Rule 120-2-67-.08 - Special Enrollment(a) Individuals who decline group health insurance coverage when first eligible and satisfy subparagraphs (1) or (2) shall be considered newly eligible employees and not late enrollees, and must be offered coverage under the group policy or contract as newly eligible employees in accordance with paragraph (b), if such eligible individuals elect to enroll within the specified period in each subparagraph. Such individuals are:(1) Existing employees or group members, and existing dependents of such existing employees or group members, who declines coverage when first eligible or when first offered because of coverage under other creditable coverage, provided that: (A) the employee or group member stated in writing that existing creditable coverage was the reason for the employee, group member, or dependent declining enrollment, but only if such statement is required by the insurer, and the insurer has provided the employee or group member notice of such a requirement at the time of declination and included in such notice the consequences of not making a statement;(B)(i) federal or state continuation coverage has been exhausted; or(ii) other coverage unrelated to continuation has terminated as a result of loss of eligibility for such other coverage under the terms of that coverage or; (iii) contributions for such other coverage from a former or current employer have terminated;(C) such other creditable coverage was not terminated in accordance with the Rules and Regulations of the Office of Commissioner of Insurance Rule 120-2-67-.10(b)(2) or for failure of the employee, group member, or dependent to pay premiums or contributions on a timely basis in accordance with the terms of coverage and the Georgia Insurance Code or the Rules and Regulations of the Office of Commissioner of Insurance; and(D) the employee or group member requests enrollment for the employee or group member and/or dependents not later than thirty (30) days after the effective date of the event described in subparagraph (B).(2) Any of the following as a result of marriage, birth, adoption or placement for adoption: (A) the employee or group member, if not enrolled under the group policy as a result of declining coverage when first eligible;(B) the spouse of an employee or group member, provided the employee or group member is covered or elects coverage with the spouse; or(C) the dependent or dependents of an employee or group member, provided the employee or group member is covered or elects coverage with the dependent or dependents.(3) Coverage must be elected for any individual or individuals specified in paragraph (2) no later than thirty (30) days after the date of marriage, birth, adoption or placement for adoption, or, only for newborns or adopted children, thirty-one (31) days after the date of birth, adoption or placement for adoption if dependent or family coverage was not previously elected or payment of additional specific premium is required to provide coverage for such children.(4) Coverage must be elected no later than thirty (30) days after a group policy is modified to make dependent coverage available for all employees or group members.(b) Special enrollment date is to be determined as follows:(1) In the event an employee, group member, or dependent becomes eligible in accordance with paragraph (a)(1) of this Rule, enrollment must become effective no later than the first day of the first calendar month after the date the completed request for enrollment is received by the insurer.(2) In the event an employee, group member, or dependent becomes eligible in accordance with subparagraph (a)(2) of this Rule, enrollment must become effective on the date of birth, adoption or placement for adoption, or in the case of marriage, no later than the first day of the first calendar month after the date the completed request for enrollment is received.Ga. Comp. R. & Regs. R. 120-2-67-.08
O.C.G.A. Sec. 33-2-9, 33-24-22, 33-30-15.
Original Rule entitled "Reporting Requirements" 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 entitled "Special Enrollment" adopted. F. Feb. 17, 1998; eff. Mar. 9, 1998.