Rule 120-2-81-.06. Optional Policies or Plans

1. (1) A health insurer or managed care organization may offer, in addition to the standard policies or plans, other additional individual health insurance policies or plans approved by the Commissioner for use in this state. A health insurer or managed care organization may also offer additional policies or plans with benefit options based on the standard plans but with different benefit schedules, provided such policies are filed with the Commissioner for approval. In the event a health insurer or managed care organization elects to offer such optional plans to qualifying eligible individuals and eligible dependents, the health insurer or managed care organization must assure that:

   1. (a) both the standard and optional policies or plans are presented in a written offer of coverage and there is no unfair inducement to persuade the applicant in his or her selection;
   2. (b) all optional policies or plans are made available to all qualifying eligible individuals and eligible dependents applying for coverage under the assignment system and assigned to the health insurer or managed care organization;
   3. (c) all optional policies or plans comply with Rules 120-2-81-.11, .12, .13, .14, .15, .18, and .19; and

   4. (d) all optional policies or plans are accompanied by a certification from the health insurer or managed care organization which asserts the following:

      "This policy option is not a standard plan developed by the Commissioner of Insurance of the State of Georgia. Unlike the standard plans, it may not contain maximum rate limitations and benefits as guaranteed by state law and regulation. Should you have questions regarding any differences between this policy and the standard plan, you may contact [name of health insurer or managed care organization] at [phone number]".

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

History. 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 "Optional Policies or Plans" adopted. F. Apr. 29, 1998; eff. May 19, 1998.