Subject 120-2-96 GEORGIA AFFORDABLE HSA ELIGIBLE HIGH DEDUCTIBLE HEALTH PLAN
O.C.G.A. Section 33-51-2(1)Authorizes the Commissioner of Insurance to "establish flexible guidelines" for HSA-High Deductible Health Plan filings submitted in connection with products that incorporate health promotion and wellness principles. Within the provisions of Chapter 33-51-4, it is stated that to the extent wellness principles are applied within approved policy contracts, that discounts, refunds, credits or other incentives shall not be considered to be illegal inducements or rebating under applicable provisions of the Georgia Insurance Code, including Unfair Trade Practice provisions. Other provisions of the Act make changes to PPO allowable differentials between classes of providers and product design potential changes. This Rule is intended to amplify and promulgate practical guidelines to carry out the Georgia Affordable HSA Eligible High Deductible Health Plan Act.
Under this Rule, a health insurance policy, which satisfies Internal Revenue Code requirements for a High Deductible Health Plan, may be used by an insurer in connection with a Wellness Program and with a Health Savings Account program.
Health insurance product categories include, without limitation:
|(1)||Comprehensive or major medical health insurance products offered by Life, Accident and Sickness Insurers or Property and Casualty Insurers;|
|(2)||Comprehensive or major medical health coverage products styled and appropriately disclosed as health maintenance organization coverage when offered by a licensed HMO;|
|(3)||Preferred Provider Organization comprehensive or major medical health coverage products offered by insurers of any applicable licensure type;|
|(4)||Point of Service comprehensive or major medical health insurance coverage products (when offered by licensed insurers in connection with approved HMO products); or|
comprehensive or major medical health insurance products which do not violate
IRS Rules for High Deductible Health Plans under Section 223 of the Internal
Revenue Code or related IRS Rules and Regulations.
Filings of product types described in (1) through (5) above may be reviewed and considered for approval by the Commissioner. Such product filings may also be considered for favorable treatment under Georgia provisions relating to taxation and relief from unfair trade practice provisions regarding rebating or illegal inducements with respect to wellness program benefits under O.C.G.A. Sections 33-51-2 and 33-51-4.
Rule 120-2-96-.03 Special Provisions for Preferred Provider Organization Products Under O.C.G.A. Section 33-51-5, O.C.GA. Section 33-51-6 and This Rule
|(1)||Preferred Provider Organization ("PPO") products offered under O.C.G.A. Section 33-51-5 may contain greater percentage differentials between preferred and non-preferred providers than the 30% percentage differential limitations under Rule 120-2-44-.04(5). Notwithstanding O.C.G.A. Section 33-51-5 and Rule 120-2-96-.03(1), plans may not have a coinsurance percentage applicable to benefit levels for services provided by non-preferred providers that is less than 60% of the benefit levels under the policy for such services. This means the maximum coinsurance percentage which may be required by insurers for the enrollee's responsibility for non-preferred provider benefits under PPO products remains at a maximum of 40%.|
|(2)||O.C.G.A. Section 33-51-6 confirms the continuation of the historical requirement under Georgia Law that within PPO coverage, non-preferred dental and/or non-preferred pharmaceutical providers be reimbursed by insurers at the same level as preferred dental or pharmaceutical providers as stated in O.C.G.A. Section 33-30-23 and O.C.G.A. Section 33-51-6.|
Examples of plans that will not be allowable or approved under O.C.G.A. Section 33-51-2 would include, but not be limited to:
|(1)||limited benefit insurance products, as defined in O.C.G.A. Section 33-30-12, where the term "limited benefit insurance" means accident and sickness insurance designed, advertised, and marketed to supplement major medical insurance. The term "limited benefit insurance" includes accident only, CHAMPUS supplement, dental, disability income, fixed indemnity, long term care, Medicare supplement, specified disease, vision, and any other accident and sickness insurance other than basic hospital expense, basic medical-surgical expense, or major medical insurance.|
|(2)||limited duration health insurance products of terms of less than 12 months, regardless of the scope or limitations of benefits within the health insurance coverage.|
|(1)|| Insurers proposing products for
consideration and potential approval under O.C.G.A. Chapter 33-51 and this Rule
shall, in cover letters or their equivalent if filed electronically under
SERFF, indicate their intent and shall:
|(2)||High Deductible Health Plan Policies which contain the appropriate disclosures should receive an expedited review with respect to those coverage issues and the overall filing. All otherwise applicable requirements regarding mandated benefits, limitations, disclosures, notices and other requirements remain in effect to the extent they do not violate IRS Rules for High Deductible Health Plans under Section 223 of the Internal Revenue Code or related IRS Rules and Regulations.|
|(3)||The Commissioner will consider and may accept a statement from the insurer in a cover letter or its electronic equivalent in the case of SERFF or other electronic filing submission modes accompanying a filing for High Deductible Health Plan coverage, signed by an officer of the company, that indicates the insurer has sought and obtained appropriate advice of counsel familiar with Internal Revenue Service Laws and Rules and that to the best of the company's knowledge and belief, the proposed product qualifies as High Deductible Health Plan coverage under all applicable IRS laws and rules.|
|(4)||The Commissioner may accept, but is not required to accept, a statement from an officer of the Insurer that the product is similar to a previously approved health insurance product, if so identified by exact form number, date of original or most recent approval, and if accompanied by documentation of differences from any such prior approved form. Such documentation may take the form of a redline version, markup, summary of differences or other clearly designed instrument which helps the reviewer isolate and identify substantive differences from previously approved versions of similar coverage.|
|(6)||The Commissioner may post enhanced instructions for insurers to use in making formalized SERFF or other electronic or other expedited filings under O.C.G.A. Section 33-51-2 on Office of Commissioner of Insurance website materials. The Commissioner will continue to apply applicable policy form filing fees on any such expedited filing methods, but insurers are encouraged to utilize such methods of filing and any such methods of Electronic Funds Transfer to pay applicable policy form and rate filing fees whenever possible or as required in the future for all other SERFF filings.|