reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 65 - Regulations Implementing The Comprehensive Motor Vehicle Insurance Reparations Act › Subpart 65-5 - Unauthorized Providers Of Health Services › Section 65-5.4 - Hearings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Unless
					 otherwise provided, any hearing may be held before the superintendent,
					 Commissioner of Health or Commissioner of Education, any deputy, or any
					 designated salaried employee of the Department of Financial Services,
					 Department of Health, or Department of Education who is authorized by the
					 superintendent or noticing commissioner for such purpose. The hearing shall be
					 noticed, conducted, and administered in compliance with the State
					 Administrative Procedure Act.
(b)
					 The person conducting the hearing shall have the power to administer oaths,
					 examine and cross-examine witnesses, and receive documentary evidence, and
					 shall report his or her findings, in writing, to the superintendent or noticing
					 commissioner with a recommendation. The report, if adopted by the
					 superintendent or noticing commissioner, may be the basis of any determination
					 made by the superintendent or noticing commissioner.
(c) Every such hearing shall be open to the
					 public unless the superintendent or noticing commissioner, or the person
					 authorized by the superintendent or noticing commissioner to conduct such
					 hearing, shall determine that a private hearing would be in the public
					 interest, in which case the hearing shall be private.
(d) Every provider affected shall be
					 permitted to: be present during the giving of all the testimony; be represented
					 by counsel; have a reasonable opportunity to inspect all adverse documentary
					 proof; examine and cross-examine witnesses; and present proof in support of the
					 provider's interest. A stenographic record of the hearing shall be made, and
					 the witnesses shall testify under oath.
(e) Nothing herein contained shall require
					 the observance at any such hearing of formal rules of pleading or
					 evidence.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 65 - Regulations Implementing The Comprehensive Motor Vehicle Insurance Reparations Act › Subpart 65-5 - Unauthorized Providers Of Health Services › Section 65-5.5 - Report of hearing and findings

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Pending a final determination by the
					 superintendent, Commissioner of Health, or Commissioner of Education, if the
					 superintendent or noticing commissioner believes that the provider has engaged
					 in any activity set forth in Insurance Law section 5109(b), then the
					 superintendent or noticing commissioner may temporarily prohibit the provider
					 from demanding or requesting any payment for medical services under Insurance
					 Law article 51 for up to 90 days from the date of the notice of such temporary
					 prohibition pursuant to Insurance Law section 5109(e).
(b) The hearing officer shall issue to the
					 superintendent or noticing commissioner the report described in section
					 65-5.4(b) 
					 of this Subpart, with a recommendation. The superintendent or noticing
					 commissioner may adopt, modify, remand, or reject the hearing officer's report
					 and recommendation.
(c)
(1) Upon consideration of the hearing
					 officer's report and recommendation, the superintendent or noticing
					 commissioner may issue a final order prohibiting the provider from demanding or
					 requesting any payment for medical services in connection with any claim under
					 Insurance Law article 51 and requiring the provider to refrain from
					 subsequently treating, for remuneration, as a private patient, any person
					 seeking medical treatment under Insurance Law article 51, for a period
					 specified by the superintendent or noticing commissioner.
(2) If the superintendent or noticing
					 commissioner issues a final order prohibiting the provider from demanding or
					 requesting any payment for medical services in connection with any claim under
					 Insurance Law article 51 and requiring the provider to refrain from
					 subsequently treating, for remuneration, as a private patient, any person
					 seeking medical treatment under Insurance Law article 51, for a period longer
					 than three years, then the provider may, after the expiration of three years,
					 submit a written application to the superintendent or noticing commissioner
					 requesting that the superintendent or noticing commissioner reconsider his or
					 her order. The written application shall explain why revising the order would
					 not jeopardize the health, safety, and welfare of the people of this
					 State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 66 - Surety Bond Forms-waiver Of The Filing And Prior Approval Requirements Of Section 2307 Of The Insurance Law › Section 66.1 - Waiver of requirement for filing and approval of surety bond forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				  requirement of Insurance Law section
				  2307(b) regarding the
				  filing and approval of surety bond forms is hereby waived, except for bail bond
				  forms.
(b) Every insurer and
				  charitable bail organization shall file for approval by the superintendent all
				  contracts and other forms that are signed by or provided to an indemnitor or
				  principal in connection with the issuance of a bail bond or depositing money or
				  property as bail and shall only use approved contracts and forms.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.0 - Preamble and Plan of Operation Filing

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part implements
				  Insurance Law section 3411 by establishing inspection requirements applicable
				  to the issuance and renewal of insurance policies providing private passenger
				  automobile physical damage insurance. Chapter 638 of the Laws of 2023 amended
				  Insurance Law section 3411 to permit an insurer to waive the right to such
				  inspection.
(b) Unless an insurer
				  has filed with the superintendent a statement waiving its right to inspections
				  for all automobiles, it shall be the responsibility of every insurer that
				  issues and delivers automobile physical damage insurance in this State and of
				  the New York Automobile Insurance Plan ("NYAIP") to establish and maintain
				  inspection procedures that fully comply with section 3411, as implemented by
				  the provisions of this Part. Each such insurer and the NYAIP shall file with
				  the superintendent a statement describing in detail its plan of operation for
				  establishing and adequately maintaining an inspection system. If an insurer
				  wishes to waive its right to such an inspection for some automobiles, then the
				  insurer shall submit to the superintendent a revised plan of operation that
				  specifies the automobiles that are subject to inspection and those automobiles
				  for which the insurer is waiving the inspection. Any amendments to the plan of
				  operation shall take effect upon filing with the superintendent. Failure to
				  adhere to the provisions of section 3411 and this Part shall subject the
				  violator to the penalty provisions of the Insurance Law, including section
				  3411(n).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in Insurance Law section 3411 and this
					 Part:
(a)
Private passenger
				  automobile
or
automobile
means an owned or leased
				  motor vehicle as defined in VTL section 125 but shall not include:
(1) an
ambulance
as defined
				  in VTL section 100-b;
(2) a
fire vehicle
as defined in VTL section 115-a;
(3) a
motorcycle
as defined
				  in VTL section 123;
(4) a
livery
vehicle as defined in VTL section 121-e;
(5) a
police vehicle
as
				  defined in VTL section 132-a;
(6) a
taxicab
as defined in VTL section 148-a ;
(7) a
farm vehicle
as
				  defined in VTL section 501-a; or
(8) a motor vehicle weighing more than 6,500
				  pounds unloaded.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.2 - Inspection requirement for private passenger automobiles

Current through Register Vol. 46, No. 28, July 10, 2024
Except where an insurer has waived its right to an
					 inspection or deferred an inspection pursuant to section
					 67.4  of this Part, an insurer
					 shall not issue a new insurance policy or modify an existing insurance policy
					 providing automobile physical damage insurance for a new, additional or
					 replacement private passenger automobile unless the insurer's authorized
					 representative has inspected the automobile.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.3 - Waiver of the inspection requirement

Current through Register Vol. 46, No. 28, July 10, 2024
Except where an insurer has submitted a statement waiving
					 its right to inspections for all automobiles, the following shall apply:
(a)
Mandatory waivers
. An
				  insurer shall waive an inspection of:
(1) a
				  temporary substitute automobile; and
(2) an automobile that is leased for less
				  than six months.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.4 - Deferral of the inspection requirement

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Unless an insurer either waives an inspection or immediately inspects the
				  automobile, upon a named insured's request for private passenger automobile
				  physical damage insurance, an insurer shall, at the time of the insured's
				  request, notify the named insured of the physical damage inspection
				  requirement.
(b) At the insurer's
				  option, the automobile may be inspected prior to the effective date of coverage
				  but no more than ten days prior to the effective date or defer the inspection
				  for 14 calendar days after the effective date.
(c) The notification specified in subdivision
				  (a) of this section shall advise the named insured:
(1) of one or more inspection locations where
				  the inspection may be completed during the fourteen-day deferral
				  period;
(2) of the potential
				  consequences of the named insured's failure to make the insured automobile
				  available for inspection; and
(3)
				  that coverage will be suspended at 12:01 a.m. on the day following the
				  fourteenth day after the effective date of coverage if the mandatory inspection
				  is not timely completed.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.5 - Standards for inspections

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer shall use
				  authorized representatives that conduct inspections in accordance with the
				  provisions of this section. An insurer's authorized representative shall
				  conduct the inspection at a time and place reasonably convenient to the named
				  insured. A reasonably convenient time shall include, in addition to customary
				  business hours, sufficient early morning, evening and weekend hours.
(1) If the insured automobile is located
				  within this state, then a reasonably convenient place shall be:
(i) ten miles or less from the place where
				  the automobile is principally garaged when the place is within the counties of
				  Westchester, Nassau or Suffolk, or any city with a population of 100,000 or
				  more; or
(ii) 25 miles or less from
				  the place where the automobile is principally garaged when the place is in all
				  other parts of this state.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.6 - Standards for suspension of private passenger automobile physical damage insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Unless an insurer waives
				  an inspection, if the named insured fails to make the insured automobile
				  available for the inspection prior to expiration of the deferral period
				  specified in section
				  67.4(b)  of this
				  Part, then automobile physical damage insurance on the insured automobile shall
				  be suspended at 12:01 a.m. of the day following the 14th calendar day after the
				  effective date of coverage.
(1) If the named
				  insured makes the named insured's automobile available for the inspection after
				  the automobile physical damage insurance has been suspended, then the insurer
				  shall accept the inspection and reinstate the automobile physical damage
				  insurance effective as of the date and time of the inspection.
(2) For the purposes of sections 3425 and
				  3426  of the Insurance Law, reinstatement of automobile physical damage
				  insurance shall not be considered new business.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.7 - Standards for renewal inspections

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer
				  may require that a named insured's automobile be reinspected as a condition of
				  renewing the automobile's physical damage insurance.
(b) An insurer shall document any renewal
				  inspection requirement in its plan of operations and shall base any such
				  requirement on underwriting criteria that relates to the risk being insured. An
				  insurer shall not apply any renewal inspection requirement in an unfair and
				  discriminatory manner.
(c)
(1) Whenever an inspection of the insured
				  automobile is required upon renewal of the automobile's physical damage
				  insurance, the insurer shall:
(i) mail, deliver or transmit the CONFIRMATION OF PHYSICAL DAMAGE COVERAGE--NOTICE OF
				  MANDATORY PHOTO INSPECTION REQUIREMENT (NYS APD form B) or a substantially
				  equivalent form to the named insured and the producer of record at least 45 but
				  not more than 60 calendar days prior to the annual policy renewal date to
				  provide notification to the named insured that:
(a) an inspection of the insured automobile
				  is required within 30 calendar days from the named insured's private passenger
				  automobile physical damage insurance annual policy renewal date; and
(b) if the named insured fails to make the
				  insured automobile available for inspection, then the insurer shall suspend the
				  automobile physical damage insurance at 12:01 a.m. on the thirty-first day
				  after the annual policy renewal date;
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.8 - Standards for inspection by NYAIP

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except where the NYAIP has submitted a
				  statement waiving its right to inspections for all automobiles, the standards
				  for conducting inspections contained in this Part shall be applicable to new
				  assignments by NYAIP, except that:
(1) the
				  14-calendar-day deferral period for new business provided by section
				  67.4  of this Part shall be
				  mandatory; and
(2) the NYAIP may
				  waive the inspection requirement for any automobile, including the automobiles
				  specified in section
				  67.3(b)  of this
				  Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.9 - Required amendatory endorsements

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Every policy providing private passenger automobile physical damage insurance
				  shall contain language that is substantially equivalent to the following: the
				  insurer or its authorized representative has the right to inspect any private
				  passenger automobile, including a nonowned automobile, insured or intended to
				  be insured under this policy, before the automobile physical damage insurance
				  shall become effective, except to the extent that this right is prescribed and
				  limited by Insurance Regulation No. 79 (11 NYCRR Part 67) or section 3411  of the Insurance Law.
(b) When the insurer requires an inspection,
				  the named insured shall cooperate and make the automobile available for
				  inspection.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.10 - Permissible premium adjustments

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer may grant premium reductions
				  when an inspection made pursuant to this Part discloses that previous damage or
				  the prior condition of an insured automobile would result in a reduction in the
				  amount payable for settlement of a private passenger automobile physical damage
				  claim in the event of a total loss. An insurer may file revised premium rates,
				  which would be effective under such circumstances, to reduce their fire and
				  theft or comprehensive premium rates as follows:
Diminution of Value
Reduction Permitted
Under $ 500.00
None
$ 500.01 to $ 750.00
5%
$ 750.01 to $ 1,000.00
7.5%
more than $1000.00
10%
(b) An insurer may deviate from the premium
				  reductions specified in subdivision (a) of this section, upon filing the
				  proposed deviation as a rating rule subject to the superintendent's approval in
				  accordance with Article 23 of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 67 - Underwriting Inspection Requirement for Private Passenger Automoblies › Section 67.11 - Inspection report central repository

Current through Register Vol. 46, No. 28, July 10, 2024
An insurer may utilize a separate entity to maintain a
					 central repository of its private passenger automobile physical damage
					 inspection reports to improve the effectiveness of the insurer's inspection
					 program. More than one insurer may use the services provided by the same
					 central repository. Reporting to a central repository shall be
					 voluntary.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chapter 892 of
				  the Laws of 1977 provides, as a means of containing the cost of no-fault
				  insurance, for the establishment of schedules of maximum permissible charges
				  for medical, hospital and other professional health services payable under
				  no-fault insurance benefits. Specifically, section 5108 (a)  of the Insurance
				  Law provides that the charges for services specified in section 5102 (a)(1)  of the
				  Insurance Law, and any further health service charges which are incurred as a
				  result of the injury and which are in excess of basic economic loss, ". . .
				  shall not exceed the charges permissible under the schedules prepared and
				  established by the chairman of the Workers' Compensation Board for industrial
				  accidents, except as otherwise provided in section thirteen-a  of the Workers'
				  Compensation Law."
(b) Paragraph
				  (1) of subdivision (a) of section 5102  of
				  the Insurance Law defines basic economic loss to include necessary expenses
				  incurred for (i) medical, hospital, surgical, nursing, dental, ambulance,
				  X-ray, prescription drug and prosthetic services; (ii) psychiatric, physical
				  and occupational therapy and rehabilitation; (iii) any nonmedical remedial care
				  and treatment rendered in accordance with a religious method of healing
				  recognized by the laws of this State; and (iv) any other professional health
				  services.
(c) Section 5102 (a)  of the Insurance
				  Law provides that for the purpose of determining basic economic loss, the
				  expenses incurred under section 5102(a)(1) shall be in accordance with the
				  limitations of section 5108  of the Insurance Law.
(d) The Superintendent of Insurance is
				  required, after consulting with the chairman of the Workers' Compensation Board
				  and the Commissioner of Health, to promulgate rules and regulations
				  implementing and coordinating the Comprehensive Automobile Insurance
				  Reparations Act and the Workers' Compensation Law regarding the charges for
				  other professional health services, including the establishment of schedules
				  for all such services for which schedules have not been prepared and
				  established by the chairman of the Workers' Compensation Board.
(e) The chairman of the Workers' Compensation
				  Board has to date prepared and established fee schedules for medical,
				  chiropractic and podiatric services. These schedules also include fees for some
				  dental, psychiatric and physical therapy services.
(f) Providers of health services are
				  prohibited from demanding or requesting any payment for services in excess of
				  permissible charges, and the law requires insurers to report to the
				  Commissioner of Health patterns of overcharging, excessive treatment or other
				  improper actions by a health provider.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.1 - Adoption of certain workers' compensation schedules

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) The existing fee schedules prepared and
				  established by the chair of the Workers' Compensation Board for industrial
				  accidents are hereby adopted by the Superintendent of Financial Services with
				  appropriate modification so as to adapt such schedules for use pursuant to the
				  provisions of Insurance Law section
				  5108.
(2)
(i)
				  Notwithstanding paragraph (1) of this subdivision, and except as provided in
				  subparagraph (ii) of this paragraph, the amendments to the fee schedules set
				  forth in Parts 329, 333, 343, and 348 of Title 12 NYCRR that were promulgated
				  by the chair of the Workers' Compensation Board on December 11, 2018, and the
				  amendments to the fee schedules set forth in Parts 329, 333, and 348 of Title
				  12 NYCRR that were adopted by the chair of the Workers' Compensation Board on
				  November 19, 2019, shall take effect for purposes of Insurance Law section
				  5108 on October 1, 2020, and shall only
				  apply to all charges for health services performed on or after October 1,
				  2020.
(ii) The following ground
				  rules in the amendments to the fee schedules set forth in Parts 329, 333, 343,
				  and 348 of 12 NYCRR that were promulgated by the chair of the Workers'
				  Compensation Board on December 11, 2018, shall take effect for purposes of
				  Insurance Law section
				  5108 on April 1, 2019, and shall apply to
				  all charges for health services performed on or after April 1, 2019:
(a) General Ground Rule 10 in the Workers'
				  Compensation Chiropractic Fee Schedule set forth in 12 NYCRR 348;
(b) General Ground Rule 19 in the Workers'
				  Compensation Medical Fee Schedule set forth in 12 NYCRR 329;
(c) General Ground Rule 13 in the Workers'
				  Compensation Behavioral Health Fee Schedule (formerly the Psychology Fee
				  Schedule) set forth in 12 NYCRR 333, and;
(d) General Ground Rule 16 in the Workers'
				  Compensation Podiatry Fee Schedule set forth in 12 NYCRR
				  343.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.2 - Establishment of certain health provider schedules

Current through Register Vol. 46, No. 28, July 10, 2024
(a) After consultation with the chairman of
				  the Workers' Compensation Board and the Commissioner of Health, the
				  Superintendent of Insurance hereby establishes fee schedules for professional
				  health services referred to in section 5102 (a)(1)  of the
				  Insurance Law, and for which schedules have not been prepared and established
				  by the chairman of the Workers' Compensation Board. The schedules for such
				  professional health services, hereby adopted by the Superintendent of
				  Insurance, are incorporated herein as Appendix 17-C and charges for services
				  listed therein shall not exceed the charges permissible under such
				  schedules.
(b) The fee schedules
				  established by the superintendent for professional services referred to in
				  section 5102 (a)(1)  of the
				  Insurance Law are hereby amended as set forth in amendment 23 to Appendix 17-C.
				  Charges for the services listed in the fee schedules, as amended, shall not
				  exceed the charges permissible under such schedules and shall apply to charges
				  for services performed on or after September 1, 1994.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.3 - Applicability of limitations

Current through Register Vol. 46, No. 28, July 10, 2024
The limitations set forth in this Part for charges by
					 providers of health services apply to all services specified in section 5102 (a)(1)  of the
					 Insurance Law, and any further health service charges which are incurred as a
					 result of the injury and which are in excess of basic economic loss. Such
					 limitations shall apply to all health services performed on or after December
					 1, 1977 with respect to any personal injury arising from the use and operation
					 of a motor vehicle on or after December 1, 1977. Charges for health services
					 performed on or after December 1, 1977 as a result of personal injury due to
					 the use and operation of a motor vehicle prior to such date are not, by
					 statute, subject to the limitations of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.4 - Exception to limitations

Current through Register Vol. 46, No. 28, July 10, 2024
A charge in excess of the scheduled fee may be authorized
					 by the insurer, the arbitrator of disputes involving health services or a court
					 of competent jurisdiction, if such insurer, arbitrator or court finds that an
					 unusual procedure or unique circumstance justifies the necessity for such
					 charge. This exception to the fee schedule limitations shall not apply to
					 charges for hospital inpatient services subject to a per diem rate in the
					 hospital fee schedule.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.5 - Health services not set forth in schedules

Current through Register Vol. 46, No. 28, July 10, 2024
If a professional health service is performed which is
					 reimbursable under section 5102 (a)(1)  of the
					 Insurance Law, but is not set forth in fee schedules adopted or established by
					 the superintendent, and:
(a) if the
				  superintendent has adopted or established a fee schedule applicable to the
				  provider, then the provider shall establish a fee or unit value consistent with
				  other fees or unit values for comparable procedures shown in such schedule,
				  subject to review by the insurer; or
(b) if the superintendent has not adopted or
				  established a fee schedule applicable to the provider, then the permissible
				  charge for such service shall be the prevailing fee in the geographic location
				  of the provider subject to review by the insurer for consistency with charges
				  permissible for similar procedures under schedules already adopted or
				  established by the superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.6 - Health services performed outside New York State

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) If
				  a professional health service reimbursable under Insurance Law section
				  5102(a)(1) is performed
				  outside this State, the amount that the insurer shall reimburse for [such] the
				  service shall be the lower of the amount charged by the provider and the
				  prevailing fee in the geographic location of the provider with respect to
				  services:
(i) that constitute emergency
				  care;
(ii) provided to an eligible
				  injured person that is not a resident of this State; or
(iii) provided to an eligible injured person
				  that is a resident of this State who, at the time of treatment, is residing in
				  the jurisdiction where the treatment is being rendered for reasons unrelated to
				  the treatment.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.7 - Restriction on health provider charges

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No provider of health services specified
				  in section 5102 (a)(1)  of the
				  Insurance Law may demand or request any payment in addition to the charges
				  permitted by the provisions of this Part. If the insured also possesses health
				  insurance coverage and such health insurance contract does not exclude payment
				  for no-fault benefits, payment by the health insurer for health services under
				  such contract is restricted by the limitations of section 5108  of the Insurance Law, unless such
				  limitation would impair the terms of a provider's contract with the health
				  insurer, in which case payment by the health insurer to the provider may be
				  made in accordance with the provider's contract; however, the provider may not
				  receive duplicate payment.
(b) If
				  coverage for health services specified in section 5102 (a)(1)  of the
				  Insurance Law is provided pursuant to section 5103 (g)  of the Insurance
				  Law, charges for such health services are restricted by the limitation of
				  section 5108  of the Insurance Law.
(c) This subdivision is applicable to
				  accidents that occurred between December 1, 1977 and December 5, 1980,
				  regardless of the date service was rendered; and to services rendered prior to
				  June 6, 1983 for accidents that occurred on or after December 5, 1980. If a
				  health service provider accepts an assignment of an eligible injured person's
				  Medicare benefits, the provider, for purposes of this Part, is deemed to have
				  contracted with the Social Security Administration. Reimbursement for services
				  rendered to a patient eligible for both No-Fault and Medicare is illustrated by
				  the following example: assume a procedure where a physician's usual and
				  customary charge is $50, the Medicare allowable charge is $40 and the No-Fault
				  fee schedule amount is $30:
(1) If the
				  physician takes a Medicare assignment:
(i)
				  Medicare would pay $32 (80%);
(ii)
				  No-Fault should be billed $8 (20%);
(iii) the No-Fault insurer would be
				  responsible for the amount credited by Medicare to the patient's deductible;
				  and
(iv) physicians should bill
				  Medicare first in the manner they customarily would have billed prior to
				  December 1, 1977.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.8 - Insurers' reports relating to health providers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Insurers shall report any pattern of
				  overcharging, excessive treatment or any other improper actions by a health
				  provider, within 30 days after such insurer has knowledge of such pattern to
				  the No-Fault Unit, Property Bureau, New York State Insurance Department, 25
				  Beaver Street, New York, NY 10004, and to the following:
(1) Complaints about:
(i) Physicians and physicians' assistants.
New York State Department of Health
Office of Professional Medical Conduct
433 River Street, Suite 303
Troy, NY 12180
(ii) Hospitals.
New York State Department of Health
Centralized Hospital Intake Program
433 River Street, 6th Floor
Troy, NY 12180
(iii) Other health providers. (Complaint
				  should be sent to the nearest office based on the location of the health
				  provider.)
Central Administration
Office of Professional Discipline
New York State Education Department
475 Park Avenue South, 2nd Floor
New York, NY 10016-6901
Albany
Office of Professional Discipline
New York State Education Department
80 Wolf Road, 2nd Floor
Albany, NY 12205-2643
Brooklyn, Staten Island
Office of Professional Discipline
New York State Education Department
196 Montague Street, 4th Floor
Brooklyn, NY 11201
Buffalo
Office of Professional Discipline
New York State Education Department
295 Main Street, Suite 756
Buffalo, NY 14203
Bronx/Queens
Office of Professional Discipline
New York State Education Department
2400 Halsey Avenue
Bronx, NY 10461
Mid-Hudson Region
Office of Professional Discipline
New York State Education Department
One Gateway Plaza, 3rd Floor
Port Chester, NY 10573
Nassau/Suffolk
Office of Professional Discipline
New York State Education Department
1121 Walt Whitman Road, Suite 301
Melville, NY 11747
Manhattan
Office of Professional Discipline
New York State Education Department
163 West 125th Street, Room 819
New York, NY 10027
Syracuse
Office of Professional Discipline
New York State Education Department
State Tower Building
108 South Warren Street, Suite 320
Syracuse, NY 13202
Rochester
Office of Professional Discipline
New York State Education Department
220 Idlewood Road, Room 106
Rochester, NY 14618
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 68 - Charges For Professional Health Services › Section 68.9 - Health services provided through a managed care organization

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notwithstanding any other provision of
				  this Part, a health care provider participating in a certified managed care
				  organization pursuant to an approved managed care program, in accordance with
				  section 5109  of the Insurance Law, may accept a
				  fee, or agree to bundle services for fees, different than the fees prescribed
				  in this Part, provided that costs for medical and other health care services
				  provided by managed care organizations for an insurer's managed care program
				  shall not, in the aggregate, exceed the costs that would be otherwise payable
				  by application of the fee schedules established by the superintendent or the
				  Chair of the Workers' Compensation Board.
(b) No insurer subject to this Part shall
				  contract with a managed care organization on a capitation basis, unless the
				  managed care organization is:
(1) a health
				  maintenance organization issued a certificate of authority under article 44 of
				  the Public Health Law or licensed under article 43 of the Insurance Law;
				  or
(2) an insurer (including an
				  article 43 corporation) licensed to write accident and health insurance
				  pursuant to the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.0 - Introduction

Current through Register Vol. 46, No. 28, July 10, 2024
Section 6503(a)(2) of the New York Insurance Law gives
					 authority to mortgage insurers to insure pools of loans secured by mortgages,
					 deeds of trust, or other instruments constituting a lien or charge on real
					 estate. It has been deemed necessary therefore, to set forth the following
					 rules and guidelines for the writing of such insurance in addition to the
					 requirements of article 65 of the New York Insurance Law where
					 applicable.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.1 - Minimum requirements

Current through Register Vol. 46, No. 28, July 10, 2024
Each pool insurance policy shall be subject to all of the
					 following:
(a) The mortgage loans in
				  an insured pool shall not have loan-to-value ratios (defined as the ratio of
				  the original principal balance of the mortgage loan to the lesser of the
				  purchase price or original appraised value of the related security) in excess
				  of 80 percent after giving effect to any primary policies of mortgage guaranty
				  insurance, FHA insurance or VA guarantee.
(b) Outstanding principal balances of the
				  mortgage loans insured, as stated in the mortgage pool policy, shall be not
				  less than $5,000,000.
(c) The
				  minimum number of mortgage loans insured shall be not less than 75.
(d) The mortgage loans insured shall be on
				  one- to four-family residences and the loans, or a statistically valid random
				  sample thereof, shall be individually underwritten. Where a random sample of
				  mortgage loans is underwritten, the insurer's files shall document the basis
				  for the selection of the sample utilized. No more than 10 percent of the
				  outstanding principal balances of the mortgage loans insured as stated in the
				  mortgage pool policy shall be on properties which, as of the date of the loan
				  origination, the borrower did not intend to occupy as a primary or secondary
				  residence.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.2 - Substitutions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For a policy
				  providing mortgage pool insurance issued prior to January 11, 1995, there shall
				  be no additions to or substitutions in a pool of mortgages after one year
				  following the issuance of the policy.
(b) For a policy providing mortgage pool
				  insurance issued on or after January 11, 1995, there shall be no additions to
				  or substitutions in a pool of mortgages after two years following the issuance
				  of the policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.3 - Limitation of liability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For
				  mortgage guaranty insurance in force prior to January 11, 1995, no more than 25
				  percent of the total liability, net of reinsurance, of a mortgage insurance
				  company shall be mortgage pool insurance.
(b) For the purpose of subdivision (a) of
				  this section, total liability shall be computed on the basis of the aggregate
				  loss limit in a policy providing mortgage pool insurance coverage.
(c) In any pool insurance policy written by a
				  mortgage insurer prior to January 11, 1995, the total amount at risk on any one
				  pool shall not at any time exceed 20 percent of the outstanding principal
				  balance of mortgage loans insured as stated in the mortgage pool
				  policy.
(d) In any pool insurance
				  policy written by a mortgage insurer on or after January 11, 1995, the total
				  amount at risk on any one pool shall not at any time exceed 25 percent of the
				  outstanding principal balance of mortgage loans insured, as stated in the
				  mortgage pool policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.4 - Limitations under reinsurance contracts

Current through Register Vol. 46, No. 28, July 10, 2024
For policies issued prior to January 11, 1995, the mortgage
					 insurer shall cede any risk in excess of 25 percent of the entire indebtedness
					 on an individual loan. The assuming insurer to a reinsurance agreement under a
					 pool insurance policy must be authorized to do business in New York State and
					 shall be subject to the same limitations and restrictions on its portion of
					 retention or assumed insurance writings as the direct writer.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.5 - Reinsurance of mortgage pool insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A ceding insurer may, consistent with the
				  applicable requirements of section 6507  of
				  the Insurance Law, reinsure any pooled mortgage loans under a pool insurance
				  policy with:
(1) an insurer not under common
				  control;
(2) a mortgage insurer
				  under common control, provided that the mortgage insurer, either directly or
				  indirectly, does not own, or is not owned by, in whole or in part, the ceding
				  insurer; or
(3) a non-mortgage
				  insurer under common control.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 69 - Mortgage Pool Insurance › Section 69.6 - Geographic diversification standards; report

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) A
				  mortgage insurer's direct written and assumed mortgage pool certificates in
				  force in any one Metropolitan Statistical Area (MSA) of Primary Metropolitan
				  Statistical Area (PMSA), net of reinsurance, shall not exceed 10 percent of the
				  insurer's total direct written and assumed certificates in force, net of
				  reinsurance, with respect to pool and non-pool mortgage guaranty
				  insurance.
(2) A mortgage insurer's
				  mortgage pool insurance risk in force in any one geographic region, net of
				  reinsurance, shall not exceed 30 percent of its total mortgage guaranty
				  insurance risk in force, net of reinsurance. For purposes of this paragraph,
				  the United States shall be divided into the following regions:
(i) CT
(ii) MA (other)
(iii) Boston, MA-NH (PMSA) and Lawrence,
				  MA-NH (PMSA)
(iv) ME,RI,VT,NH
				  (other)
(v) NJ (other)
(vi) Bergen-Passaic, NJ (PMSA)
(vii) NY (other)
(viii) New York, NY (PMSA)
(ix) Nassau-Suffolk, NY (PMSA)
(x) Buffalo-Niagara Falls, NY (MSA) and
				  Rochester, NY (MSA) and Syracuse, NY (MSA)
(xi) Albany-Schenectady-Troy, NY
				  (MSA)
(xii) PA (other)
(xiii) Philadelphia, PA-NJ (PMSA)
(xiv) CA (other)
(xv) Los Angeles-Long Beach, CA (PMSA) and
				  Orange County, CA (PMSA)
(xvi) San
				  Diego, CA (MSA)
(xvii)
				  Riverside-San Bernadino, CA (PMSA)
(xviii) San Francisco, CA (PMSA) and Oakland,
				  CA (PMSA)
(xix) Sacramento, CA
				  (PMSA)
(xx) WA, AK
(xxi) DE
(xxii) Washington, DC-MD-VA-WV (PMSA) and MD
				  (other) and VA (other)
(xxiii)
				  Baltimore, MD (PMSA)
(xxiv) FL
				  (other)
(xxv) Tampa-St.
				  Petersburg-Clearwater, FL (MSA)
(xxvi) Miami, FL (PMSA) and Ft. Lauderdale,
				  FL (PMSA)
(xxvii) Orlando, FL
				  (MSA)
(xxviii) GA (other)
(xxix) Atlanta, GA (MSA)
(xxx) NC, SC, WV (other)
(xxxi) IL (other)
(xxxii) Chicago, IL (PMSA)
(xxxiii) IN, MI, OH, WI
(xxxiv) AL, KY, MS, TN
(xxxv) IA, KS, MN, MO, NE, ND,SD
(xxxvi) AR, LA, OK
(xxxvii) TX (other)
(xxxviii) Houston, TX (PMSA)
(xxxix) Dallas, TX (PMSA) and Fort
				  Worth-Arlington, TX (PMSA)
(xxxx)
				  AZ
(xxxxi) CO
(xxxxii) ID, MT, NV, NM, OR, UT, WY
(xxxxiii) HI
(xxxxiv) PR
(xxxxv) U.S VI
(3) In the case of mortgage insurers which
				  are members of the same holding company system, compliance with the foregoing
				  diversification standards of this subdivision shall be determined on a
				  consolidated basis.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 70 - Medical Malpractice Insurance Rate Modifications, Provisional Rates, Required Policy Provisions And Availability Of Additional Coverages › Section 70.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
The provisions of this Part are limited to insurance
					 companies authorized, pursuant to subdivisions 13 and 14 of section 1113 (a)  of the Insurance
					 Law, to write medical malpractice insurance. Such limitation is appropriate
					 since it has been determined after review and a public hearing that
					 applicability to other areas of professional liability insurance is unnecessary
					 at this time.