Posts Tagged ‘Health Insurance in Georgia’
Health Insurance in Georgia – Regulation and Operation
Several private health insurance providers operate in Georgia, including Blue Cross Blue Shield of Georgia, which is one of the few members of the national Blue Cross Blue Shield federation of private health insurers that are publicly-traded companies. In Georgia, health insurance regulation is overseen by the Insurance and Safety Fire Commissioner, currently John W. Oxendine. Insurers are required to obtain a licence from the Office of the Commissioner, so that in the event of a licensed insurer becoming bankrupt, the State of Georgia’s Life & Health Guaranty Association will be able to provide cover up to $100,000.
Georgia state law requires private health insurance providers to perform certain tasks such as make a decision on whether to pay claims within specified timeframes. Under state law, insurers are required to pay, deny or request more information in relation to a claim within 15 days of receiving the claim. After the insurer obtains all the information it needs to justify a payment on a claim, an insurer has 15 more days to process the payment If an insurer has all the information they need to pay a claim, but delays doing so, the insurer must pay a penalty rate of 18% per annum on the amount of the unpaid claim for the duration of the period beginning on the sixteenth working day following receipt of all the information it needs up until the payment is made. However, insurers can generally audit and reverse a payment within 18 months of the date of service.
Individuals are permitted to be covered under two sets of family health insurance coverage. Georgia state insurance regulations permit this, with one policy designated the ‘primary’ and the other ‘secondary’ for each individual. This often occurs when a both members of a married couple have private health insurance provided to them by their employers covering all members of their family. Children may also benefit from this system. However, secondary insurers only pay if the payment would be more than the payment from a primary policy, which means that in many cases, secondary insurance policies do not pay out.