2023 New York Laws › ISC - Insurance › Article 45 - Fraternal Benefit Societies › 4512 - Accident and Health and Disability Insurance Certificates; Compliance With Rules and Regulations.

§  4512.  Accident  and  health and disability insurance certificates;
compliance with rules and  regulations.  (a)  No  certificate  or  other
evidence  of  any  contract  of  accident  insurance,  disability income
insurance, or health insurance or of any total and permanent  disability
insurance  and  no  application  or  rider  or  endorsement  for  use in
connection therewith shall be delivered or issued for delivery  in  this
state   unless   it  conforms  with  reasonable  rules  and  regulations
prescribed by the superintendent  and  contains  a  provision  that  the
rights  or  obligations of the insured member under any such certificate
or other evidence of such contract, or of any person rightfully claiming
thereunder, shall be governed by the laws of this state. Pursuant to the
foregoing provisions the superintendent shall have power, from  time  to
time  to  make,  alter  and  supersede  reasonable rules and regulations
prescribing the required, optional and  prohibited  provisions  in  such
contracts,  and  such  rules  and  regulations  shall conform, as far as
practicable, to the provisions of section  three  thousand  two  hundred
fifteen of this chapter or of section three thousand two hundred sixteen
of this chapter, whichever shall be applicable. Where the superintendent
deems  inapplicable, either in part or in their entirety, the provisions
of the aforesaid sections, he may prescribe the portions, or  a  summary
thereof,  of the contract to be printed in the certificate issued to the
member.
(b) Anything in this article to  the  contrary  notwithstanding,  each
certificate  of  hospitalization expense benefits or surgical or medical
expense benefits delivered or issued for delivery in this state  to  any
member individually or as the head of a family shall:
(1)  stipulate  a  premium  determined  on the basis of the age of the
member, which premium shall be subject to change only if the premiums on
all outstanding certificates in the same class are changed in accordance
with the standards which  shall  have  been  established  prior  to  the
issuance  of  the  certificate  for the determination of the increase or
decrease in the premiums and are  on  file  with  and  approved  by  the
superintendent,
(2)  contain the following provisions under the caption "Incontestable
and Guaranteed Renewable":
"After this certificate has been in force for a  period  of  one  year
from  the  date  of  issue,  it  shall  become  incontestable  as to the
statements contained in the application and the member  shall  have  the
right  to  continue  the same in force, subject to the timely payment of
premiums and the conditions of  the  certificate  relating  to  military
service;" and
(3)  in  the  case  of  such  certificates  written at issue age above
sixty-five years, contain the following provision:
"No claim for benefits provided in this certificate shall  be  reduced
or denied on the ground that a disease or physical condition had existed
prior to the effective date of coverage of this certificate, except only
such  disease  or physical condition which is specifically eliminated by
rider, attached to this  certificate,  a  copy  which  shall  have  been
furnished  to the member and its receipt evidenced by a signed amendment
to the application for such certificate."