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
Universal Citation: GA Rules and Regs r 120-2-48-.04
Current through Rules and Regulations filed through March 20, 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.
(b) No contract may contain a provision that
its benefits are "excess" or "always secondary" to any plan as defined in this
Regulation, except in accord with the rules permitted by this
Regulation.
O.C.G.A. Sec. 33-2-9.
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