2023 New York Laws › ISC - Insurance › Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies › 4236 - Joint Underwriting of Group Health Insurance for Persons Aged Sixty-Five and Over.

§  4236. Joint underwriting of group health insurance for persons aged
sixty-five and over. (a) It is the concern of the legislature that  many
residents  of this state of advanced years do not have readily available
to  them  health  insurance  adequate  to  their  needs.   It   is   the
legislature's  intent  to  encourage  and facilitate the writing of such
insurance by private insurers on a non-profit group basis  in  order  to
make  available  to such persons broader coverage at lower rates than is
possible on a regular commercial basis. It is, therefore, the purpose of
the legislature to authorize  and  regulate,  in  the  public  interest,
cooperative  action  among such insurers in the preparation and issuance
of policies of health insurance, the  making  of  rates  to  be  charged
therefor and other matters within the scope of this section.
(b) In this section, unless the context otherwise requires,
(1) "Association"   means   a   voluntary   unincorporated  non-profit
association formed for the sole purpose of enabling  cooperative  action
to provide health insurance in accordance with this section.
(2) "Health  insurance"  means  hospital, surgical and medical expense
insurance, provided by a  group  health  insurance  policy  or  contract
issued in accordance with this section.
(3) "Insurer"  means  any  insurance  company  authorized  to  do  the
business of accident and health insurance in this state.
(4) "Insured" means a person covered under a group policy or  contract
issued pursuant to this section.
(c)  (1) Notwithstanding any other provision of this chapter or of any
other law which may be inconsistent herewith, any insurer may join  with
one  or  more other insurers, on a uniform basis with respect to premium
rates, policy provisions, commissions and other matters within the scope
of this section, to offer, sell and issue to a policyholder group health
insurance covering residents of this state who are sixty-five  years  of
age or older and the spouses of such residents.
(2) Such insurance may also cover an employer's non-resident employees
and  non-resident retired employees sixty-five years of age or older and
their spouses, provided such employees  are  regularly  employed  within
this state or were so employed at the time of their retirement.
(3)  Such insurance may be offered, issued and administered jointly by
two or more such insurers through an association formed by such insurers
solely for the purpose of offering, selling, issuing  and  administering
such  insurance  in  accordance  with  this  section. Membership in such
association shall be open to any insurer.
(d) (1) Such association shall offer health insurance coverage to  all
residents  of  this  state  who  are sixty-five years of age or over and
their spouses, subject to reasonable underwriting restrictions to be set
forth in the plan of the association.
(2) Such coverage may consist of one or more of the  following  types:
(i)  basic  hospital and surgical coverage, (ii) basic medical coverage,
(iii) major medical  coverage,  and  any  combination  of  those  types;
provided,  however,  that  if  coverage  of  the first or second type is
offered, it shall not be required as a condition of obtaining same  that
coverage of the third type also be obtained.
(e)  (1)  Such association shall file with the superintendent its plan
for offering, selling, issuing and administering health insurance  which
plan  shall  be subject to his approval as conforming to the purpose and
requirements of this section, and any policy, contract,  certificate  or
other  evidence  of  insurance, application or other forms pertaining to
such insurance together with the premium rates to be charged therefor.
(2) No  such  policy,  contract,  certificate  or  other  evidence  of
insurance,  application  or other form shall be sold, issued or used and
no endorsement shall be attached to or printed or stamped thereon unless

the form thereof and the premium rates to be charged therefor shall have
been approved by the superintendent.
(3)  The  superintendent  shall,  within  a  reasonable time after the
filing of any such premium  rates,  policies,  contracts,  endorsements,
applications  or  other forms, notify the association filing the same of
his approval or disapproval thereof.
(4) The superintendent may disapprove such premium rates if  he  finds
them  to  be  unfairly discriminatory or unreasonable in relation to the
benefits provided  and  he  may  disapprove  such  policies,  contracts,
certificates,  applications,  endorsements  or  other  forms  if  in his
judgment they contain provisions which he finds to  be  unjust,  unfair,
inequitable,  misleading,  deceptive,  prejudicial  to  the  insured  or
otherwise contrary to law or to the public policy of this state.
(5) The superintendent may, after  notice  and  hearing,  withdraw  an
approval  previously  given, if the use thereof is contrary to the legal
requirements applicable thereto at the time of such withdrawal,  or  the
premiums  are unfairly discriminatory or unreasonable in relation to the
benefits provided, or in his judgment they contain provisions which are,
or the continued use thereof  would  be,  unjust,  unfair,  inequitable,
misleading,  deceptive, prejudicial to the insured or otherwise contrary
to law or to the public policy of this state.  Any  such  withdrawal  of
approval  shall  be effective at the expiration of such period, not less
than ninety days after the  giving  of  notice  of  withdrawal,  as  the
superintendent shall in such notice prescribe.
(6) In exercising the powers conferred upon him by this subsection the
superintendent  shall  not  be  bound  by  any other requirement of this
chapter with respect to standard provisions to be included  in  accident
and health policies or forms.
(7)  The  name  of  such  association  or  any  advertising  and other
promotional and solicitation material used  in  connection  with  health
insurance  offered, sold or delivered pursuant to this section shall not
be such as to mislead or deceive the public.
(f) Such association may solicit the sale  of  such  health  insurance
through  any  insurance  agent licensed pursuant to section two thousand
one hundred three of this chapter  and  any  insurance  broker  licensed
pursuant  to  section  two thousand one hundred four of this chapter. It
shall not  pay  to  such  agent  or  broker  or  any  other  person  any
commission,  compensation  or  other  fee or allowance not in accordance
with a schedule thereof which shall have  been  filed  by  it  with  and
approved  by  the  superintendent. Except as aforesaid, it shall not pay
any commission, compensation, fee or allowance to any person but it  may
pay a salary or compensation to persons regularly employed by it.
(g)  Such  association shall file annually with the superintendent, on
such date and in such form as he may prescribe, a statement with respect
to its operations.
(h)  Notwithstanding  any  other  provision  of   this   chapter,   an
association  may offer, sell, issue or administer such a group policy or
contract of health insurance on  a  non-participating  basis,  provided,
however,  that  the  excess,  if  any,  of  premiums received by it from
insureds over the cost of providing such  insurance  benefits  shall  be
used solely for the benefit of the insureds.
(i) Premiums for policies issued pursuant to this section shall not be
included in "premiums" for purposes of section five hundred fifty-two of
the  former  insurance law in effect immediately preceding the effective
date of this chapter and former section one hundred eighty-seven of  the
tax  law,  nor  shall  section  one  thousand one hundred twelve of this
chapter be construed as subjecting the premiums  for  such  policies  to

taxation; nor shall such premiums be subject to any other tax imposed by
any other governmental subdivision.