Georgia Health Insurance

Georgia (GA)

Individual Health Insurance Regulations

Medical insurance is the best solution when it comes to assuring your family's physical well-being. In the event of unforeseen circumstances, suitable health coverage can save you from unanticipated medical bills. Shopping for a policy is tedious and needs evaluation of family's medical needs and finances. If you are a Georgia resident, you can choose from wide range of health insurance alternatives. The Georgia Department of Insurance regulates the laws under which the Georgia health insurers can sell private health plans to individuals and families.
Individual health insurance plans in Georgia are not guaranteed issue, but rather are medically underwritten. This process allows the insurance company an opportunity to review your past and current health history. The insurance company may choose to deny coverage based on medical history; or approve coverage with specific limitations set with regard to pre-existing conditions; or even 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 mandate health insurers to place a 24-month exclusionary period limit for pre-existing conditions and they are not obligated to provide credit for prior coverage. In addition, insurance carriers may impose an elimination rider which may temporarily or permanently exclude coverage for a specific health condition, body part or body system. The state has not provided the limit for the look-back period for the determination of pre-existing conditions. Premium rates vary from one insurer to another and are based upon plan type, age health status and gender.
For medically uninsurable individuals, those utilizing their HIPAA rights are guaranteed coverage through a Georgia health insurer. The state does not have a high-risk pool for those individuals without insurance and without HIPAA rights eligibility.
Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

Georgia (GA)

Small Group Health Insurance Regulations

Defined as any company with 2-50 employees, small employer group medical 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, 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 may be offered to the applicants 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

Groups with 20 or more employees must follow federal COBRA regulations which state that a departing employee is entitled to remain on the group health plan for a period of 18 months, provided that group health plan remains in existence. An employee who has left work on his own or was terminated from the job is eligible to be covered by COBRA. The one exception to this is if the former employer was fired for gross misconduct. COBRA provides health coverage to individuals and their beneficiaries, spouses and dependents. The COBRA recipient will be responsible for the payment of the entire the insurance premium that the employer was paying for his coverage as well as 2% administrative costs.
Georgia has a state mini-COBRA regulation, issued through the Official Code of Georgia Annotated Title 33, Chapter 24, Sections 33-24-21.1 and 33-24-21.2., 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 continuation of coverage for the remainder of the month and an additional 3 months. To qualify for Georgia State COBRA, an employee must have been covered under the group plan for a minimum of 6 months. Georgia's Cobra law requires that individuals pay no more than 100% of premium during the three-month coverage period. For persons that have exhausted their COBRA coverage, guaranteed issue individual medical insurance options may be available through a conversion option from their insurance company. Georgia does not currently have a high-risk pool.