So John Oxendine refused to implement high risk pools in Georgia.
Except Georgia already has high risk pools.
“Taxpayers are already paying for the administration of Georgia’s limited high risk pool alternatives and Oxendine’s misrepresentation of facts are an attempt to continue keeping Georgian’s from getting access to the pools” Squires said.
“This should come as no surprise given the millions of dollars Oxendine has received from Insurance Companies to fund his campaigns.”
A CTRL-C, CTRL-V of the press release (NOW INCLUDING THREE PAGES OF GEORGIA CODE!!!!!!!!!) below.
Mary Squires Questions Oxendine’s Refusal to Implement High Risk Pool
(Atlanta, Ga) Mary Squires, Democratic Candidate for Georgia Insurance Commissioner, responded today to current Insurance Commissioner John Oxendine’s refusal to implement the first phase of the federal health care legislation, stating Oxendine is purposely misleading Georgian’s for political and financial gain.
“Georgia already has two limited high risk pool alternatives. The “Georgia Health Insurance Assignment System” was passed by the Georgia Legislature in 1997 creating both pools and the rules and regulations were promulgated by Oxendine in the office of the Insurance Commissioner. Taxpayers are already paying for the administration of Georgia’s limited high risk pool alternatives and Oxendine’s misrepresentation of facts are an attempt to continue keeping Georgian’s from getting access to the pools. This should come as no surprise given the millions of dollars Oxendine has received from Insurance Companies to fund his campaigns.”
Squires was elected to the Georgia General Assembly in 1998. Squires served two terms in the State House (1999-2003) and one term in the Georgia State Senate (2003-2005). In addition to her legislative experience, Squires served ten years in the Georgia Army National Guard. Mary Squires currently is the Executive Director of the Georgia Society of Professional Benefit Administrators, Inc., a self-insured health care trade association. Squires and her husband Tom West of Augusta currently reside in Atlanta, Georgia and have four children.
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Georgia Assignment System
Intent
O.C.G.A. § 33-29A-1
(a) It is the intention of this chapter together with Code Section 33-24-21.1 to provide an acceptable alternative mechanism for the availability of individual health insurance coverage
Condition to Licensure
O.C.G.A. § 33-29A-3
Each health insurer and managed care corporation which is licensed to and does offer health insurance coverage in the individual market in this state shall as a condition of such licensure agree to participation in its respective assignment system provided by this chapter. This Code section shall not apply to an entity which offers only excepted benefits as specified in Section 2791(c) of the federal Public Health Service Act, 42 U.S.C.A. Section 300gg-91(c).
Georgia Healh Insurance Assignment System-one of two assignment systems
O.C.G.A. § 33-29A-4
(a) Each eligible individual in this state whose most recent creditable coverage was provided by an entity other than a managed care organization shall be entitled to participate in the Georgia Health Insurance Assignment System (sometimes referred to as GHIAS in this chapter) created pursuant to this Code section. Each eligible individual in this state whose most recent creditable coverage was provided by a managed care organization shall be entitled to participate in the Georgia Health Benefits Assignment System created pursuant to Code Section 33-29A-5.
(b) The Commissioner shall develop the GHIAS system which shall provide for the equitable assignment of eligible individuals who are entitled to and desirous of participating in the system to health insurers offering coverage in the individual market in the state. Such assignment shall be based primarily on the pro rata volume of individual health insurance business done in this state by each such health insurer. The system may include other factors for equitable assignment, as determined to be appropriate by the Commissioner, including but not limited to the geographic area or areas in the state normally served by a health insurer.
(c) Upon assignment of an eligible individual to a health insurer, the eligible individual shall have the right to purchase and the health insurer shall have the obligation to sell either of the standard health insurance policies provided for in subsection (d) of this Code section at a premium not to exceed the maximum specified in said subsection.
Georgia Health Benefits Assignment System-two of two assignment systems
O.C.G.A § 33-29A-5
(a) Each eligible individual in this state whose most recent creditable coverage was provided by a managed care organization shall be entitled to participate in the Georgia Health Benefits Assignment System (sometimes referred to as GHBAS in this chapter) created pursuant to this Code section. Each eligible individual in this state whose most recent creditable coverage was provided by an entity other than a managed care organization shall be entitled to participate in the Georgia Health Insurance Assignment System created pursuant to Code Section 33-29A-4.
Commissioner Oxendine’s Responsibility to Develop the System and Oversight
(b) The Commissioner shall develop the GHBAS system which shall provide for the equitable assignment of eligible individuals who are entitled to and desirous of participating in the system to managed care organizations doing business in the state. Such assignment shall be based primarily on the pro rata volume of individual business done in this state by each such managed care organization and the geographic area or areas in the state normally served by a managed care organization. The system may include other factors for equitable assignment, as determined to be appropriate by the Commissioner. No managed care organization shall be required to provide coverage outside the geographic area or areas normally served by that managed care organization. However, where this geographic limitation makes it impossible to assign to a managed care organization its equitable share of eligible individuals, a managed care organization may be required by the Commissioner to contract for provision of coverage of eligible individuals, as provided for in Code Section 33-29A-6.
(c) Upon assignment of an eligible individual to a managed care organization, the eligible individual shall have the right to purchase and the managed care organization shall have the obligation to sell enrollment in either of the standard health benefit plans provided for in subsection (d) of this Code section at a premium not to exceed the maximum specified in said subsection.
(d) The Commissioner shall develop two standard health benefit plans to be provided by managed care organizations to which eligible individuals are assigned pursuant to this Code section. The actuarial value of the benefits under each such health benefit plan shall be at least 85 percent of the average actuarial value of the benefits provided by all health benefit plans issued in the individual market by all managed care organizations in the state. Except to the extent specifically provided to the contrary in this chapter, all laws of this state relating to the normal provision of such coverage in the individual market shall apply to the provision of such coverage under this chapter. The Commissioner shall fix a maximum premium to be charged for each such standard health benefit plan which shall be not more than 150 percent of the average premium which is or would be charged by all managed care organizations in the state for the same or similar coverage issued other than under this Code section, as determined by the Commissioner. The Commissioner may authorize a managed care organization to charge a premium in excess of said 150 percent maximum if and only if the managed care organization demonstrates to the Commissioner that the application of the 150 percent maximum would endanger the financial solvency of that managed care organization.
(e) Nothing in this Code section shall be construed to require a managed care organization to offer to an eligible individual any coverage other than one of the two standard health benefit plans developed under subsection (d) of this Code section. Nothing in this Code section shall be construed to prohibit any managed care organization from offering to any individual any otherwise lawful coverage.
Contracting Between Managed Care Organizations
O.C.G.A. § 33-29A-6
Any combination of one or more health insurers and one or more managed care organizations may contract with each other for the assumption by one or more health insurers of the obligations otherwise imposed by this chapter on one or more managed care organizations. Under any such contract the responsibility for providing the coverage required by this chapter shall be with a health insurer licensed to do business in this state. Where the obligations of a managed care organization are contractually assumed by a health insurer, the assuming health insurer may substitute coverage under a standard policy of health insurance for coverage under a standard health benefit plan, and provision of such substituted coverage shall satisfy the obligation otherwise owed to an affected eligible individual.
Moratorium on Required Issuance of Coverage
O.C.G.A. § 33-29A-7
The Commissioner may impose a moratorium upon the required issuance of coverage by a health insurer or managed care organization, if the Commissioner determines after public notice and hearing that the continuation of such required issuance by that entity will endanger the solvency of that entity.
Rules and Regulations; Compensation to Licensed Insurance Agents
O.C.G.A. § 33-29A-8
(a) The Commissioner shall adopt rules and regulations for the implementation of this chapter. Notwithstanding any provision of Chapter 2 of this title or any other law to the contrary, such rules and regulations shall be adopted in exact compliance with the procedures specified in Article 1 of Chapter 13 of Title 50, the ‘Georgia Administrative Procedure Act.’ In addition to any other materials submitted under subsection (e) of Code Section 50-13-4, there shall be so submitted the full text of the Georgia Health Insurance Assignment System, the Georgia Health Benefits Assignment System, the standard health insurance policies provided for in Code Section 33-29A-4, and the standard health benefit plans provided for in Code Section 33-29A-5.
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