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Georgia Health Insurance Rules

Health insurance provides coverage for medical procedures and conditions as determined medically necessary by the provider. The rules that govern health insurance are complicated and may depend upon the state in which you live. Georgia has its own health insurance rules for insurance companies doing business within state lines.

  1. Plan Eligibility

    • The Georgia Department of Insurance regulates all types of insurance in the state, including health insurance. In Georgia, an insurer can reject an application for coverage based on health status. There are, however, notable exceptions. For example, if you've had at least six months of coverage under a group plan, then you are eligible for a conversion policy. This conversion policy will change your group plan into an individual policy. Also, if you've had a minimum of 18 months of continuous creditable coverage, the last day of the 18 months falls under a group plan, and you have exhausted any and all COBRA continuation coverage, then you may qualify for HIPAA insurance. HIPAA is the Health Insurance Portability and Accountability Act that protects an individual's right to health insurance.

    Medicaid

    • Georgia also has a Medicaid program for health insurance. In Georgia, the Medicaid program provides health coverage for the poor and indigent. Eligible individuals include pregnant women and those under the age of 19 who meet income requirements. The income requirements vary depending on the number of individuals in your family and the program you qualify under. For example, as of April 2010, if you qualify for 100 percent payments for Medicaid, then you can only make up to $674 per month for an individual or $1,011 per month as a couple. Additional individuals who may qualify for Medicaid in Georgia are the blind, the disabled and the elderly.

    Filing Complaints in Georgia

    • Private health insurance is also available through insurance agents and companies in the state. If you have an issue with the insurance agent or the insurance company, you can file a complaint through the Georgia Department of Insurance. You can either file in person or online through the Georgia Department of Insurance website. If you receive health insurance through your employer in Georgia, the plan is regulated by the U.S. Department of Labor's Employee Benefits Security Administration, and complaints must be filed through that venue.

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