Rule 120-2-67-.05 - Preexisting ConditionsGroup health insurance policies subject to O.C.G.A. § 33-30-15 and this Regulation Chapter shall not include a limitation for preexisting conditions for individuals without previous creditable coverage in excess of twelve (12) months following the eligibility date of a newly eligible insured's coverage or the first day of any applicable waiting period, whichever is earlier, and eighteen (18) months following the effective date of coverage for late enrollees. Limitations on coverage include any form of exclusion rider or waiver for preexisting conditions. Conditions pertaining to preexisting limitations are as follows:
(a) The time period applicable to preexisting condition limitations under the new group health insurance benefit plan shall be reduced by the amount of time any newly eligible insured was previously covered by creditable coverage, or a combination of creditable coverages not separated by any gap in coverage greater than 90 days;(b) If an insured was covered under prior creditable coverage, or a combination of creditable coverages, for twelve (12) months when first eligible, or eighteen (18) months if a late enrollee, no preexisting conditions limitation or exclusion period shall be applicable to any preexisting condition under the group health insurance benefit plan;(c) An insurer may provide a maximum limitation of less than twelve months for preexisting conditions;(d) Any preexisting exclusion or limitation must run concurrently with any applicable waiting period; and(e) No preexisting condition exclusion or limitation may be placed on a newborn child or newly adopted child, if that child is enrolled within thirty (30) days following the date of birth, adoption, placement for adoption, or within thirty-one (31) days following such dates if dependent or family coverage was not previously elected or payment of additional specific premium is required to provide coverage for the child.Ga. Comp. R. & Regs. R. 120-2-67-.05
O.C.G.A. Secs. 33-2-9, 33-24-22, 33-30-15.
Original Rule entitled "Preexisting Conditions" adopted. F. Feb. 29, 1996; eff. Mar. 20, 1996.Amended: ER 120-2-67-0.7 adopted F. and eff. November 10, 1997, to remain in effect for 120 days or until the effective date of a permanent Rule covering the Same subject matter superseding this ER is adopted, as specified by the Agency.Repealed: Permanent Rule, same title, adopted. F. Feb. 17, 1998; eff. Mar. 9, 1998.