reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.2 - General provisions

Current through Register Vol. 46, No. 28, July 10, 2024
The LRRA exempts purchasing groups and their insurers from
				  certain state laws which are specified therein. Section 5907  of the Insurance Law codifies those
				  exemptions into New York law. All other provisions of New York law, and the
				  rules and regulations promulgated thereunder, are applicable to a purchasing
				  group doing business in this State, its members and its representatives,
				  insurers writing policies for such purchasing groups, and any other person,
				  firm, association or corporation acting in connection with the placement of
				  liability insurance for a purchasing group or a member of such purchasing
				  group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.3 - Policy form and rate filing and approval requirements for authorized insurers

Current through Register Vol. 46, No. 28, July 10, 2024
An authorized insurer providing coverage for a purchasing
				  group or a member of such purchasing group, with respect to risks or operations
				  in this State, shall comply with article 23 and all other provisions of the
				  Insurance Law, rules and regulations governing policy form and rate standards,
				  including filing and approval requirements.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.4 - Unauthorized insurers: doing an insurance business

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In connection with a purchasing group or
				a member of such group, an unauthorized insurer shall not do any act that would
				constitute the doing of an insurance business in this State.
(b) Except to the extent specifically
				permitted under section 1101  of the Insurance Law, the delivery in
				this State by mail or otherwise of any liability insurance policy by an
				unauthorized insurer to a purchasing group or a member of such group is
				prohibited.
(c) Except to the
				extent specifically permitted under section 1101  of the Insurance Law, an unauthorized
				insurer is doing an insurance business in this State if, acting on behalf of
				such unauthorized insurer:
(1) any person,
				firm, association or corporation in this State delivers a liability insurance
				policy to a purchasing group or a member of such group; or
(2) any purchasing group, its representative
				or any other person, firm, association or corporation in this State delivers a
				liability insurance policy to a member of such group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.5 - Location of a purchasing group

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				For the purposes of section 5909 (a)  of the Insurance
				Law, to determine when liability insurance from an unauthorized insurer for a
				purchasing group or its member must be obtained through an excess line broker,
				a purchasing group is located in this State:
(1) with respect to the purchasing group,
				when there is any solicitation, negotiation, issuance or delivery in this State
				of such group policy by, to, or on behalf of such group; or
(2) with respect to a member, when there is
				any solicitation, negotiation, issuance or delivery in this State of such
				member's policy.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.6 - Excess line broker requirement

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No person, firm, association or
				corporation, except as specifically permitted by section 2117  of the Insurance Law, shall procure
				insurance in this State from an unauthorized insurer for a purchasing group or
				a member of such group, unless such person, firm, association or corporation
				is:
(1) licensed as an excess line broker
				pursuant to section 2105 of the New York Insurance Law; and
(2) acting in accordance with section 2118  of the Insurance Law and Part 27
				(Regulation No. 41) of this Title.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.7 - Aiding unauthorized insurers

Current through Register Vol. 46, No. 28, July 10, 2024
Except as specifically permitted for an insurance broker or
				  an excess line broker under section 2117 or
				  2118  of the Insurance Law, in connection
				  with the procurement of liability insurance for a purchasing group or a member
				  of such purchasing group, no purchasing group, its representative or any other
				  person, firm, association or corporation shall in this State:
(a) solicit, negotiate or effectuate any
				insurance contract, or place risks with an unauthorized insurer;
(b) act as agent for an unauthorized insurer,
				or aid an unauthorized insurer, in any manner in effecting such a
				contract;
(c) call attention by
				advertisement or public announcement to an unauthorized insurer; or
(d) act in any other manner that would
				violate section 2117 or
				2122  of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.8 - Notice and registration requirements-prior to december 10, 1988

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Notice. The
				LRRA requires that a purchasing group which intends to do business in any state
				furnish notice of such intention to the insurance commissioner of such state.
(1) Such notice, to be submitted to the
				superintendent, as required by the LRRA, shall include the following
				information:
(i) the state in which the
				purchasing group is domiciled;
(ii)
				the lines and classifications of liability insurance which the purchasing group
				intends to purchase;
(iii) the
				insurer or risk retention group from which the purchasing group intends to
				purchase insurance and the domicile of such insurer or risk retention group;
				and
(iv) the principal place of
				business of the purchasing group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 301 - Purchasing Groups › Section 301.9 - Notice and registration requirements on and after december 10, 1988

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Section 5908  of the Insurance Law requires that a
				purchasing group which intends to do business in this State shall, prior to
				doing such business, furnish notice of such intention to the superintendent,
				and requires a purchasing group which does business in this State to submit to
				the superintendent a statement of registration. For the purpose of section 5908, doing business in this State shall have the meaning contained in section
				301.1(b) 
				of this Part.
(b) A purchasing
				group shall file the statement of registration, consisting of a power of
				attorney and certificate of designation, which shall be submitted in the form
				prescribed by the superintendent. The power of attorney shall:
(1) be executed and certified;
(2) appoint the superintendent and any
				successors in office, and any authorized deputy, as the purchasing group's true
				and lawful attorney in and for the State of New York, for the purpose of
				receiving all legal documents or process in any proceeding against the
				purchasing group that may be served;
(3) be of indefinite duration;
(4) bind any person or corporation which, as
				successor, acquires the purchasing group's assets and assumes its liabilities
				by merger, or consolidation or otherwise;
(5) not be terminated by the purchasing group
				or such successor so long as any contracts, or liabilities or duties arising
				out of such contracts, entered into by the purchasing group while doing
				business in New York, are in effect; and
(6) be accompanied by a certified copy of a
				resolution by the purchasing group's governing body or empowered person
				authorizing the requisite power of attorney.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part, the following definitions shall
				  apply:
(a) Certificate means any
				evidence of insurance coverage, or rider or endorsement thereto, issued to a
				group member under a product or system group policy.
(b) Group member means a person who purchases
				or owns a product or system and who is insured under a product or system group
				policy.
(c) Group policyholder
				means a manufacturer, distributor, or installer of a product or system, or a
				trustee of a trust established, or participated in, by one or more
				manufacturers, distributors, or installers, to which a product or system group
				policy is issued.
(d) Issue
				includes issue for delivery.
(e)
				Manufacturer shall have the meaning ascribed by Insurance Law, section
				3446(j).
(f) Policy means any policy, contract,
				certificate, or other evidence of insurance, or rider or endorsement
				thereto.
(g) Product or system
				group policy means a policy issued on a group basis to a group policyholder
				that provides coverage to group members when the manufacturer, distributor, or
				installer of a product or system has represented that the product or system is
				designed to prevent loss or damage to property from a specific cause (other
				than loss or damage resulting from defect in materials or workmanship, or wear
				and tear), and the coverage provided to the group members is for loss or damage
				to such property from such cause. For purposes of this Part, loss or damage to
				the property (valued as actual cash value, stated value, replacement cost, or
				other method of valuation acceptable to the superintendent) may also include
				unreimbursed incidental expenses that may be incurred as a result of the loss
				or damage to the property, such as rental or registration costs for replacement
				property.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.2 - General requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				product or system group policy issued to a group policyholder or a certificate
				issued to a group member thereunder may be issued or delivered in this State
				only in compliance with the provisions of Insurance Law, section
				3446 and this Part.
(b) A product or system group policy may
				provide coverage only for a kind or kinds of insurance authorized by Insurance
				Law, section
				1113(a)(4) through (12),
				(19), or (20).
(c) No product or system group policy or
				certificate may be issued or delivered in this State except by an authorized
				insurer. No such policy or certificate shall be eligible for placement by an
				excess line broker licensed pursuant to Insurance Law, article 21.
(d) The group shall consist of at least 25
				members. This requirement shall be satisfied if the insurer reasonably relies
				on the group policyholder's good faith expectation at the time that the policy
				is issued that the group will maintain a membership of at least 25 during the
				policy period.
(e) The premium for
				a product or system group policy, including certificates thereunder, shall be
				paid by the group policyholder from funds contributed wholly by the group
				policyholder.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.3 - Rates and forms

Current through Register Vol. 46, No. 28, July 10, 2024
(a) All product
				or system group policy and certificate forms shall be subject to the approval
				requirements of Insurance Law, section
				2307(a), and shall comply
				with applicable Insurance Law, article 23 standards.
(b)
(1)
				Except as provided in paragraph (3) of this subdivision, all product or system
				group policy rates, including rating plans, rating rules, and rating
				classifications and territories shall be submitted to the superintendent
				pursuant to the applicable provisions of Insurance Law, article 23.
(2) Except as provided in paragraph (3) of
				this subdivision, rates and rating plans and rules for a product or system
				group policy written as inland marine insurance shall not be exempt from filing
				requirements.
(3)
(i) Notwithstanding any other provision of
				this section, in accordance with the provisions of section 2311  of the Insurance Law, individual rate
				filings for 'a' rated risks shall not be required to be filed with the
				superintendent.
(ii) The insurer
				shall maintain all rating information used to support the rate in an individual
				underwriting file for each policy issued, in accordance with the records
				retention requirements of Part 243 of this Title (Regulation 52).
(iii) As used in this section, an 'a' rated
				risk means any insurance coverage for which rates are individually determined
				based upon judgment because the insurer has not established a manual rate based
				upon experience, except that if the insurer acquires sufficient experience to
				establish, or the insurer itself has, a manual rate for such coverage, then
				such coverage shall no longer be considered an 'a' rated risk for such
				insurer.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.4 - Certificate of insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				insurer shall be responsible for the mailing or delivery of a certificate of
				insurance to each group member insured under the product or system group
				policy. If the coverage is automatic and the group member is not required to
				register with the insurer to effect coverage, then the certificate shall be
				delivered with the product or system. If the coverage is not automatic and the
				group member is required to register with the insurer to effect coverage, and
				the certificate is not delivered with the product or system, the certificate
				shall be mailed or delivered to the group member not more than 20 days after
				receipt of the registration.
(b)
				The certificate shall contain in substance all material terms and conditions of
				coverage afforded to the group member, unless the product or system group
				policy is incorporated by reference and a copy of the product or system group
				policy accompanies the certificate.
(c) Each certificate shall contain a
				conspicuous notice advising the group member that, if the member has other
				applicable insurance coverage, the coverages under the product or system group
				policy shall not duplicate the other insurance coverage.
(d) Each certificate shall contain a
				conspicuous notice with the phone number to call or an address to write to, and
				the procedures to be followed, in the event of a claim under the
				policy.
(e) No group policy or
				certificate may contain an aggregate policy limit to be shared among group
				members or applicable to the group itself.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.5 - Cancellation, nonrenewal, and conditional renewal

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A product or system group policy or
				certificate shall not be subject to Insurance Law, section
				3425 or 3426. T he following requirements
				shall apply in regard to cancellation, nonrenewal, or conditional renewal (as
				defined in subdivision [d] of this section) of coverage.
(b) Product or system group policy.
(1) Unless a product or system group policy
				provides for a longer policy period, the policy shall be issued or renewed for
				a one-year policy period.
(2) A
				product or system group policy may be canceled by an insurer only if
				cancellation is based on one or more of the reasons set forth in Insurance Law,
				section
				3426(c)(1); provided,
				however, that an act or omission by a group member shall not constitute the
				basis for cancellation of the policy.
(3) An insurer's cancellation, nonrenewal, or
				conditional renewal of a product or system group policy shall not become
				effective until at least 30 days after the insurer mails or delivers written
				notice of such cancellation, nonrenewal, or conditional renewal to the group
				policyholder at the mailing address shown in the policy.
(4) Every notice of cancellation, nonrenewal,
				or conditional renewal shall contain the specific reason or reasons for
				cancellation, nonrenewal, or conditional renewal.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XII - Group Property/casualty Insurance › Part 310 - Product Or System Group Insurance Policies › Section 310.6 - Group insurance producers and adjusters; administration

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If so authorized by the insurer, the
				group policyholder may perform ministerial services on behalf of the insurer,
				including supplying or delivering the certificate to the group member and
				administration of claims. However, no person shall act as an insurance agent,
				broker, or adjuster in connection with a product or system group policy unless
				that person is duly licensed under Insurance Law, article 21 or exempt from
				licensing therefrom.
(b) An insurer
				may reimburse a group policyholder for expenses incurred in administration of
				the product or system group policy if the payment is equivalent to the costs of
				rendering such services and such services would normally have been performed by
				the insurer, an agent or broker.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.0 - Approval of the superintendent

Current through Register Vol. 46, No. 28, July 10, 2024
In addition to any specifically stated requirements for
				  approval of the superintendent, the continuing care retirement community shall
				  make a demonstration of actuarial validity and show that the proposed action
				  will not adversely affect the continued financial viability of the continuing
				  care retirement community.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part, unless the context indicates
				  otherwise, the following definitions shall apply:
(a)
Affiliate
shall have the
				meaning ascribed by Insurance Law section
				107(a)(4).
(b)
Capital assets
means
				those assets related to the continuing care retirement community as follows:
(1) class 1-land;
(2) class 2-building;
(3) class 3-equipment, furnishings,
				refurbishments; and
(4) class
				4-original startup costs actually incurred, which may include, if applicable,
				architect fees, legal fees, original marketing costs, development fees, sewer
				construction and financing costs involved with development, if not included
				above.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.2 - Reserves

Current through Register Vol. 46, No. 28, July 10, 2024
After release of funds held in escrow pursuant to Public
				  Health Law section
				  4610, the operator of a continuing care
				  retirement community operating under a certificate of authority pursuant to
				  Public Health Law article 46 shall maintain a reserve liability for amounts due
				  and unpaid and a reserve liability for estimated future capital, operating and
				  refund expenses provided for under the terms of the continuing care retirement
				  contracts and continuing care at home contracts.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.3 - Reserve liability calculation

Current through Register Vol. 46, No. 28, July 10, 2024
At the end of each fiscal year, the sum of the actuarial
				  reserve liabilities of a continuing care retirement community shall be at least
				  as great as the greatest of the following:
(a) A retrospective reserve liability defined
				as an accumulation of not less than:
(1) the
				entrance fees received; plus
(2)
				the monthly fees received; plus
(3)
				revenues received from nonresidents for services rendered (such as for health
				care); plus
(4) interest and
				dividend income received plus (minus) an adjustment for any difference between
				interest and dividend income accrued at the end and beginning of the year from
				assets eligible under section
				350.6(a)(3)
				and (c)  of this Part; plus (minus)
(5) an adjustment for capital gains or losses
				both realized and unrealized on assets eligible under section
				350.6(a)(3)
				and (c)  of this Part for supporting reserve
				liabilities; plus (minus)
(6)
				adjustment for capital gains or losses realized on sale or disposal of class 3
				capital assets; plus
(7) capital
				gains both unrealized and realized on class 1 and class 2 capital assets;
				minus
(8) capital losses both
				unrealized and realized during the original assumed lifetime of class 1 and
				class 2 capital assets; minus
(9)
				the actual operating expenses, excluding any prepayment of expenses;
				minus
(10) any refunds to residents
				of either entrance fees or monthly fees; minus
(11) the capital expenses; minus
(12) the interest payment on any loans, bonds
				or any other debt obligation, including the interest payments on the mortgage
				and any interest attributed to Part 1 paid in surplus; minus
(13) the change in any unearned or advance
				payment liability; minus
(14) the
				expenses for nonresidents for services for which the revenues are included in
				paragraph (3) of this subdivision; minus
(15) any releases of the excess of the
				retrospective reserve over the prospective reserve approved under the
				provisions of section
				350.5  of
				this Part; plus or minus
(16) any
				revenue or expense that the operator can demonstrate as appropriate, subject to
				the approval of the superintendent; minus
(17) any profit credited to part 1 paid in
				surplus pursuant to section
				350.7(c) 
				of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.4 - General rules regarding reserve liability calculation

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The minimum
				reserve for replacement for class 1 capital assets shall be the excess of any
				realized and unrealized capital gains on the land including any gains realized
				on sale of all or any portion of the land over any realized and unrealized
				capital losses and less the cost of any additional or replacement land. In the
				event of realized capital gains from the sale of land, which is not to be
				replaced, the operator may request approval of the superintendent for the
				exclusion of such capital gains from the reserve for replacement.
(b) The minimum reserve for replacement of
				class 2 capital assets shall be determined as follows:
(1) During the original assumed useful
				lifetime of the buildings (the useful lifetime of the assets used for purposes
				of calculating depreciation or amortization), the minimum reserve shall equal
				any excess of the realized and unrealized capital gains on the capital (fixed)
				asset (including that due to replacement or repair) over the realized and
				unrealized capital losses relative to that asset less the cost of any
				replacement or repairs.
(2) At any
				other time the minimum reserve shall be equal to the greatest of:
(i) the value of the reserve of the class 2
				capital asset at the end of the original assumed useful lifetime;
(ii) the highest previous value of the
				reserve for a class 2 capital asset which was outlived its original assumed
				useful lifetime, as determined in accordance with this paragraph; and
(iii) any excess of the realized and
				unrealized capital gains on the capital (fixed) asset over the realized and
				unrealized capital losses relative to that asset, less the cost of any
				replacement or repairs made since the end of the original assumed useful
				lifetime.
(3) In
				addition, an operator may use a plan for the systematic funding of a reserve
				for replacement over and above the requirements of paragraphs (1) and (2) of
				this subdivision, subject to the approval of the superintendent.
(4) Notwithstanding the requirements of
				paragraphs (1) and (2) of this subdivision, the reserves held under those
				paragraphs along with any reserves held under paragraph (3) of this subdivision
				need not at any time exceed the current replacement cost.
(5) At the time of replacement of a capital
				(fixed) asset, the reserve for replacement may be reduced by the replaced
				capital (fixed) asset's portion of the reserve for replacement.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.5 - Adjustments to reserves

Current through Register Vol. 46, No. 28, July 10, 2024
If the retrospective reserve liability calculated according
				  to section
				  350.3(a)(1) 
				  of this Part is greater than the prospective reserve liability calculated
				  according to section
				  350.3(a)(2) 
				  of this Part, then annually, upon a demonstration satisfactory to the
				  superintendent, the retrospective reserve may be reduced in accordance with the
				  priorities and conditions set forth in subdivisions (a), (b) and (c) of this
				  section. The demonstration shall show that after such actions have been taken,
				  the continuing care retirement community will continue to be in satisfactory
				  actuarial balance, and the continuing care retirement community's projected
				  invested assets will be at least equal to the requirements of section
				  350.6(a) 
				  of this Part for each of the next 10 projection years.
(a) If the earned surplus is negative, the
				retrospective reserve may be reduced by an amount not to exceed the lesser of:
(1) the excess of the retrospective reserve
				over the prospective reserve; and
(2) the absolute value of any negative earned
				surplus.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.7 - Surplus

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1) All part 1 paid in surplus contributions
				to a continuing care retirement community shall be documented in a written
				agreement between the continuing care retirement community and the person
				making the part 1 paid in surplus contribution. The agreement shall state
				whether the paid in surplus is expected to earn an investment return, and, if
				so, the agreement shall state the terms of the annual investment return that is
				subject to the restrictions in subdivision (b) of this section. A copy of each
				such agreement shall be submitted to the superintendent for review at least 30
				days in advance of it being finalized. A copy of each signed agreement shall be
				submitted to the superintendent within 10 business days of the agreement being
				signed.
(2) All part 2 paid in
				surplus contributions to a continuing care retirement community shall be
				documented in a written agreement between the continuing care retirement
				community and the person making the part 2 surplus contribution. Investment
				return on part 2 paid in surplus shall be made only as permitted pursuant to
				subdivision (e) of this section. A copy of each such agreement shall be
				submitted to the superintendent for review at least 30 days in advance of it
				being finalized. A copy of each signed agreement shall be submitted to the
				superintendent within 10 business days of the agreement being signed.
(3) A paid in surplus contribution may be
				implemented using a subordinated loan agreement provided that the terms of the
				agreement comply with the provisions of this subdivision and the subordinated
				loan agreement contains a provision stating that no portion of the loan and
				interest thereon may be repaid without the prior written approval of the
				superintendent. A copy of each such agreement shall be submitted to the
				superintendent for review at least 30 days in advance of it being finalized. A
				copy of each signed agreement shall be submitted to the superintendent within
				10 business days of the agreement being signed.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.8 - Test for solvency

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If an operator
				of a continuing care retirement community submits an actuarial study that
				indicates that the continuing care retirement community is not in satisfactory
				actuarial balance, the operator shall prepare a plan designed to achieve
				satisfactory actuarial balance and submit the plan to the superintendent for
				approval.
(1) The operator's plan shall
				include a discussion of the reasons causing the continuing care retirement
				community not to be in satisfactory actuarial balance, the detailed action
				steps to be taken that are designed to achieve satisfactory actuarial balance,
				and a discussion of each of the action steps included in the plan.
(2) The continuing care retirement
				community's qualified consulting actuary shall prepare an actuarial study or
				other appropriate actuarial communication that reflects the action steps in the
				operator's plan, the actuary's discussion of the operator's plan, and the
				actuary's estimate of when the community is projected to achieve satisfactory
				actuarial balance and how this estimate was developed.
(3) The operator's plan prepared pursuant to
				paragraph (1) of this subdivision and the appropriate actuarial communication
				prepared pursuant to paragraph (2) of this subdivision shall be submitted to
				the superintendent within 90 days of the preparation date of the actuarial
				study indicating that the continuing care retirement community is not in
				satisfactory actuarial balance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.10 - Fee schedule submission

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Fee schedules
				submitted pursuant to an approved rating methodology.
(1) The fee schedule shall be submitted to
				the superintendent at least 45 days prior to the scheduled effective date of
				the fee schedule and shall include the following:
(i) a certification by an officer of the
				continuing care retirement community, or of the management company for the
				community, that the submission has been prepared pursuant to an approved rating
				methodology; and
(ii) supporting
				exhibits showing how the rating methodology was applied and how the rating
				methodology calculations produced the fees in the schedule submitted.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.11 - Transactions between a continuing care retirement community and its parent corporation, affiliates and subsidiaries

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In any
				transactions between a continuing care retirement community and its parent
				corporation or any affiliate or subsidiary:
(1) the terms of the financial transactions
				shall be fair and equitable to the continuing care retirement community at the
				time of the transaction;
(2)
				charges or fees for services performed shall be reasonable; and
(3) expenses incurred and payments received
				shall be allocated to the continuing care retirement community on an equitable
				basis in conformity with customary accounting practices consistently
				applied.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIII - Life Care Communities › Part 350 - Continuing Care Retirement Communities › Section 350.12 - Financial reports and information requests

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A continuing care retirement community
				shall submit to the superintendent an annual statement pursuant to Public
				Health Law section 4607.
(b) A
				continuing care retirement community shall submit to the superintendent a copy
				of any report submitted to a trustee pursuant to a mortgage loan, bond
				indenture or other long-term financing agreement within seven business days of
				submitting the report to the trustee. The continuing care retirement community
				may submit an electronic copy of the report in a form and manner acceptable to
				the superintendent. If the report is available for downloading from a publicly
				accessible internet location, the continuing care retirement community may
				utilize the report upon notification to the superintendent, if the report is in
				a form acceptable to the superintendent.
(c) The continuing care retirement community
				shall notify the superintendent at least 30 days prior to the sale or transfer
				to another entity of a class 1 or class 2 capital asset worth more than
				$250,000, unless the superintendent permits a shorter notification period when
				the date of sale or transfer is uncertain.
(d) The continuing care retirement community
				shall notify the superintendent at least 30 days prior to the acquisition of a
				class 1 or class 2 capital asset worth more than $250,000 or the signing of a
				lease for a building to be used to provide services to residents, unless the
				superintendent permits a shorter notification period when the date of
				acquisition or lease signing is uncertain.
(e) The continuing care retirement community
				shall promptly provide any additional information that the superintendent may
				require.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.1 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chapter 501 of
				the Laws of 1992 requires fundamental changes in the way health insurance is
				sold and rated by insurers, including HMOs, to both individuals and small
				groups in New York State.
(b)
				Chapter 501 and this Part are designed to achieve the following goals:
(1) to facilitate access to health insurance
				by all New York residents who wish to obtain it directly or as members of small
				groups; and
(2) to promote
				competition among insurers and health maintenance organizations on the basis of
				efficient claims handling, ability to manage health care services, consumer
				satisfaction, and low administrative costs; rather than on the basis of
				differing underwriting and rating practices which allowed some insurers to
				exclude higher risk applicants from coverage and caused unaffordable premium
				rates to those unable to meet selection standards.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.3 - Eligibility for individual and small group health insurance policies

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No insurer may
				restrict or limit eligibility for individual or small group policies except in
				the following ways:
(1) Insurers may issue
				policies only to or through groups recognized under sections 4235 (c)(1)(A) (B) (D) (H) (K) (L) and (M) and
				4237  of the Insurance Law.
(i) Small group health insurance policies may
				be issued to cover only certain classes of employees as provided in section
				4235(c)(1)(A) based upon conditions pertaining to employment, but only if the
				employer requesting coverage seeks coverage for only such classes.
(ii) Minimum participation requirements as
				set forth in section 4235(c)(1) must continue to be utilized. Health
				maintenance organizations may not establish any minimum participation
				requirements within a group and must accept one person within a small group who
				elects the HMO coverage.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.5 - Prohibited underwriting practices and eligibility rules affecting individual and small group health insurance

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In addition to the specific prohibitions
				set forth in sections 3221 (q) and
				4305 (k)  of the Insurance
				Law, the following underwriting practices are prohibited in regard to an
				insurer's decision whether to offer or accept health insurance applications:
(1) lists of excluded industries or
				occupations;
(2) use of medical or
				laboratory tests;
(3) medical
				examinations;
(4) questions about
				avocations, hobbies, or other activities;
(5) attending physician statements,
				questionnaires or any investigations or reviews regarding health status, health
				history, family health status or sexual orientation;
(6) medical underwriting information obtained
				pursuant to other lines of business not subject to chapter 501 of the Laws of
				1992 (such as applications for life insurance, disability income insurance, or
				long term care insurance);
(7)
				medical underwriting information obtained from other sources (such as agents,
				brokers, consultants, third-party administrators, trustees, associations, group
				policyholders or the Medical Information Bureau); and
(8) consideration of the nonprofit status of
				the small group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.6 - Pre-existing condition waiting periods

Current through Register Vol. 46, No. 28, July 10, 2024
Pre-existing condition waiting periods are governed by the
				  rules set forth in section
				  52.20 
				  of this Title.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.7 - Continuation of health insurance benefits

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Continuation of benefits coverage is to
				be provided pursuant to the requirements of sections 3221, 4304 and
				4305 
				of the Insurance Law.
(b) Notice
				requirements applicable to continuation of benefits.
(1) An insurer shall provide in the policy,
				contract and certificate written notice of the right to continuation of
				benefits coverage provided by Insurance Law, sections
				3221,
				4304 and
				4305
				and shall notify the employer, policyholder or remitting agent, at the time of
				commencement of coverage, of the importance of the notification of the
				continuation benefit to each covered employee or member and the spouse of the
				employee or member.
(2) In the case
				of events described in sections 3221 (m)(4)(C), 4304 (k)(4)(C) and
				4305 (e)(4)(C)  of the
				Insurance Law, the employee or member or spouse of the employee or member (if
				any) shall be responsible for notifying the employer, policyholder or remitting
				agent, as applicable, of the occurrence of any such event within 60 days of
				such occurrence.
(3) In the case of
				determinations of disability made as described in sections 3221 (m)(4)(D), 4304 (k)(4)(D) and
				4305 (e)(4)(D)  of the
				Insurance Law, the employee or member or spouse of the employee or member (if
				any) shall be responsible for notifying the employer, policyholder or remitting
				agent, as applicable, within 60 days of such determination and also responsible
				for notifying the employer, policyholder or remitting agent, as applicable,
				within 30 days of any final determination that the disability in question no
				longer exists.
(4) Within 14 days
				of receipt of the notification described in paragraphs (2) and (3) of this
				subdivision, and within 14 days of any other event, condition or action which,
				as described in sections 3221 (m), 4304 (k) and
				4305 (e)  of the Insurance
				Law, cause termination of employment or membership in the class or classes
				eligible for coverage under the policy or contract, the employer, policyholder
				or remitting agent, as applicable, shall notify the employee or member or
				spouse of the employee or member (if any) of their rights under the
				continuation of benefits coverage described in subdivision (a) of this
				section.
(5) For purposes of the
				notification described in paragraph (4) of this subdivision, such notification
				to an individual who is the employee or a spouse of the employee or member
				shall be treated as notification to all other eligible dependents residing with
				such spouse at the time such notice is given.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.8 - Group health insurance policies issued to association groups

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Rules relating
				to an association group written pursuant to subparagraphs (B) and (K) of
				paragraph (1) of subsection (c) of section 4235  of the Insurance Law having its own
				community rate.
(1) At the insurer's option,
				the community rate may be based upon the collective experience of only one
				association group so long as the following requirements are met:
(i) the group policy issued to the
				association group must have been validly issued pursuant to section 4235 (c)(1)(B) or (K)  of
				the Insurance Law;
(ii) the
				association group policy must cover at least 10,000 persons, including spouses
				and dependents, in New York State;
(iii) the association group must include
				members from diverse and unrelated industries or occupations; provided,
				however, that this subparagraph shall not apply to any association group
				insuring 20,000 or more persons, including spouses and dependents, in New York
				State, which was established prior to December 31, 1991; and
(iv) the policy issued to the association
				group with its own community rate is also offered on an open enrollment basis
				to any other association or small group.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.10 - Filing and approval of rates by commercial insurers intending to change to a community rating methodology

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Rate filing rules.
(1) A community rating methodology must be
				applied to the following policies as of April 1, 1993, unless otherwise
				specified:
(i) all small group
				policies;
(ii) all optionally
				renewable and conditionally renewable individual policies;
(iii) all policies that are guaranteed
				renewable, as that term is defined in sections
				52.17(a)(5)
				or (6) and
				58.1(b)(1) 
				of this Title issued on or after February 1, 1993, including previously issued
				policies on such forms issued as guaranteed renewable; and
(iv) all individual or group policies issued
				pursuant to a statutory or contractual right of conversion, except for
				conversions from and to guaranteed renewable and noncancellable individual
				forms issued prior to July 17, 1992.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.12 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
The amendment to section
				  360.10(d)(1) 
				  of this Part and the new section
				  360.11(j)
				  and (k)  of this Part shall take effect on
				  March 1, 2001 and shall apply to all policies and contracts subject to chapter
				  501 of the Laws of 1992 issued, renewed, modified, altered or amended on or
				  after such date.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance › Section 360.20 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If any
				provision of this Part or the application thereof to any person or circumstance
				is adjudged invalid by a court of competent jurisdiction, such judgment shall
				not affect or impair the validity of the other provisions of this Part or the
				applications thereof to other persons and circumstances.