Rule 120-2-79-.15 - Choice of Health Benefit Plans; Enrollment(1) A health plan purchasing cooperative shall contract with at least two (2) unaffiliated carriers with Certificates of Authority from the Commissioner for participation in the health plan purchasing cooperative to ensure that employers and enrollees have a choice from among a reasonable number of competing carriers and types of health benefit plans. The Commissioner may, upon a demonstration of good cause by the health plan purchasing cooperative, waive the requirement to have at least two (2) unaffiliated participating carriers throughout any or all portions of the health plan purchasing cooperative's service area.(2) A health plan purchasing cooperative may establish criteria relating to choice of health benefit plans offered by the health plan purchasing cooperative. Provided that the criteria is consistent and uniform with regard to market type, a health plan purchasing cooperative may require each member of a specific market type to choose one plan for all eligible employees, or may permit all eligible employees of all members of a specific market type to choose one plan out of all plans offered by the health plan purchasing cooperative, or may permit any additional limitations by members on employee choice of health benefit plans, provided that such limitations apply consistently to all members in a specific market type without regard to health status related factors.(3) Criteria described in paragraph (2) of this Rule shall include procedures for annual or rolling open enrollment periods in which members or employees may elect to enroll in any health benefit plan available through the health plan purchasing cooperative. Such criteria shall describe enrollment procedures for newly eligible employees and late entrants, and shall demonstrate compliance with Rule 120-2-67 regarding crediting of prior coverage.(4) Health plan purchasing cooperatives, subject to any written agreement with a participating carrier or licensed third-party administrator to the contrary, shall be responsible for the issuance of certifications of creditable coverage pursuant to Rule 120-2-67-.12.Ga. Comp. R. & Regs. R. 120-2-79-.15
O.C.G.A. Secs. 33-2-9, 33-30A-5, 33-30A-9.
Original Rule entitled "Choice of Health Benefit Plans; Enrollment" adopted. F. Feb. 23, 2000; eff. Mar. 14, 2000.