HB 616 - Health insurance; requirements
Georgia House of Representatives - 1995/1996 Sessions
HB 616 - Health insurance; requirements
Page Numbers - 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10
1. Lord 121st 2. Culbreth 132nd 3. Henson 65th
4. Towery 30th 5. Heard 89th 6. Shipp 38th
House Comm: Ins / Senate Comm: I&L /
House Vote: Yeas 101 Nays 0 Senate Vote: Yeas 50 Nays 0
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House Action Senate
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2/6/95 Read 1st Time 2/27/95
2/7/95 Read 2nd Time 3/14/95
2/17/95 Favorably Reported 3/14/95
Sub Committee Amend/Sub Sub
2/22/95 Read 3rd Time 3/15/95
2/22/95 Passed/Adopted 3/15/95
FS Comm/Floor Amend/Sub CS
3/15* Amend/Sub Agreed To 3/17*
4/5/95 Sent to Governor
4/21/95 Signed by Governor
494 Act/Veto Number
4/21/95 Effective Date
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House Agrees to Senate Substitute as Amended by House; Senate Agrees to House
Amendment to Senate Substitute
Code Sections amended: 33-1-17, 33-24-56, 33-30-15, 33-54.1, 33-54-2, 33-54-3,
33-54-4, 33-54-5, 33-54-6, 33-54-7, 33-54-8
HB 616 HB 616/AP
H. B. No. 616 (AS PASSED HOUSE AND SENATE)
By: Representatives Lord of the 121st, Culbreth of the
132nd, Henson of the 65th, Towery of the 30th, Heard of the
89th and others
A BILL TO BE ENTITLED
AN ACT
1- 1 To amend Title 33 of the Official Code of Georgia Annotated,
1- 2 relating to insurance, so as to provide for the
1- 3 establishment of the Special Insurance Fraud Fund; to
1- 4 provide for the purposes of the fund; to provide for the
1- 5 submission of an annual budget relative to the cost of
1- 6 investigating and prosecuting insurance fraud; to provide
1- 7 for assessments against insurers; to authorize the
1- 8 Commissioner of Insurance to provide by regulation a formula
1- 9 for assessments; to provide for penalties and interest
1-10 relative to assessments; to authorize rules and regulations;
1-11 to authorize appropriations for certain purposes relative to
1-12 insurance fraud; to provide for the sharing of information
1-13 relative to the investigation of insurance fraud; to provide
1-14 for immunity for certain insurers and their agents and
1-15 employees; to provide for the payment of certain expenses
1-16 incurred by insurers; to provide definitions; to provide
1-17 requirements for health insurance contracts; to provide for
1-18 the modification of certain health insurance contracts; to
1-19 impose certain requirements on health insurers; to provide
1-20 for the termination of coverage; to provide requirements for
1-21 the continuity of coverage; to provide for conversion
1-22 policies to be issued under certain circumstances; to
1-23 provide for statutory construction; to provide requirements
1-24 for preexisting condition provisions in group policies of
1-25 accident and sickness insurance; to provide for
1-26 applicability; to authorize the promulgation of rules and
1-27 regulations; to provide for information concerning the costs
1-28 of certain health insurance coverages to be supplied to
1-29 members of the General Assembly; to provide that genetic
1-30 testing shall be conducted for certain purposes only; to
1-31 provide that information derived from genetic testing is
1-32 confidential and privileged; to prohibit genetic testing
1-33 without the consent of the individual; to prohibit release
1-34 of the results of genetic testing without explicit consent
1-35 of the person tested; to provide that information derived
1-36 from genetic testing may not be sought by insurers engaging
1-37 in accident and sickness insurance underwriting and shall
H. B. No. 616
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HB 616/AP
2- 1 not be used to deny access to accident and sickness
2- 2 insurance; to provide for the disclosure of information
2- 3 derived from genetic testing to law enforcement agencies for
2- 4 certain purposes; to provide for the disclosure of
2- 5 information derived from genetic testing for scientific
2- 6 research purposes; to provide for restrictions on such
2- 7 disclosures; to provide for applicability; to provide for
2- 8 violations; to provide for penalties and remedies; to
2- 9 provide for other matters relative to the foregoing; to
2-10 provide for legislative intent, findings, and declarations;
2-11 to provide effective dates; to repeal conflicting laws; and
2-12 for other purposes.
2-13 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
2-14 Title 33 of the Official Code of Georgia Annotated, relating
2-15 to insurance, is amended by adding immediately following
2-16 Code Section 33-1-16, relating to the investigation of
2-17 fraudulent insurance acts, a new Code Section 33-1-17 to
2-18 read as follows:
2-19 "33-1-17. (Index)
2-20 (a) The General Assembly finds that the proper and
2-21 expeditious investigation and prosecution of fraudulent
2-22 insurance acts are beneficial to the public interest. The
2-23 General Assembly further finds that proper investigation
2-24 of fraudulent insurance acts, followed by vigorous
2-25 prosecution of insurance fraud, will bring about lower
2-26 insurance rates for the citizens of this state.
2-27 (b) There is created a Special Insurance Fraud Fund for
2-28 the purpose of funding the investigation and prosecution
2-29 of insurance fraud.
2-30 (c)(1) The Commissioner shall prepare, on an annual
2-31 basis, a separate budget request to the General Assembly
2-32 which sets forth the anticipated cost and expense of
2-33 funding the investigation and prosecution of insurance
2-34 fraud in this state for the ensuing 12 months.
2-35 Beginning with the year 1997, such budget request shall
2-36 set forth the annual cost and expense of the
2-37 investigation and prosecution of insurance fraud in
2-38 Georgia for the preceding 12 months.
2-39 (2) There is imposed upon each foreign, alien, and
2-40 domestic insurance company doing business in the state
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HB 616/AP
3- 1 an annual assessment under a formula to be established
3- 2 by regulation promulgated by the Commissioner. The
3- 3 formula shall be calculated such that the total proceeds
3- 4 paid or collected from such assessments for any year
3- 5 shall not exceed the amounts appropriated by the General
3- 6 Assembly pursuant to paragraph (3) of this subsection,
3- 7 which appropriation shall be based upon the budget
3- 8 request setting forth the applicable annual cost and
3- 9 expense of the investigation and prosecution of
3-10 insurance fraud in Georgia submitted by the
3-11 Commissioner. Such assessments may be measured by kind
3-12 of company, kind of insurance, income, volume of
3-13 transactions, or such other factors as the Commissioner
3-14 determines appropriate. Assessments shall be due and
3-15 payable for each calendar quarter at the times specified
3-16 in subsection (b) of Code Section 33-8-6. Any insurance
3-17 company which fails to report and pay any installment of
3-18 such assessment shall be subject to penalties and
3-19 interest as provided by subsection (d) of Code Section
3-20 33-8-6. The Commissioner shall provide by regulation
3-21 for such other terms and conditions for the payment or
3-22 collection of such assessments as may be necessary to
3-23 ensure the proper payment and collection thereof.
3-24 (3) The General Assembly may appropriate to the
3-25 Insurance Department funds for the investigation of
3-26 insurance fraud and for the funding of the prosecution
3-27 of insurance fraud. The Commissioner is authorized to
3-28 use such funds for investigation of insurance fraud and
3-29 to reimburse prosecuting attorneys for some or all of
3-30 the costs of retaining assistant prosecuting attorneys
3-31 to prosecute insurance fraud cases. The Commissioner
3-32 shall provide by regulation for such other terms and
3-33 conditions for the use of the funds for the
3-34 investigation, reimbursement, and prosecution
3-35 contemplated by the terms of this paragraph.
3-36 (d) Insurers shall make personnel involved in
3-37 investigating insurance fraud and any files relating to
3-38 insurance fraud investigation available to the
3-39 Commissioner, the Attorney General, local prosecuting
3-40 officials, special prosecuting attorneys, or other law
3-41 enforcement agencies as needed in order to further the
3-42 investigation and prosecution of insurance fraud.
3-43 Information supplied by an insurer and contained in such
3-44 files shall upon receipt become part of the investigative
3-45 file and subject to the provisions of Code Section
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HB 616/AP
4- 1 50-18-72. The insurer and its employees and agents shall
4- 2 be entitled to immunity as provided in Code Section
4- 3 33-1-16.
4- 4 (e) Any expenses incurred by insurers as a result of this
4- 5 Code section shall be defrayed by such insurers from their
4- 6 own funds and shall not be borne by the state or by the
4- 7 Special Insurance Fraud Fund."
SECTION 2.
4- 8 Said title is further amended by adding immediately
4- 9 following Code Section 33-24-55, relating to health
4-10 insurance and recovery rights of the state for payments made
4-11 under Medicaid, a new Code section, to be designated Code
4-12 Section 33-24-56, to read as follows:
4-13 "33-24-56. (Index)
4-14 (a) As used in this Code section, the term:
4-15 (1) 'Insurer' means an accident and sickness insurer,
4-16 fraternal benefit society, nonprofit hospital service
4-17 corporation, nonprofit medical service corporation,
4-18 health care corporation, health maintenance
4-19 organization, or any similar entity and any self-insured
4-20 health care plan not subject to the exclusive
4-21 jurisdiction of the Employee Retirement Income Security
4-22 Act of 1974, 29 U.S.C. Sec. 1001, et seq.
4-23 (2) 'Policy' means any health care plan, subscriber
4-24 contract, or accident and sickness plan, contract, or
4-25 policy by whatever name called other than a disability
4-26 income policy, a long-term care insurance policy, a
4-27 medicare supplement policy, a health insurance policy
4-28 written as a part of workers' compensation equivalent
4-29 coverage, a specified disease policy, a credit insurance
4-30 policy, a hospital indemnity policy, a limited accident
4-31 policy, or other type of limited accident and sickness
4-32 policy.
4-33 (b) Notwithstanding any provisions of this title which
4-34 might be construed to the contrary, on and after April 1,
4-35 1996, all individual basic hospital or medical expense,
4-36 major medical, or comprehensive medical expense insurance
4-37 policies issued, delivered, issued for delivery, or
4-38 renewed in this state shall provide that once an
4-39 individual has been accepted for coverage, his or her
4-40 coverage cannot be terminated by the insurer due solely to
4-41 his or her individual claims experience.
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HB 616/AP
5- 1 (c) The Commissioner shall promulgate appropriate
5- 2 procedures and guidelines by rules and regulations to
5- 3 implement the provisions of this Code section on or before
5- 4 November 1, 1995, after notification and review of such
5- 5 regulation by the appropriate standing committees of the
5- 6 House of Representatives and Senate in accordance with the
5- 7 requirements of applicable law. Nothing in this Code
5- 8 section shall be construed to prohibit the Commissioner
5- 9 and any insurers with a desire to do so from mutually
5-10 agreeing on procedures, rules, regulations, and guidelines
5-11 and from implementing the provisions of this Code section
5-12 on a voluntary basis before April 1, 1996.
5-13 (d) Beginning April 1, 1999, the Commissioner shall
5-14 conduct a review of the costs associated with the coverage
5-15 required by this Code section and shall provide the
5-16 members of the General Assembly with such information no
5-17 later than December 31, 1999."
SECTION 3.
5-18 Said title is further amended by adding to Article 1 of
5-19 Chapter 30, relating to general provisions with regard to
5-20 group or blanket accident and sickness insurance, a new Code
5-21 section, to be designated Code Section 33-30-15, to read as
5-22 follows:
5-23 "33-30-15. (Index)
5-24 (a) As used in this Code section, the term:
5-25 (1) 'Insurer' means an accident and sickness insurer,
5-26 fraternal benefit society, nonprofit hospital service
5-27 corporation, nonprofit medical service corporation,
5-28 health care corporation, health maintenance
5-29 organization, or any similar entity and any self-insured
5-30 health care plan not subject to the exclusive
5-31 jurisdiction of the Employee Retirement Income Security
5-32 Act of 1974, 29 U.S.C. Sec. 1001, et seq.
5-33 (2) 'Policy' means any medical expense plan, subscriber
5-34 contract, or accident and sickness plan, contract, or
5-35 policy by whatever name called other than a disability
5-36 income policy, a long-term care insurance policy, a
5-37 medicare supplement policy, a health insurance policy
5-38 written as a part of workers' compensation equivalent
5-39 coverage, a specified disease policy, a credit insurance
5-40 policy, a blanket accident and sickness policy, a
5-41 franchise policy issued on an individual basis to a
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HB 616/AP
6- 1 member of a true association as defined in Code Section
6- 2 33-30-12, a hospital indemnity policy, a limited
6- 3 accident policy, or other similar limited accident and
6- 4 sickness policy.
6- 5 (3) 'Similar coverage' under another health benefit plan
6- 6 means medical expense coverage under any of the
6- 7 following:
6- 8 (A) Medicare or Medicaid;
6- 9 (B) An employer based accident and sickness insurance
6-10 or health benefit arrangement;
6-11 (C) An individual accident and sickness insurance
6-12 policy, including coverage issued by a health
6-13 maintenance organization, nonprofit hospital or
6-14 nonprofit medical service corporation, health care
6-15 corporation, or fraternal benefit society;
6-16 (D) A spouse's benefits or coverage under medicare or
6-17 Medicaid or an employer based health insurance or
6-18 health benefit arrangement;
6-19 (E) A conversion policy; or
6-20 (F) A franchise policy issued on an individual basis
6-21 to a member of a true association as defined in Code
6-22 Section 33-30-12.
6-23 (b) Notwithstanding any other provision of this title
6-24 which might be construed to the contrary, on and after
6-25 April 1, 1996, all group basic hospital or medical
6-26 expense, major medical, or comprehensive medical expense
6-27 policies which are issued, delivered, issued for delivery,
6-28 or renewed in this state shall provide the following:
6-29 (1) Subject to compliance with the provisions of
6-30 subsection (c) of this Code section, any newly eligible
6-31 employee, member, subscriber, enrollee, or dependent who
6-32 has had similar coverage under another health benefit
6-33 plan within the previous 90 days shall be eligible for
6-34 coverage immediately; and
6-35 (2) Once such similar coverage terminates, including
6-36 termination of such similar coverage after any period of
6-37 continuation of coverage required under Code Section
6-38 33-24-21.1 or the provisions of Title X of the Omnibus
6-39 Budget Reconciliation Act of 1986, the insurer must
6-40 offer a conversion policy to the eligible employee,
6-41 member, subscriber, enrollee, or dependent.
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HB 616/AP
7- 1 (c) Notwithstanding any provisions of this Code section
7- 2 which might be construed to the contrary, such policies
7- 3 may include a limitation for preexisting conditions not to
7- 4 exceed 12 months following the effective date of coverage;
7- 5 provided, however, that such policies shall waive any time
7- 6 period applicable to the preexisting condition exclusion
7- 7 or limitation for the period of time an individual was
7- 8 previously covered by similar coverage.
7- 9 (d) The Commissioner shall promulgate appropriate
7-10 procedures and guidelines by rules and regulations to
7-11 implement the provisions of this Code section on or before
7-12 November 1, 1995, after notification and review of such
7-13 regulations by the appropriate standing committees of the
7-14 House of Representatives and Senate in accordance with the
7-15 requirements of applicable law. Nothing in this Code
7-16 section shall be construed to prohibit the Commissioner
7-17 and any insurers with a desire to do so from mutually
7-18 agreeing on procedures, rules, regulations, and guidelines
7-19 and from implementing the provisions of this Code section
7-20 on a voluntary basis before April 1, 1996.
7-21 (e) Beginning April 1, 1999, the Commissioner shall
7-22 conduct a review of the costs associated with the coverage
7-23 required by this Code section and shall provide the
7-24 members of the General Assembly with such information no
7-25 later than December 31, 1999."
SECTION 4.
7-26 Said title is further amended by adding a new chapter, to be
7-27 designated Chapter 54, to read as follows:
"CHAPTER 54
7-28 33-54-1. (Index)
7-29 The General Assembly finds and determines that recent
7-30 advances in genetic science have led to improvements in
7-31 the diagnosis, treatment, and understanding of a
7-32 significant number of human diseases. The General
7-33 Assembly further finds and declares that:
7-34 (1) Genetic information is the unique property of the
7-35 individual tested;
7-36 (2) The use and availability of information concerning
7-37 an individual obtained through the use of genetic
7-38 testing techniques may be subject to abuses if disclosed
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8- 1 to unauthorized third parties without the willing
8- 2 consent of the individual tested;
8- 3 (3) To protect individual privacy and to preserve
8- 4 individual autonomy with regard to an individual's
8- 5 genetic information, it is appropriate to limit the use
8- 6 and availability of genetic information; and
8- 7 (4) The intent of this chapter is to prevent accident
8- 8 and sickness insurance companies, health maintenance
8- 9 organizations, managed care organizations, and other
8-10 payors from using information derived from genetic
8-11 testing to deny access to accident and sickness
8-12 insurance.
8-13 33-54-2. (Index)
8-14 As used in this chapter, the term:
8-15 (1) 'Genetic testing' means laboratory tests of human
8-16 DNA or chromosomes for the purpose of identifying the
8-17 presence or absence of inherited alterations in genetic
8-18 material or genes which are associated with a disease or
8-19 illness that is asymptomatic at the time of testing and
8-20 that arises solely as a result of such abnormality in
8-21 genes or genetic material. For purposes of this
8-22 chapter, genetic testing shall not include routine
8-23 physical measurements; chemical, blood, and urine
8-24 analysis; tests for abuse of drugs; and tests for the
8-25 presence of the human immunodeficiency virus.
8-26 (2) 'Insurer' means an insurer, a fraternal benefit
8-27 society, a nonprofit medical service corporation, a
8-28 health care corporation, a health maintenance
8-29 corporation, or a self-insured health plan not subject
8-30 to the exclusive jurisdiction of the Employee Retirement
8-31 Income Security Act of 1974, 29 U.S.C. Section 1001, et
8-32 seq.
8-33 33-54-3. (Index)
8-34 (a) Except as otherwise provided in this chapter, genetic
8-35 testing may only be conducted to obtain information for
8-36 therapeutic or diagnostic purposes. Genetic testing may
8-37 not be conducted without the prior written consent of the
8-38 person to be tested.
8-39 (b) Information derived from genetic testing shall be
8-40 confidential and privileged and may be released only to
8-41 the individual tested and to persons specifically
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9- 1 authorized by such individual to receive the information.
9- 2 Any insurer that possesses information derived from
9- 3 genetic testing may not release the information to any
9- 4 third party without the explicit written consent of the
9- 5 individual tested. Information derived from genetic
9- 6 testing may not be sought by any insurer as defined in
9- 7 Code Section 33-54-2.
9- 8 33-54-4. (Index)
9- 9 Any insurer that receives information derived from genetic
9-10 testing may not use the information for any nontherapeutic
9-11 purpose.
9-12 33-54-5. (Index)
9-13 Notwithstanding the provisions of Code Sections 33-54-3
9-14 and 33-54-4, information derived from genetic testing
9-15 regarding the identity of any individual who is the
9-16 subject of a criminal investigation or a criminal
9-17 prosecution may be disclosed to appropriate legal
9-18 authorities conducting the investigation or prosecution.
9-19 The information may be used during the course of the
9-20 investigation or prosecution with respect to the
9-21 individual tested without the consent of such individual.
9-22 33-54-6. (Index)
9-23 Notwithstanding the provisions of Code Sections 33-54-3
9-24 and 33-54-4, any research facility may conduct genetic
9-25 testing and may use the information derived from genetic
9-26 testing for scientific research purposes so long as the
9-27 identity of any individual tested is not disclosed to any
9-28 third party, except that the individual's identity may be
9-29 disclosed to the individual's physician with the consent
9-30 of the individual.
9-31 33-54-7. (Index)
9-32 This chapter shall not apply to a life insurance policy,
9-33 disability income policy, accidental death or
9-34 dismemberment policy, medicare supplement policy,
9-35 long-term care insurance policy, credit insurance policy,
9-36 specified disease policy, hospital indemnity policy,
9-37 blanket accident and sickness policy, franchise policy
9-38 issued on an individual basis to members of an
9-39 association, limited accident policy, health insurance
9-40 policy written as a part of workers' compensation
9-41 equivalent coverage, or other similar limited accident and
9-42 sickness policy.
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HB 616/AP
10- 1 33-54-8. (Index)
10- 2 (a) Any violation of this chapter by an insurer shall be
10- 3 unfair trade practice subject to the provisions of Article
10- 4 1 of Chapter 6 of this title, and a violation of this
10- 5 chapter by any other person shall be an unfair practice
10- 6 and shall be subject to the provisions of Part 2 of
10- 7 Article 15 of Chapter 1 of Title 10, the 'Fair Business
10- 8 Practices Act of 1975.' In addition, any individual who
10- 9 is harmed as a result of a violation of this chapter shall
10-10 have a cause of action against the person whose violation
10-11 caused the harm.
10-12 (b) Any insurer that is found in violation of the
10-13 provisions of this chapter by a court of competent
10-14 jurisdiction is liable to the individual injured by the
10-15 violation in an amount equal to any actual damages
10-16 suffered by the individual. In the alternative, the court
10-17 may issue an order directing the insurer to provide
10-18 accident and sickness insurance to the injured individual
10-19 under the same terms and conditions as would have applied
10-20 had the violation not occurred.
10-21 (c) The court shall award costs and reasonable attorney's
10-22 fees to any individual who is successful in enforcing the
10-23 provision of this chapter."
SECTION 5.
10-24 (a) Except as provided in subsection (b) of this section,
10-25 this Act shall become effective upon its approval by the
10-26 Governor or upon its becoming law without such approval.
10-27 (b) Sections 1 and 4 of this Act shall become effective on
10-28 July 1, 1995.
SECTION 6.
10-29 All laws and parts of laws in conflict with this Act are
10-30 repealed.
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Last Updated on 01/02/97