Georgia Administrative Code

(1) Each insurer shall maintain records concerning all data, statistics, or underwriting rules so that the Commissioner is able to determine whether that insurer is in compliance with applicable laws and Rules and Regulations. Such information shall also be reported through a rec…

With respect to large commercial risks, upon a finding by the Commissioner that a sufficient degree of competition does not exist for a particular line, class or type of insurance, he or she may suspend all or part of this Regulation Chapter.

Each policy issued to a large commercial risk rated in accordance with this Regulation Chapter shall include a disclaimer with language similar to the following: "The rates, rating plans, or resulting premiums provided for in this policy are exempt from the filing and approval re…

Any insurer, or any agent, counselor, representative, officer, or employee of such insurer 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 of it to any person or circumstance is held invalid, such invalidity shall not affect the provisions or applications of the rules herein which can be given effect without the invalid portion. To that end, the provisio…

This regulation is promulgated pursuant to the authority granted by O.C.G.A. §§ 33-2-9 and 33-7-14.

The purpose of this regulation is to set forth rules and procedural requirements that the commissioner deems necessary to carry out the provisions of O.C.G.A. § 33-7-14. The actions and information required by this regulation are declared to be necessary and appropriate in the pu…

If any provision of this regulation, or the application of the provision to any person or circumstance, is held invalid, the remainder of the regulation, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not be af…

Pursuant to O.C.G.A. § 33-7-14(a), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that was licensed in this state as of any date on which statutory financial statement credit for reinsurance is claimed.

(1) Pursuant to O.C.G.A. § 33-7-14(a)(2), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is accredited as a reinsurer in this state as of the date on which statutory financial statement credit for reinsurance is claimed…

(1) Pursuant to O.C.G.A. § 33-7-14(a)(3), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that as of any date on which statutory financial statement credit for reinsurance is claimed: (a) Is domiciled in (or, in the case of a…

(1) Pursuant to O.C.G.A. § 33-7-14(a)(4), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer which, as of any date on which statutory financial statement credit for reinsurance is claimed, and thereafter for so long as credit fo…

(1) Pursuant to O.C.G.A. § 33-7-14(a)(5), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that has been certified as a reinsurer in this state at all times for which statutory financial statement credit for reinsurance is cla…

(1) Pursuant to O.C.G.A. § 33-7-14(a)(6), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer that is licensed to write reinsurance by, and has its head office or is domiciled in, a Reciprocal Jurisdiction, and which meets the ot…

Pursuant to O.C.G.A. § 33-7-14(a)(6), the commissioner shall allow credit for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of O.C.G.A. § 33-7-14(a)(1) - (5) but only as to the insurance of risks located in jurisdictions where the rei…

(1) Pursuant to O.C.G.A. § 33-7-14(b), the commissioner shall allow a reduction from liability for reinsurance ceded by a domestic insurer to an assuming insurer not meeting the requirements of O.C.G.A. § 33-7-14(a) in an amount not exceeding the liabilities carried by the ceding…

(1) As used in this section: (a) "Beneficiary" means the entity for whose sole benefit the trust has been established and any successor of the beneficiary by operation of law. If a court of law appoints a successor in interest to the named beneficiary, then the named beneficiary …

(1) The letter of credit must be clean, irrevocable, unconditional and issued or confirmed by a qualified United States financial institution as defined in O.C.G.A. § 33-7-14(c)(1). The letter of credit shall contain an issue date and expiration date and shall stipulate that the …

A ceding insurer may take credit for unencumbered funds withheld by the ceding insurer in the United States subject to withdrawal solely by the ceding insurer and under its exclusive control.

Credit will not be granted, nor an asset or reduction from liability allowed, to a ceding insurer for reinsurance effected with assuming insurers meeting the requirements of Sections 4, 5, 6, 7, 8 or 9 of this regulation or otherwise in compliance with O.C.G.A. § 33-7-14(a) after…

All new and renewal reinsurance transactions entered into after [insert date] shall conform to the requirements of the Act and this regulation if credit is to be given to the ceding insurer for such reinsurance.

This Regulation applies to any health plan purchasing cooperative as defined in O.C.G.A. § 33- 30A-1.

(1) This Regulation applies to any health plan purchasing cooperative as defined in O.C.G.A. § 33-30A-1. (2) The purposes of this Regulation include: (a) Providing disclosure of contracts between insurance carriers and health plan purchasing cooperatives, both to potential insure…

As used in this Regulation Chapter, the term: (1) "Employer-sponsored Health Benefit Arrangement" means any program of delivery, funding, or sponsorship of major medical, hospital, or medical and hospital expense coverage, or any type of coverage considered a health benefit plan …

(1) It is unlawful for any person or entity to act as or hold itself out to be a health plan purchasing cooperative in this State without a valid certificate of authority issued by the Commissioner of Insurance. To qualify for and hold a certificate of authority to act as a healt…

(1) At application and renewal every health plan purchasing cooperative shall file with the Commissioner a surety bond executed by a corporate surety insurer authorized to transact insurance in this state in favor of the Commissioner of Insurance of the State of Georgia, continuo…

No health plan purchasing cooperative shall act as such without a written agreement between the health plan purchasing cooperative and each participating carrier, and such written agreement shall be retained as part of the official records of the carrier and the health plan purch…

(1) Every health plan purchasing cooperative shall maintain at its principal administrative office for the duration of the written agreement referred to in § and five years thereafter books and records of all transactions between it, carriers and insured persons. The Commissioner…

Payment to the health plan purchasing cooperative of any premiums or charges for a health benefit plan by or on behalf of the insured or member shall be deemed to have been received by the participating carrier, and the payment of return premiums or claims by the carrier to the h…

(1) All insurance charges, fees, or premiums collected by a health plan purchasing cooperative on behalf of or for a participating carrier, and return premiums received from such carrier, shall be held by the health plan purchasing cooperative in a fiduciary capacity. Such funds …

(1) Each authorized health plan purchasing cooperative shall file with the Commissioner a full and true report of its financial condition, transactions, and affairs. The report shall be filed annually on or before May 1 or within such extension of time therefore as the Commission…

(1) A health plan purchasing cooperative shall file any enrollment or marketing materials which provide the standardized information on each health benefit plan as specified in O.C.G.A. § 33-30A-4(b)(2) for distribution to cooperative members at least ninety (90) days prior to th…

Any policies, certificates, booklets, termination notices, or other written communications delivered by the participating carrier to the health plan purchasing cooperative for delivery to its policyholders or certificate holders shall be delivered by the health plan purchasing co…

The health plan purchasing cooperative shall provide, upon enrollment, a written notice approved by the participating carrier, to individuals covered by such carrier, advising them of the identity of and relationship between the health plan purchasing cooperative, the member empl…

(1) As part of its application for a certificate of authority, a health plan purchasing cooperative shall file with the Commissioner a description of the entire service area of the health plan purchasing cooperative. All changes to a service area shall be filed for approval with …

(1) A health plan purchasing cooperative shall contract with at least two (2) unaffiliated carriers with Certificates of Authority from the Commissioner for participation in the health plan purchasing cooperative to ensure that employers and enrollees have a choice from among a r…

(1) A health plan purchasing cooperative may do any of the following: (a) Set reasonable fees, which may vary by employer size, for membership in the health plan purchasing cooperative that will finance reasonable and necessary costs incurred in administering the health plan purc…

(1) Small Employer Rating Requirements. Participating carriers offering coverage to small employers through a health plan purchasing cooperative must comply with the rating requirements of Rule and must consistently use the same set of rating factors otherwise used for small grou…

(1) A health plan purchasing cooperative may set contribution rules for members in each market type served by the cooperative, which require a minimum percentage of premium contribution from each member for each eligible employee or dependent. A health plan purchasing cooperative…

(1) Contracts or written service agreements between the health plan purchasing cooperative and a participating carrier shall: (a) Establish, on a consistent and uniform basis, a policyholder, which shall be either the health plan purchasing cooperative or each of its members; (b)…

(1) For purposes of renewability, health plan purchasing cooperatives, members, and participating carriers shall be subject to Rule with regard to renewability and non-termination of coverage, and coverage under a health plan purchasing cooperative shall be considered coverage un…

(1) A health plan purchasing cooperative shall, at the request of the Commissioner, respond in writing within fifteen (15) working days to any complaint received by the Commissioner concerning the health plan purchasing cooperative. If, in the Commissioner's discretion, the frequ…

Any health plan purchasing cooperative, carrier, agent, representative, officer or employee of such carrier, 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 rule or portion of a Rule in this chapter or the applicability thereof to any particular circumstances is held invalid by a court of competent jurisdiction, the remainder of the Rules or the applicability of such provision to other persons or circumstances shall not be aff…

The purpose of this regulation is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such poli…

This regulation is issued pursuant to the authority vested in the Commissioner under Chapter 2 of Title 33 and O.C.G.A. Sections 33-43-3, 33-43-4 and 33-43-5.

(1) Except as otherwise specifically provided in Sections , , , and , this regulation shall apply to: (a) All Medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this regulation; and (b) All certificates issued under group…