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Subject 120-2-99 SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES

Rule 120-2-99-.01 Authority and Purpose

Article 3 of Chapter 29A of Title 33 directs the Commissioner to adopt implementing rules and regulations governing the filing, approval, and sale of individual health insurance products that have been approved for issuance in other states. This regulation is issued pursuant to the authority vested in the Commissioner under Chapter 2 of Title 33 and O.C.G.A. Sections O.C.G.A. 33-29A-30et seq.

Rule 120-2-99-.02 Individual Health Insurance Products Approved in Other States

(1) An insurer authorized to transact insurance in this state may file for approval and issuance in this state an individual health insurance product currently approved for issuance by the insurer or its affiliate in another state, provided that such product meets the requirements of Article 3 of Chapter 29A of Title 33, other applicable provisions of Title 33, and the regulations of the Commissioner.
(2) An insurer authorized to transact insurance in this state may offer an individual health insurance product with benefits equivalent to those in any individual health insurance product approved pursuant to Article 3 of Chapter 29A of Title 33.
(3) Any individual health insurance product offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall comply with O.C.G.A. § 9-9-2(c)(3) and shall not require the insured or his or her beneficiary to arbitrate disputes arising under the terms of the policy.

Rule 120-2-99-.03 Filing Requirements

(1) All individual health insurance products offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall be filed for prior review and approval and subject to the applicable SERFF filing and policy form filing fees.
(2) Proof of current approval and product line authority in domicile state is required of foreign insurers.
(3) Proof of current state approval other than Georgia, if different from domicile state should be furnished and referenced in filing.
(4) Outlines of coverage must be prepared and filed for approval with the policy forms filing.
(5) Insurer filings shall conform to applicable actuarial standards set forth by the National Association of Insurance Commissioners or regulations promulgated by the Commissioner including, but not limited to:
(a) Assumptions and rating processes;
(b) Presumed loss ratio in the pricing of any such product; and
(c) Any other appropriate actuarial standards of practice under comprehensive major medical coverage for medical and surgical benefits, or for high deductible health plans sold under the applicable provisions of Section 223 of the Internal Revenue Code.
(6) Insurers shall include a cover letter describing the relationship between the insurer making the filing and the affiliate, if any, which currently has approval for the issuance of the individual health insurance product in another state, the original state where the proposed product was approved, and the date of such approval. Any insurer authorized to transact insurance in this state seeking to offer an individual health insurance product with benefits equivalent to those of individual health insurance product already approved pursuant to Article 3 of Chapter 29A of Title 33 shall disclose the name of the insurer, the policy form number of such insurer, and the date approved in this state.
(7) All policies delivered or issued for delivery in Georgia are subject to Georgia jurisdiction and all legal disputes arising under the policy shall be resolved in accordance with applicable Georgia law, including specifically the requirements of Title 9 and Title 33.

Rule 120-2-99-.04 Required Disclosures

(1) Each policy application for a product offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall contain the following language in boldface type at the beginning of the document:

"The benefits of this policy may primarily be governed by the laws of a state other than Georgia; therefore, all of the laws applicable to policies filed in this state may not apply to this policy. Any purchase of individual health insurance should be considered carefully since future medical conditions may make it impossible to qualify for another individual health insurance policy."

(2) Each delivered policy must contain the following language in boldface type at the beginning of the document:

"The benefits of this policy providing your coverage may be governed primarily by the laws of a state other than Georgia. The benefits covered may be different from other policies you can purchase. Please consult your insurance agent or insurer to determine which health benefits are covered under this policy."

(3) Each policy offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall also contain the following standard forms for the disclosure and comparison of benefits.
(a)

[INSURER NAME AND ADDRESS]

Standard Form for Disclosure of

Benefits Definition Differences (O.C.G.A Section 33-29A-35)

Georgia Benefits Definitions vs. Non-Georgia Based Product Definitions

Georgia Defined Term and Definition

[Non-Georgia Product]

Defined Term and Definition

   
   
   
   
   
   
   
   
   
   

(b)

[INSURER NAME, ADDRESS]

Standard Form for Disclosure of

Benefits Definition Differences (O.C.G.A Section 33-29A-35)

Georgia Benefits Definitions vs. This Non-Georgia based Product Definitions

Georgia

Mandated Benefit

Georgia Citation

Mandate or

Mandated Offer or

Qualifications

[Non-Georgia Product]

Does This Individual Policy Cover this benefit? (reference page and section in policy)

       

Asthma; Prescription Inhalers

33-24-59.8

Mandated behavior in RX plans

 

Autism; non-discrimination in products covering neurological disorders

33-24-59.10

Mandate (subject to policy benefits, limitations consistent with other neurological disorders)

 

Bone Marrow Transplants for treatment of breast cancer, Hodgkins Disease

33-29-3.3

Mandated Offer in Major Medical Plans

 

Bone Mass Measurement

31-15A

Mandated Offer

(availability)

 

Breast Cancer Patient Care; Mastectomies

33-24-70-72

Mandate for policies covering surgery, mastectomies

 

Child Cancer Clinical Trials

33-24-59.1

Mandate

 

Child Deliveries

(48 / 96 hour hospital stay)

33-24-58.2

Mandated Benefit for policies covering maternity benefits; Notice requirement on insurers 30 days after insurer learns covered person is pregnant, added in 2002.

 

Child Wellness to age 5

33-29-3.4

Mandate

 

Chlamydia Screening to certain females, ages

31-14-4.1

Mandate

 

Colorectal Cancer Screening

Colorectal Cancer Screening (continued)

33-24-56.3

Mandates coverage for Colorectal Cancer Screening, exams, lab tests, along guidelines of American Cancer Society, American College of Gastroenterology & American College of Radiology. Exceptions are limited policies.

 

Dental; General Anesthesia

33-24-28.4

Mandate

 

Dermatologist Direct Access

33-24-56

Mandates Access (subject to policy benefits)

 

Diabetes Outpatient Self Management Training, Equipment

33-24-59.2

Mandate for Major Medical Policies, Managed, Capitated plans

 

Human Heart Transplants

33-29-3.1

Mandated Offer

(make available on major med plans)

 

Mammograms, PAP

Smears, PSA Test

33-29-3.2

Mandate

 

Mental Disorders

33-24-28.1

Mandated Offer

(make available)

 

Morbid Obesity

33-24-59.7

Mandated Offer (Georgia policy "may" cover)

 

OB / GYN

Direct Access

33-24-59

Mandates Access

(subject to policy benefits)

 

Off-Label Prescription Drugs for insureds with life-threatening or chronic and disabling conditions

33-24-59.11

Mandate (subject to certain conditions and prior authorization of insurer)

 
       

Ovarian Cancer; Surveillance Tests for women at risk

33-24-56.2

Mandates Coverage for certain women over age 35 (subject to same deductibles, coinsurance as other benefits)

 

Pregnancy, Complications of

33-24-24

Mandate for Major Medical

 

Prescription Contraceptives

33-24-59.6

Mandate for RX plans

 

TMJ

33-29-20

Mandate

 

Rule 120-2-99-.05 Severability

If any provision of these sections or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of these sections which can be given effect without the invalid provisions or application. To this end all provisions of these sections are declared to be severable.