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SB 462

"Surprise Billing Consumer Protection Act"; insurance coverage for certain out-of-network ambulance transportation service; provide

2025-2026 Regular Session Introduced by Jason Anavitarte and 7 co-sponsors

SB 462 creates a regulator-driven excess-profit framework for Georgia auto insurance and sets protections for emergency ambulance billing, including minimum reimbursements and fast

House Passed/Adopted By Substitute
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Bill Summary · SB 462

Summary of SB 462 (Session 2025-26, Georgia) – "Surprise Billing Consumer Protection Act" (House Substitute)

Purpose and intent

  • Establishes two main strands of policy: 1) Strengthen regulation of excess profit in private passenger automobile insurance (PPAutomobile) to protect policyholders from excessive underwriting gains. 2) Improve protections around ground ambulance transportation billing, ensuring coverage and clear payment responsibilities for emergency ambulance services under healthcare plans.

Key provisions

A. Regulation of excess profit in private passenger auto insurance (Title 33)

  • Revisions to Code Section 33-9-41 (reserved section historically) to create a formal framework for excess profit regulation.
  • Definitions introduced:
    • Anticipated underwriting profit: projected net underwriting profit from rate filings (excluding investment income).
    • Excess profit: underwriting gain in the five most recent calendar accident years that exceeds anticipated underwriting profit by more than 6%.
    • Final compilation year: last year in the five-year data reporting period.
    • Other terms: cash refund, credit refund, private passenger automobile insurance, etc.
  • Data collection and reporting:
    • By July 1, 2028 and annually thereafter, insurers writing PP auto in Georgia must file annual data with the Department, including:
    • Total calendar year earned premium.
    • Accident-year incurred losses and loss adjustment expenses.
    • Administrative and selling expenses in/on allocated to Georgia.
    • Policyholder dividends, and a five-year loss-and-loss-adjustment-experience schedule.
    • Any supplemental data needed for compliance.
  • Calculation and review:
    • The Department reviews reported data to determine excess profit by comparing each insurer’s underwriting gain/loss (for each accident year) to the five-year anticipated underwriting profit.
    • Underwriting gain/loss is calculated using incurred losses and L&A expenses, admin/selling expenses, and policyholder dividends, against earned premium, evaluated on an ultimate basis through multiple annual points.
  • Enforcement and remedies:
    • If excess profit is determined, the Commissioner issues an order to return excess profit and provides a hearing notice.
    • Refunds:
    • Generally, insurers must refund excess profit unless financial impairment/insolvency would result.
    • Insurers must propose a plan within 30 days of notification; the plan must refund or credit policyholders in an approved manner.
    • Approved methods include:
      • Cash refunds within 60 days after a final order, or
      • Credit refunds applied to renewal premiums (notices to policyholders within 60 days after final order); cash refunds due within 60 days after policy termination if applicable.
    • Certification and timing:
    • Insurer must certify once all refunds are made. Refunds count as policyholder dividends for subsequent reporting.
    • Compliance and prohibitions:
    • Insurers receiving refunds may not adjust commissions, premium taxes, or other taxes due as a result of the refund.
    • Regs:
    • Commissioner authorized to promulgate rules to implement and enforce the section.

Note: This section creates a formal, regulator-driven framework to identify and return “excess profits” in private passenger auto insurance, with specific metrics, timelines, and refund mechanisms.

B. Ground ambulance transportation – financial responsibilities (Surprise Billing Consumer Protection Act) (Title 33, Chapter 20E)

  • Effective date: Generally July 1, 2026 for most provisions; some enforcement specifics apply to 2027 (see below).
  • Definitions (Section 33-20E-23):
    • Ambulance provider: licensed emergency transport provider (excluding air ambulance).
    • Clean claim: a reimbursement claim with no defects or need for additional substantiating documentation.
    • Covered service: emergency transport service covered by a health plan.
    • Emergency transport service: ground ambulance transportation to/from medical care.
    • First responder: defined set of public safety personnel and related professionals.
  • Coverage and rates:
    • Health plans must treat emergency transport as a covered service when requested by a first responder.
    • Minimum allowable reimbursement rate for out-of-network ambulance providers:
    • Either the rate set by contract/ordinance for the jurisdiction, or
    • If no rate exists, the lesser of:
      • 325% of Medicare Part A/B (as adjusted), or
      • The provider’s charges.
  • Balance and cost sharing:
    • Payments to ambulance providers under this section relieve the covered person of further payment obligations beyond copayment, coinsurance, or deductible.
    • Copays/coinsurance/deductibles for out-of-network ambulance services cannot exceed the amount that would apply within-network ambulance services.
  • Payment timing and denial handling:
    • Insurers must pay clean claims for covered services to ambulance providers within 30 days of receipt and not pay the patient.
    • For non-clean claims, insurers must notify the ambulance provider within 30 days of receipt, acknowledging receipt and identifying any missing information or reasons for denial.

Effective dates and applicability

  • General effective date: July 1, 2026 (Section 3(a)), applying to policies issued/delivered on or after that date.
  • Ambulance provisions (Section 2):
    • Becomes effective January 1, 2027 for Section 2, applying to contracts/policies issued, delivered, or renewed on or after that date.
  • Repeals/conflicts: Repeals conflicting laws as needed.

Who is affected

  • Domestic, foreign, and alien insurers authorized to write private passenger automobile insurance in Georgia:
    • Subject to annual data reporting and potential excess profit refunds.
  • Policyholders of PP auto insurance:
    • May receive refunds (cash or credits) tied to excess profits.
  • Health plan enrollees and providers (ambulance):
    • Benefit from clarified coverage of emergency ground ambulance services.
    • Potentially lower out-of-network cost-sharing for ambulance transport.
    • Insurance payments directed to ambulance providers to the exclusion of patient payments for covered clean claims.

Procedural and timeline notes

  • Data reporting for PP auto insurance begins by July 1, 2028, with annual updates thereafter.
  • Excess profit determinations trigger orders and refunds, with hearing rights for insurers.
  • Ambulance billing reforms come into effect mid-2026 (general provisions) and late-2026/early-2027 for implementation in contracts.
  • Insurers must issue refunds/credits within defined timeframes after final order.

Summary assessment

SB 462 (as substituted) aims to:
- Tighten regulatory oversight of underwriting profits in private passenger auto insurance and provide a structured process for returning excess profits to policyholders.
- Strengthen protections against surprise medical billing in ground ambulance transport by establishing minimum out-of-network reimbursement standards, limiting patient liability, and ensuring timely payment of clean claims to ambulance providers.

Compiled from official sources — confirm details with the bill’s official record.

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