Provision in Group or Blanket Accident and Sickness Policies of Coverage for Complications of Pregnancy

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  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Provision in Group or Blanket Accident and Sickness Policies of Coverage for Complications of Pregnancy

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  1. For the purposes of this Code section, the term:
    1. "Complications of pregnancy" means the following:
      1. Conditions requiring hospital confinement when the pregnancy is not terminated and whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion, pre-eclampsia, intrauterine fetal growth retardation, and similar medical and surgical conditions of comparable severity; but the term shall not include false labor, occasional spotting, physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy; and
      2. Ectopic pregnancy which is terminated.
    2. "Group policy or group contract" means a group or blanket accident and sickness insurance policy or contract as defined in Chapter 30 of this title, a group contract of the type issued by a health care plan established under Chapter 20 of this title, or any similar group benefit plan, policy, or contract.
    3. "Major medical coverage" means coverage which provides benefits of at least 75 percent of necessary, reasonable, and customary charges for medical care, including hospitalization in semiprivate accommodations, with maximum lifetime benefits of at least $100,000.00.
  2. Each group policy or group contract issued, delivered, issued for delivery, amended, or renewed in this state which provides major medical coverage and which includes maternity benefits shall include complications of pregnancy within such major medical coverage for all persons who have been covered by the policy or contract for a period of nine months or for a period of at least 30 days immediately prior to the date conception occurs or pregnancy commences.The same coverage for complications of pregnancy shall be provided for all family members and dependents with major medical coverage under the group policy or group contract.
  3. Group policies or group contracts subject to this Code section shall not contain any exclusions, reductions, or other limitations as to coverages, deductibles, or coinsurance provisions which apply to complications of pregnancy unless the provisions apply generally to all benefits provided or paid for under the group policies or group contracts.
  4. If fixed amounts for surgery are specified in any group policy or group contract subject to this Code section, the fixed amounts for surgical procedures involving complications of pregnancy shall be commensurate with other fixed amounts payable for procedures of comparable difficulty and severity.
  5. If any group policy or group contract subject to this Code section provides a fixed amount for maternity benefits, complications of pregnancy shall be treated the same as an illness rather than pregnancy and a person covered by the group policy or group contract shall be entitled to benefits otherwise provided by the group policy or group contract.
  6. Nothing contained in this Code section shall be deemed to prohibit an insurer or nonprofit corporation from issuing group policies or group contracts which contain provisions providing benefits greater than the minimum benefits required by this Code section or from issuing group policies or group contracts which contain provisions which are generally more favorable to the insured than those required by this Code section.

(Code 1933, § 56-2443, enacted by Ga. L. 1977, p. 1229, § 2; Ga. L. 2017, p. 164, § 19/HB 127; Ga. L. 2019, p. 386, § 36/SB 133.)

The 2019 amendment, effective July 1, 2019, deleted "after January 1, 1978," following "renewed in this state" near the middle of the first sentence of subsection (b).

Cross references.

- Contents of group or blanket accident and sickness insurance, T. 33, C. 30.

RESEARCH REFERENCES

ALR.

- Insurance: pregnancy as misrepresentation or breach of warranty, 2 A.L.R. 1507.


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