reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 13 - Mass Merchandising Of Personal Property - Liability Insurance › Section 13.10 - Disclosure required

Current through Register Vol. 46, No. 28, July 10, 2024
Every insurer, agent or broker selling insurance pursuant to
				  a mass merchandising plan shall, prior to sale, make full and fair disclosure
				  to prospective insureds of all features of such plan, whether favorable or
				  unfavorable, including but not limited to premium rates, benefits, duration of
				  coverage and policyholder services.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 13 - Mass Merchandising Of Personal Property - Liability Insurance › Section 13.11 - Underwriting standards

Current through Register Vol. 46, No. 28, July 10, 2024
No insurer shall use underwriting standards for individual
				  risk selection in a mass merchandising plan which are, on the whole, more
				  restrictive than the standards used by such insurer for individual risk
				  selection in the sale of the same kind of insurance in this State other than
				  pursuant to mass merchandising plans. In the event such insurer does not sell
				  such kind of insurance in this State other than pursuant to mass merchandising
				  plans, its underwriting standards for individual risk selection in such plans
				  shall, on the whole, be no more restrictive than the standards used by its
				  principal affiliate, if any, for individual risk selection in the sale of such
				  kind of insurance in this State other than pursuant to mass merchandising
				  plans.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 13 - Mass Merchandising Of Personal Property - Liability Insurance › Section 13.12 - Cancellation and nonrenewal

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
				purposes of section 3425  of the Insurance Law, limiting the
				cancellation and nonrenewal of insurance policies, the failure of an employer,
				association or organization to remit premiums when due for any reason
				(including but not limited to interruption or termination of employment or
				membership) shall not be regarded as "nonpayment of premium" by any insured
				under any such plan providing for remittance of premium by such employer,
				association or organization, unless such insured shall have been given written
				notice of such failure to remit and shall not himself have paid such premium by
				the later of:
(1) 20 days after such notice;
				or
(2) the due date of such premium
				remittance under the mass merchandising plan.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 13 - Mass Merchandising Of Personal Property - Liability Insurance › Section 13.13 - Compulsory facilities

Current through Register Vol. 46, No. 28, July 10, 2024
An insurer, agent or broker selling insurance pursuant to a
				  mass merchandising plan shall, with respect to any employees or members who
				  apply for, but are denied insurance under such plan, offer to such persons the
				  services provided by a broker in the placement of insurance through the
				  automobile insurance plan or the New York Property Insurance Underwriting
				  Association.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 15 - Simplified Comprehensive Policies Of Insurance › Section 15.1 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Section 3101  of the Insurance Law, relating to
				simplified policies of insurance providing broad coverage of all or various
				combinations of risks, became effective on May 30, 1974. This section provides
				for the promulgation of a regulation
"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."
(b) The purpose of the law and of this Part
				is to encourage insurance companies to offer consumers both broader and simpler
				coverages which will be easy to understand and should result in prompt and fair
				settlement of claims. This Part is not intended to provide for minor, basically
				editorial changes or general improvements in the readability of insurance
				policies. While these are worthwhile goals in and of themselves, there is no
				provision in the Insurance Law or other statute which, even in the absence of
				section 3101 and this Part, would substantially prevent the attainment of these
				goals. This Part is designed to promote the development of both dramatically
				simplified and comprehensive policies which are otherwise unattainable without
				section 3101.
(c) In order to
				facilitate the writing of such broad or simplified policies, section 3101
				authorizes the superintendent to waive requirements of the Insurance Law and of
				other laws which specify the content of insurance policies. At the same time,
				the statute requires that policyholders be afforded no less protection than
				they would otherwise have received.
(d) This Part will eventually encompass all
				types of insurance protection. If successful, this experimental program has the
				potential to accomplish the following:
(1)
				People will be better able to understand their insurance policies, and, in
				particular, to know what they are and are not covered for;
(2) Insurance protection will be
				substantially broadened, and generally will not depend on the cause of the
				loss, which is irrelevant to the policyholder's need for financial protection;
				and
(3) Claims will be paid
				according to common sense expectations, without the annoying and unexpected
				technicalities which so often, today, delay claims payments and frustrate
				consumers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 15 - Simplified Comprehensive Policies Of Insurance › Section 15.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For the purpose of this Part:
(a) Approved policy means an insurance policy
				approved by the Superintendent of Insurance as meeting the requirements of
				Insurance Law, section
				3101 and of this Part.
(b) Replacement policy means an insurance
				policy issued upon termination of an approved policy, as provided in section
				15.5 
				of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 15 - Simplified Comprehensive Policies Of Insurance › Section 15.3 - Requirements for policies other than life insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No simplified or comprehensive policy
				issued pursuant to section 3101 may be sold in this State unless such policy
				has been approved in writing by the superintendent.
(b) Every insurer filing a policy pursuant to
				this Part must be authorized to write in this State every kind of insurance set
				forth in section 1113 (a)  of the Insurance
				Law included in such policy.
(c)
				Every policy shall state that it provides coverage and terms at least as
				favorable as that required by any provision of law with respect to the kinds of
				coverage included under such policy, and it shall be so construed. The approved
				policy need not then contain the language required under any provision of law
				which specifies the content of insurance policies.
(d) Each policy filed for approval pursuant
				to this Part shall be accompanied by the following:
(1) A statement describing the insurance
				coverages included in such policy.
(2) A copy of each replacement policy which
				must be offered pursuant to the provisions of section
				15.5 
				of this Part, together with the rates and limits of coverage applicable to each
				replacement policy.
(3) A statement
				indicating:
(i) the intended market for the
				approved policy;
(ii) the
				underwriting standards which the company will apply in accepting
				applicants;
(iii) the standards of
				suitability to be used by the insurer, which must include an assertion that no
				approved policy will be issued in the absence of reasonable grounds to believe
				that the purchase of such policy is not unsuitable for such applicant, on the
				basis of information furnished after reasonable inquiry of such applicant
				concerning the applicant's insurance needs; and
(iv) a copy of the application form which
				will be used in connection with the approved policy.
(4) Any supplementary documents, such as
				certificates of coverage, which the insurer will issue to or on behalf of an
				insured.
(5) A plan, approved where
				necessary by the appropriate authorities, for identifying and reporting premium
				or other appropriate exposure bases for purposes of determining:
(i) the participation of the insurer in the
				New York Automobile Insurance Plan and the New York Property Insurance
				Underwriting Association;
(ii)
				assessments for security funds;
(iii) applicable taxes; and
(iv) any other requirement for identification
				of premium components.
(6) Such other information as the
				superintendent may request.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 15 - Simplified Comprehensive Policies Of Insurance › Section 15.5 - Replacement of coverages upon policy termination

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An approved policy may, notwithstanding
				any provision of the Insurance Law, provide for termination of coverage by
				cancellation or non-renewal by the insurer upon not less than 45 days written
				notice to the named insured, except where cancellation is for non-payment of
				premium, in which case only 15 days written notice need be provided.
(b) After an approved policy has been in
				effect for 60 days or, if the policy is a renewal, effective immediately, every
				notice of cancellation or non-renewal, except where cancellation is for
				non-payment of premium, shall offer the named insured replacement policies for
				the basic coverages insured under the approved policy. Replacement policies
				which are not subject to the provisions of section 3425 need not be
				offered.
(c) Replacement policies
				shall be offered with limits of coverage approved by the superintendent,
				provided that the insured may accept any or all of the replacement policies
				offered and may select lower limits of coverage for any or all of the
				replacement policies accepted.
(d)
				Each replacement policy shall be issued at the rate which is in effect for such
				policy on its date of issue.
(e)
				Each replacement policy which is subject to the provisions of section 3425  of the Insurance Law shall be subject
				to such provisions as if it had been originally issued on the day when coverage
				first commenced under the approved policy and renewed at annual intervals
				thereafter in accordance with the provisions of section 3425.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 15 - Simplified Comprehensive Policies Of Insurance › Section 15.6 - Withdrawal of approval

Current through Register Vol. 46, No. 28, July 10, 2024
The superintendent may after notice and hearing withdraw an
				  approval previously given pursuant to this Part upon a finding that:
(a) the premiums charged for an approved
				policy are unreasonable in relation to the benefits provided;
(b) the approved policy is not in compliance
				with the provisions of this Part at the time of withdrawal; or
(c) the use of an approved policy has results
				which are unjust, unfair, inequitable, misleading, deceptive, contrary to the
				public policy of this State or prejudicial to the policyholders of the
				company.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
This Part implements article 63 of the Insurance Law and
				  establishes methods, procedures and reports for licensing, facilitating,
				  monitoring and verifying compliance with the requirements of the Insurance Law.
				  In effect, article 63 allows special risks that are jumbo in dimensions or
				  exotic in nature to be written, free of filing rates or policy forms with the
				  superintendent, in what is sometimes called the "Free Trade Zone". In addition,
				  article 63 allows certain coverage for "large commercial insureds" to be
				  written as special risks. Although filing is not required except as specified
				  in section 6303, rates and policy forms applied to special risks must still
				  satisfy governing standards set forth in the Insurance Law and
				  regulations.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part:
(a) Accident and health insurer has the
				meaning set forth in section 107 (a)(1)  of the Insurance
				Law.
(b) Authorized insurer has the
				meaning set forth in section 107 (a)(10)  of the Insurance
				Law.
(c) Large commercial insured
				has the meaning set forth in section 6303 (b)(1)  of the
				Insurance Law.
(d) Life insurer has
				the meaning set forth in section 107 (a)(28)  of the Insurance
				Law.
(e) Major type of insurance as
				used in this Part means the annual statement line of business based on the
				coverage part with the highest estimated premium at the time of issuance of the
				certificate of insurance.
(f)
				Medical malpractice insurance has the meaning set forth in section 5501 (b)  of the Insurance
				Law.
(g) Net premiums written means
				gross premiums (direct and assumed premiums, including policy and membership
				fees, less return premiums and premiums for policies not taken) less
				reinsurance ceded.
(h)
				Property/casualty insurer means an insurer licensed pursuant to article 41 or
				61 of the Insurance Law.
(i)
				Special risk manager has the meaning set forth in section 6303 (b)(2)  of the
				Insurance Law.
(j) Special risk
				means:
(1) Class 1. Class 1.
Where all or part of the insured's business operations, for
				  which coverage is authorized by the kinds of insurance defined in section 1113 (a)  of the Insurance
				  Law, is insured in a single policy written in accordance with section 6303  of
				  the Insurance Law, and which is written with or is reasonably expected to
				  produce a billed annual premium of at least:
(i) $100,000 for at least one kind of
				insurance; or
(ii) $150,000 for
				more than one kind of insurance where the premium for any one kind of insurance
				does not exceed $100,000.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.2 - Limitations on transactions

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
For property/casualty insurers:
(1)
(i) the
				insurer's net premiums written pursuant to section 6302 
				of the Insurance Law during the prior calendar year shall not exceed 75 percent
				of the surplus to policyholders, as reported in the insurer's annual statement
				filed with the superintendent for the corresponding calendar year;
(ii) the insurer's direct premiums written
				pursuant to section 6302 
				of the Insurance Law during the prior calendar year shall not exceed 75 percent
				of the surplus to policyholders, as reported in the insurer's annual statement
				filed with the superintendent for the corresponding calendar year;
				and
(iii) the insurer's total net
				premiums written in the United States shall not exceed 200 percent of surplus
				to policyholders, as reported in the insurer's annual statement filed with the
				superintendent for the corresponding calendar year.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.3 - Disclosure to insureds

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				following notice shall appear conspicuously on the front page of each binder,
				policy, contract, rider or endorsement, and on all subsequent additions
				thereto, issued or renewed under class 1 or 2 pursuant to section 6303 (a)(1) or (2)  of the Insurance Law, provided, however,
				that such notice need not appear separately on a rider or endorsement issued
				contemporaneously with, and as part of, a policy or contract, if, in accordance
				with the provisions of Insurance Law section 6303(a)(1) or (2) and this Part,
				all such riders or endorsements, and the rates associated therewith have not
				been filed with, the superintendent:
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE
				  EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND
				  REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF
				  THE NEW YORK INSURANCE LAW AND REGULATIONS.
(b) The following notice shall appear
				conspicuously on the front page of each binder, policy, contract, rider or
				endorsement, and on all subsequent additions thereto, issued or renewed under
				class 3 pursuant to section 6303 (a)(3)  of the
				Insurance Law, provided, however, that such notice need not appear separately
				on a rider or endorsement issued contemporaneously with, and as part of, a
				policy or contract, if, in accordance with the provisions of Insurance Law
				section 6303(a)(1) or (2) or (3) and this Part, all such riders or endorsements
				have in fact not been approved by, and the rates associated therewith have not
				been filed with, the superintendent:
NOTICE: THESE POLICY FORMS ARE NOT SUBJECT TO THE
				  APPROVAL REQUIREMENTS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING
				  REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS
				  AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND
				  REGULATIONS.
(c)
				Each "Notice" required by subdivision (a) or (b) of this section shall be in
				bold capital letters, no less than 14 point font, enclosed in a
				border.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.4 - Policy forms and other standards

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				Every binder, policy, contract, rider and endorsement issued pursuant to
				section 6301  of the Insurance Law on special risks
				located or resident in New York State shall comply with minimum standard policy
				provisions of the Insurance Law and this Title.
(b) For a coverage coded as a class 3 risk
				pursuant to section
				16.12 
				of this Part, the insurer shall electronically file with the superintendent a
				policy form that has not been previously filed with the superintendent. The
				insurer shall file the policy form in a form and manner acceptable to the
				superintendent, within three business days after first delivery of a policy
				using the form, but no later than 60 calendar days after the inception date of
				the policy.
(c)
(1) An insurer required to make a filing or a
				submission to the superintendent electronically pursuant to this Part may apply
				to the superintendent for an exemption from the electronic filing requirement
				by submitting a written request to the superintendent for approval at least 30
				days in advance of making the filing or submission.
(2) The request for an exemption shall:
(i) identify the time period for which the
				insurer is requesting the exemption; and
(ii) specify whether the insurer is making
				the request for an exemption based upon undue hardship, impracticability, or
				good cause, and set forth a detailed explanation as to the reason that the
				superintendent should approve the request.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.5 - Rate standards

Current through Register Vol. 46, No. 28, July 10, 2024
The rates applied to policies issued pursuant to section 6301  of the Insurance Law shall not be
				  excessive, inadequate, unfairly discriminatory, destructive of competition,
				  detrimental to insurer solvency, or otherwise unreasonable. Each insurer shall
				  maintain in its files the premium charged for each special risk and the basis
				  for the rate or premium.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.6 - Licensing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An authorized
				insurer may apply for a special risk license to transact business written
				pursuant to section 6302 
				of the Insurance Law by completing an application form, prescribed by the
				superintendent and available from the Property Bureau of the Department of
				Financial Services. Every special risk license shall be issued for a term
				expiring on August 31st. Every such license may be renewed for the ensuing
				period of 12 months upon the filing of an application in conformity with this
				Part.
(b) An insurer shall file an
				application for a renewal license with the superintendent not less than 30 days
				prior to the date the license expires.
(c) Nothing in this Part shall authorize an
				insurer to do any kind of insurance business for which it is not licensed in
				this State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.7 - Reporting requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Financial reports.
Every insurer writing special risks pursuant to this Part
				  shall file with its annual and quarterly statements supplemental financial
				  reports using a form prescribed by the superintendent.
(b)
Experience reports.
Every insurer writing special risks pursuant to this Part
				  shall file with its annual and quarterly statements the following information
				  on a direct basis, in accordance with section
				  16.12 
				  of this Part, classification codes, in a form prescribed by the
				  superintendent:
(1) written
				premiums;
(2) earned
				premiums;
(3) losses
				paid;
(4) cumulative number of
				claims closed with payment;
(5)
				cumulative number of claims closed without payment;
(6) outstanding loss reserves;
(7) number of claims outstanding;
(8) losses incurred;
(9) loss adjustment expenses paid;
(10) unallocated loss adjustment expenses
				paid;
(11) allocated loss
				adjustment expenses outstanding;
(12) unallocated loss adjustment expenses
				outstanding;
(13) allocated loss
				adjustment expenses incurred;
(14)
				unallocated loss adjustment expenses incurred;
(15) commissions incurred;
(16) commissions paid; and
(17) number of policies issued.
For premium tax purposes, premiums allocated to locations
				  outside this State shall be coded separately.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.8 - Operational requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Class
				1, class 2 or class 3 coverages may be provided only to:
(1) a single entity; or
(2) two or more related entities, in each of
				which the same person, group of persons, or corporation holds a controlling
				interest.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.9 - Records maintenance and examination

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer granted a special risk license
				by the superintendent pursuant to section 6302 
				of the Insurance Law shall maintain in this State an underwriting office:
(1) that shall be under the control of the
				insurer's management and staffed with personnel who are charged with the
				responsibility for making underwriting decisions relating to policies issued
				pursuant to this Part; and
(2) in
				which the insurer shall maintain or have electronic access to the underwriting
				files, experience statistics, financial and other records, applicable to
				business underwritten and transacted under section 6302 
				of the Insurance Law, subject to examination by the superintendent as often as
				the superintendent deems necessary.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.10 - Other requirements

Current through Register Vol. 46, No. 28, July 10, 2024
All insurers licensed under section 6302 
				  of the Insurance Law shall be subject to all other provisions of the Insurance
				  Law and this Title that are not inconsistent with article 63 or this
				  Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.11 - Other provisions

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall not alter or change any other exemption from
				  rate and form filing requirements extended pursuant to the Insurance Law or any
				  other Part of this Title.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 16 - SPECIAL RISK INSURANCE › Section 16.12 - Coding of class 1, class 2, and class 3 risks

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The principal operations of class 1 and
				class 3 risks shall be coded in accordance with the classification codes filed
				by the Insurance Services Office under the commercial statistical
				plan.
(b) Class 2 risks shall be
				coded in accordance with the classification codes included in the list issued
				annually by the superintendent pursuant to section
				16.1(f)(2) 
				of this Part.
(c) The appropriate
				classification code shall be indicated on the lower left corner of the front
				page of each binder, policy, contract, rider or endorsement, and on all
				subsequent amendments thereto, used pursuant to this Part, with a summary
				classification of codes attached to the rating worksheets or similar data
				contained in the policy files.
(d)
(1) Special risks classified under class 2
				that generate a premium in an amount that qualifies as a class 1 risk shall,
				for reporting purposes, be designated as class 2 risks; and
(2) Special risks classified under class 2
				that also qualify as class 3 risks shall, for reporting purposes, be designated
				as class 2 risks.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.1 - Establishment of standard claim forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The Superintendent of Insurance hereby
				established standard claim forms for the services performed by physicians and
				dentists in New York State. For the services provided by hospitals in New York
				State, the Superintendent of Insurance establishes as a standard claim form the
				uniform inpatient hospital billing form prescribed by the Commissioner of
				Health in section 405.28 (10 NYCRR Part 405) to be used statewide by all
				hospitals.
(b) The standard claim
				form for physician services is the HCFA 1500 (New York State), and is
				incorporated herein as Appendix 18-C, infra. With the understanding that
				instructions for this form will be provided to the physician by the various
				payors to fit their particular claim needs, no claim form instructions are
				included in Appendix 18-C, infra. With the understanding that instructions for
				this form will be provided to the physician by the various payors to fit their
				particular claim needs, no claim form instructions are included in Appendix
				18-C, infra. The standard claim form for the services of dentists is the
				attending dentist's statement approved by the Council of Dental Care Programs
				of the American Dental Association, 1975, and is incorporated herein as
				Appendix 18-B, infra. Appendix 18-B, infra does not include claim form
				instructions.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.2 - Applicability of standard claim forms

Current through Register Vol. 46, No. 28, July 10, 2024
All commercial insurers providing accident and health
				  insurance in New York State and all article IX-C corporations shall accept the
				  standard claim forms established by the Superintendent of Insurance when
				  submitted by physicians, dentists or by a hospital for services rendered in New
				  York State to an individual covered by an accident and health policy, or when
				  submitted directly by an insured for covered services.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.3 - Additional information

Current through Register Vol. 46, No. 28, July 10, 2024
The establishment of any standard claim form by the
				  superintendent shall not preclude a commercial insurer or an article IX-C
				  corporation from obtaining any necessary additional information regarding a
				  claim from the claimant, provider of health care or treatment, or certifier of
				  coverage. Recognizing that unlimited requests for additional information by a
				  commercial insurer or an article IX-C corporation may negate the benefits to be
				  gained by a standard claim form, "necessary additional information" should be
				  requested only when a claim cannot be resolved without obtaining such
				  information or certification of coverage is needed.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.4 - Modifications to standard claim forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A commercial insurer or an article IX-C
				corporation may add to the claim form its own identification and similar
				information; however, no alteration may be made to the format of the standard
				claim form.
(b) Attachments to the
				standard claim forms by physicians and dentists, in lieu of completion of a
				portion of the claim forms, are permitted when the attachment is part of an
				office and bookkeeping system, provides information consistent with that
				required in the standard claim form, and is not found objectionable by the
				superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.5 - Effective date for use of standard claim forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a) On and after September 1, 1979 and, until
				January 1, 1982, no commercial insurer may require any physician, dentist or
				insured to complete claim forms differing from the medical and dental standard
				claim forms established by the superintendent and set forth in Appendix 18-A
				and Appendix 18-B of this Part.
(b)
				On and after January 1, 1982, no commercial insurer or article IX-C corporation
				may require any physician, dentist or insured to complete claim forms different
				from the medical and dental standard claim forms established by the
				superintendent in Appendix 18-B and Appendix 18-C of this Part.
(c) On and after November 1, 1979, no
				commercial insurer may require any hospital to complete claim forms differing
				from the inpatient hospital claim form established by the superintendent in
				this Part. On and After January 1, 1982, no article IX-C corporation may
				require any hospital to complete claim forms differing from the inpatient
				hospital claim form established by the superintendent in this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 17 - Standard Health Insurance Claims Forms For The Services Of Physicians, Dentists And Hospitals › Section 17.6 - Additional standard claim forms

Current through Register Vol. 46, No. 28, July 10, 2024
Standard claim forms for the services of other health care
				  providers may be established by the superintendent upon a demonstration that
				  such standard claim forms are required because existing claim forms fail to
				  produce the desired efficiency in claim processing, and that additional
				  standard claim forms will result in a more expeditious and economical
				  settlement of claims.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) This Part was initially promulgated in
				  1979. However, in November 1987, the members of the New York Insurance
				  Exchange, Inc. voted to suspend writing new and renewal business, and no
				  business has been written on the Exchange since that time. In November 1999,
				  the New York Insurance Exchange, Inc. was liquidated. Nonetheless, because
				  article 62 remains in the Insurance Law, this Part is continued. The original
				  statutory references have been retained.
(2) Section 425-a, now article 62 of the
				  Insurance Law, was added by chapter 480 of the Laws of 1978, effective July 20,
				  1978, and was amended by chapter 11 of the Laws of 1979, effective February 28,
				  1979. Subdivision 1 of section 425- a, now section 6201(a), provides for the
				  creation of a New York insurance exchange, subject to such regulations as may
				  be promulgated by the superintendent; subdivision 6 of section 425-a, now
				  section 6203(c), makes the Insurance Law and regulations promulgated thereunder
				  applicable to the exchange, its members, and the insurance or reinsurance
				  written through the exchange except as may be exempted by the superintendent
				  pursuant to regulation; provided, however, that no such exemption shall be
				  unfairly discriminatory or detrimental to the solvency of licensed
				  insurers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Exchange means
				  the New York Insurance Exchange, Inc.
(b) Constitution means the constitution and
				  bylaws of the exchange.
(c) Board
				  means the board of governors of the New York Insurance Exchange, Inc. then in
				  office.
(d) Board of directors
				  means the board of directors of the Security Fund as described in article 13,
				  section 9 of the constitution.
(e)
				  Superintendent means the Superintendent of Insurance of the State of New
				  York.
(f) Insurance Law means the
				  Insurance Law of the State of New York.
(g) Underwriting member shall have the
				  meaning as set forth in paragraph (a), section 1, article VII of the
				  constitution.
(h) Broker member
				  shall have the meaning as set forth in paragraph (b), section 1, article VII of
				  the constitution.
(i) Member shall
				  mean an underwriting member or broker member.
(j) Associate broker shall have the meaning
				  as set forth in section 2, article VII of the constitution.
(k) Underwriting manager shall have the
				  meaning as set forth in section 3, article IX of the constitution.
(l) Subscriber shall have the meaning as set
				  forth in section 3, article VII of the constitution.
(m) Security Fund means the NYIE Security
				  Fund, Inc. as set forth in section 1, article XIII of the
				  constitution.
(n) Exchange contract
				  shall have the meaning as set forth in section 1, article IX of the
				  constitution.
(o) Earned surplus
				  shall have the meaning as set forth in section 102(a)(6) of the New York
				  Business Corporation Law.
(p) Life
				  department means that portion of business of a life and property and casualty
				  syndicate, as referred to in section
				  18-1.2(h)(3) 
				  of this Subpart, that can be attributed to life insurance and
				  reinsurance.
(q) Deputy or deputies
				  shall mean a natural person or persons to whom binding authority has been
				  delegated by an underwriting manager pursuant to section 3, article IX of the
				  constitution.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.2 - General provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except
				  as hereinafter provided and subject to section 425-a of the Insurance Law, any
				  person, firm, corporation or other entity may become an underwriting member.
				  However, no insurer licensed under the laws of this State, any other state,
				  territory or possession of the United States, or under the laws of a foreign
				  country, shall become an underwriting member of the exchange. Nothing contained
				  herein, however, shall prohibit any such insurer from owning the stock of a
				  corporation which is an underwriting member or of a corporation which is a
				  partner in an underwriting member of the exchange, subject to the applicable
				  provisions of the Insurance Law.
(b)
(1) No
				  rule, regulation or plan of operation of the Security Fund shall become
				  effective unless a copy of said rule, regulation or plan of operation has been
				  submitted to the superintendent at least 30 days prior thereto, or such shorter
				  period as he may permit, and he has not disapproved it within such
				  period.
(2) In the reporting of
				  data for the annual statement pursuant to section 26 of the Insurance Law,
				  underwriting members shall use statutory insurance accounting
				  principles.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.3 - Organization, licensing, corporate procedures and capital and surplus requirements for underwriting members

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Underwriting members shall be subject to
				  the provisions of all sections of article IV of the Insurance Law, except as
				  follows:
(1)
(i) subdivisions 1-4 of section 40;
(ii) subdivision 5 of section 40, except that
				  whenever the superintendent shall determine, after notice and hearing, that any
				  underwriting member is doing business in a manner detrimental to the people of
				  this State, or its further conduct of business may jeopardize the interests of
				  other members, associate brokers or policyholders or has failed or refused to
				  take such steps as may be necessary to remove from office any officer or
				  director of such underwriting member whom the superintendent has found, after
				  notice and hearing, to be a dishonest or untrustworthy person, he may remove,
				  with respect to such underwriting member, any exemptions granted in this
				  Subpart and proceed according to article XVI of the Insurance Law; the
				  superintendent shall furnish the exchange with a copy of any notice issued
				  pursuant to this subparagraph;
(iii) subdivisions 6 and 7 of section 40;
				  or
(iv) subdivision 9 of section
				  40, except that no entity which is controlled through stock ownership, by
				  management contract or otherwise, by another state of the United States or by a
				  foreign government or by any political subdivision of either, or which is an
				  agency of any such state, government or subdivision, may become an underwriting
				  member of the exchange without the prior approval of the superintendent;
				  provided, however, that no underwriting member which was not so controlled at
				  the time it was admitted as an underwriting member of the exchange, and which
				  thereafter becomes so controlled, may continue as an underwriting member of the
				  exchange unless it has received the prior approval of the
				  superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.4 - Exemptions from other provisions of the insurance law

Current through Register Vol. 46, No. 28, July 10, 2024
The exchange, its members and the insurance or reinsurance
					 written through the exchange shall be subject to all the provisions of the
					 Insurance Law and regulations promulgated thereunder, except as provided in
					 section
					 18-1.3 
					 of this Subpart and the specified sections of the following articles of the
					 Insurance Law:
(a) article III:
				  subdivision 2 of section 28 except as provided in section 18- 1.2 of this
				  Subpart; section 32-a, except as provided in subdivision 5 of section 425-a of
				  the Insurance Law, and except for business written pursuant to section 425-1
				  (1)(a)(iii); sections 32-b; 33; 33-a; and 36-a;
(b) article III-A: section 37 through
				  37-q;
(c) article IV-A: sections
				  69-a through 69-k, provided the exchange adopts rules requiring members to
				  register, report or otherwise disclose information substantially equivalent to
				  that required under article IV-A and Regulation 52 (11 NYCRR 80);
(d) article V:
(1) section 76, only to the extent that the
				  approvals required of the superintendent shall become the responsibility of the
				  exchange;
(2) subdivisions 4, 5 and
				  6 of section 77, provided the exchange adopts substantially equivalent rules to
				  regulate the reinsurance transactions therein described and such other rules as
				  may be required:
(i) to achieve the
				  legislative intent of creating additional capacity for buyers of insurance and
				  reinsurance and maintaining within the United States insurance business now
				  exported to other countries;
(ii)
				  to prevent the use of the reinsurance mechanism as a means for insurers not
				  authorized in this State to effectively transact an insurance business in this
				  State; and
(iii) to preclude the
				  making of, or entering into, any reinsurance agreement or other arrangement by
				  an underwriting member which may diminish, weaken or impair the undertaking of
				  such underwriting member, as a primary insurer to indemnify its policyholders
				  or as a reinsurer to fulfill its obligations to ceding insurers;
(3) section 77-a; section 78,
				  provided the exchange adopts rules to accomplish the intent and purposes of
				  this section; section 79 except that the provisions of section
				  18-1.3(c) 
				  of this Subpart shall apply; sections 96; 98; 99; 100; 101; 102; 103;
				  104;
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-1 - General › Section 18-1.5 - Filing and notification requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The superintendent may, from time to
				  time, prescribe that copies of statements, reports and other information be
				  submitted by the exchange to him. The exchange shall furnish copies of any such
				  statements, reports and other information to the superintendent within 10 days
				  from the date such material becomes available to it, unless a different time
				  limit is indicated by the superintendent.
(b) No rule, regulation or plan of operation
				  of the exchange proposed pursuant to the provisions of the constitution shall
				  be implemented unless a copy of said rule, regulation or plan of operation is
				  submitted to the superintendent. Such rule, regulation or plan of operation
				  shall include, but not be limited to, those proposed pursuant to section 1,
				  article II; section 5, article VII; section 3, article IX; section 3, article
				  X; section 1, article XII; section 7 (a), article XII; and section 2, article
				  XIV of the constitution.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-2 - Investments In Underwriting Members, Broker Members And Associate Brokers › Section 18-2.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) This Subpart was initially promulgated in
				  1979. However, in November 1987, the members of the New York Insurance
				  Exchange, Inc. voted to suspend writing new and renewal business, and no
				  business has been written on the Exchange since that time. In November 1999,
				  the New York Insurance Exchange, Inc. was liquidated. Nonetheless, because
				  article 62 remains in the Insurance Law, this Subpart is continued. The
				  original statutory references have been retained.
(2) Section 425-a, now article 62 of the
				  Insurance Law, was added by chapter 480 of the Laws of 1978, effective July 20,
				  1978, and was amended by chapter 11 of the Laws of 1979, effective February 28,
				  1979. Subdivision 1 of section 425- a, now section 6201(a), provides for the
				  creation of a New York insurance exchange, subject to such regulations as may
				  be promulgated by the superintendent; subdivision 6 of section 425-a, now
				  section 6203(d), gives the superintendent authority to establish limitations on
				  investments in members of the exchange.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-2 - Investments In Underwriting Members, Broker Members And Associate Brokers › Section 18-2.2 - Investments in members and associate brokers

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) No
				  broker member or associate broker and no person which controls, is controlled
				  by or is under common control with a broker member or associate broker may have
				  an investment, directly or indirectly, of 20 percent or more in an underwriting
				  member.
(2) No underwriting member
				  and no person which controls, is controlled by or is under common control with
				  an underwriting member may have an investment, directly or indirectly, of 20
				  percent or more in a broker member or an associate broker.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter I - GENERAL PROVISIONS › Part 18 - New York Insurance Exchange, Inc › Subpart 18-3 - Criteria For Eligibility For The Position Of Public Governor › Section 18-3.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) This Subpart was initially promulgated in
				  1979. However, in November 1987, the members of the New York Insurance
				  Exchange, Inc. voted to suspend writing new and renewal business, and no
				  business has been written on the Exchange since that time. In November 1999,
				  the New York Insurance Exchange, Inc. was liquidated. Nonetheless, because
				  article 62 remains in the Insurance Law, this Subpart is continued. The
				  original statutory references have been retained.
(2) Section 425-a, now article 62 of the
				  Insurance Law, was added by chapter 480 of the Laws of 1978, effective July 20,
				  1978, and was amended by chapter 11 of the Laws of 1979, effective February 28,
				  1979. Subdivision 1 of section 425- a, now section 6201(a), provides for the
				  creation of a New York insurance exchange, subject to such regulations as may
				  be promulgated by the superintendent.