25 LC 52 0764
Senate Bill 262
By: Senators Halpern of the 39th, Hufstetler of the 52nd, Goodman of the 8th, Watson of the
11th, Still of the 48th and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
1
insurance generally, so as to provide for health benefit policies to cover preventive services;2
to provide for definitions; to prohibit cost-sharing requirements; to protect the eligibility of3
health savings accounts; to provide for review by the Commissioner of Insurance; to provide4
for rules and regulations; to provide for related matters; to repeal conflicting laws; and for5
other purposes.6
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
SECTION 1.8
Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance9
generally, is amended by adding a new article to read as follows:10
"ARTICLE 5
11
33-24-100.12
As used in this article, the term:13
S. B. 262
- 1 - 25 LC 52 0764
(1) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any14
maximum limitation on the application of such deductible, coinsurance, copayment, or15
similar out-of-pocket expense.16
(2) 'Evidence based' means founded on principles and concepts supported by research,17
practical strategies learned from clinical experience, and practices consistent with an18
individual's needs and circumstances.19
(3) 'Evidence informed' means incorporating evidence, clinical experience or20
professional expertise, and the perspectives of an individual directly affected.21
(4) 'Health benefit policy' means any individual or group plan, policy, or contract for22
healthcare services issued, delivered, issued for delivery, executed, or renewed in this23
state which provides major medical benefits, including those contracts executed by this24
state on behalf of indigents and on behalf of state employees under Article 1 of25
Chapter 18 of Title 45, on behalf of public school teachers and employees under Part 626
of Article 17 of Chapter 2 of Title 20, and on behalf of members and employees of the27
board of regents under Code Section 31-2-4, by a healthcare corporation, health28
maintenance organization, preferred provider organization, accident and sickness insurer,29
fraternal benefit society, hospital service corporation, medical service corporation, or any30
similar entity and any self-insured healthcare plan not subject to the exclusive jurisdiction31
of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et32
seq.33
(5) 'Health insurer' means an entity subject to the insurance laws and regulations of this34
state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract,35
or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of36
the costs of healthcare services.37
(6) 'Nationally recognized clinical practice guidelines' means evidence based or evidence38
informed clinical practice guidelines developed by medical or public health experts in39
independent organizations, medical professional societies, or the federal government40
S. B. 262
- 2 - 25 LC 52 0764
utilizing a transparent methodology and reporting structure and with a conflict-of-interest41
policy such as the United States Preventive Services Task Force, and by guidelines42
established by federal agencies such as the Advisory Committee on Immunization43
Practices of the Centers for Disease Control and Prevention and the Health Resources and44
Services Administration of the United States Department of Health and Human Services. 45
Such guidelines establish standards of care informed by a systematic review of evidence46
and an assessment of the benefits and risks of alternative care options and include47
recommendations intended to optimize patient care.48
(7) 'Preventive services' means clinical products or services, including, but not limited49
to, screening tests, counseling services, and prescription medicines, that are50
recommended for individuals in accordance with nationally recognized clinical practice51
guidelines to prevent health problems before they develop, occur, or worsen, as further52
provided in Code Section 33-24-101.53
33-24-101.54
Preventive services includes:55
(1) Evidence based items and services that are necessary for implementing the federal56
Patient Protection and Affordable Care Act as it existed January 1, 2025, and have a high57
or moderate net benefit for the individual directly affected;58
(2) Immunizations for routine use in children, adolescents, and adults;59
(3) Evidence informed preventive care and screenings for infants, children, and60
adolescents;61
(4) Evidence informed preventive care for women; and62
(5) Any preventive services as required under federal or state law in existence63
January 1, 2025.64
S. B. 262
- 3 - 25 LC 52 0764
33-24-102.65
(a) Every health insurer shall provide coverage for preventive services for covered persons66
under such policy.67
(b) The coverage provided for in subsection (a) of this Code section shall not be subject68
to any cost-sharing requirement of the covered person's health benefit policy and shall not69
diminish or limit any other benefits provided under such policy.70
(c) Nothing in this article shall prohibit a health insurer from providing coverage for items71
and services in addition to those provided for in subsection (a) of this Code section or from72
denying coverage for items and services that are not provided for in subsection (a) of this73
Code section.74
33-24-103.75
If application of the provisions of this Code section would result in health savings account76
ineligibility under 26 U.S.C. Section 223 as it existed on January 1, 2025, then such77
provisions shall apply only to health savings accounts with qualified high deductible health78
plans with respect to the deductibles of such plans after the individual has satisfied the79
minimum deductibles; provided, however, that the provisions of this Code section shall80
apply to items and services that are deemed to be preventive care.81
33-24-104.82
(a) No later than January 1, 2026, and annually thereafter, the Commissioner shall review83
health benefit policies provided by health insurers to ensure compliance with this article.84
(b) No later than October 1, 2025, the Commissioner shall promulgate rules and85
regulations necessary to implement the provisions of this article in accordance with86
nationally recognized clinical practice guidelines. The Commissioner shall regularly87
review nationally recognized clinical practice guidelines to determine if rules and88
regulations promulgated pursuant to this subsection require modification."89
S. B. 262
- 4 - 25 LC 52 0764
SECTION 2.
90
All laws and parts of laws in conflict with this Act are repealed.91
S. B. 262
- 5 -