Section 30. Group or Blanket Accident and Sickness Insurance, 33-30-1 through 33-30-29.
ARTICLE 1
GENERAL PROVISIONS
33-30-4. Required provisions generally.
Each group accident and sickness policy shall contain in substance the following provisions:
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A provision that, in the absence of fraud or intentional misrepresentation of material fact in applying for or procuring coverage under the terms of the group policy or contract, all statements made by the policyholder shall be deemed representations and not warranties, and that no statement made for the purpose of effecting insurance shall avoid the insurance or reduce benefits unless contained in a written instrument signed by the policyholder, a copy of which has been furnished to the policyholder;
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A provision that the insurer will furnish to the policyholder, for delivery to each employee or member of the insured group, an individual certificate setting forth in summary form a statement of the essential features of the insurance coverage of the employee or member and to whom benefits are payable. If dependents or family members are included in the coverage, additional certificates need not be issued for delivery to the dependents or family members;
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A provision that from time to time eligible new employees or members or dependents, in accordance with the terms of the policy, may be added to the group originally insured;
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A provision that, with respect to termination of benefits for, or coverage of, any person who is a dependent child of an insured, the child shall continue to be insured up to and including age 25 so long as the coverage of the member continues in effect, the child remains a dependent of the insured parent or guardian, and the child, in each calendar year since reaching any age specified for termination of benefits as a dependent, has been enrolled for five calendar months or more as a full-time student at a postsecondary institution of higher learning or, if not so enrolled, would have been eligible to be so enrolled and was prevented from being so enrolled due to illness or injury. This paragraph shall not apply to group policies under which an employer provides coverage for dependents of its employees and pays the entire cost of the coverage without any charge to the employee or dependents; and
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A provision that the policyholder is entitled to a grace period of not less than 31 days for the payment of any premium due except the first, during which grace period the policy shall continue in force unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.
(Code 1933, § 56-3102, enacted by Ga. L. 1960, p. 289, § 1; Ga. L. 1978, p. 1149, § 1; Ga. L. 1983, p. 3, § 24; Ga. L. 1989, p. 675, § 1; Ga. L. 2005, p. 481, § 11/HB 291.)
JUDICIAL DECISIONS
Insurer not responsible for way employer imparts information to employee.
- Having furnished to the party acting for and on behalf of the employee full and accurate information as to the terms of the contract it would make, the insurer is not required to go further and cannot be held responsible for the way in which the employer imparted the information to the employee for whom the employer was acting. Rider v. Westinghouse Elec. Corp., 152 Ga. App. 805, 264 S.E.2d 276 (1979), modified, 155 Ga. App. 70, 270 S.E.2d 288 (1980).
Controlling master policy is subject to employee's inspection
to determine full details of the policy's coverage and exclusions. Rider v. Westinghouse Elec. Corp., 155 Ga. App. 61, 270 S.E.2d 288 (1980).
Master policy and certificate must be construed together.
- Contract of group insurance is made up of the master group policy and the certificate, which must be construed together, and the certificate holder is bound by the provisions of the group policy, the certificate being evidence of coverage thereunder. Morrison Assurance Co. v. Armstrong, 152 Ga. App. 885, 264 S.E.2d 320 (1980).
Provisions of master policy hold over conflicting terms of certificate
upon which the group insured has relied. Morrison Assurance Co. v. Armstrong, 152 Ga. App. 885, 264 S.E.2d 320 (1980).
RESEARCH REFERENCES
ALR.
- Constitutionality, construction, and application of statutes relating to contractual time limitation provisions of insurance policies, 112 A.L.R. 1288.
