6.1 Georgia Group Life and Health Insurance Requirements

Group Life Conversion Privilege

A group life insurance policy covers many people under one master contract held by an employer or association. Individual insureds receive a certificate of coverage, not the policy itself. When an insured leaves the group, Georgia (following the model group life law) requires a conversion privilege: the right to convert group term coverage to an individual permanent (whole life) policy without proving insurability.

Conversion is triggered by termination of employment, retirement, elimination of an eligible class, or a dependent aging out. If the master policy itself terminates and the person had been insured 5+ years, a limited conversion right still applies, usually capped at the lesser of the group amount or $10,000. The converted policy uses attained-age rates, so the older the insured at conversion, the higher the premium — a key counseling point because many leaving employees assume rates stay level.

Converted group life is permanent coverage, not term; the insured cannot demand a term plan at the lower premium. There is no new contestable or suicide clause restart for the converted amount because the conversion is a continuation of existing coverage, not a new application requiring underwriting.

Death during the conversion period

If the insured dies within the 31-day conversion window, the group insurer pays the group death benefit even if no individual policy was applied for or issued. This protects beneficiaries during the transition. Example: Maria is laid off March 1 and dies March 20 without converting. Because death occurred inside the 31-day window, the group death benefit is payable to her beneficiary — the conversion paperwork is irrelevant. If she had instead survived to April 5 and never applied, the conversion right would have lapsed, leaving no coverage.

Small Group Market and Certificate Requirements

Georgia defines its small group market by headcount, which governs guaranteed issue, rating, and renewability protections aligned with the federal Affordable Care Act (ACA).

Small group rating in the individual and small group markets may vary only by age (3:1 max ratio), geography, tobacco use, and family size — not by health status or gender. A carrier may impose minimum participation and contribution requirements at issue but cannot decline a qualified small employer.

Certificate of coverage contents

Each covered employee must receive a written certificate summarizing coverage. Required disclosures include:

• Benefits summary — covered services, deductibles, copays, and the Summary of Benefits and Coverage (SBC) in the federal standard format
• Eligibility and effective dates — who is covered and when coverage begins or ends
• Conversion rights — the 31-day group life conversion and any health continuation
• Continuation rights — COBRA or Georgia state continuation (see Section 6.2)
• Claims and appeals procedures — how to file, internal appeal, and external review

Exam trap: A certificate is evidence of coverage; the master policy is the actual contract. If a certificate conflicts with the master policy, the master policy controls.

Mental Health Parity, Dependent Coverage, and Coordination of Benefits

Mental health and substance use parity

Georgia group health plans must apply parity between behavioral health and medical/surgical benefits, consistent with the federal Mental Health Parity and Addiction Equity Act (MHPAEA).

Dependent coverage to age 26

Georgia follows the federal rule: plans offering dependent coverage must extend it to a child until age 26, regardless of marital status, student status, residency, financial dependence, or whether the child is offered coverage through their own employer.

Coordination of benefits (COB)

When a person is covered by more than one plan, COB rules prevent paying more than 100% of the loss and set the order of determination.

The birthday rule uses calendar month and day — not the older parent. Worked example: Dad's birthday is April 2, Mom's is September 15. Their child's claim is paid first by Dad's plan because April precedes September. The secondary plan then coordinates: it may pay the remaining balance up to its own allowable amount so the family pays little or nothing out of pocket, but the two plans together never reimburse more than 100% of the actual charge.

For an active employee versus retiree or COBRA conflict, the plan covering the person as an active employee is primary over the plan covering them as a retiree or COBRA continuant. Knowing the order of determination prevents the common error of assuming the plan the patient "likes" or names first must pay first.