Georgia insurance law and regulation
News that affects your health insurance and planning
May 26, 2019 – Status of alternative non-ACA health plans: Georgia does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, permits insurers to sell non-compliant transitional policies in the individual market and does not limit the sale of short-term coverage more strictly than the federal government.
March 19, 2019 – About 15% of Georgia’s residents lack health insurance, according to a new state report.
December 2, 2018 – After a decade of improvement in children’s health coverage rates, the number of uninsured children in Georgia rose last year according to research by Georgetown University Center for Children and Families. Some health authorities are concerned that incoming Governor Kemp is opposed to expanding coverage for low income residents so the number of uninsured children could rise even more. Many of the uninsured children are in the category of “working poor”. Freedom Benefits recommends that employers offer low cost limited benefit coverage to part time workers and their children as the easiest way to address the growing problem.
The history of health care planning in Georgia (Information is outdated and links may be expired)
12/23/2015 500,000 Georgia residents enrolled for 2016 health insurance coverage through the government-run individual insurance exchange. About 8 out of 10 applicants received premium subsidies and most of the enrollees paid less than $75 per month for their coverage after the subsidies. The statistics show that the insurance exchange is more effective for lower income individuals but not so effective in meeting the needs of higher-earning working class residents.12/21/2014 Georgia small buininess owners were featured in a story on NPR about employers dropping coverage at a faster than expected pace. Freedom Benefits recommends that employers pressured to drop health insurance should consider offering supplemental coverage instead that is exempt from ACA rules.
7/1/2014 Georgia Health News reports that UnitedHealthcare, Coventry, Cigna and Time Insurance Company have each submitted plans with the state to offer health insurance in the federally run exchange in Georgia next year. hey join the five holdovers from this year’s exchange that are also submitting rates for review: Alliant Health Plans, Blue Cross and Blue Shield of Georgia, Humana, Kaiser Permanente, and Peach State Health Plans. We do not yet know if the new insurance plans will be available statewide or just in specific regions.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Georgia residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
3/6/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
7/13/2012 Georgia will not move ahead with reform and expansion of Medicaid. Governor Deal hopes that the federal health reform law will be repealed after the November presidential election. The state now covers 1.7 million people under its Medicaid program and yet one in five people do not have health insurance.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 BCBS Healthcare Plan of Georgia is the state’s largest health insurance provider and as such, earns the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
11/7/2011 Georgia opened its Children’s Health Insurance Program (CHIP) to the kids of low-income and part-time state employees, an option that was prohibited until the passage of the 2010 health-care law. The program is jointly financed by the state and the federal government to provide coverage to the uninsured children of families who earn too much to qualify for Medicaid but cannot afford private insurance.
10/17/2011 Georgia state law H 47 enacted 5/13/2011 authorizes health insurance companies to offer “cross-border” or out-of-state individual sickness insurance policies in-state, that have been approved for issuance in other states. Freedom Benefits has endorsed this provision for more than a decade. We hope that Georgia’s progressive leadership is noticed and adapted by other states.
3/8/2011 Georgia is playing “catch-up” with health reform. We expect that the development of a state health insurance exchange will soon be expedited through the use of an executive order by the Governor. Meanwhile, the state will request an exemption from the federal minimum loss ratio rules for its health plans this year. Existing health plans are reported to be unprepared and unable to meet the requirements this year.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
2/3/2011 Georgia is named as one of the states most likely to cut back on Medicaid spending and coverage. The Universal Health Insuranceblog discusses the impact on the state’s commercial insurance consumers.
1/30/2011 Patients with health insurance and a credit card now have access to VIP treatment when care is needed at a hospital emergency room. Emory-Adventist Hospital in Smyrna and North Fulton Hospital in Roswell joined the growing list of hospitals that allows patients to use InQuickER, a reservation system that books appointments and reduces waiting time in the emergency room. The reservation system makes check-in easier by recording your insurance and payment information in advance. The service costs $15 to $25. Of course the nature unpredictable medical emergencies mean that the service cannot absolutely guarantee that you’ll be seen immediately at your appointment time, but you get a full refund if not treated within 15 minutes after arrival. The InQuickER service works in conjunction with any of the private health insurance plans listed here at FreedomBenefits.net but is not available to uninsured patients.
12/26/2010 A summary of research findings of the Georgia State University Center for Health Services Research Institute of Health Administration of the J. Mack Robinson College of Businesses published in “Sources of Health Insurance in Georgia” shows those groups most at risk to be uninsured when affordable health coverage is not available.
12/16/2010 Georgia Governor’s Office of Planning and Budget officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Office of Planning and Budget said that it would: 1) Form an Exchange Work Group to carry out the activities of the Georgia Health Benefit Exchange Feasibility Study. An Exchange Advisory Committee will also be formed with broader representation from key State agencies and stakeholder groups, 2) Gather stakeholder input through an advisory committee, large group meetings to educate and inform stakeholders, focus groups, and web-based surveys. Website and email notices will be used to keep stakeholders and the general public informed, 3) Determine whether or not Georgia should establish an Exchange and the implications of doing so on insurance markets both in Georgia and nationally, and 4) Provide recommendations on governance structure and regulatory changes required to establish as Exchange to decision makers.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Georgia is now available at Freedom Benefits.