Georgia Administrative Code

For the purpose of this Regulation Chapter, the following definitions shall apply: (a) For the purposes of this Regulation Chapter and for the purpose of implementing and interpreting O.C.G.A. § 33-24-46, the term "residential real property" shall mean any property on which the p…

On or before the first day of February, May, August and November, unless notified by the Commissioner of Insurance to cease prior thereto, and continuing until notified by the Commissioner to cease, all insurance companies doing business in the State of Georgia and issuing polici…

Any insurer doing business in the State of Georgia and issuing policies of property and/or casualty insurance shall file with the Office of Commissioner of Insurance the information required in § and such other specifically related information for such periods of time as the Comm…

On or before the first day of February, May, August, and November, unless notified by the Commissioner to cease prior thereto, and continuing until notified by the Commissioner to cease, all insurance companies transacting business in the State of Georgia and issuing policies of …

Any insurer, representative, officer, or employee or such insurer, failing to comply with the requirements of this Regulation Chapter shall be subject to such penalties and other enforcement action as may be appropriate under the insurance laws of this State.

If any provisions of this Regulation Chapter or the application thereof to any person or circumstance is for any reason held to be invalid by a court of competent jurisdiction, the remainder of the Regulation Chapter or the applicability of such provision to other persons or circ…

The purpose of this regulation is to implement O.C.G.A. Chapter 33-42, to promote the public interest, to promote the availability of long-term care insurance coverage, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment pr…

This regulation is issued pursuant to the authority vested in the Commissioner under O.C.G.A. Sections 33-2-9 and 33-42-7.

Except as otherwise specifically provided, this Regulation applies to all long-term care insurance policies, including qualified long-term care contracts and life insurance policies that accelerate benefits for long-term care delivered or issued for delivery in this state on or a…

For the purpose of this Regulation, the terms "long-term care insurance," "qualified long-term care insurance," "group long-term care insurance," "Commissioner," "applicant," "policy" and "certificate" shall have the meanings set forth in O.C.G.A. Section 33-42-4. In addition, th…

No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements: (1) "Activities of daily living" means at least bathing, conti…

(1) Renewability. The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of Section of this Regulation: (a) A policy issued to an…

Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: (1) (a) Notice before lapse or termination. No individual long-term care policy or certificate shall be issued until the insurer has received from the app…

(1) Renewability. Individual long-term care insurance policies shall contain a renewability provision. (a) The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancell…

(1) This section shall apply as follows: (a) Except as provided in paragraph (b), this section applies to any long-term care policy or certificate issued in this state on or after April 1, 2008. (b) For certificates issued on or after the effective date of this amended regulation…

(1) This section applies to any long-term care policy issued in this state on or after April 1, 2008. (2) An insurer shall provide the information listed in this subsection to the Commissioner 30 days prior to making a long-term care insurance form available for sale. (a) A copy …

(1) All applications for long-term care insurance policies or certificates except those that are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant. (2) (a) If an application for long-term care insurance cont…

(1) A long-term care insurance policy or certificate shall not, if it provides benefits for home health care or community care services limit or exclude benefits: (a) By requiring that the insured or claimant would need care in a skilled nursing facility if home health care servi…

(1) No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder in addition to any other inflation protection the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations w…

(1) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is inte…

(1) Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. (2) E…

A producer is not authorized to sell, solicit or negotiate with respect to long-term care insurance except as authorized by O.C.G.A. Chapter 33-23.

The Commissioner may upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this Regulation with respect to a specific long-term care insurance policy or certificate upon a written finding that: (1) The …

(1) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for the benefits shall be determined in accordance with O.C.G.A. Section 33-10-13. Claim reserves shall also be e…

(1) This section shall apply to all long-term care insurance policies or certificates except those covered under Sections and . (2) Benefits under long-term care insurance policies shall be deemed reasonable in relation to premiums provided the expected loss ratio is at least 60 …

(1) This section shall apply as follows: (a) Except as provided in paragraph (2), this section applies to any long-term care policy or certificate issued in this state on or after October 1, 2008. (b) For certificates issued on or after the effective date of this amended regulati…

Prior to an insurer or similar organization offering group long-term care insurance to a resident of this state pursuant to O.C.G.A. Section 33-42-5, it shall file with the Commissioner evidence that the group policy or certificate thereunder has been approved by a state having s…

(1) Every insurer, health care service plan or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement intended for use in this state whether through written, radio or television medium to the Co…

(1) Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: (a) Establish marketing procedures and agent training requirements to assure that: (i) Any marketing activities, includ…

(1) This section shall not apply to life insurance policies that accelerate benefits for long-term care. (2) Every insurer, health care service plan or other entity marketing long-term care insurance (the "issuer") shall: (a) Develop and use suitability standards to determine whe…

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy for similar benefits to the…

(1) An insurer shall notify policyholders of the availability of a new long-term policy series that provides coverage for new long-term care services or providers material in nature and not previously available through the insurer to the general public. The notice shall be provid…

(1) (a) Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificateholder to reduce coverage and lower the policy or certificate premium in at least one of the following ways: (i) Reducing the maximum benefit; or (ii…

(1) Except as provided in subsection (2), a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificateholder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. …

(1) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits shall not be more restrictive than requiring either…

(1) For purposes of this section, the following definitions apply: (a) "Qualified long-term care services" means services that meet the requirements of Section 7702(c)(1) of the Internal Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive, therapeutic, …

This section of the Regulation implements, interprets and makes specific, the provisions of O.C.G.A. Section 33-42-6(g) in prescribing a standard format and the content of an outline of coverage. (1) The outline of coverage shall be a free-standing document, using no smaller than…

(1) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate…

In addition to any other penalties provided by the laws of this state any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to such fines and penalt…

(1) In accordance with § 6021 of the Deficit Reduction Act of 2005 (Pub.L. 109-171) and O.C.G.A. Section 49-4-162, in addition to the applicable provisions of this Rule Chapter, the provisions of this section shall apply to any qualified state long-term care insurance partnership…