reglab/statecodes huggingface dataset:
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2904 - Reporting Requirements for Pharmacy Benefit Managers.

§  2904.  Reporting requirements for pharmacy benefit managers. (a)(1)
On or before July first of each year,  every  pharmacy  benefit  manager
shall  report  to  the  superintendent,  in  a  statement subscribed and
affirmed as true under penalties of perjury, the  information  requested
by the superintendent including, without limitation,
(i) any pricing discounts, rebates of any kind, inflationary payments,
credits,  clawbacks,  fees,  grants,  chargebacks, reimbursements, other
financial or other reimbursements, incentives, inducements,  refunds  or
other benefits received by the pharmacy benefit manager; and
(ii)  the  terms  and  conditions  of  any  contract  or  arrangement,
including  other   financial   or   other   reimbursements   incentives,
inducements  or  refunds  between  the  pharmacy benefit manager and any
other party relating to pharmacy benefit management services provided to
a health plan including but not limited  to,  dispensing  fees  paid  to
pharmacies.
(2)  The  superintendent  may require the filing of quarterly or other
statements, which shall be in such form and shall contain  such  matters
as the superintendent shall prescribe.
(3)  The superintendent may address to any pharmacy benefit manager or
its officers any inquiry  in  relation  to  its  provision  of  pharmacy
benefit  management  services  or  any matter connected therewith. Every
pharmacy benefit manager or person so addressed shall reply  in  writing
to  such  inquiry  promptly  and truthfully, and such reply shall be, if
required by the superintendent, subscribed by  such  individual,  or  by
such  officer  or  officers  of  the  pharmacy  benefit  manager, as the
superintendent shall designate, and affirmed by them as true  under  the
penalties of perjury.
(b)  In  the  event  any  pharmacy  benefit manager or person does not
submit the report required by paragraph one of subsection  (a)  of  this
section or does not provide a good faith response to an inquiry from the
superintendent  pursuant  to  paragraph  three of subsection (a) of this
section within a time period specified by the superintendent of not less
than fifteen business days, the superintendent is authorized to  levy  a
civil  penalty,  after notice and hearing, against such pharmacy benefit
manager or person not to exceed four thousand dollars per day  for  each
day  beyond  the  date  the  report  is due or the date specified by the
superintendent for response to the inquiry.
(c) All information, documents and material disclosed  by  a  pharmacy
benefit  manager  under  this  section  and  in  the possession or under
control of the superintendent  shall  be  deemed  confidential  and  not
subject  to disclosure except where and as the superintendent determines
that disclosure is in the public interest.  This  subsection  shall  not
apply  to  information,  documents  and  materials where they are in the
possession and under the control of a person or entity  other  than  the
superintendent.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2905 - Acting Without a License.

§  2905.  Acting  without a license. (a) No person, firm, association,
corporation or other entity may act as a pharmacy benefit manager on  or
after  January  first, two thousand twenty-four without having authority
to do so by virtue  of  a  license  issued  in  force  pursuant  to  the
provisions of this article.
(b)  Any  person,  firm, association, corporation or other entity that
violates this section shall, in addition to any other  penalty  provided
by law, be liable for restitution and compensatory damages to any health
plan,  pharmacy,  covered  individual  or  other  person  harmed  by the
violation and further shall be subject to a penalty  not  exceeding  the
greater  of  (1)  four  thousand dollars for the first violation and ten
thousand dollars for each subsequent  violation  or  (2)  the  aggregate
economic gross receipts attributable to all violations, as determined by
the superintendent at a hearing.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2908 - Penalties for Violations.

§  2908. Penalties for violations. (a) The superintendent, in addition
to any other power conferred by law, may in any one proceeding by order,
require the registrant or licensee who violates the provisions  of  this
article or section two hundred eighty-a of the public health law, or any
regulation   promulgated   thereunder   to   make  restitution  and  pay
compensatory  damages,  in  an  amount   to   be   determined   by   the
superintendent,  to  any  person injured by the unlawful actions of said
registrant or licensee and to pay to the people of this state a  penalty
in a sum not exceeding the greater of (1) four thousand dollars for each
offense  and  ten  thousand dollars for each subsequent violation or (2)
the aggregate gross receipts attributable to all offenses.
(b) Upon the failure of such a  registrant  or  licensee  to  pay  the
penalty ordered pursuant to subsection (a) of this section within twenty
days  after  the  mailing of the order, postage prepaid, registered, and
addressed to the last known place of business of  the  licensee,  unless
the  order  is  stayed by an order of a court of competent jurisdiction,
the superintendent  may  revoke  the  registration  or  license  of  the
registrant  or  licensee  or may suspend the same for such period as the
superintendent determines.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2909 - Stay or Suspension of Superintendent's Determination.

§  2909.  Stay  or  suspension  of superintendent's determination. The
  commencement of a proceeding under article seventy-eight  of  the  civil
  practice  law  and  rules, to review the action of the superintendent in
  suspending or revoking or refusing to renew any certificate  under  this
  article,  shall  stay  such action of the superintendent for a period of
  thirty days. Such stay shall not be extended for a longer period  unless
  the  court  shall  determine,  after  a preliminary hearing of which the
  superintendent is notified forty-eight hours in advance, that a stay  of
  the  superintendent's  action pending the final determination or further
  order of the court will not unduly injure the interests of the people of
  the state.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2911 - Additional Obligations.

§  2911.  Additional obligations. (a) A pharmacy benefit manager shall
assist a health plan in answering any inquiry made under  section  three
hundred eight of this chapter.
(b)  No  pharmacy  benefit manager shall violate any provisions of the
public health law applicable to pharmacy benefit managers.
(c) No  pharmacy  benefit  manager  shall  permit  any  subcontractor,
affiliate, subsidiary, or other individual or entity performing pharmacy
benefit  management  services for a pharmacy benefit manager to take any
action which would violate any provision of law if taken by the pharmacy
benefit manager. A pharmacy benefit manager shall be responsible for the
actions of any subcontractor, affiliate, subsidiary, or other individual
or entity who violates any provision of this article in  performance  of
any  pharmacy  benefit  management  services  for  such pharmacy benefit
manager whether or not the pharmacy benefit manager  was  aware  of,  or
sanctioned, the conduct.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2913 - Applicability of Other Laws.

§  2913. Applicability of other laws. Nothing in this article shall be
  construed to exempt a pharmacy benefit manager from complying  with  the
  provisions  of  articles  twenty-one  and forty-nine of this chapter and
  articles forty-four and forty-nine and section two hundred  eighty-a  of
  the  public health law, section three hundred sixty-four-j of the social
  services law, or any other provision of this chapter  or  the  financial
  services law.
2023 New York Laws › ISC - Insurance › Article 29 - Pharmacy Benefit Managers › 2914 - Assessments.

§  2914.  Assessments.  Notwithstanding section two hundred six of the
  financial  services  law,  pharmacy  benefit  managers   that   file   a
  registration with the department or are licensed by the department shall
  be  assessed  by  the  superintendent  for the operating expenses of the
  department that are attributable to  regulating  such  pharmacy  benefit
  managers  in  such proportions as the superintendent shall deem just and
  reasonable.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3101 - Simplified Comprehensive Policies of Insurance.

§  3101.  Simplified  comprehensive  policies of insurance. Simplified
  policies of  insurance  providing  broad  coverage  of  all  or  various
  combinations  of  risks may be approved by the superintendent and issued
  by  insurers  notwithstanding  any  provision  of  this   chapter,   and
  notwithstanding  those  provisions  of  any  other law which specify the
  content of insurance policies, provided  that  such  policies  shall  be
  subject  to regulations promulgated by the superintendent specifying the
  standards which must be met by insurers for issuing  such  policies  and
  assuring  to  policyholders and claimants protections not less favorable
  than they would be entitled to  under  a  substantially  similar  policy
  which is not subject to this section.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3103 - Non-Conforming Contracts.

§ 3103. Non-conforming contracts. (a) Except as otherwise specifically
provided in this chapter, any policy of insurance or contract of annuity
delivered  or  issued  for delivery in this state in violation of any of
the provisions of this chapter shall  be  valid  and  binding  upon  the
insurer  issuing  the  same, but in all respects in which its provisions
are in violation of the requirements or prohibitions of this chapter  it
shall  be  enforceable  as  if  it  conformed  with such requirements or
prohibitions.
(b) No policy of insurance or contract of annuity delivered or  issued
for  delivery in this state shall provide that the rights or obligations
of the insured or of any person  rightfully  claiming  thereunder,  with
respect to:
(1)  a  policy  of  life, accident and health insurance or contract of
annuity upon a person resident in this state,
(2) a policy of insurance upon property then in this state, or
(3) the liabilities to be incurred by  the  insured  as  a  result  of
activity then carried on by the insured in this state,
shall be governed by the laws of any jurisdiction other than this state.
This subsection shall not apply to policies of marine insurance.
(c)  In  any  action  to recover under the provisions of any policy of
insurance or contract of annuity delivered or  issued  for  delivery  in
this  state  which  the  superintendent is authorized by this chapter to
approve  if  in  his  opinion  its  provisions  are  more  favorable  to
policyholders, the court shall enforce such policy or contract as if its
provisions  were  the same as those specified in this chapter unless the
court  finds  that  its  actual  provisions  were  more   favorable   to
policyholders at the date when the policy or contract was issued.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3104 - Contract Provisions Required by Laws of Other Jurisdictions.

§  3104.  Contract provisions required by laws of other jurisdictions.
(a) Any foreign or alien insurer authorized to do business in this state
may, with the approval of  the  superintendent,  include  in  any  life,
accident and health insurance policy or contract of annuity delivered or
issued for delivery in this state any provisions required by the laws of
the  jurisdiction  in which such insurer is domiciled if such provisions
are not substantially in conflict with the laws of this state.
(b) Any domestic insurer may include in any  policy  of  insurance  or
contract  of  annuity  issued  for  delivery in another jurisdiction and
governed by the laws thereof, any provision required by the laws of such
other jurisdiction applicable to such policy or contract.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3105 - Representations by the Insured.

§  3105.  Representations  by  the  insured. (a) A representation is a
statement as to past or present fact, made to the insurer by, or by  the
authority of, the applicant for insurance or the prospective insured, at
or  before  the making of the insurance contract as an inducement to the
making thereof. A misrepresentation is a false representation,  and  the
facts  misrepresented  are  those  facts  which  make the representation
false.
(b)(1) No misrepresentation shall avoid any contract of  insurance  or
defeat  recovery  thereunder unless such misrepresentation was material.
No misrepresentation shall be deemed material unless  knowledge  by  the
insurer  of  the facts misrepresented would have led to a refusal by the
insurer to make such contract.
(2) With respect to  a  policy  of  hospital,  medical,  surgical,  or
prescription  drug  expense  insurance subject to articles thirty-two or
forty-three of  this  chapter,  no  misrepresentation  shall  avoid  any
contract   of   insurance  or  defeat  recovery  thereunder  unless  the
misrepresentation was also intentional.
(c) In determining  the  question  of  materiality,  evidence  of  the
practice  of  the  insurer  which made such contract with respect to the
acceptance or rejection of similar risks shall be admissible.
(d) A misrepresentation that an applicant for  life  or  accident  and
health insurance has not had previous medical treatment, consultation or
observation,  or has not had previous treatment or care in a hospital or
other like institution, shall be deemed, for the purpose of  determining
its  materiality, a misrepresentation that the applicant has not had the
disease, ailment or other medical impairment for which such treatment or
care  was  given  or  which  was  discovered  by  any  licensed  medical
practitioner  as a result of such consultation or observation. If in any
action to rescind any such contract or  to  recover  thereon,  any  such
misrepresentation is proved by the insurer, and the insured or any other
person having or claiming a right under such contract shall prevent full
disclosure  and  proof  of  the  nature of such medical impairment, such
misrepresentation shall be presumed to have been material.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3106 - Warranty Defined; Effect of Breach.

§  3106.  Warranty  defined;  effect  of  breach.  (a) In this section
"warranty" means any provision of an insurance contract  which  has  the
effect  of  requiring,  as a condition precedent of the taking effect of
such contract or as a condition precedent  of  the  insurer's  liability
thereunder,  the  existence  of  a  fact which tends to diminish, or the
non-existence of a fact  which  tends  to  increase,  the  risk  of  the
occurrence  of  any  loss,  damage, or injury within the coverage of the
contract. The term "occurrence of loss, damage, or injury" includes  the
occurrence  of  death,  disability,  injury,  or  any  other contingency
insured against, and the term "risk" includes both  physical  and  moral
hazards.
(b)  A  breach  of  warranty  shall not avoid an insurance contract or
defeat recovery thereunder unless such breach materially  increases  the
risk  of  loss, damage or injury within the coverage of the contract. If
the insurance contract specified two or more  distinct  kinds  of  loss,
damage  or  injury  which  are within its coverage, a breach of warranty
shall not avoid such contract or defeat recovery thereunder with respect
to any kind or kinds of loss, damage or injury other than  the  kind  or
kinds to which such warranty relates and the risk of which is materially
increased by the breach of such warranty.
(c)  This  section  shall not affect the express or implied warranties
under a contract of marine insurance in respect to, appertaining  to  or
in  connection  with any and all risks or perils of navigation, transit,
or transportation, including war risks, on, over or under  any  seas  or
inland  waters,  nor  shall  it  affect  any  provision  in an insurance
contract requiring notice, proof or other conduct of the  insured  after
the occurrence of loss, damage or injury.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3107 - Sale of Insurance Policies by Vending Machine.

§  3107.  Sale  of  insurance  policies  by  vending  machine. (a) Any
provision in a policy of accident insurance, requiring the signature  of
the insured, where such insurance is sold by a vending machine, shall be
inoperative  and  of  no  effect, unless a notice shall have been placed
upon such vending machine, containing letters  each  at  least  one-half
inch  high,  advising  that  the signature of the insured must be placed
upon such policy or contract, at time of purchase, to make  such  policy
or contract valid.
(b)  No insurance shall be offered for sale, issued or sold by or from
any vending machine or appliance or any other medium, device  or  object
designed or used for vending purposes, herein called a device, except as
provided in this section.
(c)  A  licensed agent may solicit applications for and issue policies
of accident insurance or baggage insurance on personal effects by  means
of mechanical vending machines or other coin operated devices supervised
by  him  and  placed  at  airports, railroad stations or bus stations or
other places to meet the convenience  of  the  public,  subject  to  the
provisions of this section.
(d)  Each  policy  to  be sold by or from a device shall be reasonably
suited for sale and issuance through such a device, and the location  of
such device shall be one that is of material convenience to the public.
(e)  No  policy  of insurance, issued through any such device shall be
for a period of time longer than ten days, or  for  the  duration  of  a
one-way or round trip, as applicable.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3109 - False Statements in Applications for Membership in Fraternal Benefit Societies.

§  3109.  False statements in applications for membership in fraternal
  benefit  societies.  No   applicant,   officer,   solicitor,   examining
  physician,  surgeon or other person shall knowingly or wilfully make any
  false or fraudulent statements or representations in or  with  reference
  to  any  application  for  membership  or  reinstatement  or  any  other
  documentary or other proof for the purpose of obtaining  or  reinstating
  membership  in  or  benefit from any fraternal benefit society, order or
  association, any corporation, association  or  society  transacting  the
  business of life or casualty insurance or both, upon the co-operative or
  assessment plan, or a corporation for the insurance of domestic animals.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3110 - Withdrawal of Any Policy Form.

§  3110. Withdrawal of any policy form. (a) Whenever by the provisions
of this chapter the superintendent is authorized to give approval of any
form of insurance policy or  contract,  the  superintendent  may,  after
notice  and  hearing  given  to the insurer that submitted such form for
approval, withdraw an approval previously given, if the use of such form
is contrary to the requirements applicable to such form at the  time  of
such   withdrawal.  Any  such  withdrawal  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.
(b)  Whenever  by  the provisions of this chapter an insurer may use a
policy form without obtaining the prior approval of the  superintendent,
the  superintendent  may, after notice and hearing given to the insurer,
order the insurer to cease using such policy form, if the  use  of  such
form is contrary to the requirements applicable to such form at the time
of  the  effective date of such order. Any such order shall be effective
at the expiration of such period, not less than ninety  days  after  the
giving  of  a  notice  of cessation, as the superintendent shall in such
notice prescribe.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3112 - Automatic Bank Withdrawal Agreements; Notification Required.

§  3112.  Automatic bank withdrawal agreements; notification required.
  Any insurer licensed  to  issue  insurance  in  the  state  who  has  an
  automatic  bank  withdrawal agreement with an insured for the payment of
  insurance premiums for any type of insurance shall give the  insured  at
  least  fifteen  days  advance  written  notice of any increase in policy
  premiums prior to any automatic bank withdrawal of an increased premium.
2023 New York Laws › ISC - Insurance › Article 31 - Insurance Contracts - General › 3113 - Consent of and Notification of an Irrevocable Beneficiary Under a Court Order of Divorce or Separation.

§  3113.  Consent  of  and  notification of an irrevocable beneficiary
under a court order of divorce or separation. In any case where a policy
owner has, pursuant to an order of separation or divorce, designated his
or her spouse or children as the irrevocable beneficiary of a policy  of
insurance  subject  to  the  provisions  of  section  three thousand two
hundred three of this chapter, and a copy of such order has been served,
by registered mail, on the home office of  the  insurer  specifying  the
name and mailing address of the spouse or children, such insurer shall:
(a)  prohibit  the policy holder from borrowing from the cash value or
changing the named beneficiary of  such  insurance  policy  without  the
written consent of the irrevocable beneficiary; and
(b) provide written notification to the irrevocable beneficiary in the
event   that  such  insurance  policy  is  scheduled  to  lapse  due  to
non-payment of premium.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3202 - Withdrawal of Approval of Policy Forms.

§  3202.  Withdrawal  of  approval of policy forms. The superintendent
  may, in accordance with section three thousand one hundred ten  of  this
  chapter, withdraw an approval previously given to a policy form pursuant
  to  section  three  thousand  two  hundred  one  of  this  article.  The
  superintendent may also withdraw an approval in the  case  of  any  such
  policy  form  (i)  pertaining  to  accident and health insurance, if the
  benefits provided therein are unreasonable in relation  to  the  premium
  charged,  or if it contains provisions which encourage misrepresentation
  or are unjust, unfair, inequitable, misleading, deceptive,  contrary  to
  law  or  to  the public policy of this state, or (ii) pertaining to life
  insurance, annuity  contract,  group  annuity  certificate,  or  funding
  agreement,  if in his judgment the use of such form would be prejudicial
  to the interests of policyholders or members, or it contains  provisions
  which are unjust, unfair or inequitable.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3204 - Policy to Contain Entire Contract; Statements of Applicant to Be Representations and Not Warranties; Alterations.

§  3204. Policy to contain entire contract; statements of applicant to
be representations and not warranties; alterations. (a) (1) Every policy
of life, accident or health insurance, or contract of annuity, delivered
or issued for delivery in this state, shall contain the entire  contract
between  the  parties,  and  nothing  shall  be  incorporated therein by
reference to any writing, unless a copy  thereof  is  endorsed  upon  or
attached to the policy or contract when issued.
(2)  No  application  for  the issuance of any such policy or contract
shall be admissible in evidence unless a true copy was attached to  such
policy or contract when issued.
(3)  Such policy or contract cannot be modified, nor can any rights or
requirements be waived, except in a writing signed by a person specified
by the insurer in such policy or contract.
(b) Subsection (a) hereof shall not apply to a table  or  schedule  of
rates,   premiums   or   other  payments  which  is  on  file  with  the
superintendent for use in connection with such policy or contract.
(c) All statements made by, or by the authority of, the applicant  for
the  issuance,  reinstatement  or renewal of any such policy or contract
shall be deemed representations and not warranties.
(d) No insertion in or other alteration of any written application for
any such policy or contract shall be made by any person other  than  the
applicant  without  his  written  consent, except that insertions may be
made by the insurer for administrative purposes only in such  manner  as
to  indicate  clearly  that the insertions are not to be ascribed to the
applicant.
(e) If any policy of life, accident and health insurance delivered  or
issued  for  delivery  in this state is reinstated or renewed, or if any
such policy of life insurance  provides  that  a  change  in  the  death
benefit  or other policy provisions may be made on application or by the
written notice of exercise of  one  or  more  options  provided  in  the
policy,  and  the  insured or the beneficiary or assignee of such policy
makes written request to the insurer for a copy of the  application,  if
any, for such reinstatement or renewal or change in the death benefit or
other  policy provisions or of the written notice of exercise of such an
option, the insurer shall, within fifteen days after the receipt of such
request at its home office or any branch office of the insurer,  deliver
or mail to the person making such request, a copy of such application or
notice.  If  such  copy is not delivered or mailed, the insurer shall be
precluded from introducing such application or notice as evidence in any
action or  proceeding  based  upon  or  involving  such  policy  or  its
reinstatement, renewal or change.
(f) Any waiver of the provisions of this section shall be void.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3208 - Antedating of Life Insurance Policies and Burial Agreements Prohibited.

§  3208.  Antedating  of life insurance policies and burial agreements
prohibited. (a) No insurer shall knowingly deliver or issue for delivery
in this state any policy of life insurance that purports  to  have  been
issued  or  to have taken effect more than six months before the date on
which the application therefor was  made,  if  thereby  the  premium  is
reduced below the premium that would be payable thereon as determined by
the  insured's  birthday  nearest  the date on which the application was
made.
(b) No agent, other representative  of  an  insurer  or  broker  shall
prepare,  submit  or  accept  in  this  state  any  application for life
insurance dated earlier than the date on which the application was  made
by  the  insured  or the applicant, if thereby the premium is reduced as
above stated.
(c) This section shall not be construed  to  invalidate  any  contract
made  in  violation  of  the  provisions  hereof;  nor  to  prohibit the
exchange, alteration or conversion of any policy of life insurance as of
the original date thereof if the amount of insurance of the  new  policy
does not exceed the greater of that of the original policy or that which
the premium paid for the original policy would have purchased if the new
policy  had been originally applied for; nor to prohibit the exercise of
any conversion privilege contained in any policy.
(d) No person, firm, association, society, or corporation  engaged  in
this  state  in  the  business  of providing for the payment of funeral,
burial or other expenses of deceased  members,  whether  or  not  it  be
subject to the other provisions of this chapter, and no insurer shall:
(1) deliver or issue for delivery in this state any contract or policy
whereby  the benefit or any part thereof accruing under such contract or
policy, upon the death of such member or of the person insured, shall be
payable to a  designated  or  restricted  funeral  director  or  funeral
directing  concern or other person engaged in such trade or business, or
to any official or designated group of them; or
(2) pay any such benefit or any part thereof to any  funeral  director
or  funeral  directing  concern or other person engaged in such trade or
business or to any official or designated group  of  them,  without  the
consent  of  the  person or persons entitled to such benefits, or to pay
any commission or other consideration to any funeral director or funeral
directing concern or employee thereof to induce such person to  sell  or
offer to sell any contract or policy of insurance designated or marketed
as payable for funeral or burial expenses upon the death of the insured;
or
(3)  in  any  way deprive the personal representative or family of the
deceased of the advantages of competition in  procuring  and  purchasing
supplies  and  services  in  connection  with  the  funeral  and  burial
arrangements of such deceased.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3210 - Incontestability After Reinstatement.

§  3210.  Incontestability  after reinstatement. Any policy of life or
  non-cancellable disability insurance or contract of annuity delivered or
  issued  for  delivery  in  this  state  that  is  reinstated  shall   be
  incontestable after the same period following reinstatement and with the
  conditions  and  exceptions  provided  in  the  policy  or contract with
  respect to incontestability.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3213 - Payment of Proceeds.

§  3213.  Payment  of proceeds. Where the proceeds of a policy of life
  insurance delivered or issued for delivery in this  state  are  payable,
  according to its terms, to two or more beneficiaries without designation
  of  their  respective  interests,  the  proceeds  shall  be paid to such
  beneficiaries in equal portions.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3214 - Interest Upon Proceeds of Life Insurance Policies and Annuity Contracts.

§  3214. Interest upon proceeds of life insurance policies and annuity
contracts. (a) If an action to recover the proceeds due under  a  policy
of  life  insurance  or  contract  of  annuity  delivered  or issued for
delivery in this state  results  in  a  judgment  against  the  insurer,
interest thereon shall be paid from the date of the death of the insured
or  annuitant  in  connection  with  a  death  claim on a policy of life
insurance or contract of annuity and from the date  of  maturity  of  an
endowment  contract to the date the verdict is rendered or the report or
decision is made, computed pursuant to the provisions of subsection  (c)
hereof,  and  thereafter  in accord with the provisions of sections five
thousand two and five thousand three  of  the  civil  practice  law  and
rules.
(b)  If  an action to recover is commenced and a settlement is reached
before the verdict is rendered  or  the  report  or  decision  is  made,
interest  on  the settlement shall be paid from the date of the death of
the insured or annuitant in connection with a  death  claim  on  such  a
policy  of  life  insurance  or contract of annuity and from the date of
maturity of an endowment contract to the date of payment computed  under
the provisions of subsection (c) hereof.
(c)  If  no action has been commenced, interest upon the principal sum
paid to the beneficiary or policyholder shall be computed daily  at  the
rate  of  interest  currently paid by the insurer on proceeds left under
the interest settlement option, from the date of the death of an insured
or annuitant in connection with a death claim on such a policy  of  life
insurance  or  contract  of  annuity and from the date of maturity of an
endowment contract to the date of payment and shall be added to and be a
part of the total sum paid.
(d) This section shall not require the payment  of  interest  for  any
period  during  which  an  insurer is required to pay interest under any
state or federal law pertaining to interpleader.
(e) This section shall not apply to policies or contracts issued prior
to  September  first,  nineteen  hundred  seventy-five,  which   contain
specific provisions to the contrary.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-C - Primary and Preventive Obstetric and Gynecologic Care.

§  3217-c.  Primary and preventive obstetric and gynecologic care. (a)
No insurer subject to this article shall by contract, written policy  or
procedure  limit  a  female  insured'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  insured's  primary  care
practitioner in accordance with the requirements of the insurer; and (2)
such  qualified  provider agrees to adhere to the insurer'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
insurer.
(b) An insurer 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 insurer subject to the provisions of this  article  to
advise  each  female  insured,  in  writing,  of  the provisions of this
section.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-D - Grievance Procedure and Access to Specialty Care.

§  3217-d.  Grievance  procedure  and access to specialty care. (a) An
insurer that issues a comprehensive policy that utilizes  a  network  of
providers and is not a managed care health insurance contract as defined
in  subsection  (c)  of  section four thousand eight hundred one of this
chapter shall establish and maintain a  grievance  procedure  consistent
with the requirements of section four thousand eight hundred two of this
chapter.
(b)  An  insurer  that  issues  a comprehensive policy that utilizes a
network of providers and is not a managed care health insurance contract
as defined in subsection (c) of section four thousand eight hundred  one
of this chapter and requires that specialty care be provided pursuant to
a  referral  from  a  primary care provider shall provide access to such
specialty care consistent with the requirements of subsections (b),  (c)
and  (d)  of  section  four thousand eight hundred four of this chapter;
provided, however, that nothing in this section shall  be  construed  to
require  that  an  insurer,  or a primary care provider on behalf of the
insurer, make a referral to a provider that  is  not  in  the  insurer's
network.
(c)  An  insurer  that  issues  a comprehensive policy that utilizes a
network of providers and is not a managed care health insurance contract
as defined in subsection (c) of section four thousand eight hundred  one
of  this  chapter  shall  provide access to transitional care consistent
with the requirements  of  subsections  (e)  and  (f)  of  section  four
thousand eight hundred four of this chapter.
(d)  An  insurer  that  issues  a comprehensive policy that utilizes a
network of providers and is not a managed care health insurance contract
as defined in subsection (c) of section four thousand eight hundred  one
of  this  chapter,  shall  provide  access  to  out-of-network  services
consistent with the requirements  of  subsection  (a)  of  section  four
thousand eight hundred four of this chapter, subsections (g-6) and (g-7)
of section four thousand nine hundred of this chapter, subsections (a-1)
and  (a-2)  of  section four thousand nine hundred four of this chapter,
paragraphs three and four of subsection (b)  of  section  four  thousand
nine  hundred  ten  of  this  chapter,  and subparagraphs (C) and (D) of
paragraph four of subsection (b) of section four thousand  nine  hundred
fourteen of this chapter.
(e)  An insurer that issues a comprehensive policy that uses a network
of providers and is not a managed care  health  insurance  contract,  as
defined  in subsection (c) of section four thousand eight hundred one of
this chapter, shall establish and maintain procedures  for  health  care
professional   applications   and   terminations   consistent  with  the
requirements of section  four  thousand  eight  hundred  three  of  this
chapter  and procedures for health care facility applications consistent
with section four thousand eight hundred six of this chapter.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-E - Choice of Health Care Provider.

§  3217-e.  Choice of health care provider. An insurer that is subject
  to this article and requires or provides for designation by  an  insured
  of  a  participating  primary  care provider shall permit the insured to
  designate any participating primary care provider who  is  available  to
  accept  such  individual,  and  in the case of a child, shall permit the
  insured  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 insurer.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-F - Prohibition on Lifetime and Annual Limits.

§  3217-f.  Prohibition  on lifetime and annual limits. (a) An insurer
shall not establish a lifetime limit on the dollar amount  of  essential
health  benefits  in an individual, group or blanket policy of hospital,
medical, surgical or prescription drug expense insurance.
(b) An insurer shall not establish  an  annual  limit  on  the  dollar
amount  of  essential health benefits in an individual, group or blanket
policy of hospital,  medical,  surgical  or  prescription  drug  expense
insurance  for  policy  years  beginning  on  and after January one, two
thousand fourteen.
(c) For policy years beginning prior  to  January  one,  two  thousand
fourteen,  an  insurer  may  establish  restricted  annual limits on the
dollar amount of essential health benefits in an individual,  group,  or
blanket  policy  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 an individual policy that is a grandfathered health
plan. For purposes of this section, "grandfathered  health  plan"  means
coverage  provided  by an insurer 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 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3217-G - Maternal Depression Screenings.

§  3217-g.  Maternal  depression  screenings.  To  the extent a policy
  provides coverage for maternal depression screening, no insurer  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 policy
  under which the patient insured is covered.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3218 - Medicare Supplemental Insurance Policies.

§ 3218. Medicare supplemental insurance policies. (a) In this section:
(1) "Medicare"  means the coverage of health care costs provided under
subchapter XVIII of the federal Social Security Act, 42 U.S.C.  §§  1395
et seq.
(2) "Medicare  supplemental  insurance"  means any individual or group
accident and health policy issued for delivery in this state on or after
June tenth, nineteen  hundred  eighty,  providing  for  the  payment  or
reimbursement  for health care services not provided by medicare, except
that such  terms  shall  not  include  a  contract  issued  pursuant  to
subsections (c) and (d) of section four thousand two hundred thirty-five
or section four thousand three hundred five of this chapter which covers
employees  of firms doing business in more than one state or the benefit
structure of which was the subject of  collective  bargaining  affecting
employees of firms doing business in more than one state.
(b) The superintendent shall promulgate rules and regulations which:
(1)  Establish  as  a  separate  classification, medicare supplemental
insurance.
(2) Provide for minimum standards for medicare supplemental  insurance
policies.
(3)  Require  the ratio of benefits to premiums to be not less than an
appropriate percentage determined by the  superintendent  and  requiring
the   annual   filing  of  data  that  will  demonstrate  the  insurer's
compliance.
(4) Provide a uniform system of designation for  said  policies  which
indicates the type and scope of coverage afforded.
(5)  Provide  for  full disclosure of coverage in a clear and coherent
manner using words with common everyday language.
(6) Prohibit the advertisement, sale, or solicitation of any  accident
or  health  insurance  policy as being supplemental to medicare coverage
unless it  conforms  to  minimum  standards  for  medicare  supplemental
insurance policies provided by this section.
(7)  Provide  for  the  publication  and dissemination of a consumer's
shopping guide for medicare supplemental insurance.
(c) No authorized insurer shall issue or deliver  in  this  state  any
medicare   supplemental   insurance   policy   other   than  a  medicare
supplemental insurance policy which includes the  minimum  standards  as
approved by the superintendent.
(d)  (1)  Every  authorized insurer engaged in issuing for delivery in
this state, policies for medicare supplemental insurance as set forth in
this section shall file with the superintendent a report of  all  claims
experience  for such coverage for each twelve month period preceding the
dates fixed by the superintendent for the filing of such reports.   Such
reports  shall  be  made  in  writing  and  on  a form prescribed by the
superintendent not  less  than  annually  on  dates  determined  by  the
superintendent.
(2)  The  provisions  of  this  subsection shall remain in force until
December thirty-first, nineteen hundred eighty-three.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3224 - Standard Claim Forms; Accident and Health Insurance.

§  3224.  Standard claim forms; accident and health insurance. (a) The
superintendent shall establish standard claim forms for the services  of
hospitals, physicians and other health care providers to be used for all
accident  and  health  insurance  claims.  All  insurers  providing such
insurance shall accept said standard claim forms  when  submitted  by  a
hospital,  physician  or  other  health  care provider covering services
rendered to an individual covered by the policy or when submitted by  an
insured  covering  these  same  services.  Corporations  operating under
article forty-three of this chapter shall be required  to  use  standard
claim  forms  as  established  by  the  superintendent  pursuant to this
section.
(b) The adoption of any uniform  claim  forms  by  the  superintendent
pursuant  hereto  shall  not  preclude  an  insurer  from  obtaining any
necessary additional information regarding a claim  from  the  claimant,
provider of health care or treatment, or certifier of coverage.
(c) The superintendent is authorized and empowered to take such action
as  he  deems  appropriate  for  the proper implementation hereof and to
provide by rule and regulation that any form which does not comply  with
the  provisions  of  this  section  shall not be issued or reissued. The
rules and regulations so adopted shall specify an effective date,  which
shall  not  be  less  than  one  hundred  eighty  days after the date of
adoption or  promulgation,  after  which  no  insurer  may  require  any
hospital,  physician,  other health care provider or insured to complete
forms differing from those prescribed  by  the  superintendent  pursuant
hereto,  other  than  additional  requests  for  information pursuant to
subsection (b) hereof.
2023 New York Laws › ISC - Insurance › Article 32 - Insurance Contracts - Life, Accident and Health, Annuities › 3224-C - Coordination of Benefits.

§  3224-c.  Coordination  of  benefits.  An insurer or organization or
  corporation licensed or certified pursuant  to  article  forty-three  or
  forty-seven  of  this chapter or article forty-four of the public health
  law shall not deny a claim, either in whole or in  part,  on  the  basis
  that  it is coordinating benefits and another insurer or organization or
  corporation or other entity is liable for  the  payment  of  the  claim,
  unless  it  has a reasonable basis to believe that the insured has other
  health insurance coverage which is  primary  for  that  benefit.  If  an
  insurer or organization or corporation does not have current information
  from the insured regarding other coverage, and requests such information
  in  accordance with subsection (b) of section three thousand two hundred
  twenty-four-a of this article, and no  information  is  received  within
  forty-five  days,  the claim shall be adjudicated provided, however, the
  claim shall not be denied based  on  the  insurer,  or  organization  or
  corporation not having received such information.