reglab/housing_qa huggingface dataset:
NY Ins L § 3224-C (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3224-C - Coordination of Benefits.

§  3224-c.  Coordination  of  benefits.  An insurer or organization or   corporation licensed or certified pursuant  to  article  forty-three  or   forty-seven  of  this chapter or article forty-four of the public health   law shall not deny a claim, either in whole or in  part,  on  the  basis   that  it is coordinating benefits and another insurer or organization or   corporation or other entity is liable for  the  payment  of  the  claim,   unless  it  has a reasonable basis to believe that the insured has other   health insurance coverage which is  primary  for  that  benefit.  If  an   insurer or organization or corporation does not have current information   from the insured regarding other coverage, and requests such information   in  accordance with subsection (b) of section three thousand two hundred   twenty-four-a of this article, and no  information  is  received  within   forty-five  days,  the claim shall be adjudicated provided, however, the   claim shall not be denied based  on  the  insurer,  or  organization  or   corporation not having received such information.
NY Ins L § 3224-D (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3224-D - Prescription Synchronization.

§  3224-d. Prescription synchronization. (a) Every individual or group health  insurance  policy  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  individual  or  group  health  insurance   policy   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 individual  or  group  health  insurance policy 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 § 3225 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3225 - Eligibility for Health Insurance in Cases of Exposure to Des.

§  3225. Eligibility for health insurance in cases of exposure to DES.   No policy of accident or health insurance, or group or blanket  accident   or  health insurance or renewals thereof shall be denied or cancelled by   the insurer, solely because the  insured  person  has  been  exposed  to   diethylstilbestrol, commonly referred to as DES.
NY Ins L § 3226 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3226 - Reinsurance Contracts Excepted.

§ 3226. Reinsurance contracts excepted. The provisions of this article   shall  not  apply  to  contracts  of  reinsurance,  except  as otherwise   provided by law.
NY Ins L § 3227 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3227 - Interest Upon Surrenders, Policy Loans and Other Funds.

§  3227.  Interest  upon surrenders, policy loans and other funds. (a) Interest, at the rate provided for in section three thousand two hundred fourteen of this article, shall be payable by life  insurers,  fraternal benefit societies, and life insurance departments of savings banks upon: (1)  the value of policies surrendered by policyholders for cash values, including the rollover of annuity funds to other entities, and  (2)  the funds disbursed as policy loans. Such interest payment shall be added to and  be a part of the total sum paid or be paid separately at the option of the insurer.  (b) The interest calculated on amounts described in paragraphs one and two of subsection (a) hereof shall  be  calculated  from  the  date  the documentation  necessary  to complete the transaction is received by the insurer and shall be payable if the funds are not mailed or delivered by the insurer within ten working days of said receipt.  (c) No interest need be payable pursuant to this  section  unless  the amount  of  such  interest  is  at  least  twenty-five dollars or if the payment of benefits by the insurer has been deferred pursuant  to  other provisions of this chapter.  (d)  Irrespective  of  the  payment of interest in accordance with the above provisions, such life insurers, fraternal  benefit  societies  and life  insurance  departments  of  savings banks shall make disbursements under paragraphs one and two of subsection (a) hereof  as  expeditiously as possible.
NY Ins L § 3228 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3228 - Individual Accident and Health Insurance Policies; Premium Refund at Death of Insured.

§  3228.  Individual  accident  and health insurance policies; premium   refund at death of insured. If the death of the  insured  or  a  covered   dependent  occurs  during  a  period  for  which  the  premium  under an   individual accident and health  insurance  policy  has  been  paid,  the   insurer  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 § 3229 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3229 - Minimum Benefit Standards for Certain Long Term Care Plans.

§  3229.  Minimum  benefit standards for certain long term care plans. (a) The minimum standards for an insurance plan, which may qualify under the partnership for long term care program  pursuant  to  section  three hundred  sixty-seven-f  of the social services law, shall be established by  regulations  of  the  superintendent,  in  consultation   with   the commissioner  of  health  and  the  director of the state office for the aging, as approved by the director of the budget, which shall require at a minimum (1) a residential health care facility benefit in an amount to be determined by the regulations of the superintendent; (2) a home  care benefit  with  personal  care,  nursing  care, adult day health care and respite care services, which shall provide total benefits in  an  amount determined  by  regulations  of  the  superintendent;  (3) a duration of benefits not less than twelve months; and (4) arrangements  through  the insurance  plan  for managed care including preauthorized assessment and referral programs, utilization controls and use of approved providers.  (b) In establishing minimum  benefit  standards  for  insurance  plans pursuant  to  this  section, the superintendent shall seek to ensure the cost effectiveness  of  the  partnership  for  long  term  care  program established  pursuant  to  section  three  hundred  sixty-seven-f of the social services law, and  may  establish  minimum  permissible  payments under  such  insurance  plans.  The  superintendent shall not approve an insurance plan which includes an exclusion for  pre-existing  conditions that  exceeds six months, or which does not comply with paragraph six of subsection (b) of section one thousand one  hundred  seventeen  of  this chapter.
NY Ins L § 3231-2 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3231*2 - Health Insurance Policies and Subscriber Contracts; Prohibited Claims.

* §   3231.   Health  insurance  policies  and  subscriber  contracts; prohibited claims. (a) For the purposes of this section the terms health care provider,  practitioner,  clinical  laboratory  services,  pharmacy services, radiation therapy services, physical therapy services or x-ray or  imaging  services  shall  have the same meanings as are set forth in section two hundred thirty-eight of the public health law.  (b) No health care provider or practitioner may demand or request  any payment  for  clinical laboratory services, pharmacy services, radiation therapy services, physical therapy services or x-ray or imaging services furnished pursuant to  a  referral  prohibited  by  subdivision  one  of section two hundred thirty-eight-a of the public health law.  (c)  No  insurer  shall  be  required  to pay any claim, bill or other demand or request for payment by a health  care  provider  for  clinical laboratory  services,  pharmacy  services,  radiation  therapy services, physical  therapy  services  or  x-ray  or  imaging  services  furnished pursuant  to  a  referral  prohibited  by subdivision one of section two hundred thirty-eight-a of the public health law.  (d)  Every  policy  of  accident  or  health  insurance  issued  by  a commercial  insurer  and  every subscriber contract issued by a hospital service corporation,  health  service  corporation  or  medical  expense indemnity  corporation  which  provides coverage for clinical laboratory services,  pharmacy  services,  radiation  therapy  services,   physical therapy  services or x-ray or imaging services shall include a provision excluding payment of any claim, bill or  other  demand  or  request  for payment for such services furnished pursuant to a referral prohibited by subdivision  one  of  section  two  hundred thirty-eight-a of the public health law.  (e) Every insurer subject to the  provisions  of  this  section  shall report  to  the  commissioner  of  health  any  pattern of submission of claims, bills or other demands or  requests  for  payment  submitted  in violation  of  subsection  (b) of this section, within thirty days after such insurer has knowledge of such pattern.  (f) Notwithstanding the requirements of subsections (c), (d)  and  (e) of   this  section,  an  insurer  reimbursing  for  clinical  laboratory services,  pharmacy  services,  radiation  therapy  services,   physical therapy  services  or x-ray or imaging services is not required to audit or investigate any claim, bill or other demand or  request  for  payment for such items or services furnished pursuant to a referral.   * NB There are 2 § 3231's
NY Ins L § 3232-A (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3232-A - Certification of Creditable Coverage.

§  3232-a. Certification of creditable coverage. (a) Every insurer who delivers or issues for delivery individual health insurance policies  or group or blanket accident and health insurance policies shall provide to covered   individuals   written   certification,   in   a  form  as  the superintendent may approve, of:  (1) the period of creditable coverage, as  defined  in  section  three thousand two hundred thirty-two of this article, of the individual under such  policy and any continuation coverage of the individual pursuant to state or federal law; and  (2) any waiting period or affiliation period (if  applicable)  imposed with respect to the individual for any coverage under the policy.  (b) The insurer shall provide such written certification:  (1)  at  the time an individual ceases to be covered under the policy, including any period of time such individual was covered pursuant to any right of continuation under such policy; 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 policy or plan and such individual provides written certification of coverage of the individual pursuant to  subsection  (a) of this section, then upon request of such insurer or group health plan, the insurer that issued the certification of coverage so 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  its  policy.  An  insurer  disclosing  such information may charge the requesting plan or insurer for the reasonable cost of such disclosure.  (d) An insurer who delivers or issues for delivery  group  or  blanket accident  and  health insurance policies is deemed to have satisfied the requirements of subsection (a) of this section if  the  policyholder  by written  agreement  with  the  insurer  actually  provides  the  written certification in accordance with this section.
NY Ins L § 3234 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3234 - Pre-Existing Condition Provisions in Group and Blanket Disability Policies.

* §  3234.  Pre-existing  condition  provisions  in  group and blanket disability policies. (a) Every group or blanket policy issued or  issued for  delivery  in  this  state  which provides benefits by reason of the disability of the insured and which includes  a  pre-existing  condition provision   shall  contain  in  substance  the  following  provision  or provisions which in the opinion of the superintendent are more favorable to the members of the group:  (1) In determining whether a pre-existing condition provision  applies to  an  eligible  person,  the  group or blanket disability policy shall credit the time the person was previously covered under a previous group or blanket disability insurance  plan  or  policy  or  employer-provided disability  benefit arrangement, if the previous coverage was continuous to a date not more than sixty days prior to the effective  date  of  the new  coverage.  The  credit  shall apply to the extent that the previous coverage or level of benefits  was  substantially  similar  to  the  new coverage or level of benefits; and  (2)  No  pre-existing condition provision shall exclude coverage for a period in excess of  twelve  months  following  the  effective  date  of coverage for the covered person.  (b)  Nothing  herein  shall  be  construed  to prohibit or restrict an insurer from utilizing other forms of underwriting for  the  members  of the  group  in  lieu  of,  or in addition to, the pre-existing condition provision described in subsection (a) of this section.   * NB There are 3 § 3234's
NY Ins L § 3234-2 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3234*2 - Limitations on Administrative Services and Stop-Loss Coverage.

* §   3234.  Limitations  on  administrative  services  and  stop-loss   coverage.  No insurer, subsidiary of an insurer, or controlled person of   a holding company system may act as an administrator  or  claims  paying   agent,  as  opposed  to an insurer, on behalf of a group which denies or   limits benefits for a specific disease or condition or for  a  procedure   or treatment unique to a specific disease or condition in a manner which   would  be  inconsistent  with this chapter or regulations promulgated by   the superintendent  had  the  group  purchased  insurance.  No  insurer,   subsidiary  of an insurer, or controlled person of a holding company may   provide stop loss, catastrophic or reinsurance coverage to groups  which   deny  or  limit  benefits  for  a specific disease or condition or for a   procedure or treatment unique to a specific disease or  condition  in  a   manner  which  would  be  inconsistent  with this chapter or regulations   promulgated by the superintendent had the group purchased  insurance.  A   limit,  maximum, or other mechanism that controls total coverage without   regard to a specific disease or condition shall not be deemed  one  that   denies  or limits benefits for a specific disease or condition, or for a   procedure or treatment  unique  to  a  specific  disease  or  condition.   Nothing  herein shall be construed to mandate the inclusion of specified   benefits in an employer group plan, if such plan is not subject  to  the   provisions of this chapter.* NB There are 3 § 3234's
NY Ins L § 3234-3 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3234*3 - Explanation of Benefits Forms Relating to Claims Under Certain Accident and Health Insurance Policies.

* §  3234.  Explanation  of  benefits  forms  relating to claims under certain accident and  health  insurance  policies.  (a)  Every  insurer, including  health  maintenance  organizations  operating  under  article forty-four of the public health  law  or  article  forty-three  of  this chapter and any other corporation operating under article forty-three of this  chapter,  is required to provide the insured or subscriber with an explanation of benefits form in response to  the  filing  of  any  claim under a policy or certificate providing coverage for hospital or medical expenses,  including  policies  and  certificates providing nursing home expense or home care expense benefits.  (b) The explanation  of  benefits  form  must  include  at  least  the following:  (1)  the  name  of  the provider of service the admission or financial control number, if applicable;  (2) the date of service;  (3) an identification of the service for which the claim is made;  (4) the provider's charge or rate;  (5) the amount or percentage payable under the policy  or  certificate after  deductibles,  co-payments,  and any other reduction of the amount claimed;  (6) a specific explanation of any denial, reduction, or other  reason, including  any  other third-party payor coverage, for not providing full reimbursement for the amount claimed; and  (7) a telephone number or address where an insured or  subscriber  may obtain  clarification  of  the  explanation  of  benefits,  as well as a description of the time limit, place and manner in which an appeal of  a denial of benefits must be brought under the policy or certificate and a notification  that  failure to comply with such requirements may lead to forfeiture of a consumer's right to challenge  a  denial  or  rejection, even when a request for clarification has been made.  (c) Except on demand by the insured or subscriber, insurers, including health  maintenance  organizations operating under article forty-four of the public health law or article forty-three of  this  chapter  and  any other  corporation  operating under article forty-three of this chapter, shall not be required to provide  the  insured  or  subscriber  with  an explanation  of  benefits form in any case where the service is provided by a facility or provider participating in  the  insurer's  program  and full  reimbursement  for  the  claim,  other  than  a co-payment that is ordinarily paid directly to the provider at  the  time  the  service  is rendered,  is paid by the insurer directly to the participating facility or provider.  (d) This section shall not apply to  medicare  supplemental  insurance policies  or  certificates or limited benefits health insurance policies or certificates designed primarily to supplement medicare benefits.   * NB There are 3 § 3234's
NY Ins L § 3235-A (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3235-A - Payment for Early Intervention Services.

§  3235-a.  Payment  for early intervention services. (a) No policy of accident and health insurance, including contracts  issued  pursuant  to article   forty-three  of  this  chapter,  shall  exclude  coverage  for otherwise covered  services  solely  on  the  basis  that  the  services constitute  early  intervention  program  services  under title two-A of article twenty-five of the public health law.  (b) Where a policy of  accident  and  health  insurance,  including  a contract  issued  pursuant  to  article  forty-three  of  this  chapter, provides coverage  for  an  early  intervention  program  service,  such coverage  shall  not  be  applied against any maximum annual or lifetime monetary limits set forth in such policy or contract. Visit  limitations and  other  terms and conditions of the policy will continue to apply to early  intervention  services.  However,  any  visits  used  for   early intervention  program  services  shall  not  reduce the number of visits otherwise available under the policy or contract for such services.  (c) Any right of subrogation  to  benefits  which  a  municipality  or provider  is  entitled  in  accordance with paragraph (d) of subdivision three of section twenty-five hundred fifty-nine of the public health law shall be valid and enforceable to  the  extent  benefits  are  available under any accident and health insurance policy. The right of subrogation does  not  attach  to  insurance  benefits  paid  or  provided under any accident and health insurance policy prior to receipt by the insurer  of written  notice  from  the  municipality or provider, as applicable. The insurer shall provide the  municipality  and  service  coordinator  with information  on  the  extent of benefits available to the covered person under such policy within  fifteen  days  of  the  insurer's  receipt  of written  request  and  notice  authorizing  such  release.  The  service coordinator shall provide such information  to  the  rendering  provider assigned to provide services to the child.  (d)  No  insurer, including a health maintenance organization issued a certificate of authority under article forty-four of the  public  health law  and  a  corporation  organized  under  article  forty-three of this chapter, shall refuse to issue an accident and health  insurance  policy or  contract  or refuse to renew an accident and health insurance policy or contract  solely  because  the  applicant  or  insured  is  receiving services under the early intervention program.