Ga. Comp. R. & Regs. r. 120-2-99-.04
Rule 120-2-99-.04. Required Disclosures
"The benefits of this policy may primarily be governed by the laws of a state other than Georgia; therefore, all of the laws applicable to policies filed in this state may not apply to this policy. Any purchase of individual health insurance should be considered carefully since future medical conditions may make it impossible to qualify for another individual health insurance policy."
"The benefits of this policy providing your coverage may be governed primarily by the laws of a state other than Georgia. The benefits covered may be different from other policies you can purchase. Please consult your insurance agent or insurer to determine which health benefits are covered under this policy."
(3) Each policy offered or sold pursuant to Article 3 of Chapter 29A of Title 33 shall also contain the following standard forms for the disclosure and comparison of benefits.
(a)
[INSURER NAME AND ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section 33-29A-35)
Georgia Benefits Definitions vs. Non-Georgia Based Product Definitions
Georgia Defined Term and Definition [Non-Georgia Product] Defined Term and Definition
(b)
[INSURER NAME, ADDRESS]
Standard Form for Disclosure of
Benefits Definition Differences (O.C.G.A Section 33-29A-35)
Georgia Benefits Definitions vs. This Non-Georgia based Product Definitions
Georgia Mandated Benefit Georgia Citation Mandate or Mandated Offer or Qualifications [Non-Georgia Product] Does This Individual Policy Cover this benefit? (reference page and section in policy) Asthma; Prescription Inhalers 33-24-59.8 Mandated behavior in RX plans Autism; non-discrimination in products covering neurological disorders 33-24-59.10 Mandate (subject to policy benefits, limitations consistent with other neurological disorders) Bone Marrow Transplants for treatment of breast cancer, Hodgkins Disease 33-29-3.3 Mandated Offer in Major Medical Plans Bone Mass Measurement 31-15A Mandated Offer (availability) Breast Cancer Patient Care; Mastectomies 33-24-70-72 Mandate for policies covering surgery, mastectomies Child Cancer Clinical Trials 33-24-59.1 Mandate Child Deliveries (48 / 96 hour hospital stay) 33-24-58.2 Mandated Benefit for policies covering maternity benefits; Notice requirement on insurers 30 days after insurer learns covered person is pregnant, added in 2002. Child Wellness to age 5 33-29-3.4 Mandate Chlamydia Screening to certain females, ages 31-14-4.1 Mandate Colorectal Cancer Screening Colorectal Cancer Screening 33-24-56.3 Mandates coverage for Colorectal Cancer Screening, exams, lab tests, along guidelines of American Cancer Society, American College of Gastroenterology & American College of Radiology. Exceptions are limited policies. Dental; General Anesthesia 33-24-28.4 Mandate Dermatologist Direct Access 33-24-56 Mandates Access (subject to policy benefits) Diabetes Outpatient Self Management Training, Equipment 33-24-59.2 Mandate for Major Medical Policies, Managed, Capitated plans Human Heart Transplants 33-29-3.1 Mandated Offer (make available on major med plans) Mammograms, PAP Smears, PSA Test 33-29-3.2 Mandate Mental Disorders 33-24-28.1 Mandated Offer (make available) Morbid Obesity 33-24-59.7 Mandated Offer (Georgia policy "may" cover) OB / GYN 33-24-59 Mandates Access Direct Access (subject to policy benefits) Off-Label Prescription Drugs for insureds with lifethreatening or chronic and disabling conditions 33-24-59.11 Mandate (subject to certain conditions and prior authorization of insurer) Ovarian Cancer; Surveillance Tests for women at risk 33-24-56.2 Mandates Coverage for certain women over age 35 (subject to same deductibles, coinsurance as other benefits) Pregnancy, Complications of 33-24-24 Mandate for Major Medical Prescription Contraceptives 33-24-59.6 Mandate for RX plans TMJ 33-29-20 Mandate
Authority: O.C.G.A. §§ 33-2-9 and 33-29A-30et seq.
History. Original Rule entitled "Required Disclosures" adopted. F. Nov. 18, 2011; eff. Dec. 8, 2011.