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Summary of differences between federal and state regulations
Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).
Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply.
Georgia laws require coverage for a number of different situations beyond federal requirements such as the following, for example:
- Bone density testing (§31-15A-3)
- Autism, if neurological disorders are covered (§33-24-59.10)
Effective 7/1/2015, plans are to over autism for children six or younger. No need for the plan to already cover neurological disorders. - Georgia laws provide for the following optional coverage:
- Mental disorders (§33-24-28.1)
- Outpatient surgeries (if plan covers medical or surgical procedures which are required to be performed on an inpatient basis) (§33-24-28.2)
- As of July 1, 2005, plans must include payment for services that are covered and are appropriately provided through telemedicine. (§33-24-56.4)
- The plan must allow covered persons who seek eye care, from obtaining such service directly from a provider on the health benefit plan provider panel who is licensed to provide eye care. (§33-24-59.12) (SB 81)
- As of July 1, 2005, employees in group plans may choose among new health insurance plans that include all state mandated health benefits and an alternative plan that does not include all state mandated health benefits. This stems from the Small Business Employee Choice of Benefits Health Insurance Plan Act, which added a Chapter 59 to the Code. See SB 174.
- Plans must cover at least two employees.
- As of July 1, 2015, plans must cover prescribed treatment based on the insured’s diagnosis with a terminal condition. (§33-24-59-18)
State
Contact
Georgia Insurance and Safety Fire Commissioner
Regulations
Georgia Code, Chapters 31 and 33
www.lexisnexis.com/hottopics/gacode/Default.asp
For more information on health benefits for women, see the topic Women’s Health Rights.
Federal
Contact
Employee Benefits Security Administration (EBSA)
Regulations
29 CFR chapter XXV (Parts 2509 – 2590)