State Laws, Rules, & Regulations

Agent Training Requirements

-Licensed & appointed insurance agent -Initial 8 hour training -Ongoing 4 hours training every 24 months

6 Classes of Insurance in GA

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

Limiting age of dependence

19

How long must agents keep records?

5 years after the completion of a transaction or for the term of the contract - whichever is greater

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 insurer

Commissioner of Insurance

Chief officer of the Department of Insurance - 4 year terms - carry out and enforce the provisions of the Insurance Code

Medicare Supplement Policy

Either a policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or HMOs - don't include Parts C or D or any Health Care Prepayment Plan that provides benefits related to Social Security

License Maintenance

Expire every 2 years on last day of licensee's birth month, 24 Continuing Education credit hours required to renew, including 3 in ethics education

Partnership Disclosure Notice

Explains the benefits associated with the policy and indicates that at the time of issue, the policy is a qualified state long-term care insurance partnership policy.

Temporary License

May be issued for 6 months without requirements to a member of the agent's family, or to an executor or administrator for the servicing of an insurance business in the event of an agent's death, disability, or military service

When do certificates of authority expire?

Midnight on June 30th the year following issuance

Claim Forms in GA

Must be furnished within 10 working days

Agent Responsibility

If the agent is working within the conditions of his/her contract, the company is fully responsible.

False Advertising

Include untrue, deceptive, or misleading statements that apply to the business of insurance or anyone who conducts it

Foreign Insurer

Incorporated in another state

Domestic insurer

Incorporated in this state

Alien

Incorporated outside the US

Replacement Notice

Must be signed by applicant and the producer in the case of replacement

Qualifications for a producer license

18 years old Resident of the state, present at least 6 months/year Good character Passed a written exam

How long must insurer's keep files of advertisements?

4 years

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

60 days

A written request must be filed with the Commissioner for a refund within.....

7 years of the payment

How long does the commissioner have to approve an application for a certificate of authority?

90 days (+ additional 90 if applicant is notified)

Express Authority

Agent's authority that is written in the contract

Long-Term Care insurance

Any accident and sickness insurance policy designed primarily to provide coverage for at least 12 months or which provides coverage for recurring confinements separated by a period not to exceed 6 months

How often must the Commissioner examine all domestic insurers?

At least once every 5 years

Authorized/Admitted Insurer

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

Misrepresentation

Issue, publish, or circulate and illustration or sales material that is false, misleading, or deceptive as to policy benefits or terms, the payment of dividends, etc.

Cease & Desist Order

Issued by commissioner (may be issued before hearing)

Fiduciary Responsibility

It is illegal for insurance producers to commingle premiums collected from the applicants with their own personal funds

Other penalties from a violation

License denial/suspension/revocation or monetary fines

Limited Subagent

Licensees are required to complete 5 hours of Continuing Education every 2 years

Qualified State Long-Term Care Insurance Partnership Policy

Long-term care insurance policy that meets model regulations and requirements of the NAIC, and covers an insured who was a resident of the state when coverage first became effective under the policy

Qualifications for Certificate of Authority

Minimum of $1.5 million in capital stock or surplus $100,000 deposit in a trust with the state for one class of insurance, and $25,000 for each additional class of insurance, not to exceed $200,000

Legal Action

No sooner than 60 days, no later than 3 years after proof of loss

Georgia Life and Health Insurance Guaranty Association

Nonprofit, unincorporated association that protects policyowners, insureds, and beneficiaries of life, health, annuities, and supplemental contracts issued by member insurers who become insolvent or are unable to perform their contractual obligations

Unauthorized/unadmitted Insurer

Not approved to do business in the state

Implied Authority

Not expressed or written into the contract, but the agent is assumed to have in order to transact the business of insurance.

Defamation

Oral or written statement is made that is intended to injure a person engaged in the insurance business

Mutual Companies

Owned by the policyowners and issue participating policies (issue nontaxable dividends)

Existing Insurer

The insurance company whose policy is being replaced

If a licensee's application has been refused or revoked...

They cannot file a new application for 5 years following that action

Inactive Status

When an agent does not have on file with the commissioner a certificate of authority to represent at least one insurer licence to do business in the state

Time of Payment of Claims in GA

Within 30 days

Notice of hearing

Notice of time and place: 15 days in advance Hearing: within 30 days of receipt of request Decision: within 30 days of hearing

Partnership Program Notice

Outlines the requirements and benefits of the policy when insurers or agents solicit partnership policies

Stock Companies

Owned by the stockholders who provide the capital necessary to establish and operate the insurance company and who share in any profits or losses

Nonparticipating policies

Policyowners do not share in profits or loss

Churning

Replacing insurance policies for the sole purpose of making commissions.

Insurance Transaction

Solicitation & inducement Preliminary insurance negotiations Effectuation of insurance contracts transactions of matters arising out of the effectuation of insurance contracts

Reciprocity Agreement

States award nonresident agent licenses on the same basis

Conservation

Any attempt by the existing insurer or its producer, or by a broker, to dissuade a current policyowner from the replacement of existing life insurance or annuity.

Controlled Business

Any coverage written on a producer's own life, health or property, and/or that of the producer's immediate family or business associates.

Rebating

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

Replacement

Any transaction in which new life insurance or a new annuity is to be purchased, and an existing policy has been or will be: -Lapsed, forfeited, surrendered, or terminated -Reissued with any reduction in cash value

Counselor

Anyone who engages in the business of advising customers as to the benefits under any contract on insurance issued, & can provide ancillary services

Apparent Authority (perceived)

Appearance or assumption of authority based on the actions, words, or deeds of the principal or because of circumstances the principal created

Certificate of Authority

Authorizes a company to start conducting business and specifies the kind(s) of insurance a company can transact

Nonresident Producer

Individual who is domiciled and licensed as a resident producer in another state