HB658: HB658 Insurance; certain consumer protections contingent upon repeal of Patient Protection and Affordable Care Act; provide

25 LC 46 1170 House Bill 658 By: Representatives Holcomb of the 101st, Hugley of the 141st, Miller of the 62nd, Au of the 50th, Draper of the 90th, and others A BILL TO BE ENTITLED AN ACT To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to1 insurance generally, so as to provide for certain consumer protections contingent upon the2 repeal of the Patient Protection and Affordable Care Act; to pr ovide for definitions; to3 provide that preventive services shall be included at no additi onal cost to the insured; to4 include dependents in coverage up to age 26; to prohibit a health benefit policy issued in this5 state from imposing an annual or lifetime limit of coverage; to provide for exceptions; to6 provide for a right to appeal; to provide for applicability; to provide for related matters; to7 repeal conflicting laws; and for other purposes.8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9 SECTION 1.10 Chapter 24 of Title 33 of the Official Code of Georgia Annotate d, relating to insurance11 generally, is amended by adding a new Code section to read as follows:12 "33-24-59.34.13 (a) As used in this Code section, the term:14 (1) 'Cost-sharing amount' means the share of costs an insured person is required to pay15 under a health benefit plan for certain covered healthcare serv ices which may include16 H. B. 658 - 1 - 25 LC 46 1170 deductibles, coinsurance, copayments, or other similar charges, but does not include17 premium payments.18 (2) 'Essential health benefits' means:19 (A) Ambulatory patient services;20 (B) Chronic disease management;21 (C) Emergency services;22 (D) Hospitalization;23 (E) Laboratory services;24 (F) Maternity and newborn care;25 (G) Mental health and substance use disorder services;26 (H) Pediatric services, including oral and vision care for children;27 (I) Prescription drugs; and28 (J) Rehabilitative and habilitative services and devices.29 The terms listed in subparagraphs (A) through (J) of this parag raph shall be further30 defined through regulations to be promulgated by the Commissioner which shall be based31 on the federal Patient Protection and Affordable Care Act, 42 U .S.C. Section 18001 et32 seq., as it existed immediately prior to being repealed.33 (3) 'Health benefit plan' means any hospital, health, or medical expense insurance policy,34 hospital or medical service contract, employee welfare benefit plan, contract or35 agreement with a health maintenance organization, subscriber contract or agreement, or36 preferred provider organization. Such term shall also include any health insurance plan37 established under Article 1 of Chapter 18 of Title 45.38 (4) 'Preventive services' means screening tests, counseling, a nd preventive medicines,39 or treatments provided or conducted to prevent a medical illnes s or condition prior to40 symptoms or physical manifestations of such medical illness or condition.41 (b) No health benefit plan shall be offered or issued in this state which:42 H. B. 658 - 2 - 25 LC 46 1170 (1) Limits or restricts payment of benefits for any medical il lness or condition solely43 because such illness or condition preexisted the application fo r s u c h p l a n . T h i s44 preexisting condition exclusion prohibition shall also prohibit insurers of health benefit45 plans from denying an application for insurance coverage due to the existence of a46 preexisting condition or charging an applicant with a preexisti ng condition a higher47 premium than a similar applicant without such condition would b e charged, due to the48 existence of such condition;49 (2) Does not cover preventive services as described in the federal Patient Protection and50 federal Patient Protection and Affordable Care Act, 42 U.S.C. Section 18001 et seq., as51 it existed immediately prior to being repealed. Such coverage shall be provided without52 any cost-sharing amount being charged to the insured;53 (3) Imposes an annual or lifetime limit on the provision of essential health benefits;54 (4) Does not offer coverage of any person who is a dependent child of an insured parent55 or guardian, up to and including age 26, so long as the coverage of such insured parent56 or guardian continues in effect and such child remains a depend ent of such parent or57 guardian. Upon such child becoming 26 years of age, the insurer of such child's parent58 or guardian shall open a special enrollment period of 30 days, during which time such59 child may enroll with such insurer; or60 (5) Allows the insurer to cancel or nonrenew such plan for any reason other than the61 failure to pay any premium when due or the intentional provision of false or incomplete62 information on the application.63 (6) Allows for any underwriting other than that allowed by the federal Patient Protection64 and Affordable Care Act, 42 U.S.C. Section 18001 et seq., as it existed immediately prior65 to being repealed.66 (c) This Code section shall apply to all policies, contracts, and certificates executed,67 delivered, issued for delivery, continued, renewed, and only upon the repeal of the federal68 Patient Protection and Affordable Care Act, 42 U.S.C. Section 18001 et seq."69 H. B. 658 - 3 - 25 LC 46 1170 SECTION 2.70 This Act shall become effective only upon the repeal of the fed eral Patient Protection and71 Affordable Care Act.72 SECTION 3.73 All laws and parts of laws in conflict with this Act are repealed.74 H. B. 658 - 4 -