reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Rules for Health Information › Section 420.17 - When authorization required for disclosure of nonpublic personal health information

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A
				  licensee shall not disclose nonpublic personal health information about a
				  consumer or customer unless an authorization is obtained from the consumer or
				  customer whose nonpublic personal health information is sought to be
				  disclosed.
(b) Nothing in this
				  section shall prohibit, restrict or require an authorization for the disclosure
				  of nonpublic personal health information by a licensee for the performance of
				  the following insurance functions by or on behalf of the licensee: claims
				  administration; claims adjustment and management; detection, investigation or
				  reporting of actual or potential fraud, misrepresentation or criminal activity;
				  underwriting; policy placement or issuance; loss control; ratemaking and
				  guaranty fund functions; reinsurance and excess loss insurance; risk
				  management; case management; disease management; quality assurance; quality
				  improvement; performance evaluation; provider credentialing verification;
				  utilization review; peer review activities; actuarial, scientific, medical or
				  public policy research; grievance procedures; internal administration of
				  compliance, managerial, and information systems; policyholder service
				  functions; auditing; reporting; database security; administration of consumer
				  disputes and inquiries; external accreditation standards; the replacement of a
				  group benefit plan or workers' compensation policy or program; activities in
				  connection with a sale, merger, transfer or exchange of all or part of a
				  business or operating unit; any activity that permits disclosure without
				  authorization pursuant to the Federal Health Insurance Portability and
				  Accountability Act privacy rules promulgated by the U.S. Department of Health
				  and Human Services; disclosure that is required, or is one of the lawful or
				  appropriate methods to enforce the licensee's rights or the rights of other
				  persons engaged in carrying out a transaction or providing a product or service
				  that a consumer requests or authorizes; and any activity otherwise permitted by
				  law, required pursuant to governmental reporting authority, or to comply with
				  legal process. Additional insurance functions may be added with the approval of
				  the superintendent to the extent they are necessary for appropriate performance
				  of insurance functions and are fair and reasonable to the interest of
				  consumers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Rules for Health Information › Section 420.18 - Authorizations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A valid
				  authorization to disclose nonpublic personal health information pursuant to
				  this Part shall be in written or electronic form and shall contain all of the
				  following:
(1) the identity of the consumer
				  or customer who is the subject of the nonpublic personal health
				  information;
(2) a general
				  description of the types of nonpublic personal health information to be
				  disclosed;
(3) general descriptions
				  of the parties to whom the licensee discloses nonpublic personal health
				  information, the purpose of the disclosure and how the information will be
				  used;
(4) the signature of the
				  consumer or customer who is the subject of the nonpublic personal health
				  information or the individual who is legally empowered to grant authority and
				  the date signed; and
(5) notice of
				  the length of time for which the authorization is valid and that the consumer
				  or customer may revoke the authorization at any time and the procedure for
				  making a revocation.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Rules for Health Information › Section 420.19 - Authorization request delivery

Current through Register Vol. 46, No. 28, July 10, 2024
A request for authorization and an authorization form may
					 be delivered to a consumer or a customer as part of an opt-out notice pursuant
					 to section
					 420.9  of this
					 Part, provided that the request and the authorization form are clear and
					 conspicuous. An authorization form is not required to be delivered to the
					 consumer or customer or included in any other notices unless the licensee
					 intends to disclose protected health information pursuant to section
					 420.17(a) 
					 of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Rules for Health Information › Section 420.20 - Nondiscrimination regarding nonpublic personal health information

Current through Register Vol. 46, No. 28, July 10, 2024
A licensee shall not unfairly discriminate against a
					 consumer or customer because that consumer or customer has not granted
					 authorization for the disclosure of his or her nonpublic personal health
					 information pursuant to the provisions of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Rules for Health Information › Section 420.21 - Relationship to federal rules

Current through Register Vol. 46, No. 28, July 10, 2024
Irrespective of whether a licensee is subject to the
					 Federal Health Insurance Portability and Accountability Act (P.L.
					 104-191) privacy rules and regulations as
					 promulgated by the U.S. Department of Health and Human Services (the Federal
					 rule) pursuant to sections 262 and 264 of such act, if a licensee complies with
					 all requirements of the Federal rule, when promulgated, except for its
					 effective date provision, the licensee shall not be subject to any provisions
					 of sections
					 420.17
					 through
					 420.20 
					 of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Additional Provisions › Section 420.22 - Protection of fair credit reporting acts

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Nothing in this Part shall be construed
				  to modify, limit, or supersede the operation of the Federal Fair Credit
				  Reporting Act (15 U.S.C.
				  1681 et seq.), and no inference shall be
				  drawn on the basis of the provisions of this Part regarding whether information
				  is transaction or experience information under section 603 of that
				  act.
(b) Nothing in this Part shall
				  be construed to modify, limit or supersede the operation of the New York Fair
				  Credit Reporting Act (General Business Law, article 25).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Additional Provisions › Section 420.23 - Determined violation

Current through Register Vol. 46, No. 28, July 10, 2024
A contravention of this Part shall be deemed to be an
					 unfair method of competition or an unfair or deceptive act and practice in the
					 conduct of the business of insurance in this State, and shall be deemed to be a
					 trade practice constituting a determined violation, as defined in section 2402 (c)  of the Insurance
					 Law, in violation of section 2403 of such law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 420 - Privacy Of Consumer Financial And Health Information › Additional Provisions › Section 420.24 - Effective date; transition rule

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Effective date. This Part is effective November 13, 2000. In order to provide
				  sufficient time for insurers and other licensees to establish policies and
				  systems to comply with the requirements of this Part, time for compliance with
				  this Part is extended until July 1, 2001, except that time for compliance with
				  sections
				  420.17
				  through
				  420.21 
				  of this Part is extended until December 31, 2001.
(b)
(1)
				  Notice requirement for consumers who are the licensee's customers on the
				  compliance date. By July 1, 2001, the licensee shall provide an initial notice,
				  as required by section
				  420.4 
				  of this Part, to consumers who are the licensee's customers on July 1,
				  2001.
(2) Example. A licensee meets
				  the requirement in paragraph (1) of this subdivision, if, by July 1, 2001, a
				  licensee has established a system for providing an initial notice to all new
				  customers and has mailed the initial notice to all the licensee's existing
				  customers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › General Provisions › Section 421.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) This Part
				  establishes standards for developing and implementing administrative,
				  technical, and physical safeguards to protect the security, confidentiality,
				  and integrity of customer information, pursuant to sections 501, 505(b) and
				  507, codified at
				  15 U.S.C.
				  6801,
				  6805(b)
				  and
				  6807, of
				  the Gramm-Leach-Bliley Act.
(b)
				  Section 501(a) provides that it is the policy of the Congress that each
				  financial institution has an affirmative and continuing obligation to respect
				  the privacy of its customers and to protect the security and confidentiality of
				  those customers' nonpublic personal information. Section 501(b) requires the
				  State insurance regulatory authorities to establish appropriate standards
				  relating to administrative, technical, and physical safeguards:
(1) to insure the security and
				  confidentiality of customer records and information;
(2) to protect against any anticipated
				  threats or hazards to the security or integrity of such records; and
(3) to protect against unauthorized access to
				  or use of such records or information which could result in substantial harm or
				  inconvenience to any customer.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › General Provisions › Section 421.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For purposes of this Part, the following definitions
					 apply:
(a) Customer means any customer
				  of the licensee as the term customer is defined in section
				  420.3(h) 
				  of this Title (Regulation 169).
(b)
				  Customer information means nonpublic personal information as defined in section
				  420.3(r) 
				  of this Title, about a customer, whether in paper, electronic, or other form,
				  that is maintained by or on behalf of the licensee.
(c) Customer information systems means the
				  electronic or physical methods used to access, collect, store, use, transmit,
				  protect, or dispose of customer information.
(d) Licensee means a licensee as that term is
				  defined in section
				  420.3(p)(l) 
				  of this Title, except that licensee shall not include: a purchasing group; or
				  an unauthorized insurer in regard to the excess line business conducted
				  pursuant to section 2118  of the Insurance Law and Part 27 of
				  this Title (Regulation 41).
(e)
				  Service provider means any person or entity that maintains, processes, or
				  otherwise is permitted access to customer information through its provision of
				  services for the licensee.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › General Provisions › Section 421.2 - Information security program

Current through Register Vol. 46, No. 28, July 10, 2024
Each licensee shall implement a comprehensive written
					 information security program that includes administrative, technical and
					 physical safeguards for the protection of customer information. The
					 administrative, technical, and physical safeguards included in the information
					 security program shall be appropriate to the size and complexity of the
					 licensee and the nature and scope of its activities.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › General Provisions › Section 421.3 - Objectives of information security program

Current through Register Vol. 46, No. 28, July 10, 2024
A licensee's information security program shall be designed
					 to:
(a) ensure the security and
				  confidentiality of customer information;
(b) protect against any anticipated threats
				  or hazards to the security or integrity of such information; and
(c) protect against unauthorized access to or
				  use of such information that could result in substantial harm or inconvenience
				  to any customer.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Development and Implementation of Information Security Program › Section 421.4 - Examples of methods of development and implementation

Current through Register Vol. 46, No. 28, July 10, 2024
The actions and procedures described in sections
					 421.5
					 through
					 421.8  of this
					 Part are examples of methods of implementation of the requirements of sections
					 421.2
					 and
					 421.3 
					 of this Part. Such examples are nonexclusive illustrations of actions and
					 procedures that licensees may follow to implement sections
					 421.2
					 and
					 421.3 
					 of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Development and Implementation of Information Security Program › Section 421.5 - Assess risk

Current through Register Vol. 46, No. 28, July 10, 2024
The licensee:
(a)
				  identifies reasonably foreseeable internal or external threats that could
				  result in unauthorized disclosure, misuse, alteration, or destruction of
				  customer information or customer information systems;
(b) assesses the likelihood and potential
				  damage of these threats, taking into consideration the sensitivity of customer
				  information; and
(c) assesses the
				  sufficiency of policies, procedures, customer information systems, and other
				  arrangements in place to control risks.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Development and Implementation of Information Security Program › Section 421.6 - Manage and control risk

Current through Register Vol. 46, No. 28, July 10, 2024
The licensee:
(a)
				  designs its information security program to control the identified risks,
				  commensurate with the sensitivity of the information as well as the complexity
				  and scope of the licensee's activities;
(b) trains staff, as appropriate, to
				  implement the licensee's information security program; and
(c) regularly tests the key controls, systems
				  and procedures of the information security program. The frequency and nature of
				  such tests are determined by the licensee's risk assessment.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Development and Implementation of Information Security Program › Section 421.7 - Oversee service provider arrangements

Current through Register Vol. 46, No. 28, July 10, 2024
The licensee:
(a)
				  exercises appropriate due diligence in selecting its service providers;
				  and
(b) requires its service
				  providers to implement appropriate measures designed to meet the objectives of
				  this Part, and, where indicated by the licensee's risk assessment, takes
				  appropriate steps to confirm that its service providers have satisfied such
				  obligations.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Development and Implementation of Information Security Program › Section 421.8 - Adjust the program

Current through Register Vol. 46, No. 28, July 10, 2024
The licensee monitors, evaluates, and adjusts, as
					 appropriate, the information security program in light of any relevant changes
					 in technology, the sensitivity of its customer information, internal or
					 external threats to information, and the licensee's own changing business
					 arrangements, such as mergers and acquisitions, alliances and joint ventures,
					 outsourcing arrangements, and changes to customer information
					 systems.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Additional Provisions › Section 421.9 - Determined violation

Current through Register Vol. 46, No. 28, July 10, 2024
A contravention of section
					 421.2,
					 421.3,
					 or
					 421.10 
					 of this Part shall be deemed to be an unfair method of competition or an unfair
					 or deceptive act and practice in the conduct of the business of insurance in
					 this State, and shall be deemed to be a trade practice constituting a
					 determined violation, as defined in section 2402 (c)  of the Insurance
					 Law, in violation of section 2403 of such law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIX - Privacy Of Consumer Financial and health Information › Part 421 - Standards For Safeguarding Customer Information › Additional Provisions › Section 421.10 - Compliance date

Current through Register Vol. 46, No. 28, July 10, 2024
Each licensee shall establish policies and systems and
					 implement an information security program pursuant to this Part by June 1,
					 2002.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Chapter 147 of
				the Laws of 2000 amended section 5502 (c)  of the Insurance
				Law to provide for the dissolution of the Medical Malpractice Insurance
				Association (MMIA) at such time and under such conditions as the superintendent
				deems proper. MMIA provides medical malpractice insurance to physicians,
				dentists, podiatrists, certified registered nurse anesthetists, certified
				nurse-midwives and hospitals. All policies of insurance written by the MMIA
				must expire or be transferred prior to its dissolution.
(b) Section 5502(c) was also amended to
				require the superintendent to promulgate regulations prescribing a plan for the
				equitable distribution of the insureds of the MMIA, and health care
				practitioners and facilities which are otherwise unable to secure coverage in
				the voluntary market following the dissolution of MMIA, to authorized medical
				malpractice insurers writing such coverage in New York.
(c) In order to provide for this equitable
				distribution, this Part establishes the New York Medical Malpractice Insurance
				Plan, of which all insurers licensed in New York and writing medical
				malpractice insurance on a direct basis are required to be members. Eligible
				health care providers unable to obtain medical malpractice insurance in the
				voluntary market will be assigned to members writing the applicable class of
				business in the rating territory.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
For the purposes of this Part:
(a) Eligible health care provider means any
				New York licensed physician, dentist, podiatrist, certified nurse-midwife,
				certified registered nurse anesthetist or hospital.
(b) Hospital has the meaning contained in
				section 5501(c) of the New York Insurance Law.
(c) Medical malpractice insurance has the
				meaning contained in section 5501(b) of the New York Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.2 - Organization of the new york medical malpractice insurance plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Except as
				provided in section
				430.7  of
				this Part, there shall be created the New York Medical Malpractice Insurance
				Plan (plan), a mechanism for providing medical malpractice insurance to all
				eligible health care providers who are unable to secure coverage in the
				voluntary market after June 30, 2000.
(b) All insurers licensed in New York
				writing, or that begin writing, medical malpractice insurance in New York on a
				direct basis after June 30, 2000, shall be members of the plan.
(c) The plan shall:
(1) accept applications from eligible health
				care providers and assign applicants to members as determined in its plan of
				operations; and
(2) develop, and
				submit to the superintendent for approval:
(i)
				policy forms and endorsements, on both an occurrence and claims-made basis;
				and
(ii) a manual or manuals
				containing:
(a) classifications, territories,
				rates and rating plans;
(b) limits
				and deductibles to be offered to insureds; and
(c) underwriting rules and
				procedures.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.3 - Standards for forms and rates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				All policy forms and endorsements shall be subject to prior approval pursuant
				to section 2307  of the Insurance Law, and, except as
				provided in subdivision (b) of this section, all rates, rating plans, or rating
				classifications or territories of the plan shall be subject to prior approval
				pursuant to section 2305  of the Insurance Law.
(b) Rates for physicians and surgeons are
				subject to establishment by the superintendent pursuant to section 40 of
				chapter 266 of the Laws of 1986, as amended.
(c) For policy year July 1, 2000 through June
				30, 2001, all insureds of the plan must receive policies with provisions and at
				a rate which are at least as favorable to the insured as those which would have
				been provided by the MMIA had that association not been in the process of
				dissolution. For physicians and surgeons, the rates will be those established
				for the MMIA for the period July 1, 2000 through June 30, 2001 in Part 70 of
				this Title (Regulation 101).
(d)
				Cancellation and nonrenewal of policies issued by the plan shall be in
				accordance with the provisions of section 5504  of the
				Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.4 - Administration of the new york medical malpractice insurance plan

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The plan shall
				be governed by a Board of Directors consisting of the following:
(1)
(i)
				three members elected by cumulative voting by the members whose votes in such
				election shall be weighted in accordance with each member's net direct premiums
				written for medical malpractice insurance during the preceding calendar year.
				At least one of these directors must be an insurer writing medical malpractice
				insurance in New York but not writing medical malpractice insurance in New York
				for physicians or hospitals;
(ii)
				two members elected by cumulative voting by the members whose votes in such
				election shall have equal weight;
(iii) under subparagraphs (i) and (ii) of
				this paragraph, no member may serve as more than one director at any one
				time;
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.5 - Financial statements and other reporting requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The plan shall:
(1) file such reports as required by the
				superintendent; and
(2) be
				responsible for all reporting requirements required of insurers in the
				authorized medical malpractice market.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.6 - Examinations

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				superintendent shall make an examination into the affairs of the plan as often
				as the superintendent deems necessary pursuant to section 309  of the Insurance Law. The examination
				shall be conducted and the report filed in the manner prescribed in article 3
				of the Insurance Law.
(b) The
				expenses of the examination shall be paid by the plan in the manner prescribed
				by section 313  of the Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.7 - Alternative mechanism

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				provisions of sections
				430.2
				through
				430.6  of
				this Part shall not become effective if, prior to June 30, 2000 the
				superintendent approves one or more insurers in the voluntary market to provide
				medical malpractice insurance to all eligible health care providers.
(b) Such insurer must agree to:
(1) provide coverage for policy year July 1,
				2000 - June 30, 2001 using policies with provisions and rates which are at
				least as favorable to the insured as those which would have been provided by
				the MMIA had that association not been dissolved; and
(2) notify the superintendent at least 180
				days in advance, of its intent to cease providing medical malpractice insurance
				to all eligible health care providers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XX - Medical Malpractice Residual Market › Part 430 - Mechanism For The Equitable Distribution Of Insureds Unable To Obtain Medical Malpractice Insurance › Section 430.8 - Temporary administrator

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
				order to provide for the orderly transition of policies from the MMIA to the
				plan, and to avoid disruption in the medical malpractice insurance market, the
				superintendent may appoint one or more insurers writing medical malpractice
				insurance in this State as a temporary administrator, to act on behalf of the
				plan for the period beginning June 30, 2000 until such time as the plan becomes
				operational.
(b) The temporary
				administrator shall have the authority, on behalf of the plan, to:
(1) accept applications and deposit premiums
				from prospective insureds; and
(2)
				issue binders evidencing insurance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXI - Pharmacy Benefits Bureau › Part 440 - Provider Requirements For Insurance Reimbursement Of Applied Behavior Analysis

Current through Register Vol. 46, No. 28, July 10, 2024
Statutory authority: Financial Services Law, §§
										202, 
				  302;  Insurance Law, §§301, 1109,
				  1124, 3216, 3221, 4303, 4709; Public Health Law,
				  §4406
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this part:
(a) Board shall mean the Drug Accountability
				Board established by Insurance Law section 202.
(b) Bureau shall mean the Pharmacy Benefits
				Bureau established by this Part.
(c) Chair shall mean the chair of the Drug
				Accountability Board appointed by the superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.2 - Bureau established

Current through Register Vol. 46, No. 28, July 10, 2024
(a) There
				is hereby established within the department a Pharmacy Benefits Bureau, which
				bureau shall be responsible for the regulation of pharmacy benefits managers,
				conducting investigations with respect to prescription drugs, and other matters
				assigned by the superintendent. Except as may be limited by order of the
				superintendent, the deputy superintendent of pharmacy benefits shall be
				authorized to take any action that the superintendent is authorized to take
				under the Insurance Law or Public Health Law section 280-a, and any action
				authorized under any other provision of law with respect to investigations
				authorized under Insurance Law section 111.
(b) All documents submitted to the bureau
				shall be submitted electronically. The exemption provided for in 11 NYCRR 6.3
				shall apply to all such documents as if those documents were specifically set
				forth in 11 NYCRR 6.2(a).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.3 - Membership of the Drug Accountability Board

Current through Register Vol. 46, No. 28, July 10, 2024
(a) No person shall be a member of the board
				unless appointed by the superintendent to the board.
(b) No person shall be appointed to the board
				nor attend any meeting thereof unless the person has reviewed and agreed to be
				bound by the code of conduct for members of the board and any disclosures
				required thereunder.
(1) If the chair
				determines that any member of the board is not in compliance with the
				requirements of the code of conduct or this Part, then the member shall not
				take any part in any business of the board until the member comes into
				compliance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.4 - Chair of the Drug Accountability Board

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The chair shall be responsible for
				calling meetings of the board.
(b)
				The chair shall be responsible for the conduct of meetings of the
				board.
(c) The chair shall be
				responsible, in the chair's sole discretion, for all determinations of
				recusal.
(d) The chair may adopt
				by-laws related to the conduct of board operations.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.5 - Drug Accountability Board recusals

Current through Register Vol. 46, No. 28, July 10, 2024
(a) If
				a conflict of interest, or appearance of a conflict of interest, arises with a
				member of the board, the member shall recuse himself or herself from
				participating in the presentation, discussion or vote for which the conflict
				arises.
(b) The bureau shall
				determine, before any materials are shared with the members of the board, if a
				conflict of interest, or appearance of a conflict of interest, arises with any
				member of the board and shall report the conflict to the chair for a
				determination.
(c) Each member of
				the board shall review the topics to be discussed at each meeting of the board
				in advance and shall communicate in writing any real or potential conflict, or
				the appearance of any conflict, to the chair prior to reviewing any materials
				or attending any meetings of the board.
(d) The chair shall have final authority to
				determine whether and when recusal is required, or whether the conflict of
				interest can be avoided only by divestiture or resignation from the
				board.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 450 - General Provisions › Section 450.6 - Meetings of the Drug Accountability Board

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Meetings of the board shall be held only
				upon the call of the chair, and the chair, in the chair's sole discretion, may
				adjourn a meeting of the board for any reason. No quorum is needed to hold a
				meeting.
(b) Location of meetings.
				The meetings of the board may be held at any office of the department or may be
				held virtually.
(1) The location of the
				meeting shall be determined by the chair.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 451 - Registration of Pharmacy Benefit Managers › Section 451.1 - Registration of pharmacy benefit managers

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Definitions.
(1) As used in this section, the terms
				"controlling person", "health plan", "pharmacy benefit manager", "pharmacy
				benefit management services" and "superintendent" have the same meanings as
				defined by Public Health Law section 280-a.
(2) As used in this section, the term "a
				substantial number of beneficiaries who work or reside in this state" means
				where 50 percent or more of the beneficiaries of the health plan work or reside
				in New York.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 451 - Registration of Pharmacy Benefit Managers › Section 451.2 - First annual report of pharmacy benefit managers

Current through Register Vol. 46, No. 28, July 10, 2024
Each pharmacy benefit manager shall electronically file a
				  first annual report with the department pursuant to Insurance Law section 2904
				  no later than July 1, 2022 on a form and in a manner prescribed by the
				  superintendent. The exemption provided for in 11 NYCRR 6.3 shall apply to this
				  annual report as if this filing were listed in 11 NYCRR
				  6.2(a).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 451 - Registration of Pharmacy Benefit Managers › Section 451.3 - Duty, accountability and transparency

Current through Register Vol. 46, No. 28, July 10, 2024
Pursuant to the authority granted to the superintendent by
				  Public Health Law section 280-a(2)(g) to limit the duties, obligations,
				  requirements and other provisions relating to pharmacy benefit managers under
				  Public Health Law section 280-a(2), the duties, obligations and requirements
				  contained in Public Health Law section 280-a(2)(b), (c), (d), (e), and (f)
				  shall not apply to pharmacy benefit managers until January 1, 2023.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers › Section 452.1 - Application

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Pursuant to the
				authority granted to the superintendent by Public Health Law section
				280-a(2)(g) to make regulations defining, limiting, and relating to the duties,
				obligations, requirements, and other provisions relating to pharmacy benefit
				managers under Public Health Law section 280-a(2), the duties, obligations, and
				requirements contained in Public Health Law section 280-a(2)(b), (c), (d), and
				(e) shall be applied as set forth in this Part.
(b) Safe Harbor. Each pharmacy benefit
				manager shall come into compliance with the provisions of this Part by December
				31, 2023, provided, however, that no application for licensure under Insurance
				Law section 2906 submitted on or before December 31, 2023 shall be accepted by
				the superintendent unless the pharmacy benefit manager certifies that it is in
				compliance with the provisions of this Part.
(c) A pharmacy benefit manager may submit the
				information and documents requested under this Part electronically to the
				health plan to an email address provided by the health plan for purposes of
				this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers › Section 452.2 - Health plan right to an accounting

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Pharmacy
				benefit managers that provide pharmacy benefit management services only for
				health plans that provide workers' compensation or automobile insurance are
				exempt from the requirements listed in Public Health Law section 280-a(2)(b)
				and (c).
(b) Upon written request
				of any health plan for which the pharmacy benefit manager provides pharmacy
				benefit management services, a pharmacy benefit manager shall provide an
				accounting of all funds received by the pharmacy benefit manager for pharmacy
				benefit management services attributable to the health plan sufficient to
				demonstrate that such funds were used or distributed only pursuant to the
				pharmacy benefit manager's contract with the health plan or applicable
				law.
(c) Each pharmacy benefit
				manager shall have in place accounting measures, practices, and procedures that
				will permit such an accounting to each health plan for which it performs
				pharmacy benefit management services.
(d) A pharmacy benefit manager shall have a
				commercially reasonable time of not more than 60 days to produce the accounting
				to the health plan.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers › Section 452.3 - Terms and conditions of contract relating to pharmacy benefit management services provided to health plans

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The disclosures
				provided for by Public Health Law section 280-a(2)(d) shall:
(1) be made by the pharmacy benefit manager
				within 30 days from receipt of a written request from the health plan, but such
				request shall not be made by the health plan more than once every six
				months;
(2) require that the
				contracts or arrangements requested be provided to the health plans in full and
				unredacted; and
(3) not apply to
				health plans that provide workers' compensation or automobile
				insurance.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 452 - General Duties, Accountability, and Transparency Provision For Pharmacy Benefit Managers › Section 452.4 - Conflicts of interest

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any of
				following activities, policies, practices, contracts, or arrangements shall be
				considered potential conflicts of interest for purposes of Public Health Law
				section 280-a(2)(e) and therefore the following information shall be disclosed
				to a health plan, upon written request by the health plan, within 30 days of
				such request:
(1) Where there is a difference
				in the amount charged to the health plan for a prescription drug's ingredient
				cost or dispensing fee and the amount the pharmacy benefit manager reimburses a
				pharmacy for the same prescription drug's ingredient cost or dispensing fee:
(i) the pharmacy benefit manager shall
				disclose to the health plan the actual total reimbursement amounts for each
				drug the pharmacy benefit manager paid to each network pharmacy after all
				direct and indirect administrative and other fees that have been
				retrospectively charged to the pharmacies are applied; and
(ii) the pharmacy benefit manager shall
				disclose to the health plan the actual total reimbursement amounts for each
				drug the pharmacy benefit manager pays each and every pharmacy benefit
				manager's owned or affiliated mail order or specialty pharmacy after all direct
				and indirect administrative and other fees have been retrospectively charged to
				the pharmacies are applied;
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 453

Current through Register Vol. 46, No. 28, July 10, 2024
The
				adopted version of this part by
				New
				York State Register November 15, 2023/Volume XLV, Issue 46, eff.
				11/15/2023 is not
				yet available.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 454

Current through Register Vol. 46, No. 28, July 10, 2024
The
				adopted version of this part by
				New
				York State Register November 15, 2023/Volume XLV, Issue 46, eff.
				11/15/2023 is not
				yet available.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XXII › Part 455

Current through Register Vol. 46, No. 28, July 10, 2024
The
				adopted version of this part by
				New
				York State Register November 15, 2023/Volume XLV, Issue 46, eff.
				11/15/2023 is not
				yet available.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Appendices › Appendix 6

Current through Register Vol. 46, No. 28, July 10, 2024
(cf. §
								9.1)
PUBLICATIONS PRICE LIST
*Statistical Tables (annual) ..11.50
				.........................................................................
____
*One copy free to a New York State resident.
PRICES FOR ADDITIONAL COPIES OF ANNUAL STATEMENT FORMS
				AND SCHEDULES
5
Annual Statement-Charitable Annuity .......
$ 4.75
11
Annual Statement-Retirement Systems .......
5.15
Exhibit of Loss Portfolio Transfer .......
.25
Supplement to Article 43 Corporation's Annual Statement
						  .......
15.00
HMO Data Requirements (Annual) .......
13.75
New York Business Page (Life) .......
.25
Supplement to Article 43 Corporation's Quarterly
						  Statement .......
4.50
HMO Data Requirements (Quarterly) .......
7.50
SR
Quarterly Statement-Schedule SR-Life .......
1.50
C-1
Quarterly Statement-Special Risk .......
.25
Supplement-Property and Casualty .......
6.50
Supplement-Fraternal .......
3.50
Supplement-Life .......
5.00
NAIC Property Annual Statement-Statutory Page 14 .......
.25
FORMS FROM THE PROPERTY
							 SUPPLEMENT
271A
Insurance Expense Exhibit .......
1.75
271AS
Insurance Expense Exhibit II .......
.60
NY Supplemental Insurance Expense Exhibit .......
.80
NY Property & Casualty Supplement Exhibit of
						  Premiums and Losses-Business in New York During Year .......
.25
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Appendices › Appendix 11 - DEPARTMENT OF FINANCIAL SERVICES OF THE STATE OF NEW YORK DEFINITION OF REPLACEMENT

Current through Register Vol. 46, No. 28, July 10, 2024
IN ORDER TO DETERMINE WHETHER YOU ARE REPLACING OR OTHERWISE
				CHANGING THE STATUS OF EXISTING LIFE INSURANCE POLICIES OR ANNUITY CONTRACTS,
				AND IN ORDER TO RECEIVE THE VALUABLE INFORMATION NECESSARY TO MAKE A CAREFUL
				COMPARISON IF YOU ARE CONTEMPLATING REPLACEMENT, THE AGENT OR BROKER IS
				REQUIRED TO ASK YOU THE FOLLOWING QUESTIONS AND EXPLAIN ANY ITEMS THAT YOU DO
				NOT UNDERSTAND.
AS PART OF YOUR PURCHASE OF A NEW LIFE INSURANCE POLICY OR A
				NEW ANNUITY CONTRACT, HAS EXISTING COVERAGE BEEN, OR IS IT LIKELY TO BE:
(1) LAPSED, SURRENDERED, PARTIALLY SURRENDERED, FORFEITED,
				ASSIGNED TO THE INSURER REPLACING THE LIFE INSURANCE POLICY OR ANNUITY
				CONTRACT, OR OTHERWISE TERMINATED?
YES ____ NO _____
(2) CHANGED OR MODIFIED INTO PAID-UP INSURANCE; CONTINUED AS
				EXTENDED TERM INSURANCE OR UNDER ANOTHER FORM OF NONFORFEITURE BENEFIT; OR
				OTHERWISE REDUCED IN VALUE BY THE USE OF NONFORFEITURE BENEFITS, DIVIDEND
				ACCUMULATIONS, DIVIDEND CASH VALUES OR OTHER CASH VALUES?
YES ____ NO ____
(3) CHANGED OR MODIFIED SO AS TO EFFECT A REDUCTION EITHER IN
				THE AMOUNT OF THE EXISTING LIFE INSURANCE OR ANNUITY BENEFIT OR IN THE PERIOD
				OF TIME THE EXISTING LIFE INSURANCE OR ANNUITY BENEFIT WILL CONTINUE IN
				FORCE?
YES ____ NO ____
(4) REISSUED WITH A REDUCTION IN AMOUNT SUCH THAT ANY CASH
				VALUES ARE RELEASED, INCLUDING ALL TRANSACTIONS WHEREIN AN AMOUNT OF DIVIDEND
				ACCUMULATIONS OR PAID-UP ADDITIONS IS TO BE RELEASED ON ONE OR MORE OF THE
				EXISTING POLICIES?
YES ____ NO ____
(5) ASSIGNED AS COLLATERAL FOR A LOAN OR MADE SUBJECT TO
				BORROWING OR WITHDRAWAL OF ANY PORTION OF THE LOAN VALUE, INCLUDING ALL
				TRANSACTIONS WHEREIN ANY AMOUNT OF DIVIDEND ACCUMULATIONS OR PAID-UP ADDITIONS
				IS TO BE BORROWED OR WITHDRAWN ON ONE OR MORE EXISTING POLICIES?
YES ____ NO ____
(6) CONTINUED WITH A STOPPAGE OF PREMIUM PAYMENTS OR REDUCTION
				IN THE AMOUNT OF PREMIUM PAID?
YES ____ NO ____
IF YOU HAVE ANSWERED YES TO ANY OF THE ABOVE QUESTIONS, A
				REPLACEMENT AS DEFINED BY NEW YORK INSURANCE REGULATION 60 HAS OCCURRED OR IS
				LIKELY TO OCCUR AND YOUR AGENT OR BROKER IS REQUIRED TO PROVIDE YOU WITH THE
IMPORTANT
NOTICE REGARDING REPLACEMENT OR
				CHANGE OF LIFE INSURANCE POLICIES OR ANNUITY CONTRACTS. YOU WILL ALSO RECEIVE A
				COMPLETED DISCLOSURE STATEMENT NO LATER THAN THE TIME YOUR NEW POLICY OR NEW
				CONTRACT IS DELIVERED.
Date: _____________ Signature of Applicant:
				_________________________________________
Date: _____________ Signature of Applicant:
				_________________________________________
TO THE BEST OF MY KNOWLEDGE, A REPLACEMENT IS INVOLVED IN THIS
				TRANSACTION: YES ____ NO ____
Date: _____________ Signature of Agent or Broker:
				____________________________________