N.Y. ISC Law § 3217 — New York Code / Act ISC / Article 32 / Section 3217
Minimum standards in the form, content and sale of accident and health insurance; policies and subscriber contracts
Status: in_force

§ 3217. Minimum standards in the form, content and sale of accident\nand health insurance; policies and subscriber contracts. (a) The\nsuperintendent shall issue such regulations he deems necessary or\ndesirable to establish minimum standards, including standards of full\nand fair disclosure, for the form, content and sale of accident and\nhealth insurance policies and subscriber contracts of corporations\norganized under this article and article forty-three of this chapter or\nentities licensed pursuant to article forty-four of the public health\nlaw. With regard to contracts issued pursuant to such articles which\nincorporate a usual and customary or reasonable form of reimbursement,\nsuch regulations shall require such schedules to be updated\nperiodically, to accurately reflect geographic differences in costs and\nthat information be furnished to insureds regarding the method upon\nwhich the usual and customary or reasonable charge is determined and the\npercentile of charges upon which the schedule is based. Such regulations\nshall also require, in addition to such other information as the\nsuperintendent deems necessary, the disclosure of the reimbursement for\na particular elective surgical procedure or treatment, upon written\nrequest by an insured, subscriber or enrollee. Such regulations may\napply to all, any portion or reasonable classifications of such policies\nor contracts.\n  (b) The purposes of such minimum standards shall include any or all of\nthe following:\n  (1) reasonable standardization and simplification of coverages to\nfacilitate understanding and comparisons;\n  (2) elimination of provisions which may be misleading or unreasonably\nconfusing, in connection either with the purchase of such policies or\ncontracts or with the settlement of claims;\n  (3) elimination of deceptive practices in connection with the sale of\nsuch policies or contracts;\n  (4) elimination of provisions which may be contrary to the health care\nneeds of the public, as certified to the superintendent by the\ncommissioner of health; and\n  (5) elimination of coverages which are so limited in scope as to be of\nno substantial economic value to the holders.\n  (c) Prior to the issuance of regulations pursuant to this section, the\nsuperintendent shall afford the public, including the companies affected\nthereby, reasonable opportunity for comment and shall obtain the views,\nin writing, of the commissioner of health and the secretary of state.\n  (d) When a regulation adopted pursuant to this section so provides,\nall forms of such policies or contracts which are not in compliance with\nsuch regulation shall be deemed to be disapproved for use without any\nfurther or additional notice after a date to be specified in such\nregulation which date shall not be less than sixty days following its\neffective date.\n  (e) When a regulation adopted pursuant to this section so provides,\nany such policy or contract which does not comply with the regulation\nshall, when issued after a date not less than sixty days from the\neffective date of such regulation, be construed, and the insurer or\ncorporation shall be liable, as if the policy or contract did comply\nwith the regulation.\n  (f) Violation of any regulation adopted pursuant to this section shall\nbe a violation of this chapter for purposes of section one hundred nine\nof this chapter.\n