N.Y. ISC Law § 3201 — New York Code / Act ISC / Article 32 / Section 3201
Approval of life, accident and health, credit unemployment, and annuity policy forms
Status: in_force

§ 3201. Approval of life, accident and health, credit unemployment,\nand annuity policy forms. (a) In this article, "policy form" means any\npolicy, contract, certificate, or evidence of insurance and any\napplication therefor, or rider or endorsement thereto, affording\nbenefits of the kinds of insurance specified in paragraph one, two,\nthree or twenty-four of subsection (a) of section one thousand one\nhundred thirteen of this chapter, a group annuity certificate to which\nsubsection (a) of section three thousand two hundred nineteen of this\narticle applies, and a funding agreement authorized by section three\nthousand two hundred twenty-two of this article. The term "policy form"\nshall not include an agreement, special rider, or endorsement relating\nonly to the manner of distribution of benefits or to the reservation of\nrights and benefits used at the request of the individual policyholder,\ncontract holder or certificate holder.\n  (b) (1) No policy form shall be delivered or issued for delivery in\nthis state unless it has been filed with and approved by the\nsuperintendent as conforming to the requirements of this chapter and not\ninconsistent with law. A group life, group accident, group health, group\naccident and health or blanket accident and health insurance certificate\nevidencing insurance coverage on a resident of this state shall be\ndeemed to have been delivered in this state, regardless of the place of\nactual delivery, unless the insured group is of the type described in:\n(A) section four thousand two hundred sixteen, except paragraph four\nwhere the group policy is issued to a trustee or trustees of a fund\nestablished or participated in by two or more employers not in the same\nindustry with respect to an employer principally located within the\nstate, paragraph twelve, thirteen or fourteen of subsection (b) thereof;\n(B) section four thousand two hundred thirty-five except subparagraph\n(D) where the group policy is issued to a trustee or trustees of a fund\nestablished or participated in by two or more employers not in the same\nindustry with respect to an employer principally located within the\nstate, subparagraph (K), (L) or (M) of paragraph one of subsection (c)\nthereof; or (C) section four thousand two hundred thirty-seven (except\nsubparagraph (F) of paragraph three of subsection (a) thereof; of this\nchapter; and where the master policies or contracts were lawfully issued\nwithout this state in a jurisdiction where the insurer was authorized to\ndo an insurance business. With regard to any certificate deemed to have\nbeen delivered in this state by virtue of this paragraph, the\nsuperintendent shall (i) require that the premiums charged be reasonable\nin relation to the benefits provided, except in cases where the\npolicyholder pays the entire premium; (ii) have power to issue\nregulations prescribing the required, optional and prohibited provisions\nin such certificates; (iii) establish an accelerated certificate form\napproval procedure available to an insurer which includes a statement in\nits policy form submission letter that it is the company's opinion that\nthe certificate form or forms comply with applicable New York law and\nregulations. The superintendent, upon receipt of such a filing letter,\nshall grant conditional approval of such certificate form or forms in\nreliance on the aforementioned statement by the company upon the\ncondition that the company will retroactively modify such certificate\nform or forms, to the extent necessary, if it is found by the\nsuperintendent that the certificate form fails to comply with applicable\nNew York laws and regulations. The superintendent may, with regard to\nthe approval of any certificate deemed to have been delivered in this\nstate by virtue of this paragraph, approve such certificate if the\nsuperintendent finds that the certificate affords insureds protections\nsubstantially similar to those which have been provided by certificates\ndelivered in this state. Any regulations issued by the superintendent\npursuant to this paragraph may not impose stricter requirements than\nthose applicable to similar policies and certificates actually delivered\nin this state.\n  (2) No unallocated group annuity contract or funding agreement, or\npolicy form for accident and health insurance or any other policy form\nspecified by the superintendent pursuant to regulation shall be issued\nby a domestic insurer or fraternal benefit society for delivery outside\nthis state unless it has been filed with the superintendent.\n  (3) In exercising the authority granted by this subsection and by\nsubsection (c) hereof, with respect to a policy or certificate form\nunder which additional amounts may be credited pursuant to subsection\n(b) of section four thousand two hundred thirty-two or section four\nthousand five hundred eighteen of this chapter, the superintendent shall\ntake into account the tax aspects of the policy form as they relate to\nall parties concerned.\n  (4) (A) No credit insurance or credit unemployment insurance policy\nform shall be issued unless it and its premium rates have been filed\nwith and approved by the superintendent. In this section "credit\ninsurance" and "credit unemployment insurance" mean insurance on a\ndebtor, including an intended borrower, pursuant to a program as defined\nin paragraph three of subsection (b) of section four thousand two\nhundred sixteen of this chapter for defraying the costs of attendance of\na student at a college or university, in connection with a specified\nloan or other credit transaction to provide payment to the creditor in\nthe event of the death of the debtor or indemnity to the creditor for\nthe installment payments on the indebtedness becoming due while the\ndebtor is disabled as defined in the policy, or payment to the creditor\nfor the installment payments on the indebtedness becoming due while the\ndebtor is unemployed as set forth in section three thousand four hundred\nthirty-six of this chapter.\n  (B) The superintendent shall from time to time prescribe regulations\nwhich, among other things, shall require that, in the event of the\ntermination of the insurance prior to the scheduled maturity date of the\nindebtedness or the last maturing instalment thereof, there shall be an\nappropriate refund by the insurer to the policyholder of any amount\ncollected from or charged to the policyholder for such terminated\ninsurance, and an appropriate refund or credit by the policyholder or\ncreditor to the debtor of an amount collected from or charged to the\ndebtor for such terminated insurance, if such refund amounts to one\ndollar or more.\n  (5) Notwithstanding the other provisions of this section, on and after\nJune first, nineteen hundred eighty no policy form of industrial life\ninsurance, industrial accident insurance or industrial health insurance\nshall be approved by the superintendent for delivery or issuance for\ndelivery in this state.\n  (6) (A) As an alternative procedure to the policy form filing\nrequirements of paragraph (1) of this subsection, an insurer has the\noption to file an expedited policy form approval application with the\nsuperintendent pursuant to this paragraph. If this option is elected,\nthe filing shall include the proposed policy form, including rates as\nrequired, and all necessary supporting material requested by the\nsuperintendent pursuant to rule, and a certification signed by an\nofficer of the insurer, who is knowledgeable with respect to the law and\nregulation applicable to the type of policy form, that such form is in\ncompliance with the applicable law and regulations to the best of his or\nher knowledge and belief.\n  Within ninety days of receipt of a filing, the superintendent shall,\nin writing, either approve, submit a detailed list to the insurer\nrequesting all additional information necessary to make a determination\non the filing, or deny such filing, otherwise, such filing shall be\ndeemed approved. Any denial issued by the superintendent shall state the\nreasons for such disapproval. If an insurer does not provide the\nadditional information requested by the superintendent, or respond to\nthe superintendent's objections within forty-five days of receipt of\nsuch request or denial, then such filing shall be deemed denied and such\nfiling may not be resubmitted for a period not to exceed ninety days\nfrom the date that such information or response was due. The forty-five\nday limit for providing such additional information or response may be\nextended at the option of the superintendent.\n  In the event that an insurer properly submits the additional\ninformation or response, then such filing shall be deemed approved\nforty-five days after receipt of such information or response by the\nsuperintendent, unless the insurer is notified in writing prior to such\ndate that the filing has been denied. Such denial shall state the\nreasons for such disapproval and cannot be based on any objection not\nspecified in the superintendent's initial review of the filing, unless\nthe objection arises from a modification of the policy forms made by the\ninsurer in addressing the objections or new material submitted by the\ninsurer.  Notwithstanding anything to the contrary contained in this\nsection, the superintendent may, at any time, before the filing is\neither deemed approved, affirmatively approved, or denied, raise\nobjections to the policy form that is based on the explicit requirements\nof this chapter and any applicable regulations.\n  The superintendent shall, as soon as practicable, but no later than\nsixty days after receipt of the filing, notify the insurer if its filing\nis incomplete or fails to comply with applicable statutory or regulatory\nrequirements. Such notice shall indicate that the filing is being\nreturned with no action by the superintendent and that the period for\nthe superintendent's substantive review has not commenced.\n  (B) Nothing contained in this paragraph shall prohibit the\nsuperintendent from requiring an insurer to retroactively modify or\nwithdraw a form approved pursuant to the expedited filing procedure if\nsuch form is found to fail to conform with the requirements of this\nchapter, provided that the order to withdraw or modify such form is\nissued in accordance with the provisions of section three thousand one\nhundred ten or section three thousand two hundred two of this chapter.\n  (C) In addition to any penalties for violations contained in this\nchapter, any insurer which receives approval under this subsection for a\nform which is found to fail to comply with the provisions of this\nchapter shall be ineligible to apply for an expedited review under this\nsubsection for a period not to exceed one year.\n  (7) Notwithstanding any other provision of this section, an approved\npolicy form that has been revised may continue to be delivered or issued\nfor delivery in this state without further approval from the\nsuperintendent, provided that the policy form is revised solely to\nreflect:\n  (A) a change in the investment options of a separate account offered\nunder the policy form, in accordance with an amended statement as to the\nmethods of operation of the separate account approved by the\nsuperintendent pursuant to subsection (e) of section four thousand two\nhundred forty of this chapter, and further provided that an\ninformational filing, in a form acceptable to the superintendent,\nidentifying the policy forms that have been revised and the investment\noptions offered in each policy form, is submitted to the superintendent\nno later than sixty days after the amended statement as to the methods\nof operation of the separate account has been approved; or\n  (B) any other type of change to a class or classes of policy forms for\nwhich the superintendent waives or otherwise modifies the filing and\napproval requirements of this section provided, however, that such\ndetermination to waive or otherwise modify shall be published in written\nguidance issued by the superintendent after such determination has been\nmade.\n  (c) (1) The superintendent may disapprove any policy form for delivery\nor issuance for delivery in this state if he finds that the same\ncontains any provision or has any title, heading, backing or other\nindication of the contents of any or all of its provisions, which is\nlikely to mislead the policyholder, contract holder or certificate\nholder.\n  (2) The superintendent may disapprove any life insurance policy form,\nor any form of annuity contract or group annuity certificate, or any\nform of funding agreement for delivery or issuance for delivery in this\nstate, if its issuance would be prejudicial to the interests of\npolicyholders or members or it contains provisions which are unjust,\nunfair or inequitable.\n  (3) The superintendent may disapprove any accident and health\ninsurance policy form for delivery or issuance for delivery in this\nstate if the benefits provided therein are unreasonable in relation to\nthe premium charged or any such form contains provisions which encourage\nmisrepresentation or are unjust, unfair, inequitable, misleading,\ndeceptive, or contrary to law or to the public policy of this state.\n  (4) The superintendent shall not approve any life insurance policy\nform containing any war or travel exclusion or restriction, for delivery\nor issuance for delivery in this state, unless such policy form shall\nhave printed or stamped across its face in red and in capital letters\nnot smaller than twelve point type, or in an equally prominent manner\nestablished at the discretion of the superintendent and promulgated\nthrough regulations, the following:\n  "Read your policy (certificate) carefully.\n  "Certain (war, travel) risks are not assumed.\n  __________________________________\n  (state which or both)\n  In case of any doubt write your company (society) for further\nexplanation."\n  (5) The superintendent shall not approve any annuity or life insurance\npolicy form which is subject to the provisions of section four thousand\ntwo hundred twenty, four thousand two hundred twenty-one or four\nthousand five hundred eleven of this chapter, unless a detailed\nstatement of the method used by the insurer in calculating any cash\nsurrender value and any paid-up nonforfeiture benefit in the policy form\nis stated therein or, in lieu thereof, a statement that such method of\ncomputation has been filed with the insurance supervisory official of\nthe state in which the policy form is delivered, and unless a statement\nof the method to be used in calculating the cash surrender value and\npaid-up nonforfeiture benefit available on any anniversary beyond the\nlast anniversary for which such value and benefits are consecutively\nshown in the policy form is included therein, and, with respect to\npolicy forms under which additional amounts may be credited pursuant to\nsubsection (b) of section four thousand two hundred thirty-two or\nsection four thousand five hundred eighteen of this chapter, the insurer\nshall also furnish such further information to the superintendent as the\nsuperintendent may require.\n  (6) (a) The superintendent may disapprove any policy form specified in\nparagraph two of subsection (b) of this section issued by a domestic\nlife insurer or fraternal benefit society for delivery outside the state\nif its issuance would be prejudicial to the interests of its\npolicyholders or members.\n  (b) Except for the policy forms specified in paragraph two of\nsubsection (b) of this section, every domestic life insurer and\nfraternal benefit society shall file annually with the superintendent a\nlist identifying and describing the policy forms issued by the insurer\nor fraternal benefit society for delivery outside the state in a form\nprescribed by the superintendent. If the superintendent determines that\nthe issuance of a policy form has been or may be prejudicial to the\ninterests of policyholders or members, the superintendent may take any\naction he or she deems appropriate, including issuing an order, after a\nhearing, to cease and desist issuing the policy form.\n  (7) If any policy of individual accident and health insurance is\nissued by an insurer domiciled in this state for delivery to a person\nresiding in another state, and if the official having responsibility for\nthe administration of the insurance laws of such other state shall have\nadvised the superintendent that any such policy form is not subject to\napproval or disapproval by such official, the superintendent may by\nruling require that such policy form meet the standards set forth in\nsubsections (c) and (d) of section three thousand two hundred sixteen of\nthis article.\n  (8) Without limitation on his other powers and duties under this\nsection, the superintendent shall not approve any credit insurance or\ncredit unemployment insurance policy forms or premium rates if the\npremium rates are unreasonable in relation to the benefits provided.\n  (9) Each insurer shall file with the superintendent of financial\nservices any change in the premium rates for policies authorized under\nsubparagraph (J) of paragraph one of subsection (c) of section four\nthousand two hundred thirty-five of this chapter, and the same shall be\nsubject to his approval.\n  (10) The superintendent shall not approve any form of life insurance\npolicy that is subject to the provisions of section four thousand two\nhundred twenty-one of this chapter or any form of annuity contract that\nis subject to the provisions of section four thousand two hundred\ntwenty-three of this chapter if such form of policy or contract provides\nfor the adjustment of any cash surrender benefit or policy loan value in\naccordance with a market-value adjustment formula, unless there shall\nhave been filed with the superintendent a memorandum, in form and\nsubstance satisfactory to the superintendent, describing the\nmarket-value adjustment formula and stating that, in the opinion of the\ninsurer, the formula provides reasonable equity to terminating and\ncontinuing policy and contract holders and to the insurer and complies\nwith the nonforfeiture provisions of this chapter.\n  (11) (A) The superintendent shall not approve a life insurance policy\nwhich provides for accelerated payment of death benefits or special\nsurrender values pursuant to subparagraph (B), (C), (D), (E) or (F) of\nparagraph one of subsection (a) of section one thousand one hundred\nthirteen of this chapter unless it also provides for such accelerated\npayments or special surrender values pursuant to subparagraph (A) of\nparagraph one of subsection (a) of such section.\n  (B) The superintendent shall promulgate a regulation establishing\nrules for advertising, disclosure, benefit levels, benefit eligibility,\npayment of long term care benefits, nonforfeiture, and reserves for\naccelerated payment of death benefits or special surrender values\nprovided under a life insurance policy. The regulation shall establish\nreasonable disclosure requirements concerning the percentage of the\ndeath benefit payable when accelerated payment of the death benefit or\nspecial surrender value occurs, the impact of accelerated payment of the\ndeath benefit or special surrender value on eligibility for public\nassistance (as determined by the commissioner of social services), the\nprohibition that no health care facility as defined in section twenty of\nthe public health law can require any person to accelerate payment of a\ndeath benefit or obtain a special surrender value as a condition of\nadmission, providing or continuing care, and notice of possible tax\nobligations.\n  (12) The superintendent shall promulgate a regulation relating to\nwaiver of premium for unemployment as authorized by paragraph one of\nsubsection (a) of section one thousand one hundred thirteen of this\nchapter establishing minimum standards for benefit levels, benefits\neligibility and exclusions. The premium charged shall be reasonable in\nrelation to the benefit provided.\n  (d) The superintendent shall, within a reasonable time after the\nfiling of any policy form requiring approval, notify the insurer filing\nthe form of his approval or disapproval of it.\n