| 5 | | - | To amend Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated,1 |
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| 6 | | - | relating to general provisions regarding insurance, so as to require major medical coverage2 |
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| 7 | | - | for annual prostate cancer screenings for certain men; to provide for definitions; to amend3 |
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| 8 | | - | Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare4 |
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| 9 | | - | supplement insurance, so as to provide for Medicare supplement policies to be issued and5 |
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| 10 | | - | renewed for individuals under 65 years of age who are eligible by reason of disability or end6 |
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| 11 | | - | stage renal disease under federal law; to provide for open enrollment periods; to prohibit an7 |
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| 12 | | - | insurer from charging premium rates for such policies for such individuals that exceed8 |
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| 13 | | - | premium rates charged for individuals who are 65 years of age; to provide for related9 |
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| 14 | | - | matters; to provide for effective dates and applicability; to repeal conflicting laws; and for10 |
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| 15 | | - | other purposes.11 |
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| 16 | | - | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:12 |
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| 17 | | - | SECTION 1.13 |
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| 18 | | - | Article 1 of Chapter 24 of Title 33 of the Official Code of Georgia Annotated, relating to14 |
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| 19 | | - | general provisions regarding insurance, is amended by adding a new Code section to read as15 |
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| 20 | | - | follows:16 |
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| 21 | | - | S. B. 91 (SUB) |
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| 22 | | - | - 1 - 25 LC 46 1238S |
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| 23 | | - | "33-24-59.34.17 |
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| 24 | | - | (a) As used in this Code section, the term:18 |
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| 25 | | - | (1) 'Health benefit policy' means any individual or group plan, policy, or contract for19 |
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| 26 | | - | healthcare services issued, delivered, issued for delivery, or renewed in this state which20 |
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| 27 | | - | provides major medical benefits by a healthcare corporation, health maintenance21 |
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| 28 | | - | organization, preferred provider organization, accident and sickness insurer, fraternal22 |
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| 29 | | - | benefit society, hospital service corporation, medical service corporation, or other insurer23 |
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| 30 | | - | or similar entity.24 |
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| 31 | | - | (2) 'Men with a family history of prostate cancer' means men who have a first-degree25 |
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| 32 | | - | relative:26 |
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| 33 | | - | (A) Who has been diagnosed with prostate cancer;27 |
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| 34 | | - | (B) Who developed prostate cancer;28 |
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| 35 | | - | (C) Whose death was a result of prostate cancer;29 |
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| 36 | | - | (D) Who has been diagnosed with a cancer known to be associated with an increased30 |
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| 37 | | - | risk of prostate cancer; or31 |
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| 38 | | - | (E) Who has a genetic alteration known to be associated with an increased risk of32 |
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| 39 | | - | prostate cancer.33 |
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| 40 | | - | (3) 'Men with a high risk for prostate cancer' means:34 |
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| 41 | | - | (A) Men with a family history of prostate cancer who are 40 to 49 years of age;35 |
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| 42 | | - | (B) Men who are 50 years of age and older; and36 |
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| 43 | | - | (C) Other men, as may be determined by a physician.37 |
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| 44 | | - | (b) A health benefit policy shall provide coverage for annual prostate cancer screenings38 |
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| 45 | | - | for men with a high risk for prostate cancer. Such coverage shall include a digital rectal39 |
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| 46 | | - | examination and a prostate-specific antigen test."40 |
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| 47 | | - | S. B. 91 (SUB) |
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| 48 | | - | - 2 - 25 LC 46 1238S |
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| 49 | | - | SECTION 2.41 |
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| 50 | | - | Chapter 43 of Title 33 of the Official Code of Georgia Annotated, relating to Medicare42 |
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| 51 | | - | supplement insurance, is amended by revising Code Section 33-43-3, relating to duplicate43 |
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| 52 | | - | benefits prohibited and establishment of standards, as follows:44 |
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| 53 | | - | "33-43-3.45 |
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| 54 | | - | (a) As used in this Code section, the term '42 U.S.C. Section 426(b) or 421-1' means such46 |
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| 55 | | - | federal law as it existed on January 1, 2025.47 |
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| 56 | | - | (a)(b) No medicare Medicare supplement insurance policy or certificate in force in this48 |
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| 57 | | - | state shall contain benefits which duplicate benefits provided by medicare Medicare.49 |
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| 58 | | - | (b)(c) Notwithstanding any other provision of Georgia law, a medicare Medicare50 |
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| 59 | | - | supplement policy or certificate shall not exclude or limit benefits for losses incurred more51 |
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| 60 | | - | than six months from the effective date of coverage because it involved a preexisting52 |
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| 61 | | - | condition. The policy or certificate shall not define a preexisting condition more53 |
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| 62 | | - | restrictively than a condition for which medical advice was given or treatment was54 |
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| 63 | | - | recommended by or received from a physician within six months before the effective date55 |
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| 64 | | - | of coverage.56 |
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| 65 | | - | (c)(d) The Commissioner shall adopt reasonable regulations to establish specific standards57 |
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| 66 | | - | for policy provisions of medicare Medicare supplement policies and certificates. Such58 |
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| 67 | | - | standards shall be in addition to and in accordance with applicable laws of this state. No59 |
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| 68 | | - | requirement of this title relating to minimum required policy benefits, other than the60 |
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| 69 | | - | minimum standards contained in this chapter, shall apply to medicare Medicare supplement61 |
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| 70 | | - | policies and certificates. The standards shall cover, but shall not be limited to:62 |
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| 71 | | - | (1) Terms of renewability;63 |
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| 72 | | - | (2) Initial and subsequent conditions of eligibility;64 |
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| 73 | | - | (3) Nonduplication of coverage;65 |
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| 74 | | - | (4) Probationary periods;66 |
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| 75 | | - | (5) Benefit limitations, exceptions, and reductions;67 |
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| 76 | | - | S. B. 91 (SUB) |
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| 77 | | - | - 3 - 25 LC 46 1238S |
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| 78 | | - | (6) Elimination periods;68 |
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| 79 | | - | (7) Requirements for replacement;69 |
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| 80 | | - | (8) Recurrent conditions; and70 |
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| 81 | | - | (9) Definitions of terms.71 |
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| 82 | | - | (d)(e) The Commissioner shall adopt reasonable regulations to establish minimum72 |
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| 83 | | - | standards for benefits, claims payment, marketing practices, compensation arrangements,73 |
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| 84 | | - | and reporting practices for medicare Medicare supplement policies and certificates.74 |
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| 85 | | - | (e)(f) The Commissioner may adopt from time to time such reasonable regulations as are75 |
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| 86 | | - | necessary to conform medicare Medicare supplement policies and certificates to the76 |
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| 87 | | - | requirements of federal law and regulations promulgated thereunder, including, but not77 |
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| 88 | | - | limited to:78 |
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| 89 | | - | (1) Requiring refunds or credits if the policies or certificates do not meet loss ratio79 |
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| 90 | | - | requirements;80 |
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| 91 | | - | (2) Establishing a uniform methodology for calculating and reporting loss ratios;81 |
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| 92 | | - | (3) Assuring public access to policies, premiums, and loss ratio information of issuers82 |
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| 93 | | - | of medicare Medicare supplement insurance;83 |
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| 94 | | - | (4) Establishing a process for approving or disapproving policy forms, certificate forms,84 |
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| 95 | | - | and proposed premium increases;85 |
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| 96 | | - | (5) Establishing a policy for holding public hearings prior to approval of premium86 |
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| 97 | | - | increases; and87 |
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| 98 | | - | (6) Establishing standards for medicare Medicare select policies and certificates.88 |
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| 99 | | - | (f)(g) The Commissioner may adopt reasonable regulations that specify prohibited policy89 |
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| 100 | | - | provisions not otherwise specifically authorized by statute which, in the opinion of the90 |
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| 101 | | - | Commissioner, are unjust, unfair, or unfairly discriminatory to any person individual91 |
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| 102 | | - | insured or proposed to be insured under a medicare Medicare supplement policy or92 |
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| 103 | | - | certificate.93 |
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| 104 | | - | S. B. 91 (SUB) |
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| 105 | | - | - 4 - 25 LC 46 1238S |
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| 106 | | - | (g)(h) Insurers offering medicare Medicare supplement policies in this state to persons for94 |
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| 107 | | - | individuals 65 years of age or older shall also offer medicare Medicare supplement policies95 |
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| 108 | | - | to persons for individuals in this state who are eligible for and enrolled in medicare96 |
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| 109 | | - | Medicare by reason of disability or end-stage end stage renal disease, as specified under97 |
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| 110 | | - | 42 U.S.C. Section 426(b) or 426-1. Such Medicare supplement policies shall be issued on98 |
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| 111 | | - | a guaranteed renewable basis under which the insurer shall be required to continue99 |
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| 112 | | - | coverage so long as premiums are paid on such policy. Except as otherwise provided in100 |
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| 113 | | - | this Code section, all benefits, protections, policies, and procedures that apply to persons101 |
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| 114 | | - | individuals 65 years of age or older shall also apply to persons individuals who are eligible102 |
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| 115 | | - | for and enrolled in medicare Medicare by reason of disability or end-stage end stage renal103 |
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| 116 | | - | disease, as specified under 42 U.S.C. Section 426(b) or 426-1.104 |
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| 117 | | - | (h)(i) Persons may enroll in a medicare Medicare supplement policy at any time authorized105 |
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| 118 | | - | or required by the federal government or within six months of:106 |
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| 119 | | - | (1) Enrolling in medicare Medicare Part B for an individual who is under 65 years of age107 |
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| 120 | | - | and is eligible for medicare Medicare because by reason of disability or end-stage end108 |
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| 121 | | - | stage renal disease, as specified under 42 U.S.C. Section 426(b) or 426-1, whichever is109 |
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| 122 | | - | later;110 |
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| 123 | | - | (2) Receiving notice that such person individual has been retroactively enrolled in111 |
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| 124 | | - | medicare Medicare Part B due to a retroactive eligibility decision made by the Social112 |
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| 125 | | - | Security Administration; or113 |
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| 126 | | - | (3) Experiencing a qualifying event identified in regulations adopted pursuant to114 |
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| 127 | | - | subsection (c) of this Code section.115 |
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| 128 | | - | (j) Beginning January 1, 2026, in addition to the provisions in subsection (i) of this Code116 |
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| 129 | | - | section, an individual may enroll in a Medicare supplement policy when such individual117 |
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| 130 | | - | is currently enrolled in Medicare by reason of disability or end stage renal disease, as118 |
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| 131 | | - | specified under 42 U.S.C. Section 426(b) or 426-1, during a one-time open enrollment119 |
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| 132 | | - | period of six months beginning on January 1, 2026.120 |
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| 133 | | - | S. B. 91 (SUB) |
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| 134 | | - | - 5 - 25 LC 46 1238S |
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| 135 | | - | (i)(k) No policy or certificate issued pursuant to this chapter shall prohibit payment made121 |
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| 136 | | - | by third parties on behalf of individual applicants or individuals within a group applicant122 |
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| 137 | | - | so long as:123 |
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| 138 | | - | (1) The third party is an immediate family member of a person lawfully exercising an124 |
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| 139 | | - | in-force power of attorney or legal guardianship; or125 |
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| 140 | | - | (2) The third party is a nonprofit, charitable organization that:126 |
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| 141 | | - | (A) Is the named requestor of an advisory opinion issued by the United States127 |
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| 142 | | - | Department of Health and Human Services (HHS) Office of Inspector General under128 |
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| 143 | | - | the requirements of 42 C.F.R. Part 1008; and129 |
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| 144 | | - | (B) Provides, upon request by the medicare Medicare supplement issuer, the specific130 |
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| 145 | | - | advisory opinion relied upon by the third party to make such payment and a written131 |
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| 146 | | - | certification that the advisory opinion is in full force and effect and has not been132 |
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| 147 | | - | rescinded, modified, or terminated by the United States Department of Health and133 |
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| 148 | | - | Human Services (HHS) Office of Inspector General.134 |
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| 149 | | - | (j) Premiums for medicare supplemental insurance policies may differ between persons135 |
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| 150 | | - | who qualify for medicare who are 65 years of age or older and those who qualify for136 |
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| 151 | | - | medicare who are younger than 65 years of age; provided, however, that such differences137 |
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| 152 | | - | in premiums shall not be excessive, inadequate, or unfairly discriminatory and shall be138 |
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| 153 | | - | based on sound actuarial principles and reasonable in relation to the benefits provided.139 |
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| 154 | | - | (l) An insurer shall not charge premium rates for a standardized Plan A, Plan B, or Plan D140 |
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| 155 | | - | Medicare supplement policy or certificate for an individual under sixty-five years of age141 |
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| 156 | | - | who becomes eligible for Medicare by reason of disability or end stage renal disease, as142 |
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| 157 | | - | specified under 42 U.S.C. Section 426(b) or 426-1, that exceed premium rates charged for143 |
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| 158 | | - | such policies to an individual who is 65 years of age.144 |
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| 159 | | - | (m) An insurer shall not charge premium rates for any standardized lettered Medicare145 |
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| 160 | | - | supplement policy or certificate other than those specified in subsection (l) of this Code146 |
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| 161 | | - | section for an individual under 65 years of age who becomes eligible for Medicare by147 |
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| 162 | | - | S. B. 91 (SUB) |
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| 163 | | - | - 6 - 25 LC 46 1238S |
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| 164 | | - | reason of disability or end stage renal disease, as specified under 42 U.S.C. Section 426(b)148 |
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| 165 | | - | or 426-1, that exceed 200 percent of the premium rates charged for such policy or149 |
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| 166 | | - | certificate to an individual who is 65 years of age or issue to an individual under 65 years150 |
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| 167 | | - | of age who becomes eligible for Medicare by reason of disability or end stage renal151 |
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| 168 | | - | disease, as specified under 42 U.S.C. Section 426(b) or 426-1, a Medicare supplement152 |
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| 169 | | - | policy or certificate that contains a waiting period or a preexisting condition limitation or153 |
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| 170 | | - | exclusion."154 |
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| 171 | | - | SECTION 3.155 |
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| 172 | | - | For purposes of rule making, this Act shall become effective upon its approval by the156 |
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| 173 | | - | Governor or upon its becoming law without such approval. For all other purposes, this Act157 |
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| 174 | | - | shall become effective on January 1, 2026, and shall apply to all applicable insurance policies158 |
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| 175 | | - | issued, delivered, issued for delivery, or renewed on or after such date. 159 |
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| 176 | | - | SECTION 4.160 |
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| 177 | | - | All laws and parts of laws in conflict with this Act are repealed.161 |
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| 178 | | - | S. B. 91 (SUB) |
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| 179 | | - | - 7 - |
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| 8 | + | To amend Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia |
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| 9 | + | 1 |
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| 10 | + | Annotated, relating to the state employees' health insurance plan, so as to prohibit the Board2 |
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| 11 | + | of Community Health from entering into, executing, or renewing a contract or contracts with3 |
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| 12 | + | any pharmacy benefits manager that owns or has an ownership interest in any retail4 |
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| 13 | + | pharmacy or any legal entity that contracts with or uses such pharmacy benefits manager; to5 |
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| 14 | + | provide for related matters; to repeal conflicting laws; and for other purposes.6 |
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| 15 | + | BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7 |
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| 16 | + | SECTION 1.8 |
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| 17 | + | Part 1 of Article 1 of Chapter 18 of Title 45 of the Official Code of Georgia Annotated,9 |
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| 18 | + | relating to the state employees' health insurance plan, is amended by adding a new Code10 |
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| 19 | + | section to read as follows:11 |
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| 20 | + | "45-18-6.2. |
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| 21 | + | 12 |
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| 22 | + | (a) On or after July 1, 2025, the board shall not enter into, execute, or renew any contract13 |
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| 23 | + | or contracts to provide benefits under the plan of health insurance benefits in accordance14 |
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| 24 | + | with this part with:15 |
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| 25 | + | S. B. 91 |
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| 26 | + | - 1 - 25 LC 52 0705 |
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| 27 | + | (1) Any pharmacy benefits manager that owns or has an ownership interest in any retail16 |
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| 28 | + | pharmacy; or17 |
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| 29 | + | (2) Any legal entity that contracts with or uses any pharmacy benefits manager that owns18 |
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| 30 | + | or has an ownership interest in any retail pharmacy.19 |
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| 31 | + | (b) This Code section shall not be construed to impair any contracts in existence on20 |
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| 32 | + | June 30, 2025."21 |
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| 33 | + | SECTION 2.22 |
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| 34 | + | All laws and parts of laws in conflict with this Act are repealed.23 |
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| 35 | + | S. B. 91 |
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| 36 | + | - 2 - |
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