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 Year 2024 and 2025

For PY 2024 and 2025 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 Area Tier 2 Area Tier 3 Area
Rating Regions 2, 3, 5, 8, 14 1,7,9, 12, 16 4, 6, 10, 11, 13, 15
Coinsurance % 15% 45% 80%

 

  • Public Forum

    Public Forum Information

    OCI will hold its annual Public Forum to provide updates on the progress of the 1332 Waiver and accept public comments. The public is invited to join in-person or virtually.

    Date: [TBD]

    Time: [TBD]

    Join in Person:

    Hearing Room of the Office of Commissioner of Insurance
    Ninth Floor, West Tower, Floyd Building
    2 Martin Luther King Jr. Dr.
    Atlanta, GA 30334

    Join Virtually:

    [TBD]

  • Annual Reporting

    Download this pdf file. 1332 Final Annual Report for Plan Year 2023

    Download this xls file. Georgia FFE EXP-State Premium-Pass-through-Calculations

    Download this pdf file. Reinsurance Waiver Annual Report PY2023_2024.03.28 signed

  • Background

    Plan Year 2024 and 2025

    For PY 2024 and 2025 the parameters for the Reinsurance Program are:

    • Attachment point of $35,000
    • Cap of $500,000
      Tier 1 Area Tier 2 Area Tier 3 Area
    Rating Regions 2, 3, 5, 8, 14 1, 7, 9, 12, 16 4, 6, 10, 11, 13, 15
    Coinsurance % 15% 45% 80%
  • Documents