Georgia Health Insurance (GA)

Georgia (GA)
Individual Health Insurance Regulations

Learn more about Georgia Individual Health Insurance

Individual health insurance plans in Georgia are not guaranteed issue, but rather are medically underwritten. This process allows the health insurance company an opportunity to review your past and current health history. Based upon information provided during the application process, the insurance company may choose to deny coverage based on medical history, approve coverage with specific limitations set with regard to pre-existing conditions, impose elimination riders as a part of your health contract, or approve the application and offer full coverage. Insurance laws in the State of Georgia provide for a 24 month exclusionary period limit for pre-existing conditions and do not require credit for prior coverage. In addition, health insurance carriers may impose an elimination rider which may temporarily or permanently exclude coverage for a specific health condition, body part or body system. Premium rates vary and are based upon plan type, age and gender.

Georgia (GA)
Small Group Health Insurance Regulations

Defined as any company with 2-50 employees, small employer group health insurance coverage in Georgia is issued on a guarantee-issue basis, meaning that the group may not be declined coverage due to past or current medical history of its employees. Under Georgia insurance laws, health insurance carriers may impose a 6 month look back and a 12 month exclusionary period for pre-existing conditions on all applicants who do not have prior creditable coverage. Pre-existing exclusion periods may not be applied to pregnancy, newborns or newly adopted children, children placed for adoption or genetic information. Creditable coverage is required provided that there is not a break in coverage of more than 63 days in a row. Once eligible to join the group health plan, an employer may impose a waiting period prior to allowing you to sign up for health care coverage. If group coverage is under an HMO plan, the insurance carrier may impose a waiting period, known as an affiliation period that may not exceed 2 months. Georgia allows a rate adjustment factor of 25% based on claims history when insurers are calculating small group for newly enrolled businesses.

Georgia COBRA and Continuation Coverage

Georgia has a state mini-COBRA regulation which applies to groups of 2 -19 employees. Under the state COBRA regulations an employee who suffers a qualifying event may opt, at their sole expense, to continue their group coverage through their employer group when their group health coverage is lost due to certain and specific events. Continuation coverage under the state COBRA regulations provides for an additional 3 months of health insurance coverage. To qualify for Georgia State COBRA, an employee must have been covered under the group plan for a minimum of 6 months. Employers with more than 20 employees must follow federal COBRA regulations. For persons that have exhausted their COBRA coverage, guaranteed issue individual health insurance options may be available through a conversion option from their insurance company. Georgia does not currently have a high-risk pool.

Additional Georgia Resources

• Georgia PeachCare for Kids
  Provides health insurance coverage to children of low-income families who are under the age of 19 and residents of the State of Georgia.
• Georgia Department of Community Health
  The Georgia Department of Community Health administers the states Medicaid program, as well as PeachCare for Kids and Georgia Healthy Families.
• Georgia Medicare
  Blue Cross Blue Shield of Georgia, Inc. serves as the Part A Medicare Intermediary under the Medicare program.

Related Blog Posts

• Georgia PeachCare in Trouble?

GA Medical Insurance Statistics

Total Population: 9,045,000
With Health Insurance: 7,335,000 / 81.1%
Without Health Insurance: 1,709,000 / 18.9%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Georgia residents without health insurance has increased 1.5% since 2004.

Georgia Insurance and Safety Fire Commissioner
Phone: 800-656-2298
The Life and Health Division regulates insurance companies licensed in the state of Georgia by reviewing policy contracts, set insurance rules and regulations and review and approve insurance rate submissions.

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