New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure › Section 52.31 - Preparation of forms for submission

Current through Register Vol. 46, No. 28, July 10, 2024
(a) New policy forms shall comply with
				  statutory requirements without the necessity of amendatory riders or
				  endorsements, except to the extent that minor changes are necessitated by
				  distinctive New York requirements or unless riders or endorsements are
				  expressly permitted by statute. Riders may be approved for use with previously
				  approved policies for the purpose of conforming such policies to changes in the
				  law or in rules and regulations, unless the resulting policy in its entirety
				  would have the tendency to mislead or confuse the policyholder.
(b) No form will be approved in which the
				  printed text has been changed by striking out, except those effecting simple
				  administrative alternatives, or except in the case of policies where changes
				  are authorized by an approved rider or endorsement, and appropriate attention
				  is called to the change.
(c) Forms
				  submitted for either preliminary review or approval shall be submitted in
				  duplicate, except for Medicare supplement and combination group life and
				  accident and health forms which shall be in triplicate. Domestic insurers shall
				  submit one copy of a form for filing for delivery exclusively outside New
				  York.
(d) Each policy form shall be
				  designated by a suitable form number which may be made up of numerical digits
				  or letters, or both, in the lower left-hand corner of the first page. The form
				  number shall distinguish the form from all others used by the
				  insurer.
(e) Forms submitted for
				  approval shall be in the form intended for actual use. A form which is not
				  printed shall be permitted only when its use is too limited to justify other
				  preparation, and shall be clear, legible and reasonably permanent, considering
				  its probable lifetime.
(f) Blank
				  spaces of forms shall be filled in and completed with hypothetical data. The
				  purpose and use of the form may be explained in the submission letter required
				  by section
				  52.33  of
				  this Part.
(g) A new form which
				  makes reference to the provisions of a form previously used, that did not
				  require filing or approval, shall be accompanied by such previous form for
				  reference purposes.
(h) A policy
				  form to which a copy of the application will be attached when issued shall have
				  a copy of the application attached when submitted for approval.
(i) If the form does not affect benefits,
				  coverages, exclusions or rates, the filing shall so state.
(j) All endorsements to be applied by stamp
				  shall be submitted on the insurer's letterhead.
(k) Variable material used with impairment,
				  waiver or exclusion riders shall be submitted with the form for approval. Such
				  variable material shall be confined to specific diseases, afflicted areas of
				  the body or specific extra-hazardous activity. The use of such a rider shall be
				  based on the known physical condition or extra-hazardous activity of the
				  covered person. The use of variable fill-in material in any impairment, waiver
				  or exclusion rider delivered in New York before approval by the department
				  shall constitute the use of an unapproved form.
(l) Illustrative material may be used for
				  items which may vary from case to case, such as names, dates, eligibility
				  requirements, and premiums and schedules for determining the amount of
				  insurance for each insured person. For group insurance plans, if an explanatory
				  memorandum accompanying a covering letter, or appropriate reference to material
				  filed with schedules of premium rates, clearly indicates the nature and scope
				  of the variations to be used, portions of other provisions, such as insuring
				  clauses, benefit provisions, restrictions and termination of coverage
				  provisions, may be submitted as variable, if suitably indicated by red ink,
				  underlining, bracketing or otherwise. For example, it may be indicated that
				  variations will be made within the limits set out in the explanatory
				  memorandum, or that any one of several alternative provisions may be used, or
				  that a provision may be either included as submitted or else completely
				  omitted. An explanation of variable material, that the variations "will conform
				  to law" or "as requested by the policyholder" is not acceptable. The
				  alternative language, if any, shall be supplied independent of the submission
				  letter.