Georgia Individual Health Insurance Plans

Individual and family health insurance plans in Georgia are not guaranteed issue, but instead are underwritten to determine eligibility. During the underwriting process the insurance company will gather an applicant's past and present medical history. The insurance company will use this information as well as information submitted in your Georgia Health Insurance application to:

• decline health insurance coverage based on medical history
• approve health insurance coverage but place limitations on coverage for pre-existing conditions,
• approve health insurance coverage but include elimination riders as a part of your health contract, or
• approve the application and offer full standard health insurance coverage as applied for.

Georgia state insurance laws require a 24 month exclusionary period limit for pre-existing conditions and prior credible coverage does not apply toward this period. In addition, medical insurance companies can include an elimination rider which may temporarily or permanently exclude medical insurance coverage for a specific medical condition.

Small Group Health Insurance in Georgia

Small employer groups are defined as groups with 2 - 50 employees and small group medical insurance in Georgia is issued on a guaranteed issue basis. Therefore, small employer groups cannot be declined coverage by the insurance company due to the past or present health status of their employees.

Health insurance companies may, under Georgia insurance laws, impose a 6 month look back and a 12 month exclusionary period for pre-existing medical conditions on all applicants who do not have prior creditable Georgia health insurance coverage among other things Pregnancy, new born babies and newly adopted children cannot be included in pre-existing exclusion periods. Continued creditable insurance coverage is credited when there has not been a period when the applicant is uninsured for more than 63 days.

Employers may require new employees to complete an eligibility period before they can join the group health insurance plan in Georgia. HMO group health plans may require new applicants to complete a waiting period known as an affiliation period. The affiliation period cannot be longer than 2 months. When medical insurance companies are calculating the rates for small group insurance coverage, the state of Georgia allows a rate adjustment factor of 25% based on claims history.

For more information: Affordable Georgia Health Insurance For The Self-Employed

Georgia COBRA and Continuation Coverage

Small employer groups of 2 -19 employees must comply with Georgia's mini-COBRA regulation which requires groups of 2 -19 employees offers continuation coverage. State COBRA regulations mandate that an employee who suffers a qualifying event may choose, at their expense, to be covered under their previous employers Georgia group health insurance plan. State COBRA regulations require an additional 3 months of medical coverage. Employees must have been covered by their employer group medical plan for a minimum of 6 months to qualify for continued coverage under COBRA regulations. Businesses with more than 20 employees must abide by federal COBRA regulations.

People who have exhausted their COBRA coverage may be able to exercise a conversion option, available through the insurance company, for guaranteed issue individual health insurance coverage in Georgia . Georgia does not have a high risk pool for those that have pre-existing medical conditions.