Title 33, Chapter 27, Section 8
( 33-27-8)
(a) As used in this Code section, the term "small group" means a
group or subgroup of 50 or fewer employees, members, or enrollees. (b) The claims experience produced by small groups covered under
group life insurance for each insurer shall be fully pooled for
rating purposes. Except to the extent that the claims experience of
an individual small group affects the overall experience of the
small group pool, the claims experience produced by any individual
small group of an insurer shall not be used in any manner for rating
purposes or solely as a reason for termination of any individual
small group. (c) Each insurer's small group pool shall consist of each insurer's
total claims experience produced by all small groups in this state,
regardless of the marketing mechanism or distribution system
utilized in the sale of the group life insurance. The pool shall
include the experience generated under separate group contracts;
contracts issued to trusts, multiple employer trusts, or association
groups or trusts; or any other group-type coverage. The experience
produced under multiple employer trusts or arrangements through
contracts issued in this state or provided by solicitation and sale
to Georgia residents through an out-of-state multiple employer trust
or arrangement for all the Georgia small groups shall be fully
pooled for rating purposes. Multiple employer trusts or
arrangements shall include any group or group-type coverage issued
to a trust or association or to any other group policyholder where
such group or group-type contract provides coverage, primarily or
incidentally, for sole proprietors, employers, or both. (d) Notwithstanding subsection (b) of this Code section, age, sex,
area, industry, occupational, and avocational factors may be
considered in the initial and renewal rating of each small group.
Durations since issue and tier factors may not be considered.
Substandard rating in accordance with recognized underwriting
practices may be applied to each employee, member, or enrollee and
to each dependent member of the small group in the initial
underwriting of a new or replacement group or when the member or
dependent enters the small group for the first time but shall not be
used for renewal rating purposes. Notwithstanding subsection (b) of
this Code section, the total premium calculated for any individual
small group may deviate from the pool rate by not more than plus or
minus 25 percent based upon individual small group experience
factors. The direct premium result of select or substandard
underwriting practices shall not be considered a deviation from the
pool rate. (e) If standard or substandard rating cannot be offered to any
individual according to recognized underwriting practices, coverage
may be declined if the balance of the small group is accepted. (f) This Code section shall not apply to: (1) Policies issued to an employer in another state which provides
coverage for employees of this state employed by such employer
policyholder; (2) Policies issued to true association groups, which shall be
defined as an association of governmental or public employees, an
association of employees of a common employer, or an organization
formed and operated in good faith for purposes other than that of
procuring insurance and composed of members engaged in a common
trade, business, or profession; or (3) A policy negotiated in connection with a collective bargaining
agreement. |