2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3240*2 - Student Accident and Health Insurance.

* § 3240. Student accident and health insurance. (a) In this section:
(1)(A)  "Student  accident  and  health  insurance"  means a policy or
contract of hospital, medical, or surgical expense  insurance  delivered
or  issued  for  delivery  in  this state on or after January first, two
thousand fourteen, by an insurer or a corporation, to an institution  of
higher  education  covering students enrolled in the institution and the
students' dependents.
(B) "Student accident and health insurance" shall not include:
(i) a policy or contract that provides limited scope dental or  vision
benefits  meeting  the  definition  of  "excepted benefits" set forth in
section 2791 of the public health service act, 42 U.S.C. § 300gg-91(c);
(ii) an accident policy or contract that provides benefits meeting the
definition of "excepted benefits" set  forth  in  section  2791  of  the
public  health  service  act,  42 U.S.C. § 300gg-91(c), if the policy or
contract:
(I) is limited to coverage for intercollegiate sports injuries only;
(II) provides benefits  to  diagnose  and  treat  any  intercollegiate
sports  injury  and does not include a benefit dollar maximum amount per
injury that is less than the overall benefit dollar maximum  amount  per
student under the intercollegiate sports injury policy or contract;
(III) provides benefits on an expense incurred basis;
(IV)  provides  that  premiums  are paid in full by the institution of
higher education;
(V) includes prominent disclosure to the  student  that  the  accident
policy  is  not  a  substitute  for  comprehensive  hospital and medical
coverage;
(VI) provides coverage for intercollegiate sports injuries primary  to
any  student  accident  and  health  insurance policy or contract or any
student health plan issued pursuant to section one thousand one  hundred
twenty-four  of  this  chapter; except that a policy or contract meeting
the requirements of this item may be excess or secondary  to  any  other
policy or contract of accident and health insurance; and
(VII)  includes  a  maximum  benefit  amount  that is no less than the
deductible under the separate athletic association policy or contract if
designed to coordinate with a separate policy or contract issued  to  an
athletic  association  that  extends coverage for intercollegiate sports
injuries;
(iii) an accident policy or contract that  provides  benefits  meeting
the  definition  of "excepted benefits" set forth in section 2791 of the
public health service act, 42 U.S.C. § 300gg-91(c)(1)(A), if the  policy
or contract:
(I)  is  limited  to  transportation  expenses in the event an insured
student incurs a covered sickness or accident, including  transportation
expenses   for   a  medical  escort  to  travel  with  the  student  and
transportation expenses for  returning  the  student  to  the  student's
domicile;
(II)  provides  that  premiums  are paid in full by the institution of
higher education;
(III) covers students enrolled in the institution of higher education;
(IV) includes prominent disclosure to the student  that  the  accident
policy  is  not  a  substitute  for  comprehensive  hospital and medical
coverage; and
(V) provides coverage for a period of twelve months; or
(iv) an insurance  policy,  contract,  or  certificate  that  provides
hospital,  medical,  or  surgical  expense  coverage for a student while
studying outside the United States for a period of twelve months or less
that is issued to a student, provided that the student is  also  covered

by  comprehensive hospital and medical coverage within the United States
and the insurance policy, contract, or certificate:
(I)  is subject to the requirements of subsections (b), (c), (d), (e),
(h), and (i) of this section;
(II) meets the definition of "expatriate health plan" set forth in  42
U.S.C. § 18014(d)(2);
(III) excludes coverage within the United States;
(IV)  may offer coverage for global evacuation and repatriation in the
event of the insured student's sickness or accident; and
(V) may offer  coverage  for  trip  cancellation,  trip  interruption,
baggage,  personal  effects,  or  global  evacuation  and  repatriation,
including evacuation in the event of a  natural  or  man-made  disaster,
such as an epidemic, political event, war, terrorist act, riot, or civil
insurrection,  pursuant to section three thousand four hundred fifty-two
of this chapter.
(2) "Institution of higher education" or "institution" shall have  the
meaning set forth in the higher education act of 1965, 20 U.S.C. § 1001.
(3)  "Insurer"  means an insurer licensed to write accident and health
insurance pursuant to this chapter.
(4) "Corporation" means a corporation  organized  in  accordance  with
article forty-three of this chapter.
(5)  "Intercollegiate sport" means a sport that has been designated as
an intercollegiate sport by the institution of higher education in which
a student  is  enrolled  and  that  is  organized  or  sponsored  by  an
institution of higher education.
(6)  "Intercollegiate  sports  injury"  means an injury sustained by a
student  member  of  an  athletics  team  during  participation  in   an
intercollegiate sport.
(b)  An  insurer  or  corporation  shall  not  impose any pre-existing
condition exclusion in a student accident and health insurance policy or
contract. An insurer or corporation  shall  not  condition  eligibility,
including  continued  eligibility,  for  a  student  accident and health
insurance policy  or  contract  on  health  status,  medical  condition,
including both physical and mental illnesses, claims experience, receipt
of  health  care,  medical  history,  genetic  information,  evidence of
insurability, including conditions  arising  out  of  acts  of  domestic
violence, or disability.
(c)  An  insurer  or corporation shall condition eligibility including
continuing eligibility, on the covered individual being  enrolled  as  a
student  in  an  institution  of  higher  education to which the student
accident and health insurance policy or contract is issued.
(d) A student accident and health insurance policy or  contract  shall
provide  coverage for essential health benefits as defined in subsection
(a) of section three thousand two hundred seventeen-i or subsection  (a)
of  section  four  thousand  three  hundred  six-h  of  this chapter, as
applicable.
(e) An insurer or corporation shall not refuse to renew  or  otherwise
terminate  a  student  accident  and health insurance policy or contract
except for one or more of the reasons set forth in:
(1) subparagraphs (A), (B), (D) or (G) of paragraph two of  subsection
(p) of section three thousand two hundred twenty-one of this article; or
(2)  subparagraphs (A), (B), (D) or (G) of paragraph two of subsection
(j) of section four thousand three hundred five of this chapter.
(f)  Other  than  the  provisions  herein  also  required  by  article
forty-three  of  this  chapter, this section shall not apply to coverage
under a student health plan issued pursuant to section one thousand  one
hundred twenty-four of this chapter.
(g)  The  superintendent  may promulgate regulations regarding student
accident and health insurance, which may include minimum  standards  for
the   form,  content  and  sale  of  the  policies  and  contracts  and,
notwithstanding the provisions of section  three  thousand  two  hundred
thirty-one  and  four  thousand three hundred eight of this chapter, the
establishment of rating methodology to be applied to  the  policies  and
contracts; provided that any such regulations shall be no less favorable
to  the  insured than that which is provided under federal law and state
law applicable to individual insurance.
(h) The  ratio  of  benefits  to  premiums  shall  be  not  less  than
eighty-two  percent  as  calculated  in a manner to be determined by the
superintendent.
(i) Every insurer or corporation shall report  to  the  superintendent
annually,  on  a  date  specified by the superintendent in a regulation,
claims  experience  and  other  data  in  a  manner  acceptable  to  the
superintendent  that  shall  demonstrate  the insurer's or corporation's
compliance with the applicable  rules  and  regulations,  including  the
minimum  loss  ratio required by subsection (h) of this section. Failure
to comply with subsection (h) of this section is subject  to  corrective
action,  which  may include the submission, to the superintendent, of an
appropriate rate filing  or  form  and  rate  filing  to  reduce  future
premiums,  increase  benefits, issue dividends, issue premium refunds or
credits, or any combination of these such that the  minimum  loss  ratio
can reasonably be expected to be achieved.
(j)   With   respect   to   benefits  for  treatment  relating  to  an
intercollegiate sports injury, as defined in paragraph six of subsection
(a) of this section, a policy or contract of student accident and health
insurance or a student  health  plan  issued  pursuant  to  section  one
thousand one hundred twenty-four of this chapter shall be secondary to a
separate accident policy or contract meeting the requirements of clauses
(I)  through  (VII) of item (ii) of subparagraph (B) of paragraph one of
subsection (a) of this section.
* NB There are 2 § 3240's