SB205: SB205 Insurance; pediatric autoimmune neuropsychiatric disorders; require coverage for healthcare services

PANDAS and PANS are conditions where children suddenly develop obsessive-compulsive behaviors, tics, or other neuropsychiatric symptoms, sometimes linked to a strep infection. Right now, Georgia law does not specifically require insurance to cover care for these conditions, which can leave families facing coverage disputes. This bill would add new sections to Georgia's insurance code (O.C.G.A. § 33-24-59.34) and to the law governing the state employees' health plan (O.C.G.A. § 45-18-4.2). Both would require coverage for diagnosis, treatment, management, and monitoring of PANDAS and PANS when supported by nationally recognized clinical practice guidelines. Insurers could apply their normal deductibles and copays but could not impose special extra costs just for this care. Private health benefit policies would need to comply starting July 1, 2025, and the state employee health plan starting January 1, 2026. The Commissioner of Insurance would write rules to carry out the law.

• Requires private health benefit policies issued or renewed in Georgia on or after July 1, 2025 to cover healthcare services for PANDAS and PANS.
• Requires the state employees' health benefit plan to cover the same conditions starting January 1, 2026.
• Limits required coverage to services supported by nationally recognized clinical practice guidelines, a term the bill defines.
• Allows insurers to apply normal deductibles, coinsurance, and copays but bans special extra costs just for PANDAS/PANS care.
• Directs the Georgia Insurance Commissioner to create rules and regulations to implement the new coverage requirement.

Children and adolescents diagnosed with PANDAS or PANS and their families, private health insurers and HMOs operating in Georgia, state and public employees and retirees covered by the state health benefit plan, and the Georgia Insurance Commissioner's office, which must write implementing rules.

Families of children with PANDAS or PANS could see insurance claims for diagnosis and treatment covered rather than denied, as long as the care follows recognized clinical guidelines. Insurers and the state health plan would face a new coverage mandate with capped extra costs to patients.

• Section 1 adds O.C.G.A. § 33-24-59.34, defining PANDAS, PANS, and 'nationally recognized clinical practice guidelines' and requiring private health benefit policies to cover related care starting July 1, 2025.
• Section 1 bars special deductibles, coinsurance, or copayments for PANDAS/PANS care beyond what applies to other covered benefits.
• Section 1 directs the Insurance Commissioner to issue implementing rules and regulations.
• Section 2 adds O.C.G.A. § 45-18-4.2, applying the same coverage requirement to the state employees' health benefit plan beginning January 1, 2026.
• Section 2 similarly restricts special cost-sharing limits for PANDAS/PANS treatment under the state plan.
• Section 3 repeals any conflicting laws.

1. 2025-02-20Senate Read and Referred (Senate)
2. 2025-02-19Senate Hopper (Senate)

• Sam Watson (R, SD-011)Primary sponsor
• Matt Brass (R, SD-006)
• Mike Hodges (R, SD-003)
• Ben Watson (R, SD-001)
• Kay Kirkpatrick (R, SD-032)
• Lee Anderson (R, SD-024)
• Russ Goodman (R, SD-008)

• health insurance coverage
• pediatric health
• PANDAS and PANS
• state employee benefits
• insurance mandates