N.Y. ISC Law § 4236 — New York Code / Act ISC / Article 42 / Section 4236
Joint underwriting of group health insurance for persons aged sixty-five and over
Status: in_force

§ 4236. Joint underwriting of group health insurance for persons aged\nsixty-five and over. (a) It is the concern of the legislature that many\nresidents of this state of advanced years do not have readily available\nto them health insurance adequate to their needs. It is the\nlegislature's intent to encourage and facilitate the writing of such\ninsurance by private insurers on a non-profit group basis in order to\nmake available to such persons broader coverage at lower rates than is\npossible on a regular commercial basis. It is, therefore, the purpose of\nthe legislature to authorize and regulate, in the public interest,\ncooperative action among such insurers in the preparation and issuance\nof policies of health insurance, the making of rates to be charged\ntherefor and other matters within the scope of this section.\n  (b) In this section, unless the context otherwise requires,\n  (1) "Association" means a voluntary unincorporated non-profit\nassociation formed for the sole purpose of enabling cooperative action\nto provide health insurance in accordance with this section.\n  (2) "Health insurance" means hospital, surgical and medical expense\ninsurance, provided by a group health insurance policy or contract\nissued in accordance with this section.\n  (3) "Insurer" means any insurance company authorized to do the\nbusiness of accident and health insurance in this state.\n  (4) "Insured" means a person covered under a group policy or contract\nissued pursuant to this section.\n  (c) (1) Notwithstanding any other provision of this chapter or of any\nother law which may be inconsistent herewith, any insurer may join with\none or more other insurers, on a uniform basis with respect to premium\nrates, policy provisions, commissions and other matters within the scope\nof this section, to offer, sell and issue to a policyholder group health\ninsurance covering residents of this state who are sixty-five years of\nage or older and the spouses of such residents.\n  (2) Such insurance may also cover an employer's non-resident employees\nand non-resident retired employees sixty-five years of age or older and\ntheir spouses, provided such employees are regularly employed within\nthis state or were so employed at the time of their retirement.\n  (3) Such insurance may be offered, issued and administered jointly by\ntwo or more such insurers through an association formed by such insurers\nsolely for the purpose of offering, selling, issuing and administering\nsuch insurance in accordance with this section. Membership in such\nassociation shall be open to any insurer.\n  (d) (1) Such association shall offer health insurance coverage to all\nresidents of this state who are sixty-five years of age or over and\ntheir spouses, subject to reasonable underwriting restrictions to be set\nforth in the plan of the association.\n  (2) Such coverage may consist of one or more of the following types:\n(i) basic hospital and surgical coverage, (ii) basic medical coverage,\n(iii) major medical coverage, and any combination of those types;\nprovided, however, that if coverage of the first or second type is\noffered, it shall not be required as a condition of obtaining same that\ncoverage of the third type also be obtained.\n  (e) (1) Such association shall file with the superintendent its plan\nfor offering, selling, issuing and administering health insurance which\nplan shall be subject to his approval as conforming to the purpose and\nrequirements of this section, and any policy, contract, certificate or\nother evidence of insurance, application or other forms pertaining to\nsuch insurance together with the premium rates to be charged therefor.\n  (2) No such policy, contract, certificate or other evidence of\ninsurance, application or other form shall be sold, issued or used and\nno endorsement shall be attached to or printed or stamped thereon unless\nthe form thereof and the premium rates to be charged therefor shall have\nbeen approved by the superintendent.\n  (3) The superintendent shall, within a reasonable time after the\nfiling of any such premium rates, policies, contracts, endorsements,\napplications or other forms, notify the association filing the same of\nhis approval or disapproval thereof.\n  (4) The superintendent may disapprove such premium rates if he finds\nthem to be unfairly discriminatory or unreasonable in relation to the\nbenefits provided and he may disapprove such policies, contracts,\ncertificates, applications, endorsements or other forms if in his\njudgment they contain provisions which he finds to be unjust, unfair,\ninequitable, misleading, deceptive, prejudicial to the insured or\notherwise contrary to law or to the public policy of this state.\n  (5) The superintendent may, after notice and hearing, withdraw an\napproval previously given, if the use thereof is contrary to the legal\nrequirements applicable thereto at the time of such withdrawal, or the\npremiums are unfairly discriminatory or unreasonable in relation to the\nbenefits provided, or in his judgment they contain provisions which are,\nor the continued use thereof would be, unjust, unfair, inequitable,\nmisleading, deceptive, prejudicial to the insured or otherwise contrary\nto law or to the public policy of this state. Any such withdrawal of\napproval shall be effective at the expiration of such period, not less\nthan ninety days after the giving of notice of withdrawal, as the\nsuperintendent shall in such notice prescribe.\n  (6) In exercising the powers conferred upon him by this subsection the\nsuperintendent shall not be bound by any other requirement of this\nchapter with respect to standard provisions to be included in accident\nand health policies or forms.\n  (7) The name of such association or any advertising and other\npromotional and solicitation material used in connection with health\ninsurance offered, sold or delivered pursuant to this section shall not\nbe such as to mislead or deceive the public.\n  (f) Such association may solicit the sale of such health insurance\nthrough any insurance agent licensed pursuant to section two thousand\none hundred three of this chapter and any insurance broker licensed\npursuant to section two thousand one hundred four of this chapter. It\nshall not pay to such agent or broker or any other person any\ncommission, compensation or other fee or allowance not in accordance\nwith a schedule thereof which shall have been filed by it with and\napproved by the superintendent. Except as aforesaid, it shall not pay\nany commission, compensation, fee or allowance to any person but it may\npay a salary or compensation to persons regularly employed by it.\n  (g) Such association shall file annually with the superintendent, on\nsuch date and in such form as he may prescribe, a statement with respect\nto its operations.\n  (h) Notwithstanding any other provision of this chapter, an\nassociation may offer, sell, issue or administer such a group policy or\ncontract of health insurance on a non-participating basis, provided,\nhowever, that the excess, if any, of premiums received by it from\ninsureds over the cost of providing such insurance benefits shall be\nused solely for the benefit of the insureds.\n  (i) Premiums for policies issued pursuant to this section shall not be\nincluded in "premiums" for purposes of section five hundred fifty-two of\nthe former insurance law in effect immediately preceding the effective\ndate of this chapter and former section one hundred eighty-seven of the\ntax law, nor shall section one thousand one hundred twelve of this\nchapter be construed as subjecting the premiums for such policies to\ntaxation; nor shall such premiums be subject to any other tax imposed by\nany other governmental subdivision.\n