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-.10 - Renewability and Modification of Coverage under Individual 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 individual policies or contracts of health insurance in the State of
				Georgia shall renew or continue such coverage at the option of the
				insured.
(b) Notwithstanding
				paragraph (a), an insurer may cancel or nonrenew coverage only in the following
				instances:
(1) The insured has failed to pay
				premiums in accordance with the terms of the individual health insurance policy
				or contract, including any timeliness requirements, subject to applicable State
				law;
(2) The insured has performed
				an act or practice that constitutes fraud or intentional misrepresentation of
				material fact in applying for or procuring coverage, subject to the time limit
				specified in O.C.G.A. §
										33-29-3(b)(2)(A);
				or
(3) Subject to the Rules and
				Regulations of the Office of Commissioner of Insurance Rule
				120-2-33-.06(6),
				the insured no longer lives, resides, or works in the service area of the
				network if the individual policy or contract is issued by a health maintenance
				organization or a provider-sponsored health care corporation, but only if
				coverage is canceled or non-renewed uniformly without regard to any health
				status related factor of the insureds.
(4) 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 discontinuance of the policy form to all insured and
				to the Commissioner;
(B) the
				insurer offers to such insured all other individual policies currently being
				offered or renewed by the insurer in this State for which the insured are
				otherwise eligible without regard to any health status related factor;
				and
(C) the insurer acts uniformly
				without regard to the claims experience or any health-status related factor of
				individuals insured or eligible to be insured.
(5) An insurer discontinues offering and
				terminates, cancels, or does not renew all coverage under all policy forms in
				the individual market, provided that:
(A) the
				insurer provides at least 180 days notice prior to the discontinuance or
				nonrenewal of a policy or contract to all insured under that policy or
				contract;
(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 (5)(C);
(C) the insurer does not issue coverage in
				such market for 5 years beginning with the date of the last health insurance
				policy or contract in that market not renewed; and
(D) the insurer acts uniformly without regard
				to the claims experience or any health status related factor of individuals
				insured or eligible to be insured.
(6) An insured 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, individuals insured under such association policies shall be guaranteed
				renewability by the insurer.