---
title: SB 205. Insurance; pediatric autoimmune neuropsychiatric disorders; require coverage for healthcare services
collection: bills
id: 2025-2026/sb205
cite_as: SB 205, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/sb205
md_url: https://georgiacommons.org/bills/2025-2026/sb205.md
text_url: https://georgiacommons.org/bills/2025-2026/sb205/text
source_url: https://www.legis.ga.gov/legislation/70477
date: 2025-02-20
status: introduced
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 95
omitted_url: https://georgiacommons.org/bills/2025-2026/sb205.md?full=1
bill_number: SB 205
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: Senate
bill_type: bill
status_date: 2025-02-19
last_action: Senate Read and Referred
sponsors:
  - Sam Watson
  - Matt Brass
  - Mike Hodges
  - Ben Watson
  - Kay Kirkpatrick
  - Lee Anderson
  - Russ Goodman
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/SB205/2025
upstream_id: 1976262
summaries_model: claude-sonnet-5
topic_tags:
  - health insurance coverage
  - pediatric health
  - PANDAS and PANS
  - state employee health plan
  - insurance mandates
---

# SB 205. Insurance; pediatric autoimmune neuropsychiatric disorders; require coverage for healthcare services

## Text

Senate Bill 205
By: Senators Watson of the 11th, Brass of the 6th, Hodges of the 3rd, Watson of the 1st,
Kirkpatrick of the 32nd and others
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 and Article 1 of Chapter 18 of Title 45 of the
Official Code of Georgia Annotated, relating to general provisions relative to insurance and
the state employees' health insurance plan and post-employment health benefit fund,
respectively, so as to require coverage for healthcare services for pediatric autoimmune
neuropsychiatric disorders associated with streptococcal infection (PANDAS) and pediatric
acute onset neuropsychiatric syndrome (PANS) in accordance with nationally recognized
clinical practice guidelines; to provide for definitions; to allow for deductibles; to prohibit
special deductibles; to provide for rules and regulations; to provide for related matters; to
repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
general provisions relative to insurance, 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:
</ins>
<ins>(1) 'Health benefit policy' means any 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, including those contracts executed by the State of
Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by a
health care corporation, health maintenance organization, preferred provider organization,
accident and sickness insurer, fraternal benefit society, hospital service corporation,
medical service corporation, or other insurer or similar entity. Such term shall not
include any self-insured health benefit plan subject to the exclusive jurisdiction of the
federal Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001,
et seq.
(2) 'Nationally recognized clinical practice guidelines' means evidence based clinical
practice guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with a
conflict-of-interest policy. Such guidelines establish standards of care informed by a
systematic review of evidence and an assessment of the benefits and risks of alternative
care options and include recommendations intended to optimize patient care.
(3) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute
onset obsessive compulsive or tic disorders or other behavioral changes presenting in
children and adolescents that are not otherwise explained by another known neurologic
or medical disorder.
(4) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and
remitting course of symptom severity.
</ins>
<ins>(b) All health benefit policies renewed or issued on or after July 1, 2025, shall include
coverage for healthcare services for PANDAS or PANS for an individual covered under
such policy as provided in this Code section.
(c) Healthcare services for PANDAS or PANS for an individual covered under a health
benefit policy shall be covered for the purposes of diagnosis, treatment, appropriate
management, or ongoing monitoring of a covered person's disorder when such services are
supported by nationally recognized clinical practice guidelines.
(d) The benefits in a health benefit policy as provided for in this Code section shall be
subject to the same deductibles, coinsurance, copayment provisions, and other limitations
established for all covered benefits within such health benefit policy. Special deductibles,
coinsurance, copayment, and other limitations that are not generally applicable to other
healthcare services covered by a health benefit policy shall not be imposed on coverage for
healthcare services for PANDAS or PANS.
(e) The Commissioner shall promulgate rules and regulations necessary to implement the
provisions of this Code section."
</ins> SECTION 2.
Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated, relating to the
state employees' insurance health insurance plan and post-employment health benefit fund,
is amended by adding a new Code section to read as follows:
<ins>"45-18-4.2.
(a) As used in this Code section, the term:
(1) 'Nationally recognized clinical practice guidelines' means evidence based clinical
practice guidelines developed by independent organizations or medical professional
societies utilizing a transparent methodology and reporting structure and with a
conflict-of-interest policy. Such guidelines establish standards of care informed by a
</ins>
<ins>systematic review of evidence and an assessment of the benefits and risks of alternative
care options and include recommendations intended to optimize patient care.
(2) 'Pediatric acute onset neuropsychiatric syndrome' or 'PANS' means a class of acute
onset obsessive compulsive or tic disorders or other behavioral changes presenting in
children and adolescents that are not otherwise explained by another known neurologic
or medical disorder.
(3) 'Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections' or 'PANDAS' means a condition in which a streptococcal infection in a child
or adolescent causes the abrupt onset of clinically significant obsessions, compulsions,
tics, or other neuropsychiatric symptoms or behavioral changes, or a relapsing and
remitting course of symptom severity.
(4) 'State health benefit plan' means the health insurance plan or plans established
pursuant to this article and Part 6 of Article 17 of Chapter 2 of Title 20 for state and
public employees, dependents, and retirees.
(b) Beginning January 1, 2026, the state health benefit plan shall include coverage for
healthcare services for PANDAS or PANS for an individual covered under such policy as
provided in this Code section.
(c) Healthcare services for PANDAS or PANS for an individual covered under the state
health benefit plan shall be covered for the purposes of diagnosis, treatment, appropriate
management, or ongoing monitoring of a covered person's disorder when such services are
supported by nationally recognized clinical practice guidelines.
(d) The benefits in the state health benefit plan as provided for in this Code section shall
be subject to the same deductibles, coinsurance, copayment provisions, and other
limitations established for all covered benefits within such plan. Special deductibles,
coinsurance, copayment, and other limitations that are not generally applicable to
healthcare services covered by such plan shall not be imposed on coverage for healthcare
services for PANDAS or PANS."
</ins>
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.

## Summaries written by Georgia Commons

The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.

A Georgia Senate bill would require health insurance plans, including the state employees' health plan, to cover diagnosis and treatment for PANDAS and PANS, two neuropsychiatric conditions that can appear suddenly in children after strep infections.

### Plain-language summary

PANDAS and PANS are conditions where children can suddenly develop obsessive-compulsive behavior, tics, or other neuropsychiatric symptoms, sometimes linked to a strep infection. Currently Georgia law does not specifically require insurance to cover care for these conditions. This bill adds new sections to the state insurance code (O.C.G.A. Title 33) and the state employees' health plan law (O.C.G.A. Title 45) requiring coverage for diagnosis, treatment, management, and monitoring of PANDAS and PANS, as long as the care follows nationally recognized clinical practice guidelines.
Most private and group health insurance policies would have to include this coverage for policies issued or renewed on or after July 1, 2025. The state employees' health plan would have to include the same coverage starting January 1, 2026. Insurers can apply their normal deductibles and copays to this coverage, but they cannot create special, higher deductibles or copays that apply only to PANDAS or PANS care. The bill also directs the Insurance Commissioner to write rules to carry out the law.

### What it does

- Adds a new Georgia insurance law (O.C.G.A. § 33-24-59.34) requiring most health insurance policies issued or renewed after July 1, 2025 to cover PANDAS and PANS care.
- Adds a parallel requirement (O.C.G.A. § 45-18-4.2) that the state employees' health benefit plan cover the same conditions starting January 1, 2026.
- Defines PANDAS and PANS, and requires that covered treatment follow nationally recognized, evidence-based clinical practice guidelines.
- Allows insurers to apply normal deductibles and copays but bans special, higher out-of-pocket costs specifically for PANDAS or PANS care.
- Directs the Insurance Commissioner to create rules and regulations to implement the new coverage requirement.
- Excludes self-insured health plans regulated exclusively under the federal ERISA law from the state coverage mandate.

### Who it affects

Children and adolescents diagnosed with PANDAS or PANS and their families, health insurance companies and HMOs operating in Georgia, the state government as administrator of the state employees' health plan, state and public employees and retirees on that plan, and the Insurance Commissioner's office, which must write implementing rules.

### Why it matters

Families dealing with these sudden-onset conditions would gain a guaranteed right to insurance coverage for diagnosis and treatment, rather than depending on individual insurer discretion. Insurers could not charge extra deductibles or copays for this care, though ERISA-governed self-insured plans remain outside the mandate.

### Key provisions

- Section 1 creates O.C.G.A. § 33-24-59.34, defining 'health benefit policy,' 'nationally recognized clinical practice guidelines,' PANDAS, and PANS, and requiring covered policies issued or renewed on or after July 1, 2025 to include PANDAS/PANS coverage.
- Section 1(d) bars insurers from imposing special deductibles, coinsurance, or copayments for PANDAS/PANS care beyond what applies to other covered services.
- Section 1(e) directs the Insurance Commissioner to adopt rules and regulations to implement the coverage requirement.
- Section 2 creates O.C.G.A. § 45-18-4.2, requiring the state health benefit plan to cover PANDAS/PANS starting January 1, 2026, with the same deductible and anti-discrimination rules as Section 1.
- Section 3 repeals any conflicting laws.

## Status

- Status: Introduced (2025-02-19)
- Last action: Senate Read and Referred (2025-02-20)
- Sponsors: Sam Watson, Matt Brass, Mike Hodges, Ben Watson, Kay Kirkpatrick, Lee Anderson, Russ Goodman
- Official page: https://www.legis.ga.gov/legislation/70477

> The history, votes, and amendments (95 characters) are at https://georgiacommons.org/bills/2025-2026/sb205.md?full=1