Title 33, Chapter 43, Section 3
( 33-43-3)
(a) No medicare supplement insurance policy or certificate in force
in this state shall contain benefits which duplicate benefits
provided by medicare. (b) Notwithstanding any other provision of Georgia law, a medicare
supplement policy or certificate shall not exclude or limit benefits
for losses incurred more than six months from the effective date of
coverage because it involved a preexisting condition. The policy or
certificate shall not define a preexisting condition more
restrictively than a condition for which medical advice was given or
treatment was recommended by or received from a physician within six
months before the effective date of coverage. (c) The Commissioner shall adopt reasonable regulations to establish
specific standards for policy provisions of medicare supplement
policies and certificates. Such standards shall be in addition to
and in accordance with applicable laws of this state. No
requirement of this title relating to minimum required policy
benefits, other than the minimum standards contained in this
chapter, shall apply to medicare supplement policies and
certificates. The standards may cover, but shall not be limited to: (1) Terms of renewability; (2) Initial and subsequent conditions of eligibility; (3) Nonduplication of coverage; (4) Probationary periods; (5) Benefit limitations, exceptions, and reductions; (6) Elimination periods; (7) Requirements for replacement; (8) Recurrent conditions; and (9) Definitions of terms. (d) The Commissioner shall adopt reasonable regulations to establish
minimum standards for benefits, claims payment, marketing practices,
compensation arrangements, and reporting practices for medicare
supplement policies and certificates. (e) The Commissioner may adopt from time to time such reasonable
regulations as are necessary to conform medicare supplement policies
and certificates to the requirements of federal law and regulations
promulgated thereunder, including, but not limited to: (1) Requiring refunds or credits if the policies or certificates
do not meet loss ratio requirements; (2) Establishing a uniform methodology for calculating and
reporting loss ratios; (3) Assuring public access to policies, premiums, and loss ratio
information of issuers of medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy
forms, certificate forms, and proposed premium increases; (5) Establishing a policy for holding public hearings prior to
approval of premium increases; and (6) Establishing standards for medicare select policies and
certificates. (f) The Commissioner may adopt reasonable regulations that specify
prohibited policy provisions not otherwise specifically authorized
by statute which, in the opinion of the Commissioner, are unjust,
unfair, or unfairly discriminatory to any person insured or proposed
to be insured under a medicare supplement policy or certificate. |