House Bill 1149
By: Representatives Cooper of the 45th, Jones of the 47th, Hawkins of the 27th, Gisler of the
121st, Hagan of the 156th, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 24 of Title 33 of the Official Code of Georgia, relating to insurance
generally, so as to require certain health insurers to offer a preenrollment option for
anticipated newly born or adopted children; to provide for definitions; to provide for the
provision of routine well baby care in certain circumstances; to provide for documentation;
to provide for notification; to provide for statutory construction; to provide for applicability;
to provide for related matters; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 24 of Title 33 of the Official Code of Georgia, relating to insurance generally, is
amended by revising Code Section 33-24-22, relating to provisions in health insurance
policies for coverage of newly born or adopted children, as follows:
"33-24-22.
<ins>(a) As used in this Code section, the term:
(1) 'Anticipated family member' means an individual whose birth or adoption is
reasonably anticipated to occur within three months.
</ins>
<ins>(2) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any
maximum limitation on the application of such a deductible, coinsurance, copayment, or
similar out-of-pocket expense.
(3) 'Health benefit policy' means an individual or group plan, policy, or contract for
healthcare services issued, delivered, issued for delivery, or renewed in this state which
provides major medical benefits by a healthcare corporation, health maintenance
organization, preferred provider organization, fraternal benefit society, hospital service
corporation, medical service corporation, or other health insurer or similar entity. Such
term shall not include self-funded, employer sponsored health insurance plans subject to
the exclusive jurisdiction of the federal Employee Retirement Income Security Act
of 1974, as codified and amended at 29 U.S.C. Section 1001, et seq.
(4) 'Health insurer' means any person, corporation, or other entity authorized to provide
health benefit policies under this title.
(a)(b)</ins> All <del>individual and group health insurance policies providing coverage on an expense
incurred basis and individual and group service or indemnity type contracts issued by a
nonprofit corporation</del> <ins>health benefit policies</ins> which, under the terms of such policies,
provide coverage for a family member of the insured or subscriber shall, as to the family
members' coverage, also provide that the health insurance benefits applicable for children
shall be payable with respect to a newly born child of the insured or subscriber from the
moment of birth. A newly born child of the insured or subscriber shall include an adopted
child. The coverage for the adopted child shall be effective from the date of the placement
for adoption or final decree of adoption, whichever occurs first.
<del>(b)(c)</del> The coverage for newly born children or adopted children shall consist of coverage
of injury or sickness, including <ins>routine well baby care and</ins> the necessary care and treatment
of medically diagnosed congenital defects and birth abnormalities, but need not include
<del>benefits for routine well baby care.
</del>
<ins>(c)(d)</ins> If payment of a specific premium or subscription fee is required to provide coverage
for a child, the <ins>health benefit</ins> policy <del>or contract</del> may require that notification of birth of a
newly born child or the date of the placement for adoption or final adoption of a child and
payment of the required premium or fees must be furnished to the insurer or nonprofit
service or indemnity corporation within 31 days after the date of birth, placement for
adoption, or final decree of adoption, whichever is applicable, in order to have the coverage
continue beyond the 31 day period.
<ins>(e) Beginning January 1, 2027, any health insurer offering a health benefit policy in this
state shall provide insureds and subscribers with the opportunity to participate in an
optional preenrollment period in preparation of the arrival of an anticipated family member.
The coverage for the anticipated family member shall not become effective until the birth
or adoption of the child.
(f) In order to participate in the preenrollment of the anticipated family member, insureds
or subscribers shall be required to obtain documentation which establishes that the insured
is pregnant or will be adopting a child.
(1) If the insured is pregnant, the insured shall submit to the health insurer any of the
following:
(A) A note from a physician or other appropriate healthcare provider;
(B) The result of an ultrasound test; or
(C) The result of a urine test.
(2) If the insured will be adopting a child, the insured shall submit to the health insurer
such documentation as the Commissioner shall determine is necessary through the
promulgation of rules and regulations.
(g) The documentation described in subsection (f) of this Code section shall not be
submitted by the insured or subscriber unless the birth or adoption is reasonably anticipated
to occur within three months of such submission.
</ins>
<ins>(h) Once the health insurer receives the documentation required in subsection (f) of this
Code section, within ten business days of such receipt, such insurer shall:
(A) Disclose to the insured or subscriber the coverage changes that may occur upon
childbirth or adoption, including, but not limited to, any changes to the deductible or
premium; and
(B) Notify the insured or subscriber of the 31 day period described in subsection (d)
of this Code section.
</ins> <del>(d)(i)</del> This Code section shall not apply to persons adopted as adults pursuant to the
provisions of Code Section 19-8-21, relating to the adoption of adult persons.
<ins>(j) The preenrollment option benefit shall be subject to the same cost-sharing requirements
established for other covered benefits within such health benefit policy. Special
deductibles, coinsurance, copayment, or other limitations that are not generally applicable
to other benefits shall not be imposed regarding coverage for the preenrollment option
benefit described in this Code section.
(k) Prior to the arrival of the anticipated family member, the health insurer shall assign to
the documentation submitted pursuant to subsection (f) of this Code section, such health
benefit policy information that will reasonably identify such member in preparation for his
or her birth or adoption.
(l) Nothing in this Code section shall be construed to prohibit a health insurer from issuing
or renewing a health benefit policy which provides benefits greater than the minimum
benefits required under this Code section or from issuing or renewing a policy which
provides benefits which are generally more favorable to the insured or subscriber than
those required under this Code section.
(m)(1) The provisions of this Code section shall apply to all policies, contracts, and
certificates executed, delivered, issued for delivery, continued, or renewed in this state
on or after January 1, 2027.
</ins>
<ins>(2) For purposes of this Code section, all contracts are deemed to be renewed no later
than the first anniversary of the contract date."
</ins> SECTION 2.
All laws and parts of laws in conflict with this Act are repealed.