Group health insurance policies subject to O.C.G.A. ยง
33-30-15 and this Regulation
Chapter shall not include a limitation for preexisting conditions for
individuals without previous creditable coverage in excess of twelve (12)
months following the eligibility date of a newly eligible insured's coverage or
the first day of any applicable waiting period, whichever is earlier, and
eighteen (18) months following the effective date of coverage for late
enrollees. Limitations on coverage include any form of exclusion rider or
waiver for preexisting conditions. Conditions pertaining to preexisting
limitations are as follows:
(a) The
time period applicable to preexisting condition limitations under the new group
health insurance benefit plan shall be reduced by the amount of time any newly
eligible insured was previously covered by creditable coverage, or a
combination of creditable coverages not separated by any gap in coverage
greater than 90 days;
(b) If an
insured was covered under prior creditable coverage, or a combination of
creditable coverages, for twelve (12) months when first eligible, or eighteen
(18) months if a late enrollee, no preexisting conditions limitation or
exclusion period shall be applicable to any preexisting condition under the
group health insurance benefit plan;
(c) An insurer may provide a maximum
limitation of less than twelve months for preexisting conditions;
(d) Any preexisting exclusion or limitation
must run concurrently with any applicable waiting period; and
(e) No preexisting condition exclusion or
limitation may be placed on a newborn child or newly adopted child, if that
child is enrolled within thirty (30) days following the date of birth,
adoption, placement for adoption, or within thirty-one (31) days following such
dates if dependent or family coverage was not previously elected or payment of
additional specific premium is required to provide coverage for the
child.
Notes
Ga. Comp. R.
& Regs. R.
120-2-67-.05
O.C.G.A. Secs.
33-2-9,
33-24-22,
33-30-15.
Original Rule entitled
"Preexisting Conditions" adopted. F. Feb. 29,
1996; eff. Mar. 20,
1996.
Amended: 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Repealed: Permanent Rule, same title, adopted. F.
Feb. 17, 1998; eff.
Mar. 9,
1998.
