NY Ins L § 3217 (2021)
2021 New York Laws ISC - Insurance Article 32 - Insurance Contracts - Life, Accident and Health, Annuities 3217 - Minimum Standards in the Form, Content and Sale of Accident and Health Insurance; Policies and Subscriber Contracts.

§  3217.  Minimum  standards in the form, content and sale of accident and  health  insurance;  policies  and  subscriber  contracts.  (a)  The superintendent  shall  issue  such  regulations  he  deems  necessary or desirable to establish minimum standards, including  standards  of  full and  fair  disclosure,  for  the  form, content and sale of accident and health insurance  policies  and  subscriber  contracts  of  corporations organized  under this article and article forty-three of this chapter or entities licensed pursuant to article forty-four of  the  public  health law.  With  regard  to  contracts issued pursuant to such articles which incorporate a usual and customary or reasonable form  of  reimbursement, such   regulations   shall   require   such   schedules  to  be  updated periodically, to accurately reflect geographic differences in costs  and that  information  be  furnished  to  insureds regarding the method upon which the usual and customary or reasonable charge is determined and the percentile of charges upon which the schedule is based. Such regulations shall also require,  in  addition  to  such  other  information  as  the superintendent  deems necessary, the disclosure of the reimbursement for a particular elective surgical  procedure  or  treatment,  upon  written request  by  an  insured,  subscriber  or enrollee. Such regulations may apply to all, any portion or reasonable classifications of such policies or contracts.  (b) The purposes of such minimum standards shall include any or all of the following:  (1) reasonable standardization  and  simplification  of  coverages  to facilitate understanding and comparisons;  (2)  elimination of provisions which may be misleading or unreasonably confusing, in connection either with the purchase of  such  policies  or contracts or with the settlement of claims;  (3)  elimination of deceptive practices in connection with the sale of such policies or contracts;  (4) elimination of provisions which may be contrary to the health care needs  of  the  public,  as  certified  to  the  superintendent  by  the commissioner of health; and  (5) elimination of coverages which are so limited in scope as to be of no substantial economic value to the holders.  (c) Prior to the issuance of regulations pursuant to this section, the superintendent shall afford the public, including the companies affected thereby,  reasonable opportunity for comment and shall obtain the views, in writing, of the commissioner of health and the secretary of state.  (d) When a regulation adopted pursuant to this  section  so  provides, all forms of such policies or contracts which are not in compliance with such  regulation  shall  be deemed to be disapproved for use without any further or additional notice after  a  date  to  be  specified  in  such regulation  which  date  shall not be less than sixty days following its effective date.  (e) When a regulation adopted pursuant to this  section  so  provides, any  such  policy  or contract which does not comply with the regulation shall, when issued after a date  not  less  than  sixty  days  from  the effective  date  of  such  regulation,  be construed, and the insurer or corporation shall be liable, as if the policy  or  contract  did  comply with the regulation.  (f) Violation of any regulation adopted pursuant to this section shall be  a violation of this chapter for purposes of section one hundred nine of this chapter.