Your Rights under Georgia Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
Individuals, families, self employed and small business owners are having an increasingly difficult time finding health insurance. Those with pre-existing medical conditions have even more difficulty. There are a multitude of companies offering health insurance in most states and people without serious pre-existing health conditions should be able to find a health insurance plan to suit their needs and budget.
In Georgia, as in many other states, your health insurance options are somewhat dependent on your health status. However, your health insurance cannot be canceled in the case of your becoming sick. Most health insurance is guaranteed renewable.
Georgia PeachCare for Kids provides health coverage to low-income Georgia children under the age of 19 who are not eligible for Medicaid and who have limited or no health insurance.
A child whose family has a household income below 235% of the federal poverty level is eligible for Georgia PeachCare for Kids. There is no cost for children under age 5.
PeachCare for Kids health benefits include care from a doctor when your child is sick and preventative services such as immunizations and regular check-ups.
In order to be eligible for the Georgia Cancer Screening Program, you must be a Georgia resident. For the cervical cancer screening, you must be between the ages of 18 and 64, while you must be between the ages of 40 and 64 to be eligible to receive screening for breast cancer. You must also have no or limited health coverage, be ineligible for Medicaid or Medicare, and have an income at or below 200% of the federal poverty level.
Except in the case of conversion policies, individual health insurers in Georgia are free to turn you down because of your health status and other factors. In addition, law does not limit what you can be charged for individual health insurance.
If you move away from Georgia, you may not be able to buy individual health insurance in another state unless you are HIPAA eligible (Health Insurance Portability and Accountability).
If you have recently left coverage under a group health insurance plan and meet other requirements, you may be guaranteed the right to buy a certain type of individual health insurance policy called a conversion policy.
Insurers offering individual health plans are generally limited to a two-year period for pre-existing condition exclusions. Pregnancy may be considered a pre-existing condition in an individual health insurance policy.
For more information, please visit the Georgia Insurance Commission at
Georgia doesn’t have a high risk pool program.
Group Health Insurance:
Georgia Group Health Insurance is for businesses with 2 or more employees, which can include the owner of the business.
Group health insurance is regulated by both the state and federal government. The HIPAA act of 1997 determines eligibility in some cases and provides rules for individuals leaving a group plan. The group plans usually have more benefits than an individual plan because of federal requirements established by ERISA and HIPAA laws.
As long as an employer meets the criteria required by the
Georgia Health Insurance Company, they cannot be turned down for insurance nor can any of the employees be turned down.
Insurance companies can impose a pre-existing medical condition waiting period if the employee was without insurance for more than 63 days prior to enrolling or if the employee did not have insurance for an 18 month period prior to enrolling.
Coverage under your group health plan cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.
If you are HIPAA eligible, (Health Insurance Portability and Accountability), you are eligible to buy an enhanced conversion policy. However, whether your previous group health insurance was fully insured or self-insured will determine which insurer must sell you an enhanced conversion policy.
State Continuation Coverage can help when you are between jobs or waiting for a new health plan to cover you pre-existing condition. There are limits on what you can be charged for this coverage.
If you change jobs, you usually cannot take your old health benefits with you. Except when you exercise your federal COBRA or state continuation rights, you are not entitled to take your actual group health coverage with you when you leave a job. Your new health plan may not cover all of the benefits or the same doctors that your old plan did.
The Acme Company offers two different health plans. Full time employees are offered a high option plan that covers prescription drugs; part time employees are offered a low option plan that does not. This is permitted under the law. By contrast, in a cost-cutting move, Acme restricts its high option plan to hose employees who can pass a physical examination. This is not permitted under the law.
Fully insured and self-insured group health plans count continuous coverage differently. In determining continuous coverage, employer-imposed waiting periods and HMO affiliation periods do not count as a break in coverage.
If you are self-employed with no other workers, insurers may, but are not required to , treat you similarly to other small employers.
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