Georgia Group Health Insurance Is Not Regulated In Georgia
Group health insurance is one of the only types of insurance that is not regulated on a state level. If you live in Atlanta, Georgia, for example, and have individual health insurance, that insurance company is bound by the laws of the state of Georgia. However, group health insurance in Georgia, and everywhere in America, is federally regulated, which means that the United States government makes the laws that the group health insurance providers have to abide by.
Group health insurance is insurance that you get through your job. When you sign up for group health insurance from work you agree to allow your employer to take the premiums directly out of your earnings. They must do this because companies are required to pay a portion of your insurance premium as well. They just get one big bill from the insurance company and everyone who is enrolled at the time that they pay the bill is covered under the group plan.
The reason that the federal government, and not Georgia, regulates your group health insurance is because of a law enacted by Congress back in 1974 called ERISA (Employee Retirement Income Security Act). ERISA covers the regulations of employee benefits of all kinds, including retirement plans, employer stock options, and your group health insurance in Atlanta. Employees who take COBRA will pay up to 102% of the employer’s portion of their part of the group health insurance bill.
A 1985 act of Congress called COBRA (Consolidated Omnibus Budget Reconciliation Act) is another of the group health insurance laws that Georgia must follow. COBRA forces businesses who offer group health insurance to offer to extend that insurance if the employee is terminated or otherwise leaves their job. There are specific terms to this law that must be met for an employee to qualify for COBRA.
If the employee loses their job for any reason except that they were fired for misconduct, then they will be eligible for COBRA. If work hours were reduced and the worker no longer qualifies as a full time employee, and therefore no longer qualifies for group health insurance, that employee must be offered COBRA insurance. Once an employee becomes eligible for Medicare, they have the right to carry on COBRA insurance between the time their group health insurance expires and their Medicare kicks in.
COBRA isn’t just for employees who carried the group health insurance. Covered family members are also eligible for COBRA under certain conditions. If the employee dies, his or her covered dependents are eligible. If the employee gets divorced, the ex-spouse has the right to carry on COBRA insurance. A dependent child can also take COBRA once they are too old to remain on the insured’s group health insurance plan, even if the child moves away from Georgia.
The HIPAA act of 1996 is the newest congressional act to regulate group health insurance in Georgia and around the country. HIPAA stands for Health Insurance Portability and Accountability Act. There are three main objectives of HIPAA for group health insurance. First, as long as an employer offers group health insurance, no matter how large or small the group is, any employee who opts for the insurance cannot be denied, regardless of their health status.
Second, preexisting conditions must be covered under the group health insurance after an exclusionary period of no longer than 18 months. This period is reduced if the insured has had prior insurance within 63 days of enrolling for the new group health insurance plan, even if that insurance coverage was outside of the state of Georgia. Third, group health insurance coverage is guaranteed to be renewed regardless of the number of claims made by the insured.
Many states have already set forth insurance mandates, requiring every person to be covered by some kind of health insurance. Many more states are looking into this, and it is even being considered on a federal level. The reason for this is to lower the cost of insurance for everyone. Currently many people are not insured because they are low risk and don’t feel that insurance would be cost effective.
If these people were all insured, then their low risk would offset the cost of the high risk insured. If insurance mandates are enacted in Georgia, group health insurance regulations are likely to change.