(1) Definitions. The terms used in this Rule
are defined as follows:
(a) "Anticipated
Group Premium" shall mean the premium expected to be generated on each new and
existing group over a period of the next twelve (12) months including only
deviations permitted pursuant to subparagraphs (b), (d), (e) and (f) of
paragraph (5) of this Rule.
(b)
"Anticipated Pool Premium" shall mean the total amount of premium expected to
be generated on all new or existing groups over a period of the next twelve
(12) months. The anticipated pool premium shall equal the sum of all
anticipated group premiums for all small groups in an insurer's pool.
(c) "Dependent" shall mean any dependent of
an employee, member, or enrollee, including children, adopted children, and
non-custodial children, as permitted in O.C.G.A. §§
33-24-28(b) and
33-30-4(3) and
(4), or a spouse, or other family member
eligible for coverage under the terms of the group health insurance policy or
contract because of that person's dependency on the employee, member, or
enrollee.
(d) "Eligible employees,
members or enrollees" shall mean persons who are actively employed with a small
group and are eligible for coverage under the employment rules of the small
group or who are otherwise, except for dependents, eligible for coverage under
a group health insurance policy, without regard to claims experience or any
health status related factor.
(e)
"Existing Group" shall mean a small group that is insured by an insurer and
part of that insurer's small group pool.
(f) "Group Health Insurance" shall mean any
major medical insurance, medical expense coverage, hospital expense coverage,
comprehensive health benefit plan, or managed health care plan issued by an
insurer to small groups, other than a blanket accident and sickness policy, a
health insurance policy written as part of workers' compensation equivalent
coverage or supplemental to a liability policy, a credit insurance policy, or
any limited benefit insurance policy as defined in O.C.G.A. §
33-30-12(e)(4).
Group health insurance shall include all types of policies, contracts, or
certificates, as applicable, or other comparable group-type coverage as
specified in Rule
120-2-10-.10(2),
actively marketed or issued in this state to small groups, including the
following:
1. Group health insurance policies
or certificates issued pursuant to group insurance contracts;
2. Group health insurance policies issued or
marketed to association groups or trusts, except bona fide associations as
defined in O.C.G.A. §
33-30-1(b) and
as specified in subparagraph (10) of this Rule;
3. Group health insurance policies issued to
multiple employer trusts established in or out of this state; and
4. Except for policies excluded under
O.C.G.A. §
33-30-12(e),
individual health insurance policies which provide as a minimum primary or
basic medical or hospital expense benefits and are spon- sored in any manner by
an employer or other group insurance policyholder.
(g) "Insured" shall mean any employee,
member, enrollee, or dependent of an employee, member or enrollee insured under
group health insurance issued to a small group.
(h) "New Entrant" shall mean an eligible
employee, member, enrollee or dependent not previously covered by the existing
group insurance contract or policy and who is either a late enrollee or does
not have previous creditable coverage as defined by O.C.G.A. §
33-30-15(a)(2).
A New Entrant shall not include the following
individuals:
1. a "newly eligible
employee" as defined by O.C.G.A. §
33-30-15(a)(4);
2. an insured covered under the group's prior
group health insurance contract or policy, provided that such contract or
policy constitutes previous creditable coverage; or
3. newborn children or newly adopted children
enrolled as permitted in O.C.G.A. §
33-30-15(e) and
Rule Chapter 120-2-67.
(i) "New Group" shall mean a small group that
is not currently insured by an insurer or any affiliated insurer.
(j) "Policyholder" shall mean, with respect
to group health insurance coverage, the small group to which a group health
insurance policy or contract is issued in accordance with O.C.G.A. §
33-30-1, including, but not
limited to, an employer or employer groups issued certificates of coverage
through a multiple employer trust.
(k) "Pool Rate" shall mean the average rate
for employees, members, and enrollees, or dependents of such individuals, in
all small groups within an insurer's small group health insurance pool, to be
determined and used over a period of the next twelve months and adjusted for
benefit design but unadjusted for factors specified in paragraph (5). In
determining pool rates, the insurer must take into account all actual and
anticipated experience data of the entire pool itself as well as other
experience data of the insurer or data available generally, and must apply
recognized actuarial practices as to credibility, trend factors, expense
factors, and margins. Insurers shall use pool rates to determine premiums for
new and existing groups.
(l) "Small
Employer" shall mean any employer that employed an average of at least two but
not more than 50 employees on business days during the preceding calendar year
and that employs at least two employees on the first day of the rating period.
All employers treated as a single employer under subsection (b), (c), (m), or
(o) of Section 414 of the Internal Revenue Code of 1986 shall be treated as one
employer. Subsequent to the issuance of a health insurance policy or contract
to a small employer and for the purpose of determining continued eligibility,
the size of a small employer shall be determined annually. Except as otherwise
specifically provided, provisions of this Act that apply to a small employer
shall continue to apply at least until the final day of the rating period
following the date the small employer no longer meets the requirements of this
definition. In the case of an employer which was not in existence throughout
the preceding calendar year, the determination of whether or not an employer is
a small employer shall be based on the average number of employees that it is
reasonably expected that the employer will employ on business days in the
current calendar year. Each small employer shall be considered a small
group.
(m) "Small Group" shall
mean, as defined in O.C.G.A. §
33-30-12(a), a
group which is a single employer, including a Small Employer, firm,
corporation, partnership, sole proprietor, or other legitimate group as
specified in O.C.G.A. §
33-30-1(a) with
at least two and no more than fifty (50) total eligible employees, members or
enrollees (not including dependents) on the initial application date and on
average during the calendar quarter preceding application. In determining the
number of eligible employees, members, or enrollees, companies that are
affiliated companies, are eligible to file a combined tax return for purposes
of taxation by this state, or are subsidiaries of another company and covered
under the parent company's group health insurance contract or policy, shall be
considered one group. Subsequent to the issuance of a health insurance policy
or contract to a small group and for the purpose of determining continued
eligibility, the size of a small group shall be determined annually. Except as
otherwise specifically provided, provisions of this Rule shall continue to
apply at least until the renewal date following the date the small group no
longer meets the requirements of this definition. Such small groups include
sole proprietors or employer members of a trust or an association which does
not meet the definition in O.C.G.A. §
33-30-1(b). For
the purposes of applying this Rule, a small group shall be subject to this Rule
if:
1. the majority of insured employees,
members, or enrollees in the group are employed or reside in this state;
or
2. if no state contains a
majority of the insured employees, members, or enrollees in a group, the
primary business location of the employer is in this state. If an employer
which constitutes a small group meets subparagraphs 1. or 2. of this
definition, it shall not be considered to be an employer in another state as
specified in O.C.G.A. §
33-30-1.1.
(n) "True Association" shall mean an
association which meets the requirements of O.C.G.A. §
33-30-1(b) and
any applicable Rules and Regulations issued by the Commissioner.
(2) Each insurer shall maintain
only one small group health insurance experience pool for all types of group
health insurance insuring small groups in Georgia as defined in paragraph
(l)(m) and subject to O.C.G.A. §
33-30-12, regardless of where the
group health insurance policy or contract is issued. Each insurer's small group
health insurance pool shall consist of each insurer's total claims experience
produced by all small groups in this state, regardless of the marketing
mechanism or distribution system utilized.
(3) Prohibitions. The following practices by
an insurer are prohibited with regard to small groups and the small group
health insurance pool:
(a) Durational rating
which increases premiums for any small group based solely on the length of time
the small group has been insured;
(b) Except as permitted under O.C.G.A. §
33-30-12(d) and
paragraph (5)(e), tier rating which increases rates directly related to the
tier within which any one small group's claims experience falls;
(c) Cancellation or termination of any small
group or any insured individual in a small group, provided that insurers may
refuse to re- new coverage only for those reasons permitted by the Rules and
Regulations of the Office of Commissioner of Insurance Chapter
120-2-67;
(d) Waivers for one or
more preexisting conditions, except that insurers may use preexisting condition
exclusions pursuant to O.C.G.A. §
33-30-15;
(e) Declination of any small employer for
coverage, or refusal to offer to insure, make insurance available or make a
quote or offer of coverage to any small employer, or engagement in practices
directly or through agents or representatives which prevent, discourage, delay
or impede the availability or marketing of group health insurance to any small
employer, under all policies or contracts offered or actively made available by
an insurer to small employers in the state or service area, except that an
insurer may decline a small employer for coverage if any of the following
applies:
1. minimum participation or
contribution rules are not satisfied by the small employer;
2. with regard to policies offered only
through a true association of employers, a small employer is not a member of
the association;
3. none of the
eligible employees, members, or enrollees live, work, or reside in the service
area of the network if the policy or contract is offered by a health
maintenance organization or a provider- sponsored health care
corporation;
4. a health
maintenance organization or provider-sponsored health care corporation has
demonstrated, to the satisfaction of the Commissioner, and based on current
documentary evidence, that it does not have the service capacity to adequately
provide medical services to new small employers through network providers in a
particular service area because of its obligations to existing groups in the
service area, provided that:
(i) all
declinations apply uniformly to all small employers in the service area without
regard to claims experience or any health status- related factors;
and
(ii) the health maintenance
organization or provider-sponsored health care corporation includes in such
filing a certification from the President, Executive Director, or Chief
Financial Officer which purports to claim such service capacity limits;
and
(iii) the Commissioner has not
determined that such a claim is not warranted within 90 days of filing
documentary evidence.
5.
an insurer has demonstrated, to the satisfaction of the Commissioner, and based
on its most recent quarterly financial report, examination, or any other more
current documentary evidence, that it does not have sufficient financial
capacity to underwrite additional coverage under any and all policy forms
available to small employers in the state, provided that:
(i) all declinations apply uniformly to all
small employers in the state without regard to claims experience or any health
status-related factors; and
(ii)
the insurer includes in such filing a certification from the President,
Executive Director, or Chief Financial Officer which purports to claim such
financial capacity limits; and
(iii) the Commissioner has not determined
that such a claim is unwarranted within 90 days of filing documentary
evidence.
(f)
Issuing coverage under any and all policies or contracts in the small employer
market in the state (or a particular service area if applicable) after
satisfactorily demonstrating to the Commissioner the conditions described in
subparagraphs (e)4. or (e)5., unless at least 180 days have elapsed since the
date coverage was declined and the Commissioner has approved such resumption of
issue based on documentary evidence that conditions have changed.
(g) Discriminatory rating practices which
result in premium rate differentials for an individual employee, member,
enrollee, or dependent of such employee, member, or enrollee, within a small
group based solely on any health status-related factor or claims experience in
relation to that individual in the small group, or premium rate differentials
for classes of employees, members, or enrollees within a small group subdivided
solely on the basis of any health status-related factor or claims experience.
Rate adjustments for demographic underwriting factors, differences in benefit
designs or network arrangements, premium differentials based on family or
dependent coverage, or other rate differentials permitted by this Rule do not
constitute discriminatory rating practices.
(h) Repealed.
(4) Eligibility.
(a) Eligible employees, members, or enrollees
in a small group who apply when first eligible for coverage under group health
insurance during the most recent continuing period of employment, and
dependents of such employees, members, and enrollees who apply when first
eligible for coverage, are deemed to be insurable and must be accepted for
enrollment. No insurer may subdivide any small group for benefit eligibility
under a group insurance policy or contract solely on the basis of any health
status-related factor or claims experience.
(b) An insurer may establish, either as a
provision applying to all small groups insured by the insurer, or at the option
of a particular small group policyholder, terms of coverage which govern
acceptance of late enrollees to a small group. Once established, such terms may
not be changed within a contract period or the entire effective term of the
policy for a small group policy or contract in such a way as to discriminate
against late enrollees on the basis of health status. Such terms, and any
changes thereto, must be disclosed within each policy and all certificates, and
may only be changed either for all small groups insured by the insurer, or at
the option of each small group policyholder.
(5) Rating.
(a) Rating Period and Rate Guarantee.
1. The initial or renewal rate for any small
group shall be based on the pool rate adjusted for benefit design and the
factors permitted by this Rule section. The rating period for any small group
shall be not less than twelve (12) months. An insurer may not modify rates
during this period except for any benefit alteration elected by a small group
during this period or as otherwise permitted by this paragraph. The rates in
effect at the beginning of the rating period, or on the effective date of any
benefit alteration during such period, shall be used for adjusting small group
premiums as a result of new or terminating employees, members, enrollees, or
dependents. For small groups not rated on a composite basis, an insurer may
further adjust small group rates for a newly eligible employee, New Entrant, or
the dependent of either using only demographic underwriting factors as
permitted by this Rule.
2. If a New
Entrant enters an existing group at any time during the rating period other
than on the small group's renewal date, and such a New Entrant elects coverage
when first eligible, an insurer may impose a waiting period on such a New
Entrant not to extend beyond the next renewal date, with coverage becoming
effective for the New Entrant on the effective date of the next rating period.
Imposition of such a waiting period must be applied consistently for all New
Entrants, without regard to any health status-related factor, and any
preexisting condition exclusion must run concurrently with the waiting
period.
3. If an insurer does not
elect to choose the New Entrant waiting period, it must enroll a New Entrant
under the terms of the group health insurance policy or contract during the
rating period without assessing any substandard rating.
4. An insurer electing the New Entrant
waiting period must disclose this method within each policy and to all small
group policyholders prior to use or issue. An insurer may require such a method
for all small groups insured by it, or may elect to use it at the option of the
small group policyholder.
(b) Permitted Demographic Underwriting
Factors. An insurer may set rates using pool rates adjusted for age, group size
(provided that the group size factor may not vary by more than 15% from a base
factor of 1.0), family size or composition, sex, area, industry, occupational,
and avocational factors (including, but not limited to, tobacco usage).
Demographic underwriting factors used by the insurer must be applied
consistently with respect to all small groups in the insurer's pool, except
that area factors may vary between policies or contracts with different network
reimbursement provisions. These demographic underwriting factors may be
adjusted:
1. on a composite basis for any
small group,
2. on a composite
basis for all small groups in an insurer's pool, or
3. on an individual, family, or other tier
basis as used by the insurer for all insureds in any small group.
Methods 1. and 3. of adjusting demographic underwriting
factors may both be used in an insurer's small group pool provided that group
size is the only determining factor and such methods are applied consistently
within the insurer's small group pool. An insurer may use the demographic
underwriting factors in renewal rating of such a small group where changes in
these underwriting factors have occurred.
(c) Use of Claims Experience under Previous
Insurance Coverage Prohibited. Previous claims experience of a new group under
any other group health insurance prior to its entry into a pool is deemed not
to be credible and such previous claims experience may not be considered in the
initial rating of any small group. This paragraph shall not be construed to
prevent insurers from using the health status of individuals in the small group
for the purposes of substandard rating or determining group experience factors
at initial rating as permitted under this Rule.
(d) Rate Changes Based on Trend. The pool
rate change for the next twelve months shall be based on the experience trend
for the entire pool and shall be applied uniformly to the current pool rate for
each small group's upcoming rating period. Trend factors may vary during a
small group's rating period or between small groups to account for changes to
or differences in benefit design or network requirements only. Trend factors
may not be based on the demographic characteristics, experience, or any health
status-related factor of a small group or any insureds in a small group.
Nothing in this paragraph shall prevent an insurer from applying the annual
trend factor on a graduated basis in an equitable, consistent, and uniform
manner to small groups according to the month, quarter, or semi-annual period
in which a small group was issued its policy or contract.
(e) Group Experience Factor.
1. Except as prohibited in subparagraph (c),
the actual claims experience produced by a small group may be used to deviate
the premium from the pool rate applicable for that group. The group experience
factor must be applied uniformly, consistently, and equitably to the rates
charged for all employees, members, enrollees, and dependents in the small
group and may not exceed plus or minus twenty-five percent (25%) of the pool
rate. The change in premium resulting directly from select or substandard
ratings applied to any group following recognized underwriting practices and
the provisions of this Rule shall not be considered a deviation from the pool
rate only for the purposes of determining the group experience factor. A group
experience factor may be adjusted upon renewal.
2. The percent change in the group experience
factor at renewal shall not exceed 15% from one rating period to the
next.
(f) Select and
Substandard Ratings.
1. General Application.
Select and substandard ratings resulting from the health status of one or more
New Entrants must only be applied to an existing group or new group as set
forth in O.C.G.A. §
33-30-12(d) and
this Rule.
2. Applicability of
Substandard Ratings.
(i) An insurer may not,
with regard to a new group or existing group, use substandard rating for, nor
adjust any individual or group premium by way of a substandard rating as a
result of the health status of anyone who is not a New Entrant as defined in
this Rule. An insurer may not assess a substandard rate on any small group or
small group member because of the health status of dependents with previous
creditable coverage who enroll when first eligible or during special enrollment
in accordance with O.C.G.A. §
33-30-15(a)(4)(A) and
(e).
(ii) Substandard rating may only be
determined and assessed as a result of the health status of New Entrants to an
existing group or New Entrants in a new group, relative to what may be
considered a standard health risk by the insurer using recognized underwriting
practices. Substandard ratings assessed as the result of New Entrants to an
existing group may be imposed only at the beginning of the first rating period
after the New Entrant waiting period permitted in subparagraph (b)2.
3. Compliant Methods of Applying
Select and Substandard Rating. No insurer may bill or charge select or
substandard rating adjustments allowed in this subparagraph to individual
employees, members, enrollees, or dependents because of health status-related
factors for which the adjustments are applied. Select or substandard rating
assessed as a result of the health status of a New Entrant must be applied
uniformly, consistently, and equitably to the rates charged for all employees,
members, enrollees, and dependents in the small group. For example, select or
substandard ratings may be assessed to all insureds in a small group on a
composite basis as a uniform factor derived from the total select or
substandard rating for all New Entrants insured through the small group; or,
select or substandard ratings may be assessed as a lump-sum quantity divided
equally among all insured employees, members, or enrollees.
4. Rating Parameters. Effective for all
rating periods commencing on or after May 1st, 1998, and all subsequent rating
periods, the differential resulting from applying select or substandard ratings
as permitted in this subparagraph onto group premiums may not be greater than
plus or minus twenty percent of the total premium for a small group determined
using pool rates as adjusted for permitted demographic underwriting factors,
group experience factors, and rate changes based on trend. The Commissioner may
adjust these permitted select and substandard rating parameters at any time in
the interest of ensuring affordable coverage and access in the small group
health insurance market after such due notice and hearing as may be required by
law. The effective date of any such adjustments shall be a reasonable period of
time as determined by the Commissioner not to exceed one year after the date
such adjustments have been promulgated by the Commissioner.
5. Other Prohibitions on Assessing
Substandard Ratings:
(i) Insurers may not add,
assess, use, or continue to use substandard ratings for an insured in replacing
group health insurance where the replacing insurer is affiliated with the prior
insurer, nor may an insurer add, assess, use, or continue to use substandard
ratings when discontinuing a policy form and offering coverage under another
policy form; and
(ii) Insurers may
not add, assess, or increase a substandard rating at any time other than during
initial underwriting of a New Entrant to a new or existing group as permitted
by this Rule.
6.
Removal. Insurers may remove substandard ratings at any time with a
corresponding reduction in the group's premium. When an insured with a
substandard rating leaves a small group, the insurer must remove the
substandard rating from the small group premium within thirty (30) days of the
date on which the insured is no longer eligible for coverage or continuation of
coverage under the group.
(g) Deviations Resulting From Rating Factors.
In setting premiums to be charged each small group, insurers must determine
upward and downward premium deviations from the pool rate resulting from
application of each small group's demographic underwriting factors as specified
in subparagraph (b), the group experience factor as specified in subparagraph
(e), rate changes based on trend as specified in subparagraph (d), and select
or substandard ratings permitted in subparagraph (f), in such a manner that the
anticipated total of the upward deviations for all small groups in an insurer's
pool is offset by the anticipated total of downward deviations. The total of
all anticipated group premiums, which include all deviations resulting from
factor adjustments described in this subparagraph (g), must equal the total
anticipated pool premium.
(h) Other
Permissible Methodologies. Insurers may use a rating methodology which
establishes a lowest possible base rate charged by an insurer for all small
groups in lieu of a pool rate, and adjusts the rate upward for all factors
permitted in this Rule, provided that:
(i) the
group experience factor applied to the lowest possible base rate is no greater
than 1.67;
(ii) the select and
substandard rating is applied as permitted in subparagraph (f)4. and is limited
to a factor no greater than 1.20 as applied to the small group's total premium
based on the lowest possible base rate adjusted for demographic underwriting
factors, group experience factors, and rate changes based on trend as permitted
in this Rule;
(iii) the midpoint of
all rates for all small groups in an insurer's pool is equivalent to the pool
rate which would be determined in accordance with this Rule, such that all
anticipated rate deviations below the midpoint are offset by all anticipated
rate deviations above the midpoint; and
(iv) the methodology otherwise complies with
all the requirements of this Rule.
(i) The rating provisions of this Rule
section shall apply to all rating periods commencing on or after November 1,
2002.
(6) Documentation.
(a) All insurers must determine pool rates
annually or more frequently and document their rate and deviation
determinations.
(b) All insurers
must disclose at the initial sale of a small group case the degree to which
rates may vary within allowable +/-25% range around the pool rate.
(c) All insurers must provide to each small
group upon request at each rating period, the pool rate compared to the
proposed rate for the small group to demonstrate where the rate for the small
group lies in comparison to the pool rate, and shall be required to document to
each small group the benefit design, demographic factors, group experience
factor, select or substandard or other permitted adjustments from the pool rate
and percentage change in the base pool rate, demographic and group experience
factors since the pool rate utilized in the small group's previous rating
period. In addition, reference must be made to legal and regulatory citations
that relate to changes in rating factors. Each small group policy must contain
a notice to the insured that this information is available upon request. If
such information is requested, the insurer must respond to such request within
ten (10) business days of the request for information.
(d) Rating documentation shall be maintained
at the insurer's home or principal office for a period of five years and
insurers shall furnish this information to the Commissioner of Insurance or
insurance department examiners upon request.
(7) On or before March 1 each year, an
insurer writing small group health insurance in this State shall provide for
the preceding calendar year a certification by a responsible officer of the
insurer as follows:
"I (name of officer), hereby certify that the rates charged
small groups in the State of Georgia by the (name of insurer) are in compliance
with all the requirements of §
120-2-10-.12 of the Rules and
Regulations of the Georgia Insurance Department.
I further certify and affirm that my company will provide
prior, written notice to the Commissioner and to each small group in my
company's small group health insurance pool within the State of Georgia at
least 180 days before my company withdraws from the small group health
insurance market in Georgia. Such written notice to the Commissioner will
include a report or other substantial documentation of the extent of coverage,
including identification of policy forms, certificates, and the number of
insureds covered at the time of any notice of proposed withdrawal from this
small group market in Georgia. I understand and agree to submit such other
documentation as the Commissioner may reasonably require at that time.
Additionally, I further certify and affirm that my company will comply with all
other provisions in the Official Code of Georgia, Annotated, or in the Rules
and Regulations of the Georgia Insurance Department, pertaining to withdrawal
or discontinuation of coverage in the small group market.
(Date) ____________________________
(Signature of Officer)"
___________________________________
(8) One-life Groups.
(a) Insurers may issue small group health
insurance policies or contracts actively marketed to small groups, or
certificates from such policies or contracts, to sole proprietors or other
employers with only one employee, member, or enrollee (not counting
dependents). In order for such coverage to qualify as group coverage, it must
meet all rating and eligibility requirements of this Rule except those
applicable only to small employers. At such time as the one life group acquires
one or more additional employees, members, or enrollees, the exceptions shall
not apply. Such one-life groups shall include sole proprietors offered coverage
under a group health insurance policy or contract issued through a trust or
association which does not meet the definition of O.C.G.A. §
33-30-1(b),
provided that such group health insurance policy or contract covers other small
groups as defined by this Rule. One-life groups may also include other such
arrangements as provided for in the Rules and Regulations of the Office of
Commissioner of Insurance or at the discretion of the Commissioner.
(b) All policies or certificates issued to
one-life groups as permitted by this Rule shall comply with the requirements of
O.C.G.A. Title 33, including Chapter 30.
(c) All policies or certificates issued to
one-life groups in this state on or before June 30, 1997, shall be deemed
one-life groups and shall be subject to the provisions of this Rule, as well as
all the requirements of O.C.G.A. Title 33, including Chapter 30.
(d) Insurers may not issue multiple one-life
group policies or certificates to a single employer with more than one
employee.
(9) Minimum
participation rules for small groups.
(a)
Minimum participation rules for a particular group health insurance policy
shall apply uniformly and consistently to all small groups.
(b) An insurer shall not require a minimum
participation level for small groups greater than:
1. One hundred percent (100%) of eligible
employees, members, or enrollees with three (3) or less employees;
and
2. Seventy-five percent (75%)
of eligible employees, members, or enrollees with more than three (3) employees
but not more than fifty (50) employees.
(c) An insurer shall not modify such minimum
participation rules applicable to a small group at any time after the small
group has obtained coverage, except that an insurer may relax such rules
prospectively upon notification to all existing groups, and must apply such
relaxed rules to all new groups. Relaxation of such rules means that such rules
are made more favorable to the insured than what is required in subparagraph
(b).
(d) In applying minimum
participation rules with respect to a small group as permitted in (b), an
insurer may not count eligible employees, members, or enrollees who have other
group health insurance coverage from an unaffiliated insurer as a spouse or
dependent in determining whether the applicable minimum participation level is
met.
(10) Associations.
Only the provisions of paragraph (3) shall apply to true
associations.
Notes
Ga. Comp. R.
& Regs. R.
120-2-10-.12
O.C.G.A. Secs.
33-2-9,
33-24-21.1,
33-27-8,
33-27-9,
33-30-1,
33-30-1.1,
33-30-12,
33-30-15.
Original Rule entitled
"Penalties" adopted. F. Apr. 11, 1980;
eff. July 1, 1980, as specified
by the Agency.
Repealed: Rule reserved. F. July 24, 1986; eff. September 1, 1986, as specified by the
Agency.
Amended: New Rule entitled "Group Premium Rate
Increase Notice and Experience Rating for Mulitple Employer Trusts or
Arrangements" adopted. F. Aug. 24, 1989;
eff. Jan. 1, 1990, as specified
by the Agency.
Repealed: F. May 9,
1990; eff. June 15,
1990, as specified by the Agency.
Amended: New Rule entitled "Small Group Pooling"
adopted. F. Sept. 6, 1990; eff.
Oct. 1, 1990, as specified by
the Agency.
Repealed: New Rule entitled "Small Group Health
Insurance Access and Pooling" adopted. F. Mar. 25,
1998; eff. Apr. 14,
1998.
Repealed: New Rule of same title adopted. F.
May 23, 2002; eff.
November 1, 2002, as specified
by the Agency.
Repealed: New Rule of same title adopted. F.
Aug. 15, 2002; eff.
Nov. 1, 2002. as specified by
the Agency.
Amended: F. Oct. 20,
2009; eff. Nov. 9,
2009.