reglab/statecodes huggingface dataset:
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4211 - Election of Directors of Domestic Stock Life Insurance Companies.

§  4211.  Election  of  directors  of  domestic  stock  life insurance
companies. (a) No  election  of  directors  of  a  domestic  stock  life
insurance company shall be valid unless a copy of the notice of election
shall  have  been filed in the office of the superintendent at least ten
days before the day of such election in addition to the service thereof,
as required by section six hundred five of the business corporation law.
(b) Whenever any directors of such a company shall have  resigned  and
successors  shall  have  been  chosen  pursuant to the provisions of the
by-laws, such successors shall not take office nor exercise their duties
until ten days after written notice of their election  shall  have  been
filed in the office of the superintendent.
(c)  Policyholders  of such an insurance company shall be eligible for
election as directors or officers, whether or not they are shareholders.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4212 - Stock Life Insurance Companies; Voting Power of Policyholders.

§ 4212. Stock life insurance companies; voting power of policyholders.
(a)  (1)  Any domestic stock life insurance company may, by amendment to
its charter,  confer  upon  its  policyholders,  or  upon  such  of  its
policyholders  as  shall  have  a specified amount of insurance on their
lives, the right to vote for all or any less number of directors of such
company in a manner not inconsistent with this chapter.
(2)  Such  amendment  shall  take  effect   upon   approval   by   the
superintendent.  The  superintendent  may give such approval if he finds
that the proposed change is in conformity with the requirements  of  law
and  that  the  representation  of  policyholders  therein  conferred is
equitable and reasonable.
(3) If the right to vote for all of the directors of such  company  is
conferred  upon such policyholders, then the election of directors shall
thereafter be governed by the provisions of subsection  (e)  of  section
four thousand two hundred ten of this article.
(b)  This  section  shall  not  apply  to  any  such company which has
conferred voting power upon policyholders pursuant to any  previous  law
effective  before  January first, nineteen hundred forty, but the voting
rights of such policyholders shall  continue  to  be  governed  by  such
previous law.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4213 - Industrial Life Insurance.

§  4213.  Industrial  life  insurance. (a) In this chapter "industrial
life insurance" means that form of life insurance, either:
(1) under which the premiums are payable weekly, or
(2) under which the premiums are payable monthly or oftener, but  less
often  than weekly, if the face amount of insurance provided in any such
policy is less than one thousand dollars and if  the  words  "industrial
policy" are printed upon the policy as a part of the descriptive matter.
(b)  (1)  No  insurer or fraternal benefit society doing in this state
the business of industrial life insurance shall  deliver  or  issue  for
delivery  in  this  state,  and  no  agent or representative of any such
company or society shall aid in so issuing or delivering, any policy  of
weekly  premium industrial life insurance on the life of a person of the
age, as determined  by  next  birthday,  of  ten  years  or  more,  with
knowledge  that  the  amount of such policy, together with the amount of
all other policies of weekly premium industrial life insurance  then  in
force  as  premium  paying insurance on the life of such person, exceeds
one thousand dollars but nothing contained in this section shall  affect
the  validity  or  enforceability,  in accordance with its terms, of any
such policy.
(2) The amounts of weekly premium industrial life  insurance  referred
to   in  this  subsection  shall  not  include  dividend  additions  nor
additional  amounts  payable  under  provisions  for  accidental   death
benefits.
(3)  Any rules or regulations of any such insurer or fraternal benefit
society, which are designed to limit the amount of insurance, as  herein
provided, shall be filed with the superintendent.
(c) No authorized life insurance company, including a cooperative life
and  accident  insurance  company  and  no  authorized fraternal benefit
society, shall deliver or issue for delivery in this state any policy or
contract  of  industrial  life  insurance  in  the  form  of   endowment
insurance.
(d)  Notwithstanding  the  provisions  of  subsection  (c) hereof, any
domestic life insurance company or fraternal benefit society  may  issue
in  this  state  for delivery outside of this state through its agent or
like representative in another state or foreign country  any  policy  of
industrial  life  insurance,  in  the form of endowment insurance, which
insures the life of a non-resident  of  this  state  and  which  is  not
prohibited by the laws of such other state or foreign country.
(e) Notwithstanding the foregoing provisions, on and after June first,
nineteen hundred eighty, no policy of industrial life insurance shall be
delivered or issued for delivery in this state.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4214 - Industrial Accident and Industrial Health Insurance.

§  4214.  Industrial  accident and industrial health insurance. (a) In
this chapter:
(1) "Industrial  accident  insurance"  means  that  form  of  accident
insurance  wherein  the  premium  is payable in the manner prescribed in
subsection (a) of section four thousand two  hundred  thirteen  of  this
article,  covering such risks as death, dismemberment, loss of eyesight,
or loss of time, as a result of accidental means.
(2) "Industrial health insurance" means that form of health  insurance
wherein  the  premium  is payable in the manner prescribed in subsection
(a) of section four thousand  two  hundred  thirteen  of  this  article,
covering such risk as loss of time caused by illness or sickness.
(b) Notwithstanding the foregoing provisions, on and after June first,
nineteen  hundred  eighty, no policy designated or sold as an industrial
accident insurance  or  industrial  health  insurance  policy  shall  be
delivered  or issued for delivery in this state; provided, however, that
this prohibition shall not prevent the delivery or issuance for delivery
of a policy approved by the superintendent where the premium is  payable
weekly  or  monthly and such policy is approvable under other provisions
of this chapter.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4215 - Contracts With Industrial Life Insurance Agents; Prohibitions.

§ 4215. Contracts with industrial life insurance agents; prohibitions.
(a)  No  life  insurance  company  licensed to do business in this state
shall  make  any  contract  with  any  agent,  superintendent  or  other
representative employed in this state which provides:
(1)  That the company shall charge against the past, present or future
compensation of  the  agent,  superintendent  or  other  representative,
either  salary  or  commission,  any  sum  of  money  as a result of the
surrender for cash of any industrial policy by any policyholder;
(2) That the company shall charge against the past, present or  future
compensation  of  the  agent,  superintendent  or  other representative,
either salary or commission, any sum of money as a result of  the  lapse
of  any  industrial  policy  that  has  been in force for three years or
longer.
(b) The provisions of subsection (a) hereof  shall  not  prohibit  the
company  from  contracting  with  its  agents,  superintendents or other
representatives,  to  charge  any   agent,   superintendent   or   other
representative, a sum not exceeding the commission on any policy written
by  the agent, superintendent or other representative on the life of any
person, or any relative sharing  the  home  with  the  person,  who  has
terminated  a policy of the company not more than three months before or
who terminates such a policy within three months after  the  policy  was
written.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4222 - Policy Loans.

§  4222.  Policy loans. The policy loan value referred to in paragraph
eight of subsection (a) of section three thousand two hundred  three  of
this chapter shall be the cash surrender value at the end of the current
policy year calculated in accordance with the provisions of:
(a) Subsection (a) of section four thousand two hundred twenty of this
article,  for  policies issued before the operative date of section four
thousand two  hundred  twenty-one  of  this  article,  except  that  any
dividends  credited to the policy need not be included and such policies
may provide that the company may defer any such loan for  not  exceeding
six months after receipt of the loan application;
(b)  Section four thousand two hundred twenty-one of this article, for
policies issued on or after the operative date of such  section,  except
that  the  policy loan value for a policy under which any cash surrender
value is adjusted in accordance with a market-value  adjustment  formula
shall be a percentage (not less than seventy-five percent) of the sum of
(1)  the amount of any loan outstanding and (2) the remaining portion of
the cash surrender value as so adjusted at the time the loan is  applied
for,  but,  if  the  policy  so  provides,  not  in  excess of such cash
surrender value before adjustment. The company shall reserve  the  right
to defer any such loan, except when made to pay premiums, for six months
after receipt of the loan application.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4225 - Domestic Life Insurance Companies; Discrimination as to Brokers.

§  4225.  Domestic  life  insurance  companies;  discrimination  as to
  brokers. No officer, trustee or director of a  domestic  life  insurance
  company  shall  direct  or  require  a  borrower from the life insurance
  company on  mortgage  to  negotiate  any  policy  of  insurance  on  the
  mortgaged  property  through any particular insurance broker, or attempt
  to divert to any particular insurance broker the patronage of  borrowers
  from  the life insurance company, or refuse to accept any such insurance
  policy because it was not  negotiated  through  a  particular  insurance
  broker.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4230 - Salaries and Pensions to Officers and Employees.

§  4230.  Salaries  and  pensions  to  officers  and employees. (a) No
domestic life insurance company shall pay any  salary,  compensation  or
emolument  in  any  amount  to  any  officer,  deemed  by a committee or
committees of the board to be a principal officer pursuant to subsection
(b) of section one thousand two hundred two of this chapter, or  to  any
salaried employee of the company if the level of compensation to be paid
to such employee is equal to, or greater than, the compensation received
by any of its principal officers, or to any trustee or director thereof,
unless  such  payment  be  first  authorized  by  a vote of the board of
directors of such company.
(b) (1) No such company shall make  any  agreement  with  any  of  its
officers  or  salaried employees whereby it agrees that for any services
rendered or  to  be  rendered  he  or  she  shall  receive  any  salary,
compensation  or  emolument  that  will  extend beyond a period of sixty
months from the date of such  agreement,  except  that  payment  of  the
salary  or other compensation of any of its officers or employees, other
than a mechanic, worker or laborer, may by written contract be  deferred
beyond   such  period  of  sixty  months,  which  contract  may  include
conditions to be met by such officer or employee before payment will  be
made.
(2)  Paragraph  one of this subsection shall not apply to contracts by
the company with its agents for the payment of  first  year  or  renewal
commissions  and  additional  compensation  as  provided in section four
thousand two hundred twenty-eight of this article.
(3) Paragraph one of this subsection shall not apply to any  long-term
incentive  compensation  plan offered to any officer or employee of such
company which has been approved by the board of directors, is  based  in
whole  or  in  part upon the financial performance of the company and is
submitted for informational purposes to the superintendent prior to  its
implementation.
(c)  No  principal  officer  or  employee  of  the  class described in
subsection (a) hereof who is  paid  a  salary  for  his  services  shall
receive  any  other  compensation, bonus or emolument from such company,
directly or indirectly, except in accordance with a plan recommended  by
a  committee  of  the  board  pursuant  to subsection (b) of section one
thousand two hundred two of this chapter and approved by  the  board  of
directors.
(d) No such company shall grant any pension to any officer, trustee or
director  thereof or to any member of his family after his death, except
that such company may pursuant to the terms of a retirement plan adopted
by the board of directors of such company, provide for any person who is
or has been a salaried officer or employee of such  company,  a  pension
payable  at  the  time of his retirement by reason of age or disability,
and also life insurance benefits payable at his death.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4232 - Amounts Credited on Certain Contracts or Life Insurance Policies.

§  4232.  Amounts  credited  on  certain  contracts  or life insurance
policies. (a) (1) If any contract subject to section four  thousand  two
hundred twenty-three of this article, provides for additional amounts to
be  credited  to  the  contract during any period in accordance with the
provisions of paragraph one of subsection (g) of section  four  thousand
two  hundred  thirty-one of this article, then any additional amounts to
be so credited must be determined for  each  year  during  such  period.
Except  as otherwise provided in the contract in accordance with section
four thousand two hundred twenty-three of this article, the total amount
so credited shall be available to the contract holder upon surrender  of
the contract for its cash surrender benefits.
(2)  No such additional amounts shall be guaranteed or credited except
upon: (i) reasonable assumptions as to investment income, mortality, and
expenses; (ii) a basis equitable to all  contract  holders  of  a  given
class;  and (iii) written criteria approved by the board of directors of
the company or a committee thereof.
(3) Any  such  additional  amounts  credited  under  a  group  annuity
contract for which certificates are subject to section four thousand two
hundred   twenty-three  of  this  article  shall  be  credited  to  such
certificates.
(b) (1) Any individual life  insurance  policy  may  provide  that  in
addition  to  any  minimum benefits guaranteed in the policy, additional
amounts may be credited to the policy.
(2) No such additional amounts shall be guaranteed or credited  except
upon   reasonable   assumptions  as  to  investment  income,  mortality,
persistency, and expenses. The declaration of such additional amounts by
an insurer must be made prospectively; no such additional amounts  shall
be  credited  retroactively  to  apply  to  any  period  prior  to  such
declaration.
(3) Such additional amounts are required to be credited to any policy,
providing for the crediting of additional amounts, while continued under
a reduced paid-up insurance option, with respect to the period after the
termination or lapse of such policy by reason of default in  payment  of
any  premium,  installment or interest on any policy loan and before the
reinstatement of such policy, if it is reinstated.  However, an  insurer
may  use  reasonable  assumptions  as  to  investment income, mortality,
persistency, and expenses which differ from  the  assumptions  used  for
policies in force on a premium paying basis.
(4) Any such additional amounts shall be credited on a basis equitable
to  all  policyholders  of  a  given class and shall be based on written
criteria approved by  the  board  of  directors  of  the  company  or  a
committee thereof.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4237-A - Stop-Loss Insurance.

§  4237-a.  Stop-loss  insurance.  (a) An insurer authorized to do the
business of accident and health insurance in this  state  and  a  health
service  corporation organized under article forty-three of this chapter
shall be authorized to issue stop-loss insurance  as  provided  in  this
section.
(b)  "Stop-loss  insurance"  means  an  insurance  policy  whereby the
insurer agrees to  pay  claims  or  indemnify  an  employer  for  losses
incurred  under a self-insured employee benefit plan or a student health
plan as authorized by section one thousand one  hundred  twenty-four  of
this  chapter  in  excess of specified loss limits for individual claims
and/or for all claims combined, or any similar arrangement.
(c) A stop-loss insurance policy delivered, issued  for  delivery,  or
entered into in this state shall clearly describe:
(1) the entire money or other consideration for the policy;
(2) the time at which the insurance takes effect and terminates;
(3) the specified per-claim, per-employee or, in the case of a student
health  plan  under section one thousand one hundred twenty-four of this
chapter, per student, or aggregate amount of claims above which  payment
or reimbursement is to be made by the insurer; and
(4)  the  payments  to  be  made  by  the  insurer  once the specified
stop-loss thresholds have been exceeded.
(d) No stop-loss insurance contract shall  be  issued  or  renewed  if
issuance  of  the policy would be prohibited by section two thousand six
hundred thirteen, three thousand two hundred thirty-one,  four  thousand
three  hundred  seventeen  or four thousand three hundred twenty of this
chapter.
(e) The superintendent may promulgate such rules  and  regulations  he
deems  necessary  or  desirable  to establish financial requirements and
standards for the form  and  content  of  stop-loss  insurance  policies
authorized by this section.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4239 - Allocation and Reporting of Income and Expenses of Life Insurers.

§  4239.  Allocation  and  reporting  of  income  and expenses of life
insurers. (a)  In  order  to  enable  the  superintendent  to  determine
compliance  with  this  chapter,  he  may  issue  reasonable regulations
prescribing  standards  for  the  equitable  allocation  of  income  and
expenses  as  among lines of business and as between investment expenses
and insurance expenses. No such regulation or amendment thereto shall be
promulgated except upon notice to all  insurers  affected  thereby,  and
after  hearing.  Such regulation or amendment shall not preclude the use
of other reasonable and equitable standards previously approved  by  the
superintendent. He may also promulgate regulations defining the items of
income and expenses to be reported in each line of the annual statement.
Any  regulation  or  amendment thereto shall be promulgated at least six
months before the beginning of the calendar year in which the same shall
take effect.
(b) The restrictions in subsection (a) hereof as to  notice,  hearing,
and  effective  period shall not apply to such regulations or amendments
as may be approved by the superintendent for calendar years as to  which
similar  regulations  or  amendments  have  been adopted by the National
Association of Insurance Commissioners.
(c) If the superintendent finds, after notice and  hearing,  that  any
such insurer has failed to comply with the requirements of this section,
he  may  order  such  insurer  to  change its methods of reporting or to
modify its basis of allocation so as to produce reasonable and equitable
results.
2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4241 - Penalty for Violation of Filing Requirements.

§  4241.  Penalty  for  violation  of  filing  requirements.  (a)  Any
authorized insurer, representative of such insurer,  licensed  insurance
agent  or  licensed  insurance  broker  wilfully  violating  any  of the
provisions of this article or of articles thirty-one  or  thirty-two  of
this  chapter  relating  to  filings  of  life,  accident and health and
annuity contract forms, premium rates, rules, classification  of  risks,
and  commissions, compensation or other fees or allowances to agents and
brokers pertaining to the solicitation or sale of such insurance and  of
fees  or  allowances  to  any  individuals,  firms  or  corporations for
services pertaining to the  service  or  administration  of  such  group
insurance and annuity contracts, shall, in addition to any other penalty
provided  by  law, be liable for a penalty as provided in subsection (b)
hereof.
(b) If the superintendent finds after notice  and  hearing,  that  any
authorized  insurer,  representative of such insurer, licensed insurance
agent or licensed insurance broker has wilfully violated the  provisions
of  subsection  (d)  hereof or this article relating to such filings, he
may, in lieu of any other penalty provided by law, order  such  insurer,
or person to pay to the people of this state a penalty not exceeding one
thousand dollars for each such offense.
(c)  Failure  of any such insurer or person to pay such penalty within
thirty days after the making of such order, unless suspended by an order
of a court of competent jurisdiction, shall constitute  a  violation  of
this chapter.
(d)  In this section, the issuance, procurement or negotiation of each
policy of insurance, by such insurer or person in  wilful  violation  of
the  provisions  of  this  subsection  or this article shall be deemed a
separate offense.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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).
2023 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.
2023 New York Laws › ISC - Insurance › Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations › 4306-I - Coverage for Medically Fragile Children.

§  4306-i. Coverage for medically fragile children. A corporation that
  is subject to the provisions of this article shall have  procedures  for
  coverage  of  medically  fragile  children consistent with section three
  thousand two hundred seventeen-j of this chapter.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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) of this section,  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 eight
of the financial services law.
2023 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.
2023 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.
2023 New York Laws › ISC - Insurance › Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations › 4320 - Limitations on Administrative Services and Stop-Loss Coverage.

§ 4320. 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.