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 50 - Separate Accounts and Separate Account Contracts › Subpart 50-1 - Separate Accounts and Separate Account Contracts Prior to January 1, 2023 › Section 50-1.10 - Authorized foreign and alien insurance companies

Current through Register Vol. 46, No. 28, July 10, 2024
No authorized foreign insurer or United States branch of
						an alien insurer shall deliver or issue for delivery within this State any
						separate account annuity contract unless the insurer shall comply substantially
						with the provisions of this Subpart that in the judgment of the superintendent
						are reasonably necessary to protect the interests of the people of this
						State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-1 - Separate Accounts and Separate Account Contracts Prior to January 1, 2023 › Section 50-1.11 - Separability clause

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Subpart shall be held invalid,
						the remainder of the Subpart 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 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.1 - Purpose

Current through Register Vol. 46, No. 28, July 10, 2024
The purpose of this Part is to prescribe the terms and
						conditions under which authorized insurers may deliver or issue for delivery
						separate account annuity contracts and separate account funding agreements in
						this State and the procedures for establishing and maintaining such separate
						accounts.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.2 - Scope

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Subpart 50-2
					 shall apply to all separate account contracts, as defined in section
					 50-2.3(a)(6)  of this Subpart, delivered or issued for delivery in this State on
					 or after January 1, 2023 except as provided in Parts 40, 44, and 97 of this
					 Title (Insurance Regulations 139, 127, and 128) and only with respect to
					 amounts allocated to one or more separate accounts, whether the separate
					 accounts are established pursuant to Insurance Law section 4240 or otherwise.
					 Notwithstanding the forgoing, the maximum surrender charge authorized in
					 section 50-2.9(a)(3)  of this Subpart and the withdrawal benefit provisions of
					 section 50-2.9(h)  of this Subpart shall apply to separate account contracts
					 delivered or issued for delivery in this State on or after January 1,
					 2024.
(b) Subpart 50-2 shall apply
					 to all separate accounts established pursuant to Insurance Law section 4240 on
					 or after January 1, 2023. Subpart 50-2 shall further apply to all separate
					 accounts used in connection with separate account contracts delivered or issued
					 for delivery on or after January 1, 2023 regardless of when the separate
					 account was established.
(c)
					 Subpart 50-2 shall apply to all separate account plans of operation required to
					 be filed in this State for separate accounts established pursuant to Insurance
					 Law section 4240 on or after January 1, 2023. Subpart 50-2 shall further apply
					 to all separate account plans of operation used in connection with separate
					 account contracts delivered or issued for delivery on or after January 1, 2023
					 regardless of when the separate account was established.
(d) Section 50-2.12  shall apply to all
					 separate accounts of any authorized foreign insurer or United States branch of
					 any alien insurer used in connection with separate account contracts delivered
					 or issued for delivery in this State on or after January 1, 2023.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.4 - Qualification of insurers to issue separate account contracts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Before any authorized insurer may qualify
					 to deliver or issue for delivery in this State any separate account contract,
					 the insurer shall, in addition to complying with the applicable provisions of
					 the Insurance Law and the other sections of this Subpart, submit the following
					 information to the superintendent:
(1) a
					 description of the kinds and characteristics of separate account contracts the
					 insurer 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 separate account contracts;
(3) 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 governing body of the
					 separate account;
(4) with respect
					 to an authorized foreign insurer, if requested by the superintendent, a copy of
					 the laws and regulations of its domiciliary state under which the insurer is
					 authorized to issue such separate account contracts; and
(5) such further 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 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.5 - Separate accounts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
					 separate account contract may provide that some or all of the assets of the
					 separate account are not chargeable with liabilities arising out of any other
					 business of the insurer, provided that the portion of assets of the separate
					 account not chargeable with liabilities arising out of any other business of
					 the insurer shall not exceed the following:
(1) the assets purchased with considerations
					 allocated to the separate account by the contract holder or certificate holder;
					 minus
(2) any benefits paid from
					 such assets; minus
(3) any charges
					 taken from such assets under the terms of the contract or certificate;
					 minus
(4) any contract holder or
					 certificate holder initiated transfers of such assets out of the separate
					 account; plus
(5) the net
					 investment returns earned on the net amount of such assets.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.6 - Insurer contributions to separate accounts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer may, upon the establishment
					 and during the initial stages of a separate account allocate and contribute
					 funds to the separate account as a participant for a limited period and without
					 the purpose of funding annuities, using funds that it might otherwise invest in
					 accordance with Insurance Law section 1405(a)(6) and (8) and invest in the same
					 type of securities as may be purchased for the separate accounts for the
					 purpose of providing for the effective and economical diversification of
					 investments by the separate account and to facilitate the orderly establishment
					 and maintenance of that separate account. The insurer shall have a
					 proportionate interest in any such account, along with all other participating
					 contract holders, to the extent of its participation therein and with respect
					 thereto shall be subject to all the provisions of Insurance Law section 4240
					 applicable to separate account contract holders generally.
(b) Except as may be permitted in writing by
					 the superintendent, the aggregate amount, net of withdrawals made pursuant to
					 subdivision (d) of this section, so allocated and contributed by the insurer in
					 accordance with subdivision (a) of this section to one or more separate
					 accounts, shall not exceed the lesser of:
(1)
					 $500,000, plus not more than $125,000 for each separate account in excess of
					 four to which the insurer so allocates and contributes funds;
(2) one percent of the insurer's admitted
					 assets as of December 31 next preceding; or
(3) five percent of the insurer's surplus to
					 policyholders as of said date.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.7 - Filing and approval of contracts and certificates

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 and group annuity
						contracts, certificates used in connection with group annuity contracts and
						individual and group funding agreements shall, to the extent appropriate, apply
						to individual and group separate account annuity contracts, certificates used
						in connection with group separate account annuity contracts and individual and
						group funding agreements, and the requirements of Insurance Law section
						3223(d), to the extent appropriate, shall further apply to any allocated group
						funding agreement whether issued out of a separate account or general
						account.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.8 - Variable income payments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Every
					 separate account annuity contract that provides for annuity income payments
					 that vary with the investment experience of any separate account shall be
					 subject to the following:
(1) Each separate
					 account annuity contract that provides for annuity income payments that vary
					 with the investment experience of any separate account delivered or issued for
					 delivery in this State shall provide that neither expenses actually incurred,
					 other than taxes on the investment return, nor mortality actually experienced,
					 shall adversely affect the dollar amount of variable annuity payments to any
					 annuitant for whom variable annuity payments have commenced. Where a group
					 variable annuity contract provides that the scale of charges to be made against
					 the assets of a separate account may be changed without the consent of the
					 participants for whom variable annuity payments have commenced, the contract
					 shall provide that such changes shall not adversely affect the dollar amount of
					 variable annuity payments that have commenced. The method of computing the
					 dollar amount of variable annuity payments shall be such that, if the annual
					 rate of investment return of the separate account, as defined in section
					 50-2.3(a)(9)  of this Subpart, were six and one-half percent at all times from
					 the issue of the contract, the amounts would not decrease. The superintendent
					 may authorize the use of other methods or rates in computing the dollar amount
					 of variable annuity payments where the methods or rates are determined by the
					 superintendent to be fair, equitable, reasonable and not less favorable to the
					 participants or annuitants; and
(2)
					 Except as otherwise permitted by the superintendent, each authorized insurer
					 issuing separate account annuity contracts that provide for annuity income
					 payments that vary with the investment experience of any separate account shall
					 accumulate an annuitant mortality fluctuation fund or funds over and above the
					 required contract reserves and liabilities, pursuant to a plan for such
					 accumulation that specifies reasonable maximum targets for the fund or funds
					 and is approved by the superintendent as otherwise reasonable. Losses arising
					 from mortality actually experienced shall be charged against the mortality
					 fluctuation fund or funds until the fund or funds are exhausted.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.10 - Illustrations of benefits payable under separate account contracts

Current through Register Vol. 46, No. 28, July 10, 2024
Illustrations of benefits payable under any separate
						account contract, which are incorporated in or attached to the contract or are
						utilized in advertising or sales material relating to the contract, shall not
						include projections of past investment experience into the future or attempted
						predictions of future investment experience; provided that nothing herein
						contained shall prohibit the use of hypothetical rates of investment return,
						clearly designated as such, to illustrate possible levels of variable annuity
						payments, if the use of the hypothetical rates is not in conflict with
						applicable requirements of the United States Securities and Exchange
						Commission. If any hypothetical rate of investment return is used for
						illustration purposes, a corresponding additional illustration also shall be
						included using a hypothetical rate of investment return at least at the same
						interval below the pivotal rate of investment return. As used in this section,
						the pivotal rate of investment return is the smallest annual rate of investment
						return, as defined in section 50-2.3(a)(9)  of this Subpart, which must be
						earned by the separate account if the dollar amount of variable annuity
						payments is not to decrease. Except as approved by the superintendent, no
						hypothetical rate of investment return in excess of eight percent shall be used
						in any illustration.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.11 - Required reports

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each
					 insurer issuing a separate account contract shall at least once in each
					 contract year mail or deliver to every separate account annuity contractholder,
					 addressed to the contractholder's last address known to the insurer or
					 delivered in person or electronically in a manner agreed to between the insurer
					 and contractholder, a statement or statements reporting the investments held in
					 the separate account and, in addition, in the case of contracts under which
					 benefit payments have not yet commenced, a statement reporting as of a date not
					 more than four months prior to the date of mailing or delivery, the number of
					 accumulation units credited to such contracts, and the dollar value of each
					 unit or the total value of the contractholder's account, except that such
					 statements need not be mailed or delivered with respect to contracts that have
					 been issued not more than four months prior to the date of the mailing or
					 delivery. Contractholder, as used in this subdivision, shall include a
					 certificate holder who has accumulation units credited to the certificate
					 holder's account. Such statement may be distributed to the certificate holder
					 by providing the statements to the contractholder pursuant to a bona fide plan
					 that provides for the further distribution of the statement or statements to
					 the certificate holders.
(b) Each
					 insurer issuing any separate account contract shall submit annually to the
					 superintendent, in such form as the superintendent may prescribe, a statement
					 of the business of its separate account or accounts.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.12 - Separate accounts of foreign and alien insurance companies

Current through Register Vol. 46, No. 28, July 10, 2024
No authorized foreign insurer or United States branch of
						an alien insurer shall deliver or issue for delivery within this State any
						separate account contract unless the insurer shall comply substantially with
						the provisions of this Subpart related to the method of operation of separate
						accounts that, in the judgment of the superintendent are reasonably necessary
						to protect the interests of the people of this State. The insurer shall file
						with the superintendent a statement as to the method of operation of its
						separate accounts used in connection with separate account contracts delivered
						or issued for delivery in this State. The insurer shall, upon request of the
						superintendent, also file with the superintendent a statement as to the method
						of operation of any other separate account.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.13 - Separability clause

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Subpart shall be held invalid,
						the remainder of the Part 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 50 - Separate Accounts and Separate Account Contracts › Subpart 50-2 - Separate Accounts and Separate Account Contracts on or after January 1, 2023 › Section 50-2.14 - Violations

Current through Register Vol. 46, No. 28, July 10, 2024
A contravention of this Part shall be deemed to be an
						unfair method of competition or an unfair or deceptive act and practice in the
						conduct of the business of insurance in this State and shall be deemed to be a
						trade practice constituting a determined violation, as defined in Insurance Law
						section 2402(c), except where such act or practice shall be a defined
						violation, as defined in Insurance Law section 2402(b), and in either such case
						shall be a violation of Insurance Law section 2403.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.1 - Purposes

Current through Register Vol. 46, No. 28, July 10, 2024
The purposes of this Part are to:
(a) implement the New York Insurance Law by
				  regulating the acts and practices of insurers, insurance agents, insurance
				  brokers and other licensees of the department with respect to the internal and
				  external replacement of life insurance policies and annuity contracts;
				  and
(b) protect the interest of the
				  public by establishing minimum standards of conduct to be observed in the
				  replacement or proposed replacement of life insurance policies and annuity
				  contracts; by making available full and clear information on which an applicant
				  for life insurance or annuities can make a decision in his or her own best
				  interest; by reducing the opportunity for misrepresentation and incomplete
				  comparison in replacement situations (commonly referred to as twisting); and by
				  precluding unfair methods of competition and unfair practices.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
In this Part:
(a)
Replacement of a life insurance policy or an annuity contract
means, except as exempted in Section
				  51.3  of
				  this Part, that new life insurance or new annuities are to be purchased and
				  delivered or issued for delivery in New York and it is known to the department
				  licensee that, as part of the transaction, existing life insurance policies or
				  annuity contracts have been or are likely to be:
(1) lapsed, surrendered, partially
				  surrendered, forfeited, assigned to the insurer replacing the life insurance
				  policy or annuity contract, or otherwise terminated;
(2) changed or modified into paid-up
				  insurance; continued as extended term insurance or under another form of
				  nonforfeiture benefit; or otherwise reduced in value by the use of
				  nonforfeiture benefits, dividend accumulations, dividend cash values or other
				  cash values;
(3) changed or
				  modified so as to effect a reduction either in the amount of the existing life
				  insurance or annuity benefit or in the period of time the existing life
				  insurance or annuity benefit will continue in force;
(4) reissued with a reduction in amount such
				  that any cash values are released, including all transactions wherein an amount
				  of dividend accumulations or paid-up additions is to be released on one or more
				  of the existing policies;
(5)
				  assigned as collateral for a loan or made subject to borrowing or withdrawal of
				  any portion of the loan value, including all transactions wherein any amount of
				  dividend accumulations or paid-up additions is to be borrowed or withdrawn on
				  one or more existing policies; or
(6) continued with a stoppage of premium
				  payments or reduction in the amount of premium paid.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.3 - Exemptions

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall not apply when:
(a) the application for the new life
				  insurance policy or new annuity contract is made to the same insurer that
				  issued the existing life insurance policy or annuity contract or to any
				  authorized life insurer in such insurer's holding company system, and the new
				  life insurance policy or new annuity contract is being issued in accordance
				  with the terms of a contractual conversion privilege in the existing life
				  insurance policy or annuity contract or is being issued pursuant to a plan
				  approved by the superintendent for the insurer to meet its obligations under
				  Insurance Law section 3220(a)(6);
(b) a policy change customarily granted by
				  the insurer is being exercised, provided such change results in no additional
				  surrender or expense charge or suicide or contestable restrictions, and only to
				  the extent that the change is approved by the superintendent;
(c) the new coverage is provided under:
(1) a group life insurance policy or group
				  annuity contract, except when an insurance agent or broker or insurer directly
				  solicits the certificateholder for the new coverage and a portion of the
				  premium or consideration is borne, directly or indirectly, by the
				  certificateholder;
(2) an
				  individual life insurance policy or individual annuity contract where the cost
				  of the policy or contract is borne wholly by the applicant's employer or by an
				  association of which the applicant is a member; or
(3) individual life insurance policies or
				  individual annuity contracts covering employees of an employer, debtors of a
				  creditor, or members of an association, that are distributed on a mass
				  merchandising basis and administered by group-type methods, except when an
				  insurance agent or broker or insurer directly solicits the applicant for the
				  new coverage and a portion of the premium or consideration is borne, directly
				  or indirectly, by the applicant; or
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.4 - Alternate procedures

Current through Register Vol. 46, No. 28, July 10, 2024
An insurer may substitute procedures that are designed to
					 meet the purposes of this Part, provided that:
(a) the procedures are approved in advance
				  and determined by the superintendent not to be detrimental to policyholders and
				  contractholders; and
(b)
(1) no sales agency force is used and the
				  application is solicited and received by the insurer by mail or under other
				  methods that are without insurance agent or broker involvement; or
(2) the application is initially solicited by
				  the insurer by mail or under other methods without insurance agent or broker
				  involvement, and there is subsequent insurance agent or broker involvement
				  limited to customer assistance or administrative support at the request of the
				  customer, provided that an accurate and complete "Disclosure Statement" is
				  signed by the insurance agent or broker and presented to the policy or contract
				  holder in accordance 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 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.6 - Duties of insurers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Each insurer shall:
(1) inform and train its insurance agents and the insurance brokers that place business with the insurer with respect to the requirements of this Part;
(2) require with or as part of each application, a completed "Definition of Replacement" signed by the applicant and insurance agent or broker;
(3) maintain signed and completed copies of the "Definition of Replacement" in accordance with Part 243 of this Title (Regulation 152); and
(4) require with or as part of each application a statement signed by the insurance agent or broker as to whether, to the best of the agent's or broker's knowledge, replacement of a life insurance policy or annuity contract is involved in the transaction.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.7 - Prohibited acts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No insurer
				  or insurance agent or broker shall:
(1) make
				  or give any deceptive or misleading information in the "Disclosure Statement"
				  or in the sales material, including any proposal, used in the sale of the life
				  insurance policy or annuity contract;
(2) in completing the application, fail to
				  ask the applicant the pertinent questions relating to the probability of
				  replacement;
(3) incorrectly record
				  an answer;
(4) counsel an applicant
				  to answer the questions with respect to replacement negatively in order to
				  prevent notice to the insurer to be replaced; or
(5) counsel an applicant to write directly to
				  the insurer in such a way as to attempt to bypass such insurer's agency
				  representation or obscure the identity of the insurance agent or broker
				  replacing the life insurance policy or 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 51 - Replacement of Life Insurance Policies and Annuity Contracts › Section 51.8 - Exhibits

Current through Register Vol. 46, No. 28, July 10, 2024
The forms set forth in Appendices 10A, 10B, 10C and 11 of
					 this Title are hereby approved for use as specified in this Part. The forms
					 shall be set forth in at least 12-point type and shall be highlighted as
					 indicated herein. In lieu of the forms set forth in the appendices, an insurer
					 may adopt and use forms that the superintendent has determined to be
					 substantially equivalent to the forms set forth in the appendices.
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 52.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part, the following words and phrases are defined as follows:
(a) Accident and health insurance means insurance written under sections 1113 (a)(3) and 4505  of the Insurance Law.
(b) Article 43 corporation means a corporation organized under article 43 of the Insurance Law.
(c) Blanket insurance means insurance written under the provisions of section 4237  of the Insurance Law.
(d) Charges means the amount billed by the provider for services rendered, including the reimbursement made by article 43 corporations pursuant to the provisions of section 2807  of the Public Health Law.
(e) Complications of pregnancy means:
(1) conditions requiring hospital stays (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy but are adversely affected by pregnancy or are caused by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation, missed abortion and similar medical and surgical conditions of comparable severity, and shall not include false labor, occasional spotting, physician-prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, preeclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy; and
(2) nonelective caesarean section, ectopic pregnancy which is terminated and spontaneous termination of pregnancy, which occurs during a period of gestation in which a viable birth is not possible.
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 52.5 - Basic hospital insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Basic hospital insurance is an insurance policy which
					 provides coverage subject to no deductible in excess of $500 for a period of
					 not less than 60 days for any continuous hospital confinement of each covered
					 person for services rendered while confined in a hospital (except as to
					 subdivision [c] of this section) or, in the case of an article 43 corporation,
					 for services rendered while confined in a member hospital, for necessary
					 treatment because of sickness or injury for at least:
(a) Daily room and board, consisting of bed
				  and board, including general nursing care and special diets, in an amount not
				  less than the lesser of:
(1) 80 percent of
				  the charges for semiprivate accommodations;
(2) 100 percent of the charges for
				  semiprivate accommodations for the first 20 days of confinement and at least 50
				  percent of such charges for the next 40 days; or
(3) $240 per day; except that such $240 may
				  be reduced to $165 for policies issued for delivery outside the metropolitan
				  area.
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 52.6 - Basic medical insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Basic medical insurance is an insurance policy which
					 provides coverage for services rendered by a physician or, in the case of
					 article 43 corporations, a participating physician, to each covered person for
					 sickness or injury for:
(a) Surgical
				  services, consisting of operating and cutting procedures for the treatment of a
				  sickness or injury, and endoscopic procedures, including any pre- and
				  post-operative care usually rendered in connection with such operation or
				  procedure, in an amount:
(1) not less than 80
				  percent of the reasonable charges; or
(2) if specified in dollar amounts, a fee
				  schedule providing amounts for any procedure at least equal to those provided
				  for in a fee schedule with a maximum of $2,600 based on the relative values
				  contained in the State of New York Certified Surgical Fee Schedule, or an
				  equivalent fee schedule approved by the superintendent.
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 52.7 - Major medical insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Major medical insurance is an insurance policy which
					 provides coverage for each covered person, to a maximum of not less than
					 $100,000; copayment by the covered person not to exceed 25 percent; a
					 deductible stated on a per-person, per-family, per-illness, per-benefit period,
					 or per- year basis, or a combination of such bases, not to exceed five percent
					 of the lowest overall maximum limit under the policy, unless the policy is
					 written to complement underlying hospital and medical insurance, in which case
					 such deductible may be increased by the amount of the benefits provided by such
					 underlying insurance, for at least:
(a) daily room and board, as defined in
				  section
				  52.5(a) 
				  of this Part;
(b) miscellaneous
				  hospital services, as defined in section
				  52.5(b) 
				  of this Part; provided, however, that the maximum amount limitation shall not
				  apply;
(c) surgical services, as
				  defined in section
				  52.6(a) 
				  of this Part;
(d) anesthetic
				  services, as defined in section
				  52.6(b) 
				  of this Part;
(e) in-hospital
				  medical services, as defined in section
				  52.6(c) 
				  of this Part;
(f) mental health
				  care consisting of coverage for diagnosis and treatment of mental illness for
				  at least:
(1) 30 days per year of inpatient
				  care in a hospital as defined by subdivision ten of section 1.03  of the Mental Hygiene Law;
(2) 30 outpatient visits per year at no less
				  than $30 per visit and a yearly maximum of no less than $1,500 with
				  reimbursement for early visits greater than or at least equal to reimbursement
				  for subsequent visits in a facility issued an operating certificate by the
				  Commissioner of Mental Health pursuant to the provisions of article 31 of the
				  Mental Hygiene Law, or in a facility operated by the Office of Mental Health,
				  or by a psychiatrist or psychologist licensed to practice in this State, or a
				  professional corporation thereof; and
(3) outpatient crisis intervention services
				  consisting of at least three psychiatric emergency visits per year. Upon
				  certification, by a licensed mental health care provider whose services are
				  covered under the policy, that a visit was the result of a psychiatric
				  emergency (one where the person appears to have a mental illness for which
				  immediate observation, care and treatment is appropriate and which is likely to
				  result in serious harm to himself or others), benefits for such a visit shall
				  be no less than $60 per visit. However, benefits provided under this paragraph
				  may be used to reduce benefits otherwise payable under paragraph (1) or (2) of
				  this subdivision;
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 52.8 - Disability income insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Disability income insurance is an insurance policy which
					 provides for periodic payments, weekly or monthly, for a specified period
					 during the continuance of disability resulting from sickness or
					 injury.
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 52.9 - Accident insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Accident insurance is an insurance policy which provides
					 coverage, singly or in combination, for death, dismemberment, disability, or
					 hospital and medical care caused by accident or specified kinds of
					 accidents.
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 52.10 - Limited benefits health insurance

Current through Register Vol. 46, No. 28, July 10, 2024
Limited benefits health insurance is an accident and health
					 insurance policy other than those provided for in sections
					 52.5
					 through
					 52.9 and
					 52.11
					 through
					 52.13 
					 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 52.11 - Medicare supplement insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Medicare supplement insurance is an
				  individual or group policy or certificate of accident and health insurance that
				  is advertised, marketed or designed primarily as a supplement to reimbursements
				  under Medicare for the hospital, medical or surgical expenses of persons
				  eligible for Medicare. This definition is applicable regardless of whether the
				  policy form is labeled as Medicare supplement insurance. A Medicare supplement
				  insurance policy and certificate thereunder is governed by the rules set forth
				  in Part 58 of this Title. The disclosure requirements for Medicare supplement
				  insurance are set forth in sections
				  58.3
				  and
				  58.5 
				  of this Title.
(b) Medicare
				  supplement insurance shall not include:
(1) a
				  policy or certificate which provides continued coverage for persons beyond age
				  65;
(2) a policy or certificate
				  issued pursuant to a contract under section 1876 of the Federal Social Security
				  Act (42 U.S.C. section
				  1395 et seq.);
(3) a policy or certificate issued under a
				  demonstration project specified in
				  42 U.S.C. section
				  1395 ss(g)(1);
(4) a policy or contract offered through one
				  or more employers or labor organizations, or through the trustees of a fund
				  established by one or more employers or labor organizations, or combination
				  thereof, for employees or former employees, or a combination thereof, or for
				  members or former members, or a combination thereof, of the labor
				  organizations; or
(5) a Medicare
				  Advantage plan under part C of Medicare (42 U.S.C. section
				  1395w-21 et seq.).
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 52.12 - Long term care insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Long
				  term care insurance is an insurance policy, rider, or certificate advertised,
				  marketed, offered or designed to provide coverage, subject to eligibility
				  requirements, for not less than 24 consecutive months for each covered person
				  on an expense incurred, indemnity, prepaid or other basis and provides at least
				  the benefits set forth in either paragraph (1), (2) or (3) of this subdivision
				  or a combination of the benefits set forth in paragraphs (1), (2) and (3) as
				  approved by the superintendent:
(1) Option I:
(i) Coverage of all levels of care in a
				  nursing home of at least $100 per day; except that such $100 may be reduced to
				  at least $70 per day for policies or certificates issued for delivery outside
				  the metropolitan area.
(ii)
				  Coverage of home care of at least 50 percent of the daily indemnity amount
				  provided for care in a nursing home.
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 52.13 - Nursing home insurance only, home care insurance only, or nursing home and home care insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Nursing home and home care insurance is an insurance policy, rider, or
				  certificate advertised, marketed, offered or designed to provide coverage,
				  subject to eligibility requirements, for not less than 12 consecutive months
				  for each covered person on an expense incurred, indemnity, prepaid or other
				  basis and which provides at least the benefits set forth in paragraphs (1) and
				  (2) of this subdivision:
(1) coverage of
				  custodial care services of at least $50 a day while confined in a nursing home;
				  and
(2) coverage of custodial care
				  services of at least $25 per day in a private home.
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 52.14 - Medicare select policies and certificates

Current through Register Vol. 46, No. 28, July 10, 2024
Medicare select policy or Medicare select certificate means
					 a Medicare supplement policy or certificate respectively, that contains
					 restricted network provisions. Medicare select policies and certificates are
					 governed by the rules set forth in Part 58 (Regulation 193) of this Title. The
					 disclosure requirements for Medicare select insurance are set forth in sections
					 58.3
					 and
					 58.5 
					 of this Title.
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 52.19 - Rules relating to the content of forms for franchise insurance

Current through Register Vol. 46, No. 28, July 10, 2024
The following provisions shall apply to franchise
					 insurance:
(a) No policy shall contain
				  a provision which permits the policy to be cancelled or nonrenewed except for
				  the following reasons stated in the policy:
(1) nonpayment of premium;
(2) the insured has attained the age limit,
				  if any, prescribed in the policy, or with respect to insurance defined in
				  sections
				  52.5,
				  52.6,
				  52.7 and
				  52.10 
				  of this Part, has become eligible for any coverage under Medicare by reason of
				  age;
(3) the insured's employment
				  in the eligible classes terminates, the insured retires, or ceases to be
				  engaged in an occupation or profession, or ceases to be a member of the
				  association or union, or a supplier, with respect to which the franchise
				  policies were issued;
(4) the
				  insurer cancels or nonrenews the insurance for all employees of the employer or
				  all members of the union or association or all suppliers after 60 days'
				  notice;
(5) if the plan is
				  terminated by the employer or by the sponsor and the insurer cancels or
				  nonrenews all policies issued to all insured employees of the employer or to
				  all insured members of the association or union or all suppliers;
(6) participation falls below the minimum
				  stated in the policy, and the insurer cancels or nonrenews all policies issued
				  to all insured employees of the same class or classes or to all insured members
				  of the association or union or all suppliers;
(7) if contributions are required of insured
				  employees at a rate greater than that stated in the policy and the insurer
				  terminates or nonrenews all policies issued to all insured employees of the
				  employer; and
(8) any other
				  condition specifically set forth in the policy at issue.