2023 New York Laws › ISC - Insurance › Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations › 4306 - Required Contract Provisions.

§  4306.  Required  contract  provisions. Every contract issued by any
corporation pursuant to the provisions of section  four  thousand  three
hundred  four  of  this article, shall be in writing and shall state the
terms and conditions thereof. No such contract shall be made, issued  or
delivered in this state unless it contains the following provisions:
(a)  a  statement  of  the  amount  payable  to the corporation by the
individual to whom the contract is issued and the  times  at  which  and
manner in which such amount is to be paid;
(b)  a statement of the nature of the benefits to be furnished and the
period during which they  will  be  furnished;  and  if  there  are  any
benefits to be excepted, a detailed statement of such exceptions printed
as hereinafter specified;
(c)  a  statement  of the terms and conditions, if any, upon which the
contract may be terminated at the option of the individual, or otherwise
terminated at the option of either party as permitted by subsection  (b)
or (c) of section four thousand three hundred four of this article;
(d)  a  statement  that the contract includes the endorsements thereon
and attached papers, if any;
(e) a statement that no statement by the individual in his application
for a contract shall  avoid  the  contract  or  be  used  in  any  legal
proceeding  thereunder, unless such application or an exact copy thereof
is included in or attached to  such  contract,  and  that  no  agent  or
representative  of such corporation and no broker, other than an officer
or officers designated therein, is authorized to change the contract  or
waive any of its provisions;
(f)  a statement that if the individual defaults in making any payment
under the contract, the  subsequent  acceptance  of  a  payment  by  the
corporation  or  by  one  of  its  duly  authorized  agents or by a duly
authorized broker shall reinstate the  contract,  but  with  respect  to
sickness  and  injury,  only  to  cover  such  sickness  as may be first
manifested more than ten days after the date of such acceptance;
(g) a statement of the period of  grace  which  will  be  allowed  the
individual  for  making  any payment due under the contract which period
shall not be less than ten days;
(h) a statement on the first page of  the  contract  or  in  a  notice
attached  to  the contract that during a specified period of time, which
shall not be less than ten days nor more than twenty days from the  date
the  contract  is  delivered to the individual, it may be surrendered to
the corporation together with a written request for cancellation of  the
contract  and that in such event the corporation will refund any premium
paid therefor including any contract fees or  other  charges;  provided,
however,  that  a  contract  sold by mail order and a contract providing
medicare supplemental insurance or long-term care insurance must contain
a provision permitting the individual  a  thirty  day  period  for  such
surrender;
(i)  the age limit or date or period, if any, after which the coverage
provided by the contract will not be effective, or renewed, is stated in
a renewal provision set forth on the first page of the contract or as  a
separate  provision  bearing an appropriate caption on the first page on
the contract or in a brief description in not less than  fourteen  point
bold  face  type  set  forth  on the first page of the contract; nothing
herein contained shall limit or restrict the right of the corporation to
continue the contract after the age or period so stated;
(j) a statement under the caption "CONVERSION PRIVILEGE"  which  shall
set  forth in substance the conversion privileges and related provisions
required by subsections (d) and  (e)  of  section  four  thousand  three
hundred four of this article;
(k)  the  exceptions  of  the  contract  shall  appear  with  the same
prominence as the benefits to which they apply;
(l)  if  the  contract  contains  any provision purporting to make any
portion of the articles, constitution or by-laws of  the  corporation  a
part of the contract, such portion shall be set forth in full; and
(m)  in  every  such  contract made, issued or delivered in this state
there shall be a brief description of the contract on its first page and
on its filing back.
(n) a statement that a health care claim from a  subscriber  shall  be
submitted  within  one  hundred  twenty  days  from the date of service;
provided, however, that if  it  was  not  reasonably  possible  for  the
subscriber  to  submit  the  claim within that timeframe, then the claim
shall be submitted as soon as reasonably possible.
* (o) Space shall be provided on any enrollment,  renewal  or  initial
online  portal process setup forms required of a subscriber or applicant
for coverage, except forms  issued  by  the  NY  State  of  Health,  the
official   Health   Plan  Marketplace,  other  than  those  specifically
referenced in subparagraph (iv) of paragraph (a) of subdivision five  of
section  forty three hundred ten and paragraph (v) of subdivision one of
section two hundred six of the public health law, so that the subscriber
or applicant for coverage shall register or decline registration in  the
donate  life  registry  for  organ,  eye and tissue donations under this
section of the enrollment, renewal  or  initial  online  portal  process
setup  forms  and  that the following is stated on the form in clear and
conspicuous type:
"You must fill out the following section: Would you like to  be  added
to  the  Donate  Life  Registry?  Check  box  for  'yes'  or  'skip this
question'."
* NB Effective June 23, 2024