Ga. Comp. R. & Regs. R. 120-2-8-.11 - Open Enrollment

(1) An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant in the case of an application for a policy or certificate that is submitted prior to or during the six (6) month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B. Each Medicare supplement policy and certificate currently available from an insurer shall be made available to all applicants who qualify under this subsection.

(2)

(a) If an applicant qualifies under Subsection (1) and submits an application during the time period referenced in Subsection (1) and, as of the date of application, has had a continuous period of creditable coverage of at least six (6) months, the issuer shall not exclude benefits based on a preexisting condition.

(b) If the applicant qualifies under Subsection (1) and submits an application during the time period referenced in Subsection (1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six (6) months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The Secretary shall specify the manner of the reduction under this subsection.

(3) Except as provided in Subsection (2) and Sections 120-2-8-.12 and 120-2-8-.23, Subsection (1) shall not be construed as preventing the exclusion of benefits under a policy, during the first six (6) months, based on a preexisting condition for which the policyholder or certificateholder received treatment or was otherwise diagnosed during the six (6) months before the coverage became effective.

Notes

Ga. Comp. R. & Regs. R. 120-2-8-.11

O.C.G.A. Secs. 33-2-9, 33-43-3 to 33-43-6.

Original Rule entitled "Failure to Comply; Penalties" adopted. F. Oct. 28, 1980; eff. Nov. 17, 1980. Repealed: New Rule entitled "Prohibited Compensation for Replacement with the Same Company" adopted. F. Aug. 24, 1989; eff. Sept. 15, 1989. Repealed: New Rule entitled "Filing Requirements for Out-of-State Group Policies" adopted. F. Sept. 18, 1990; eff. Dec. 1, 1990, as specified by the Agency. Repealed: New Rule entitled "Open Enrollment" adopted. F. July 9, 1992; eff. July 29, 1992. Amended: ER. 120-2-8-0.4-.11 adopted. F. Apr. 30, 1996; eff. Apr. 28, 1996, as specified by the Agency. Amended: Permanent Rule adopted. F. Sept. 6, 1996; eff. Sept. 26, 1996. Repealed: New Rule of same title adopted. F. Apr. 7, 1999; eff. Apr. 27, 1999. Repealed: New Rule of same title adopted. F. Aug. 19, 2005; eff. Sept. 8, 2005. Amended: ER. 120-2-8-0.22-.11 of same title adopted. F. May 29, 2009; eff. June 1, 2009, as specified by the Agency. Amended: Permanent Rule of same title adopted. F. Sept. 3, 2009; eff. Sept. 23, 2009.