Key Takeaways
- Georgia requires group life insurance policies to include a conversion privilege within 31 days
- Small group health insurance in Georgia applies to employers with 1-50 employees
- Georgia follows federal ACA requirements for essential health benefits in small groups
- Group health plans must provide certificates of coverage to enrolled employees
- Mental health parity is required in Georgia group health plans
Georgia Group Life and Health Insurance Requirements
Georgia regulates group life and health insurance to protect employees.
Group Life Insurance Requirements
Conversion Privilege
Georgia requires a conversion privilege:
| Requirement | Details |
|---|---|
| Who Qualifies | Employees losing coverage |
| Conversion Period | 31 days |
| No Underwriting | No proof of insurability |
| Premium | Standard rates for age |
| Coverage Amount | Up to group amount |
When Conversion Applies
Conversion rights apply when:
- Employment terminates
- Employee retires
- Class is eliminated
- Group policy terminates
- Dependent loses coverage
Exam Tip: The 31-day conversion period means employees remain covered under group policy during this time.
Death During Conversion
If employee dies during 31-day period:
- Group coverage applies
- Death benefit paid
- Conversion status irrelevant
Small Group Market
Georgia Small Group Definition
| Market | Employee Count |
|---|---|
| Small Group | 1-50 employees |
| Large Group | 51+ employees |
Small Group Protections
Georgia small groups enjoy:
- Guaranteed issue
- No pre-existing condition exclusions
- Essential health benefits
- Community rating
- Guaranteed renewal
Certificate Requirements
Georgia requires certificates for employees:
Required Contents
| Element | Description |
|---|---|
| Benefits Summary | What plan covers |
| Eligibility | Who is covered |
| Effective Dates | Coverage dates |
| Conversion Rights | How to convert |
| Continuation Rights | COBRA options |
| Claims Procedures | How to file |
| Appeal Rights | How to appeal |
| Contact Info | Insurer info |
Certificate Timing
- Provided within reasonable time
- Updated for changes
- SBC also required
Mental Health Parity
Georgia requires mental health parity:
Parity Requirements
| Requirement | Details |
|---|---|
| Coverage Level | Same as medical |
| Cost Sharing | Same copays |
| Visit Limits | Not more restrictive |
| Prior Auth | Same as medical |
Covered Conditions
- Mental illness
- Substance use disorders
- Behavioral health
- Same as physical illness
Dependent Coverage
Age 26 Rule
Georgia follows federal rules:
| Requirement | Details |
|---|---|
| Age Limit | To age 26 |
| Marital Status | Doesn't matter |
| Student Status | Doesn't matter |
| Dependence | Doesn't matter |
Coordination of Benefits
When employees have multiple coverage:
Georgia Rules
| Situation | Primary Plan |
|---|---|
| Employee's plan | Primary for employee |
| Employee as dependent | Primary pays first |
| Children (birthday) | Earlier birthday primary |
| Divorced parents | Court order or rules |
Birthday Rule
Uses birthday month and day:
- Earlier birthday = primary
- Same birthday = longer coverage primary
Employer Contributions
Participation Requirements
| Contribution | Minimum |
|---|---|
| Employer-paid | 100% eligible |
| Contributory | Typically 75% |
Small Employer Flexibility
Small employers may have:
- Lower participation
- Guaranteed issue
- No surcharge for low participation
PeachCare for Kids
Georgia's CHIP program:
Eligibility
| Requirement | Details |
|---|---|
| Age | Under 19 |
| Income | Above Medicaid, up to 247% FPL |
| Residency | Georgia resident |
| Citizenship | US citizen or qualified |
Benefits
- Comprehensive health coverage
- Doctor visits
- Hospital care
- Prescription drugs
- Dental and vision
Exam Tip: PeachCare for Kids is Georgia's CHIP program for children whose families have income too high for Medicaid.
How long to convert group life insurance in Georgia?
What is Georgia's small group market size?
Under the birthday rule, which parent's plan is primary?
What is PeachCare for Kids?
What happens if employee dies during conversion period?