Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-99 - SALE OF INDIVIDUAL HEALTH INSURANCE PRODUCTS APPROVED IN OTHER STATES › Rule 120-2-99-.04 - Required Disclosures

Current through Rules and Regulations filed through June 27, 2024
(1) Each policy application for a product
				offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall contain
				the following language in boldface type at the beginning of the
				document:
"The benefits of this policy may primarily be governed
				  by the laws of a state other than Georgia; therefore, all of the laws
				  applicable to policies filed in this state may not apply to this policy. Any
				  purchase of individual health insurance should be considered carefully since
				  future medical conditions may make it impossible to qualify for another
				  individual health insurance policy."
(2) Each delivered policy must contain the
				following language in boldface type at the beginning of the document:
"The benefits of this policy providing your coverage
				  may be governed primarily by the laws of a state other than Georgia. The
				  benefits covered may be different from other policies you can purchase. Please
				  consult your insurance agent or insurer to determine which health benefits are
				  covered under this policy."
(3) Each policy offered or sold pursuant to
				Article 3 of Chapter 29A of Title 33 shall also contain the following standard
				forms for the disclosure and comparison of benefits.
(a)
[INSURER NAME AND ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section
				  33-29A-35)
Georgia Benefits Definitions vs. Non-Georgia Based
				  Product Definitions
Georgia Defined Term and
								Definition
[Non-Georgia
								Product]
Defined Term and
								Definition
(b)
[INSURER NAME, ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section
				  33-29A-35)
Georgia Benefits Definitions vs. This Non-Georgia based
				  Product Definitions
Georgia
Mandated Benefit
Georgia Citation
Mandate or
Mandated Offer
								or
Qualifications
[Non-Georgia
								Product]
Does This Individual Policy
								Cover this benefit? (reference page and section in policy)
Asthma; Prescription Inhalers
33-24-59.8
Mandated behavior in RX plans
Autism; non-discrimination in products covering
								neurological disorders
33-24-59.10
Mandate (subject to policy benefits, limitations
								consistent with other neurological disorders)
Bone Marrow Transplants for treatment of breast
								cancer, Hodgkins Disease
33-29-3.3
Mandated Offer in Major Medical Plans
Bone Mass Measurement
31-15A
Mandated Offer
(availability)
Breast Cancer Patient Care; Mastectomies
33-24-70-72
Mandate for policies covering surgery,
								mastectomies
Child Cancer Clinical Trials
33-24-59.1
Mandate
Child Deliveries
(48 / 96 hour hospital stay)
33-24-58.2
Mandated Benefit for policies covering maternity
								benefits; Notice requirement on insurers 30 days after insurer learns covered
								person is pregnant, added in 2002.
Child Wellness to age 5
33-29-3.4
Mandate
Chlamydia Screening to certain females, ages
31-14-4.1
Mandate
Colorectal Cancer Screening
Colorectal Cancer Screening (continued)
33-24-56.3
Mandates coverage for Colorectal Cancer Screening,
								exams, lab tests, along guidelines of American Cancer Society, American College
								of Gastroenterology & American College of Radiology. Exceptions are limited
								policies.
Dental; General Anesthesia
33-24-28.4
Mandate
Dermatologist Direct Access
33-24-56
Mandates Access (subject to policy benefits)
Diabetes Outpatient Self Management Training,
								Equipment
33-24-59.2
Mandate for Major Medical Policies, Managed,
								Capitated plans
Human Heart Transplants
33-29-3.1
Mandated Offer
(make available on major med plans)
Mammograms, PAP
Smears, PSA Test
33-29-3.2
Mandate
Mental Disorders
33-24-28.1
Mandated Offer
(make available)
Morbid Obesity
33-24-59.7
Mandated Offer (Georgia policy "may" cover)
OB / GYN
Direct Access
33-24-59
Mandates Access
(subject to policy benefits)
Off-Label Prescription Drugs for insureds with
								life-threatening or chronic and disabling conditions
33-24-59.11
Mandate (subject to certain conditions and prior
								authorization of insurer)
Ovarian Cancer; Surveillance Tests for women at
								risk
33-24-56.2
Mandates Coverage for certain women over age 35
								(subject to same deductibles, coinsurance as other benefits)
Pregnancy, Complications of
33-24-24
Mandate for Major Medical
Prescription Contraceptives
33-24-59.6
Mandate for RX plans
TMJ
33-29-20
Mandate