Georgia 2025-2026 Regular Session

Georgia House Bill HB323 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	25 LC 46 1064
2	2	House Bill 323
3	3	By: Representatives Mathiak of the 82
4	4	nd
5	5	, Hawkins of the 27
6	6	th
7	7	, Newton of the 127
8	8	th
9	9	, Dempsey
10	10	of the 13
11	11	th
12	12	, Cooper of the 45
13	13	th
14	14	, and others
15	15	A BILL TO BE ENTITLED
16	16	AN ACT
17	17	To amend Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to
18	18	1
19	19	Medicare supplement insurance, so as to provide for Medicare supplement policies to be2
20	20	issued and renewed for individuals under 65 years of age who are eligible by reason of3
21	21	disability or end stage renal disease under federal law; to provide for open enrollment4
22	22	periods; to prohibit an insurer from charging premium rates for such policies for such5
23	23	individuals that exceed premium rates charged for individuals who are 65 years of age; to6
24	24	provide for a short title; to provide for related matters; to provide for effective dates; to repeal7
25	25	conflicting laws; and for other purposes.8
26	26	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
27	27	SECTION 1.10
28	28	This Act shall be known and may be cited as the "Bridging the Gap for ALS and Chronic11
29	29	Kidney Disease Act of 2025."12
30	30	H. B. 323
31	31	- 1 - 25 LC 46 1064
32	32	SECTION 2.
33	33	13
34	34	Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare14
35	35	supplement insurance, is amended by revising Code Section 33-43-3, relating to duplicate15
36	36	benefits prohibited and establishment of standards, as follows:16
37	37	"33-43-3.17
38	38	(a) As used in this Code section, the term '42 U.S.C. Section 426(b) or 421-1' means such
39	39	18
40	40	federal law as it existed on January 1, 2025.19
41	41	(a)(b) No medicare Medicare supplement insurance policy or certificate in force in this20
42	42	state shall contain benefits which duplicate benefits provided by medicare Medicare.21
43	43	(b)(c) Notwithstanding any other provision of Georgia law, a medicare Medicare22
44	44	supplement policy or certificate shall not exclude or limit benefits for losses incurred more23
45	45	than six months from the effective date of coverage because it involved a preexisting24
46	46	condition. The policy or certificate shall not define a preexisting condition more25
47	47	restrictively than a condition for which medical advice was given or treatment was26
48	48	recommended by or received from a physician within six months before the effective date27
49	49	of coverage.28
50	50	(c)(d) The Commissioner shall adopt reasonable regulations to establish specific standards29
51	51	for policy provisions of medicare Medicare supplement policies and certificates. Such30
52	52	standards shall be in addition to and in accordance with applicable laws of this state. No31
53	53	requirement of this title relating to minimum required policy benefits, other than the32
54	54	minimum standards contained in this chapter, shall apply to medicare Medicare supplement33
55	55	policies and certificates. The standards shall cover, but shall not be limited to:34
56	56	(1) Terms of renewability;35
57	57	(2) Initial and subsequent conditions of eligibility;36
58	58	(3) Nonduplication of coverage;37
59	59	(4) Probationary periods;38
60	60	(5) Benefit limitations, exceptions, and reductions;39
61	61	H. B. 323
62	62	- 2 - 25 LC 46 1064
63	63	(6) Elimination periods;
64	64	40
65	65	(7) Requirements for replacement;41
66	66	(8) Recurrent conditions; and42
67	67	(9) Definitions of terms.43
68	68	(d)
69	69	(e) The Commissioner shall adopt reasonable regulations to establish minimum44
70	70	standards for benefits, claims payment, marketing practices, compensation arrangements,45
71	71	and reporting practices for medicare Medicare supplement policies and certificates.46
72	72	(e)(f) The Commissioner may adopt from time to time such reasonable regulations as are47
73	73	necessary to conform medicare Medicare supplement policies and certificates to the48
74	74	requirements of federal law and regulations promulgated thereunder, including, but not49
75	75	limited to:50
76	76	(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio51
77	77	requirements;52
78	78	(2) Establishing a uniform methodology for calculating and reporting loss ratios;53
79	79	(3) Assuring public access to policies, premiums, and loss ratio information of issuers54
80	80	of medicare Medicare supplement insurance;55
81	81	(4) Establishing a process for approving or disapproving policy forms, certificate forms,56
82	82	and proposed premium increases;57
83	83	(5) Establishing a policy for holding public hearings prior to approval of premium58
84	84	increases; and59
85	85	(6) Establishing standards for medicare Medicare select policies and certificates.60
86	86	(f)(g) The Commissioner may adopt reasonable regulations that specify prohibited policy61
87	87	provisions not otherwise specifically authorized by statute which, in the opinion of the62
88	88	Commissioner, are unjust, unfair, or unfairly discriminatory to any person individual63
89	89	insured or proposed to be insured under a medicare Medicare supplement policy or64
90	90	certificate.65
91	91	H. B. 323
92	92	- 3 - 25 LC 46 1064
93	93	(g)(h) Insurers offering medicare Medicare supplement policies in this state to persons for66
94	94	individuals 65 years of age or older shall also offer medicare Medicare supplement policies67
95	95	to persons for individuals in this state who are eligible for and enrolled in medicare68
96	96	Medicare by reason of disability or end-stage end stage renal disease, as specified under69
97	97	42 U.S.C. Section 426(b) or 426-1. Such Medicare supplement policies shall be issued on70
98	98	a guaranteed renewable basis under which the insurer shall be required to continue71
99	99	coverage so long as premiums are paid on such policy. Except as otherwise provided in72
100	100	this Code section, all benefits, protections, policies, and procedures that apply to persons73
101	101	individuals 65 years of age or older shall also apply to persons individuals who are eligible74
102	102	for and enrolled in medicare Medicare by reason of disability or end-stage end stage renal75
103	103	disease, as specified under 42 U.S.C. Section 426(b) or 426-1.76
104	104	(h)(i) Persons may enroll in a medicare Medicare supplement policy at any time authorized77
105	105	or required by the federal government or within six months of:78
106	106	(1) Enrolling in medicare Medicare Part B for an individual who is under 65 years of age79
107	107	and is eligible for medicare Medicare because by reason of disability or end-stage end80
108	108	stage renal disease, as specified under 42 U.S.C. Section 426(b) or 426-1, whichever is81
109	109	later;82
110	110	(2) Receiving notice that such person individual has been retroactively enrolled in83
111	111	medicare Medicare Part B due to a retroactive eligibility decision made by the Social84
112	112	Security Administration; or85
113	113	(3) Experiencing a qualifying event identified in regulations adopted pursuant to86
114	114	subsection (c) of this Code section.87
115	115	(j) Beginning January 1, 2026, in addition to the provisions in subsection (i) of this Code88
116	116	section, an individual may enroll in a Medicare supplement policy when such individual89
117	117	is currently enrolled in Medicare by reason of disability or end stage renal disease, as90
118	118	specified under 42 U.S.C. Section 426(b) or 426-1, during a one-time open enrollment91
119	119	period of six months beginning on January 1, 2026.92
120	120	H. B. 323
121	121	- 4 - 25 LC 46 1064
122	122	(i)(k) No policy or certificate issued pursuant to this chapter shall prohibit payment made93
123	123	by third parties on behalf of individual applicants or individuals within a group applicant94
124	124	so long as:95
125	125	(1) The third party is an immediate family member of a person lawfully exercising an96
126	126	in-force power of attorney or legal guardianship; or97
127	127	(2) The third party is a nonprofit, charitable organization that:98
128	128	(A) Is the named requestor of an advisory opinion issued by the United States99
129	129	Department of Health and Human Services (HHS) Office of Inspector General under100
130	130	the requirements of 42 C.F.R. Part 1008; and101
131	131	(B) Provides, upon request by the medicare Medicare supplement issuer, the specific102
132	132	advisory opinion relied upon by the third party to make such payment and a written103
133	133	certification that the advisory opinion is in full force and effect and has not been104
134	134	rescinded, modified, or terminated by the United States Department of Health and105
135	135	Human Services (HHS) Office of Inspector General.106
136	136	(j) Premiums for medicare supplemental insurance policies may differ between persons107
137	137	who qualify for medicare who are 65 years of age or older and those who qualify for108
138	138	medicare who are younger than 65 years of age; provided, however, that such differences109
139	139	in premiums shall not be excessive, inadequate, or unfairly discriminatory and shall be110
140	140	based on sound actuarial principles and reasonable in relation to the benefits provided.111
141	141	(l) An insurer shall not charge premium rates for a standardized Plan A, Plan B, or Plan D112
142	142	Medicare supplement policy or certificate for an individual under sixty-five years of age113
143	143	who becomes eligible for Medicare by reason of disability or end stage renal disease, as114
144	144	specified under 42 U.S.C. Section 426(b) or 426-1, that exceed premium rates charged for115
145	145	such policies to an individual who is 65 years of age.116
146	146	(m) An insurer shall not charge premium rates for any standardized lettered Medicare117
147	147	supplement policy or certificate other than those specified in subsection (l) of this Code118
148	148	section for an individual under 65 years of age who becomes eligible for Medicare by119
149	149	H. B. 323
150	150	- 5 - 25 LC 46 1064
151	151	reason of disability or end stage renal disease, as specified under 42 U.S.C. Section 426(b)120
152	152	or 426-1, that exceed 200 percent of the premium rates charged for such policy or121
153	153	certificate to an individual who is 65 years of age or issue to an individual under 65 years122
154	154	of age who becomes eligible for Medicare by reason of disability or end stage renal123
155	155	disease, as specified under 42 U.S.C. Section 426(b) or 426-1, a Medicare supplement124
156	156	policy or certificate that contains a waiting period or a preexisting condition limitation or125
157	157	exclusion."126
158	158	SECTION 3.127
159	159	For purposes of rule making, this Act shall become effective upon its approval by the128
160	160	Governor or upon its becoming law without such approval. For all other purposes, this Act129
161	161	shall become effective on January 1, 2026.130
162	162	SECTION 4.131
163	163	All laws and parts of laws in conflict with this Act are repealed.132
164	164	H. B. 323
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