Rule 120-2-12-.08. Pre-existing Conditions

1. 1. An advertisement which is subject to the requirements of these Rules shall, in negative terms, clearly, prominently and conspicuously disclose the extent to which any loss is not covered if the cause of such loss is traceable to a physical condition, injury or disease existing before issuance of the policy. If the term "pre-existing condition," or similar words or phrases are used in an advertisement, they must be accompanied by an appropriate definition or description which states exactly what conditions are included as "pre-existing conditions" for the purposes of the policy.
2. 2. When a policy does not cover losses resulting from preexisting conditions, no advertisement of the policy shall state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. This rule prohibits the use of the phrase "no medical examination required," and phrases of similar import, but does not prohibit explaining "automatic issue."
3. 3. If an insurer requires a medical examination for a specified policy, the advertisement shall prominently disclose that a medical examination is required.

4. 4. In the event any advertisement contains an application form to be completed by the applicant and returned by mail for a direct response insurance product, such application form shall contain a question which reflects the pre-existing condition provisions of the policy, immediately preceding the blank space for the applicant's signature. For example, such an application form must contain a question identical to or substantially similar to the following: "Do you understand that this policy will not pay benefits during the first _______________ year(s) after the issue date for a disease or physical condition which you now have, or have had in the past?

   [] I do understand [] I do not understand."

   No policy shall be issued unless the question is answered affirmatively.

Submitted for Publishing: Mar. 7, 2007.

Authority: Ga. L. 1960, pp. 289 to 755.

History. Original Rule entitled "Identity of Insurer" adopted. F. and eff. July 20, 1965.

Repealed: New Rule entitled "Pre-Existing Conditions" adopted. F. May 29, 1973; eff. June 18, 1973.