25 LC 46 1064
House Bill 323
By: Representatives Mathiak of the 82
nd
, Hawkins of the 27
th
, Newton of the 127
th
, Dempsey
of the 13
th
, Cooper of the 45
th
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to
1
Medicare supplement insurance, so as to provide for Medicare supplement policies to be2
issued and renewed for individuals under 65 years of age who are eligible by reason of3
disability or end stage renal disease under federal law; to provide for open enrollment4
periods; to prohibit an insurer from charging premium rates for such policies for such5
individuals that exceed premium rates charged for individuals who are 65 years of age; to6
provide for a short title; to provide for related matters; to provide for effective dates; to repeal7
conflicting laws; and for other purposes.8
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
SECTION 1.10
This Act shall be known and may be cited as the "Bridging the Gap for ALS and Chronic11
Kidney Disease Act of 2025."12
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SECTION 2.
13
Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare14
supplement insurance, is amended by revising Code Section 33-43-3, relating to duplicate15
benefits prohibited and establishment of standards, as follows:16
"33-43-3.17
(a) As used in this Code section, the term '42 U.S.C. Section 426(b) or 421-1' means such
18
federal law as it existed on January 1, 2025.19
(a)(b) No medicare Medicare supplement insurance policy or certificate in force in this20
state shall contain benefits which duplicate benefits provided by medicare Medicare.21
(b)(c) Notwithstanding any other provision of Georgia law, a medicare Medicare22
supplement policy or certificate shall not exclude or limit benefits for losses incurred more23
than six months from the effective date of coverage because it involved a preexisting24
condition. The policy or certificate shall not define a preexisting condition more25
restrictively than a condition for which medical advice was given or treatment was26
recommended by or received from a physician within six months before the effective date27
of coverage.28
(c)(d) The Commissioner shall adopt reasonable regulations to establish specific standards29
for policy provisions of medicare Medicare supplement policies and certificates. Such30
standards shall be in addition to and in accordance with applicable laws of this state. No31
requirement of this title relating to minimum required policy benefits, other than the32
minimum standards contained in this chapter, shall apply to medicare Medicare supplement33
policies and certificates. The standards shall cover, but shall not be limited to:34
(1) Terms of renewability;35
(2) Initial and subsequent conditions of eligibility;36
(3) Nonduplication of coverage;37
(4) Probationary periods;38
(5) Benefit limitations, exceptions, and reductions;39
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(6) Elimination periods;
40
(7) Requirements for replacement;41
(8) Recurrent conditions; and42
(9) Definitions of terms.43
(d)
(e) The Commissioner shall adopt reasonable regulations to establish minimum44
standards for benefits, claims payment, marketing practices, compensation arrangements,45
and reporting practices for medicare Medicare supplement policies and certificates.46
(e)(f) The Commissioner may adopt from time to time such reasonable regulations as are47
necessary to conform medicare Medicare supplement policies and certificates to the48
requirements of federal law and regulations promulgated thereunder, including, but not49
limited to:50
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio51
requirements;52
(2) Establishing a uniform methodology for calculating and reporting loss ratios;53
(3) Assuring public access to policies, premiums, and loss ratio information of issuers54
of medicare Medicare supplement insurance;55
(4) Establishing a process for approving or disapproving policy forms, certificate forms,56
and proposed premium increases;57
(5) Establishing a policy for holding public hearings prior to approval of premium58
increases; and59
(6) Establishing standards for medicare Medicare select policies and certificates.60
(f)(g) The Commissioner may adopt reasonable regulations that specify prohibited policy61
provisions not otherwise specifically authorized by statute which, in the opinion of the62
Commissioner, are unjust, unfair, or unfairly discriminatory to any person individual63
insured or proposed to be insured under a medicare Medicare supplement policy or64
certificate.65
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(g)(h) Insurers offering medicare Medicare supplement policies in this state to persons for66
individuals 65 years of age or older shall also offer medicare Medicare supplement policies67
to persons for individuals in this state who are eligible for and enrolled in medicare68
Medicare by reason of disability or end-stage end stage renal disease, as specified under69
42 U.S.C. Section 426(b) or 426-1. Such Medicare supplement policies shall be issued on70
a guaranteed renewable basis under which the insurer shall be required to continue71
coverage so long as premiums are paid on such policy. Except as otherwise provided in72
this Code section, all benefits, protections, policies, and procedures that apply to persons73
individuals 65 years of age or older shall also apply to persons individuals who are eligible74
for and enrolled in medicare Medicare by reason of disability or end-stage end stage renal75
disease, as specified under 42 U.S.C. Section 426(b) or 426-1.76
(h)(i) Persons may enroll in a medicare Medicare supplement policy at any time authorized77
or required by the federal government or within six months of:78
(1) Enrolling in medicare Medicare Part B for an individual who is under 65 years of age79
and is eligible for medicare Medicare because by reason of disability or end-stage end80
stage renal disease, as specified under 42 U.S.C. Section 426(b) or 426-1, whichever is81
later;82
(2) Receiving notice that such person individual has been retroactively enrolled in83
medicare Medicare Part B due to a retroactive eligibility decision made by the Social84
Security Administration; or85
(3) Experiencing a qualifying event identified in regulations adopted pursuant to86
subsection (c) of this Code section.87
(j) Beginning January 1, 2026, in addition to the provisions in subsection (i) of this Code88
section, an individual may enroll in a Medicare supplement policy when such individual89
is currently enrolled in Medicare by reason of disability or end stage renal disease, as90
specified under 42 U.S.C. Section 426(b) or 426-1, during a one-time open enrollment91
period of six months beginning on January 1, 2026.92
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(i)(k) No policy or certificate issued pursuant to this chapter shall prohibit payment made93
by third parties on behalf of individual applicants or individuals within a group applicant94
so long as:95
(1) The third party is an immediate family member of a person lawfully exercising an96
in-force power of attorney or legal guardianship; or97
(2) The third party is a nonprofit, charitable organization that:98
(A) Is the named requestor of an advisory opinion issued by the United States99
Department of Health and Human Services (HHS) Office of Inspector General under100
the requirements of 42 C.F.R. Part 1008; and101
(B) Provides, upon request by the medicare Medicare supplement issuer, the specific102
advisory opinion relied upon by the third party to make such payment and a written103
certification that the advisory opinion is in full force and effect and has not been104
rescinded, modified, or terminated by the United States Department of Health and105
Human Services (HHS) Office of Inspector General.106
(j) Premiums for medicare supplemental insurance policies may differ between persons107
who qualify for medicare who are 65 years of age or older and those who qualify for108
medicare who are younger than 65 years of age; provided, however, that such differences109
in premiums shall not be excessive, inadequate, or unfairly discriminatory and shall be110
based on sound actuarial principles and reasonable in relation to the benefits provided.111
(l) An insurer shall not charge premium rates for a standardized Plan A, Plan B, or Plan D112
Medicare supplement policy or certificate for an individual under sixty-five years of age113
who becomes eligible for Medicare by reason of disability or end stage renal disease, as114
specified under 42 U.S.C. Section 426(b) or 426-1, that exceed premium rates charged for115
such policies to an individual who is 65 years of age.116
(m) An insurer shall not charge premium rates for any standardized lettered Medicare117
supplement policy or certificate other than those specified in subsection (l) of this Code118
section for an individual under 65 years of age who becomes eligible for Medicare by119
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reason of disability or end stage renal disease, as specified under 42 U.S.C. Section 426(b)120
or 426-1, that exceed 200 percent of the premium rates charged for such policy or121
certificate to an individual who is 65 years of age or issue to an individual under 65 years122
of age who becomes eligible for Medicare by reason of disability or end stage renal123
disease, as specified under 42 U.S.C. Section 426(b) or 426-1, a Medicare supplement124
policy or certificate that contains a waiting period or a preexisting condition limitation or125
exclusion."126
SECTION 3.127
For purposes of rule making, this Act shall become effective upon its approval by the128
Governor or upon its becoming law without such approval. For all other purposes, this Act129
shall become effective on January 1, 2026.130
SECTION 4.131
All laws and parts of laws in conflict with this Act are repealed.132
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