SB 262: Insurance; health benefit policies to cover preventive services; provide

Under current Georgia law, health insurers are not specifically required to cover preventive services like screenings, immunizations, and preventive medicines without cost-sharing. This bill adds a new article to Georgia's insurance code (O.C.G.A. Title 33, Chapter 24) that defines preventive services based on nationally recognized clinical guidelines, such as those from the U.S. Preventive Services Task Force and the CDC's Advisory Committee on Immunization Practices, and requires health insurers to cover those services for policyholders. The bill bars insurers from applying deductibles, copays, or coinsurance to this preventive coverage and says it cannot reduce other benefits in the policy. It includes a safeguard so the requirement does not accidentally disqualify people from using health savings accounts. The Georgia Insurance Commissioner must issue implementing rules by October 1, 2025, and review insurer compliance annually starting January 1, 2026.

• Requires every health insurer offering a major medical health benefit policy in Georgia to cover preventive services for covered individuals.
• Bans cost-sharing (deductibles, copays, or coinsurance) for these preventive services and prohibits insurers from reducing other policy benefits because of this coverage.
• Defines preventive services to include immunizations, screenings for children and women, and other items required under federal or state law as of January 1, 2025.
• Protects health savings account eligibility by limiting the no-cost-sharing rule where needed to comply with federal tax law (26 U.S.C. \u00a7 223).
• Directs the Commissioner of Insurance to write implementing rules by October 1, 2025, and to review insurer compliance every year starting January 1, 2026.

Georgians covered by individual or group health insurance policies in the state, including state employees, public school teachers, university system employees, and Medicaid-style state contracts for indigent residents. It also affects health insurers, HMOs, hospital and medical service corporations, self-insured plans not governed by federal ERISA law, and the Georgia Insurance Commissioner's office.

If enacted, Georgians would no longer pay deductibles, copays, or coinsurance for preventive care like vaccines, cancer screenings, and preventive medicines covered under the bill. This could lower out-of-pocket costs for routine and preventive checkups, while requiring insurers to adjust plan designs and pricing to absorb the cost.

• Section 1 adds new Article 5 to Chapter 24 of Title 33, defining terms like 'cost-sharing requirement,' 'preventive services,' and 'nationally recognized clinical practice guidelines' (O.C.G.A. \u00a7 33-24-100).
• O.C.G.A. \u00a7 33-24-101 specifies what counts as preventive services, including Affordable Care Act preventive items, childhood and adult immunizations, and preventive care for women, children, and adolescents.
• O.C.G.A. \u00a7 33-24-102 requires health insurers to cover these services with no cost-sharing and bars reducing other benefits, while allowing insurers to cover additional services voluntarily.
• O.C.G.A. \u00a7 33-24-103 limits the no-cost-sharing rule for high-deductible health plans tied to health savings accounts, so people don't lose HSA eligibility under federal tax law.
• O.C.G.A. \u00a7 33-24-104 requires the Insurance Commissioner to issue implementing rules by October 1, 2025 and to review insurer compliance annually starting January 1, 2026.
• Section 2 repeals any conflicting state laws.

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

• Sonya Halpern (D, SD-39)Primary sponsor
• Chuck Hufstetler (R, SD-52)
• Russ Goodman (R, SD-8)
• Sam Watson (R, SD-11)
• Shawn Still (R, SD-48)
• Carden Summers (R, SD-13)
• Harold Jones II (D, SD-22)
• Ben Watson (R, SD-1)

• health insurance
• preventive care
• insurance regulation
• health savings accounts
• medical coverage costs