Ga. Comp. R. & Regs. R. 120-2-81-.10 - Eligibility for Benefits; Time Limit for Application

(1) Coverage issued through the assignment system shall cover the qualifying eligible individual and any eligible dependents if coverage for all such individuals is elected pursuant to application as provided for in this Regulation Chapter.

(2) A qualifying eligible individual or a spouse or former spouse who is an eligible dependent shall have a choice of individual coverage or family coverage to include any or all eligible dependents.

(3) An election of assignment system coverage by a qualifying eligible individual shall be deemed to be an election on behalf of any eligible dependents covered under the qualifying eligible individual's continuation coverage, unless the application indicates an election of the qualifying eligible individual otherwise. Election shall not be contingent on identical election of any other family member with regard to individual or family coverage.

(4) The Commissioner or administrator may at any time request additional information from the applicant for initial review of eligibility, and may delegate any part of the eligibility review and solicitation of additional information to health insurers and managed care organizations participating in GHIAS or GHBAS. The qualifying eligible individual must comply with a request for additional information and verification of eligibility to the fullest extent possible. Health insurers and managed care organizations are subject to the provisions of the Rules and Regulations of the Office of Commissioner of Insurance § 120-2-67-.12 with regard to accepting attestations and other evidence of coverage during verification if a certification of creditable coverage is not available.

(5) A substantially completed application for coverage under the assignment system shall be filed with the Commissioner or the delegated administrator not later than sixty-three (63) consecutive days after a qualifying event. Such filing shall toll the sixty-three (63) consecutive day election period for the qualifying eligible individual and all other eligible dependents for whom coverage is elected, provided that eligibility is ultimately verified and initial premium is paid.

(6) Notwithstanding paragraph (5), qualified eligible individuals with qualifying events on or after October 30, 1997, but before January 1, 1998, may file a substantially completed application no later than March 3, 1998.

Notes

Ga. Comp. R. & Regs. R. 120-2-81-.10

O.C.G.A. Secs. 33-2-9, 33-29A-1, et seq.

ER. 120-2-81-0.8 adopted. F. Dec. 31, 1997; eff. Jan. 2, 1998, to remain in effect for a period of 120 days or until the effective date of a permanent Rule covering the same subject matter superseding the ER, is adopted, as specified by the Agency. Amended: Permanent Rule entitled "Eligibility for Benefits; Time Limit for Application" adopted. F. Apr. 29, 1998; eff. May 19, 1998.