Free Individual Accident and Health Provisions Study Guide
Georgia Life, Accident & Health exam — Individual Accident and Health Provisions.
Georgia writes the uniform individual accident and sickness provisions into O.C.G.A. 33-29-3 (required) and 33-29-4 (optional). They follow the traditional uniform provisions that NAIC Model 180 is based on, and the national guide explains each one. Georgia uses the term "accident and sickness." Two of its numbers differ from the usual figures: the grace period for other premium modes is 30 days, and claim forms are due within 10 working days.
Required provisions (33-29-3)
| Provision | Georgia rule |
|---|---|
| Entire contract | Changes need an executive officer's approval, endorsed or attached. No agent may change or waive terms |
| Time limit on certain defenses | After two years, absent fraud, application misstatements can't void the policy or deny a claim. A preexisting condition can't be used to deny a later loss unless it was excluded by name or specific description |
| Grace period | At least 7 days (weekly premium), 10 days (monthly), 30 days (all others) |
| Reinstatement | Reinstated on the 45th day after a conditional receipt unless disapproved in writing. Covers accidents after reinstatement and sickness beginning more than 10 days later |
| Notice of claim | Within 20 days, or as soon as reasonably possible |
| Claim forms | If not furnished within 10 working days, the claimant may submit any written proof within the proof-of-loss period |
| Proof of loss | Within 90 days. Late proof is accepted if given as soon as reasonably possible and within one year, unless the claimant lacks legal capacity |
| Time of payment | Loss-of-time benefits are paid at least every 30 days while liability continues |
| Payment of claims | Death benefits go to the beneficiary (or the estate), and other benefits to the insured. Facility of payment up to $1,000 |
| Physical exam and autopsy | At the insurer's expense while a claim is pending |
| Legal actions | No suit until 60 days after proof of loss, and none after three years |
| Change of beneficiary | Reserved to the insured. The beneficiary's consent isn't needed unless the designation is irrevocable |
Optional provisions (33-29-4)
- Change of occupation: a move to a riskier job reduces benefits to what the premium buys at that rate.
- Misstatement of age: benefits are adjusted to the true age.
- Relation of earnings to insurance: if total loss-of-time benefits exceed the greater of current monthly earnings or the average for the two years before disability, the insurer pays only a proportionate amount.
- Cancellation by the insured: if the insured cancels, earned premium uses the short-rate table.
- Illegal occupation: no liability for a loss caused partly by committing a felony or working in an illegal occupation.
- Intoxicants and narcotics is also an optional provision.
Other Georgia rules
- Free look: individual A&S policies, except single-premium nonrenewable policies, may be returned within 10 days of delivery. The policy is then void from the beginning (33-29-11).
- Outline of coverage: given to the applicant when the application is signed (33-29-13).
- Ownership: someone other than the insured who has an insurable interest may own the policy (33-29-14).
- Dependents aging out may buy an individual policy without evidence of insurability by applying within 45 days (33-29-21.1).
- Prompt pay: 15 working days for electronic claims and 30 calendar days for paper claims, with 12% interest when late (33-24-59.5).
Exam traps
- The grace period for policies paid less often than monthly is 30 days in Georgia, not 31.
- Claim forms are due within 10 working days.
- Free look: 10 days for A&S. Medigap and LTC get 30.
- Change of beneficiary belongs to the insured.
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Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
