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

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.

• 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.

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.

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.

• 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.

1. 2025-02-20Senate Read and Referred (Senado)
2. 2025-02-19Senate Hopper (Senado)

• Sam Watson (R, SD-011)Patrocinador principal
• Matt Brass (R, SD-006)
• Mike Hodges (R, SD-003)
• Ben Watson (R, SD-001)
• Kay Kirkpatrick (R, SD-032)
• Lee Anderson (R, SD-024)
• Russ Goodman (R, SD-008)

• health insurance coverage
• pediatric health
• PANDAS and PANS
• state employee health plan
• insurance mandates