Chapter 8

Medicare Part A provides coverage for a maximum number of _______ days in a skilled nursing facility.

100

Every Long-Term Care policy must provide a ____ day free look period from the date the policy is delivered.

30

Medicare Supplement Advertising free look

30-day free look period

Long-Term Care Insurance Requirements

A Qualified State Long-Term Care Insurance Partnership Policy (Partnership Policy) is an insurance policy that meets the following requirements: The policy covers an insured who was a resident of the State of Georgia (a Partnership State) when coverage first became effective under the policy The policy meets the requirements of §7702B(b) of the Internal Revenue Code of 1986 and was issued no earlier than January 1, 2007 The policy meets all the applicable requirements of Georgia statutes and the requirements of the NAIC Long-Term Care Insurance Model Act and model regulation

Minor's Capacity to Contract For Insurance

A person who is at least 15 years old may contract for annuities, life insurance, and accident and sickness insurance on his/herself or any other person with insurable interest. He/she will be deemed competent to: Exercise all rights and powers under any such contract or policy Surrender interest and give a valid discharge for any benefit accruing or money payable under the contract or policy

Conversion

A policy provision that an individual whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy (and any group policy which it replaced), for at least 6 months immediately prior to termination, is entitled to the issuance of a converted policy by the insurer under whose group policy they are covered, without evidence of insurability.

Free Look Period

All individual accident and sickness policies or contracts must include a 10-day free look, during which the policy or contract may be returned for a full refund. This does not apply to group or single premium policies or contracts. medicare- 30 day free look

Records Retention

All records for any transaction must be kept for at least 5 years after the transaction or contract term is completed.

Converted Policy

An individual policy of LTC insurance providing benefits identical to or benefits determined by the Commissioner to be substantially equivalent to or in excess of those provided under the group policy from which conversion is made. Where the group policy from which conversion is made restricts provision of benefits and services to, or contains incentives to use certain providers or facilities, the Commissioner will take into consideration the differences between managed care and non-managed care plans.

Commissions and Compensation

An insurer may pay commissions to a licensed agency agency splits commission with agents, subagents, reps, etc.

Advertising

Any preexisting conditions exclusion cannot extend beyond 6 months after policy issuance.

Disability Income Benefits

Based on the employee's average indexed monthly earnings, based on the Consumer Price Index, on which Social Security taxes have been paid. This is referred to as the Primary Insurance Amount (PIA). Benefits cease when the employee reaches Social Security's definition of Full Retirement Age, dies, or is no longer disabled. When Full Retirement Age is reached, the insured worker is eligible to receive retirement benefits. Social Security disability income benefits are not taxable.

The Association will not cover:

Claims that are already covered by a like association from another state Policies or portions of policies not guaranteed by an insurer Policies issued by a nonprofit hospital/medical service corporation, HMO, prepaid legal services plan, fraternal benefit society; or Accident and sickness insurance when issued as part of an automobile insurance policy

Classifications of Insurance

Life, accident, and sickness Property, marine, and transportation Casualty Surety Title Health Maintenance Organization

Core benefis are offered in which plans?

Medicare plans A- N

To be eligible for a Medicare supplement policy, an individual must:

Must be enrolled in Medicare Parts A and B

Does Medicare cover LTC plans?

NO, There are no Medicare supplement plans that provide for long-term care.

Lapse/Termination for Nonpayment of Premium policy

No individual LTC policy or certificate can lapse or be terminated for nonpayment of premium unless the insurer, -at least 30 days before the effective date of the lapse or termination, -gives notice to the insured -Notice may not be given until 30 days after a premium is due and unpaid. -Notice is deemed to have been given as of 5 days after the date of mailing.

In addition to issuing a cease and desist order, the Commissioner has the authority to:

Place the violator on probation for up to 1 year for each act in violation Assess a penalty of up to $2,000 for each act or violation, or up to $5,000 per violation if the person knew or reasonably should have known he/she was in violation

Continuation of coverage or issuance of a converted policy is mandatory, except where:

Termination of group coverage resulted from an individual's failure to make any required payment of premium or contribution when due The terminating coverage is replaced no later than 31 days after termination, by group coverage effective on the day following the termination of coverage

Application for Certificate of Authority- approval time period

The Commissioner has 90 days to approve or disapprove an application.

Outline of Coverage and Shopper's Guide

The _______ __ _______shall be a free-standing document, using no smaller than 10-point type. The _________ __ _________ cannot contain material of an advertising nature. A long-term care insurance ________ ________ in the format developed by the NAIC, or a guide developed or approved by the Commissioner, must be provided to all prospective LTC insurance applicants.

Medigap- Medicare Supplement policies

These plans pay some or all of the Medicare deductibles, copayments, and coinsurance. A separate premium payment is required As long as the premium is paid, the policy is guaranteed renewable, or automatically renewed each year. only covers one person. policies are "standardized" and must follow federal and state laws. The __________ open enrollment period lasts for 6 months beginning the month an individual turns age 65 and enrolls in Medicare Part B.

Which one of the following provisions requires an insurer to pay claims immediately upon receipt of an insured's proof of loss?

Time of payment of claims

Definition of Disability

Unable to engage in any substantial gainful activity due to a medically determined physical or mental condition that has lasted or is expected to last at least 12 months or result in an early death.

Key Employee Policy

______ employee _________ When an employer purchases a disability income policy on a key employee and is also the beneficiary, the premiums are not tax deductible to the business Benefits received are not taxable

Classifications of Insurance

`Life, accident, and sickness `Property, marine, and transportation `Casualty `Surety `Title `Health Maintenance Organization

agent

an individual appointed or employed by an insurer who sells, solicits, or negotiates insurance whether in person or by telephone. An agent is considered an individual insurance producer and is required to be licensed for each line of authority to be transacted.

Business Disability Buyout

business _______ buyout Premiums are not tax deductible The benefits received are not taxable

Renewal forms must be filed

by March 1 preceding expiration. Certificates must be renewed annually.

Social Security Disability Insurance (SSDI)

contingent upon the employee having a "fully" insured (40 quarters or credits) status. The employee must meet other very strict requirements by meeting the definition of disabled and the elimination period to be eligible to receive benefits. 5-Month Waiting Period

Disability Benefit Period

eligible to receive payments for a specified number of years: 2, 5 or 10 up to a specific age - 65, 70 or for life. longer benefit period - higher premium. shorter benefit period - shorter premium

Application part 1

general questions about the applicant, -sex/gender -marital status -residence -date of birth -occupation.

Probationary Licenses

license valid 3 to 12 months

Short-Term Disability

maximum benefits for short periods, such as 13, 26, or 52 weeks

Favorable _____ treatment is given to Qualified Long-Term Care contracts that meet certain coverage and benefit requirements.

tax

dafamation

An insurer may not make an oral or written statement which is false or maliciously critical or misrepresentative of the insurer's financial condition with intent to injure any person engaged in the insurance business.

The fine imposed cannot exceed:

$1,000 for each misconduct resulting in a violation or $5,000 for each willful misconduct resulting in a violation.

fine imposed cannot exceed?

$1,000 for each misconduct resulting in a violation, or $5,000 for each willful misconduct resulting in a violation.

The sources of insurability

-the application -medical exam -an Attending Physician's Statement -the Medical Information Bureau (MIB) -an inspection report -the agent's report.

Disability Probationary Period

A probationary period may be included in some disability income policies to protect the insurer from paying immediate claims. The insurer may have a 15-30 day probationary period before losses due to a preexisting condition will be covered. The probationary period does not apply to losses due to an accident.

insurance transaction Restrictions

A reciprocal insurer may not transact life insurance A Lloyd's insurer may not transact life insurance; and A title insurer is authorized to transact only title insurance

Change of Address on a license

All resident and nonresident licensees must promptly notify the Commissioner in writing within 30 days of any change in the licensee's business address, residence address, and name and address of each insurer or agency the licensee represents.

Consumer Investigative Report.

An Inspection Report is a general report of the applicant's: {inspect someones life) collected through a telephone interview -finances -character -morals -work -hobbies -other habits. -credit report character references (neighbors or coworkers).

agency license

Each principal and branch office of a business entity that sells, solicits, or negotiates insurance. renew biennially

Policy Delivery - no initial premium

If no initial premium is paid, the application is considered a trial application and no offer exists. When the insurer determines the applicant is an acceptable risk, the insurer will issue the policy, which becomes the Offer. In this case, the insurer will send the policy to the producer for a formal delivery. There is no coverage until a Statement of Good Health and premium are collected at the time of delivery.

Investigation and Hearings

The Commissioner has the power to examine and investigate every person engaged in the insurance business the Commissioner will issue and serve a statement of charges and a notice of a hearing to be held at a fixed time and place not less than 15 days after service of the notice.

In addition to issuing a cease and desist order, the Commissioner may order any one or more of the following:

The Commissioner may revoke the Certificate of Authority, or licenses of any person who fails to comply with a Cease and Desist Order, within 30 days after receipt.

The Insurance Policy

The face page of the policy will contain the basic information, including the following: -Name of the insurance company -Name of the insured and policyowner -Face amount of the policy -Basic description of the type of policy purchased -Policy number and anniversary date -The insurance company's promise to pay the death benefit (Insuring Clause) -signatures of the Executive Officers which binds the company to the terms of the contract.

Tax Treatment of Individual Disability Income Premiums and Proceeds

The premiums paid for individual disability income insurance are not tax deductible Disability income benefits received from an individual policy are not taxable as income

Agent's Certificate of Authority and Appointment

The request for a certificate of authority must be submitted within 15 days of the agent's contract or first insurance application is submitted. An insurer that terminates an agent's appointment must notify the Commissioner within 30 days of the termination

Recurrent Disability

When a subsequent disability is suffered due to the same cause within a certain period of time (usually 6 months), the elimination period will not apply and the disability will be considered continuous

Insurance Transactions

`Solicitation and inducement `Preliminary negotiations `Effectuation of an insurance contract `Transaction of matters that result from the effectuation of the contract

Partial Disability

a person cannot perform 1 or more of the regular duties of his/her occupation, but is not totally disabled. -may provide up to 50% -total disability for 3 to 6 months.

Long-Term Disability ( LTD)

benefit periods of at least 2 years and as long as the lifetime of the insured. The elimination period (time-deductible) -30, 60, 90, or 180 days. It may be possible to obtain a LTD policy with a 2-year elimination period to be used in conjunction with a short term disability policy that pays benefits for 2 years.

Application part 2

medical background, about the applicant, -past and present health -any medical visits -hospitalizations or surgeries in recent years, -medical status of immediate family members.

Change of Occupation Provision

protection instead of punishment, a reduction of benefits. if the new occupation is a higher risk, or the insurer could reduce the amount of premium to fit a lower occupational rating for the current level of benefit. If the insured changes to a more hazardous occupation, the insurer could also provide the same benefit but charge a higher premium. higher risk job - reduce amt of premium more hazard job - same benefit higher premium

Reciprocity

the practice of exchanging things with others for mutual benefit, especially privileges granted by one country or organization to another. In order to obtain a nonresident license without additional requirements, the person's home state must have reciprocity with Georgia and award nonresident agent licenses to Georgia residents on the same basis.

Late Renewal Reinstatement of License

$150 penalty, If a late renewal reinstatement is received MORE THAN 6 months after the expiration date, the licensee will be required to submit electronic fingerprints. Failure to file for late renewal reinstatement prior to 1 year from the license expiration date will require the licensee to reapply for the license and satisfy the prelicensing and examination requirements.

Liability Limits - The aggregate liability of the Association may not exceed per insured, the lesser of:

$300,000 in life insurance benefits, but not more than $100,000 in net cash value, regardless of the number of policies owned $300,000 in health insurance benefits $300,000 for disability insurance $300,000 for LTC insurance $500,000 for basic hospital, medical, and surgical insurance or major medical insurance $300,000 in the present value of annuity benefits, but not more than $250,000 in net cash values for an annuity $5 million with respect to one owner of multiple individual policies of life insurance

To qualify, an individual applicant must:

-Be a resident of Georgia, who must reside and be present within the state for at least 6 months of every year, or have a principal place of business in Georgia -Be at least 18 years of age (not 21) -Be of good character -Successfully complete an approved pre-licensing course, which must contain a minimum of 20 hours of instruction per major line of authority.

Limited Licenses

-Credit insurance -Rental company insurance -Portable electronics insurance -Travel insurance No prelicensing requirements or examination are required for the issuance of a limited license.

5-Month Waiting Period- ssdi

start with the 6th full calendar month of disability and are not retroactive to the date of disablement. Accordingly, a person should apply for SSDI benefits as soon as possible following their disabling event. To be considered a "full" month of disability, the individual must be disabled prior to the first day of a month and remain disabled through the last day of a month (a person first disabled after midnight on the first day of a month will not begin a full month of disability until the first day of the following month).

Key Employee Policy

this policy pays a benefit by helping pay for a -replacement -train a new employee, -or replace loss of revenue due to the disabled employee's lack of ability to work. Taxation When an employer purchases a disability income policy on a key employee and is also the beneficiary, the premiums are NOT tax deductible to the business Benefits received are NOT taxable

Insurance Transactions

-Solicitation and inducement -Preliminary negotiations -Effectuation of an insurance contract -Transaction of matters that result from the effectuation of the contract

in order to have a license in 2 states:

An applicant licensed for the same lines of authority in another state submits an application for a license in this state within 90 days of the cancellation of the previous license will not be required to complete prelicensing education or examination. The same exemption applies if an individual licensed in another state moves to this state and applies within 90 days of establishing legal residence to become a resident licensee.

commisisoner may examine

as often as necessary, the accounts and records of any insurance agent, solicitor, broker, general agent, adjuster, or insurer representative.

Elimination Period

sometimes referred to as a "time deductible", is the length of time an individual must be totally disabled before benefits become payable. For example, a policy may have a 6-month elimination period for loss due to a sickness and may waive the elimination period entirely which will provide immediate payments for loss due to an accident.

Nonresident License and Reciprocity

-Currently be licensed and in good standing in the person's home state -Verification must be provided to the Commissioner through either the NAIC producer database or an original certification letter from the home state within 90 days of submission -Submit the proper request for licensure, a copy of the license application submitted to the home state, and pay the required fees

To qualify for a counselor license

the applicant must -submit an application, -pay the required fees, including the cost of submitting electronic fingerprints for a criminal background check, and -file a $5,000 counselor bond with the Commissioner.

Unfair discrimination includes:

Charging different rates or providing different benefits or dividends to individuals of the same class, same policy amount and equal life expectancy for any: -life insurance policy or annuity contract -accident or sickness insurance; or -property or casualty insurance

Reasons for Replacement

risk for higher premiums or no initial coverage due to a pre-existing condition may require underwriting to prove evidence of insurability new probationary period would apply, limiting coverage for losses due to sickness during a specified period of time.

To qualify for an original certificate of authority to transact one or more classes of insurance, a domestic insurer must possess and maintain a minimum of

$1.5 million in capital stock or in surplus.

3 Unfair Trade Practices

-Rebating -Defamation -Unfair Discrimination

Issuance and Display of License

A license must state all of the following: -The licensee's name and address -The date of issue, and conditions for expiration or termination -The kind(s) of insurance covered (if not an agency license) -Any license restrictions Upon request of the licensee, the Commissioner will provide a certificate of licensure which will be suitable for display at the licensee's place of business.

Commissions and Compensation

An insurer or agent may not compensate any person for services as an agent unless that person is duly licensed, except in the case of renewal or deferred compensation to a person who held a license when the compensation was earned. No person other than a duly licensed agent or counselor may accept commission or other valuable compensation from an insurer or duly licensed agency, agent, counselor or subagent. An insurer may pay commissions to a licensed agency in which all employees, directors, and officers who transact insurance are qualified insurance agents. Agents, subagents, and counselors may share commission with a licensed insurance agency.

Certificates of Authority expire

midnight on June 30 of the year following date of issuance or renewal

Partnership Policy- Inflation Protection

A __________ __________ must provide the following _____________ ____________: -If the policy is sold to an individual who is younger than age 61 on the date of purchase, the policy must provide compound annual inflation protection. -If the policy is sold to an individual who is at least age 61 but younger than age 76 on the date of purchase, the policy must provide some level of inflation protection -If the policy is sold to an individual who is age 76 or older on the date of purchase, the policy may provide inflation protection, but is not required to

Partnership Disclosure Notice

A ____________ _____________ ___________ explains the benefits associated with a partnership policy and that the policy is a qualified state LTC insurance partnership policy. This notice must include a statement that purchasing a Partnership Policy does not automatically qualify the insured for Medicaid.

Partnership Program Notice

A _____________ _______________ ____________ describing the policy's requirements and benefits must be provided to each prospective applicant.

The penalties for a violation of a cease and desist order are:

A fine of up to $10,000 per violation Suspension or revocation of the person's license if the person knew he/she was in violation Such other relief as is reasonable and appropriate

Continuation

A policy provision that maintains coverage under the existing group policy when the coverage would otherwise terminate, and which is subject only to the continued timely payment of premium when due.

Definitions of a Total Disability- Own Occupation

A policy using this definition requires that the insured be unable to perform the main duties of his/her own occupation to qualify as being totally disabled. -applies for the first 2 years of a disability, then changes to any occupation. This definition is the least restrictive and is easier to qualify for benefits. It is typically reserved for more skilled occupations and may result in a higher premium.

LTC Reinstatement

An LTC policy must include a provision that provides for reinstatement of coverage in the event of lapse if the insurer is provided proof that the policyholder or certificate holder was cognitively impaired or had a loss of functional capacity before the grace period contained in the policy expired. This option must be available to the insured if requested within 5 months after termination and must allow for the collection of past due premium. The standard of proof of cognitive impairment or loss of functional capacity must not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy.

CounterOffer

If a policy is not approved as applied for and is issued as substandard, the insurer may make a "counteroffer" to the applicant. The insurer may issue a policy with a surcharge (higher rating) or exclusions to the policy. The producer must : hand-deliver the policy to the applicant to collect any additional premium, explain any substandard rating or changes in coverage and premium, and reinforce the value of the contract.

cease and desist order

If it appears that a person has engaged in, is engaging in, or is about to engage in a prohibited act

Which of the following actions is not considered to be misrepresentation under law?

Making a false or maliciously critical statement regarding the financial condition of a competitor

Georgia Long-Term Care Partnership (LTCP) policies:

May only be sold by agents who have completed 8 hours of initial LTC training

Medicare Supplement Insurance is also called what?

MediGap private insurance plans that are designed to supplement and fill in some of the gaps of Medicare Part A and B plans.

License Denial, Revocation, or Suspension

The Commissioner may refuse, revoke, or suspend a license if the applicant or licensee has: -Misappropriated, used for own use, or illegally withheld money belonging to an insurer, insured, agency, insurance applicant, or beneficiary -Failed or refused to pay any money belonging to any insurer, agent, applicant, beneficiary, or insured

_______plans are an arrangement under which a selected group of independent hospitals and medical practitioners, in a certain area, agree to provide services to subscribers at a prearranged cost on a fee-for-service basis.

hmo

An insurer that is qualified to transact insurance in Georgia may be authorized to transact any one kind or combination of kinds of insurance, except the following three:

-A reciprocal insurer may not transact life insurance -A Lloyd's insurer may not transact life insurance; and -A title insurer is authorized to transact only title insurance

To qualify, an individual applicant must:

-Be a resident of Georgia, who must reside and be present within the state for at least 6 months of every year, or have a principal place of business in Georgia -Be at least 18 years of age -Be of good character -Successfully complete an approved pre-licensing course, which must contain a minimum of 20 hours of instruction per major line of authority.

Replacement Considerations

The process of replacement includes canceling an old policy upon the purchase of a new policy. The old policy should not be canceled before the new policy is issued; otherwise, this could leave the applicant without coverage.

Business Disability Buyout

This policy pays a lump sum benefit if a partner becomes disabled, providing funds for the non-disabled partner to buy out the totally disabled partner's interest in the business. This plan is set up as a buy-sell agreement that requires each partner to name themselves as the beneficiary of each separate disability policy on the other partners. This plan does not provide death benefits in the event of death of a partner. Taxation Premiums are not tax deductible The benefits received are not taxable

Agent's Report

a personal statement submitted by the producer to the insurer regarding any personal knowledge of the applicant, including information observed during the application process. This information remains confidential between the producer and the insurer, and it does not become part of the entire contract.

Georgia Life and Health Guaranty Association

to protect insureds from the insolvency of an insurance company. guaranty = insolvency

Temporary Licenses

-valid for 6 months from the original issue date, -renewable for 3 months at a time for a -maximum of 15 months from the original issue date. A temporary license may be issued to an applicant in the event of the death of, or the inability to act as an agent by reason of service in the armed forces, illness, disability, or termination of an appointment for the purpose of continuing to service existing insurance policies or wrap up the agent's business affairs. The Commissioner may issue a temporary license to an employee, family member, associate, guardian, receiver, executor, or administrator in the same line of authority held by the agent.

Continuing Education

24 continuing education hours, 3 hours of which must be completed in Ethics. Resident licensees continually licensed for 20 years or longer must complete a minimum of 20 continuing education hours, of which 3 hours must be in Ethics. Hours may be completed at any time during the current biennial license period, but must be completed prior to the license expiration date.

Inactive/Nonactive License

An agent's license will be placed on inactive status when he/she no longer has a Certificate of Authority to do business with at least one insurer on file with the Commissioner -prohibited from selling, soliciting, or negotiating insurance. The licensee will be required to provide evidence of compliance with the continuing education requirements before the license can become active

Lapse

An individual whose license lapses while serving in the United States armed forces may be granted a new license if applying within 1 year after his/her service terminates, and no more than 5 years from the date of expiration.

Workers' Compensation Benefits

Each state requires Workers' Compensation to be purchased by employers with 1 or more employees. This is a liability (casualty) insurance policy, not a health insurance policy, which provides coverage for bodily injury, occupational diseases (sickness), disability, and death that arise from and in the course of employment. Employers must pay the entire premium. Subrogation Transfers an insured's legal right of recovery to the insurer that has paid a claim. This prevents the insured from collecting twice for the same loss and holds the responsible third party accountable for the loss. In other words, if an insured suffers a loss, the insurance company will pay the claim and have the right to sue a negligent third party to recover the loss.

Cease and Desist Orders

If it appears that a person has engaged in, is engaging in, or is about to engage in a prohibited act, the Commissioner may issue a cease and desist order if it is in the public's best interest to prohibit that person from continuing such act, practice, or transaction. The order will include a notice of opportunity for a hearing, which must be requested within 10 days of receipt of the order. The order and notice will be delivered by registered or certified mail or overnight mail with a return receipt.

MIB- Medical Information Bureau

MIB, Inc. (Men in Black) Report is primarily used to collect adverse medical information about an applicant's health and act as an information exchange. help lower the cost of life and health insurance for consumers. These services "alert" underwriters to -previous claim information -fraud -errors -omissions -or misrepresentations made on insurance applications ***The MIB's coded reports represent general medical information and other conditions (typically hazardous hobbies and adverse driving records) affecting the insurability of the applicant.

Noncontributory Plan

Premiums are paid entirely by the employer and are tax deductible to the employer 100% of the disability benefit proceeds received by the employer are taxable to the employee

Residual Disability

Provides benefits for loss of income after the insured returns to work, usually following a total disability. Benefits are based on the reduction of earnings as a result of the disability.

The Commissioner

The Commissioner may make reasonable rules and regulations necessary for the administration and enforcement of the Insurance Code. The Commissioner has the power to examine and investigate into the affairs of every person engaged in the insurance business in Georgia. The Commissioner must have rules or regulations approved by the Attorney General and on public file for at least 10 days before a rule/regulation becomes effective.

Statement of Good Health

The Statement of Good Health is a signed statement by the applicant confirming that everything stated on the application is still true.

Counselor's License

The applicant must have 5 years of experience as an agent, subagent, or adjuster, or provide evidence of sufficient teaching or educational qualifications or experience which qualifies the applicant to act as a counselor.

counselor

any individual who engages in the business of counseling, advising, or rendering opinions as to the benefits promised under contract or offered by any insurer regarding the terms, value, effect, advantages, or disadvantages under the contract of insurance.

Definitions of a Total Disability- Any Occupation

are more strict and require the insured to be unable to perform the duties of not just his/her own job, but the duties of any occupation for which the individual is reasonably suited by education, training, and experience. This definition is more restrictive and harder to qualify for benefits.

Fines

impose an administrative fine -Failed to use diligence in processing claims, - -failed to pay claims in a timely manner, or -failed to provide proper notice when required as to the reason the insurer failed to make claim payments -Compelled, without just cause, insureds or claimants to accept less than the amount due, or to bring action against an insurer to secure the full amount of the claim or settlement -Accepted money or other remuneration for referring automobile or other property repair business, including glass breakage, to a particular repair company

Application for Certificate of Authority should include:

name home office location or principal office in the United States if an alien insurer kinds of insurance to be transacted date of organization or incorporation form of organization, state or country of domicile names of general officers with the number of shares held by each general officer a copy of its corporate charter bylaws. The application must be accompanied by the required fee, which will be returned if the application is denied.

Individual Disability Income Policy

policy that pays an income benefit when the insured is unable to work due to a covered illness or injury. Benefits are typically paid monthly and determined as either: -a flat dollar amount or -a percentage, usually 60% to 70% of the insured's current net earnings as reported at the time of application.

Examination of Records

the commissioner may conduct an examination of any insurer authorized to do business in this state as often as necessary, but most domestic insurers must be examined at least once every 5 years. may conduct an examination of any HMO and its providers no less than once every 3 years.

Correction of Inadequate or Incorrect Accounts

the person being examined will have 60 days upon notification to correct the accounting. If the examinee fails to make the corrections, the Commissioner may employ experts to rewrite, post, or balance such records at the expense of such examinee.

Attending Physician Statement (APS)

used in cases in which the individual application and/or medical reports reveal conditions for which further information is necessary to determine insurability. The applicant's treating physician will complete this as part of the applicant's medical history.

Discretionary Refusal, Revocation, or Suspension of Certificate

-Violates any insurance provision, law or regulation -Knowingly fails to comply with or violates any rule or order of the Commissioner -Is found to be in such condition that any further transactions in Georgia are deemed to be hazardous to its policyholders or to the public -Compels claimants to accept less than the amount due to them or to bring an action against it to secure full payment -Refuses to be examined -Fails to pay any final judgment rendered against it in Georgia within 30 days after such judgment becomes final -Is under the same general management or ownership as another insurer transacting direct insurance in Georgia without a certificate of authority, unless such company is a permitted surplus line insurer

Limited Licenses

Credit insurance Rental company insurance Portable electronics insurance Travel insurance

Sharing Commissions

No insurer or agent doing business in this state may pay, directly or indirectly, any commissions or any other valuable consideration to any person for services as an agent, subagent, or adjuster within this state, unless such person is duly licensed.

Rebating

Rebating is an unfair trade practice and includes knowingly permitting an agreement other than as expressed in the contract and offering anything of value as an inducement to insurance if not specified in the contract, except a rebate approved by the Commissioner.

Nonresident License and Reciprocity

Reciprocity - In order to obtain a nonresident license without additional requirements, the person's home state must have reciprocity with Georgia and award nonresident agent licenses to Georgia residents on the same basis. Nonresident agents who move to another state, or resident agents who move to another state from Georgia, must notify the Commissioner within 30 days of change of legal address to maintain a nonresident license.

Medical or Physical Examinations

Medical or physical exams are conducted by -a licensed medical professional, such as a registered nurse or paramedic, -submits directly to the underwriter. -insurer's expense. Medical exams: -checking vital statistics (height, weight, blood pressure) -lab tests including the collection of blood -urine samples or a cheek swab to detect nicotine. More extensive tests: -stress test -even an electrocardiogram (EKG).

Contributory Plan

both employer and employee contribute premiums paid by the employer are tax deductible to the employer and premiums paid by the employee are made with after-tax dollars Disability benefits received by the employee as a result of employer contributions are taxable as income to the employee based on the percentage of the premium paid by the employer

Group Disability Income Policies

usually offered only on a nonoccupational basis based on a percentage of the employee's salary at the time of the loss, not the time of application. contributory or noncontributory basis.

Business Overhead Expense

when the owner becomes disabled. The benefits include expenses such as -office rent -utilities -employee labor. -NOT the owners loss of income Taxation Premiums paid by the business are tax deductible Benefits received are taxable to the business owner and must be reported as income.

probationary period

which is a specified period of time such as 60 days after the policy effective date, before losses due to sickness are covered. This waiting period is designed to protect the insurer from an insured purchasing a policy with the intent to immediately file a claim.