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 52.21 - Rules relating to content of forms for blanket insurance

Current through Register Vol. 46, No. 28, July 10, 2024
The following provisions shall apply to blanket
					 insurance:
(a) The provisions of
				  section
				  52.18 
				  of this Part, where relevant, shall apply to blanket insurance.
(b) Hospital, surgical and medical expense
				  coverage may be written for authorized groups under the definition of total or
				  partial disability as used in section 4237 (a)(1)-(3)  of the
				  Insurance Law.
(c) Coverage under
				  section 222(1)(c) of the Insurance Law shall be provided only in connection
				  with the sponsored activity, except where the policyholder is a school, school
				  district, board of education or school principal, in which case 24-hour
				  coverage may be written.
(d)
				  Coordination of benefits provisions may be included in a policy issued under
				  section 4237 (a)(3)(c)  of the
				  Insurance Law.
(e) Groups defined
				  solely as guests of the policyholder, employees selected by the policyholder,
				  key men and others similarly defined are too vague and are not permissible
				  groups under section 4237  of the Insurance Law.
(f) An insurer may not make a binding
				  commitment to issue a student blanket health insurance policy to any school
				  prior to approval of such policy and premium rates. Solicitation material,
				  brochures, certificates or applications prepared or approved by the insurer may
				  not be distributed by any person or organization prior to approval of the
				  blanket policy.
(g) Insurers
				  planning to sell student blanket health insurance policies shall submit for
				  approval a basic policy, any riders providing variable benefits, and premium
				  rates for each benefit before offering to sell any coverage under such
				  policies. Where the premium on transfer or renewal cases is based in part on
				  prior experience, the experience rating formula shall be filed as part of the
				  general rating structure.
(h) An
				  insurer may not offer for sale any "tailor-made" student blanket health
				  insurance policy until the insurer has approval of the language and rate for
				  each benefit provision of the policy.
(i) For any student blanket health insurance
				  program not previously approved, a licensed insurer may bid on the risk subject
				  to the approval of the Superintendent of Insurance, but no solicitation or
				  enrollment of students may be made prior to such approval.
(j) Student blanket health policies are
				  subject to section 3221 (k)(5)  of the
				  Insurance Law. The statutory coverage must be provided for pregnancies which
				  commenced while the insured was covered under the policy, even after all other
				  coverage under the policy is terminated.
(k) No payment of any sums of money may be
				  made to the policyholder, or to any person designated by the policyholder, as a
				  condition for the purchase of a student blanket health insurance policy. This
				  does not prohibit an insurer from hiring students or any other persons to
				  assist in the enrollment and servicing of the insurance.
(l) The premium charged to the insured may
				  not be greater than the premium approved by the superintendent. Any additional
				  charge added to the premium by the policyholder subjects the policyholder to
				  the allegation of doing an insurance business without a license. Any brochure
				  or certificate must include a complete statement of the premiums to be
				  charged.
(m) A student blanket
				  health policy shall be deemed mandatory for purposes of section
				  52.16(f) 
				  of this Part if 75 percent of the eligible students and a minimum of 300
				  students are insured.