This bills seeks to amend O.C.G.A. §20-2-911 and O.C.G.A. § 45-18-22 to add a definition for “Defaulting medical claims administrator” as a medical claims administrator under the State Health Benefit Plan which after the close of the open enrollment period for 2014 declared a major medical facility to be outside of such medical claims administrator’s network.

The bill also seeks to require the “re-opening” of the 2014 Open Enrollment period during which any employee covered by a “Defaulting medial claims administrator” would have an option to elect coverage under a different medial claims administrator.

The bill is based on Blue Cross Blue Shield “forcing” Grady Memorial Hospital out of their coverage network by refusing to pay the same reimbursement rates that they pay to private hospitals after the close of the 2014 Open Enrollment Period. The author states that teachers and state employees have been irreparably harmed by Blue Cross Blue Shield’s decision to force a major hospital and top trauma center out of network.

While well intentioned, this bill would be a disaster for HR departments in local boards of education, as well as other state agencies.  Huge amounts of time would be spent in getting ready for this throughout the state.  Even though Grady Hospital’s removal from the BCBS network primarily affects those in the metro area, this bill as written would allow every state employee who chose BCBS as their State Health Benefit Plan provider to consider making a change in their provider mid-stream.