Ga. Comp. R. & Regs. 120-2-101-.06
Insurers that are active in the individual health insurance market in Georgia in 2013 and comply with requirements to make child-only health products available shall report as required in O.C.G.A. §33-29B-7 by March 1, 2014.
The report submitted on March 1, 2014 for the child-only 2013 coverage program shall include this information and follow this reporting format:
2013 Georgia Child-Only Individual Health Insurance Program Report
Name of Insurer: ________________________ NAIC# ___________
Total Number of Applicants that applied during Open Enrollment Period | Number of Applicants that enrolled during Open Enrollment Period | Number of Applicants that were declined during Open Enrollment Period | Reason(s) for Denial of Applicants |
(Include limited identifying details for each applicant case so denied, respecting potential privacy concerns) |
Contact Person preparing this Report: _______________________Ph: _______________
Email: ___________________________
Certification by Responsible Officer of the Insurer:
I hereby affirm that the information included in this report of 2013 activities of the company is correct and complete.
Signed: _________________________________
Printed Name: ___________________________ Title: : ________________________
Date: __________________________________
Ga. Comp. R. & Regs. R. 120-2-101-.06