Ga. Comp. R. & Regs. R. 120-2-62-.07 - Severability
If any provision of this chapter or the application thereof to any person or circumstance is held invalid by a court of competent jurisdiction, the remainder of the chapter or the applicability of such provision to other persons or circumstances shall not be affected.
EXHIBIT A
NOTICE OF TRANSFER
IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS.
PLEASE READ IT CAREFULLY.
Transfer of Policy
The ABC insurance Company has agreed to replace us as your insurer under {insert policy/certificate name and number} effective {insert date}.
The ABC Insurance Company's principal place of business is {insert address}. You may obtain financial information concerning ABC Insurance Company by contacting your Commissioner of Insurance at {insert address}.
This transfer is necessary due to {insert detailed statement explaining the reason[s]}.
The ABC Insurance Company is licensed to write this coverage in the following states: {insert states)
If the ABC Company is not licensed in the state in which you reside, this transfer may affect your guaranty fund protection or your Insurance Commissioner's ability to assist you with any matters concerning the company.
Your Rights
You may choose to reject the transfer and novation of your policy to ABC Insurance Company. If you do not want your policy transferred, you must notify us in writing no later than 60 days after the date this notice was mailed to you by signing and returning the enclosed pre-addressed, postage-paid card or by writing to us at:
{Insert name, address and facsimile number of contact person.}
IF WE DO NOT RECEIVE YOUR WRITTEN REJECTION WITHIN THE 60 DAY PERIOD, YOU WILL BE SENT A SECOND NOTICE. IF WE DO NOT RECEIVE YOUR WRITTEN REJECTION WITHIN 30 DAYS AFTER THE DATE OF THE SECOND MAILING, YOU SHALL BE DEEMED TO HAVE ACCEPTED THE TRANSFER.
If you reject the transfer, you may keep your policy with us or exercise any option under your policy.
Effect of Transfer
If you do not reject this transfer and novation, ABC
Insurance Company will be your insurer. It will have direct responsibility to you for the payment of all claims, benefits and for all other policy obligations. We will no longer have any obligations to you.
{Insert a summary of any effect that rejecting the transfer and novation will have on the policyholder's rights including, for participating policyholders, dividend payments or payments under the contract of insurance.}
If you have any further questions about this agreement, you may contact XYZ Insurance Company or ABC Insurance Company.
Sincerely,
______________________
President
XYZ Insurance Company
XYZ Insurance Company
111 No Street
Smithville, USA
555/555-5555
ABC Insurance Company
222 No Street
Jonesvilie, USA
333/333-3333
{Notice Date}
RESPONSE CARD
______ I reject the proposed transfer and novation of my policy from XYZ Insurance Company to ABC insurance company and wish to retain my policy with XYZ insurance company.
{Date} {Signature}
__________________________________________________________
Name:___________________________
Street Address:_________________
City, State, Zip:_______________
Form No.:
EXHIBIT B
SECOND NOTICE OF TRANSFER
IMPORTANT: "THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS.
PLEASE READ IT CAREFULLY.
Transfer of Policy
You were previously sent a Notice of Transfer notifying you that the ABC Insurance Company has agreed to replace us as your insurer under {insert policy/certificate name and number} effective {insert date}.
The ABC Insurance Company's principal place of business is {insert address}. You may obtain financial information concerning ABC Insurance Company by contacting your Commissioner of Insurance at {insert address}.
This transfer is necessary due to {insert detailed statement explaining the reason(s)}.
The ABC Insurance Company is licensed to write this coverage in the following states: {insert states}.
If the ABC Insurance Company is not licensed in the state in which you reside, this transfer may affect your guaranty fund protection or your Insurance Commissioner's ability to assist you with any matters concerning the company.
Your Rights
Since we did not receive the pre-addressed, postage-paid response card or other written notice from you indicating your rejection of the proposed transfer of your policy, this second notice is required to be sent to you. If you do not not want your policy transferred and novated, you must notify us in writing no later than 30 days after the date this notice was mailed to you by signing and returning the enclosed pre-addressed, postage-paid card or by writing to us at:
{Insert name, address and facsimile number of contact person.}
IF WE DO NOT RECEIVE YOUR WRITTEN REJECTION WITHIN THE THIRTY DAY PERIOD FOLLOWING THE DATE WE MAILED THIS NOTICE, YOU SHALL BE DEEMED TO HAVEACCEPTEDTHE TRANSFER.
If you reject the transfer, you may keep your policy with us or exercise any option under your policy.
Effect of Transfer
If you do not reject this transfer and novation, ABC Insurance Company will be your insurer. It will have direct responsibility to you for the payment of all claims, benefits and for all other policy obligations. We will no longer have any obligations to you.
If you do not reject this transfer and novation, you should make all premium payments and claims submissions to ABC Insurance Company and direct all questions to ABC insurance company.
{Insert a summary of any effect that rejecting the transfer and novation will have on the policyholder's rights including, for participating policyholders, dividend payments or payments under the contract of insurance.}
If you have any further questions about this agreement, you may contact XYZ Insurance Company or ABC Insurance Company.
Sincerely,
______________________
President
XYZ Insurance Company
XYZ Insurance Company
111 No Street
Smithville, USA
555/555-5555
ABC Insurance Company
222 No Street
Jonesville, USA
333/333-3333
{Notice Date}
RESPONSE CARD
_____ I reject the proposed transfer and novation of my policy from XYZ Insurance Company to ABC insurance company and wish to retain my policy with XYZ Insurance Company.
{Date} {Signature}
___________________________________________________________
Name:__________________________
Street Address:________________
City, State, Zip:______________
Form No.:
EXHIBIT C
Application for Approval of Assumption Reinsurance Agreement
Pursuant to O.C.G.A. Section 33-52-6, the Commissioner of insurance must approve or disapprove any assumption reinsurance transaction affecting Georgia insureds. This form has been designed to elicit the information required by that section.
Assuming Company Name: ___________________________________
Company NAIC #: __________________________________________
Transferring Company Name: _______________________________
Company NAIC #: __________________________________________
Form Number or Identification of Policy Contracts to be Transferred:
__________________________________________________________
Proposed Date of Transfer/Assumption:
Please provide a detailed statement explaining the reasons for the transfer of the business:
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Check the following items as submitted. Enclose additional filings referenced by these numbers as necessary to document compliance with these requirements.
______ 1. Attach a copy of the Assumption Reinsurance
Agreement.
______ 2. Attach a copy of the proposed Certificate of
Assumption.
______ 3. Attach a copy of the proposed Notice of Transfer and proposed Second Notice of Transfer.
______ 4. If either the ceding or assuming company is not domiciled in Georgia, please enclose copies of the approvals of the entire transaction by the insurance supervisory officials of the states of domicile of the companies involved.
______ 5. Attach a statement describing provisions made for servicing those policyholders who reject the transfer.
______ 6. If the block of business to be assumed is participating business by a stock or mutual company, attach a statement describing the disposition of the accumulated surplus connected with the block of business and the level of future dividends.
______ 7. Describe the effect of this assumption reinsurance transaction on any policyholder protection under the Georgia Insurers Insolvency Pool, the Georgia Life and Health Insurance Guaranty Association, or any other state guaranty association or insolvency pool.
__________________________________
Signature
__________________________________
Name and Title (please type)
__________________________________
Street Address
__________________________________
City State Zip Code
__________________________________
Telephone Number
__________________________________
Date
IF YOU ARE AN INDIVIDUAL WITH A DISABILITY AND WISH TO ACQUIRE THIS FORM IN AN ALTERNATIVE FORMAT, PLEASE CONTACT THE ADA COORDINATOR, OFFICE OF COMMISSIONER OF INSURANCE, NO.2 MARTIN LUTHER KING, JR. DRIVE, ATLANTA, GEORGIA 30334 404 656-2056, TDD # 404 656-4031.
Notes
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