New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 46 - Unemployment Lapse Protection Benefit For Life Insurance › Section 46.7 - Provisions of policies and certificates of insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No life insurance policy providing for
				  unemployment lapse protection benefit shall be delivered or issued for delivery
				  in this State, unless it contains a provision:
(1) that describes the types or causes of
				  unemployment that are covered by the unemployment lapse protection
				  benefit;
(2) that sets forth the
				  conditions of eligibility for coverage. The conditions may include:
(i) a requirement that the insured be
				  actively at work on a full-time basis on the date of application or issue, or
				  prior to the date of application or issue for a minimum period not exceeding 12
				  months. The term full-time shall be defined in the policy to mean a minimum
				  number of hours no greater than 30 hours per week;
(ii) a requirement that the insured has not
				  received or been eligible to receive a State or Federal unemployment benefit
				  for a minimum period of time, not exceeding 12 months, prior to the application
				  date or the issue date; and
(iii) a
				  requirement that the insured be an eligible age on the date of application or
				  issue, provided that the maximum age shall not be less than 65;
(3) indicating when, after
				  commencement of involuntary unemployment, the life insurance coverage first
				  becomes protected against lapse and, if applicable, that required premiums must
				  be paid by the insured until that time;
(4) that describes where the notice of claim
				  forms can be obtained or, if no claim form is required, the information
				  required for such notice of claim, together with the address where such notice
				  must be delivered;
(5) that
				  specifies any documents or other information needed to serve as proof of
				  unemployment;
(6) that describes
				  the conditions or circumstances that must occur to make a claim under the
				  policy for the unemployment lapse protection benefit. The conditions or
				  circumstances may include the following:
(i)
				  a requirement that the insured actually receive or be eligible to receive State
				  or Federal unemployment benefits for a minimum period specified in the
				  form;
(ii) a requirement regarding
				  the type or cause of the insured's unemployment to be a covered unemployment as
				  set forth in the form;
(iii) a
				  requirement that the life insurance coverage be in effect a minimum period of
				  time before any payments are payable; provided that, if the minimum period of
				  time exceeds one year, no identifiable charge for the unemployment lapse
				  protection benefit may be collected until the expiry of this period;
(iv) a requirement that a notice of claim and
				  proof of unemployment shall be provided to the insurer within a reasonable time
				  after commencement of a period of unemployment; and
(v) a requirement that the insured be
				  unemployed for a minimum specified period not to exceed 180 days.
(7) that describes the coverage to
				  which the unemployment lapse protection benefit applies as well as the terms
				  and conditions applicable to the benefit with regard to coverage in force prior
				  to termination of employment. The description shall identify the specific
				  benefits or coverages (e.g., basic life, supplemental life, accidental death
				  and dismemberment, guaranteed insurance, waiver of premium for disability
				  benefit, some specified portion of or all dependent coverage, etc.) to which
				  the unemployment lapse protection benefit applies, if the unemployment lapse
				  protection benefit does not apply to all coverages provided under the policy;
				  and
(8) that describes each basis
				  for excluding or denying a claim for an unemployment lapse protection benefit.
				  Some of the bases for excluding or denying a claim for an unemployment lapse
				  protection benefit are:
(i) voluntary
				  separation from employment, without good cause (as such term is defined in
				  section 593  of the Labor Law);
(ii) retirement;
(iii) loss of income due to disability caused
				  by accident, sickness, disease or pregnancy;
(iv) loss of income due to termination of
				  employment as the result of willful misconduct (as defined in the form),
				  criminal misconduct or unlawful behavior as determined in judicial or
				  administrative proceedings;
(v)
				  strikes, lockouts, illegal walkouts, and industrial controversy (as such term
				  is defined in section
				  592[1] of the Labor Law);
				  and
(vi) normal or routine
				  scheduled layoff or plant closing where the employee is expected to be
				  rehired.