Ga. Comp. R. & Regs. R. 120-2-10-.09 - Life, Annuities and Accident and Sickness Insurance Policy Language Simplification Standards
(1) The purpose of this Rule is to establish
minimum ease of reading standards, pursuant to O.C.G.A. Sections
33-2-9 and
33-3-25, for language used in
policies, contracts, coverage booklets provided by insurers to certificate
holders, and certificates of life insurance, accident and sickness insurance,
credit life insurance and credit accident and sickness insurance delivered or
issued for delivery in this State on and after January 1, 1984. This Rule is
not intended to increase the risk assumed by insurance companies or other
entitles subject to this Rule or to supersede their obligation to comply with
the substance of other insurance legislation applicable to life, annuities,
accident and sickness, credit life or credit accident and sickness insurance
policies. This Rule is not intended to impede flexibility and innovation in the
development of policy forms or content or to lead to the standardization of
policy forms or content.
(2) As
used in this Rule:
(a) 'Policy' or 'policy
form' means any policy contract, plan or agreement of life, annuities or
accident and sickness insurance, including credit life and credit accident and
sickness insurance, delivered or issued for delivery in this State by any
company subject to this Rule; any certificate, contract or policy issued by a
fraternal benefit society; any coverage booklet provided by insurers to
certificate holders or any certificate issued pursuant to a group insurance
policy delivered or issued for delivery in this State.
(b) 'Company' or insurer' means any life or
accident and sickness insurance company, fraternal benefit society, nonprofit
medical service corporation, nonprofit hospital service corporation, health
care plan, dental care plan, vision care plan, pharmaceutical plan, health
maintenance organization, and all similar type organizations.
(c) 'Commissioner' means the Insurance
Commissioner of this State.
(3) This Rule shall apply to all policies
delivered or issued for delivery in this State by any insurer on or after the
date such forms must be approved under this Rule, but nothing in this Rule
shall apply to:
(a) any policy which is a
security subject to federal jurisdiction;
(b) any group policy covering a group of
1,000 or more lives at date of issue, other than a group credit life insurance
policy or a group credit accident and sickness insurance policy; however, this
shall not exempt the language contained in any certificate issued pursuant to a
group policy delivered or issued for delivery in this State;
(c) any group annuity contract which serves
as a funding vehicle for pension, profit sharing, or deferred compensation
plans;
(d) any form used in
connection with, as a conversion from, as an addition to, or in exchange
pursuant to a contractual provision for, a policy delivered or issued for
delivery on a form approved or permitted to be issued prior to the dates such
forms must be approved under this Rule; or
(e) the renewal of a policy delivered or
issued for delivery prior to the dates such forms must be approved under this
Rule.
(4) In addition to
any other requirements of law, no policy forms, except as stated in paragraph
(3) of this Rule, shall be delivered or issued for delivery in this State on or
after the dates such forms must be approved under this Rule, unless:
(a) the text achieves a minimum score of
forty on the Flesch reading ease test, or an equivalent score on any other
comparable test as provided in paragraph (6) of this Rule;
(b) it is printed, except for specification
pages, schedules and tables is not less than ten-point type, one-point
leaded;
(c) the style, arrangement
and overall appearance of the policy give no undue prominence to any portion of
the text of the policy or to any endorsements or riders; and
(d) it contains a table of contents or an
index of the principal sections of the policy, if the policy has more than
3,000 words printed on three or fewer pages of text, or if the policy has more
than three pages regardless of the number of words.
(5) For the purpose of this Section, a Flesch
reading ease test score shall be measured by the following method:
(a) For policy forms containing 10,000 words
or less of text, the entire form shall be analyzed. For policy forms containing
more than 10,000 words, the readability of two, 200 word samples per page may
be analyzed instead of the entire form. The samples shall be separated by at
least twenty printed lines.
(b) The
number of words and sentences in the text shall be counted and the total number
of words divided by the total number of sentences. The figure obtained shall be
multiplied by a factor of 1.015.
(c) The total number of syllables shall be
counted and divided by the total number of words. The figure obtained shall be
multiplied by a factor of 84.6.
(d)
The sum of the figures computed under subparagraphs (5)(b) and (5)(c) above
subtracted from 206.835 equals the Flesch reading ease score for the policy
form.
(e) For purposes of
subparagraphs (5)(b), (c) and (d) above, the following procedure shall be used:
1. a contraction, hyphenated word, or numbers
and letters when separated by spaces, shall be counted as one word;
2. a unit of words ending with a period,
semicolon, or colon, but excluding headlines and captions, shall be counted as
a sentence; and
3. a syllable means
a unit of spoken language consisting of one or more letters of a word as
divided by an accepted dictionary. Where the dictionary shows two or more
equally acceptable pronunciations of a word, the pronunciation containing fewer
syllables may be used.
(f) The term 'text' as used in this Rule
shall include all printed matter except the following:
1. the name and address of the insurer; the
name, number or title of the policy; the table of contents or index; captions
and subcaptions; specification pages, schedules or tables; and
2. any policy language which is drafted to
conform to the requirements of any federal law, regulation or agency
interpretation; any policy language required by any collectively bargained
agreement; and medical terminology; any words which are defined in the policy;
and any policy language required by law or regulation; provided, however, the
insurer identifies the language or terminology excepted by this subparagraph 2.
and certifies, in writing, that the language or terminology is entitled to be
excepted by the subparagraph 2.
(6) Any other reading test may be approved by
the Commissioner for use as an alternative to the Flesch reading ease test if
it is comparable in result(s) to the Flesch reading ease test.
(7) Filings subject to this Rule shall be
accompanied by a certificate signed by an officer of the insurer stating that
is meets the minimum reading ease score on the test used or stating that the
score is lower than the minimum required but should be approved in accordance
with paragraph (10) of this Rule. To confirm the accuracy of any certification,
the Commissioner may require the submission of further information to verify
the certification in question.
(8)
At the option of the insurer, riders, endorsements, applications, and any other
forms made a part of the policy may be scored as separate forms or as part of
the policy with which they may be used.
(9) Nothing in this Rule shall be construed
to negate any law of this State permitting the issuance of any policy form
after it has been on file for the time period specified.
(10) The Commissioner may authorize a lower
score than the Flesch reading ease score required in subparagraph (4) (a) of
this Rule whenever, in his sole discretion, he finds that a lower score:
(a) will provide a more accurate reflection
of the readability of a policy form;
(b) is warranted by the nature of a
particular policy or type or class of policy forms; or
(c) is caused by certain policy language
which is drafted to conform to the requirements of any State law, regulation or
agency interpretation.
(11) A policy form meeting the requirements
of paragraph (4) or this Rule shall be approved notwithstanding the provisions
of any other Laws which specify the content of policies, if the policy form
provides the policyholders and claimants protection not less favorable than
they would be entitled to under such laws.
Notes
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