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03 HB 619/AP
House Bill 619 (AS PASSED HOUSE
AND SENATE)
By: Representatives Harbin of the 80th and Maddox of the 59th, Post 2
By: Representatives Harbin of the 80th and Maddox of the 59th, Post 2
A BILL TO BE
ENTITLED
AN ACT
AN ACT
To amend Title 33 of the Official Code of Georgia Annotated,
relating to insurance, so as to provide for the issuance of group accident and
sickness insurance under a franchise group plan; to provide for definitions; to
provide for conversion, portability, and continuation; to provide for related
matters; to repeal conflicting laws; and for other
purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF
GEORGIA:
SECTION 1.
Title 33 of the Official Code of Georgia Annotated, relating
to insurance, is amended by striking subparagraphs (K) and (L) of paragraph (1)
of subsection (a) of Code Section 33-24-21.1, relating to group accident and
sickness contracts, and inserting in lieu thereof new subparagraphs (K), (L),
and (M) to read as
follows:
"(K) A public health plan;or
(L) A Peace Corps Act health benefit plan; or
(M) A franchise group plan policy or certificate of coverage issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1."
"(K) A public health plan;
(L) A Peace Corps Act health benefit plan; or
(M) A franchise group plan policy or certificate of coverage issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1."
SECTION 2.
Said title is further amended by adding a new subsection (c)
to Code Section 33-30-1, relating to definitions of group accident and sickness
insurance, to read as
follows:
"(c)(1) As used in this subsection, the term:
(A) 'Franchise association' means an association that is made up of individual members and that:
(i) Has been actively in existence for at least three years;
(ii) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(iii) Does not condition membership in the association on any health status related factor relating to an individual member;
(iv) Allows any member of the association to apply for insurance offered through the association with the understanding that the insurer makes the determination as to acceptability for coverage based upon the insurer´s underwriting criteria; and
(v) Does not make health insurance coverage offered through the association available other than in connection with membership in the association.
(B) 'Franchise group plan' means a form of group accident and sickness insurance whereby an insurer issues a master policy to a franchise association for the benefit of individual members of such association.
(C) 'Individual member' means only an individual person and his or her dependents and shall in no way be construed to include an employer and its employees or retired employees.
(2) The insurer issuing a franchise group plan may, but shall not be required to, individually underwrite each individual applicant who is a member of the franchise association and who applies for coverage under the plan.
(3) The premium for such coverage shall be paid by the individual directly to the insurer and shall not be paid, directly or indirectly, by the employer of an individual member.
(4) Coverage under the group franchise plan shall be deemed creditable coverage for the purposes of the federal Health Insurance Portability and Accountability Act of 1996 and for purposes relating to conversions under Code Section 33-24-21.1 and relating to portability and continuation under Code Section 33-30-15.
(5) The insurer may issue individual policies to each member or may issue individual certificates of coverage. If an individual certificate of coverage is issued, the insurer also must provide a complete copy of the group policy to the individual member upon request of such member."
"(c)(1) As used in this subsection, the term:
(A) 'Franchise association' means an association that is made up of individual members and that:
(i) Has been actively in existence for at least three years;
(ii) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(iii) Does not condition membership in the association on any health status related factor relating to an individual member;
(iv) Allows any member of the association to apply for insurance offered through the association with the understanding that the insurer makes the determination as to acceptability for coverage based upon the insurer´s underwriting criteria; and
(v) Does not make health insurance coverage offered through the association available other than in connection with membership in the association.
(B) 'Franchise group plan' means a form of group accident and sickness insurance whereby an insurer issues a master policy to a franchise association for the benefit of individual members of such association.
(C) 'Individual member' means only an individual person and his or her dependents and shall in no way be construed to include an employer and its employees or retired employees.
(2) The insurer issuing a franchise group plan may, but shall not be required to, individually underwrite each individual applicant who is a member of the franchise association and who applies for coverage under the plan.
(3) The premium for such coverage shall be paid by the individual directly to the insurer and shall not be paid, directly or indirectly, by the employer of an individual member.
(4) Coverage under the group franchise plan shall be deemed creditable coverage for the purposes of the federal Health Insurance Portability and Accountability Act of 1996 and for purposes relating to conversions under Code Section 33-24-21.1 and relating to portability and continuation under Code Section 33-30-15.
(5) The insurer may issue individual policies to each member or may issue individual certificates of coverage. If an individual certificate of coverage is issued, the insurer also must provide a complete copy of the group policy to the individual member upon request of such member."
SECTION 3.
Said title is further amended by adding a new Code Section
33-30-1.2 to read as
follows:
"33-30-1.2.
Any franchise group plan issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1 shall comply with the following written disclosures that must be made to individuals at the time of solicitation for the sale of insurance and upon application for such insurance:
(1) That membership in the association will allow such individual to apply for insurance but that the insurer will make the determination as to acceptability for coverage based upon the insurer´s underwriting criteria;
(2) That insurance may not be offered to an association member if such member does not satisfy the insurer´s underwriting criteria or insurance may be offered at a higher rate; and
(3) That rates for franchise association business are not regulated in Georgia and, therefore, may be subject to unregulated increases upon renewal."
"33-30-1.2.
Any franchise group plan issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1 shall comply with the following written disclosures that must be made to individuals at the time of solicitation for the sale of insurance and upon application for such insurance:
(1) That membership in the association will allow such individual to apply for insurance but that the insurer will make the determination as to acceptability for coverage based upon the insurer´s underwriting criteria;
(2) That insurance may not be offered to an association member if such member does not satisfy the insurer´s underwriting criteria or insurance may be offered at a higher rate; and
(3) That rates for franchise association business are not regulated in Georgia and, therefore, may be subject to unregulated increases upon renewal."
SECTION 4.
Said title is further amended by striking subparagraphs (K)
and (L) of paragraph (2) of subsection (a) of Code Section 33-30-15, relating to
continuation of similar coverage, and inserting in lieu thereof new
subparagraphs (K), (L), and (M) to read as
follows:
"(K) A public health plan;or
(L) A Peace Corps Act health benefit plan; or
(M) A franchise group plan policy or certificate of coverage issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1."
"(K) A public health plan;
(L) A Peace Corps Act health benefit plan; or
(M) A franchise group plan policy or certificate of coverage issued on an individual basis to a member of a franchise association pursuant to the provisions of subsection (c) of Code Section 33-30-1."
SECTION 5.
All laws and parts of laws in conflict with this Act are
repealed.