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 120-2-67 - PORTABILITY AND RENEWABILITY › Rule 120-2-67-.09 - Renewability and Modification of Coverage under Group Health Insurance

Current through Rules and Regulations filed through June 27, 2024
(a) On and after
				July 1, 1997, all insurers which issue, issue for delivery, deliver, or renew
				existing group policies, certificates, or contracts of health insurance in the
				State of Georgia shall renew or continue such coverage at the option of the
				policyholders.
(b) Notwithstanding
				paragraph (a), an insurer may cancel or nonrenew coverage in the following
				instances:
(1) The policyholder has failed to
				pay premiums or contributions in accordance with the terms of the group health
				insurance policy or contract, including any timeliness requirements, subject to
				applicable State law;
(2) The
				policyholder has performed an act or practice that constitutes fraud or
				intentional misrepresentation of material fact in applying for or procuring
				coverage under the terms of the group health insurance policy or
				contract;
(3) The policyholder has
				violated an insurer's minimum employer contribution or group participation
				rules, provided that the insurer submits written notice to each affected
				policyholder and provides each policyholder sixty (60) days in which to bring
				the group into compliance prior to cancellation;
(4) None of the policyholder's employees,
				group members, or enrollees live, reside, or work in the service area of the
				provider network, only if the group policy or contract is issued by a health
				maintenance organization or a provider-sponsored health care corporation,
				unless there is at least one insured employee, group member, or enrollee who
				has agreed to return to the service area of a health maintenance organization
				in accordance with the Rules and Regulations of the Office of Commissioner of
				Insurance
				120-2-33-.06(5).
(5) An insurer terminates, cancels, or does
				not renew all coverage under a particular policy form, provided that:
(A) the insurer provides at least ninety (90)
				days notice prior to the termination of the policy form to all policyholders
				and certificate holders;
(B) for a
				policy form used by small employers, the insurer offers to such small employer
				policyholders the option to purchase all other group policies from the insurer
				currently being offered to or renewed by small employers in this State for
				which the small employer policyholders would otherwise be eligible;
(C) for a policy form used by large
				employers, the insurer offers to such large employer policyholders the option
				to purchase any other group policy from the insurer currently being offered to
				or renewed by a large employer in this State; and
(D) the insurer acts uniformly without regard
				to the claims experience of any or all policyholders, covered employers, or any
				healthstatus related factor relating to any enrollees or other eligibles
				covered by or eligible for coverage under the policy.
(6) An insurer discontinues offering and
				terminates, cancels, or does not renew all coverage in either the small
				employer market or the large employer market, or both, provided that:
(A) the insurer provides at least 180 days
				notice prior to the discontinuance or nonrenewal of a policy or contract to all
				policyholders and certificate holders,
(B) the insurer provides at least 180 days
				notice to the Commissioner prior to the earliest date of termination or
				non-renewal related to the discontinuation in the market and indicates in such
				notice the date described in subparagraph (6)(C), and
(C) the insurer does not issue coverage in
				such market for five (5) years beginning with the date of the last health
				insurance policy or contract in that market not renewed.
(7) An employer ceases membership in an
				association through which health insurance coverage is issued, provided that
				the insurer was still issuing coverage through that association, or the
				association was still making such coverage available, and the coverage
				cancellation or non-renewal is uniform without regard to any health status
				related factor relating to any insured. If the association ceases to make
				coverage available under any health insurance policy or contract, or ceases to
				exist, employers covered under such association policies shall be considered
				policyholders and shall be guaranteed renewability by the insurer.