Rule 120-2-67-.13 - Prohibitions on Use of Health Status; Rating(a) Except for the use of preexisting condition exclusions as permitted by this Regulation Chapter, no insurer may inpose a limitation of benefits on, or impose or condition the length of any waiting period on, or condition rules for eligibility, late, or special enrollment for, or decline any employee or group member, or any dependents of any employee or group member, for coverage under a group health insurance policy or contract solely on the basis of any of the following health status related factors:(2) medical condition or history;(4) receipt of health care;(6) evidence of insurability (such as consideration of an avocational factor or conditions arising out of acts of domestic violence); or(b) No insurer may impose a rating methodology which requires an individual employee, group member, or dependent of an employee or group member covered by a group health insurance policy or contract to pay a higher premium than other group members solely on the basis of any health status related factor relating to that employee, group member, or dependent of an employee or group member, except that insurers shall be allowed to offer premium reductions or discounts for legitimate disease prevention or health promotion programs.(c) Nothing in this section shall be construed to require insurers to accept late enrollees for coverage under a group policy, provided that an insurer may not establish terms for late enrollment based on any health status related factor. Nothing in this Regulation Chapter shall be construed to prevent an insurer from permitting late enrollees only during an annual or other periodic open enrollment period in accordance with the terms of the group health insurance policy or contract.(d) At any time during the first policy year, or the renewal period during which this Regulation Chapter becomes effective, employees, group members, or dependents of employees or group members who are otherwise eligible for coverage under the terms of the group health insurance plan but were previously declined coverage upon application when first eligible to enroll based on any health status related factor must be offered an opportunity to enroll in the group health insurance policy or contract. If an insurer does not have a record of denials under its term of coverage for a group, the insurer must accept all reasonable forms of proof submitted by such employees, group members, or dependents for whom records are unavailable. An insurer may verify denials with a policyholder, but must provide prior notice to a policyholder of its intention to offer coverage to declined employees, group members, and dependents during a specified period of enrollment. If such employees, group members, or dependents decline coverage that is offered as required in this paragraph, they may be considered late enrollees for the purposes of this Regulation Chapter.(e) An insurer replacing health insurance coverage for a group must count all previous creditable coverage under the prior insurer and any other previous creditable coverage against any preexisting condition limitations imposed by the succeeding insurer upon group members as required by this Regulation Chapter.Ga. Comp. R. & Regs. R. 120-2-67-.13
O.C.G.A. Sec. 33-2-9, 33-30-15.
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 "Prohibitions on Use of Health Status; Rating" adopted. F. Feb. 17, 1998; eff. Mar. 9, 1998.