Georgia Administrative Code

(1) Unless licensed as an insurance company, a service contract provider shall not use in its name, contracts, or literature, any of the words "insurance," "casualty," "surety," "mutual," or any other words descriptive of the insurance, casualty, or surety business or deceptively…

(1) All service contract providers shall keep accurate accounts, books, and records concerning transactions regulated under this Chapter. (2) A service contract provider's accounts, books, and records shall include (a) Copies of all service contracts; (b) The name and address of …

(1) The issuer of a reimbursement insurance policy or surety bond shall not cancel such policy or bond until a notice of cancellation in accordance with O.C.G.A. Section 33-24-47 has been mailed or delivered to the Commissioner at the following address: Office of Commissioner of …

(1) The Commissioner may receive and process each complaint made against any service contract provider which alleges certain acts or practices which may constitute one or more violations of this Chapter. Any member of the public, or any federal, state, or local official, may file…

(1) This Regulation is not applicable to vehicle service contracts or extended warranty agreements, if the vehicle service contract or extended warranty is made by the automobile vehicle manufacturer or otherwise excluded from property insurance as defined by O.C.G.A. § 33-7-6(b)…

If any provision of this Chapter or the application thereof to any person or circumstance is held invalid by a court of competent jurisdiction, the remainder of the Chapter or the applicability of such provision to other persons or circumstances shall not be affected.

This Regulation is adopted and promulgated by the Commissioner of Insurance pursuant to the authority set forth in O.C.G.A. Section 33-2-9.

The purpose of this Regulation is to: (a) Permit, but not require, plans to include a coordination of benefits (COB) provision; (b) Establish an order in which plans pay their claims; (c) Provide the authority for the orderly transfer of information needed to pay claims promptly;…

The following words and terms, when used in this Regulation, shall have the following meanings unless the context clearly indicates otherwise: (a) Allowable Expenses. 1. "Allowable Expense" means the necessary, reasonable and customary item of expense for health care when the ite…

(1) General. Appendix A contains a model COB provision for use in group contracts. That use is subject to the provisions of(2) and (3) below and to the provisions of Rule . (2) Flexibility. A group contract's COB provision does not have to use the words and format shown at Append…

(1) Order of Benefits. (a) General. The general order of benefits is as follows: 1. The Primary Plan must pay or provide its benefits as if the Secondary Plan or Plans did not exist. A Plan that does not include a coordination of benefits provision may not take the benefits of an…

(1) Total Allowable Expenses. (a) When it is determined, pursuant to Rule , that this Plan is a Secondary Plan, it may reduce its benefits so that the total benefits paid or provided by all plans during a Claim Determination Period are not more than total Allowable Expenses. The …

(1) Reasonable Cash Values of Services. A Secondary Plan which provides benefits in the form of services may recover the reasonable cash value of providing the services from the Primary Plan, to the extent that benefits for the services are covered by the Primary Plan and have no…

(1) This Regulation is applicable to every group contract which provides health care benefits and which is issued on or after the effective date of this Regulation. (2) A group contract which provides health care benefits and was issued before the effective date of this Regulatio…

This Regulation is promulgated by the Commissioner of Insurance pursuant to the authority set forth in O.C.G.A. §§ 33-2-9 and 33-23-100et seq.

(1) This Regulation applies to any administrator as defined in O.C.G.A. Section 33-23-100. (2) The purposes of this Regulation include (a) Providing disclosure of contracts between insurers and third party administrators, both to potential insureds and to the Commissioner; (b) Pr…

(1) It is unlawful for any business entity to act as or hold itself out to be an administrator in this State without a valid license issued by the Commissioner of Insurance. To qualify for and hold a license to act as an administrator in this State, an administrator must otherwis…

(1) No administrator shall act as such without a written agreement between the administrator and an insurer or self-insurer, and such written agreement shall be retained as part of the official records of an insurer or self-insurer and the administrator for the duration of the ag…

(1) Every administrator shall maintain at its principal administrative office for the duration of the written agreement referred to in Rule and five years thereafter books and records of all transactions between it, insurers, self-insurers and insured persons. The Commissioner sh…

Whenever an insurer utilizes the services of an administrator under the terms of a written contract as required in Rule , the payment to the administrator of any premiums or charges for insurance by or on behalf of the insured shall be deemed to have been received by the insurer,…

(1) Every administrator shall file a bond with the Commissioner. The administrator shall file a certificate of such bond, in a form acceptable by a corporate surety insurer authorized to transact insurance in this state in favor of Commissioner of Insurance of the state of Georgi…

All insurance charges, fees, or premiums collected by an administrator on behalf of or for an insurer, insurers, or self-insurer, and return premiums received from such insurer, insurers, or self-insurer, shall be held by the administrator in a fiduciary capacity. Such funds shal…

All claims paid by the administrator from funds collected on behalf of an insurer or self-insurer shall be paid by check, drafts, electronic funds transfer, or other method of electronic payment, as authorized by such insurer or self-insurer: provided, however, the payee may elec…

(1) Compensation to an administrator for any policies in which the administrator adjusts or settles claims shall in no way be contingent on claims experience. This section does not prevent the compensation of an administrator from being based on premiums or charges collected or t…

(1) Each authorized administrator shall file with the Commissioner an annual renewal of its license on a form prescribed by the Commissioner which sets forth the administrator's transactions, and affairs. The statement shall be filed annually on or before August 1. The annual ren…

(1) The written agreement between the administrator and an insurer shall make provision with respect to the underwriting or other standards pertaining to the business underwritten by such insurer. The written agreement between the administrator and a self-insurer shall make provi…

(1) An administrator may use only such advertising pertaining to the business underwritten by an insurer as has been approved by such insurer in advance of its use. (2) Each administrator shall maintain at its principal administrative office a complete file of all advertisements,…

Any policies, certificates, booklets, termination notices, or other written communications delivered by the insurer to the administrator for delivery to its policyholders shall be delivered by the administrator promptly after receipt of direction from the insurer to deliver them.

(1) Where the services of an administrator are utilized, the administrator shall provide a written notice approved by the insurer, or self-insurer, to insured or self-insured individuals, advising them of the identity of and relationship among the administrator, the group policyh…

(1) An administrator shall, at the request of the Commissioner, respond in writing within fifteen (15) working days to any complaint received by the Commissioner concerning the administrator. Complaints shall include those pertaining to improper adjudication of claims and any com…

(1) No administrator, nor their officers, directors, partners, trustees, agents or employees shall engage in any unfair trade practice defined in Chapter 6 of Title 33 of the Official Code of Georgia Annotated, or determined pursuant to this rule to be an unfair or deceptive act …

(1) The administrator shall, within 30 days after the event, notify the Commissioner of any material change in its management. (2) An administrator's license shall not be sold or transferred to a non-affiliated or otherwise unrelated party. (3) An administrator may not contract o…

Standard administrator forms are required and will be supplied upon request by the Commissioner's office either in paper form or electronically over the internet. Applicants and licensed administrators shall utilize all applicable forms in preparing applications, statements, noti…

Any business entity or affiliated party failing to comply with the requirements of this Regulation Chapter shall be subject to such penalties as may be appropriate under the insurance laws of this State.

If any provision of this Regulation Chapter, or the application thereof to any business entity or affiliated party or circumstance, is held invalid by a court of competent jurisdiction, the remainder of the Regulation Chapter or the applicability of such provision to other person…

(1) Each insurer reporting stocks and bonds as admitted assets in its annual statement shall be responsible for establishing a value for such securities. Except as otherwise provided by law, the procedures for establishing such values where applicable shall be as follows: (a) Oth…

The purpose of this Regulation is to implement the provisions of O.C.G.A. Chapter 33-50 and to ensure the safe and proper operation of multiple employer self-insured health plans in Georgia.

(1) "Employee" means any person in the service of another under any contract of hire, express or implied, oral or written, where the employer has the power or right to control and direct the employee in the material details of how the work is to be performed. (2) "Employer" means…

Any person who advertises, solicits, sells, transacts, or administers coverage, or who in any manner secures, helps or aids in the placing or administration of coverage with any multiple employer self-insured plan in Georgia shall prominently disclose in writing to every particip…

(1) All communications and filings must be made with the Regulatory Services Division, Georgia Insurance Department. To Complete the application for a license, the following items pertaining to the plan must be submitted: (a) Each applicant for license shall make application on f…

(1) A multiple employer self-insured health plan is required to obtain individual and aggregate excess stop-loss coverage from an insurer authorized to transact insurance in Georgia. Such coverage must be submitted for approval by the Commissioner. (2) Plan participants are requi…

Security Deposit in the amount of $100,000 shall be made with the Commissioner on forms GID-5A through GID-6, as applicable. Referenced forms are attached to Rules and Regulations of the Georgia Insurance Department, Section , Exhibits B and C, and are hereby incorporated herein …

An examination will be performed by the Commissioner to verify the books, accounts and records underlying the plan during the licensing process. This examination will be performed at the expense of the applicant by a representative of the Office of the Commissioner of Insurance. …

A power of attorney appointing a person who is a resident of Georgia to receive service of legal process must be submitted on form ME-5 entitled "Power of Attorney," attached hereto as "Exhibit D" and incorporated herein. Such person must be readily accessible and available for s…

Proof of bonding by a surety company having a certificate of authority to transact insurance in Georgia in a minimum amount of $150,000 for each plan trustee must be submitted.

A detailed statement of the method used to arrive at the plan's required surplus account as required in Section 33-50-7(b) must be submitted.