The national guide covers medical plan designs (indemnity, HMO, PPO, EPO, POS), cost-sharing, HSAs and FSAs. Georgia's own medical-plan rules on the exam are mainly about dependent coverage (O.C.G.A. 33-24-22, 33-24-28, 33-29-21.1) and prompt payment (33-24-59.5). This page covers those.

The national concepts in brief

• An HSA must be paired with a qualified high-deductible health plan to get its tax treatment (26 U.S.C. 223).
• An FSA lets employees set aside pre-tax dollars for medical expenses, usually on a use-it-or-lose-it basis (26 U.S.C. 125).

Newborns, adopted children and dependents

• Newborns: a policy that covers family members must cover a newborn from the moment of birth (33-24-22).
  • Coverage includes injury and sickness, including congenital defects and birth abnormalities. It need not include routine well-baby care.
  • The policy may require notice of the birth and any added premium within 31 days for coverage to continue past that point.
• Adopted children: covered from the date of placement or the final decree, whichever comes first. The same 31-day notice rule applies.
• Disabled dependents: a child who can't support himself because of a disability, and who depends chiefly on the insured, stays covered past the limiting age. Proof is required within 31 days of reaching that age (33-24-28).
• Dependents aging out: a dependent whose coverage ends at the limiting age may buy an individual or family policy without evidence of insurability by applying within 45 days (33-29-21.1).

Prompt payment (33-24-59.5)

• Insurers must pay a claim, or send a written explanation, within:
  • 15 working days for electronic claims
  • 30 calendar days for paper claims
• Late benefits carry interest of 12% a year.

Underwriting limits

• Coverage can't be refused, limited or priced differently because a person is blind or partially blind (33-6-5(10)).
• Insurers may not discriminate against victims of family violence or sexual assault (33-6-4(b)(15)).

Exam traps

• Newborn and adoption notice: 31 days. Disabled-dependent proof: 31 days. A dependent aging out has 45 days to convert.
• Prompt pay is 15 working days electronic and 30 calendar days paper, with 12% interest.
• Newborn coverage must include congenital defects, but not routine well-baby care.