1332 Waiver

Governor Brian P. Kemp signed Senate Bill 106, The Patients First Act, into law on March 27, 2019, amending Article 7 of Chapter 4 of Title 49 and Title 33 of the Official Code of Georgia. The Patients First Act authorizes the Governor to submit and implement one or more Section 1332 Waiver applications to the United States Department of Health and Human Services (HHS) and the Department of Treasury (Treasury) on or before December 31, 2021, to pursue innovative strategies for providing residents with access to high-quality, comprehensive, and affordable health insurance. 

The goals of the reinsurance program are to stabilize the market by reducing premiums and to attract/retain carriers across the State. All Affordable Care Act (ACA) -compliant, non-grandfathered individual market plans that cover Georgia residents are eligible for reinsurance claims payments. This includes all Qualified Health Plans (QHPs), and major medical plans sold on and off the federal exchange or Georgia Access.

Plan Years 2024, 2025, and 2026

For Plan Years 2024, 2025, and 2026 the parameters for the Reinsurance Program are:

  • Attachment point of $35,000
  • Cap of $500,000

The coinsurance rate for each tier area is listed in the table below:

 Tier 1 AreaTier 2 AreaTier 3 Area
Rating Regions2, 3, 5, 8, 141,7,9, 12, 164, 6, 10, 11, 13, 15
Coinsurance %15%45%80%

Plan Year 2027

For Plan Year 2027, the parameters for the Reinsurance Program are:

  • Attachment point of $36,960
  • Cap of $500,000

The coinsurance rate for each tier area is listed in the table below

 Tier 1 AreaTier 2 AreaTier 3 Area
Rating Regions2, 3, 5, 8, 141,7,9, 12, 164, 6, 10, 11, 13, 15
Coinsurance %15%45%70%