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HB 94 - Medicare supplement insurance; define certain terms

Williams, Robin L (114th)

Status Summary	HC:	Ins	SC:	I&L	FR:	01/14/99	LA:	01/10/00	S - Read 3rd Time

First Reader Summary

A BILL to amend Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to medicare supplement insurance, so as to define certain terms; to change certain provisions relating to applicability of chapter; and for other purposes.

Code Sections - 33-43-1

HB 94                                              LC 25 1146 
 
 
 
 
 
 
                        A BILL TO BE ENTITLED 
                               AN ACT 
 
 
  1- 1  To amend Chapter 43 of Title 33 of the Official Code of 
  1- 2  Georgia Annotated, relating to medicare supplement 
  1- 3  insurance, so as to define certain terms; to change certain 
  1- 4  provisions relating to applicability of chapter; to provide 
  1- 5  an effective date; to repeal conflicting laws; and for other 
  1- 6  purposes. 
 
  1- 7       BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: 
 
  1- 8                           SECTION 1. 
 
  1- 9  Chapter 43 of Title 33 of the Official Code of Georgia 
  1-10  Annotated, relating to medicare supplement insurance, is 
  1-11  amended by striking Code Section 33-43-1, relating to 
  1-12  definitions, and inserting in lieu thereof the following: 
 
  1-13    "33-43-1. 
 
  1-14    As used in this chapter, the term: 
 
  1-15      (1) 'Applicant' means: 
 
  1-16        (A) In the case of an individual medicare supplement 
  1-17        policy or subscriber contract, the person who seeks to 
  1-18        contract for insurance benefits; and 
 
  1-19        (B) In the case of a group medicare supplement policy, 
  1-20        the proposed certificate holder. 
 
  1-21      (1.1) 'Bankruptcy' means when a Medicare+Choice 
  1-22      organization that is not an issuer has filed, or has had 
  1-23      filed against it, a petition for declaration of 
  1-24      bankruptcy and has ceased doing business in the state. 
 
  1-25      (2) 'Certificate' means any certificate delivered or 
  1-26      issued for delivery in this state under a group medicare 
  1-27      supplement policy. 
 
  1-28      (3) 'Certificate form' means the form on which the 
  1-29      certificate is delivered or issued for delivery by the 
  1-30      issuer. 
 
 
 
 
                                 -1- 
 
 
 
  2- 1      (3.1) 'Continuous period of creditable coverage' means 
  2- 2      the period during which an individual was covered by 
  2- 3      creditable coverage if during the period of the coverage 
  2- 4      the individual had no breaks in coverage greater than 63 
  2- 5      days. 
 
  2- 6        (3.2)(A) 'Creditable coverage' means, with respect to 
  2- 7        an individual, coverage of the individual provided 
  2- 8        under any of the following: 
 
  2- 9          (i) A group health plan; 
 
  2-10          (ii) Health insurance coverage; 
 
  2-11          (iii) Part A or Part B of Title XVIII of the Social 
  2-12          Security Act (medicare); 
 
  2-13          (iv) Title XIX of the Social Security Act 
  2-14          (Medicaid), other than coverage consisting solely of 
  2-15          benefits under Section 1928; 
 
  2-16          (v) Chapter 5 of Title 10 of the United States Code 
  2-17          (CHAMPUS); 
 
  2-18          (vi) A medical care program of the Indian Health 
  2-19          Service or of a tribal organization; 
 
  2-20          (vii) A state health benefits risk pool; 
 
  2-21          (viii) A health plan offered under Chapter 89 of 
  2-22          Title 5 of the United States Code (Federal Employees 
  2-23          Health Benefits Program); 
 
  2-24          (ix) A public health plan as defined in federal 
  2-25          regulation; or 
 
  2-26          (x) A health benefit plan under Section 5(e) of the 
  2-27          Peace Corps Act (22 U.S.C. Section 2504(e)). 
 
  2-28        (B) Creditable coverage shall not include one or more, 
  2-29        or any combination of, the following: 
 
  2-30          (i) Coverage only for accident or disability income 
  2-31          insurance, or any combination thereof; 
 
  2-32          (ii) Coverage issued as a supplement to liability 
  2-33          insurance; 
 
  2-34          (iii) Liability insurance, including general 
  2-35          liability insurance and automobile liability 
  2-36          insurance; 
 
  2-37          (iv) Workers' compensation or similar insurance; 
 
 
 
                                 -2- 
 
 
 
  3- 1          (v) Automobile medical payment insurance; 
 
  3- 2          (vi) Credit only insurance; 
 
  3- 3          (vii) Coverage for on-site medical clinics; or 
 
  3- 4          (viii) Other similar insurance coverage, specified 
  3- 5          in the Code of Federal Regulations as of the 
  3- 6          effective date of this Act, under which benefits for 
  3- 7          medical care are secondary or incidental to other 
  3- 8          insurance benefits. 
 
  3- 9        (C) Creditable coverage shall not include the 
  3-10        following benefits if they are provided under a 
  3-11        separate policy, certificate, or contract of insurance 
  3-12        or are otherwise not an integral part of the plan: 
 
  3-13          (i) Limited scope dental or vision benefits; 
 
  3-14          (ii) Benefits for long-term care, nursing home care, 
  3-15          home health care, community based care, or any 
  3-16          combination thereof; or 
 
  3-17          (iii) Such other similar, limited benefits as are 
  3-18          specified in the Code of Federal Regulations as of 
  3-19          the effective date of this Act. 
 
  3-20        (D) Creditable coverage shall not include the 
  3-21        following benefits if offered as independent, 
  3-22        noncoordinated benefits: 
 
  3-23          (i) Coverage only for a specified disease or 
  3-24          illness; or 
 
  3-25          (ii) Hospital indemnity or other fixed indemnity 
  3-26          insurance. 
 
  3-27        (E) Creditable coverage shall not include the 
  3-28        following if offered as a separate policy, 
  3-29        certificate, or contract of insurance: 
 
  3-30          (i) Medicare supplemental health insurance as 
  3-31          defined under Section 1882(g)(1) of the Social 
  3-32          Security Act; 
 
  3-33          (ii) Coverage supplemental to the coverage provided 
  3-34          under Chapter 55 of Title 10 of the United States 
  3-35          Code; or 
 
  3-36          (iii) Similar supplemental coverage provided to 
  3-37          coverage under a group health plan. 
 
 
 
 
                                 -3- 
 
 
 
  4- 1      (3.3) 'Employee welfare benefit plan' means a plan, 
  4- 2      fund, or program of employee benefits as defined in 29 
  4- 3      U.S.C. Section 1002 (Employee Retirement Income Security 
  4- 4      Act). 
 
  4- 5      (3.4) 'Insolvency' means when an issuer, licensed to 
  4- 6      transact the business of insurance in this state, has 
  4- 7      had a final order of liquidation entered against it with 
  4- 8      a finding of insolvency by a court of competent 
  4- 9      jurisdiction in the issuer's state of domicile. 
 
  4-10      (4) 'Issuer' includes insurance companies, fraternal 
  4-11      benefit societies, health care service plans, health 
  4-12      maintenance organizations, and any other entity 
  4-13      delivering or issuing for delivery in this state 
  4-14      medicare supplement policies or certificates. 
 
  4-15      (5) 'Medicare' means the 'Health Insurance for the Aged 
  4-16      Act,' Title XVIII of the Social Security Act Amendments 
  4-17      of 1965, as then constituted or later amended. 
 
  4-18      (6) 'Medicare supplement policy' means a group or 
  4-19      individual policy of accident and sickness insurance or 
  4-20      a subscriber contract of hospital and medical service 
  4-21      associations or health maintenance organizations, other 
  4-22      than a policy issued pursuant to a contract under 
  4-23      Section 1876 of the federal Social Security Act (42 
  4-24      U.S.C. Section 1395, et seq.) or an issued policy under 
  4-25      a demonstration project specified in 42 U.S.C. Section 
  4-26      1395ss(g)(1), which is advertised, marketed, or designed 
  4-27      primarily as a supplement to reimbursements under 
  4-28      medicare for the hospital, medical, or surgical expenses 
  4-29      of persons eligible for medicare. 
 
  4-30      (6.1) 'Medicare+Choice plan' means a plan of coverage 
  4-31      for health benefits under medicare Part C as defined in 
  4-32      P.L. 105-33, and includes: 
 
  4-33        (A) Coordinated care plans which provide health care 
  4-34        services, including but not limited to health 
  4-35        maintenance organization plans (with or without a 
  4-36        point-of-service option), plans offered by provider 
  4-37        sponsored organizations, and preferred provider 
  4-38        organization plans; 
 
  4-39        (B) Medical savings account plans coupled with a 
  4-40        contribution into a Medicare+Choice medical savings 
  4-41        account; and 
 
  4-42        (C) Medicare+Choice private fee-for-service plans. 
 
 
                                 -4- 
 
 
 
  5- 1      (7) 'Policy form' means the form on which the policy is 
  5- 2      delivered or issued for delivery by the issuer. 
 
  5- 3      (8) 'Secretary' means the secretary of the United States 
  5- 4      Department of Health and Human Services." 
 
  5- 5                           SECTION 2. 
 
  5- 6  Said chapter is further amended by striking subsection (a) 
  5- 7  of Code Section 33-43-2, relating to applicability of 
  5- 8  chapter, and inserting in lieu thereof the following: 
 
  5- 9    "(a) Except as otherwise specifically provided, this 
  5-10    chapter shall apply to: 
 
  5-11      (1) All medicare supplement policies delivered or issued 
  5-12      for delivery in this state on or after April 28, 1996 
  5-13      the effective date of this Act; and 
 
  5-14      (2) All certificates issued under group medicare 
  5-15      supplement policies, which certificates have been 
  5-16      delivered or issued for delivery in this state." 
 
  5-17                           SECTION 3. 
 
  5-18  This Act shall become effective upon its approval by the 
  5-19  Governor or upon its becoming law without such approval. 
 
  5-20                           SECTION 4. 
 
  5-21  All laws and parts of laws in conflict with this Act are 
  5-22  repealed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                 -5-