2023 New York Laws › LAB - Labor › Article 7 - General Provisions › 217 - Employee Notification and Remittance of Premiums; Group Policies of Accident and Health Insurance.

§  217.  Employee  notification  and  remittance  of  premiums;  group
policies of accident  and  health  insurance.  1.  Statement  of  public
policy.  The  legislature  finds  that  in  today's  society  health and
accident insurance coverage for medical care and treatment is  of  prime
importance to all employees and their dependents within the state of New
York. Adequate and prospective planning is necessary to insure that such
coverage  is  in  effect  at  the  time  of commencement of the need for
medical and health care. Many employees and their dependents in New York
State are covered through group  policies  issued  to  their  employers,
employee  organizations  or  trustees  of  employee welfare funds and no
statutory provision has heretofore afforded these  employees  and  their
dependents the right as certificate holders of a group accident or group
health  policy  to  receive  notification of the intended termination or
substitution of the group  policy  and  to  have  premiums  remitted  to
insurers  on  their  behalf  should they choose to exercise continuation
privileges available under law.
Accordingly, it is the declared public policy of the state of New York
that sufficient and timely notice  be  afforded  each  employee  covered
under   a  group  accident  or  group  health  policy  of  the  intended
termination or  substitution  of  such  policy  and  that  employers  be
required  to  remit  premiums  to  insurers  on  behalf  of  individuals
exercising their right to continuation coverage under the law.
2. Definitions. As used in this section:
(a) "Policyholder" shall mean any person, co-partnership, corporation,
trade   association,   joint   stock   association,   incorporated    or
unincorporated association, trustees or labor organization as defined in
subsections  (c)  and  (g),  respectively, of section four thousand four
hundred two of the insurance law or any other entity to whom a policy or
contract of group accident, group health or group  accident  and  health
insurance has been issued.
For the purpose of this section, "policyholder" shall also include any
group remitting agent.
(b)  "Certificate  holder"  shall mean any person insured, on either a
contributory or non-contributory basis, by a policy or contract of group
accident, group health or group accident and health insurance,  as  well
as persons covered by group remittance policies.
3.  Notification. A policyholder shall, subsequent to receipt from the
insurer of notice of termination pursuant to subsection (k)  of  section
four  thousand  two  hundred  thirty-five  of  the insurance law provide
written notice to  the  certificate  holders  of  such  policy  of  such
termination.  In  any  case  where the policyholder is substituting such
policy with another policy  providing  similar  coverage  for  the  same
certificate  holders, the policyholder shall provide certificate holders
with a written notice including therein  the  name  of  the  substituted
insurer.  Where  the  employees are represented by a labor organization,
such  notice  shall  be  given  to  the  representative  of  that  labor
organization.  Such written notice shall be in accordance with the rules
and regulations of the superintendent of financial services, promulgated
pursuant  to  subsection  (l)  of  section  four  thousand  two  hundred
thirty-five of the insurance law.
4.  Exception.  The  provisions  of  subdivision three of this section
shall not be deemed to apply if, within ten days subsequent  to  receipt
of  notice  of  termination from the insurer, the policyholder has taken
necessary steps whereby the intended termination is  rendered  null  and
void.
5.  Where  the  policyholder  has  contracted  with another insurer to
replace the existing insurer for the providing of similar and continuous
coverage for the same certificate holders he  shall  file  an  affidavit

with  the commissioner of labor and superintendent of financial services
to that effect.
6.  Remittance of premiums. Any policyholder who receives notification
from an individual entitled to  exercise  a  right  to  continuation  of
coverage  by  the  policyholder's  insurer  pursuant  to  section  three
thousand two hundred twenty-one of the insurance law,  shall,  no  later
than thirty days subsequent to receipt of premiums from such individual,
remit  such  premiums  to  the  insurer on behalf of such individual and
provide evidence to the individual that the premium has been remitted.
6-a.  Residence  location  to  accompany  enrollment  data.   When   a
policyholder  provides  information  to an insurer or health maintenance
organization certified under article forty-four of the public health law
or licensed pursuant to the  insurance  law  regarding  the  initial  or
continued  enrollment  eligibility  of  a certificate holder, the policy
holder must include the current united states postal  service  zip  code
and state in which the certificate holder currently resides.
7.  Penalties.  (a)  Any  policyholder  who  fails to comply with this
section, shall forfeit to the people of the  State  a  sum  up  to  five
thousand dollars, to be recovered by the commissioner in a civil action.
Where  the policyholder is a corporation, trade association, joint stock
association, incorporated or unincorporated association, the  president,
secretary and treasurer thereof shall be liable for any forfeiture.
(b)  In addition to such penalty, where the failure to comply involves
the failure to notify an employee of the termination of a group accident
or group health policy pursuant to subdivision three of this section  or
the  failure  to  remit  premiums  pursuant  to  subdivision six of this
section, or  the  failure  to  provide  an  individual  with  notice  of
termination   pursuant   to  subdivision  six  of  section  one  hundred
ninety-five of this chapter, the policy holder shall also be liable,  in
a  civil action brought by the individual entitled to receive the notice
of termination or exercise the right to continuation of  coverage  in  a
court  of  competent  jurisdiction,  to  appropriate damages which shall
include reimbursement for medical expenses which were not covered by the
policyholder's insurer by virtue of his termination  of  the  policy  or
failure to remit such premiums.