reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.65 - Required disclosure statement for policies and certificates meeting definition of sections 52.12 and 52.13 of this Part

Current through Register Vol. 46, No. 28, July 10, 2024
In order to comply with section
					 52.54  of
					 this Part, policies of individual insurance and certificates and policies of
					 group insurance meeting the definition of section
					 52.12 or
					 52.13 
					 of this Part shall use the following statement only, except that appropriate
					 policy identification may be included.
(COMPANY NAME) (LONG TERM CARE INSURANCE) OR (NURSING HOME
					 AND
(HOME CARE INSURANCE) OR (NURSING HOME INSURANCE ONLY) OR
					 (HOME CARE INSURANCE ONLY)
REQUIRED DISCLOSURE STATEMENT
(Policy Number or Group Master Policy and Certificate
					 Number)
1. This policy or certificate
				  is (an individual policy of insurance) (a group policy or certificate) that was
				  issued in the (indicate jurisdiction in which the policy or certificate was
				  issued).
2. This disclosure
				  statement provides a very brief description of the important features of the
				  policy or certificate. You should compare this disclosure statement to outlines
				  of coverage for other policies or certificates available to you. This is not an
				  insurance contract, but only a summary of coverage. Only the individual or
				  group policy contains governing contractual provisions. This means that the
				  policy sets forth in detail the rights and obligations of both you and the
				  insurance company. Therefore, if you purchase this coverage, or any other
				  coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE)
				  CAREFULLY!
3. TERMS UNDER WHICH THE
				  POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.
(a) (Provide a brief description of the right
				  to return - "free look" provision of the policy or certificate.)
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.69 - Rules relating to the content of health insurance identification cards

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every
				  issuer shall provide a health insurance identification card to the primary
				  insured and to each dependent of the primary insured who is 18 years of age or
				  older within 30 days of the effective date of the insured's or dependent's
				  coverage, or if the insured or dependent is enrolled retroactively, within 30
				  days of the retroactive enrollment, under an accident and health insurance
				  policy that provides coverage for comprehensive hospital, surgical and medical
				  care, except coverage that is provided by this State to its employees or
				  retirees or by governmental programs administered by the Commissioner of
				  Health, including Medicaid, Children's Health Insurance Program, and Essential
				  Plan. The health insurance identification card shall, at a minimum, contain the
				  following information:
(1) the primary
				  insured's name and identification number;
(2) each insured dependent's name and, if
				  applicable, identification number, which shall appear either on the primary
				  insured's identification card or on a separate card issued to the
				  dependent;
(3) the full legal name
				  of the issuer providing the coverage or the name under which the issuer is
				  authorized to do business;
(4) a
				  phrase that reads as follows: "fully insured coverage";
(5) the plan name;
(6) the coverage type, which shall be
				  identified as point-of-service (POS), health maintenance organization (HMO),
				  exclusive provider organization (EPO), preferred provider organization (PPO),
				  or fee-for-service;
(7) the name of
				  the issuer's health care provider network or networks for the plan, if
				  applicable;
(8) the name of the
				  plan's formulary, if applicable;
(9)
				  the phone number or numbers at which the insured or health care provider may
				  readily obtain the following:
(i) member
				  services assistance;
(ii)
				  confirmation of eligibility or verification of benefits; and
(iii) prior authorization for health care
				  services, if applicable;
(10) the internet website address of the
				  issuer;
(11) copayment or
				  coinsurance information applicable to participating providers for the following
				  services:
(i) primary care office
				  visits;
(ii) specialist office
				  visits;
(iii) urgent
				  care;
(iv) emergency room visits;
				  and
(v) prescription drugs for a
				  30-day supply at a retail pharmacy, if applicable;
(12) the annual or plan year deductible
				  amount for participating providers, if applicable; and
(13) the plan's annual maximum out-of-pocket
				  amount.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.70 - Special rules for group, blanket and franchise insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) General rules for franchise insurance.
(1) The insurer may require evidence of
				  insurability as to each person to be insured.
(2) The insurer shall submit a statement as
				  to its rule, if any, with respect to the minimum participation requirement for
				  insuring all applicants without a statement of good health.
(3) The insurer's underwriting rules shall be
				  filed with the superintendent.
(4)
				  In the case of association franchise insurance, eligible members shall be
				  informed in writing of the sponsorship of the plan by the sponsoring
				  organization or by its representative, agent or trustee.
(5) Franchise policies approved prior to the
				  effective date of this Part may be used for new entrants to a franchise plan
				  existing prior to the effective date of this Part, provided that the
				  appropriate disclosure required by section
				  52.54(a) 
				  of this Part is made with respect to such new entrant.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.71 - Essential health benefits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every
				  individual and small group accident and health insurance policy that provides
				  hospital, surgical, or medical expense coverage and is not a grandfathered
				  health plan, and every student accident and health insurance policy shall
				  provide coverage of at least the following essential health benefits:
(1) ambulatory patient services, such as
				  office visits, ambulatory surgical services, dialysis, radiology services,
				  chemotherapy, infertility treatment, abortion services, hospice care, and
				  diabetic equipment, supplies and self-management education;
(2) emergency services, such as emergency
				  room services, urgent care services, and ambulance services;
(3) hospitalization, such as preadmission
				  testing, inpatient physician and surgical services, hospital care, skilled
				  nursing facility care, and hospice care;
(4) maternity and newborn care, such as
				  delivery, prenatal a nd postnatal care, and breastfeeding education and
				  equipment;
(5) mental health and
				  substance use disorder services, including behavioral health treatment, such as
				  inpatient and outpatient services for the diagnosis and treatment of mental,
				  nervous and emotional disorders including maternal depression, screening,
				  diagnosis and treatment for autism spectrum disorder, and inpatient and
				  outpatient services for the diagnosis and treatment of substance use disorder;
(6) prescription drugs, such as
				  coverage for generic, brand name and specialty drugs, enteral formulas,
				  contraceptive drugs and devices, abortifacient drugs, and orally administered
				  anticancer medication;
(7)
				  rehabilitative and habilitative services and devices, such as durable medical
				  equipment, medical supplies, prosthetic devices, hearing aids, chiropractic
				  care, physical therapy, occupational therapy, speech therapy, and home health
				  care;
(8) laboratory services,
				  such as diagnostic testing;
(9)
				  preventive and wellness services and chronic disease management, such as well
				  child visits, immunizations, mammography, gynecological exams including
				  cervical cytology screening, bone density measurements or testing, and prostate
				  cancer screening; and
(10)
				  pediatric services, including oral and vision care, such as preventive and
				  routine pediatric vision and dental care, and prescription lenses and frames.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.72 - Nondiscrimination on the basis of race, color, creed, national origin, sex, age, marital status, disability, or preexisting condition

Current through Register Vol. 46, No. 28, July 10, 2024
(a) With regard to an individual or small
				  group accident and health insurance policy that provides hospital, surgical, or
				  medical expense coverage and a student accident and health insurance policy
				  delivered or issued for delivery in this State, no insurer shall, because of
				  race, color, creed, national origin, sex, age, marital status, disability, or
				  preexisting condition:
(1) make any
				  distinction or discrimination between persons as to the premiums or rates
				  charged for the policy or in any other manner whatever;
(2) demand or require a greater premium from
				  any person than it requires at that time from others in similar
				  cases;
(3) make or require any
				  rebate, discrimination or discount upon the amount to be paid or the service to
				  be rendered on any policy;
(4)
				  insert in the policy any condition, or make any stipulation, whereby the
				  insured binds his or herself, or his or her heirs, executors, administrators or
				  assigns, to accept any sum or service less than the full value or amount of
				  such policy in case of a claim thereon except such conditions and stipulations
				  as are imposed upon others in similar cases; and any such stipulation or
				  condition so made or inserted shall be void;
(5) reject any application for a policy
				  issued or sold by it;
(6) cancel
				  or refuse to issue, renew or sell such policy after appropriate application
				  therefor; or
(7) fix any lower
				  rate or discriminate in the fees or commissions of insurance agents or
				  insurance brokers for writing or renewing such a policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.73 - Formulary exception process for medication for the detoxification or maintenance treatment of a substance use disorder

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every insurer that delivers or issues for
				  delivery in this state an accident and health insurance policy that provides
				  hospital, surgical, or medical expense coverage and also provides coverage for
				  medication for the detoxification or maintenance treatment of a substance use
				  disorder shall include in the policy processes that allow an insured, the
				  insured's designee, or the insured's prescribing physician (or other
				  prescriber, as appropriate) to request a formulary exception and gain access to
				  clinically appropriate medication for the detoxification or maintenance
				  treatment of a substance use disorder not otherwise covered by the policy (a
				  request for formulary exception). With respect to the process for such a
				  formulary exception, an insurer shall follow the process an d procedures
				  specified in Insurance Law Article 49 or Public Health Law Article 49, as
				  applicable, except as otherwise provided in this section.
(b) Standard formulary exception request.
(1) An insurer shall have a process for an
				  insured, the insured's designee, or the insured's prescribing physician (or
				  other prescriber) to request a standard review of a decision that a medication
				  for the detoxification or maintenance treatment of a substance use disorder
				  drug is not covered by the policy.
(2) An insurer shall make a determination on
				  a standard exception request and notify the insured or the insured's designee
				  and the prescribing physician (or other prescriber, as appropriate) of its
				  coverage determination no later than 72 hours following receipt of the request.
(3) An insurer that grants a
				  standard exception request shall provide coverage of the non-formulary
				  medication for the detoxification or maintenance treatment of a substance use
				  disorder for the duration of the prescription, including refills.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.75 - Prohibition on discrimination based on sexual orientation, gender identity or expression, or transgender status

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In addition to the prohibitions against
				  discrimination set forth in section
				  52.72 
				  of this Part, an insurer shall not discriminate based on an insured's or
				  prospective insured's actual or perceived sexual orientation, gender identity
				  or expression, or transgender status. Discrimination prohibited by this section
				  includes any of the following:
(1) including
				  a policy clause that purports to deny, limit, or exclude coverage based on an
				  insured's sexual orientation, gender identity or expression, or transgender
				  status;
(2) denying, limiting, or
				  otherwise excluding medically necessary services or treatment otherwise covered
				  by a policy on the basis that the treatment is for gender dysphoria; provided
				  further that an insurer shall provide an insured with the utilization review
				  appeal rights required by Insurance Law and Public Health Law Articles 49 for
				  gender dysphoria treatment that is denied based on medical necessity;
(3) designating an insured's sexual
				  orientation, gender identity or expression, or transgender status as a
				  pre-existing condition for the purpose of denying, limiting, or excluding
				  coverage; or
(4) denying a claim
				  from an insured of one gender or sex for a service that is typically or
				  exclusively provided to an individual of another gender or sex unless the
				  insurer has taken reasonable steps, including requesting additional
				  information, to determine whether the insured is eligible for the services
				  prior to denial of such claim.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.76 - Coverage for preventive care and screenings

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) Every policy that provides hospital,
				  surgical, or medical care coverage, except for a grandfathered health plan,
				  shall provide coverage for preventive care and screenings for insureds pursuant
				  to Insurance Law sections
				  3216(i)(17)(E),
				  3221(l)(8)(E) and (F), and
				  4303(j)(3), including
				  coverage for preexposure prophylaxis with effective antiretroviral therapy to
				  persons who are at high risk of HIV acquisition. Such coverage shall not be
				  subject to cost-sharing.
(2) A
				  policy shall cover preventive care and screenings described in Insurance Law
				  sections
				  3216(i)(17)(E),
				  3221(l)(8)(E) and (F), and
				  4303(j)(3) upon any policy
				  issuance or renewal that occurs six months af- ter the date the recommendation
				  or guideline described in Insurance Law sections
				  3216(i)(17)(E),
				  3221(l)(8)(E) and (F), and
				  4303(j)(3) is
				  issued.
(3) A policy that provides
				  coverage for preventive care and screenings specified in any recommendation or
				  guideline described in Insurance Law sections
				  3216(i)(17)(E),
				  3221(l)(8)(E) and (F), and
				  4303(j)(3) shall provide
				  coverage through the last day of the policy year, even if the recommendation or
				  guideline changes during the policy year.
(4) For purposes of this section,
				  "grandfathered health plan" shall have the meaning set forth in Insurance Law
				  sections
				  3216(i)(17)(F),
				  3221(l)(8)(G), and
				  4303(j)(4).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.77 - Payment when an issuer provides inaccurate network status information

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If an insured
				  who is covered under an accident and health insurance policy that uses a
				  network of health care providers receives a bill for out-of-network services
				  resulting from an issuer providing inaccurate network status information to an
				  insured, the issuer shall not impose on the insured a copayment, coinsurance,
				  or deductible for the service that is greater than the copayment, coinsurance,
				  or deductible that would be owed if the insured had received services from a
				  participating provider. The issuer shall apply the out-of-pocket maximum that
				  would have applied had the services been received from a participating
				  provider.
(b) Pursuant to Insurance
				  Law sections 3217-b(n) and 4325(o) and Public Health Law section 4406-c(12), if
				  an issuer provides inaccurate network status information to an insured, the
				  issuer shall reimburse the provider for the out-of-network services regardless
				  of whether the insured's coverage includes out-of-network services.
(c)
(1) An
				  issuer that issues comprehensive health insurance policies shall provide
				  network status information to an insured in writing through print or electronic
				  means, if the insured consents to electronic communication, within one business
				  day of the insured requesting the information by telephone or through
				  electronic means, if available.
(2)
				  An issuer that issues a policy, other than a comprehensive health insurance
				  policy, that uses a network of providers shall provide network status
				  information to an insured in writing through print or electronic means, if the
				  insured consents to electronic communication, within three business days of the
				  insured requesting the information by telephone or through electronic means, if
				  available.
(3) An issuer shall
				  retain any recordings of telephone requests for network status information and
				  a copy of its written response to the insured in the insured's file in
				  accordance with section 243.2(b)(8)  of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.90 - Applicability provisions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This
				  Part shall apply to accident and health insurance, except insurance defined in
				  section 3201 (b)(4)  of the
				  Insurance Law.
(1) On January 1, 1983 with
				  respect to provisions of this Part previously promulgated on April 1, 1982
				  affecting:
(i) policies delivered or issued
				  for delivery in this State on or after January 1, 1983; and
(ii) any policies which are amended on or
				  after January 1, 1983 to substantially alter or change benefits or
				  coverages.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.95 - Separability provision

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Part or the application thereof to
					 any person or circumstance is for any reason held invalid, the remainder of
					 this Part and application of such provision to other persons or circumstances
					 shall not be affected thereby.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-1 - General Provisions › Section 53-1.1 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The purposes of this Part are:
(a) to establish rules for the content and
					 format of sales illustrations for life insurance policies, annuity contracts,
					 variable life insurance policies, variable annuity contracts and individual
					 funding agreements in accordance with section 3209 (k)  of the Insurance
					 Law;
(b) to define in accordance
					 with section 3209 (k)  of the Insurance
					 Law the preliminary information and the information to appear in the policy
					 summary including specimen values of fund accumulation and cash surrender
					 values for the life insurance policies subject to section 4232 (b)  of the Insurance
					 Law;
(c) to define in accordance
					 with section 3209 (k)  of the Insurance
					 Law the contents of illustrations for life insurance policies which can serve
					 as the preliminary information and policy summary information as authorized by
					 section 3209 (l)  of the Insurance
					 Law;
(d) to prescribe rules with
					 respect to the calculation of life insurance cost indexes and the equivalent
					 level annual dividend referred to in section 3209 (d) and (e)  of the
					 Insurance Law;
(e) to prescribe in
					 accordance with section 3209 (c)  of the Insurance
					 Law guidelines pursuant to which insurers may charge policyholders a reasonable
					 fee for the preparation of a policy summary for in-force premium paying
					 policies for which no policy summary has ever been furnished; and
(f) to establish pursuant to section 3209 (k)  of the Insurance
					 Law additional disclosure rules for certain graded death benefit life insurance
					 policies issued to individuals age 50 to 75 on the basis of minimal or no
					 underwriting.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-1 - General Provisions › Section 53-1.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall apply to all insurers, fraternal benefit
						societies, and life insurance departments of savings banks licensed to do
						business in this State. This Part shall be applicable to any act of
						solicitation, negotiation or procurement of a life insurance policy or an
						annuity contract within the State including any act done by mail, telephone,
						electronic or any other method to present the information required by section 3209  of the Insurance Law, and shall be
						applicable to any illustration presented in this State for the purpose of
						proposing to make a sale of a life insurance policy or an annuity
						contract.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-1 - General Provisions › Section 53-1.4 - Enforcement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In addition to
					 the requirements imposed by section
					 53-3.5(e) 
					 of this Part, each insurer shall maintain at its home or principal office, a
					 complete file containing one specimen copy each of the preliminary information
					 form, policy summary form, and sales illustrations authorized by the insurer
					 for each policy form subject to this Part. Such files shall be subject to
					 regular and periodic inspection by the department. All such forms shall be
					 maintained in said file for a period of either six years or until the filing of
					 the next regular report on examination of the insurer, whichever is the longer
					 period of time. Nothing herein shall be construed as affecting any retention
					 period required by a statute other than the Insurance Law or preventing any
					 insurer from retaining records for a longer period of time.
(b) Each insurer shall file with its annual
					 statement to this department a certificate of compliance executed by an
					 authorized officer of the insurer wherein it is stated that to the best of such
					 officer's knowledge, the preliminary information forms, policy benefit
					 summaries, and sales illustrations disseminated by the insurer during the
					 preceding statement year complied or were made to comply in all respects with
					 the provisions of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-1 - General Provisions › Section 53-1.5 - Penalties

Current through Register Vol. 46, No. 28, July 10, 2024
In addition to any other penalties provided by the laws
						of this State, a violation of this Part may be considered an unfair act or
						practice in the conduct of the business of insurance in this State and a
						violation of section 2403 as well as a violation of section 2123 or section 4226  of the Insurance
						Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-1 - General Provisions › Section 53-1.6 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Part or its application to any
						person or circumstance is for any reason held to be invalid by any court of
						law, the remainder of the Part and its application to other persons or
						circumstances shall not be affected.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-2 - Disclosure Requirements › Section 53-2.1 - Preliminary information for policies subject to section 4232(b) of the insurance law

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The preliminary
					 information shall be in writing and include, to the extent applicable, the
					 following:
(1) the name and address of the
					 insurance agent, or broker, or if no agent or broker is involved, a statement
					 of the procedure to be followed to receive responses to inquiries concerning
					 the preliminary information;
(2)
					 the full name and home office, administrative office or branch or agency office
					 address of the insurer in whose name the life insurance policy is to be
					 written;
(3) the date of the
					 preliminary information and the generic name of the policy, the initial amount
					 of insurance and the initial annual premium for the base policy and each rider,
					 if applicable;
(4) a table of
					 values and benefits based upon current, median and guaranteed policy cost
					 factors for the base policy and any rider at the end of each of the first five
					 policy years, the 10th policy year and at the end of the policy years in which
					 the proposed insured attains age 65, 75, 85 and 95. These values may be shown
					 on a per thousand or per unit basis;
(5) the year coverage will terminate based
					 upon current, median and guaranteed policy cost factors. These values may be
					 shown on a per thousand or per unit basis;
(6) the interest rate basis for each table of
					 values based upon current, median and guaranteed policy cost factors;
(7) the effective policy loan annual
					 percentage interest rate and whether this rate is applied in advance or in
					 arrears, adjustable or fixed;
(8)
					 acknowledgment that the potential purchaser understands that policy values,
					 cash surrender values and death benefits based on current and median policy
					 cost factors are not guaranteed and that any changes in the company's interest
					 earnings, expenses or claim experience may result in lower or higher premium
					 payments or lower or higher policy benefits;
(9) a statement advising the applicant that
					 when the policy is issued, a complete policy summary including cost data, based
					 on the benefits, premiums and dividends of the policy as issued will be
					 furnished, and that, following the receipt of the policy and policy summary,
					 there will be a period of not less than 10 days within which the applicant may
					 return the policy for an unconditional refund of the premium paid or the
					 adjusted amount if such policy provides for a market-value adjustment pursuant
					 to section 3203 (a)(11)  of the
					 Insurance Law; and
(10) life
					 insurance cost indexes and the equivalent level annual dividend for the basic
					 policy for 10 and 20 years, but in no case beyond the premium-paying
					 period.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-2 - Disclosure Requirements › Section 53-2.3 - Additional disclosure rules for graded death benefit life insurance issued between ages 50 and 75

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Preliminary
					 information.
(1) The prospective purchaser
					 shall be provided with a prominent notice either on the application or with the
					 application in the following form or in a form containing substantially similar
					 information approved by the superintendent:
"Since this policy is issued with minimal or no medical
						underwriting, the premium rate charged includes an extra mortality risk charge.
						If you are healthy enough to qualify as a "standard" risk, premiums would
						likely have been lower if you had applied for a fully underwritten
						policy."
(2) Such prominent
					 notice may be included as part of a sales illustration summary, if such summary
					 is adopted by the insurer as the preliminary information.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-2 - Disclosure Requirements › Section 53-2.4 - Rules for the calculation of the life insurance surrender cost index

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The life
					 insurance surrender cost index is calculated as follows:
(1) Determine the guaranteed cash surrender
					 value, if any, available at the end of the 10th and 20th policy
					 years.
(2) For participating
					 policies, add the terminal dividend payable upon surrender, if any, to the
					 accumulation of the annual cash dividends at five percent interest compounded
					 annually to the end of the period selected and add this sum to the amount
					 determined in paragraph (1) of this subdivision.
(3) Divide the result of paragraph (2) of
					 this subdivision (paragraph [1] of this subdivision for guaranteed-cost
					 policies) by an interest factor that converts it into an equivalent level
					 annual amount that, if paid at the beginning of each year, would accrue to the
					 value in paragraph (2) of this subdivision (paragraph [1] of this subdivision
					 for guaranteed cost policies) over the respective periods stipulated in
					 paragraph (1) of this subdivision. If the period is 10 years, the factor is
					 13.207 and if the period is 20 years, the factor is 34.719.
(4) Determine the equivalent level premium by
					 accumulating each annual premium payable for the basic policy or rider at five
					 percent interest compounded annually to the end of the period stipulated in
					 paragraph (1) of this subdivision and dividing the result by the respective
					 factors stated in paragraph (3) of this subdivision (this amount is the annual
					 premium payable for a level premium plan).
(5) Subtract the result of paragraph (3) of
					 this subdivision from paragraph (4) of this subdivision.
(6) Divide the result of paragraph (5) of
					 this subdivision by the number of thousands of the equivalent level death
					 benefit to arrive at the life insurance surrender cost index.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-2 - Disclosure Requirements › Section 53-2.5 - Rules for the calculation of the life insurance net payment cost index

Current through Register Vol. 46, No. 28, July 10, 2024
The life insurance net payment cost index is calculated
						in the same manner as the comparable life insurance surrender cost index except
						that the cash surrender values and any terminal dividends are set at
						zero.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-2 - Disclosure Requirements › Section 53-2.6 - Buyer's guide

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No life
					 insurance policy shall be delivered or issued for delivery in this State unless
					 the prospective purchaser has been provided a copy of the Life Insurance
					 Buyer's Guide set forth in section
					 53-2.7 
					 of this Subpart at the time specified in section 3209 (b)(1)  of the
					 Insurance Law. If the use of life insurance cost indexes is required by section
					 3209, the Life Insurance Buyer's Guide shall contain an explanation describing
					 the use of such indexes set forth in section
					 53-2.8 
					 of this Subpart. A separate addendum for such explanation may be used which is
					 provided at the time that the buyer's guide is delivered.
(b) Where an insurance broker is involved,
					 the insurer or the broker may include a separate notice that states as follows:
					 "Where the term agent is used in the Life Insurance Buyer's Guide or in the
					 addendum to such guide, the term agent shall also mean an insurance
					 broker."
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-3 - Life Illustrations And Reports › Section 53-3.1 - Policies to be illustrated

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except
					 as otherwise provided, this Subpart shall apply to all policies other than
					 variable life insurance policies, individual and group annuities, credit life
					 insurance and life insurance policies with no illustrated death benefits on any
					 individual exceeding $10,000.
(b)
					 Each insurer marketing policies to which this Subpart is applicable shall
					 notify the superintendent whether a policy form is to be marketed with or
					 without an illustration. For all policy forms being actively marketed on the
					 effective date of this Subpart, the insurer shall identify in writing those
					 forms and whether or not an illustration will be used with them. For policy
					 forms filed after the effective date of this Subpart, the identification shall
					 be made at the time of filing. Any previous identification may be changed by
					 notice to the superintendent.
(c)
					 If the insurer identifies a policy form as one to be marketed without an
					 illustration, any use of an illustration for any policy using that form prior
					 to the first policy anniversary is prohibited.
(d) If a policy form is identified by the
					 insurer as one to be marketed with an illustration, a basic illustration
					 prepared and delivered in accordance with this Subpart is required, except that
					 a basic illustration need not be provided to individual members of a group or
					 to individuals insured under multiple lives coverage issued to a single
					 applicant unless the coverage is marketed to these individuals. The
					 illustration furnished an applicant for a group life insurance policy or
					 policies issued to a single applicant on multiple lives may be either an
					 individual or composite illustration representative of the coverage on the
					 lives of members of the group or the multiple lives covered.
(e) Potential enrollees of non-term group
					 life subject to this Subpart shall be furnished a quotation with the enrollment
					 materials. The quotation shall show potential policy values for sample ages and
					 policy years on a guaranteed and non-guaranteed basis appropriate to the group
					 and the coverage. This quotation shall not be considered an illustration for
					 purposes of this Subpart, but all information provided shall be consistent with
					 the illustrated scale. A basic illustration shall be provided at delivery of
					 the certificate to enrollees for non-term group life who enroll for more than
					 the minimum premium necessary to provide pure death benefit protection. In
					 addition, the insurer shall make a basic illustration available to any non-term
					 group life enrollee who requests it.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-3 - Life Illustrations And Reports › Section 53-3.2 - General rules and illustrations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An illustration used in the sale of a
					 life insurance policy and subject to this Subpart shall satisfy the applicable
					 requirements of this Subpart, be clearly labeled "life insurance illustration"
					 and contain the following basic information:
(1) name of insurer;
(2) name and business address of producer or
					 insurer's authorized representative, if any;
(3) name, age and sex of proposed insured,
					 except where a composite illustration is permitted under this
					 Subpart;
(4) underwriting or rating
					 classification upon which the illustration is based;
(5) generic name of policy, the company
					 product name, if different, and form number;
(6) initial death benefit; and
(7) dividend option election or application
					 of non-guaranteed elements, if applicable.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-3 - Life Illustrations And Reports › Section 53-3.4 - Standards for supplemental illustrations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A supplemental illustration may be
					 provided so long as:
(1) it is appended to,
					 accompanied by or preceded by a basic illustration that complies with this
					 Subpart;
(2) the non-guaranteed
					 elements shown are not more favorable to the policyowner than the corresponding
					 elements based on the scale used in the basic illustration;
(3) it contains the same statement required
					 of a basic illustration that non- guaranteed elements are not guaranteed;
					 and
(4) for a policy that has a
					 contract premium, the contract premium underlying the supplemental illustration
					 is equal to the contract premium shown in the basic illustration. For policies
					 that do not require a contract premium, the premium outlay underlying the
					 supplemental illustration shall be equal to the premium outlay shown in the
					 basic illustration.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 53 - Life And Annuity Cost Disclosure And Sales Illustrations › Subpart 53-3 - Life Illustrations And Reports › Section 53-3.6 - Annual report; notice to policy owners

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In the case of a policy designated as one
					 for which illustrations will be used, the insurer shall provide each
					 policyowner with an annual report on the status of the policy that shall
					 contain at least the following information:
(1) For policies subject to section 4232 (b)  of the Insurance
					 Law, the report shall include the following:
(i) the beginning and end date of the current
					 report period;
(ii) the policy
					 value at the end of the previous report period and at the end of the current
					 report period;
(iii) the total
					 amounts that have been credited or debited to the policy value during the
					 current report period, identifying each by type (e.g., interest, mortality,
					 expense and riders);
(iv) the
					 current death benefit at the end of the current report period on each life
					 covered by the policy;
(v) the net
					 cash surrender value of the policy as of the end of the current report
					 period;
(vi) the amount of
					 outstanding loans, if any, as of the end of the current report period;
					 and
(vii) a notice in the report
					 for fixed premium policies, when applicable, that the policy's net cash
					 surrender value is such that it would not maintain insurance in force until the
					 end of the next reporting period assuming guaranteed issue, mortality, and
					 expense loads; or
(viii) a notice,
					 in the report for flexible premium policies, when applicable, that the policy's
					 net cash surrender value will not maintain insurance in force until the end of
					 the next reporting period unless further premium payments are made assuming
					 guaranteed interest, mortality and expense loads.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.2 - Qualifications of insurance companies to issue variable life insurance policies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Before any
				  authorized insurance company can qualify to deliver or issue for delivery any
				  variable life insurance policy within this State, the policy shall be approved
				  under section 3201  of the Insurance Law, and shall comply
				  with other applicable provisions of the Insurance Law and the other provisions
				  of this Part. In addition, the company shall submit the following information
				  to the superintendent for approval:
(1) a
				  description of the kinds and characteristics of variable life insurance
				  policies it intends to deliver or issue for delivery;
(2) a description of the proposed method of
				  operating the separate account or accounts established or to be established
				  with respect to such variable life insurance policies;
(3) with respect to any separate account
				  maintained by an insurer for any variable life insurance policy, a statement of
				  the investment policy the insurer intends to follow for the investment of the
				  assets held in such separate account and a statement of the procedures for
				  changing such investment policy. The statement of investment policy shall
				  include a description of the investment objective intended for the separate
				  account;
(4) unless expressly
				  exempted from this requirement as inapplicable to the variable life insurance
				  policies, a plan for repayment of the special contingent reserve fund pursuant
				  to section 4240 (b)  of the Insurance
				  Law;
(5) if requested by the
				  superintendent, biographical data with respect to the officers and directors of
				  the insurer and the members of the committee, board or other similar body of
				  the separate account;
(6) with
				  respect to an authorized foreign insurer, if requested by the superintendent, a
				  copy of the statutes and regulations of its state of domicile under which it is
				  authorized to issue such variable life insurance policies;
(7) a statement describing the mortality,
				  expense or other risks which the insurer will bear under the policy;
				  and
(8) such additional information
				  as the superintendent may require.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.4 - Investment policy

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) No material change in the investment
				  policy of a separate account established pursuant to section 4240  of the Insurance Law shall be made
				  unless the insurer has notified the superintendent, in writing, of its
				  intention to make such change at least 60 days prior to submitting it for any
				  other authorization as may be required, or such shorter period as the
				  superintendent may permit, and he has not disapproved it within such
				  period.
(2) No material change in
				  the investment policy of a separate account established by a foreign or alien
				  insurer, pursuant to the section of the insurance law of such insurer's state
				  of domicile which corresponds to section 4240, shall be made unless the insurer
				  has filed such change with the superintendent, in writing, at least 60 days
				  prior to submitting for any other authorization as may be required, or such
				  shorter period as the superintendent may permit.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.5 - Filing and approval of variable life insurance policies

Current through Register Vol. 46, No. 28, July 10, 2024
Except as otherwise provided by the superintendent, the
					 filing and approval requirements applicable to individual general account life
					 insurance policies shall, to the extent appropriate, be applicable to
					 individual variable life insurance policies.