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Georgia Health Insurance Guide
There are many types of health insurance
coverage plans that are sold in Georgia. Many plans provide coverage benefits for routine visits to
health care providers, prescription drugs and hospitalization.
Health Insurance Resources for GA State Residents
As a Georgia resident you can choose from a variety of health insurance programs including plans for individuals and group plans provided by private insurance carriers, as well as Georgia State-funded affordable health insurance for families and for children only, and federal programs such as Medicare.
Georgia health insurance is moderately regulated by the state. Georgia law allows insurance companies to refuse to sell you an individual health insurance plan if you have a pre-existing medical condition or based on your current health. Group insurance plans, however, which are typically offered through employers, are guaranteed issue as required by federal law. Once issued, health insurance plans in Georgia have a guaranteed renewability provision whereby the policy holder is allowed to renew without consideration of health status. The law places no limit on the premium a company can charge for health insurance, but it does prohibit cancelation based on health conditions and age.
Georgia law requires private health insurance policies to cover several state-mandated benefits of specific interest to women. These include but are not limited to cancer screening for women, in-patient mastectomy stays, osteoporosis screening, infertility treatments, maternity care and direct access to OB/GYNs.
Types of Health Insurance Plans Available in Georgia
The following major medical health insurance plans are generally available in Georgia. Major medical plans cover illness and injuries, hospitalization, prescription drugs and office visits.
- Indemnity plans
Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
- Preferred provider organization plans (PPOs)
You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
- Health maintenance organizations (HMOs)
HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
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Point of Service plans (POS)
Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you'd pay with an HMO.
Alternative Health Programs in Georgia
PeachCare for Kids
Georgia offers a State Children's Health Insurance Plan (SCHIP) called PeachCare for Kids to provide health care for children 18 and younger. It is available for families whose incomes are too high to qualify for Medicaid, but insufficient to purchase private insurance. PeachCare for Kids provides comprehensive health care coverage including primary care, preventive care, specialist services, dental care and vision care, as well as hospitalization, emergency room services, prescription drugs and mental health care. The program is a partnership between the Georgia Department of Community Health, Georgia Families and three private care management organizations (CMOs): WellCare Georgia, Amerigroup Community Care and Peach State Health Plan. Each child in the program is assigned a Georgia Families CMO who is responsible for coordinating the child's health care.
Visit: www.peachcare.org
SHBP
The State Health Benefit Plan (SHBP) provides health insurance coverage for all state employees, school system employees, and retirees and dependents of those entities.
Regulating Agency
The Georgia Department of Community Health, Division of Public Health, is responsible for the health of Georgia's communities and population.
The Office of Insurance and Safety Fire is the licensing and regulatory agency for Georgia's insurance industry.
Get access to Georgia health insurance quotes
based on your coverage needs and individual health circumstances.
INSURANCE AND SAFETY FIRE COMMISSIONER'S MAILING ADDRESS:
Two Martin Luther King, Jr. Drive
West Tower, Suite 704
Atlanta, Georgia 30334
Main Telephone: 404-656-2070
Toll Free: 800-656-2298
Fax: 404-657-8542
www.gainsurance.org
GEORGIA DEVISION OF PUBLIC HEALTH
Two Peachtree Street, NW
Atlanta, GA 30303-3186
Phone: (404) 657-2700
health.state.ga.us
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
www.naic.org
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
www.iii.org
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