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 52.59 - Required disclosure statement for policies meeting definition of section 52.10 of this Part

Current through Register Vol. 46, No. 28, July 10, 2024
(a) To comply
				  with section
				  52.54  of
				  this Part, policies of individual insurance that are issued to persons who are
				  less than 65 years of age and meet the definition of section
				  52.10 
				  of this Part shall use the following statement only, except that appropriate
				  policy identification may be included:
COMPANY NAME
LIMITED BENEFITS HEALTH INSURANCE
REQUIRED DISCLOSURE STATEMENT
This policy provides limited benefits health insurance
					 ONLY. This policy does NOT provide basic hospital, basic medical or major
					 medical insurance, as defined by the New York State Department of Financial
					 Services.
(
Accurately list benefits, exclusions, reductions
					 and limitations of the policy in a manner that does not encourage
					 misrepresentation of the actual coverage provided.
)
This disclosure statement is a very brief summary of your
					 policy.
The policy itself sets forth the rights and obligations of
					 both you and the insurance company. It is therefore imperative that you READ
					 YOUR POLICY carefully.
The expected benefit ratio for this policy is _%. This
					 ratio is the portion of future premiums that the company expects to return as
					 benefits when averaged over all people with this policy.
(b) To comply with section
				  52.54  of
				  this Part, policies of individual insurance that are issued to persons who are
				  age 65 or older and meet the definition of section
				  52.10 
				  of this Part shall use the following statement only, except that appropriate
				  policy identification may be included:
COMPANY NAME
LIMITED BENEFITS HEALTH INSURANCE
REQUIRED DISCLOSURE STATEMENT
This policy provides limited benefits health insurance
					 ONLY. This policy does NOT provide Medicare supplement insurance, long term
					 care insurance, nursing home insurance only, home care insurance only, or
					 nursing home and home care insurance as defined by the New York State
					 Department of Financial Services. For information concerning Medicare
					 supplement insurance contact the New York State Department of Financial
					 Services. You may also contact your local social security office or this
					 company and request a copy of the Medicare supplement buyers' guide.
(
Accurately list benefits, exclusions, reductions
					 and limitations of the policy in a manner that does not encourage
					 misrepresentation of the actual coverage provided.
)
This disclosure statement is a very brief summary of your
					 policy.
The policy itself sets forth the rights and obligations of
					 both you and the Insurance Company. It is therefore imperative that you READ
					 YOUR POLICY carefully.
The expected benefit ratio for this policy is _%. This
					 ratio is the portion of future premiums that the company expects to return as
					 benefits when averaged over all people with this policy.