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The House Committee on Health offers the following substitute to SB 91:
A BILL TO BE ENTITLED
AN ACT
To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,1
relating to general provisions regarding insurance, so as to require major medical coverage2
for annual prostate cancer screenings for certain men; to provide for definitions; to amend3
Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare4
supplement insurance, so as to provide for Medicare supplement policies to be issued and5
renewed for individuals under 65 years of age who are eligible by reason of disability or end6
stage renal disease under federal law; to provide for open enrollment periods; to prohibit an7
insurer from charging premium rates for such policies for such individuals that exceed8
premium rates charged for individuals who are 65 years of age; to provide for related9
matters; to provide for effective dates and applicability; to repeal conflicting laws; and for10
other purposes.11
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12
SECTION 1.13
Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to14
general provisions regarding insurance, is amended by adding a new Code section to read as15
follows:16
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"33-24-59.34.17
(a) As used in this Code section, the term:18
(1) 'Health benefit policy' means any individual or group plan, policy, or contract for19
healthcare services issued, delivered, issued for delivery, or renewed in this state which20
provides major medical benefits by a healthcare corporation, health maintenance21
organization, preferred provider organization, accident and sickness insurer, fraternal22
benefit society, hospital service corporation, medical service corporation, or other insurer23
or similar entity.24
(2) 'Men with a family history of prostate cancer' means men who have a first-degree25
relative:26
(A) Who has been diagnosed with prostate cancer;27
(B) Who developed prostate cancer;28
(C) Whose death was a result of prostate cancer;29
(D) Who has been diagnosed with a cancer known to be associated with an increased30
risk of prostate cancer; or31
(E) Who has a genetic alteration known to be associated with an increased risk of32
prostate cancer.33
(3) 'Men with a high risk for prostate cancer' means:34
(A) Men with a family history of prostate cancer who are 40 to 49 years of age;35
(B) Men who are 50 years of age and older; and36
(C) Other men, as may be determined by a physician.37
(b) A health benefit policy shall provide coverage for annual prostate cancer screenings38
for men with a high risk for prostate cancer. Such coverage shall include a digital rectal39
examination and a prostate-specific antigen test."40
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SECTION 2.41
Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare42
supplement insurance, is amended by revising Code Section 33-43-3, relating to duplicate43
benefits prohibited and establishment of standards, as follows:44
"33-43-3.45
(a) As used in this Code section, the term '42 U.S.C. Section 426(b) or 421-1' means such46
federal law as it existed on January 1, 2025.47
(a)(b) No medicare Medicare supplement insurance policy or certificate in force in this48
state shall contain benefits which duplicate benefits provided by medicare Medicare.49
(b)(c) Notwithstanding any other provision of Georgia law, a medicare Medicare50
supplement policy or certificate shall not exclude or limit benefits for losses incurred more51
than six months from the effective date of coverage because it involved a preexisting52
condition. The policy or certificate shall not define a preexisting condition more53
restrictively than a condition for which medical advice was given or treatment was54
recommended by or received from a physician within six months before the effective date55
of coverage.56
(c)(d) The Commissioner shall adopt reasonable regulations to establish specific standards57
for policy provisions of medicare Medicare supplement policies and certificates. Such58
standards shall be in addition to and in accordance with applicable laws of this state. No59
requirement of this title relating to minimum required policy benefits, other than the60
minimum standards contained in this chapter, shall apply to medicare Medicare supplement61
policies and certificates. The standards shall cover, but shall not be limited to:62
(1) Terms of renewability;63
(2) Initial and subsequent conditions of eligibility;64
(3) Nonduplication of coverage;65
(4) Probationary periods;66
(5) Benefit limitations, exceptions, and reductions;67
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(6) Elimination periods;68
(7) Requirements for replacement;69
(8) Recurrent conditions; and70
(9) Definitions of terms.71
(d)(e) The Commissioner shall adopt reasonable regulations to establish minimum72
standards for benefits, claims payment, marketing practices, compensation arrangements,73
and reporting practices for medicare Medicare supplement policies and certificates.74
(e)(f) The Commissioner may adopt from time to time such reasonable regulations as are75
necessary to conform medicare Medicare supplement policies and certificates to the76
requirements of federal law and regulations promulgated thereunder, including, but not77
limited to:78
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio79
requirements;80
(2) Establishing a uniform methodology for calculating and reporting loss ratios;81
(3) Assuring public access to policies, premiums, and loss ratio information of issuers82
of medicare Medicare supplement insurance;83
(4) Establishing a process for approving or disapproving policy forms, certificate forms,84
and proposed premium increases;85
(5) Establishing a policy for holding public hearings prior to approval of premium86
increases; and87
(6) Establishing standards for medicare Medicare select policies and certificates.88
(f)(g) The Commissioner may adopt reasonable regulations that specify prohibited policy89
provisions not otherwise specifically authorized by statute which, in the opinion of the90
Commissioner, are unjust, unfair, or unfairly discriminatory to any person individual91
insured or proposed to be insured under a medicare Medicare supplement policy or92
certificate.93
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(g)(h) Insurers offering medicare Medicare supplement policies in this state to persons for94
individuals 65 years of age or older shall also offer medicare Medicare supplement policies95
to persons for individuals in this state who are eligible for and enrolled in medicare96
Medicare by reason of disability or end-stage end stage renal disease, as specified under97
42 U.S.C. Section 426(b) or 426-1. Such Medicare supplement policies shall be issued on98
a guaranteed renewable basis under which the insurer shall be required to continue99
coverage so long as premiums are paid on such policy. Except as otherwise provided in100
this Code section, all benefits, protections, policies, and procedures that apply to persons101
individuals 65 years of age or older shall also apply to persons individuals who are eligible102
for and enrolled in medicare Medicare by reason of disability or end-stage end stage renal103
disease, as specified under 42 U.S.C. Section 426(b) or 426-1.104
(h)(i) Persons may enroll in a medicare Medicare supplement policy at any time authorized105
or required by the federal government or within six months of:106
(1) Enrolling in medicare Medicare Part B for an individual who is under 65 years of age107
and is eligible for medicare Medicare because by reason of disability or end-stage end108
stage renal disease, as specified under 42 U.S.C. Section 426(b) or 426-1, whichever is109
later;110
(2) Receiving notice that such person individual has been retroactively enrolled in111
medicare Medicare Part B due to a retroactive eligibility decision made by the Social112
Security Administration; or113
(3) Experiencing a qualifying event identified in regulations adopted pursuant to114
subsection (c) of this Code section.115
(j) Beginning January 1, 2026, in addition to the provisions in subsection (i) of this Code116
section, an individual may enroll in a Medicare supplement policy when such individual117
is currently enrolled in Medicare by reason of disability or end stage renal disease, as118
specified under 42 U.S.C. Section 426(b) or 426-1, during a one-time open enrollment119
period of six months beginning on January 1, 2026.120
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(i)(k) No policy or certificate issued pursuant to this chapter shall prohibit payment made121
by third parties on behalf of individual applicants or individuals within a group applicant122
so long as:123
(1) The third party is an immediate family member of a person lawfully exercising an124
in-force power of attorney or legal guardianship; or125
(2) The third party is a nonprofit, charitable organization that:126
(A) Is the named requestor of an advisory opinion issued by the United States127
Department of Health and Human Services (HHS) Office of Inspector General under128
the requirements of 42 C.F.R. Part 1008; and129
(B) Provides, upon request by the medicare Medicare supplement issuer, the specific130
advisory opinion relied upon by the third party to make such payment and a written131
certification that the advisory opinion is in full force and effect and has not been132
rescinded, modified, or terminated by the United States Department of Health and133
Human Services (HHS) Office of Inspector General.134
(j) Premiums for medicare supplemental insurance policies may differ between persons135
who qualify for medicare who are 65 years of age or older and those who qualify for136
medicare who are younger than 65 years of age; provided, however, that such differences137
in premiums shall not be excessive, inadequate, or unfairly discriminatory and shall be138
based on sound actuarial principles and reasonable in relation to the benefits provided.139
(l) An insurer shall not charge premium rates for a standardized Plan A, Plan B, or Plan D140
Medicare supplement policy or certificate for an individual under sixty-five years of age141
who becomes eligible for Medicare by reason of disability or end stage renal disease, as142
specified under 42 U.S.C. Section 426(b) or 426-1, that exceed premium rates charged for143
such policies to an individual who is 65 years of age.144
(m) An insurer shall not charge premium rates for any standardized lettered Medicare145
supplement policy or certificate other than those specified in subsection (l) of this Code146
section for an individual under 65 years of age who becomes eligible for Medicare by147
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reason of disability or end stage renal disease, as specified under 42 U.S.C. Section 426(b)148
or 426-1, that exceed 200 percent of the premium rates charged for such policy or149
certificate to an individual who is 65 years of age or issue to an individual under 65 years150
of age who becomes eligible for Medicare by reason of disability or end stage renal151
disease, as specified under 42 U.S.C. Section 426(b) or 426-1, a Medicare supplement152
policy or certificate that contains a waiting period or a preexisting condition limitation or153
exclusion."154
SECTION 3.155
For purposes of rule making, this Act shall become effective upon its approval by the156
Governor or upon its becoming law without such approval. For all other purposes, this Act157
shall become effective on January 1, 2026, and shall apply to all applicable insurance policies158
issued, delivered, issued for delivery, or renewed on or after such date. 159
SECTION 4.160
All laws and parts of laws in conflict with this Act are repealed.161
S. B. 91 (SUB)
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