Senate Bill 262
By: Senators Halpern of the 39th, Hufstetler of the 52nd, Goodman of the 8th, Watson of the
11th, Still of the 48th 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 health benefit policies to cover preventive services;
to provide for definitions; to prohibit cost-sharing requirements; to protect the eligibility of
health savings accounts; to provide for review by the Commissioner of Insurance; 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.
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance
generally, is amended by adding a new article to read as follows:
<ins>"ARTICLE 5
33-24-100.
As used in this article, the term:
</ins>
<ins>(1) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any
maximum limitation on the application of such deductible, coinsurance, copayment, or
similar out-of-pocket expense.
(2) 'Evidence based' means founded on principles and concepts supported by research,
practical strategies learned from clinical experience, and practices consistent with an
individual's needs and circumstances.
(3) 'Evidence informed' means incorporating evidence, clinical experience or
professional expertise, and the perspectives of an individual directly affected.
(4) 'Health benefit policy' means any individual or group plan, policy, or contract for
healthcare services issued, delivered, issued for delivery, executed, or renewed in this
state which provides major medical benefits, including those contracts executed by this
state on behalf of indigents and on behalf of state employees under Article 1 of
Chapter 18 of Title 45, on behalf of public school teachers and employees under Part 6
of Article 17 of Chapter 2 of Title 20, and on behalf of members and employees of the
board of regents under Code Section 31-2-4, by a healthcare corporation, health
maintenance organization, preferred provider organization, accident and sickness insurer,
fraternal benefit society, hospital service corporation, medical service corporation, or any
similar entity and any self-insured healthcare plan not subject to the exclusive jurisdiction
of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et
seq.
(5) 'Health insurer' means an entity subject to the insurance laws and regulations of this
state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract,
or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of
the costs of healthcare services.
(6) 'Nationally recognized clinical practice guidelines' means evidence based or evidence
informed clinical practice guidelines developed by medical or public health experts in
independent organizations, medical professional societies, or the federal government
</ins>
<ins>utilizing a transparent methodology and reporting structure and with a conflict-of-interest
policy such as the United States Preventive Services Task Force, and by guidelines
established by federal agencies such as the Advisory Committee on Immunization
Practices of the Centers for Disease Control and Prevention and the Health Resources and
Services Administration of the United States Department of Health and Human Services.
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.
(7) 'Preventive services' means clinical products or services, including, but not limited
to, screening tests, counseling services, and prescription medicines, that are
recommended for individuals in accordance with nationally recognized clinical practice
guidelines to prevent health problems before they develop, occur, or worsen, as further
provided in Code Section 33-24-101.
33-24-101.
Preventive services includes:
(1) Evidence based items and services that are necessary for implementing the federal
Patient Protection and Affordable Care Act as it existed January 1, 2025, and have a high
or moderate net benefit for the individual directly affected;
(2) Immunizations for routine use in children, adolescents, and adults;
(3) Evidence informed preventive care and screenings for infants, children, and
adolescents;
(4) Evidence informed preventive care for women; and
(5) Any preventive services as required under federal or state law in existence
January 1, 2025.
</ins>
<ins>33-24-102.
(a) Every health insurer shall provide coverage for preventive services for covered persons
under such policy.
(b) The coverage provided for in subsection (a) of this Code section shall not be subject
to any cost-sharing requirement of the covered person's health benefit policy and shall not
diminish or limit any other benefits provided under such policy.
(c) Nothing in this article shall prohibit a health insurer from providing coverage for items
and services in addition to those provided for in subsection (a) of this Code section or from
denying coverage for items and services that are not provided for in subsection (a) of this
Code section.
33-24-103.
If application of the provisions of this Code section would result in health savings account
ineligibility under 26 U.S.C. Section 223 as it existed on January 1, 2025, then such
provisions shall apply only to health savings accounts with qualified high deductible health
plans with respect to the deductibles of such plans after the individual has satisfied the
minimum deductibles; provided, however, that the provisions of this Code section shall
apply to items and services that are deemed to be preventive care.
33-24-104.
(a) No later than January 1, 2026, and annually thereafter, the Commissioner shall review
health benefit policies provided by health insurers to ensure compliance with this article.
(b) No later than October 1, 2025, the Commissioner shall promulgate rules and
regulations necessary to implement the provisions of this article in accordance with
nationally recognized clinical practice guidelines. The Commissioner shall regularly
review nationally recognized clinical practice guidelines to determine if rules and
regulations promulgated pursuant to this subsection require modification."
</ins>
SECTION 2.
All laws and parts of laws in conflict with this Act are repealed.