Current through Rules and Regulations filed through March 20, 2024
Each insurer offering long-term care insurance shall, as a
protection against unintentional lapse, comply with the following:
(1)
(a)
Notice before lapse or termination. No individual long-term care policy or
certificate shall be issued until the insurer has received from the applicant
either a written designation of at least one person, in addition to the
applicant, who is to receive notice of lapse or termination of the policy or
certificate for nonpayment of premium, or a written waiver dated and signed by
the applicant electing not to designate additional persons to receive notice.
The applicant has the right to designate at least one person who is to receive
the notice of termination, in addition to the insured. Designation shall not
constitute acceptance of any liability on the third party for services provided
to the insured. The form used for the written designation must provide space
clearly designated for listing at least one person. The designation shall
include each person's full name and home
address. In the case of an applicant who elects not to designate an
additional person, the waiver shall state: "Protection against unintended
lapse. I understand that I have the right to designate at least one person
other than myself to receive notice of lapse or termination of this long-term
care insurance policy for nonpayment of premium. I understand that notice will
not be given until 30 days after a premium is due and unpaid. I elect NOT to
designate a person to receive this notice." The insurer shall notify the
insured of the right to change this written designation, no less often than
once every 2 years.
(b) When the
policyholder or certificateholder pays premium for a long-term care insurance
policy or certificate through a payroll or pension deduction plan, the
requirements contained in paragraph (1)(a) need not be met until 60 days after
the policyholder or certificateholder is no longer on such a payment plan. The
application or enrollment form for such policies or certificates shall clearly
indicate the payment plan selected by the applicant.
(c) Lapse or termination for nonpayment of
premium. No individual long-term care policy or certificate shall lapse or be
terminated for nonpayment of premium unless the insurer, at least 30 days
before the effective date of the lapse or termination, has given notice to the
insured and to those persons designated pursuant to paragraph (1)(a), at the
address provided by the insured for purposes of receiving notice of lapse or
termination. Notice shall be given by first class United States mail, postage
prepaid; and notice may not be given until 30 days after a premium is due and
unpaid. Notice shall be deemed to have been given as of 5 days after the date
of mailing.
(2)
Reinstatement. In addition to the requirement in subsection (1), a long-term
care insurance policy or certificate shall include a provision that provides
for reinstatement of coverage, in the event of lapse if the insurer is provided
proof that the policyholder or certificateholder was cognitively impaired or
had a loss of functional capacity before the grace period contained in the
policy expired. This option shall be available to the insured if requested
within 5 months after termination and shall allow for the collection of past
due premium, where appropriate. The standard of proof of cognitive impairment
or loss of functional capacity shall not be more stringent than the benefit
eligibility criteria on cognitive impairment or the loss of functional capacity
contained in the policy and certificate.
O.C.G.A. Secs.
33-2-9,
33-42-6,
33-42-7,
49-4-164,
49-4-165.
