Georgia Health Insurance - Health Plan One

Health Plan One	START BELOW OR CALL 877.56 PLANS (877)567-5267
Health Insurance for the Well Informed

In Georgia, medical underwriting is allowed without restriction. Medical underwriting is the process of selecting risks for insurance in respect of a plan and classifying members according to their degrees of insurability so that the appropriate premium may be charged and the terms offered may be reviewed. There is a 24 month exclusionary period limit for preexisting conditions.

For medically uninsurable individuals, those utilizing their HIPAA rights are guaranteed health insurance coverage through a Georgia insurance carrier. There is currently no high risk pool for those individuals without insurance and without HIPAA rights eligibility.

Read more about Georgia HIPAA rights

In Georgia, medical underwriting is allowed for small business insurance with rate restrictions at plus or minus 25% of the pool rate depending on claims experience. For preexisting condition requirements the carrier may look back in a consumer’s medical history 6 months and impose a 12 month exclusionary period for those that did not have prior medical coverage.

COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985 is offered in the state of Georgia. COBRA enables former employees, retirees, spouses, former spouses, and dependent children the right to temporary continuation of health coverage at group rates. This insurance coverage, however, is only available when coverage is lost due to certain specific events. Group health coverage for participants under the COBRA laws is usually more expensive than health coverage for active employees, since the employer pays part of the premium for active employees while COBRA participants pay the entire premium themselves.

Medicaid is a joint state and federal program that furnishes medical assistance to eligible low income families and to eligible aged, blind, and/or disabled people whose income is insufficient to meet the cost of necessary medical services. Below outlines the income requirements necessary to qualify for Medicaid:

Income requirements:

Children
- Ages 1-5: 133% of the Federal Poverty Level
- Ages 6-19: 100% of the Federal Poverty Level
Pregnant Women and Infants
- Pregnant Women: 200% of the Federal Poverty Level
- Infants Ages 0-1: 200% of the Federal Poverty Level
Parents
- Non-Working: 32% of the Federal Poverty Level
- Working: 58% of the Federal Poverty Level
Other populations
- Medically Needy Individual: 44% of the Federal Poverty Level
- Medically Needy Couple: 39% of the Federal Poverty Level
- Supplemental Security Income Recipients: 74% of the Federal Poverty Level

Covered Services
Ambulance services, Ambulatory Surgical Services, certified Registered Nurse Anesthetists, childbirth education services, children's intervention services, community based alternatives, diagnostic, screening and preventive services, dental, dialysis, durable medical equipment, family planning services, Georgia Better Health Care Health Check, Health Insurance Premium Purchase Program, home health services, hospice, inpatient and outpatient hospital services, intermediate care for the mentally retarded, facility services, laboratory and radiological Services, Medicare crossovers, mental health, non-emergency transportation, nurse midwifery, nurse practitioner services, nursing facility services, oral surgery, orthotic and prosthetic services, pharmacy services, physician services, physician's assistant services, podiatry, pre-admission screening/annual resident review, pregnancy-related services, psychological services, Rural Health Clinic/Community Health Center Services, and vision care.

Co-Payments

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about Georgia Medicaid at http://www.cms.hhs.gov/