GA - GAC
Rules and Regulations of the State of Georgia
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Subject 120-2-68 CHILD WELLNESS

Rule 120-2-68-.01 Authority

This Regulation Chapter is issued pursuant to the authority vested in the Commissioner of Insurance under O. C. G. A. Sections 33-2-9, 33-29-3.4 and 33-30-4.5.

Rule 120-2-68-.02 Purpose

The purpose of this Regulation Chapter is to set forth guidelines to assist in the implementation of Section 3.4 of Chapter 29 of Title 33 of the Official Code of Georgia Annotated and Section 4.5 of Chapter 30 of Title 33 of the Official Code of Georgia Annotated.

Rule 120-2-68-.03 Applicability and Scope

Except as otherwise specifically provided, this Regulation Chapter shall apply to all insurers issuing policies or contracts of individual or group accident and sickness insurance, including conversion policies or contracts, which provide basic medical or hospital expenses, major medical, and comprehensive medical expense coverages.

Rule 120-2-68-.04 Definitions

For the purpose of this Regulation Chapter, the following definitions shall apply:

(a) Child Wellness services shall mean the periodic review of a child's physical and emotional status conducted by a physician or conducted pursuant to a physician's supervision, but shall not include periodic dental examinations or other dental services. The review shall include a medical history, complete physical examination, developmental assessment, appropriate immunizations, anticipatory guidance for the parent or parents, and laboratory testing in keeping with the standards outlined in the prevailing Recommendations for Preventive Pediatric Health Care as established by the American Academy of Pediatrics.
(b) Periodic Review shall mean at intervals outlined in the prevailing Recommendations for Preventive Pediatric Health Care as established by the American Academy of Pediatrics.

Rule 120-2-68-.05 Basic Coverage for Child Wellness Services

Benefits for the preventive care of children from birth through the age of five (5) years shall be consistent with the prevailing Recommendations for Preventive Pediatric Health Care. The following services shall be included in basic coverage for child wellness services:

(a) Medical history;
(b) Measurement of height, weight and head circumference;
(c) Testing of blood pressure;
(d) Sensory screening including vision and hearing;
(e) Hereditary and metabolic screening in accordance with state law;
(f) Developmental/behavioral assessment;
(g) Immunizations consistent with prevailing American Academy of Pediatric Committee statements;
(h) Tuberculin test;
(i) Hematocrit or hemoglobin;
(j) Urinalysis;
(k) Anticipatory guidance.

Rule 120-2-68-.06 Penalties

Any insurer, representative, officer, or employee of such insurer failing to comply with the requirements of this Regulation Chapter shall be subject to such penalties and other enforcement actions as may be appropriate under the insurance laws of this State.

Rule 120-2-68-.07 Severability

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.