reglab/statecodes huggingface dataset:
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.03 - Definitions

Current through Rules and Regulations filed through June 27, 2024
(1) "Commissioner"
				means the Commissioner of Insurance.
(2) "Extended warranty agreement" means a
				vehicle service contract.
(3)
				"Service contract holder" means a person who purchases or otherwise obtains a
				service contract.
(4) "Vehicle
				service contract" or "VSC" means a contract or agreement that undertakes to
				perform or provide repair or replacement service, or indemnification for that
				service, for the operational or structural failure of a motor vehicle due to a
				defect in materials or skill of work or normal wear and tear.
(5) "Vehicle service contract provider" or
				"VSC provider" means a person who issues, makes, provides, sells, or offers to
				sell a vehicle service contract.
(6) "Vehicle service contract reimbursement
				insurance policy" or "VSC reimbursement insurance policy" means a policy of
				insurance providing coverage for all sums which the provider is legally
				obligated to pay for failure to perform under the terms of vehicle service
				contracts issued by the provider.
(7) "Service contract" shall mean a vehicle
				service contract (VSC
).
(8) "Person" shall mean any person, firm,
				partnership, association or other entity which transacts vehicle service
				contract business.
(9) "Provider"
				shall mean a vehicle service contract (VSC) provider.
(10)"Reimbursement insurance policy" shall
				mean a vehicle contract service (VSC) reimbursement insurance policy.
(11) "Retail Installment Seller" shall have
				the same meaning as provided in Code Section
				10-1-31.
(12) "Security Deposit" means amount(s)
				posted with the Commissioner's Office to cover provider's legal obligations
				under the terms of vehicle service contracts or extended warranty issued by the
				retail installment service.
(13)
				"Surety Bond" means a bond providing coverage for all sums which the provider
				is legally obligated to pay for failure to perform.
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.04 - Insurance Required

Current through Rules and Regulations filed through June 27, 2024
A service contract shall not be issued, sold, or offered for
				  sale in this State unless the provider of the service contract is a named
				  insured under a service contract reimbursement insurance policy issued by an
				  insurer authorized to do business in this state, or by a surplus lines insurer
				  meeting all of the requirements of O.C.G.A. Section
				  33-5-21, which has not been
				  rejected by the Commissioner for such purpose, and which is provided by a
				  licensed surplus lines broker pursuant to O.C.G.A. §
									33-5-20
et
				  seq.
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.05 - Filing Requirements

Current through Rules and Regulations filed through June 27, 2024
(1) In order to issue, sell, or offer for
				sale a service contract in this state:
(a)
				The service contract must not be unduly restrictive, ambiguous, inequitable,
				misleading or unreadable by a person with normal vision;
(b) The service contract must comply with any
				general or specific filing requirement published by the Commissioner;
(c) The provider's reimbursement insurance
				policy must be filed with and accepted by the Commissioner; and
(d) The rates for the reimbursement insurance
				policy must conform to the requirements of O.C.G.A. Title 33 Chapter
				9.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.06 - Disclosure to Provider

Current through Rules and Regulations filed through June 27, 2024
A reimbursement insurance policy shall not be issued, sold,
				  or offered for sale in this State unless the reimbursement insurance policy
				  conspicuously states that the issuer of the policy shall pay on behalf of the
				  provider all sums which the provider is legally obligated to pay for failure to
				  perform according to the provider's contractual obligations under the service
				  contracts issued or sold by the provider.
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.07 - Disclosure to Service Contract Holder

Current through Rules and Regulations filed through June 27, 2024
(1) A service contract shall not be issued,
				sold or offered for sale in this State unless the contract conspicuously states
				that the obligations of the provider to the service contract holder are
				guaranteed under a service contract reimbursement policy, and unless the
				contract conspicuously states the name and address of the insurer of the
				reimbursement policy.
(2) Every
				service contract shall be written in clear, understandable language and shall
				be printed or typed in easy-to-read type, size, and style, and shall not be
				issued, sold, or offered for sale in this State unless the contract:
(a) Conspicuously states that the obligations
				of the provider to the service contract holder are guaranteed under a service
				contract reimbursement policy;
(b)
				Conspicuously states the name and address of the issuer of the reimbursement
				policy;
(c) Conspicuously states
				the name, address and telephone number of the provider(s);
(d) Conspicuously states the name, address
				and telephone number of the administrator, if any;
(e) Identifies the provider, the seller and
				the service contract holder;
(f)
				Sets forth the total purchase price, if any, and the terms under which it is to
				be paid;
(g) Sets forth the
				procedure for making a claim, or request for benefits including a telephone
				number;
(h) Conspicuously states
				the existence of a deductible amount, if any;
(i) Specifies the merchandise or services, or
				both, to be provided and the limitations, exceptions or exclusions;
(j) Sets forth the conditions on which
				substitution will be allowed;
(k)
				Conspicuously sets forth all of the obligations and duties of the service
				contract holder (such as the duty to protect against any further damage to the
				vehicle, the obligation to notify the provider in advance of any repair, etc.),
				if any;
(l) Sets forth any terms,
				restrictions, or conditions governing transferability of the service contract,
				if any;
(m) Conspicuously sets
				forth the term or duration of the contract; and
(n) Contains the provisions required under
				O.C.G.A. §
										33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.09 - Recordkeeping

Current through Rules and Regulations filed through June 27, 2024
(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 each service contract holder; and
(c) The dates, amounts, and descriptions of
				all receipts, claims and expenditures.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.10 - Cancellation of a Reimbursement Insurance Policy

Current through Rules and Regulations filed through June 27, 2024
(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 Insurance
604 West Tower, Floyd Building
#2 Martin Luther King, Jr. Drive
Atlanta, Georgia 30334
and to each insured provider, including but not limited to
				  automobile dealers and third party administrators.
(2) The cancellation of a reimbursement
				insurance policy or surety bond shall not reduce the issuer's responsibility
				for vehicle service contracts issued by providers prior to the date of
				cancellation.
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.11 - Procedures for Public Complaint

Current through Rules and Regulations filed through June 27, 2024
(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 a
				complaint with the Commissioner. Complaints may be received from sources
				outside the State of Georgia and processed in the same manner as those
				originating in Georgia.
(2)
				Complaints may be mailed or delivered to the following address:
Office of Commissioner of Insurance
716 West Tower, Floyd Building
#2 Martin Luther King, Jr. Drive
Atlanta, Georgia 30334
(3) All complaints shall be made in writing
				and shall fully identify the complainant by name and address. If required by
				the Commissioner, complaints shall be made on forms prescribed and provided by
				the Office of Commissioner of Insurance.
(4) Oral or telephone communications may not
				be considered or processed as complaints. However, any member of the staff of
				the Office of Commissioner of Insurance may file a complaint based upon
				information and belief, in reliance upon oral, telephone, or written
				communications received by the Office of Commissioner of Insurance.
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.12 - Repealed

Current through Rules and Regulations filed through June 27, 2024
O.C.G.A. Secs.
				  33-2-9,
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.13 - Exemptions

Current through Rules and Regulations filed through June 27, 2024
(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)(1).
(2) Code Section
				33-7-6(b)(1)  is
				not applicable to vehicle service contracts or extended warranty agreements if
				such contract or agreement has a term not exceeding nine months, has been
				approved by the Commissioner before its use, and is issued by a retail
				installment seller in conjunction with the sale of a vehicle. Moreover, such
				retail installment seller must:
(a) Maintain
				or have a parent company which maintains a net worth or stockholders' equity of
				a least $50 million, provided the parent company guarantees the obligations of
				the retail installment seller arising from vehicle service contracts or
				extended warranty agreements issued by the retail installment seller.
(b) Comply with the exemption application
				requirements prescribed by the Commissioner including but not limited to the
				provision of names, addresses, FEIN numbers, affiliates, and corporate
				officers.
(c) Files with the
				Commissioner, a copy of its form 10-K or form 20-F disclosure statements, or if
				it does not file such statements with the United States Securities and Exchange
				Commission a copy or its audited financial statement on a GAAP basis. If the
				retail installment seller's financial statements are consolidated with those of
				its parent company, then the retail installment seller may comply with this
				provision by filing the statements of its parent company. The statement shall
				be filed with the Commissioner 30 days prior to the retail installment sellers
				initial offering or delivering of a service contract or extended warranty
				agreement and thereafter the statement shall be filed with the Commissioner
				annually; and
(d) Upon the request
				of the Commissioner posts a security deposit or surety bond guaranteeing the
				retail installment sellers obligations in accordance with the terms of vehicle
				service contracts or extended warranty agreements issued by the retail
				installment seller in an amount not to exceed $250,000.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-47 - RULES AND REGULATIONS FOR VEHICLE AND AUTOMOBILE CLUB SERVICE CONTRACTS › Rule 120-2-47-.14 - Severability

Current through Rules and Regulations filed through June 27, 2024
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.
O.C.G.A. Sec.
				  33-7-6.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
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.
O.C.G.A. Sec.
				  33-2-9.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.02 - Purpose and Applicability

Current through Rules and Regulations filed through June 27, 2024
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;
(d) Reduce duplication of
				benefits by permitting a reduction of the benefits paid by a plan when the
				plan, pursuant to rules established by this Regulation, does not have to pay
				its benefits first;
(e) Reduce
				claims payments delays; and
(f)
				Make all contracts that contain a COB provision consistent with this
				Regulation.
O.C.G.A Sec.
				  33-2-9.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.03 - Definitions

Current through Rules and Regulations filed through June 27, 2024
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 item of
				expense is covered at least in part under any of the plans involved, except
				where a statute requires a different definition.
2. Notwithstanding the above definition,
				items of expense under coverages such as dental care, vision care, prescription
				drug or hearing aid programs may be excluded from the definition of Allowable
				Expense. A plan which provides benefits only for any such item of expense may
				limit its definition of Allowable Expenses to like items of expense.
3. When a plan provides benefits in the form
				of service, the reasonable cash value of each service will be considered as
				both an Allowable Expense and a benefit paid.
4. The difference between the cost of a
				private hospital room and the cost of a semiprivate hospital room is not
				considered an Allowable Expense under the above definition unless the patient's
				stay in a private hospital room is medically necessary in terms of generally
				accepted medical practice.
5. When
				COB is restricted in its use to specific coverage in a contract (for example,
				major medical or dental), the definition of "Allowable Expense" must include
				the corresponding expenses or services to which COB applies.
6. When benefits are reduced under a Primary
				Plan because a covered person does not comply with the plan provisions, the
				amount of such reduction will not be considered an Allowable Expense. Examples
				of such provisions are those related to second surgical opinions,
				precertification of admissions or services, and preferred provider
				arrangements.
(i) Only benefit reductions
				based upon provisions similar to those described above and which are contained
				in the Primary Plan may be excluded from Allowable Expenses.
(ii) This provision shall not be used by a
				Secondary Plan to refuse to pay benefits because an HMO member has elected to
				have health care services provided by a non-HMO provider and the HMO, pursuant
				to its contract, is not obligated to pay for providing those
				services.
(iii) This subparagraph
				(6) is not intended to allow a Secondary Plan to exclude expenses that are
				applied towards the satisfaction of the deductible, copayments or coinsurance
				amounts required by the Primary Plan, except for the benefit reductions
				expressly described in this paragraph.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.04 - Model COB Contract Provision

Current through Rules and Regulations filed through June 27, 2024
(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
				120-2-48-.05.
(2) Flexibility. A group contract's COB
				provision does not have to use the words and format shown at Appendix A.
				Changes may be made to fit the language and style of the rest of the group
				contract or to reflect the difference among plans which provide services, which
				pay benefits for expenses incurred, and which indemnify. No other substantive
				changes are allowed.
(3) Prohibited
				Coordination and Benefit Design.
(a) A group
				contract may not reduce benefits on the basis that:
1. Another plan exists;
2. A person is or could have been covered
				under another plan, except with respect to Part B of Medicare; or
3. A person has elected an option under
				another plan providing a lower level of benefits than another option which
				could have been elected.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.05 - Rules for Coordination of Benefits

Current through Rules and Regulations filed through June 27, 2024
(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 another Plan as defined in Rule
				120-2-48-.03 into account when it
				determines its benefits. There is one exception: a contract holder's coverage
				that is designed to supplement a part of a basic package of benefits may
				provide that the supplementary coverage shall be excess to any other parts of
				the plan provided by the contract holder.
2. A Secondary Plan may take the benefits of
				another plan into account only when, under these rules, it is Secondary to that
				other plan.
3. The benefits of the
				plan which covers the person as an employee, member or subscriber (that is,
				other than as a dependent) are determined before those of the plan which covers
				the person as a dependent.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-48 - GROUP COORDINATION OF BENEFITS › Rule 120-2-48-.06 - Procedure to be Followed by Secondary Plan

Current through Rules and Regulations filed through June 27, 2024
(1) Total Allowable Expenses.
(a) When it is determined, pursuant to Rule
				120-2-48-.05, 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 amount by which the Secondary Plan's benefits
				have been reduced shall be used by the Secondary Plan to pay Allowable
				Expenses, not otherwise paid, which were incurred during the Claim
				Determination Period by the person for whom the claim is made. As each claim is
				submitted, the Secondary Plan determines its obligation to pay for Allowable
				Expenses based on all claims which were submitted up to that point in time
				during the Claim Determination Period.
(b) The benefits of the Secondary Plan will
				be reduced when the sum of the benefits that would be payable for the Allowable
				Expenses under the Secondary Plan in the absence of this COB provision and the
				benefits that would be payable for the Allowable Expenses under the other
				Plans, in the absence of provisions with a purpose like that of this COB
				provision, whether or not claim is made, exceeds those Allowable Expenses in a
				Claim Determination Period. In that case, the benefits of the Secondary Plan
				will be reduced so that they and the benefits payable under the other plans do
				not total more than those Allowable Expenses.
1. When the benefits of this Plan are reduced
				as described above, each benefit is reduced in proportion. It is then charged
				against any applicable benefit limit of this Plan.
2. Subparagraph (b)1. above may be omitted if
				the plan provides only one benefit, or may be altered to suit the coverage
				provided.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.01 - Authority

Current through Rules and Regulations filed through June 27, 2024
This Regulation is promulgated by the Commissioner of
				  Insurance pursuant to the authority set forth in O.C.G.A. §§
									33-2-9 and
				  33-23-100
et
				  seq.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-103,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.02 - Scope and Purpose

Current through Rules and Regulations filed through June 27, 2024
(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) Promoting the
				financial responsibility of insurance administrators;
(c) Subjecting those business entities
				defined in O.C.G.A. §
										33-23-100 to the jurisdiction of
				the Commissioner of Insurance; and
(d) Regulating insurance administrators'
				practices in conformity with the general purposes of the Georgia Insurance
				Code.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.04 - Written Agreement Necessary

Current through Rules and Regulations filed through June 27, 2024
(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 agreement and five years thereafter. Such written agreement
				shall contain provisions which meet the requirements of Rules
				120-2-49-.05,
				120-2-49-.08,
				120-2-49-.09,
				120-2-49-.10,
				120-2-49-.12,
				120-2-49-.13,
				120-2-49-.14, and
				120-2-49-.15, except insofar as
				those requirements do not apply to the functions performed by the
				administrator.
(2) Where a policy
				is issued to a trustee or trustees, a copy of the trust agreement and any
				amendments thereto shall be furnished to the insurer or self-insurer by the
				administrator and shall be retained as part of the official records of both the
				insurer and the administrator for the duration of the policy and five years
				thereafter.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.05 - Maintenance of Information; Books and Records; Reporting Requirements; Return Credits; Correction o

Current through Rules and Regulations filed through June 27, 2024
(1) Every administrator shall maintain at its
				principal administrative office for the duration of the written agreement
				referred to in Rule
				120-2-49-.04 and five years
				thereafter books and records of all transactions between it, insurers,
				self-insurers and insured persons. The Commissioner shall have access to such
				books and records for the purpose of examination, audit and inspection. Any
				trade secrets contained therein, including but not limited to the identity and
				addresses of policyholders and certificate holders, shall be confidential,
				except the Commissioner may use such information in any proceedings instituted
				against the administrator. The insurer shall retain the right to continuing
				access to such books and records of the administrator sufficient to permit the
				insurer to fulfill all of its contractual obligations to insured persons,
				subject to any restrictions in the written agreement between the insurer and
				administrator on the proprietary rights of the parties in such books and
				records.
(2) Administrators shall
				maintain detailed books and records that reflect all administered transactions
				specifically in regard to premiums, premium taxes, agent's commissions,
				administrator's fees, contributions received and deposited and claims and
				authorized expenses paid.
(3) The
				detailed preparation, journalizing, and posting of such books and records shall
				be made in accordance with the terms and conditions of the service agreement
				between the administrator and the insurer, self-insurer, or plan sponsor, and
				in accordance with the "Employee Retirement and Income Security Act of 1974,"
				88 Stat. 829, 29 U.S.C.
				§
										1001
et seq.
, as
				amended and to enable the insurer to complete the National Association of
				Insurance Commissioners' annual financial statement.
(4) All books and records maintained by an
				administrator on behalf of an insurer, self-insurer or plan sponsor for a
				calendar or fiscal year shall be maintained for the period in which the
				administrator is providing service for the insurer, self-insurer or plan
				sponsor and for five years thereafter.
(5) Administrators shall maintain a cash
				receipts register of all premiums or contributions received. The minimum detail
				required in the register shall be:
(a) Date
				received and deposited;
(b) The
				mode of payment;
(c) The policy
				number;
(d) Name of group
				policyholder;
(e) Names of
				certificate-holders;
(f) Individual
				premium amounts; and
(g)
				Agent.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.06 - Payment to Administrator

Current through Rules and Regulations filed through June 27, 2024
Whenever an insurer utilizes the services of an administrator
				  under the terms of a written contract as required in Rule
				  120-2-49-.04, 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, and the payment
				  of return premiums or claims by the insurer to the administrator shall not be
				  deemed payment to the insured or claimant until such payments are received by
				  the insured or claimant. Nothing herein shall limit any right of the insurer
				  against the administrator resulting from its failure to make payments to the
				  insurer, insureds or claimants.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.07 - Administrator Bond; Errors and Omissions Coverage

Current through Rules and Regulations filed through June 27, 2024
(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
				Georgia, continuous in form and in an amount equal to at least ten percent of
				the amount of the funds handled or managed annually by the administrator based
				on the preceding year, or if no funds were handled during the preceding year,
				ten percent of the amount of funds reasonably estimated to be handled during
				the current calendar year. In no event will the bond be less than
				$100,000.
(2) The bond shall inure
				to the benefit of any person damaged by any fraudulent act or conduct of the
				administrator and must be conditioned upon faithful accounting and application
				of all money coming into the administrator's possession in connection with its
				activities as an administrator.
(3)
				The bond remains in force until released by the Commissioner or canceled by the
				surety. Without prejudice to any liability previously incurred, the surety may
				cancel the bond upon 30 days' advance notice to the administrator and the
				Commissioner. An administrator's license shall be suspended if it does not file
				with the Commissioner a replacement bond before the date of cancellation of the
				previous bond. A replacement bond must meet all requirements of this section
				for the initial bond.
(4) Each
				administrator shall obtain errors and omissions coverage or other appropriate
				liability insurance, written by an insurer authorized to transact insurance in
				this state, in an amount of at least $100,000.
(5) Any policy written in accordance with
				paragraph (4) of this Rule shall be for a term of at least one year and shall
				contain provisions that:
(a) Cancellation or
				termination of the policy is not effective except upon sixty (60) days written
				notice by registered or certified mail to the other party to the policy and to
				the Commissioner; and
(b) The
				policy is automatically renewable at the expiration of the policy period except
				upon sixty (60) days written notice by registered or certified mail by the
				party not renewing the policy to the other party to the policy and to the
				Commissioner.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.08 - Premium Collection

Current through Rules and Regulations filed through June 27, 2024
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 shall be
				  immediately remitted to the person or persons entitled thereto, or shall be
				  deposited promptly in a fiduciary bank account established and maintained by
				  the administrator. If charges or premiums so deposited have been collected on
				  behalf of or for more than one insurer, or self-insurer, the administrator
				  shall cause the bank in which such fiduciary account is maintained to keep
				  records clearly recording the deposits in and withdrawals from such account on
				  behalf of or for each insurer and for each self-insurer. The administrator
				  shall promptly obtain and keep copies of all such records and, upon request of
				  an insurer, or self-insurer, shall furnish such insurer or self-insurer with
				  copies of such records pertaining to deposits and withdrawals on behalf of or
				  for such insurer or self-insurer. The administrator shall not pay any claim by
				  withdrawals from such fiduciary account. Withdrawals from such account shall be
				  made, as provided in the written agreement between the administrator and the
				  insurer, or self-insurer, for
(a)
				Remittance to an insurer, or self-insurer, entitled thereto;
(b) Deposit in an account maintained in the
				name of such insurer or self-insurer;
(c) Transfer to and deposit in a claims
				paying account, with claims to be paid as provided in
				120-2-49-.09;
(d) Payment to a group policyholder for
				remittance to the insurer or self-insurer entitled thereto;
(e) Payment to the administrator of its fees
				or charges; or
(f) Remittance of
				return premiums to the person or persons entitled thereto.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.09 - Payment of Claims

Current through Rules and Regulations filed through June 27, 2024
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 elect to receive
				  payment by check.
O.C.G.A.
				  §§
											33-2-9,
				  33-23-100
et seq
.,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.10 - Compensation for Adjusting or Settling Claims

Current through Rules and Regulations filed through June 27, 2024
(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 the number of claims paid or processed.
(2) An administrator shall not receive from
				any plan sponsor, insurer, self-insurer, covered individual or beneficiary
				under a plan any compensation or other payments except as expressly set forth
				in the written agreement between the administrator and the plan sponsor,
				insurer, or self-insurer.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.11 - Annual Renewal

Current through Rules and Regulations filed through June 27, 2024
(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 March 1. The annual
				renewal shall be in such form and contain such matters as the Commissioner
				prescribes and shall be verified by at least one officer of the administrator.
				For good cause shown the Commissioner may extend the time for filing of the
				annual renewal of the license conditioned upon payment of a fee prescribed
				therefore.
(2) At the time of
				filing its annual renewal, the administrator shall pay a filing fee as provided
				in O.C.G.A. §
									33-8-1.
(3) The annual renewal shall include the
				complete names, addresses, N.A.I.C. company and N.A.I.C. group number of all
				insurers with which the administrator had an agreement during the preceding
				fiscal year, and the complete names and addresses of all self-insurers where
				such agreement existed during the preceding fiscal year.
(4) The administrator shall at all times
				maintain a net worth of $200,000. If the administrator fails to maintain a net
				worth of $200,000 the Commissioner, in his/her discretion, may enter any
				disciplinary order as he/she deems appropriate pursuant to Title 33 of the
				Georgia Insurance Code.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-101,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.12 - Underwriting Provisions

Current through Rules and Regulations filed through June 27, 2024
(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 provision with respect to any underwriting requirements or other
				standards pertaining to the benefit coverage to be provided.
(2) As to the administration of coverage
				insured by an insurance company, the insurance company, and not the
				administrator, shall be responsible for determining the benefits, rates,
				underwriting criteria, and claims payment procedures applicable to such
				coverage and for securing reinsurance, if any.
(3) No administrator shall place any
				insurance or reinsurance coverage on behalf of a plan sponsor with an insurer
				that is not authorized or approved to do business in Georgia.
(4) No administrator shall have the authority
				to move the coverage of a group or subgroup to a new insurer unless such action
				is at the request of the current insurer or the group policyholder following
				notice of termination of the group coverage by the insurer or group
				policyholder, and the new insurer must hold a Certificate of Authority to do
				business in Georgia.
(5) Any
				insured individual whose group insurance coverage terminates, regardless of the
				situs of the group policy, shall be entitled to conversion rights as required
				under O.C.G.A. §§
									33-24-21.1 and
				120-2-10-.11 of the Rules and
				Regulations of the Office of Commissioner of Insurance, or as provided in the
				group insurance policy, if more favorable.
(6) Where group insurance coverage is
				discontinued and replaced, the individual insureds shall be entitled to all
				takeover rights provided under Rule
				120-2-10-.10 of the Rules and
				Regulations of the Office of Commissioner of Insurance.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.13 - Approval of Advertising

Current through Rules and Regulations filed through June 27, 2024
(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,
				regardless of by whom written, created or designed, which are used in the
				course of the administrator's business in this state, with a notation
				indicating the manner and extent of distribution and the form number of any
				policy advertised. Such file shall be subject to inspection by the Office of
				Commissioner of Insurance. All such advertisements shall be maintained in said
				file for a period of not less than five (5) years.
(3) Each administrator shall file with the
				Commissioner of Insurance on or before March 1 in each year, a certification
				executed by an authorized officer of the administrator attesting that to the
				best of his or her knowledge, information and belief, the advertisements
				disseminated by the administrator during the preceding calendar year complied,
				or were made to comply in all respects, with the advertising regulations of
				this state.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.14 - Delivery of Policies and Notices

Current through Rules and Regulations filed through June 27, 2024
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.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105.
Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-49 - ADMINISTRATOR REGULATION › Rule 120-2-49-.15 - Notification Required

Current through Rules and Regulations filed through June 27, 2024
(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
				policyholder and the insurer or self-insurer. Where an administrator collects
				funds, it must identify and state separately in writing to the person paying to
				the administrator any charge or premium for insurance coverage or self-funded
				benefits, the amount of any such charge or premium specified by the insurer or
				self-insurer for such insurance coverage or self-funded benefits.
(2) Each administrator shall identify to the
				Commissioner any ownership interest or affiliation of any kind with any
				insurance company responsible for providing benefits directly or through
				reinsurance to any plan for which the administrator provides administrative
				services.
O.C.G.A. Secs.
				  33-2-9,
				  33-23-100
et seq.
,
				  33-23-104,
				  33-23-105