SB262: SB262 Insurance; health benefit policies to cover preventive services; provide

Currently, Georgia law does not separately guarantee that health insurance plans must cover preventive care like cancer screenings, vaccines, and preventive prescriptions without out-of-pocket costs. This bill adds a new article to Georgia's insurance code (O.C.G.A. Title 33, Chapter 24) requiring every health insurer offering a health benefit policy in the state to cover preventive services recommended by nationally recognized clinical guidelines, such as those from the U.S. Preventive Services Task Force and the CDC's immunization advisory committee. The bill defines preventive services broadly to include items required under the federal Affordable Care Act as it existed on January 1, 2025, childhood and adult immunizations, and preventive screenings for children and women. Insurers cannot apply deductibles, copays, or coinsurance to this coverage. The bill protects health savings account eligibility by limiting the no-cost-sharing rule for high deductible health plans until the minimum deductible is met. The Commissioner of Insurance must write implementing rules by October 1, 2025, and review insurer compliance starting January 1, 2026.

• Requires every health insurer in Georgia to cover preventive services, including screenings, immunizations, counseling, and certain prescription medicines.
• Prohibits insurers from applying deductibles, copays, coinsurance, or similar out-of-pocket costs to this preventive care coverage.
• Defines preventive services by reference to nationally recognized clinical guidelines and to items required under the Affordable Care Act as it existed January 1, 2025.
• Protects eligibility for health savings accounts by allowing cost-sharing to apply to high deductible health plans until the minimum deductible is met, except for preventive care.
• Directs the Commissioner of Insurance to issue implementing rules by October 1, 2025 and to annually review insurer compliance starting January 1, 2026.

Georgia residents with individual or group health benefit policies, including state employees, public school teachers and employees, university system employees, and Medicaid enrollees covered under state contracts. Health insurers, HMOs, and similar entities that must provide the coverage, and the Georgia Department of Insurance, which must write rules and monitor compliance.

If enacted, Georgians with covered health plans would be able to get preventive screenings, vaccines, and certain preventive medicines without paying a deductible, copay, or coinsurance, potentially lowering costs for routine and preventive care while adding a new compliance requirement for insurers operating in the state.

• Section 1 adds a new Article 5 to Chapter 24 of Title 33, defining terms like 'cost-sharing requirement,' 'health benefit policy,' 'health insurer,' and 'nationally recognized clinical practice guidelines' (O.C.G.A. § 33-24-100).
• Code Section 33-24-101 lists categories of required preventive services, including ACA-based items, immunizations, and preventive care for children, adolescents, and women.
• Code Section 33-24-102 requires health insurers to cover these preventive services without cost-sharing and without reducing other policy benefits, while allowing insurers to offer additional coverage voluntarily.
• Code Section 33-24-103 limits the no-cost-sharing rule for high deductible health plans linked to health savings accounts, so those accounts remain eligible under federal tax law (26 U.S.C. § 223).
• Code Section 33-24-104 requires the Commissioner of Insurance to issue implementing rules by October 1, 2025 and to review insurer compliance annually starting January 1, 2026.
• Section 2 repeals any conflicting Georgia laws.

1. 2025-02-27Senate Read and Referred (Senate)
2. 2025-02-26Senate Hopper (Senate)

• Sonya Halpern (D, SD-039)Primary sponsor
• Chuck Hufstetler (R, SD-052)
• Russ Goodman (R, SD-008)
• Sam Watson (R, SD-011)
• Shawn Still (R, SD-048)
• Carden Summers (R, SD-013)
• Harold Jones (D, SD-022)
• Ben Watson (R, SD-001)

• health insurance
• preventive care
• insurance regulation
• health savings accounts
• insurance coverage mandates