2023 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.