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 to
insurance generally, so as to provide for certain consumer protections contingent upon the
repeal of the Patient Protection and Affordable Care Act; to provide for definitions; to
provide that preventive services shall be included at no additional cost to the insured; to
include dependents in coverage up to age 26; to prohibit a health benefit policy issued in this
state from imposing an annual or lifetime limit of coverage; to provide for exceptions; to
provide for a right to appeal; 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 Annotated, relating to insurance
generally, is amended by adding a new Code section to read as follows:
<ins>"33-24-59.34.
(a) As used in this Code section, the term:
(1) 'Cost-sharing amount' means the share of costs an insured person is required to pay
under a health benefit plan for certain covered healthcare services which may include
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<ins>deductibles, coinsurance, copayments, or other similar charges, but does not include
premium payments.
(2) 'Essential health benefits' means:
(A) Ambulatory patient services;
(B) Chronic disease management;
(C) Emergency services;
(D) Hospitalization;
(E) Laboratory services;
(F) Maternity and newborn care;
(G) Mental health and substance use disorder services;
(H) Pediatric services, including oral and vision care for children;
(I) Prescription drugs; and
(J) Rehabilitative and habilitative services and devices.
The terms listed in subparagraphs (A) through (J) of this paragraph shall be further
defined through regulations to be promulgated by the Commissioner which shall be based
on the federal Patient Protection and Affordable Care Act, 42 U.S.C. Section 18001 et
seq., as it existed immediately prior to being repealed.
(3) 'Health benefit plan' means any hospital, health, or medical expense insurance policy,
hospital or medical service contract, employee welfare benefit plan, contract or
agreement with a health maintenance organization, subscriber contract or agreement, or
preferred provider organization. Such term shall also include any health insurance plan
established under Article 1 of Chapter 18 of Title 45.
(4) 'Preventive services' means screening tests, counseling, and preventive medicines,
or treatments provided or conducted to prevent a medical illness or condition prior to
symptoms or physical manifestations of such medical illness or condition.
(b) No health benefit plan shall be offered or issued in this state which:
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<ins>(1) Limits or restricts payment of benefits for any medical illness or condition solely
because such illness or condition preexisted the application for such plan. This
preexisting condition exclusion prohibition shall also prohibit insurers of health benefit
plans from denying an application for insurance coverage due to the existence of a
preexisting condition or charging an applicant with a preexisting condition a higher
premium than a similar applicant without such condition would be charged, due to the
existence of such condition;
(2) Does not cover preventive services as described in the federal Patient Protection and
federal Patient Protection and Affordable Care Act, 42 U.S.C. Section 18001 et seq., as
it existed immediately prior to being repealed. Such coverage shall be provided without
any cost-sharing amount being charged to the insured;
(3) Imposes an annual or lifetime limit on the provision of essential health benefits;
(4) Does not offer coverage of any person who is a dependent child of an insured parent
or guardian, up to and including age 26, so long as the coverage of such insured parent
or guardian continues in effect and such child remains a dependent of such parent or
guardian. Upon such child becoming 26 years of age, the insurer of such child's parent
or guardian shall open a special enrollment period of 30 days, during which time such
child may enroll with such insurer; or
(5) Allows the insurer to cancel or nonrenew such plan for any reason other than the
failure to pay any premium when due or the intentional provision of false or incomplete
information on the application.
(6) Allows for any underwriting other than that allowed by the federal Patient Protection
and Affordable Care Act, 42 U.S.C. Section 18001 et seq., as it existed immediately prior
to being repealed.
(c) This Code section shall apply to all policies, contracts, and certificates executed,
delivered, issued for delivery, continued, renewed, and only upon the repeal of the federal
Patient Protection and Affordable Care Act, 42 U.S.C. Section 18001 et seq."
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SECTION 2.
This Act shall become effective only upon the repeal of the federal Patient Protection and
Affordable Care Act.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.