NY Ins L § 3201 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3201 - Approval of Life, Accident and Health, Credit Unemployment, and Annuity Policy Forms.

§  3201.  Approval  of life, accident and health, credit unemployment, and annuity policy forms. (a) In this article, "policy form"  means  any policy,   contract,  certificate,  or  evidence  of  insurance  and  any application  therefor,  or  rider  or  endorsement  thereto,   affording benefits  of  the  kinds  of  insurance specified in paragraph one, two, three or twenty-four of subsection  (a)  of  section  one  thousand  one hundred  thirteen  of this chapter, a group annuity certificate to which subsection (a) of section three thousand two hundred  nineteen  of  this article  applies,  and  a  funding agreement authorized by section three thousand two hundred twenty-two of this article. The term "policy  form" shall  not  include an agreement, special rider, or endorsement relating only to the manner of distribution of benefits or to the reservation  of rights  and benefits used at the request of the individual policyholder, contract holder or certificate holder.  (b) (1) No policy form shall be delivered or issued  for  delivery  in this   state  unless  it  has  been  filed  with  and  approved  by  the superintendent as conforming to the requirements of this chapter and not inconsistent with law. A group life, group accident, group health, group accident and health or blanket accident and health insurance certificate evidencing insurance coverage on a  resident  of  this  state  shall  be deemed  to have been delivered in this state, regardless of the place of actual delivery, unless the insured group is of the type  described  in: (A)  section  four  thousand  two hundred sixteen, except paragraph four where the group policy is issued to a trustee  or  trustees  of  a  fund established  or participated in by two or more employers not in the same industry with respect to an  employer  principally  located  within  the state, paragraph twelve, thirteen or fourteen of subsection (b) thereof; (B)  section  four  thousand two hundred thirty-five except subparagraph (D) where the group policy is issued to a trustee or trustees of a  fund established  or participated in by two or more employers not in the same industry with respect to an  employer  principally  located  within  the state,  subparagraph  (K), (L) or (M) of paragraph one of subsection (c) thereof; or (C) section four thousand two hundred  thirty-seven  (except subparagraph  (F)  of paragraph three of subsection (a) thereof; of this chapter; and where the master policies or contracts were lawfully issued without this state in a jurisdiction where the insurer was authorized to do an insurance business. With regard to any certificate deemed to  have been   delivered  in  this  state  by  virtue  of  this  paragraph,  the superintendent shall (i) require that the premiums charged be reasonable in relation  to  the  benefits  provided,  except  in  cases  where  the policyholder   pays  the  entire  premium;  (ii)  have  power  to  issue regulations prescribing the required, optional and prohibited provisions in such certificates; (iii) establish an  accelerated  certificate  form approval procedure available to an insurer which includes a statement in its  policy form submission letter that it is the company's opinion that the certificate form or forms comply with applicable New  York  law  and regulations.  The  superintendent, upon receipt of such a filing letter, shall grant conditional approval of such certificate form  or  forms  in reliance  on  the  aforementioned  statement  by  the  company  upon the condition that the company will retroactively  modify  such  certificate form  or  forms,  to  the  extent  necessary,  if  it  is  found  by the superintendent that the certificate form fails to comply with applicable New York laws and regulations. The superintendent may,  with  regard  to the  approval  of  any certificate deemed to have been delivered in this state by virtue of this  paragraph,  approve  such  certificate  if  the superintendent  finds  that the certificate affords insureds protections substantially similar to those which have been provided by  certificates delivered  in  this  state. Any regulations issued by the superintendent  pursuant to this paragraph may not  impose  stricter  requirements  than those applicable to similar policies and certificates actually delivered in this state.  (2)  No  unallocated  group  annuity contract or funding agreement, or policy form for accident and health insurance or any other  policy  form specified  by  the superintendent pursuant to regulation shall be issued by a domestic insurer or fraternal benefit society for delivery  outside this state unless it has been filed with the superintendent.  (3)  In  exercising  the  authority  granted by this subsection and by subsection (c) hereof, with respect to  a  policy  or  certificate  form under  which  additional  amounts may be credited pursuant to subsection (b) of section four thousand two  hundred  thirty-two  or  section  four thousand five hundred eighteen of this chapter, the superintendent shall take  into  account the tax aspects of the policy form as they relate to all parties concerned.  (4) (A) No credit insurance or credit  unemployment  insurance  policy form  shall  be  issued  unless it and its premium rates have been filed with and  approved  by  the  superintendent.  In  this  section  "credit insurance"  and  "credit  unemployment  insurance"  mean  insurance on a debtor, including an intended borrower, pursuant to a program as defined in paragraph three of  subsection  (b)  of  section  four  thousand  two hundred sixteen of this chapter for defraying the costs of attendance of a  student  at  a  college or university, in connection with a specified loan or other credit transaction to provide payment to the  creditor  in the  event  of  the death of the debtor or indemnity to the creditor for the installment payments on the  indebtedness  becoming  due  while  the debtor  is disabled as defined in the policy, or payment to the creditor for the installment payments on the indebtedness becoming due while  the debtor is unemployed as set forth in section three thousand four hundred thirty-six of this chapter.  (B)  The  superintendent shall from time to time prescribe regulations which, among other things, shall require  that,  in  the  event  of  the termination of the insurance prior to the scheduled maturity date of the indebtedness  or the last maturing instalment thereof, there shall be an appropriate refund by the insurer to  the  policyholder  of  any  amount collected  from  or  charged  to  the  policyholder  for such terminated insurance, and an appropriate refund or credit by  the  policyholder  or creditor  to  the  debtor  of an amount collected from or charged to the debtor for such terminated insurance, if  such  refund  amounts  to  one dollar or more.  (5) Notwithstanding the other provisions of this section, on and after June  first,  nineteen  hundred eighty no policy form of industrial life insurance, industrial accident insurance or industrial health  insurance shall  be  approved  by  the superintendent for delivery or issuance for delivery in this state.  (6) (A)  As  an  alternative  procedure  to  the  policy  form  filing requirements  of  paragraph  (1)  of this subsection, an insurer has the option to file an expedited policy form approval  application  with  the superintendent  pursuant  to  this paragraph. If this option is elected, the filing shall include the proposed policy form,  including  rates  as required,  and  all  necessary  supporting  material  requested  by  the superintendent pursuant to  rule,  and  a  certification  signed  by  an officer of the insurer, who is knowledgeable with respect to the law and regulation  applicable  to the type of policy form, that such form is in compliance with the applicable law and regulations to the best of his or her knowledge and belief.   Within ninety days of receipt of a filing, the  superintendent  shall, in  writing,  either  approve,  submit  a  detailed  list to the insurer  requesting all additional information necessary to make a  determination on  the  filing,  or  deny  such filing, otherwise, such filing shall be deemed approved. Any denial issued by the superintendent shall state the reasons  for  such  disapproval.  If  an  insurer  does  not provide the additional information requested by the superintendent,  or  respond  to the  superintendent's  objections  within  forty-five days of receipt of such request or denial, then such filing shall be deemed denied and such filing may not be resubmitted for a period not  to  exceed  ninety  days from  the date that such information or response was due. The forty-five day limit for providing such additional information or response  may  be extended at the option of the superintendent.   In   the  event  that  an  insurer  properly  submits  the  additional information or response, then  such  filing  shall  be  deemed  approved forty-five  days  after  receipt  of such information or response by the superintendent, unless the insurer is notified in writing prior to  such date  that  the  filing  has  been  denied.  Such denial shall state the reasons for such disapproval and cannot be based on  any  objection  not specified  in  the superintendent's initial review of the filing, unless the objection arises from a modification of the policy forms made by the insurer in addressing the objections or new material  submitted  by  the insurer.    Notwithstanding  anything  to the contrary contained in this section, the superintendent may, at  any  time,  before  the  filing  is either   deemed  approved,  affirmatively  approved,  or  denied,  raise objections to the policy form that is based on the explicit requirements of this chapter and any applicable regulations.   The superintendent shall, as soon as practicable, but  no  later  than sixty days after receipt of the filing, notify the insurer if its filing is incomplete or fails to comply with applicable statutory or regulatory requirements.  Such  notice  shall  indicate  that  the  filing is being returned with no action by the superintendent and that  the  period  for the superintendent's substantive review has not commenced.  (B)   Nothing   contained   in   this  paragraph  shall  prohibit  the superintendent from requiring an  insurer  to  retroactively  modify  or withdraw  a  form approved pursuant to the expedited filing procedure if such form is found to fail to conform  with  the  requirements  of  this chapter,  provided  that  the  order  to withdraw or modify such form is issued in accordance with the provisions of section three  thousand  one hundred ten or section three thousand two hundred two of this chapter.  (C)  In  addition  to  any  penalties for violations contained in this chapter, any insurer which receives approval under this subsection for a form which is found to fail  to  comply  with  the  provisions  of  this chapter  shall be ineligible to apply for an expedited review under this subsection for a period not to exceed one year.  (7) Notwithstanding any other provision of this section,  an  approved policy form that has been revised may continue to be delivered or issued for   delivery   in   this  state  without  further  approval  from  the superintendent, provided that the  policy  form  is  revised  solely  to reflect:  (A)  a  change in the investment options of a separate account offered under the policy form, in accordance with an amended statement as to the methods  of  operation  of  the  separate  account   approved   by   the superintendent  pursuant  to subsection (e) of section four thousand two hundred  forty  of  this  chapter,  and   further   provided   that   an informational  filing,  in  a  form  acceptable  to  the superintendent, identifying the policy forms that have been revised and  the  investment options  offered in each policy form, is submitted to the superintendent no later than sixty days after the amended statement as to  the  methods of operation of the separate account has been approved; or  (B) any other type of change to a class or classes of policy forms for which  the  superintendent  waives  or otherwise modifies the filing and approval requirements of  this  section  provided,  however,  that  such determination to waive or otherwise modify shall be published in written guidance  issued by the superintendent after such determination has been made.  (c) (1) The superintendent may disapprove any policy form for delivery or issuance for delivery in  this  state  if  he  finds  that  the  same contains  any  provision  or  has  any  title, heading, backing or other indication of the contents of any or all of  its  provisions,  which  is likely  to  mislead  the  policyholder,  contract  holder or certificate holder.  (2) The superintendent may disapprove any life insurance policy  form, or  any  form  of  annuity contract or group annuity certificate, or any form of funding agreement for delivery or issuance for delivery in  this state,  if  its  issuance  would  be  prejudicial  to  the  interests of policyholders or members or it contains  provisions  which  are  unjust, unfair or inequitable.  (3)   The  superintendent  may  disapprove  any  accident  and  health insurance policy form for delivery or  issuance  for  delivery  in  this state  if  the benefits provided therein are unreasonable in relation to the premium charged or any such form contains provisions which encourage misrepresentation  or  are  unjust,  unfair,  inequitable,   misleading, deceptive, or contrary to law or to the public policy of this state.  (4)  The  superintendent  shall  not approve any life insurance policy form containing any war or travel exclusion or restriction, for delivery or issuance for delivery in this state, unless such  policy  form  shall have  printed  or  stamped across its face in red and in capital letters not smaller than twelve point type, or in an  equally  prominent  manner established  at  the  discretion  of  the superintendent and promulgated through regulations, the following:   "Read your policy (certificate) carefully.   "Certain (war, travel) risks are not assumed.   __________________________________state which or both)   In case  of  any  doubt  write  your  company  (society)  for  further explanation."  (5) The superintendent shall not approve any annuity or life insurance policy  form which is subject to the provisions of section four thousand two hundred  twenty,  four  thousand  two  hundred  twenty-one  or  four thousand  five  hundred  eleven  of  this  chapter,  unless  a  detailed statement of the method used by the  insurer  in  calculating  any  cash surrender value and any paid-up nonforfeiture benefit in the policy form is  stated  therein or, in lieu thereof, a statement that such method of computation has been filed with the insurance  supervisory  official  of the  state in which the policy form is delivered, and unless a statement of the method to be used in calculating the  cash  surrender  value  and paid-up  nonforfeiture  benefit  available on any anniversary beyond the last anniversary for which such value  and  benefits  are  consecutively shown  in  the  policy  form  is  included therein, and, with respect to policy forms under which additional amounts may be credited pursuant  to subsection  (b)  of  section  four  thousand  two  hundred thirty-two or section four thousand five hundred eighteen of this chapter, the insurer shall also furnish such further information to the superintendent as the superintendent may require.  (6) (a) The superintendent may disapprove any policy form specified in paragraph two of subsection (b) of this section  issued  by  a  domestic life insurer or fraternal benefit society for delivery outside the state  if   its   issuance  would  be  prejudicial  to  the  interests  of  its policyholders or members.  (b)  Except  for  the  policy  forms  specified  in  paragraph  two of subsection  (b)  of  this  section,  every  domestic  life  insurer  and fraternal  benefit society shall file annually with the superintendent a list identifying and describing the policy forms issued by  the  insurer or  fraternal  benefit  society for delivery outside the state in a form prescribed by the superintendent. If the superintendent determines  that the  issuance  of  a  policy  form has been or may be prejudicial to the interests of policyholders or members, the superintendent may  take  any action  he or she deems appropriate, including issuing an order, after a hearing, to cease and desist issuing the policy form.  (7) If any policy of  individual  accident  and  health  insurance  is issued  by  an  insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state shall  have advised  the  superintendent that any such policy form is not subject to approval or disapproval by such  official,  the  superintendent  may  by ruling  require  that  such  policy form meet the standards set forth in subsections (c) and (d) of section three thousand two hundred sixteen of this article.  (8) Without limitation on his  other  powers  and  duties  under  this section,  the  superintendent  shall not approve any credit insurance or credit unemployment insurance policy  forms  or  premium  rates  if  the premium rates are unreasonable in relation to the benefits provided.  (9)  Each  insurer  shall  file  with  the superintendent of financial services any change in the premium rates for policies  authorized  under subparagraph  (J)  of  paragraph  one  of subsection (c) of section four thousand two hundred thirty-five of this chapter, and the same shall  be subject to his approval.  (10)  The  superintendent shall not approve any form of life insurance policy that is subject to the provisions of section  four  thousand  two hundred  twenty-one of this chapter or any form of annuity contract that is subject to the  provisions  of  section  four  thousand  two  hundred twenty-three of this chapter if such form of policy or contract provides for the adjustment of any cash surrender benefit or policy loan value in accordance  with  a  market-value adjustment formula, unless there shall have been filed with  the  superintendent  a  memorandum,  in  form  and substance   satisfactory   to   the   superintendent,   describing   the market-value adjustment formula and stating that, in the opinion of  the insurer,  the  formula  provides  reasonable  equity  to terminating and continuing policy and contract holders and to the insurer  and  complies with the nonforfeiture provisions of this chapter.  (11)  (A) The superintendent shall not approve a life insurance policy which provides for accelerated payment  of  death  benefits  or  special surrender  values  pursuant to subparagraph (B), (C), (D), (E) or (F) of paragraph one of subsection (a) of  section  one  thousand  one  hundred thirteen  of  this  chapter unless it also provides for such accelerated payments or special surrender values pursuant  to  subparagraph  (A)  of paragraph one of subsection (a) of such section.  (B)  The  superintendent  shall  promulgate  a regulation establishing rules for advertising, disclosure, benefit levels, benefit  eligibility, payment  of  long  term  care  benefits, nonforfeiture, and reserves for accelerated payment  of  death  benefits  or  special  surrender  values provided  under  a life insurance policy. The regulation shall establish reasonable disclosure requirements  concerning  the  percentage  of  the death  benefit  payable when accelerated payment of the death benefit or special surrender value occurs, the impact of accelerated payment of the  death benefit or special  surrender  value  on  eligibility  for  public assistance  (as  determined by the commissioner of social services), the prohibition that no health care facility as defined in section twenty of the  public health law can require any person to accelerate payment of a death benefit or obtain a special surrender  value  as  a  condition  of admission,  providing  or  continuing  care,  and notice of possible tax obligations.  (12) The superintendent shall  promulgate  a  regulation  relating  to waiver  of  premium  for  unemployment as authorized by paragraph one of subsection (a) of section one thousand  one  hundred  thirteen  of  this chapter  establishing  minimum  standards  for  benefit levels, benefits eligibility and exclusions. The premium charged shall be  reasonable  in relation to the benefit provided.  (d)  The  superintendent  shall,  within  a  reasonable time after the filing of any policy form requiring approval, notify the insurer  filing the form of his approval or disapproval of it.