reglab/housing_qa huggingface dataset:
NY Ins L § 4303-A (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4303-A - Prescription Synchronization.

§  4303-a.  Prescription  synchronization.  (a) Every hospital service corporation and health service corporation providing  prescription  drug coverage  when  applicable  to  permit  synchronization shall permit and apply a daily pro-rated cost-sharing  rate  to  prescriptions  that  are dispensed  by a network pharmacy for less than a thirty day supply, when it is agreed among the covered individual, a health  care  practitioner, and  a pharmacist that synchronization of multiple prescriptions for the treatment of a chronic illness is in the best interest  of  the  covered individual  for  the  management  or  treatment  of that chronic illness provided that all of the following apply:  (i) The medications are covered by the policy or plan.  (ii) The medications are used for treatment and management of  chronic conditions that are subject to refills.  (iii)  The medications are not a Schedule II controlled substance or a Schedule III controlled substance containing hydrocodone.  (iv) The medications meet all prior authorization criteria specific to medications at the time of the synchronization request.  (v) The medications are of a formulation that can be effectively split over required short fill periods to achieve synchronization.  (vi) The medications do not have quantity limits or dose  optimization criteria   or   requirements   that  would  be  violated  in  fulfilling synchronization.  (b) No hospital service  corporation  or  health  service  corporation providing  prescription  drug  coverage  shall  deny  coverage  for  the dispensing of a medication for partial fill when it is for  purposes  of synchronizing  the  patient's  medications.  When  applicable  to permit synchronization, every hospital service corporation  or  health  service corporation  providing  prescription drug coverage must allow a pharmacy to override any denial codes indicating that  a  prescription  is  being refilled too soon for the purposes of medication synchronization.  (c)  Dispensing  fees  for  partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any pro-rated copay for the beneficiary or fee paid for alignment services.  (d) Nothing in this section shall be deemed  to  require  health  care practitioners  and  pharmacists to synchronize the refilling of multiple prescriptions for a covered individual.  (e) The requirements of this paragraph shall apply only once for  each prescription  drug  subject  to  medication  synchronization except when either of the following occurs:  (i) The prescriber changes the dosage or frequency  of  administration of the prescription drug subject to a medication synchronization; or  (ii) The prescriber prescribes a different drug.
NY Ins L § 4306-A (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-A - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.

§  4306-a. Health insurance coverage for full-time students on medical leaves of absence. (a)  Every  contract  issued  by  a  medical  expense indemnity  corporation,  hospital  service corporation or health service corporation that  provides  coverage  for  dependent  children  who  are full-time  students  to a higher age than other dependent children shall continue the coverage of a  dependent  student  who  takes  a  leave  of absence  from  school  due to illness for a period of twelve months from the last day of attendance at school, provided, however, that nothing in this section shall require coverage of a dependent  student  beyond  the age at which coverage would otherwise terminate.  (b) In order to qualify under this section, the medical necessity of a leave  of  absence  from  school  must  be certified to by the student's attending physician who is licensed to practice  in  the  state  of  New York.  Written  documentation  of  the  illness must be submitted to the medical expense indemnity corporation, hospital service  corporation  or health service corporation.  (c)  The  rate charged for such extended coverage shall be the same as that charged while the dependent is enrolled as a full-time student.
NY Ins L § 4306-B (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-B - Primary and Preventive Obstetric and Gynecologic Care.

§  4306-b.  Primary and preventive obstetric and gynecologic care. (a) No corporation subject to  the  provisions  of  this  article  shall  by contract, written policy or procedure limit a female subscriber's direct access  to  primary  and  preventive obstetric and gynecologic services, including  annual  examinations,  care  resulting   from   such   annual examinations,  and  treatment  of  acute  gynecologic conditions, from a qualified provider of such services of her choice from within  the  plan or  for  any  care  related  to  a  pregnancy,  provided  that: (1) such qualified provider discusses such services and treatment plan  with  the subscriber's   primary   care   practitioner   in  accordance  with  the requirements of the corporation; and (2) such qualified provider  agrees to  adhere  to  the corporation's policies and procedures, including any applicable  procedures   regarding   referrals   and   obtaining   prior authorization for services other than obstetric and gynecologic services rendered  by  such  qualified  provider,  and agrees to provide services pursuant to a treatment plan (if any) approved by the corporation.  (b)  A  corporation  shall  treat  the  provision  of  obstetric   and gynecologic  care, and the ordering of related obstetric and gynecologic items  and  services,  pursuant  to  the  direct  access  described   in subsection  (a) of this section by a participating qualified provider of such services, as the authorization of the primary care provider.  (c) It shall be the duty of the administrative officer or other person in charge of each corporation subject to the provisions of this  article to  advise each female subscriber, in writing, of the provisions of this section.
NY Ins L § 4306-D (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-D - Choice of Health Care Provider.

§  4306-d.  Choice  of  health  care  provider.  A corporation that is   subject to the provisions of this article and requires or  provides  for   designation  by  a  subscriber  of a participating primary care provider   shall permit the subscriber to designate any participating primary  care   provider  who is available to accept such individual, and in the case of   a  child,  shall  permit  the  subscriber  to  designate   a   physician   (allopathic or osteopathic) who specializes in pediatrics as the child's   primary  care  provider  if such provider participates in the network of   the corporation.
NY Ins L § 4306-E (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-E - Prohibition on Lifetime and Annual Limits.

§ 4306-e. Prohibition on lifetime and annual limits. (a) A corporation shall  not  establish a lifetime limit on the dollar amount of essential health benefits in an individual, group or blanket contract of hospital, medical, surgical or prescription drug expense insurance.  (b) A corporation shall not establish an annual limit  on  the  dollar amount  of  essential health benefits in an individual, group or blanket contract of hospital, medical, surgical  or  prescription  drug  expense insurance  for  contract  years  beginning on and after January one, two thousand fourteen.  (c) For contract years beginning prior to January  one,  two  thousand fourteen,  a  corporation  may establish restricted annual limits on the dollar amount of essential health benefits in an  individual,  group  or blanket  contract  of  hospital,  medical, surgical or prescription drug expense insurance consistent with section  2711  of  the  Public  Health Service Act, 42 U.S.C. § 300gg-11 or any regulations thereunder.  (d)  The requirements of subsections (b) and (c) of this section shall not be applicable to any individual contract  that  is  a  grandfathered health  plan.  For purposes of this section, "grandfathered health plan" means coverage provided by a corporation  in  which  an  individual  was enrolled  on  March  twenty-third,  two  thousand ten for as long as the coverage maintains  grandfathered  status  in  accordance  with  section 1251(e) of the Affordable Care Act, 42 U.S.C. § 18011(e).  (e)  For  purposes  of this section, "essential health benefits" shall have the meaning ascribed by section 1302(b) of the Affordable Care Act, 42 U.S.C. § 18022(b).
NY Ins L § 4306-F (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-F - Maternal Depression Screenings.

§  4306-f.  Maternal  depression  screenings. To the extent a contract   provides coverage for  maternal  depression  screening,  no  corporation   subject  to  this article shall by contract, written policy or procedure   limit a patient insured's direct access to screening  and  referral  for   maternal   depression,   as   defined  in  subdivision  one  of  section   twenty-five hundred-k of the public  health  law,  from  a  provider  of   obstetrical,  gynecologic, or pediatric services of her choice; provided   that the patient insured's access to such services, coverage and  choice   of  provider  is  otherwise  subject  to the terms and conditions of the   contract under which the patient insured is covered.
NY Ins L § 4306-G (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4306-G - Telehealth Delivery of Services.

§ 4306-g. Telehealth delivery of services. (a) A corporation shall not exclude  from  coverage  a  service  that  is  otherwise covered under a contract that provides comprehensive coverage for hospital,  medical  or surgical  care  because the service is delivered via telehealth, as that term is defined in subsection (b) of this  section;  provided,  however, that  a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation may subject  the  coverage  of  a  service  delivered  via telehealth to co-payments, coinsurance or deductibles provided that they are  at  least  as favorable to the insured as those established for the same service when  not  delivered  via  telehealth.  A  corporation  may subject the coverage of a service delivered via telehealth to reasonable utilization  management  and  quality  assurance  requirements  that are consistent  with  those  established  for  the  same  service  when  not delivered via telehealth.  (b)  For  purposes  of  this  section,  "telehealth"  means the use of electronic information and communication technologies by a  health  care provider  to deliver health care services to an insured individual while such individual is located at a site that is  different  from  the  site where the health care provider is located.
NY Ins L § 4309 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4309 - Limitation on Expenses.

§  4309.  Limitation  on  expenses.  (a) No corporation subject to the provisions of this article shall, during any  one  year,  disburse  more than the percentages hereafter prescribed of the aggregate amount of the premiums  received during such year as expenditures for expenses, which, for the purposes of this article, shall include  all  expenses  paid  or incurred  by  the  corporation  which do not constitute benefit payments made to or on behalf of persons covered under contracts issued  by  such corporations:  (1)  For  hospital service corporations: fifteen per centum reduced by one per centum for each five million dollars or fraction  thereof  above one million dollars of premiums received to ten per centum.  (2)  All  other  corporations:  twenty  per  centum reduced by one per centum for each five million  dollars  or  fraction  thereof  above  one million  dollars  of premiums received to fifteen per centum except that for any corporation which derives more than  fifty  per  centum  of  its premiums  received  from  the  sale  of contracts which provide hospital service benefits: seventeen and one-half per centum reduced by  one  per centum  for  each  five  million  dollars  or fraction thereof above one million dollars of premiums received to twelve and one-half per centum.  (3)  Upon  written  application,  the  superintendent  may  waive  the limitations  in  paragraph  one  or  two  of  this  subsection  for  any corporation which has not attained the  level  of  enrollment  which  it needs  to  attain  a  break-even  position.  The  break-even position is attained when the amount of annual losses and expenses incurred  by  the corporation  is  equal  to  the  amount  of  premiums earned during this period. Such corporation shall be subject to  such  limitations  in  the calendar  year  following  the  year  in  which  it attains a break-even position.  (b) If any such corporation shall in any calendar year make  or  incur expenses  as  hereinabove  defined  in  excess  of its expense limit the superintendent may, upon written application of such corporation  and  a showing  that such corporation has taken steps in accordance with a plan submitted by the corporation and approved by  the  superintendent  which will  enable it to comply with the provisions of this section during the next calendar year, suspend the expense limit for such  corporation  for the   calendar   year   in   which  the  excess  was  incurred  but  the superintendent  shall  not  suspend  the  expense  limit  for  any  such corporation for more than two calendar years in succession.
NY Ins L § 4312 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4312 - Employment of Solicitors; Pension Plans.

§  4312.  Employment  of  solicitors;  pension  plans.  (a)  1.  Every corporation subject  to  the  provisions  of  this  article  may  employ solicitors  or  accept  business from agents and brokers on a commission basis, but all solicitors shall be paid on a salary basis  only.  It  is expressly  provided such solicitors are exempt from obtaining a license. Commissions shall be included in the corporation's rate manual and  rate filings  and  commissions  payable  by  health maintenance organizations organized  under  this  article  or  health  maintenance   organizations operating  as  a  line  of business of corporations organized under this article shall continue to be subject to existing  regulations  governing commissions payable by health maintenance organizations.   2.  Any  corporation exercising the authority granted in paragraph one of this subsection shall provide to the superintendent  at  the  time  a corporation  commences  the  use  of  agents and brokers on a commission basis, a detailed plan explaining  the  purpose  for  which  agents  and brokers  are  to  be  utilized,  the lines of business or products where agents and brokers are to be  utilized,  the  commission  scales  to  be employed  in  compensating  such  agents  and  brokers,  and  such other information as required by the superintendent.  (b) No corporation subject to the provisions  of  this  article  shall hereafter  enter  into  any  agreement,  directly or indirectly, with an officer, director or salaried employee of such  corporation  whereby  it agrees that for any services rendered or to be rendered he shall receive any  salary,  compensation or emolument that will extend beyond a period of thirty-six months from  the  date  of  such  agreement,  except  that payment  of  an  amount  not  in  excess of twenty percent for the years nineteen  hundred  eighty-five  and  nineteen  hundred  eighty-six   and thirty-three  and  one-third  percent  for  the  year  nineteen  hundred eighty-seven and thereafter of the salary or other compensation  of  any of  its  officers  or  employees,  other  than a mechanic, workingman or laborer, may by written contract  be  deferred  beyond  such  period  of thirty-six  months,  which  contract may include conditions to be met by such  officer  or  employee  before  payment  will  be  made.  No   such corporation  shall grant any pension to any officer, director or trustee thereof or to any member of his family after  death,  except  that  such corporation  may, in pursuance of the terms of a retirement plan adopted by the board of directors  of  such  corporation  and  approved  by  the superintendent,  provide  for  any  person  who is a salaried officer or employee of such corporation, a pension  payable  at  the  time  of  his retirement  by  reason  of  age  or  disability, and also life insurance benefits payable at his death.
NY Ins L § 4313 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4313 - Applicability of Other Provisions of This Chapter.

§  4313. Applicability of other provisions of this chapter. (a) Except as otherwise provided and except  as  the  context  otherwise  requires, every  medical  expense  indemnity corporation, dental expense indemnity corporation,  health   service   corporation,   and   hospital   service corporation  shall  be  subject to all requirements of this chapter made applicable to insurance  companies  generally,  and  to  the  rules  and regulations  of  the superintendent except in so far as said laws, rules and regulations may  be  inconsistent  with  other  provisions  of  this article.  (b)   Every   such   corporation  shall  be  subject  to  liquidation, dissolution or rehabilitation pursuant  to  the  provisions  of  article seventy-four  of  this  chapter, and such proceedings shall be under the supervision of the superintendent, who shall have  such  of  the  powers granted  to  him  pursuant  to  the  provisions  of  such article as are applicable to domestic insurance companies.  (c) Every such corporation shall  be  subject  to  the  provisions  of section  two  thousand  six hundred sixteen of this chapter, relating to living organ and tissue donors.
NY Ins L § 4314 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4314 - Not to Affect Provisions of Workers' Compensation Law.

§  4314.  Not  to  affect  provisions of workers' compensation law. No   provisions of this article or  any  contract  issued  by  a  corporation   subject  to  the  provisions of this article shall in any way affect the   operation of the workers' compensation law.
NY Ins L § 4315 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4315 - Arbitration; Judicial Review.

§  4315. Arbitration; judicial review. (a) Any dispute arising between a hospital service corporation or health service corporation subject  to the  provisions  of  this  article  and  any  hospital  with  which such corporation has a contract  for  hospitalization  may,  pursuant  to  an agreement  to  that  effect  in  the  contract  or  by subsequent mutual agreement of the parties, be submitted to the commissioner of health for his decision with respect thereto. Any such decision,  pursuant  to  the terms  of such submission, shall have the effect of an arbitration award under the provisions of the civil practice law and rules.  (b) Except as provided in subsection (a) hereof,  all  orders  of  the superintendent  and all final orders or decisions of the commissioner of health made under the provisions of this article  shall  be  subject  to judicial  review as provided in section three hundred twenty-six of this chapter.
NY Ins L § 4316 (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4316 - Individual Contracts; Premium Refund at Death of Insured.

§  4316.  Individual  contracts;  premium  refund at death of insured.   Under individual contracts for which premiums are paid directly  to  the   corporation  by the individual, if the death of the insured or a covered   dependent occurs during a period for which the premium  has  been  paid,   the  corporation  shall refund the premium or the portion of the premium   actually paid by the insured for that person for any period  beyond  the   end of the policy month in which such death occurred.
NY Ins L § 4318-A (2021)
2021 New York Laws ISC - Insurance Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations 4318-A - Certification of Creditable Coverage by Corporations Organized Under This Article.

§   4318-a.  Certification  of  creditable  coverage  by  corporations organized under this article.  (a)  Every  corporation  subject  to  the provisions  of  this  article  that  issues  individual health insurance contracts or group or blanket accident and  health  insurance  contracts shall  provide covered individuals with written certification, in a form as the superintendent may approve, of:  (1) the period of creditable coverage,  as  defined  in  section  four thousand three hundred eighteen of this article, of the individual under such  contract  and under any continuation coverage pursuant to state or federal law; and  (2) any waiting period or affiliation period (if  applicable)  imposed with respect to the individual for coverage under any such contract.  (b) The corporation shall provide such certification:  (1) at the time an individual ceases to be covered under the contract, including  any period of time the individual was covered pursuant to any right of continuation under the contract; and  (2) on the request on behalf of an  individual  made  not  later  than twenty-four months after the date of cessation of the coverage described in paragraph one of this subsection.  (c)  In  the event of an election by an insurer or a group health plan to count the period of creditable coverage based on coverage of benefits within classes or categories of benefits as provided in state or federal law, if that insurer or group health  plan  enrolls  an  individual  for coverage  under  its  contract  or  plan  and  the individual provides a certification of coverage of the individual under subsection (a) of this section, then upon request of such insurer or  group  health  plan,  any corporation  subject  to  the provisions of this article that issued the certification of coverage provided  by  the  individual  shall  promptly disclose  to such requesting insurer or group health plan information on coverage of classes and categories of health  benefits  available  under the  corporation's  contract.  The corporation may charge the requesting plan or insurer for the reasonable cost of disclosing such information.  (d) A corporation that issues group or  blanket  accident  and  health insurance  contracts  is  deemed  to  have satisfied the requirements of subsection (a) of  this  section  if  the  contract  holder  by  written agreement   with   the   corporation   actually   provides  the  written certification in accordance with this section.