"Group Accident and Sickness Insurance" Defined; "True Association" Defined

  1. Law
  2. Georgia Code
  3. Insurance
  4. Group or Blanket Accident and Sickness Insurance
  5. General Provisions
  6. "Group Accident and Sickness Insurance" Defined; "True Association" Defined

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  1. "Group accident and sickness insurance" is that form of accident and sickness insurance covering the groups of persons listed in paragraphs (1) through (7) of this subsection, with or without one or more members of their families or one or more of their dependents or covering one or more members of the families or one or more dependents of persons in such groups, and issued upon the following basis:
    1. Under a policy issued to an employer or trustees of a fund established by an employer, who shall be deemed the policyholder, insuring at least two employees of such employer for the benefit of persons other than the employer. As used in this paragraph, the term "employees" includes the officers, managers, and employees of the employer; the individual proprietor or partners, if the employer is an individual proprietor or partnership; the officers, managers, and employees of subsidiary or affiliated corporations; and the individual proprietors, partners, and employees of individuals and firms, if the business of the employer and such individual or firm is under common control through stock ownership, contract, or otherwise. The term may include retired employees. A policy issued to insure employees of a public body may provide that the term "employees" shall include elected or appointed officials;
    2. Under a policy issued to an association, including a labor union, which shall have a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, insuring at least ten members, employees, or employees of members of the association for the benefit of persons other than the association or its officers or trustees. As used in this paragraph, the term "employees" may include retired employees;
    3. Under a policy issued to the trustees of a fund established by two or more employers in the same industry, by one or more labor unions, by one or more employers and one or more labor unions, or by an association, as defined in paragraph (2) of this subsection, which trustees shall be deemed the policyholder, to insure not less than ten employees of the employers or members of the union or of such association or of members of such association for the benefit of persons other than the employers or other unions or such associations. As used in this paragraph, the term "employees" includes the officers, managers, and employees of the employer and the individual proprietor or partners, if the employer is an individual proprietor or partnership. The term may include retired employees. The policy may provide that the term "employees" shall include the trustees or their employees, or both, if their duties are principally connected with such trusteeship;
    4. Under a policy issued to any person or organization to which a policy of group life insurance may be delivered in this state, to insure any class or classes of individuals that could be insured under such group life policy;
    5. Under a policy issued to a creditor, or to a trustee or agent appointed by two or more creditors, which creditor, trustee, or agent shall be deemed to be the policyholder, to insure mortgagors of the creditor. The insurance must be written in connection with a credit transaction that is secured by a first mortgage or deed of trust; must be made to finance the purchase of real property or the construction of a dwelling thereon, or to refinance a prior credit transaction made for such a purpose; and shall be payable to the policyholder. Such payment shall reduce or extinguish the unpaid mortgage of the mortgagor to the extent of such payment;
    6. Under a policy issued to cover any other substantially similar group which in the discretion of the Commissioner may be subject to the issuance of a group accident and sickness policy or contract; or
      1. Under a policy issued to a legal entity providing a multiple employer welfare arrangement, which means any employee benefit plan which is established or maintained for the purpose of offering or providing accident and sickness benefits to the employees of two or more employers, including self-employed individuals, individuals whose compensation is reported on federal Internal Revenue Service Form 1099, and their spouses or dependents. The term shall not apply to any plan or arrangement which is established or maintained by a tax-exempt rural electric cooperative or a collective bargaining agreement.
      2. The amounts of insurance under the policy must be based upon some plan precluding individual selection either by the employees, employers, or trustee.
  2. As used in this chapter, the term "true association" means an organization that:
    1. Has been in existence for at least five years;
    2. Has been formed and maintained in good faith for purposes other than obtaining insurance;
    3. Does not condition membership in the association on any health status related factor relating to an individual (including an employee of an employer or a dependent of an employee);
    4. Makes health insurance coverage offered through the association available to all members regardless of any health status related factor relating to such members (or individual eligible for coverage through a member);
    5. Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
    6. Meets such additional requirements as may be imposed under Georgia law or regulation.

(Code 1933, § 56-3101, enacted by Ga. L. 1960, p. 289, § 1; Ga. L. 1982, p. 3, § 33; Ga. L. 1987, p. 1486, § 7; Ga. L. 1989, p. 883, § 2; Ga. L. 1990, p. 1402, § 4; Ga. L. 1991, p. 94, § 33; Ga. L. 1997, p. 1462, § 6; Ga. L. 1998, p. 1064, § 9; Ga. L. 2005, p. 481, § 9/HB 291; Ga. L. 2011, p. 595, §§ 2, 3/HB 167; Ga. L. 2012, p. 775, § 33/HB 942.)

Cross references.

- Definition of accident and sickness insurance, § 33-7-2.

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2005, "paragraphs (1) through (7)" was substituted for "paragraphs (1) through (6)" in subsection (a) and, in paragraph (a)(5), "Under a" was substituted for "A", "must be" was inserted preceding "made to finance" and a semicolon was substituted for a period at the end.

Editor's notes.

- Ga. L. 1997, p. 1462, § 1, not codified by the General Assembly, provides that that Act, which amended this Code section, is intended to comply with the requirements of the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as well as to provide an acceptable alternative mechanism for the availability of individual health insurance coverage as contemplated by that federal Act; and further provides that the Act shall be narrowly construed to achieve such purpose without otherwise limiting the state's legislative or regulatory powers with respect to insurance.

Ga. L. 2011, p. 595, § 1/HB 167, not codified by the General Assembly, provides that: "This Act shall be known and may be cited as the 'Insurance Delivery Enhancement Act of 2011.'"

Law reviews.

- For review of 1998 legislation relating to insurance, see 15 Ga. St. U.L. Rev. 153 (1998).

JUDICIAL DECISIONS

Employer prohibited from being beneficiary.

- When a corporate stockholder, director, and executive vice-president was listed in a group accident policy as an employee, the corporate employer was prohibited from being a beneficiary. Johnson, Lane, Space, Smith & Co. v. Trosdal, 170 Ga. App. 456, 317 S.E.2d 294 (1984).

RESEARCH REFERENCES

14B Am. Jur. Pleading and Practice Forms, Insurance, § 291.

ALR.

- Limit of liability of members of insurance associations, 10 A.L.R. 750.

What constitutes "continuous employment" within provision of group insurance policy prescribing condition of disability benefits, 124 A.L.R. 1494.

Insurance: "accidental means" as distinguishable from "accident," "accidental result," "accidental death," "accidental injury," etc., 166 A.L.R. 469.

Coverage and exceptions under student accident policy, 74 A.L.R.2d 1253.

Group insurance: provision excluding from coverage part-time or temporary employees, 41 A.L.R.3d 1419.

Group insurance: construction of provision limiting coverage to full-time employees, 57 A.L.R.3d 801.

Who is "resident" or "member" of same "household" or "family" as named insured, within liability insurance provision defining additional insureds, 93 A.L.R.3d 420.

Termination of employee's individual coverage under group policy for nonpayment of premiums, 22 A.L.R.4th 321.


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