N.Y. ISC Law § 4304 — New York Code / Act ISC / Article 43 / Section 4304
Individual contracts
Status: in_force

§ 4304. Individual contracts. (a) Every corporation subject to the\nprovisions of this article may issue a contract to an individual the\npremiums for which may be paid to the corporation directly by the\nindividual or by a remitting agent for the group to which the individual\nbelongs. If the premiums for a contract issued pursuant to this section\nare paid to the corporation by a remitting agent, such contract shall be\nsubject to subsections (k) and (l) of section four thousand two hundred\nthirty-five of this chapter, and for the purposes of these subsections,\nthe remitting agent shall be treated as the policyholder.\n  (b)(1) Any such contract shall be for a period not in excess of twelve\nmonths, but no contract shall be made providing for the inception of\nbenefits at a date later than one year from the date of the contract.\n  (2) Any such contract shall provide that it will be automatically\nrenewed from year to year unless there shall have been one month's prior\nwritten notice of termination by the subscriber.\n  (3) No corporation shall refuse to renew any such contract because of\nthe physical or mental condition or the health of any person covered\nthereunder. The provisions of this subsection shall in no way diminish\nthe rights of individuals pursuant to section four thousand three\nhundred seventeen of this article.\n  (c) Any such contract may be terminated in the following manner:\n  (1) At the option of the individual to whom the contract is issued,\nupon not less than one month's prior written notice.\n  (2) At the option of the corporation, for one or more of the following\nreasons:\n  (A) The individual has failed to pay premiums or contributions in\naccordance with the terms of the contract or the corporation has not\nreceived timely premium payments.\n  (B) The individual has performed an act or practice that constitutes\nfraud or made an intentional misrepresentation of material fact under\nthe terms of the contract, upon not less than one month's prior written\nnotice.\n  (C) (i) Discontinuance of a class of contract upon not less than\nninety days' prior written notice. In exercising the option to\ndiscontinue coverage pursuant to this item, the corporation must act\nuniformly without regard to any health status-related factor of enrolled\nindividuals or individuals who may become eligible for such coverage and\nmust offer to subscribers or group remitting agents, as may be\nappropriate, the option to purchase all other individual health\ninsurance coverage currently being offered by the corporation to\napplicants in that market. Provided, however, the superintendent may,\nafter giving due consideration to the public interest, approve a request\nmade by a corporation for the corporation to satisfy the requirements of\nthis item through the offering of contracts at each level of coverage as\ndefined in subsection (b) of section four thousand three hundred six-h\nof this article that contains the essential health benefits package\ndescribed in paragraph three of subsection (e) of section four thousand\nthree hundred six-h of this article by another corporation, insurer or\nhealth maintenance organization within the corporation's same holding\ncompany system, as defined in article fifteen of this chapter.\n  (ii) Discontinuance of all hospital, surgical or medical expense\ncoverage in the individual direct payment market in this state upon\nwritten notice to the superintendent and to each subscriber not less\nthan one hundred eighty days prior to the date of the expiration of such\ncoverage. In the event of such a withdrawal from the individual direct\npayment market, the corporation must also provide the superintendent\nwith a written plan to minimize potential disruption in the marketplace\noccasioned by such withdrawal. In addition, the corporation may not\nprovide for the issuance of any hospital, surgical or medical expense\ncoverage in the individual direct payment market in this state during\nthe five-year period beginning on the date of the discontinuance of the\nlast health insurance coverage not so renewed.\n  (iii) Discontinuance of all individual hospital, surgical or medical\nexpense insurance contracts for which the premiums are paid by a\nremitting agent of a group, in the small group market, or the large\ngroup market, or both markets, in this state, in conjunction with a\nwithdrawal from the small group market, or the large group market, or\nboth markets, in this state. Withdrawal from the small group market, or\nthe large group market, or both markets, shall be governed by the\nrequirements of subparagraphs (E) and (F) of paragraph three of\nsubsection (j) of section four thousand three hundred five of this\narticle. For purposes of this item, "withdrawal" from a market means\nthat no coverage is offered or maintained in such market under contracts\nissued pursuant to this section or contracts issued pursuant to section\nfour thousand three hundred five of this article.\n  (D) In the case of a corporation that offers health insurance in the\nmarket through a network plan, the individual no longer resides, lives\nor works in the service area (or in an area for which the corporation is\nauthorized to do business) but only if such coverage is terminated under\nthis paragraph uniformly without regard to any health status-related\nfactor of covered individuals. For the purposes of this subparagraph,\nthe term "network plan" means health insurance coverage of a corporation\norganized under this article under which the financing and delivery of\nhealth care (including items and services paid for as such care) are\nprovided, in whole or in part, through a defined set of providers under\ncontract either with the corporation or another entity that has\ncontracted with the corporation.\n  (E) In case of a contract for which the premiums are paid by a\nremitting agent of a group, discontinuance of the individual's\nmembership in such group.\n  (F) Such other reasons as the superintendent may approve and\nauthorized by the Health Insurance Portability and Accountability Act of\n1996, Public Law 104-191, and any later amendments or successor\nprovisions, or by any federal regulations or rules that implement the\nprovisions of the Act, upon not less than one month's prior written\nnotice.\n  (3) Every notice of termination shall be in a form satisfactory to the\nsuperintendent and shall include a statement of the conversion\nprivileges, if any, upon such termination.\n  (4) In the event of termination of a contract, the corporation shall\nreturn the unearned portion of the premium.\n  (d) (1) (A) No contract issued pursuant to this section shall entitle\nmore than one person to benefits except that a contract issued and\nmarked as a "family contract" may provide that benefits will be\nfurnished to the contract holder, spouse, dependent child or children,\nor other person chiefly dependent upon the contract holder provided\nthat:\n  (i) A "family contract" may provide coverage to any child or children\nnot over nineteen years of age, provided that an unmarried student at an\naccredited institution of learning may be considered a dependent until\nthe child becomes twenty-three years of age, and provided also that the\ncoverage of any such "family contract" may include, at the option of the\ncorporation, any unmarried child until attaining age twenty-five.\nHowever, a "family contract" of hospital, medical, surgical, or\nprescription drug expense insurance that provides coverage for dependent\nchildren shall provide such coverage to a married or unmarried child\nuntil attainment of age twenty-six without regard to financial\ndependence, residency with the contract holder, student status, or\nemployment.\n  (ii) The coverage of any such "family contract" shall include any\nother unmarried child, regardless of age, who is incapable of\nself-sustaining employment by reason of mental illness, developmental\ndisability, as defined in the mental hygiene law, or physical handicap\nand who became so incapable prior to attainment of the age at which\ncoverage would otherwise terminate.\n  (B) In addition to the requirements of subparagraph (A) of this\nparagraph, every corporation issuing a contract of hospital, medical or\nsurgical expense insurance that provides coverage for children must make\navailable and if requested by the contractholder, extend coverage under\nthe contract to an unmarried child through age twenty-nine, without\nregard to financial dependence who is not insured by or eligible for\ncoverage under any employer health benefit plan as an employee or\nmember, whether insured or self-insured, and who lives, works or resides\nin New York state or the service area of the corporation. Such coverage\nshall be made available at the inception of all new contracts, and for\ngroup remittance contracts at any anniversary date. Written notice of\nthe availability of such coverage shall be delivered to the\ncontractholder prior to the inception of such contract, and for group\nremittance contracts annually thereafter.\n  (C) Notwithstanding any rule, regulation or law to the contrary, any\n"family contract" shall provide that coverage of newborn infants,\nincluding newly born infants adopted by the subscriber if such\nsubscriber takes physical custody of the infant upon such infant's\nrelease from the hospital and files a petition pursuant to section one\nhundred fifteen-c of the domestic relations law within thirty days of\nbirth; and provided further that no notice of revocation to the adoption\nhas been filed pursuant to section one hundred fifteen-b of the domestic\nrelations law and consent to the adoption has not been revoked, shall be\neffective from the moment of birth for injury or sickness including the\nnecessary care and treatment of medically diagnosed congenital defects\nand birth abnormalities including premature birth, except that in cases\nof adoption, coverage of the initial hospital stay shall not be required\nwhere a birth parent has insurance coverage available for the infant's\ncare. This provision regarding coverage of newborn infants shall not\napply to two person coverage. In the case of individual or two person\ncoverages the corporation must also permit the person to whom the\ncontract is issued to elect such coverage of newborn infants from the\nmoment of birth. If notification and/or payment of an additional premium\nor contribution is required to make coverage effective for a newborn\ninfant, the coverage may provide that such notice and/or payment be made\nwithin no less than thirty days of the day of birth to make coverage\neffective from the moment of birth. This election shall not be required\nin the case of student insurance or where the group remitting agent's\nplan does not provide coverage for children.\n  (2) Every "family contract" under which coverage of a dependent spouse\nor contract holder would terminate upon such spouse or contract holder\nattaining the age prescribed in subchapter XVIII of the Social Security\nAct, 42 U.S.C. § 1395 et seq ("Medicare"), as the age of first\neligibility for the benefits provided by such law shall not so\nterminate, if such dependent spouse is not eligible for all of such\nbenefits, for as long as the contract remains in force and such\ndependent spouse remains ineligible to receive any of such "medicare"\nbenefits, provided proof of such ineligibility is submitted to the\ncorporation within thirty-one days of the date notice of termination of\ncoverage is mailed by the corporation to the last known address of the\nsuch spouse or contract holder.\n  (3) Coverage of an unmarried dependent child who is incapable of\nself-sustaining employment by reason of mental illness, developmental\ndisability, as defined in the mental hygiene law, or physical handicap\nand who became so incapable prior to attainment of the age at which\ncoverage would otherwise terminate and who is chiefly dependent upon the\ncontract holder for support and maintenance, shall not terminate while\nthe contract remains in force and the child remains in such condition,\nif the contract holder has within thirty-one days of such child's\nattainment of the limiting age submitted proof of such child's\nincapacity as described herein.\n  (e) (1) (A) If any such contract is terminated in accordance with the\nprovisions of paragraph one of subsection (c) of this section, or any\nsuch contract is terminated because of a default by the remitting agent\nin the payment of premiums not cured within the grace period and the\nremitting agent has not replaced the contract with similar and\ncontinuous coverage for the same group whether insured or self-insured,\nor any such contract is terminated in accordance with the provisions of\nsubparagraph (E) of paragraph two of subsection (c) of this section, or\nif an individual other than the contract holder is no longer covered\nunder a "family contract" because the individual is no longer within the\ndefinition set forth in the contract, or a spouse is no longer covered\nunder the contract because of divorce from the contract holder or\nannulment of the marriage, or any such contract is terminated because of\nthe death of the contract holder, then such individual, former spouse,\nor in the case of the death of the contract holder the surviving spouse\nor other dependents of the deceased contract holder covered under the\ncontract, as the case may be, shall be entitled to convert, without\nevidence of insurability, upon application therefor and the making of\nthe first payment thereunder within sixty days after the date of\ntermination of such contract, to a contract that contains the essential\nhealth benefits package described in paragraph three of subsection (e)\nof section four thousand three hundred six-h of this article.\n  (B) The corporation shall offer one contract at each level of coverage\nas defined in subsection (b) of section four thousand three hundred\nsix-h of this article. The individual may choose any such contract\noffered by the corporation. Provided, however, the superintendent may,\nafter giving due consideration to the public interest, approve a request\nmade by a corporation for the corporation to satisfy the requirements of\nthis paragraph through the offering of contracts that comply with this\nparagraph by another corporation, insurer or health maintenance\norganization within the corporation's same holding company system, as\ndefined in article fifteen of this chapter.\n  (C) The effective date of the coverage provided by the converted\ndirect payment contract shall be the date of the termination of coverage\nunder the contract from which conversion was made.\n  (2) The corporation shall not be required to issue any such converted\nindividual direct payment contract if its issuance would result in\noverinsurance or duplication of benefits according to standards on file\nwith the superintendent and approved by the superintendent with regard\nto such contracts.\n  (3) In addition to the right of conversion herein, the employee or\nmember insured under a contract for which the premiums are paid by a\nremitting agent of a group shall at his option, as an alternative to\nconversion, be entitled to have his coverage continued under the group\nremittance contract in accordance with the conditions and limitations\ncontained in subsection (k) of this section, and have issued at the end\nof the period of continuation an individual direct payment conversion\ncontract subject to the terms of this subsection. The effective date for\nthe conversion contract shall be the day following the termination of\ninsurance under the group remittance contract, or if there is a\ncontinuation of coverage, on the day following the end of the period of\ncontinuation.\n  (4) For purposes of this subsection, the term "dependent" shall\ninclude a child as described in subsection (d) of this section.\n  (f) No such corporation shall require as a condition for renewal or\nfor failure to cancel any individual contract any rider, endorsement or\nother attachment which shall limit the nature or extent of the benefits\nthereunder, except that a corporation may at any time upon at least\nthirty days' prior written notice amend such contract to provide a\ndifferent level of benefits thereunder if approved by the superintendent\non finding, upon application by the corporation at least four months\nbefore the proposed effective date, that such level would exceed, in the\naggregate, the level of benefits theretofore provided and would be in\nthe best interests of the corporation and the persons covered under such\ncontracts.\n  (g) The provisions of this section with respect to limitations on the\ntermination of an individual contract shall not apply to a contract or\nan endorsement or rider thereto which is issued by a corporation subject\nto the provisions of this article pursuant to a plan providing for\nexperimentation in new forms of benefits in the field of health\ninsurance protection, which plan shall be submitted in writing to the\nsuperintendent. The superintendent shall approve such plan if he finds\nthat the benefits are of the type heretofore described and that the\nissuance of such contract, endorsement or rider is in the public\ninterest. Approval of such contract, rider or endorsement shall be\nsubject to any conditions which may be prescribed by the superintendent,\nincluding, but not limited to, the maximum period during which the\nexemption from the provisions of this section with respect to\ntermination shall continue. The superintendent may, for good cause\nshown, extend such period of exemption. Any termination of such\ncontract, rider or endorsement during the period of exemption, other\nthan for non-payment of premium and fraud in applying for the contract,\nshall be subject to the approval of the superintendent. Upon termination\nof such contract, or termination of a rider or endorsement providing\nexperimental benefits, as aforesaid, the contract holder thereunder who\nhas at the time of such termination been covered continuously\nimmediately preceding such termination for a period of two years or more\nunder one or more contracts of the corporation shall be entitled to have\nissued to him by the corporation, without evidence of insurability, upon\napplication therefor and the making of the first payment thereunder\nwithin thirty-one days after the date of termination, an individual\ndirect payment contract of the type and class which the superintendent\nshall determine provides benefits most nearly comparable to those\ncurrently provided other individuals. If the corporation does not\nterminate such contract or a rider or endorsement thereto providing\nexperimental benefits as aforesaid during the period of exemption, or\nany extended period provided herein, such contract shall thereafter be\nsubject to the provisions of this section with respect to termination as\nof the original effective date of such contract.\n  (h) Any contract, other than one issued in fulfillment of the\ncontinuing care responsibilities of an operator of a continuing care\nretirement community in accordance with article forty-six of the public\nhealth law, made available because of residence in a particular\nfacility, housing development, or community shall contain the following\nnotice in twelve point type in bold face on the first page:\n  "NOTICE - THIS CONTRACT DOES NOT MEET THE REQUIREMENTS OF A CONTINUING\nCARE RETIREMENT CONTRACT. AVAILABILITY OF THIS COVERAGE WILL NOT QUALIFY\nA RESIDENTIAL FACILITY AS A CONTINUING CARE RETIREMENT COMMUNITY."\n  (i) Any persons covered by the contract who are also members of a\nreserve component of the armed forces of the United States, including\nthe National Guard, shall be entitled, upon written request, to have\ntheir coverage suspended during a period of active duty as described\nherein. The contract shall provide that the insurer will refund any\nunearned premiums for the period of such suspension. Persons covered by\nthe contract shall be entitled to resumption of coverage, upon written\napplication and payment of the required premium within sixty days after\nthe date of termination of the period of active duty, with no\nlimitations or conditions imposed as a result of such period of active\nduty except as set forth in paragraphs one and two herein. Coverage\nshall be retroactive to the date of termination of the period of active\nduty. Such right of resumption provided for herein shall be in addition\nto other existing rights granted pursuant to state and federal laws and\nregulations and shall not be deemed to qualify or limit such rights in\nany way. No exclusion or waiting period may be imposed in connection\nwith coverage of a health or physical condition of a person entitled to\nsuch right of resumption, or a health or physical condition of any other\nperson who is covered by the contract unless:\n  (1) the condition arose during the period of active duty and the\ncondition has been determined by the secretary of veterans affairs to be\na condition incurred in the line of duty; or\n  (2) a waiting period was imposed and had not been completed prior to\nthe period of suspension; in no event, however, shall the sum of the\nwaiting periods imposed prior to and subsequent to the period of\nsuspension exceed the length of the waiting period originally imposed.\n  (j) To be entitled to the right defined in subsection (i) of this\nsection a person must be a member of a reserve component of the armed\nforces of the United States, including the National Guard, who either:\n  (1) voluntarily or involuntarily enters upon active duty (other than\nfor the purpose of determining his or her physical fitness and other\nthan for training), or\n  (2) has his or her active duty voluntarily or involuntarily extended\nduring a period when the president is authorized to order units of the\nready reserve or members of a reserve component to active duty, provided\nthat such additional active duty is at the request and for the\nconvenience of the federal government, and\n  (3) serves no more than four years of active duty.\n  (k) A contract for which the premiums are paid by a remitting agent of\na group issued by a hospital service, health service or medical expense\nindemnity corporation shall provide that if all or any portion of the\ninsurance on an employee or member insured under the contract ceases\nbecause of termination of employment or membership in the class or\nclasses eligible for coverage under the contract, such employee or\nmember shall be entitled without evidence of insurability upon\napplication to continue his or her insurance for himself or herself and\nhis or her eligible dependents, subject to all of the group remittance\ncontract's terms and conditions applicable to those forms of benefits\nand to the following conditions:\n  (1) Continuation shall not be available for: (A) any person who is\ncovered, becomes covered or could be covered by title XVIII of the\nUnited States Social Security Act (Medicare) as amended or superseded;\nor (B) an employee, member or dependent who is covered, becomes covered\nor could become covered as an employee, member or dependent by any other\ninsured or uninsured arrangement which provides hospital, surgical or\nmedical coverage for individuals in a group which does not contain any\nexclusion or limitation with respect to any pre-existing condition of\nsuch employee, member or dependent, except the group insurance or group\nremittance contract conversion option of this section shall not be\nconsidered as such an arrangement under which an employee, member or\ndependent could become covered.\n  (2) (A) An employee or member who wishes continuation of coverage must\nrequest such continuation in writing within the sixty day period\nfollowing the later of: (i) the date of such termination; or (ii) the\ndate the employee is given notice of the right of continuation by either\nhis employer or the group remitting agent.\n  (B) An employee or member who wishes continuation of coverage under\nsubparagraph (D) of paragraph four of this subsection must give notice\nto the employer or group remitting agent within sixty days of the\ndetermination under title II or title XVI of the United States Social\nSecurity Act that such employee or member was disabled at the time of\ntermination of employment or membership or at any time during the first\nsixty days of continuation of coverage.\n  (3) An employee or member electing continuation must pay to the group\nremitting agent or his employer, but not more frequently than on a\nmonthly basis in advance, the amount of the required premium payment,\nbut not more than one hundred two percent of the group rate for the\nbenefits being continued under the group remittance contract on the due\ndate of each payment. The employee's or member's written election of\ncontinuation, together with the first premium payment required to\nestablish premium payment on a monthly basis in advance, must be given\nto the group remitting agent or employer within sixty days of the date\nthe employee's or member's benefits would otherwise terminate.\n  (4) Subject to paragraph one of this subsection, continuation of\nbenefits under the group remittance contract for any person shall\nterminate at the first to occur of the following:\n  (A) The date thirty-six months after the date the employee's or\nmember's benefits under the contract would otherwise have terminated\nbecause of termination of employment or membership; or\n  (B) The end of the period for which premium payments were made, if the\nemployee or member fails to make timely payment of a required premium\npayment; or\n  (C) In the case of an eligible dependent of an employee or member, the\ndate thirty-six months after the date such person's benefits under the\ncontract would otherwise have terminated by reason of:\n  (i) the death of the employee or member;\n  (ii) the divorce or legal separation of the employee or member from\nhis or her spouse;\n  (iii) the employee or member becoming entitled to benefits under title\nXVIII of the United States Social Security Act (Medicare); or\n  (iv) a dependent child ceasing to be a dependent child under the\ngenerally applicable requirements of the contract; or\n  (D) The date on which the group remittance contract with that\nremitting agent is terminated or, in the case of an employee, the date\nhis employer terminates participation under the group remittance\ncontract.  However, if this clause applies and the coverage ceasing by\nreason of such termination is replaced by similar coverage under another\ngroup or group remittance contract, the following shall apply:\n  (i) The employee or member shall have the right to become covered\nunder that other group or group remittance contract, for the balance of\nthe period that he would have remained covered under the prior group\nremittance contract in accordance with this subparagraph had a\ntermination described in this subparagraph not occurred, and\n  (ii) The minimum level of benefits to be provided by the other group\nor group remittance contract shall be the applicable level of benefits\nof the prior group remittance contract reduced by any benefits payable\nunder that prior group remittance contract, and\n  (iii) The prior group remittance contract shall continue to provide\nbenefits to the extent of its accrued liabilities and extension of\nbenefits as if the replacement had not occurred.\n  (5)(A) Special enrollment period. An individual who does not have an\nelection of continuation coverage as described in this subsection in\neffect on the effective date of the American Recovery and Reinvestment\nact of 2009, but who would be an assistance eligible individual under\nTitle III of such act if such election were in effect, may elect\ncontinuation coverage pursuant to this subsection. Such election must be\nmade no later than sixty days after the date the administrator of the\ngroup health plan (or other entity involved) provides the notice\nrequired by section 3001(a)(7) of the American Recovery and Reinvestment\nact of 2009. The administrator of the group health plan (or other entity\ninvolved) shall provide such individuals with additional notice of the\nright to elect coverage pursuant to this paragraph within sixty days of\nthe date of enactment of the American Recovery and Reinvestment act of\n2009.\n  (B) Continuation coverage elected pursuant to subparagraph (A) of this\nparagraph shall commence with the first period of coverage beginning on\nor after the date of the enactment of the American Recovery and\nReinvestment act of 2009 and shall not extend beyond the period of\ncontinuation coverage that would have been required if the coverage had\ninstead been elected pursuant to paragraph two of this subsection.\n  (C) With respect to an individual who elects continuation coverage\npursuant to subparagraph (A) of this paragraph, the period beginning on\nthe date of the qualifying event and ending on the date of the first\nperiod of coverage on or after the enactment of the American Recovery\nand Reinvestment act of 2009 shall be disregarded for purposes of\ndetermining the sixty-three day period referred to in section four\nthousand three hundred eighteen of this article.\n  (6) A contract for which premiums are paid by a remitting agent for a\ngroup issued by a hospital service, health service or medical expense\nindemnity corporation shall offer an employee or member who has\nexhausted continuation coverage pursuant to Chapter 18 of the Employee\nRetirement Income Security Act, 29 U.S.C. § 1161 et seq. or Chapter 6A\nof the Public Health Service Act, 42 U.S.C. § 300 bb - 1 et seq. the\nopportunity to continue coverage for up to thirty-six months from the\ndate the employee's or member's continuation coverage began if the\nemployee or member is entitled to less than thirty-six months of\ncontinuation benefits.\n  (7) For purposes of this subsection, the term "dependent" shall\ninclude a child as described in subsection (d) of this section.\n  (l) A corporation shall not offer individual hospital, medical, or\nsurgical expense insurance contracts unless the contracts meet the\nrequirements of subsection (b) of section four thousand three hundred\ntwenty-eight of this article. Such contracts that are offered within the\nhealth benefit exchange established by this state also shall meet any\nrequirements established by the health benefit exchange. To the extent\nthat a holder of a special purpose certificate of authority issued\npursuant to section four thousand four hundred three-a of the public\nhealth law offers individual hospital, medical, or surgical expense\ninsurance contracts, the contracts shall meet the requirements of\nsubsection (b) of section four thousand three hundred twenty-eight of\nthis article.\n  (m) (1) As used in this subsection, "child" means an unmarried child\nthrough age twenty-nine of an employee or member insured under a group\nremittance contract of hospital, medical or surgical expense insurance,\nregardless of financial dependence, who is not insured by or eligible\nfor coverage under any employer health benefit plan as an employee or\nmember, whether insured or self-insured, and who lives, works or resides\nin New York state or the service area of the corporation and who is not\ncovered under title XVIII of the United States Social Security Act\n(Medicare).\n  (2) In addition to the conversion privilege afforded by subsection (e)\nof this section and the continuation privilege afforded by subsections\n(e) and (k) of this section, a hospital service, health service or\nmedical expense corporation or health maintenance organization that\nprovides hospital, medical or surgical expense insurance coverage for\nwhich the premiums are paid by the remitting agent of a group that\nprovides coverage of a child that terminates at a specified age shall,\nupon application of the employee, member or child, as set forth in\nsubparagraph (B) of this paragraph, provide coverage to the child after\nthat specified age and through age twenty-nine without evidence of\ninsurability, subject to all of the terms and conditions of the group\nremittance contract and the following:\n  (A) An employer shall not be required to pay all or part of the cost\nof coverage for a child provided pursuant to this subsection;\n  (B) An employee, member or child who wishes to elect continuation of\ncoverage pursuant to this subsection shall request the continuation in\nwriting:\n  (i) within sixty days following the date coverage would otherwise\nterminate due to reaching the specified age set forth in the group\ncontract;\n  (ii) within sixty days after meeting the requirements for child status\nset forth in paragraph one of this subsection when coverage for the\nchild previously terminated; or\n  (iii) during an annual thirty-day open enrollment period as described\nin the contract.\n  (C) An employee, member or child electing continuation as described in\nthis subsection shall pay to the group remitting agent or employer, but\nnot more frequently than on a monthly basis in advance, the amount of\nthe required premium payment on the due date of each payment. The\nwritten election of continuation, together with the first premium\npayment required to establish premium payment on a monthly basis in\nadvance, shall be given to the group remitting agent or employer within\nthe time periods set forth in subparagraph (B) of this paragraph. Any\npremium received within the thirty-day period after the due date shall\nbe considered timely;\n  (D) For any child electing coverage within sixty days of the date the\nchild would otherwise lose coverage due to reaching a specified age, the\neffective date of the continuation coverage shall be the date coverage\nwould have otherwise terminated. For any child electing to resume\ncoverage during an annual open enrollment period, the effective date of\nthe continuation coverage shall be prospective no later than thirty days\nafter the election and payment of first premium;\n  (E) Coverage for a child pursuant to this subsection shall consist of\ncoverage that is identical to the coverage provided to the employee or\nmember parent. If coverage is modified under the contract for any group\nof similarly situated employees or members, then the coverage shall also\nbe modified in the same manner for any child;\n  (F) Coverage shall terminate on the first to occur of the following:\n  (i) the date the child no longer meets the requirements of paragraph\none of this subsection;\n  (ii) the end of the period for which premium payments were made, if\nthere is a failure to make payment of a required premium payment within\nthe period of grace described in subparagraph (C) of this paragraph; or\n  (iii) the date on which the group remittance contract is terminated\nand not replaced by coverage under another group or group remittance\ncontract; and\n  (G) The corporation or health maintenance organization shall provide\nwritten notification of the continuation privilege described in this\nsubsection and the time period in which to request continuation to the\nemployee or member:\n  (i) in each certificate of coverage; and\n  (ii) at least sixty days prior to termination at the specified age as\nprovided in the contract.\n  (3)(A) Corporations and health maintenance organizations shall submit\nsuch reports as may be requested by the superintendent to evaluate the\neffectiveness of coverage pursuant to this subsection including, but not\nlimited to, quarterly enrollment reports.\n  (B) The superintendent may promulgate regulations to ensure the\norderly implementation and operation of the continuation coverage\nprovided pursuant to this subsection, including premium rate\nadjustments.\n