Health Insurance; Provision That Coverage Cannot Be Terminated Due to Individual Claims Experience Required

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Health Insurance; Provision That Coverage Cannot Be Terminated Due to Individual Claims Experience Required

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  1. As used in this Code section, the term:
    1. "Insurer" means an accident and sickness insurer, fraternal benefit society, health care corporation, health maintenance organization, or any similar entity and any self-insured health care plan not subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et seq.
    2. "Policy" means any health care plan, subscriber contract, or accident and sickness plan, contract, or policy by whatever name called other than a disability income policy, a long-term care insurance policy, a medicare supplement policy, a health insurance policy written as a part of workers' compensation equivalent coverage, a specified disease policy, a credit insurance policy, a hospital indemnity policy, a limited accident policy, or other type of limited accident and sickness policy.
  2. Notwithstanding any provisions of this title which might be construed to the contrary, all individual basic hospital or medical expense, major medical, or comprehensive medical expense insurance policies issued, delivered, issued for delivery, or renewed in this state shall provide that once an individual has been accepted for coverage, his or her coverage cannot be terminated by the insurer due solely to his or her individual claims experience.
  3. The Commissioner shall promulgate appropriate procedures and guidelines by rules and regulations to implement the provisions of this Code section after notification and review of such regulation by the appropriate standing committees of the House of Representatives and Senate in accordance with the requirements of applicable law.Nothing in this Code section shall be construed to prohibit the Commissioner and any insurers with a desire to do so from mutually agreeing on procedures, rules, regulations, and guidelines and from implementing the provisions of this Code section on a voluntary basis before April 1, 1996.

(Code 1981, §33-24-57, enacted by Ga. L. 1995, p. 1242, § 2; Ga. L. 2017, p. 164, § 29/HB 127; Ga. L. 2019, p. 386, § 58/SB 133; Ga. L. 2020, p. 493, § 33/SB 429.)

The 2019 amendment, effective July 1, 2019, deleted "on and after April 1, 1996," following "to the contrary," near the middle of subsection (b); deleted "on or before November 1, 1995," following "Code section" in the middle of the first sentence of subsection (c); and deleted former subsection (d), which read: "Beginning April 1, 1999, the Commissioner shall conduct a review of the costs associated with the coverage required by this Code section and shall provide the members of the General Assembly with such information no later than December 31, 1999."

The 2020 amendment, effective July 29, 2020, part of an Act to revise, modernize, and correct the Code, substituted "Section" for "Sec." in paragraph (a)(1).

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 1995, this Code section, originally designated as Code Section 33-24-56, was redesignated as Code Section 33-24-57.


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