Georgia Health Insurance Policy Requirements

Georgia has comprehensive health insurance regulations that work alongside federal requirements. Understanding these state-specific rules is essential for the licensing exam.

Regulatory Structure

Georgia health coverage is primarily regulated by:

Free Look Period

Georgia requires a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies
• Same as life insurance free look period

Exam Tip: Georgia's health insurance free look is 10 days, same as the standard life insurance free look.

Required Coverage

Georgia, like all states, must provide coverage for ACA Essential Health Benefits in individual and small group plans:

Essential Health Benefits

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Mental Health Parity

Georgia follows federal Mental Health Parity requirements:

• Mental health benefits must equal medical benefits
• Same copays, deductibles, and limits
• Covers mental illness and substance use disorders
• Applies to large group, small group, and individual plans

Covered Conditions

• All mental health conditions
• Substance use disorders
• Behavioral health conditions
• Must be treated equally to physical conditions

Pre-Existing Condition Protections

Georgia follows ACA requirements:

Georgia Access (HealthCare.gov)

Georgia uses the Federal Marketplace (HealthCare.gov) for ACA coverage:

• Georgia residents purchase ACA plans through HealthCare.gov
• Premium tax credits available based on income
• Open enrollment and special enrollment periods
• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)

Key Points

• Georgia does not operate its own state exchange
• Navigators and agents can help with enrollment
• Special enrollment for qualifying life events
• Cost-sharing reductions for Silver plans

Guaranteed Issue and Renewal

Georgia follows federal requirements:

Guaranteed Issue

• Insurers must accept all applicants during open enrollment
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud
  • Plan discontinuation (with notice)