10 LC 28
5059
Senate
Bill 408
By:
Senators Hill of the 32nd, Smith of the 52nd, Thomas of the 54th, Rogers of the
21st, Hawkins of the 49th and others
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 definitions; to provide for small employer health group
cooperatives; to provide for the requirements, powers, duties, and restrictions
of a small employer health group cooperative; to provide for certain reports; 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 adding a new chapter to read as follows:
"CHAPTER
30C
33-30C-1.
As
used in this chapter, the term:
(1)
'Health group cooperative' or 'cooperative' means a private purchasing
cooperative composed of small employers formed under this chapter.
(2)
'Health status related factor' means any of the following factors in relation to
the individual or dependent of the individual: health status; medical condition,
including both physical and mental illnesses; claims experience; receipt of
health care; medical history; genetic information; evidence of insurability,
including conditions arising out of acts of domestic violence; or
disability.
(3)
'Small employer' means, in connection with a health insurance plan with respect
to a calendar year and a plan year, any person, firm, corporation, partnership,
association, or employer, as defined in Section 3(5) of the federal Employee
Retirement Income Security Act of 1974, that is actively engaged in business
that, on at least 50 percent of its working days during the preceding calendar
year, employed no more than 50 eligible employees or employed an average of not
more than 50 employees on business days during the preceding calendar year and
that employs at least one employee on the first day of the plan year. In
determining the number of eligible employees, companies that are affiliated
companies or that are eligible to file a combined tax return for purposes of
state taxation or that are treated as a single employer under subsection (b),
(c), (m), or (o) of Section 414 of the federal Internal Revenue Code of
1986 are considered one employer. In the case of an employer which was not in
existence throughout the preceding calendar year, the determination of whether
that employer is a small or large employer shall be based on the average number
of employees that it reasonably is expected to employ on business days in the
current calendar year. Any reference in this chapter to an employer includes a
reference to any predecessor of the employer.
(4)
'Small employer insurer' means an insurer that offers health insurance plans
covering eligible employees of one or more small employers in this
state.
33-30C-2.
(a)
A health group cooperative of small employers may be formed only for the purpose
of obtaining insurance.
(b)
A health group cooperative shall:
(1)
Contain at least 1,000 eligible employees or shall have at least ten
participating employers;
(2)
Establish requirements for membership. A small employer's participation in a
cooperative shall be voluntary, but an employer electing to participate in a
cooperative shall commit to purchasing coverage through the cooperative for five
years, unless allowed to terminate because of a financial hardship affecting the
employer as determined by rules governing termination adopted by the
Commissioner. The health group cooperative shall not exclude a small employer
which otherwise meets the requirements for membership on the basis of claim
experience or a health status related factor in relation to an employee or a
dependent of an employee;
(3)
Hold an open enrollment period at least once per year during which new members
may join the health group cooperative;
(4)
Allow eligible employees and their dependents, upon initial enrollment and
during subsequent open enrollment periods, to choose among health insurance
plans offered through the cooperative. A person covered by a health insurance
plan which requires an enrollment period in excess of one year offered through
the cooperative shall be eligible to choose among available plans upon the
completion of the enrollment period;
(5)
Offer coverage under all plans offered through the cooperative to all eligible
employees of member small employers and their dependents. Coverage must be
offered to all employees of member small employers and their dependents;
provided, however, that late enrollees may be excluded from coverage for the
greater of 18 months or an 18 month preexisting condition exclusion,
provided that, if both a period of exclusion from coverage and a preexisting
condition exclusion are applicable to a late enrollee, the combined period shall
not exceed 18 months;
(6)
Not assume any risk or form self-insurance plans among its members;
and
(7)
Have the option of using any type of rating arrangement with the health
insurance plans and, at its discretion, premiums may be paid to the health
insurance plans by the cooperative, by member small employers, or by eligible
employees and their dependents.
(c)(1)
The health group cooperative, before offering any health insurance plan through
the cooperative, and annually after that time, shall register with the
department and demonstrate continued compliance with the provisions of paragraph
(2) of this subsection.
(2)
The health group cooperative shall be organized as a nonprofit corporation and
have the rights and duties pursuant to the provisions of Chapter 3 of Title 14.
On receipt of a certificate of incorporation from the Secretary of State, the
cooperative shall file written notification of the receipt of the certificate
and a copy of the cooperative's organizational documents with the Commissioner.
The board of directors shall file annually with the Commissioner a statement of
all amounts collected and expenses incurred for the preceding year.
(d)(1)
A health group cooperative or a member of the board of directors, the executive
director, an employee, or an agent of a cooperative, shall not be liable
for:
(A)
An act performed in good faith in the execution of duties in connection with the
cooperative; or
(B)
An independent action of a small employer insurer or a person who provides
health care services under a health insurance plan.
(2)
A health group cooperative or a member of the board of directors, the executive
director, an employee, or an agent of the cooperative shall not be liable for
failure to arrange for coverage of a particular illness, disease, or health
condition.
(e)
A small employer insurer shall not form, or be a member of, a health group
cooperative. An insurer may associate with a sponsoring entity, such as a
business association, chamber of commerce, or other organization representing
employers or serving an analogous function, to assist the sponsoring entity in
forming a health group cooperative.
33-30C-3.
A
health group cooperative shall:
(1)
Arrange for group health insurance plan coverage for small employers that are
members of the cooperative by contracting with small employer insurers that meet
the criteria established by this chapter for coverage under group health
insurance plans;
(2)
Collect premiums to cover the cost of:
(A)
Group health insurance plan coverage purchased through the cooperative;
and
(B)
The cooperative's administrative expenses;
(3)
Be authorized to contract with agents to market coverage issued through the
cooperative;
(4)
Establish administrative and accounting procedures for the operation of the
cooperative;
(5)
Establish procedures under which an applicant for or participant in coverage
issued through the cooperative may have a grievance reviewed by an impartial
person;
(6)
Be authorized to contract with a small employer insurer or third-party
administrator to provide administrative services to the
cooperative;
(7)
Contract with small employer insurers for the provision of services to small
employers covered through the cooperative;
(8)
Develop and implement a plan to maintain public awareness of the cooperative and
publicize the eligibility requirements and the procedures for enrollment in
coverage through the cooperative;
(9)
Be authorized to negotiate the premiums paid by its members; and
(10)
Be authorized to offer other ancillary products and services to its members as
are customarily offered in conjunction with group health insurance
plans.
33-30C-4.
(a)
A health group cooperative shall contract only with a small employer insurer
that demonstrates:
(1)
That the insurer or health maintenance organization is licensed and in good
standing with the Department of Insurance;
(2)
The capacity to administer the group health insurance plans;
(3)
The ability to monitor and evaluate the quality and cost effectiveness of care
and applicable procedures;
(4)
The ability to conduct utilization management and applicable procedures and
policies;
(5)
The ability to assure enrollees a sufficient number of health care providers,
including specialty providers; and
(6)
A satisfactory grievance procedure and the ability to respond to enrollees'
calls, questions, and complaints.
(b)
A health group cooperative shall comply with federal laws applicable to
cooperatives and group health insurance plans issued through cooperatives to the
extent required by this title or rules and regulations adopted pursuant to this
title.
33-30C-5.
The
Department of Insurance shall submit to the Governor and the General Assembly by
January 1, 2011, a report on the effectiveness of the health group cooperative
in expanding the availability of health insurance coverage for small
employers."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.