May 19, 2015
On April 29, 2015, Gov. Deal signed HB 429 into law, amending Chapter 24 of Title 33 of the Official Code of Georgia Annotated. The new law makes two significant changes relating to health insurance coverage.
First, plans cannot restrict coverage for prescribed, medically appropriate treatments for participants who are diagnosed with a terminal condition. ‘Terminal condition’ is defined as any physician-diagnosed illness, health condition or disease that is expected to result in death in two years or less. The health benefit plan shall not refuse to pay/reimburse for the treatment (including for any drug or device) as long as such end-of-life care is consistent with best practices for treatment of the terminal condition and such treatment is supported by peer-reviewed medical literature.
In addition, plans must provide coverage related to autism spectrum disorders for any plan participants who are six years of age or younger. Specifically, plans must provide coverage for any assessments, evaluations or tests by a licensed physician or psychologist for diagnosis and any treatment for any such disorders diagnosed. This includes counseling, habilitative, rehabilitative and therapy services. Coverage for prescription drugs to treat autism spectrum disorders must be determined in the same manner as coverage for prescription drugs to treat other illnesses or conditions covered by plans. This provision does not apply to employers that have 10 or fewer employees. Therefore, fully-insured Georgia employers with more than 10 employees should be aware of the new terminal condition and autism spectrum disorder coverage requirements, and should work with insurers if any issues arise.
These two changes are effective July 1, 2015.
HB 429 »