Title 33, Chapter 29A, Section 4
( 33-29A-4)
(a) Each eligible individual in this state whose most recent creditable coverage was provided by an entity other than a managed care organization shall be entitled to participate in the Georgia Health Insurance Assignment System (sometimes referred to as GHIAS in this chapter) created pursuant to this Code section. Each eligible individual in this state whose most recent creditable coverage was provided by a managed care organization shall be entitled to participate in the Georgia Health Benefits Assignment System created pursuant to Code Section 33-29A-5. (b) The Commissioner shall develop the GHIAS system which shall
provide for the equitable assignment of eligible individuals who are
entitled to and desirous of participating in the system to health
insurers offering coverage in the individual market in the state.
Such assignment shall be based primarily on the pro rata volume of
individual health insurance business done in this state by each such
health insurer. The system may include other factors for equitable
assignment, as determined to be appropriate by the Commissioner,
including but not limited to the geographic area or areas in the
state normally served by a health insurer. (c) Upon assignment of an eligible individual to a health insurer,
the eligible individual shall have the right to purchase and the
health insurer shall have the obligation to sell either of the
standard health insurance policies provided for in subsection (d) of
this Code section at a premium not to exceed the maximum specified
in said subsection. (d) The Commissioner shall develop two standard health insurance
policies to be provided by health insurers to which eligible
individuals are assigned pursuant to this Code section. The
actuarial value of the benefits under each such coverage shall be at
least 85 percent of the average actuarial value of the benefits
provided by all individual health insurance coverage issued by all
issuers in the state. Except to the extent specifically provided to
the contrary in this chapter, all laws of this state relating to the
normal provision of such coverage in the individual market shall
apply to the provision of such coverage under this chapter. The
Commissioner shall fix a maximum premium to be charged for each such
standard policy which shall be not more than 150 percent of the
average premium which is or would be charged by all issuers in the
state for the same or similar coverage issued other than under this
Code section, as determined by the Commissioner. The Commissioner
may authorize a health insurer to charge a premium in excess of said
150 percent maximum if and only if the insurer demonstrates to the
Commissioner that the application of the 150 percent maximum would
endanger the financial solvency of that health insurer. (e) Nothing in this Code section shall be construed to require a
health insurer to offer to an eligible individual any coverage other
than one of the two standard health insurance plans developed under
subsection (d) of this Code section. Nothing in this Code section
shall be construed to prohibit any insurer from offering to any
individual any otherwise lawful coverage. |