GA Health Insurance Laws, Rules & Regulations

Define Express authority

- Express Express authority is the authority a principal intends to grant to an agent by means of the agent's contract..

What reports must the commissioner file?

- On July 1st each year, compile a supplementary report regarding property and casualty insurance. - During the first week of each quarter, to the chairpersons of the House Committee on Insurance and the Senate Committee on Insurance and Labor. - Annual reports

What are the characteristics of a stock company?

- Owned by the stockholders who provide the capital and share in profits and losses - Officers are elected by the stockholders - issue nonparticipating policies, in which policyowners do not share in profits or losses - taxable dividends are paid to stockholders

If the Commissioner finds records inadequate how long does the person have to correct them?

60 days.

How long does the commissioner have to act on an application for a Certificate of Authority?

90 days. The Commissioner may extend this time period an additional 90 days, but the applicant must be notified.

What is a Certificate of Authority?

A license to do business in the state issued by the state department of insurance. Certificates of authority cannot be issued to an insurer that is owned by any U.S. state, foreign government or political subdivision

What assets must an insurer have?

A minimum of $1.5 million in capital stock or surplus. They must maintain that once approved.

When does GA not require fingerprints?

Active licensees who apply for additional licenses, and individuals who apply for the reinstatement of a license 6 months before the license expiration date,

How often must the commissioner examine the records of domestic corporations?

At least once every 5 years.

When does defamation occur?

Defamation occurs when an oral or written statement is made that is intended to injure a person engaged in the insurance business. This also applies to statements that are maliciously critical of the financial condition of any person or a company.

How is the Commissioner of Insurance chosen?

Elected, every 4 years during the midterm election. If he cannot serve the Chief Deputy Commissioner serves until the next election.

How often must the commissioner examine the records of HMO's?

Every 3 years. The Commissioner of Community Health examines HMO records every 5 years.

Who may hold an insurance license in GA?

Individuals only. An individual may hold more than one type of license.

What are authorized or admitted insurers?

Insurers who meet the state's financial requirements and are approved to transact business

What are the penalties for transacting insurance without a license?

It is a misdemeanor punished by a fine not to exceed $1,000, or by confinement in a jail for up to 12 months, or both

Who are Useless and Worthless?

Leslie's brothers.

Can commissions be shared?

Only if all individuals are licensed.

What are the characteristics of a mutual company ?

Owned by the policyowners - issue participating policies - policyowners are entitled to dividends, which, are a return of excess premiums and nontaxable.

When does an agent's license expire?

Producer/agent licenses expire every 2 years, on the last day of the licensee's birth month.

What qualified insurers cannot transact life insurance?

Reciprocal and Lloyd's insurers

What is unusual about title insurers?

Title insurers are not allowed to transact any other insurance.

What is twisting?

a misrepresentation, or incomplete or fraudulent comparison of insurance policies that persuades an insured/owner, to his or her detriment, to cancel, lapse, switch policies, or take out a policy with another insure

What is churning?

replacing insurance policies with the same insurer for the sole purpose of making commissions. It is illegal to replace existing life or disability policies with new policies if the producer cannot demonstrate that the replacement will benefit the insured.

How much does an insurer have to deposit in trust with the state?

$100,000 for one class of insurance; and $25,000 for each additional class of insurance. No more than $200,000 total is required for any combination of classes.

How are collected taxes handled?

Any collected taxes, fees, dues, charges, and penalties are paid to the Office of Treasury and Fiscal Services

Define apparent authority

- Apparent authority (also known as perceived authority) is the appearance or the assumption of authority based on actions, words, or deed.

What are the 6 classes of insurance in GA ?

1. Life, accident, and sickness 2. Property, marine, and transportation 3. Casualty 4. Surety 5. Title 6. Health Maintenance Organizations.

What is rebating?

any inducement offered to the insured in the sale of insurance products that is not specified in the policy

What defines domicile for a corporation?

A domicile refers to the location where an insurer is incorporated, not necessarily where the insurer conducts business

What are the continuing education requirements to maintain an agents license?

- 24 CE credit hours every 2 years including 3 credit hours in ethics education. `Agents licenses for 20 years only need 20 hours .- Excess hours may be carried to next period as long as they do not exceed 50% of the CE requirement.

What is a counselor?

- Anyone who engages in the business of counseling, advising, or rendering opinions as to the benefits under any insurance contract issued. This often involves the terms, value, effect, advantages or disadvantages under that contract. - Must have 5 years experience to apply for license.

What are the five types of companies?

- Domestic (this state) - Foreign (other US) - Alien (outside the US) - Stock -Mutual These types are not mutually exclusive

When can an individual reinstate a lapsed incense?

- If during military service - 5 years but must be within 1 year of separation from the military -No licensee whose application has been refused or revoked will be entitled to file a new application for 5 years following that action. - If an applicant was employed by the Commissioner, he or she will be permitted to reinstate a license upon termination of employment if request is made within 90.

Define implied authority

- Implied authority is authority that is not expressed or written into the contract, but which the agent is assumed to have in order to transact the business of insurance for the principal.

What coverages does GA require accident and sickness insurance to supply.?

- Mammograms Heart transplants and bone marrow transplants = Coverage for newborn children from the moment of birth - Coverage for adopted children = Child wellness services through age 5

What acts constitute transacting insurance?

- Solicitation and inducement - Preliminary insurance negotiations - Effectuation (execution) of insurance contracts - Transactions of matters arising out of the effectuation of insurance contract

What is the timing of a hearing process for a violation?

- if the Commissioner suspects that an insurer or its agent has committed a violation he or she will hold a hearing within 30 days. - notice of the time and place of the hearing must be given at least 15 days in advance - within 30 days of the hearing, the Commissioner must issue an order related to his or her decision.

What are the penalties for co-mingling?

Any willful violation will be considered a misdemeanor unless the amount involved exceeds $1,000; in which case, the violation will be considered a felony.

When does a Certificate of Authority expire?

midnight on June 30 of the year following issuance For renewal, insurers must file a copy of their annual statement for the preceding year on March 1. For good cause, the Commissioner may extend this deadline an additional 60 days.