Insurance Coverage for Child Wellness Services

  1. Law
  2. Georgia Code
  3. Insurance
  4. Individual Accident and Sickness Insurance
  5. Insurance Coverage for Child Wellness Services

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  1. As used in this Code section, the term:
    1. "Child wellness services" means 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 prevailing medical standards.
    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. Every insurer authorized to issue an individual accident and sickness policy in this state shall include, either as a part of or as a required endorsement to each basic medical or hospital expense, major medical, or comprehensive medical expense policy issued, delivered, issued for delivery, or renewed in this state basic coverage for child wellness services for an insured child from birth through the age of five years.Any such policy may provide that the child wellness services which are rendered during a periodic review shall only be covered to the extent that such services are provided by or under the supervision of a single physician during the course of one visit.The Commissioner shall define by regulation the basic coverage for child wellness services and may consider the current recommendations for preventive pediatric health care by the American Academy for Pediatrics and any other relevant data or information in the promulgation of such regulation.
  3. The coverage required under subsection (b) of this Code section may be subject to exclusions, reductions, or other limitations as to coverages or coinsurance provisions as may be approved by the Commissioner, but shall not be subject to deductibles.
  4. Nothing in this Code section shall be construed to prohibit the issuance of individual accident and sickness policies which provide benefits greater than those required by subsection (b) of this Code section or more favorable to the insured than those required by subsection (b) of this Code section.
  5. The provisions of this Code section shall apply to individual basic medical or hospital expense, major medical, or comprehensive medical expense insurance policies issued by a fraternal benefit society, a health care corporation, a health maintenance organization, or any similar entity.
  6. Nothing contained in this Code section shall be deemed to prohibit the payment of different levels of benefits or having differences in coinsurance percentages applicable to benefit levels for services provided by preferred and nonpreferred providers as otherwise authorized under the provisions of Article 2 of Chapter 30 of this title, relating to preferred provider arrangements.

(Code 1981, §33-29-3.4, enacted by Ga. L. 1995, p. 1011, § 6; Ga. L. 1995, p. 1348, § 3; Ga. L. 1996, p. 6, § 33; Ga. L. 2017, p. 164, § 41/HB 127; Ga. L. 2019, p. 386, § 90/SB 133; Ga. L. 2020, p. 493, § 33/SB 429.)

The 2019 amendment, effective July 1, 2019, deleted "on or after July 1, 1995," following "or renewed in this state" in the middle of the first sentence of subsection (b); and substituted "Reserved." for the former provisions of subsection (g), which read: "Beginning July 1, 2000, the Commissioner shall conduct a review of the cost associated with the coverage required by this Code section and shall provide the members of the General Assembly with such information not later than December 31, 2000."

The 2020 amendment, effective July 29, 2020, part of an Act to revise, modernize, and correct the Code, deleted former subsection (g) which was designated as reserved.

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 1995, Code Section 33-29-3.3, as enacted by Ga. L. 1995, p. 1011, § 6, was redesignated as Code Section 33-29-3.4.

Editor's notes.

- Ga. L. 1995, p. 1348, § 10, not codified by the General Assembly, provides: "In the event another Act requiring insurance coverage for child wellness services is enacted by the General Assembly during the 1995 regular session, it is the specific intent of the General Assembly that Sections 3 and 4 of this Act requiring insurance coverage for child wellness services shall be given effect and shall control over the provisions of such other Act requiring such coverage."

Ga. L. 1995, p. 1348, § 3, which enacted this Code section, was passed later in time than the version of this Code section as passed by Ga. L. 1995, p. 1011, § 6, effective July 1, 1995, which also related to coverage for child wellness services, and the version passed in Ga. L. 1995, p. 1348, § 3, controls as to Ga. L. 1995, p. 1011, § 6, and has been set out above.


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