HB1149: HB1149 Insurance; offer a preenrollment option for anticipated newly born or adopted children; require certain health insurers

26 LC 46 1307 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 insurance1 generally, so as to require certain health insurers to offer a preenrollment option for2 anticipated newly born or adopted children; to provide for defi nitions; to provide for the3 provision of routine well baby care in certain circumstances; to provide for documentation;4 to provide for notification; to provide for statutory construction; to provide for applicability;5 to provide for related matters; to repeal conflicting laws; and for other purposes.6 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 SECTION 1.8 Chapter 24 of Title 33 of the Official Code of Georgia, relatin g to insurance generally, is9 amended by revising Code Section 33-24-22, relating to provisio ns in health insurance10 policies for coverage of newly born or adopted children, as follows:11 "33-24-22.12 (a) As used in this Code section, the term:13 (1) 'Anticipated family member' means an individual whose birt h or adoption is14 reasonably anticipated to occur within three months.15 H. B. 1149 - 1 - 26 LC 46 1307 (2) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any16 maximum limitation on the application of such a deductible, coinsurance, copayment, or17 similar out-of-pocket expense.18 (3) 'Health benefit policy' means an individual or group plan, policy, or contract for19 healthcare services issued, delivered, issued for delivery, or renewed in this state which20 provides major medical benefits by a healthcare corporation, he alth maintenance21 organization, preferred provider organization, fraternal benefit society, hospital service22 corporation, medical service corporation, or other health insurer or similar entity. Such23 term shall not include self-funded, employer sponsored health insurance plans subject to24 the exclusive jurisdiction of the federal Employee Retirement I ncome Security Act25 of 1974, as codified and amended at 29 U.S.C. Section 1001, et seq.26 (4) 'Health insurer' means any person, corporation, or other entity authorized to provide27 health benefit policies under this title.28 (a)(b) All individual and group health insurance policies providing coverage on an expense29 incurred basis and individual and group service or indemnity ty pe contracts issued by a30 nonprofit corporation health benefit policies which, under the terms of such policies,31 provide coverage for a family member of the insured or subscriber shall, as to the family32 members' coverage, also provide that the health insurance benefits applicable for children33 shall be payable with respect to a newly born child of the insu red or subscriber from the34 moment of birth. A newly born child of the insured or subscriber shall include an adopted35 child. The coverage for the adopted child shall be effective from the date of the placement36 for adoption or final decree of adoption, whichever occurs first.37 (b)(c) The coverage for newly born children or adopted children shall consist of coverage38 of injury or sickness, including routine well baby care and the necessary care and treatment39 of medically diagnosed congenital defects and birth abnormaliti es, but need not include40 benefits for routine well baby care.41 H. B. 1149 - 2 - 26 LC 46 1307 (c)(d) If payment of a specific premium or subscription fee is required to provide coverage42 for a child, the health benefit policy or contract may require that notification of birth of a43 newly born child or the date of the placement for adoption or final adoption of a child and44 payment of the required premium or fees must be furnished to th e insurer or nonprofit45 service or indemnity corporation within 31 days after the date of birth, placement for46 adoption, or final decree of adoption, whichever is applicable, in order to have the coverage47 continue beyond the 31 day period.48 (e) Beginning January 1, 2027, any health insurer offering a health benefit policy in this49 state shall provide insureds and subscribers with the opportuni ty to participate in an50 optional preenrollment period in preparation of the arrival of an anticipated family member. 51 The coverage for the anticipated family member shall not become effective until the birth52 or adoption of the child.53 (f) In order to participate in the preenrollment of the anticipated family member, insureds54 or subscribers shall be required to obtain documentation which establishes that the insured55 is pregnant or will be adopting a child.56 (1) If the insured is pregnant, the insured shall submit to th e health insurer any of the57 following:58 (A) A note from a physician or other appropriate healthcare provider;59 (B) The result of an ultrasound test; or60 (C) The result of a urine test.61 (2) If the insured will be adopting a child, the insured shall submit to the health insurer62 such documentation as the Commissioner shall determine is neces sary through the63 promulgation of rules and regulations.64 (g) The documentation described in subsection (f) of this Code section shall not be65 submitted by the insured or subscriber unless the birth or adoption is reasonably anticipated66 to occur within three months of such submission.67 H. B. 1149 - 3 - 26 LC 46 1307 (h) Once the health insurer receives the documentation required in subsection (f) of this68 Code section, within ten business days of such receipt, such insurer shall:69 (A) Disclose to the insured or subscriber the coverage changes that may occur upon70 childbirth or adoption, including, but not limited to, any changes to the deductible or71 premium; and72 (B) Notify the insured or subscriber of the 31 day period described in subsection (d)73 of this Code section.74 (d)(i) This Code section shall not apply to persons adopted as adults pursuant to the75 provisions of Code Section 19-8-21, relating to the adoption of adult persons.76 (j) The preenrollment option benefit shall be subject to the same cost-sharing requirements77 established for other covered benefits within such health benef it policy. Special78 deductibles, coinsurance, copayment, or other limitations that are not generally applicable79 to other benefits shall not be imposed regarding coverage for t he preenrollment option80 benefit described in this Code section.81 (k) Prior to the arrival of the anticipated family member, the health insurer shall assign to82 the documentation submitted pursuant to subsection (f) of this Code section, such health83 benefit policy information that will reasonably identify such member in preparation for his84 or her birth or adoption.85 (l) Nothing in this Code section shall be construed to prohibit a health insurer from issuing86 or renewing a health benefit policy which provides benefits gre ater than the minimum87 benefits required under this Code section or from issuing or re newing a policy which88 provides benefits which are generally more favorable to the ins ured or subscriber than89 those required under this Code section.90 (m)(1) The provisions of this Code section shall apply to all policies, contracts, and91 certificates executed, delivered, issued for delivery, continued, or renewed in this state92 on or after January 1, 2027.93 H. B. 1149 - 4 - 26 LC 46 1307 (2) For purposes of this Code section, all contracts are deeme d to be renewed no later94 than the first anniversary of the contract date."95 SECTION 2.96 All laws and parts of laws in conflict with this Act are repealed.97 H. B. 1149 - 5 -