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 120-2-2 - PRACTICE AND PROCEDURE
Rule 120-2-2-.66 - Procedures-Policy Forms Division

(a) All domestic foreign and alien life and accident and sickness insurers doing business within the State of Georgia shall file a single copy of each policy form used by such insurers with duplicate letters of transmittal;

(b) Policies filed with this division will be evaluated for the purposes of determining if the policy meets the minimum requirements of law; determining if the policy is actuarially sound; determining that policies are not detrimental to the public interest; and determining if construction of the policy renders terms or language conflicting or ambiguous;

(c) After thorough evaluation a policy is either approved or denied, however, approval may consist of outright approval or conditional approval or additional information may be required prior to any action by this Division. A policy may be deemed approved by operation of law if not acted upon within 30 days after filing; an extension of 30 days may be granted by the Commissioner. Policy form approval once granted may be withdrawn after notice and cause shown.

(a) All insurance companies doing business in the State of Georgia and writing accident and sickness or hospitalization insurance shall file with the office of the Insurance Commissioner any and all advertising of every kind and description which is intended to be issued, circulated, distributed, published or used in any manner in the sale of accident and sickness or hospitalization insurance in this State;

(b) When forwarding advertising material to this Division for approval, write on each advertisement the form number of the policy or endorsement, or both which provide the benefits so advertised; send or designate one copy of each policy form or endorsement which contain said benefits so advertised; furnish any additional information that will enable this Division to identify the policy to which advertisement relates;

(c) Advertising shall truthfully and clearly represent the benefits provided by the policy and shall be designed to avoid drawing of untrue and misleading conclusions therefrom. Advertising should not have the capacity or the tendency to mislead those to whom the appeal is made;

(d) Any company filing such advertising shall attach therewith a certification over the signature of an official or authorized representative of the company stating that to their best knowledge and belief the advertising so submitted meets the requirements of Georgia's ethical standards of advertising. On such filing the Commissioner will accept same subject to his subsequent review and action should said advertising be found to be misleading to the general public and fail to meet such ethical standards as provided by law and rules and regulations of the Commissioner;

(e) In the absence of certification that the advertising material meets such ethical standards, prior approval of such advertising material shall be obtained from the Policy Forms Division of the Department of Insurance, State of Georgia.

(a) Plans of operation. Plans of operation shall be submitted at any time, any phase of the operation changes, i.e., change rates, change policy forms, change area of operation or contract with new hospitals or change or terminate contract with an old hospital. Plans of operation shall be submitted to the Policy Forms Division in duplicate, approval or disapproval shall be stamped upon the face of the duplicate plan and returned to the submitting corporation, however, approval may consist of outright approval or conditional approval or additional information may be required to be submitted prior to action thereon. Plans of operation shall include, but not be limited to, the coverage provided by the membership certificates, services to be rendered by the associations, fees to be charged for the services, the general course and method of transacting business, the area of operation of such association and the schedule of charges payable under authority of contracts with participating hospitals or doctors;

(b) Membership certificates and contracts between associations and hospitals. Each non-profit hospital service corporation and non-profit medical service corporation shall submit one copy of each membership certificate proposed for use by such corporation with duplicate letters of transmittal to the Policy Forms Division. After thorough evaluation, a membership certificate will be either approved or denied, however, approval may consist of outright approval or conditional approval or additional information may be required to be submitted prior to action thereon. Approval or disapproval shall be stamped upon the face of a duplicate letter of transmittal and returned to the submitting corporation. All contracts between associations and hospitals or doctors shall be submitted to the Policy Forms Division in duplicate. The Division's action thereon shall be stamped upon the face of the duplicate contract and returned to the submitting corporation. Approval may consist of outright approval or conditional approval or additional information may be required to be submitted prior to action thereon;

(c) Fees charged for membership certificates. Each hospital service corporation and medical service corporation shall submit all pertinent supporting data and duplicate fee schedules to the Policy Forms Division and approval or disapproval shall be stamped on the face of a duplicate fee schedule and returned to the submitting corporation indicating the Division's action thereon. Approval may consist of outright approval or conditional approval or additional information may be required to be submitted prior to action thereon by this Division.

(d) Annual Statements. Annual Statements shall be submitted annually on or before March 1, verified by at least two of the principal officers of said corporation, showing its financial condition on December 31, the next preceding; which statement shall be on form GID-25F;

(e) Annual Budgets. Annual budgets are examined by this Division to assure that projected income, claims expense and operating expense are in proper proportion.