage ceased, regardless of whether the former insured has previously received a certification from the insurer.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A certification may provide information with respect to an insured and the insured's covered dependents if the information is identical for each individual. If not, certifications may be provided on one form if the form provides all the required information for the insured and covered dependents and separately states the information that is not identical.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer may satisfy the requirement to provide a certification of creditable coverage by sending a certification via first-class mail to the last known address of the insured or former insured for all covered individuals residing at that address. If a covered dependent's or spouse's last known address is different than the former insured's last known address, a separate certification is required to be provided to the covered dependent or spouse at the dependent's or spouse's last known address. If separate certifications are being provided by mail to insureds or former insureds who reside at the same address, separate mailings of each certification are not required.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer must use reasonable efforts to determine any information needed for a certification relating to coverage of a dependent. In any case in which a certification is required to be furnished with respect to a dependent for events described in subparagraphs (a)(2)(A) or (B) or (a)(3)(A), no dependent certification is required to be furnished until the insurer knows, or making reasonable efforts, should know, of the dependent's cessation of coverage under the policy or contract. The following transition rules apply to certifications for termination or cessation of coverage occurring before June 30, 1998: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(6)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> an insurer that cannot provide the names (or related coverage information) of dependents of an insured or former insured for purposes of providing a certification of coverage for a dependent may satisfy the requirements of subparagraph (a)(1)(C) by providing the name of the insured or former insured and specifying that the type of coverage described in the certification is for dependent coverage, such as, for example, family coverage or enrollee and spouse coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(6)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> an insurer must make reasonable efforts to obtain and provide the names of any dependent covered by the certification where such information is requested to be provided; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(a)(6)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> an insurer providing a certification for an insured in accordance with subparagraph (6)(A) must furnish a certification within twenty-one (21) days after the insured ceases to be covered under an individual health insurance policy or contract.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer is not required to provide a written certification to individuals as required in paragraph (a) if: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer did not provide the creditable coverage, in which case the insurer is not required to provide information regarding coverage provided to an individual by another party;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insured or former insured entitled to receive a certification requests that the certification be sent to another insurer, administrator, or employer health benefit arrangement and such insurer, administrator, or employer health benefit arrangement agrees to accept, and actually receives from the insurer within fourteen (14) days, the information in subparagraph (a)(1) telephonically or by other means;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(b)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> There is a written agreement or contract in which an employer, administrator, or other third party is made responsible for the issuing of certifications of creditable coverage, or otherwise, if another party provides the certifications, but only to the extent that information relating to the individual's creditable coverage and waiting or affiliation period is provided by the other party; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(b)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> With regard to certification requirements relating to paragraphs (a)(2)(A) and (B), an insured's coverage under the group health insurance policy or contract ceases prior to the cessation of coverage under the employer health benefit arrangement, or because of the election of any other group health insurance option offered therein, although in any event the insurer must provide sufficient information reflecting the insured's or former insured's period of creditable coverage under the policy or contract to the employer health benefit arrangement or its delegate to enable a certification to be provided by the arrangement or its delegate after cessation of the individual's coverage under the arrangement. An insurer may presume that an insured whose coverage ceases at a time other than the group's effective date for changing enrollment options is concurrently ceasing coverage under the employer health benefit arrangement and must consequently issue certifications as required by paragraph (a)(2) for events described in paragraphs (a)(2)(A) and (B).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of demonstrating previous creditable coverage upon becoming eligible for coverage under a group health insurance policy or contract, if there is no available certification demonstrating prior creditable coverage with an insurance company or employer health benefit arrangement, or if the accuracy of a certificate is contested, it shall be the responsibility of the newly eligible insured to provide an insurer with the information necessary to verify the type of plan and the effective date of his or her previous coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall take into account all information that it obtains or that is presented on behalf of a newly eligible insured, based on the relevant facts and circumstances, to determine whether an individual has creditable coverage and is entitled to offset all or a portion of any preexisting condition exclusion period. An insurer shall accept an attestation from a newly eligible insured as to periods of creditable coverage, or periods spent in affiliation or waiting periods, if such attestation is accompanied by evidence of some form of creditable coverage during the period, and the insured cooperates with the insurer's efforts to verify the insured's previous creditable coverage. Such evidence includes the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> explanations of benefit claims;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> correspondence from an insurer, administrator, or employer health benefit arrangement indicating coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> pay stubs showing a payroll deduction for health coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> a health insurance identification card;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> a certificate of coverage under a group health insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> records from medical care providers indicating health coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> statements from third parties verifying periods of coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> telephone calls by the insurer to a previous insurer, administrator, employer, or other third party verifying coverages; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(d)(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> any other relevant documents that demonstrate coverage at any point during the period of time to which the insured attests coverage.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Provisions of this subsection permitting attestation, evidence, and verification shall be applicable to demonstrating categories of creditable coverage relating to the alternative method as permitted in this Regulation Chapter, and in demonstrating coverage as a dependent under another individual's coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If relevant information is not provided by the insured or otherwise obtained by the insurer after reasonable attempts, or if the insured fails to cooperate with the insurer's efforts to verify coverage, the insurer may apply a twelve (12) month preexisting exclusion period provison.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event an insurer receives information via a certification or through means permitted in paragraph (c) of this Rule and intends to impose any preexisting condition exclusion or limitation under the terms of a group health insurance policy or contract, the insurer is required, within a reasonable time period following receipt of the information, to disclose to the insured in writing a determination regarding the insured's period of creditable coverage which includes the basis for such determination, a written explanation of any appeal procedures established by the insurer, and a reasonable opportunity to submit additional evidence of creditable coverage. A time frame for disclosure is considered reasonable if it is based on the relevant facts and circumstances of the case, including whether the application of a preexisting condition exclusion would prevent an insured from having access to urgent medical services.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may modify an initial determination of creditable coverage if it determines, upon verification or the discovery of additional evidence, that the insured did not have the claimed creditable coverage, provided that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(h)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> a notice of the reconsideration is provided to the insured; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(h)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> until the final determination is made, the insurer, for purposes of approving access to medical services (such as pre-surgery authorization) acts in a manner consistent with the initial determination.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any administrator or designee of an insurer responsible for the provision of certifications of creditable coverage under this section must comply with all the relevant provisions of this section as they apply to the issuing of certifications of creditable coverage by insurers.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.12(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The term "certification" as used in this section shall have the same meaning as "certification" as used in the federal Public Health Service Act, Section 2701(e). Nothing in this section shall be construed to prevent insurers from using model certificate forms approved by the Health Care Financing Administration for the purposes of complying with certification requirements.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.13" name="120-2-67-.13" title="120-2-67-.13">Rule 120-2-67-.13 Prohibitions on Use of Health Status; Rating</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except for the use of preexisting condition exclusions as permitted by this Regulation Chapter, no insurer may inpose a limitation of benefits on, or impose or condition the length of any waiting period on, or condition rules for eligibility, late, or special enrollment for, or decline any employee or group member, or any dependents of any employee or group member, for coverage under a group health insurance policy or contract solely on the basis of any of the following health status related factors: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> health status;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> medical condition or history;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> claims experience;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> receipt of health care;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> genetic information;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> evidence of insurability (such as consideration of an avocational factor or conditions arising out of acts of domestic violence); or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(a)(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> disability.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No insurer may impose a rating methodology which requires an individual employee, group member, or dependent of an employee or group member covered by a group health insurance policy or contract to pay a higher premium than other group members solely on the basis of any health status related factor relating to that employee, group member, or dependent of an employee or group member, except that insurers shall be allowed to offer premium reductions or discounts for legitimate disease prevention or health promotion programs.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Nothing in this section shall be construed to require insurers to accept late enrollees for coverage under a group policy, provided that an insurer may not establish terms for late enrollment based on any health status related factor. Nothing in this Regulation Chapter shall be construed to prevent an insurer from permitting late enrollees only during an annual or other periodic open enrollment period in accordance with the terms of the group health insurance policy or contract.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> At any time during the first policy year, or the renewal period during which this Regulation Chapter becomes effective, employees, group members, or dependents of employees or group members who are otherwise eligible for coverage under the terms of the group health insurance plan but were previously declined coverage upon application when first eligible to enroll based on any health status related factor must be offered an opportunity to enroll in the group health insurance policy or contract. If an insurer does not have a record of denials under its term of coverage for a group, the insurer must accept all reasonable forms of proof submitted by such employees, group members, or dependents for whom records are unavailable. An insurer may verify denials with a policyholder, but must provide prior notice to a policyholder of its intention to offer coverage to declined employees, group members, and dependents during a specified period of enrollment. If such employees, group members, or dependents decline coverage that is offered as required in this paragraph, they may be considered late enrollees for the purposes of this Regulation Chapter.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.13(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer replacing health insurance coverage for a group must count all previous creditable coverage under the prior insurer and any other previous creditable coverage against any preexisting condition limitations imposed by the succeeding insurer upon group members as required by this Regulation Chapter.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.14" name="120-2-67-.14" title="120-2-67-.14">Rule 120-2-67-.14 Filing Requirements</a></h2> <P>Every portability and renewability provision to be included in a group health insurance policy or contract, certificate, rider and/or endorsement issued, delivered, or issued for delivery in this State, and certificates issued to a Georgia resident insured under a multiple employer trust or welfare arrangement issued in another state must be submitted to the Georgia Insurance Department for approval prior to use in this State. Existing group health insurance policies and certificates must be amended by adding an approved portability and renewability provision not later than the first anniversary date of such existing group policies following the effective date of this Regulation Chapter.</P> <h2><a href="/GAC/120-2-67-.15" name="120-2-67-.15" title="120-2-67-.15">Rule 120-2-67-.15 Effective Dates</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All portability provisions in Rules <a title="120-2-67-.03" href="120-2-67-.03">120-2-67-.03</a> through <a title="120-2-67-.08" href="120-2-67-.08">120-2-67-.08</a> and Rule <a title="120-2-67-.13" href="120-2-67-.13">120-2-67-.13</a> shall become effective for a group health insurance policy or contract as of the first day of the policy year or renewal date of the policy on or after July 1, 1997.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a> shall become effective in accordance with the transition rules specified by the Health Care Financing Administration in the Federal Register, <a href="https://links.casemakerlegal.com/states/us/books/Code_of_Federal_Regulations/browse?ci=25&amp;id=gasos&amp;codesec=146.125&amp;title=45#" target="_newtab">45 CFR § 146.125</a>. Specifically, the following apply to insurers with regard to their obligations to insureds or former insureds in delivering certifications of creditable coverage: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(b)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No insurer is required to issue certifications for termination or cessation of coverage occurring prior to July 1, 1996, nor is any insurer required to document coverage prior to July 1, 1996 on any certification;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(b)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For termination or cessation of coverage occurring on or after July 1, 1996, and before October 1, 1996, a certification is required to be provided in accordance with Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a> only upon a written request by or on behalf of the former insured to whom the certification applies;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(b)(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For termination or cessation of coverage occurring on or after October 1, 1996, and before June 1, 1997, a certification must either be furnished in accordance with Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a> on June 1, 1997, or upon request in accordance with Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a> if written notice was delivered on June 1, 1997, indicating the availability of such certification upon request; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(b)(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For termination or cessation of coverage occurring on or after June 1, 1997, a certification must be delivered as required by Rule <a title="120-2-67-.12" href="120-2-67-.12">120-2-67-.12</a>.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-67-.15(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Not including the provisions specified in paragraphs (a) and (b), the effective date of this Regulation Chapter with regard to all health insurance policies or contracts in this state shall be July 1, 1997.</td> </tr> </table> <h2><a href="/GAC/120-2-67-.16" name="120-2-67-.16" title="120-2-67-.16">Rule 120-2-67-.16 Penalties</a></h2> <P>Any insurer failing to comply with the requirements of this Regulation Chapter shall be subject to penalties and other enforcement actions as may be appropriate under the insurance laws of this State.</P> <h2><a href="/GAC/120-2-67-.17" name="120-2-67-.17" title="120-2-67-.17">Rule 120-2-67-.17 Severability</a></h2> <P>If any provision of this Regulation Chapter or the application thereof to any person or circumstance is for any reason held to be invalid by a court of competent jurisdiction, the remainder of the Regulation Chapter or the applicability of such provision to other persons or circumstances shall not be affected.</P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-67-.01" name="120-2-67-.01" title="120-2-67-.01">Rule 120-2-67-.01 Authority</a></li><li><a href="/GAC/120-2-67-.02" name="120-2-67-.02" title="120-2-67-.02">Rule 120-2-67-.02 Purpose</a></li><li><a href="/GAC/120-2-67-.03" name="120-2-67-.03" title="120-2-67-.03">Rule 120-2-67-.03 Definitions</a></li><li><a href="/GAC/120-2-67-.04" name="120-2-67-.04" title="120-2-67-.04">Rule 120-2-67-.04 Portability Eligibility</a></li><li><a href="/GAC/120-2-67-.05" name="120-2-67-.05" title="120-2-67-.05">Rule 120-2-67-.05 Preexisting Conditions</a></li><li><a href="/GAC/120-2-67-.06" name="120-2-67-.06" title="120-2-67-.06">Rule 120-2-67-.06 Affiliation Periods</a></li><li><a href="/GAC/120-2-67-.07" name="120-2-67-.07" title="120-2-67-.07">Rule 120-2-67-.07 Alternative Method of Crediting Coverage</a></li><li><a href="/GAC/120-2-67-.08" name="120-2-67-.08" title="120-2-67-.08">Rule 120-2-67-.08 Special Enrollment</a></li><li><a href="/GAC/120-2-67-.09" name="120-2-67-.09" title="120-2-67-.09">Rule 120-2-67-.09 Renewability and Modification of Coverage under Group Health Insurance</a></li><li><a href="/GAC/120-2-67-.10" name="120-2-67-.10" title="120-2-67-.10">Rule 120-2-67-.10 Renewability and Modification of Coverage under Individual Health Insurance</a></li><li><a href="/GAC/120-2-67-.11" name="120-2-67-.11" title="120-2-67-.11">Rule 120-2-67-.11 Liabilities and Duties of Prior Insurers</a></li><li><a href="/GAC/120-2-67-.12" name="120-2-67-.12" title="120-2-67-.12">Rule 120-2-67-.12 Certification of Creditable Coverage</a></li><li><a href="/GAC/120-2-67-.13" name="120-2-67-.13" title="120-2-67-.13">Rule 120-2-67-.13 Prohibitions on Use of Health Status; Rating</a></li><li><a href="/GAC/120-2-67-.14" name="120-2-67-.14" title="120-2-67-.14">Rule 120-2-67-.14 Filing Requirements</a></li><li><a href="/GAC/120-2-67-.15" name="120-2-67-.15" title="120-2-67-.15">Rule 120-2-67-.15 Effective Dates</a></li><li><a href="/GAC/120-2-67-.16" name="120-2-67-.16" title="120-2-67-.16">Rule 120-2-67-.16 Penalties</a></li><li><a href="/GAC/120-2-67-.17" name="120-2-67-.17" title="120-2-67-.17">Rule 120-2-67-.17 Severability</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 2019 Lawriter LLC - All rights reserved.</span>| <a href="mailto:support@casemakerlegal.com?subject=Rules and Regulations of the State of Georgia">Email Us</a> | 844-838-0769 | <a href="http://livechat.casemakerlegal.com/client.php?locale=en" target="_blank" onclick="if(navigator.userAgent.toLowerCase().indexOf('opera') != -1 && window.event.preventDefault)window.event.preventDefault();this.newWindow = window.open('http://livechat.casemakerlegal.com/client.php?locale=en&url='+escape(document.location.href)+'&referrer='+escape(document.referrer), 'webim','toolbar=0,scrollbars=0,location=0,status=1,menubar=0,width=640,height=480,resizable=1');this.newWindow.focus();this.newWindow.opener=window;return false;">Live Chat</a> </div> </div> </body> </html>