Georgia Health Study Guide

Georgia calls this line Accident and Sickness, and its exam devotes thirty of eighty scored questions to state law. What makes Georgia’s health chapter distinctive is that it counts in two different units, runs the shortest continuation period you are likely to meet, and puts a number almost everyone memorizes — 120 percent — in a completely different statute from the one they expect. Learn where Georgia’s numbers live and this part of the exam becomes arithmetic.

Policy provisions — a grace period that changes with the premium mode

Where Georgia’s life grace period is a flat thirty days, the accident and sickness grace period is tiered by how the premium is paid: 7 days on a weekly-premium policy, 10 days on a monthly-premium policy, and 30 days for everything else (O.C.G.A. § 33-29-3). The same section carries the claim clocks — notice of claim within 20 days after the occurrence or commencement of loss, or as soon as reasonably possible, and proof of loss within 90 days — plus a 2-year time limit on certain defenses, after which, absent fraud, no misstatement in the application will void the policy or defeat a claim.

Prompt pay — read the unit, not just the number

Georgia’s clean-claim statute, O.C.G.A. § 33-24-59.5, gives an insurer 15 working days to pay or deny an electronic claim and 30 calendar days for a paper one. Two numbers, two different units, in the same sentence — and that is the whole question. Fifteen working days is close to three weeks on a calendar; thirty calendar days is about four. When the requested documentation arrives on a pended claim, the same clocks restart.

Miss them and the insurer owes 12 percent per year interest on the overdue amount, and an administrative penalty attaches if the insurer fails to process at least 95 percent of claims on time in a quarter.

Continuation — the shortest in the region, and the misplaced 120 percent

Georgia’s state continuation is nothing like federal COBRA’s eighteen months. Under O.C.G.A. § 33-24-21.1, an employee whose group coverage terminates may continue it only for the fraction of the policy month remaining plus three additional policy months — and only if he was continuously covered for at least six months immediately before termination.

Now the part that catches people. The premium during that continuation is charged “at the same rate for active group members set forth in the contract or plan,” plus any share the employer no longer contributes. It is not 102 percent and not 120 percent.

The 120 percent figure is real, but it belongs to a different statute. O.C.G.A. § 33-24-21.2 gives an open-ended extension to group members who are 60 years of age or older when continuation begins, and to divorced or surviving spouses, running until nonpayment, termination of the plan, other group coverage, or Medicare eligibility — and that coverage is capped at 120 percent of the group rate.

Reviews, mandates and the programs Georgia names for itself

Georgia’s Patient’s Right to Independent Review Act makes an Independent Review Organization’s decision binding on the insurer when it favors the enrollee, with expedited decisions inside 72 hours (O.C.G.A. § 33-20A-30 et seq.).

On mandates, the one worth memorizing is autism spectrum disorder coverage — Ava’s Law, at § 33-24-59.10(b). Coverage is required for an individual 20 years of age or under, and the policy may limit applied behavior analysis to $35,000 per year. Older study material still quotes “age six” and “$30,000”; those were the 2015 figures and were superseded effective January 1, 2019. Do not carry them into the exam.

Three Georgia programs are asked about by name. The exchange is Georgia Access — a state-based exchange launched for plan year 2025, not HealthCare.gov, and built around agent-assisted enrollment. The CHIP program is PeachCare for Kids. And Georgia has not taken full ACA Medicaid expansion: it runs Pathways to Coverage, a §1115 demonstration covering adults up to 100 percent of the federal poverty level who complete 80 qualifying hours a month.

Senior products — where the free look stretches to thirty

The ten-day free look you learned for life insurance does not govern here. Medicare supplement policies carry a 30-day right to return under Ga. Comp. R. & Regs. 120-2-8-.17(1)(e), and long-term care policies carry a 30-day right to return under O.C.G.A. § 33-42-6(f).

Medicare supplement open enrollment is six months, beginning the first day of the first month in which the individual is both 65 or older and enrolled in Medicare Part B (Rule 120-2-8-.11). During it an insurer may not deny coverage, impose conditions, or price on health status. Note what Georgia does not have: no birthday rule and no annual guaranteed-issue window. Outside open enrollment, the only path is the event-triggered guaranteed issue in Rule 120-2-8-.12.

Selling long-term care partnership policies carries its own training obligation on top of your CE — 8 hours initially and 4 hours every 24 months thereafter, verified by the insurer before you may sell (Rule 120-2-16-.34).