Rule 120-2-104-.03 - Individual Accident and Sickness Policies(a) Notice of any premium increase shall be mailed or delivered to each holder of an individual accident and sickness insurance policy not less than 60 days prior to the effective date of such increase.(b) Concurrently with any notice of premium increase or offer of new coverage because of discontinuance or termination of an existing plan of coverage, an insurer shall provide an estimate as to the amount or percentage of any premium increase which is attributable to the PPACA. Such notices shall include the following statement: "These increases are due to the federal Patient Protection and Affordable Care Act and not the enactment of any laws or regulations of the Governor of Georgia, the Georgia General Assembly, or the Georgia Department of Insurance."(c) When determining estimates of the amount or percentage of premium increases which are attributable to the PPACA, insurers must analyze the following and may include additional relevant factors:(1) The new taxes and fees imposed under PPACA;(2) Policies being guaranteed issue with modified community rating;(3) The Essential Health Benefits;(4) The age rating bands; (5) The effect of a 70% actuarial value (out-of-pocket limit impact factored);(6) The impact of the individual mandate on the risk pool;(7) The impact of subsidies on the risk pool; and(8) The impact of the risk adjustment and reinsurance mechanisms in PPACA.(d) Each insurer shall perform an analysis of rate impact upon comprehensive or major medical health coverage according to the following conditions: (1) Each insurer shall estimate the average premium impact upon a 21 year old, 40 year old, and 60 year old male and female; and (2) When determining the average premium impact on each of the individuals listed in subparagraph (1) of paragraph (d), an insurer may use as a basis: (i) A product similar to the one owned by the recipient of the notice;(ii) Each type of product sold by the company in the individual market; or(iii) The most common policy sold in the individual market.(e) Each disclosure shall be in a form compliant with the following conditions:(1) An itemized estimate is not required for each factor listed in subparagraphs (1) through (8) of paragraph (c). However, each estimate shall, at a minimum, incorporate the applicable factors listed in that section; (2) A notice may show an estimate for each average individual in subparagraph (1) of paragraph (d) or it may include only the age range closest to the recipient; (3) Each estimate may be displayed in a range based upon the company's estimates; and(4) A notice may use as a basis a product identified by items (i), (ii), or (iii) of subparagraph (2) of paragraph (d) provided that:(i) If a notice uses as a basis the products identified by item (ii) of subparagraph (2) of paragraph (d), then an estimate must be provided for each of those products; and(ii) If a notice uses as a basis the products identified by item (iii) of subparagraph (2) of paragraph (d), then such notice shall include a web address where the recipient can go to the insurer's website to view the disclosure information for each product listed in item (ii) subparagraph (2) of paragraph (d).Ga. Comp. R. & Regs. R. 120-2-104-.03
O.C.G.A. Sections 33-2-9 and 33-29-22.
Original Rule entitled "Individual Accident and Sickness Policies" adopted. F. Sep. 6, 2013; eff. Sept. 26, 2013.