New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XI - Prepaid Legal Services Plans And Legal Services Insurance › Part 261 - Prepaid Legal Services Plans › Section 261.5 - Prepaid legal services plans; group basis

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A policy or certificate of a prepaid
				legal services plan may be issued or delivered on a group basis only if the
				group conforms to one of the following descriptions:
(1) A policy issued to an employer or to a
				trustee or trustees of a fund established by an employer, which employer or
				trustee or trustees shall be deemed the policyholder, covering employees of
				such employer, and covering all of such employees or all of any class or
				classes thereof, including retired employees, determined by conditions
				pertaining to the employment. The premium for the policy shall be paid by the
				policyholder, either wholly from the employer's funds, or from funds
				contributed by the covered employees, or from funds contributed jointly by the
				employer and employees. A policy on which no part of the premium is to be
				derived from funds contributed by the covered employees specifically for their
				coverage must cover all eligible employees. If all or part of the premium is to
				be derived from funds contributed by the covered employees, then such employees
				shall have the right to decline coverage under the policy.
(2) A policy issued to a trustee or trustees
				of a fund established by, or participated in, by the employer members of a
				trade association, which trustees shall be deemed the policyholder for the sole
				benefit of the employees of such employers. The policy shall conform to the
				following requirements:
(i) The policy may be
				issued only if the association has been in existence for at least two years and
				was formed principally for purposes other than obtaining insurance.
(ii) The persons eligible for coverage under
				the policy shall be all of the employees of the participating employers, or all
				of any class or classes thereof determined by conditions pertaining to their
				employment.
(iii) The premium for
				the policy shall be paid by the trustee or trustees either from funds
				contributed wholly by the employers or wholly by the employees, or funds
				contributed jointly by the employers and the employees. A policy on which no
				part of the premium so payable is to be derived from funds contributed by the
				covered employees specifically for their coverage must insure all eligible
				employees. If all or part of the premium is to be derived from funds
				contributed by the covered employees, then such employees shall have the right
				to decline coverage under the policy.
(3) A policy issued to a labor union, or to a
				duly organized association of civil service employees, which shall be deemed
				the policyholder, covering members of such union and covering all of such
				members or of any class or classes thereof determined by conditions pertaining
				to their employment or membership in the union or both. A policy on which no
				part of the premium is to be derived from funds contributed by the covered
				members specifically for their coverage must cover all eligible members. If all
				or part of the premium is to be derived from funds contributed by the covered
				members, then such members shall have the right to decline coverage under the
				policy.
(4) A policy issued to a
				trustee or trustees of a fund established, or participated in, by two or more
				employers or by one or more labor unions, or by one or more employers and one
				or more labor unions, which trustee or trustees shall be deemed the
				policyholder, to cover employees of the employers or members of the unions for
				the benefit of persons other than the employers or the unions, subject to the
				following requirements:
(i) The persons
				eligible for coverage shall be all of the employees of the employers or all of
				the members of the unions, or all of any class or classes thereof determined by
				conditions pertaining to their employment, or to membership in the unions, or
				to both.
(ii) The premium for the
				policy shall be paid by the trustee or trustees either wholly from funds
				contributed by the employer or employers of the covered person or by the union
				or unions, or by both, or jointly from such funds and funds contributed by the
				covered persons specifically for their coverage or from contributions by the
				covered persons. A policy on which no part of the premium so payable is to be
				derived from funds contributed by the covered persons specifically for their
				coverage must cover all eligible persons. If all or part of the premium is to
				be derived from funds contributed by the covered persons, then such persons
				shall have the right to decline coverage under the policy.
(iii) With respect to a policy issued to a
				trustee or trustees of a fund established by one or more labor unions, or by
				one or more employers and one or more labor unions, the insurer shall obtain a
				written certification that a reasonable number of comparative bids have been
				obtained from different insurers and that such bids have been considered by the
				trustees before making a decision concerning which bid to accept. The
				certification shall state that such decision was made at a trustees' meeting
				held on a date certain, and a copy of the minutes of such meeting shall be
				attached to such certification.
(5) A policy issued to an association, or to
				a trustee or trustees of a fund established, created or maintained for the
				benefit of members of one or more associations, all of whose eligible members
				have the same profession, trade or occupation, which association or
				associations have been organized and maintained in good faith for purposes
				principally other than that of obtaining coverage and have been in active
				existence for at least two years. The policy shall cover members, or employees
				of members, of such association or associations for the benefit of persons
				other than employers and the association or associations, or any officials,
				representatives, trustees or agents thereof. The members or employees eligible
				for the coverage under the policy shall be all the members, or all the members
				and their employees, or all of any class or classes thereof determined by
				conditions pertaining to their employment or to association membership or
				both.
(6) A policy issued to a
				continuing care retirement community operating under a certificate of authority
				issued pursuant to article 46 of the Public Health Law which insures the
				residents of the community.
(7) A
				policy covering persons employed under
				32 U.S.C. section
				709, members of the national guard on
				full-time training duty under title 32 of the United States Code, or on active
				duty or active duty for training under title 10 of the United States Code,
				under the full-time manning program, issued to the adjutant general, who shall
				be deemed the policyholder, or to a trustee or trustees of a fund established,
				created, or maintained for the benefit of such individuals covered, which
				trustee or trustees shall be deemed the policyholder, the premium of which is
				to be paid by the individuals covered either directly or by deduction from
				wages or salary.
(8) A policy
				issued to a college, school or other institution of learning or to the head or
				principal thereof, who or which shall be deemed the policyholder, covering the
				students of such college, school or other institution of learning.