Georgia Laws, Rules And Regulations Pertinent To Life Insurance & Sickness Insurance

Miscellaneous Provisions

Individual accident and sickness policies must make the following coverages available: human heart transplant, mammograms and prostate screenings, and bone marrow transplants. Newborn children of the insured must be covered as dependents on their parent's policy from the moment of birth. Basic coverage for child wellness services for an insured child must be provided from birth through the age of 5.The limiting age of child dependence is 26. Claims forms must be furnished within 10 working days. Claims must be paid within 30 days. Policyowners and insureds may take a legal action against the insurer no sooner than 60 days and no later than 3 years after proof of loss.

Life Insurance Advertisements

All advertisements must be clearly written, truthful, and not misleading in fact or by implication. Advertisement regulation applies to ALL life insurance policies or annuities. Life insurance advertisements may not include the words investments or profits. Advertisements are always the responsibility of the insurer. Insurers must keep records of all advertisements for 4 years.

Long-Term Care Partnership Requirements

An agent must complete 8 hours of education related to long-term care policies prior to the sale of partnership policies. An agent must complete 4 hours of long-term care-specific continuing education every 24 months. It is the insurer's responsibility to ensure that its agents have completed the required education related to LTC policies. Insurers must keep records related to the completion of LTC education for 5 years. Most qualified state long-term care insurance partnership policies must include inflation protection (a policy covering a person age 76 or older does not have to include inflation protection).

Long-Term Care Partnership Requirements

Insurers must keep records related to the completion of LTC education for 5 years. Most qualified state long-term care insurance partnership policies must include inflation protection (a policy covering a person age 76 or older does not have to include inflation protection). Partnership policies allow a person to qualify for the asset disregard program. The Partnership Program Disclosure Notice and the Outline of Coverage are both disclosure documents that must be provided to all prospective applicants. Not every person who purchases a partnership policy will qualify for Medicaid.

Long-Term Care (LTC)

LTC coverage may be automatically included in a standard life insurance policy as a provision, or may be added as a rider. LTC coverage must be guaranteed renewable. LTC policies must offer an inflation protection feature, with benefits increasing at least 5% annually. LTC policies must include a secondary address provision to prevent unintentional policy lapse.

Replacement of Life Insurance

Life insurance replacement rules apply to individual term life, as well as individual whole life. Life insurance replacement rules do not apply to group life, annuities, or credit life. In a replacement transaction, the disclosure statement must be signed by both the applicant and the producer. Existing insurers must provide policyowners with a policy summary for the existing life insurance within 10 working days of receiving the written communication and replacement if requested. Replacement notices and all written communication records must be maintained by replacing insurers for at least 3 years.

Long-Term Care (LTC)

Long-term care policies sold in Georgia may be offered on an expense incurred basis, an indemnity basis, or a prepaid basis. LTC policies sold in Georgia may not be offered on a fee-for-service basis. LTC policies must provide coverage in a nursing home for a minimum of 12 consecutive months. Long-term care insurance must cover Alzheimer's disease, as well as other organic brain disorders.

Medicare Supplement Policies

Medicare Supplement policies must be guaranteed renewable. Medicare Supplement policies cannot duplicate coverage already provided by Medicare. Medicare Supplement policy cannot be cancelled or nonrenewed based upon health status. There is a required free-look period of 30 days. Medicare Supplement policies may have a 6-month probationary period, where coverage is excluded for preexisting conditions that have occurred in the 6 months previous to the date coverage began. Insurers offering Medicare Supplements in Georgia are not required to sell all 10 plans, but they must at minimum offer Plan A.

Medicare Supplement Policies

Insurers offering Medicare Supplements in Georgia must sell at least Plan A, must offer a 6-month open enrollment period, and cannot use riders to exclude coverage for specific medical conditions. If advertised as a Medicare supplement policy, the policy must meet the minimum standards for coverage, as established by state rules and regulations. When a policy replacement is involved, the insurer or its agent must provide the applicate a Notice Regarding Replacement.