Georgia 2025-2026 Regular Session

Georgia Senate Bill SB262 Compare Versions

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

Old	New	Differences
1	1	25 LC 52 0764
2	2	Senate Bill 262
3	3	By: Senators Halpern of the 39th, Hufstetler of the 52nd, Goodman of the 8th, Watson of the
4	4	11th, Still of the 48th and others
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	To amend Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to
8	8	1
9	9	insurance generally, so as to provide for health benefit policies to cover preventive services;2
10	10	to provide for definitions; to prohibit cost-sharing requirements; to protect the eligibility of3
11	11	health savings accounts; to provide for review by the Commissioner of Insurance; to provide4
12	12	for rules and regulations; to provide for related matters; to repeal conflicting laws; and for5
13	13	other purposes.6
14	14	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
15	15	SECTION 1.8
16	16	Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to insurance9
17	17	generally, is amended by adding a new article to read as follows:10
18	18	"ARTICLE 5
19	19	11
20	20	33-24-100.12
21	21	As used in this article, the term:13
22	22	S. B. 262
23	23	- 1 - 25 LC 52 0764
24	24	(1) 'Cost-sharing requirement' means a deductible, coinsurance, or copayment and any14
25	25	maximum limitation on the application of such deductible, coinsurance, copayment, or15
26	26	similar out-of-pocket expense.16
27	27	(2) 'Evidence based' means founded on principles and concepts supported by research,17
28	28	practical strategies learned from clinical experience, and practices consistent with an18
29	29	individual's needs and circumstances.19
30	30	(3) 'Evidence informed' means incorporating evidence, clinical experience or20
31	31	professional expertise, and the perspectives of an individual directly affected.21
32	32	(4) 'Health benefit policy' means any individual or group plan, policy, or contract for22
33	33	healthcare services issued, delivered, issued for delivery, executed, or renewed in this23
34	34	state which provides major medical benefits, including those contracts executed by this24
35	35	state on behalf of indigents and on behalf of state employees under Article 1 of25
36	36	Chapter 18 of Title 45, on behalf of public school teachers and employees under Part 626
37	37	of Article 17 of Chapter 2 of Title 20, and on behalf of members and employees of the27
38	38	board of regents under Code Section 31-2-4, by a healthcare corporation, health28
39	39	maintenance organization, preferred provider organization, accident and sickness insurer,29
40	40	fraternal benefit society, hospital service corporation, medical service corporation, or any30
41	41	similar entity and any self-insured healthcare plan not subject to the exclusive jurisdiction31
42	42	of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Section 1001, et32
43	43	seq.33
44	44	(5) 'Health insurer' means an entity subject to the insurance laws and regulations of this34
45	45	state, or subject to the jurisdiction of the Commissioner, that contracts, offers to contract,35
46	46	or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of36
47	47	the costs of healthcare services.37
48	48	(6) 'Nationally recognized clinical practice guidelines' means evidence based or evidence38
49	49	informed clinical practice guidelines developed by medical or public health experts in39
50	50	independent organizations, medical professional societies, or the federal government40
51	51	S. B. 262
52	52	- 2 - 25 LC 52 0764
53	53	utilizing a transparent methodology and reporting structure and with a conflict-of-interest41
54	54	policy such as the United States Preventive Services Task Force, and by guidelines42
55	55	established by federal agencies such as the Advisory Committee on Immunization43
56	56	Practices of the Centers for Disease Control and Prevention and the Health Resources and44
57	57	Services Administration of the United States Department of Health and Human Services. 45
58	58	Such guidelines establish standards of care informed by a systematic review of evidence46
59	59	and an assessment of the benefits and risks of alternative care options and include47
60	60	recommendations intended to optimize patient care.48
61	61	(7) 'Preventive services' means clinical products or services, including, but not limited49
62	62	to, screening tests, counseling services, and prescription medicines, that are50
63	63	recommended for individuals in accordance with nationally recognized clinical practice51
64	64	guidelines to prevent health problems before they develop, occur, or worsen, as further52
65	65	provided in Code Section 33-24-101.53
66	66	33-24-101.54
67	67	Preventive services includes:55
68	68	(1) Evidence based items and services that are necessary for implementing the federal56
69	69	Patient Protection and Affordable Care Act as it existed January 1, 2025, and have a high57
70	70	or moderate net benefit for the individual directly affected;58
71	71	(2) Immunizations for routine use in children, adolescents, and adults;59
72	72	(3) Evidence informed preventive care and screenings for infants, children, and60
73	73	adolescents;61
74	74	(4) Evidence informed preventive care for women; and62
75	75	(5) Any preventive services as required under federal or state law in existence63
76	76	January 1, 2025.64
77	77	S. B. 262
78	78	- 3 - 25 LC 52 0764
79	79	33-24-102.65
80	80	(a) Every health insurer shall provide coverage for preventive services for covered persons66
81	81	under such policy.67
82	82	(b) The coverage provided for in subsection (a) of this Code section shall not be subject68
83	83	to any cost-sharing requirement of the covered person's health benefit policy and shall not69
84	84	diminish or limit any other benefits provided under such policy.70
85	85	(c) Nothing in this article shall prohibit a health insurer from providing coverage for items71
86	86	and services in addition to those provided for in subsection (a) of this Code section or from72
87	87	denying coverage for items and services that are not provided for in subsection (a) of this73
88	88	Code section.74
89	89	33-24-103.75
90	90	If application of the provisions of this Code section would result in health savings account76
91	91	ineligibility under 26 U.S.C. Section 223 as it existed on January 1, 2025, then such77
92	92	provisions shall apply only to health savings accounts with qualified high deductible health78
93	93	plans with respect to the deductibles of such plans after the individual has satisfied the79
94	94	minimum deductibles; provided, however, that the provisions of this Code section shall80
95	95	apply to items and services that are deemed to be preventive care.81
96	96	33-24-104.82
97	97	(a) No later than January 1, 2026, and annually thereafter, the Commissioner shall review83
98	98	health benefit policies provided by health insurers to ensure compliance with this article.84
99	99	(b) No later than October 1, 2025, the Commissioner shall promulgate rules and85
100	100	regulations necessary to implement the provisions of this article in accordance with86
101	101	nationally recognized clinical practice guidelines. The Commissioner shall regularly87
102	102	review nationally recognized clinical practice guidelines to determine if rules and88
103	103	regulations promulgated pursuant to this subsection require modification."89
104	104	S. B. 262
105	105	- 4 - 25 LC 52 0764
106	106	SECTION 2.
107	107	90
108	108	All laws and parts of laws in conflict with this Act are repealed.91
109	109	S. B. 262
110	110	- 5 -