Requirements as to Policies Generally

  1. Law
  2. Georgia Code
  3. Insurance
  4. Individual Accident and Sickness Insurance
  5. Requirements as to Policies Generally

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  1. No policy of accident and sickness insurance shall be delivered or issued for delivery in this state unless it meets the following requirements:
    1. The entire money and other considerations for the policy are expressed in such policy;
    2. The time at which the insurance takes effect and terminates is expressed in such policy;
    3. It purports to insure only one person, provided that a policy may insure, originally or by subsequent amendment upon the application of an adult member of a family who shall be deemed the policyholder, any two or more eligible members of that family, including husband, wife, dependent children, or any children, under a specified age which shall not exceed 19 years, and any other person dependent upon the policyholder; provided, further, that, if a policy purports to insure a dependent child of the policyholder, the child shall continue to be insured up to and including age 25 so long as the policy continues in effect, the child remains a dependent of the policyholder, and the child, in each calendar year since reaching the age specified in the policy for termination of benefits as a dependent of the policyholder, has been enrolled for five calendar months or more as a full-time student in a postsecondary institution of higher learning or, if not so enrolled, would have been eligible to be so enrolled and was prevented from being so enrolled due to illness or injury;
    4. The style, arrangement, and overall appearance of the policy gives no undue prominence to any portion of the text and every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in lightfaced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than 120 point. The text shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions. When a policy is renewable only at the option of the insurer, such fact shall be made known in prominent lettering on the face of the policy;
    5. The exceptions and reductions of indemnity are set forth in the policy and, except those which are set forth in Code Sections 33-29-3 and 33-29-4, are printed, at the insurer's option, either with the benefit provisions to which they apply or under an appropriate caption such as "exceptions," or "exceptions and reductions," provided that, if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies;
    6. Each form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof;
    7. It contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks or short-rate table filed with the Commissioner;
    8. It contains no provision purporting to exclude or reduce coverage provided an otherwise insurable person solely for the reason that the person is eligible for or receiving medical assistance, as defined in Code Section 49-4-141.Any such provision appearing in an individual accident and sickness insurance policy shall be null and void; and
    9. It contains no provision relating to insurance with other insurers, provided that group conversion policies and major medical policies may contain provisions relating to other insurance benefits payable under group or blanket accident and sickness insurance policies.
  2. Individual major medical policies, including franchise and conversion policies, shall make available to each applicant for such coverage optional cash deductible amounts up to at least $5,000.00.No such policy shall contain any provision in which the length of the cash deductible accumulation period is not reasonable in relation to the amount of the cash deductibles.An insurer may offer higher optional deductibles to existing policyholders as a means of reducing the cost of such policies or to offset premium increases.

(Code 1933, § 56-3002, enacted by Ga. L. 1960, p. 289, § 1; Ga. L. 1978, p. 1149, §§ 1, 5; Ga. L. 1978, p. 1522, § 1; Ga. L. 1981, p. 1009, § 2; Ga. L. 1983, p. 3, § 24; Ga. L. 1985, p. 149, § 33; Ga. L. 1988, p. 1760, § 2; Ga. L. 1990, p. 1402, § 3; Ga. L. 2005, p. 481, § 6/HB 291; Ga. L. 2017, p. 164, § 37/HB 127; Ga. L. 2019, p. 386, § 86/SB 133; Ga. L. 2020, p. 493, § 33/SB 429.)

The 2019 amendment, effective July 1, 2019, deleted ", subsequent to July 1, 1978," following "insurance policy" near the end of paragraph (a)(8); and substituted "Reserved." for the former provisions of subsection (c), which read: "This Code section shall not be construed so as to impair the obligation of any contract in existence prior to January 1, 1979."

The 2020 amendment, effective July 29, 2020, part of an Act to revise, modernize, and correct the Code, deleted former subsection (c) which was designated as reserved.

Law reviews.

- For note on 1990 amendment of this Code section, see 7 Ga. St. U.L. Rev. 320 (1990).

RESEARCH REFERENCES

Am. Jur. 2d.

- 43 Am. Jur. 2d, Insurance, § 269 et seq.

C.J.S.

- 44 C.J.S., Insurance, § 486 et seq.

ALR.

- Accident insurance: injury by insect, 9 A.L.R. 529.

Construction of provision in accident insurance policy in relation to injury incident to robbery, burglary, etc., 36 A.L.R. 1124; 46 A.L.R. 1083.

Right to recover under policy of accident insurance as affected by inability to assign time when, or place at which, injury was received, 64 A.L.R. 966.

Clause in health and accident, or similar, policy reducing amount of, or terminating, periodic payments after insured reaches specified age, as applicable to disability incurred before such age was reached, 53 A.L.R.2d 552.

What constitutes medical or surgical treatment, or the like, within exclusionary clause of accident policy or accidental death feature of life policy, 65 A.L.R.2d 1449.

Liability insurance: "accident" or "accidental" as including loss resulting from ordinary negligence of insured or his agent, 7 A.L.R.3d 1262.

Validity and construction of statutes relating to style or prominence with which provisions must be printed in insurance policy, 36 A.L.R.3d 464.

Construction and application of provision in health or hospitalization policy excluding or postponing coverage of illness originating prior to issuance of policy or within stated time, 94 A.L.R.3d 990.

Accident insurance: death or disability incident to partaking of food or drink as within provision as to external, violent, and accidental means, 29 A.L.R.4th 1230.


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