Ga. Comp. R. & Regs. R. 120-2-81-.05 - Georgia Health Benefits Assignment System
(1) The standard health benefit plans
developed by the Commissioner in accordance with O.C.G.A. §
33-29A-5 shall be designated as
Plan C and Plan D respectively. The model policy form template for Plans C and
D are designated as Form GHBAS-1, and the schedule of benefits for Plans C and
D is designated as Form GHBAS-S.
(2) A managed care organization who
participates in the Georgia Health Benefits Assignment System (GHBAS) must file
policy forms necessary for providing the coverage required by the GHBAS no
later than thirty (30) days following either the effective date of this
Regulation Chapter, or the date of notice from the Commissioner that the
managed care organization is subject to the provisions of O.C.G.A. §
33-29A-1
et
seq., whichever is later. Coverage provided pursuant to assignment
by the GHBAS that is effective prior to the approval of the policy form shall
be subject to the requirements of this Regulation Chapter and shall be amended
pursuant to any modifications required by the Commissioner for approval of the
filing. Such coverage made effective prior to approval of filing shall not be
in violation if the policy form is filed within thirty (30) days as
required.
(3) Methods of Filing.
(a) A participating managed care organization
may file policy forms prepared in accordance with Form GHBAS-1 and the schedule
of benefits in Form GHBAS-S . Such policy forms shall be deemed approved upon
the date the Commissioner receives the filing, provided they conform to the
template form; or
(b) A
participating managed care organization may file policy forms with contractual
language substantially similar to the model policy form template for approval,
but must include the same benefits prescribed in the model policy form template
and the same schedule of benefits prescribed in Forms GHBAS-1 and GHBAS-S .
Such filings must include a description which specifically outlines the
variances in language between the model policy form template and the filed
form. A policy form filing with variances from the model policy form template
prescribed in Form GHIAS-1 may not contain any provisions which are less
beneficial than the relevant template provisions with regard to qualifying
eligible individuals or eligible dependents.
(4) A managed care organization shall file
with the Commissioner for approval any and all materials used to offer coverage
to a qualifying eligible individual and eligible dependents through the GHBAS.
These materials include enrollment forms, forms describing or soliciting an
election of benefit options, disclosures regarding coverage under standard and
optional plans, and any other documentation issued to qualifying eligible
individuals for enrollment in standard or optional plans offered by the managed
care organization.
Notes
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