All credit accident and sickness insurance forms filed with
the Commissioner pursuant to the provisions of Sections
33-24-9 and
33-31-8 of the Georgia Code for
use in this State which do not meet the following minimum standards shall be
deemed to be forms which contain provisions which are unjust, unfair,
inequitable, misleading, deceptive or which encourage misrepresentation of the
policy and therefore shall be disapproved by the Commissioner or the previous
approval thereof withdrawn:
(1) The
form shall not contain any exclusions for preexisting conditions except
conditions which, within six months prior to the effective date of the
coverage, manifested themselves to the insured debtor by requiring medical
consultation, diagnosis, or treatment, provided that such preexisting
conditions cause loss commencing within six months following the effective date
of the coverage. However, disability commencing six months or more after the
effective date of the coverage shall not be excluded regardless of whether or
not such disability results from any preexisting condition.
(2) The form must contain a definition of
"total disability" which provides coverage during the first 12 months of such
disability even though the insured is able to perform an occupation other than
the one he held at the time such disability occurred. During the first 12
months of such disability, the definition of "total disability" must relate
such disability, to the occupation of the debtor at the time the disability
occurred. After such disability continues for more than 12 months, the
definition of "total disability" may relate such continuing disability to the
inability to perform any occupation for which the debtor is reasonably fitted
by education, training or experience. The provisions of this subsection shall
not apply to credit accident and sickness insurance policies which provide
exclusively for payment of the policy proceeds in a lump sum in the event of
"total disability."
(3) The form
shall provide that in event the indebtedness covered by the policy results from
the refinancing in whole or in part of a prior debt with the same creditor, any
period of exclusion for preexisting conditions shall be reduced by any period
that creditor-debtor disability coverage was in force in connection with the
prior indebtedness.
(4) The form
shall provide for the payment of a daily benefit equal in amount to at least
one-thirtieth of the scheduled monthly payments on the indebtedness or their
equivalent if the debt is repayable periodically at terms differing from
monthly.
(5) The form shall contain
either no age restrictions whatsoever, or shall contain only those age
restrictions which make ineligible for coverage debtors who have attained age
65 at the time the indebtedness is incurred or who will have attained age 66
prior to the maturity date of the indebtedness. However, coverage will remain
in effect and benefits shall be payable to the beneficiaries under the policy
or certificate, notwithstanding the age of the debtor, in cases where an
individual policy or certificate is issued to a debtor who has correctly stated
his age on the application.
(6) The
form shall contain either no other exclusions whatsoever or only those
exclusions which exclude coverage for disability resulting from normal
pregnancy, intentionally self-inflicted injuries, from flight in non-scheduled
aircraft, or from war or military service.
(7) The form shall state that the insurer
shall not deny a claim due to the debtor's subsequent unemployment or
retirement during the term of the insurance.
Notes
Ga. Comp. R.
& Regs. R.
120-2-27-.08
O.C.G.A. Secs.
33-2-9,
33-30-1,
33-31-7,
33-31-8,
33-31-12.
Original Rule entitled
"Minimum Requirements for Credit Accident and Sickness Insurance Forms"
adopted. F. Mar. 8, 1977; eff.
July 1, 1977, as specified by the
Agency.
Amended: F. Dec. 6,
1993; eff. Dec. 26,
1993.
Submitted for Publishing:
Apr. 6, 2007.
Amended: F. Feb. 20,
2015; eff. Mar. 12,
2015.