reglab/statecodes huggingface dataset:
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.6 - Insurance policy requirements

Current through Register Vol. 46, No. 28, July 10, 2024
Every variable life insurance policy delivered or issued
					 for delivery in this State shall be subject to the following:
(a)
(1)
				  Mortality and expense risks shall be borne by the insurer. The mortality and
				  expense charges shall be subject to the maximums stated in the contract. More
				  favorable charges, if any, must be credited to the policy not less frequently
				  than annually.
(2) For scheduled
				  premium policies, a minimum death benefit shall be provided in an amount at
				  least equal to the initial face amount of the policy so long as premiums are
				  duly paid (subject to the provisions of paragraph [b][10] of this
				  section).
(3) The policy benefits
				  shall reflect the investment experience of one or more separate accounts
				  established and maintained by the insurer.
(4) Each variable life insurance policy shall
				  be credited with the full amount of the net investment return applied to the
				  benefit base.
(5) Any changes in
				  variable death benefits of each variable life insurance policy shall be
				  determined at least annually.
(6)
				  The policy value and cash surrender value of each variable life insurance
				  policy shall be in accordance with section
				  54.7 
				  of this Part.
(7) The computation
				  of values required for each variable life insurance policy may be based upon
				  such reasonable and necessary approximations as are acceptable to the
				  superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.8 - Reserve liabilities

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Reserve liabilities for variable life insurance policies shall be established
				  in accordance with the provisions of section 4240 (d)  of the Insurance
				  Law.
(b) Reserve liabilities shall
				  be at least equal to the cash surrender value.
(c) For scheduled premium policies, reserve
				  liabilities for the guaranteed minimum death benefit shall be the reserve
				  needed to provide for the contingency of death occurring when the guaranteed
				  minimum death benefit exceeds the death benefit that would be paid in the
				  absence of the guarantee, and shall be maintained in the general account of the
				  insurer and shall be not less than the aggregate total of the term costs, if
				  any, covering a period of one full year from the valuation date, of the
				  guarantee on each variable life insurance contract, assuming an immediate
				  one-third depreciation in the current value of the assets of the separate
				  account followed by a net investment return equal to the assumed investment
				  rate. The valuation interest rate and mortality table used in computing the
				  minimum reserve shall conform to permissible standards for the valuation of
				  life insurance contracts. In determining such reserve, the company may employ
				  suitable approximations and estimates, including but not limited to groupings
				  and averages.
(d) Reserve
				  liabilities for all general account incidental insurance benefits, and any
				  guarantees associated with variable incidental insurance benefits, shall be
				  maintained in the general account, and reserve liabilities for all variable
				  aspects of the variable incidental insurance benefits shall be maintained in a
				  separate account, in amounts determined in accordance with the actuarial
				  procedures appropriate to such benefit.
(e) For flexible premium policies, reserve
				  liabilities for any guaranteed minimum death benefit shall be maintained in the
				  general account of the insurer and shall not be less than the aggregate total
				  of term costs, if any, covering the period provided in the guarantee not
				  otherwise provided for by the reserves held in the separate account, assuming
				  an immediate one-third depreciation in the current value of the assets of the
				  separate account followed by a net investment return equal to the valuation
				  interest rate.
(f) The valuation
				  interest rate and mortality table used in computing this additional reserve, if
				  any, shall conform to permissible standards for the valuation of life insurance
				  contracts. In determining such minimum reserve, the company may employ
				  approximations and estimates, acceptable to the superintendent, including but
				  not limited to groupings and averages.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.9 - Information furnished to applicants

Current through Register Vol. 46, No. 28, July 10, 2024
An insurer delivering or issuing for delivery in this State
					 any variable life insurance policies shall deliver to the applicant for the
					 policy, and obtain a written acknowledgment of receipt from such applicant
					 coincident with or prior to the execution of the application, a private
					 placement offering memorandum in the case of a private placement variable life
					 insurance policy or a prospectus included in a registration statement relating
					 to the policy in the case of any other variable life insurance policy. The
					 prospectus must satisfy the requirements of the Federal Securities Laws, have
					 been declared effective by the Securities and Exchange Commission, and include
					 the following information:
(a) A
				  summary explanation, in nontechnical terms, of the principal features of the
				  policy, including a description of the manner in which the variable benefits
				  will reflect the investment experience of the separate account and the factors
				  which affect such variation. Such explanation must include notices of the
				  provisions required by section
				  54.6(b)(1)(v) and
				  (b)(7)  of this Part. This summary shall
				  include:
(1) a statement that the death
				  benefit may be variable or fixed under specified conditions;
(2) a statement that policy values may
				  increase or decrease in accordance with the experience of the separate account
				  (subject to any specified minimum guarantees); and
(3) a statement that, in the case of a
				  variable endowment policy, the amount of the endowment payable at maturity is
				  not guaranteed but is dependent upon the then cash surrender value (subject to
				  any specified minimum guarantees).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.10 - Applications

Current through Register Vol. 46, No. 28, July 10, 2024
The application for a variable life insurance policy shall
					 contain:
(a) If either the amount or
				  duration of the death benefit may vary under specified conditions, a prominent
				  statement to that effect.
(b) A
				  prominent statement that policy values may increase or decrease in accordance
				  with the experience of the separate account (subject to any specified minimum
				  guarantees).
(c) A prominent
				  statement that, in the case of a variable endowment policy, the amount of the
				  endowment payable at maturity is not guaranteed but is dependent upon the then
				  cash surrender value (subject to any specified minimum guarantees).
(d) A prominent statement, in the case of a
				  private placement variable life policy, that due to the illiquid nature of the
				  investment options, the payment of the death benefit, the cash surrender value,
				  policy loans, partial withdrawals or partial surrenders, as applicable, may be
				  delayed. The statement shall advise the applicant to refer to the policy for
				  further details on any delay of payments.
(e) A notice that the following are available
				  upon request: Illustrations of benefits, including death benefits, policy
				  values and cash surrender values. Such illustrations shall be in a form and
				  content acceptable to the superintendent.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.12 - Authorized foreign and alien insurance companies

Current through Register Vol. 46, No. 28, July 10, 2024
No authorized foreign or alien insurer shall deliver or
					 issue for delivery within this State any variable life insurance policy unless
					 the insurer shall comply substantially with the provisions of this Part which,
					 in the judgment of the superintendent, are reasonably necessary to protect the
					 interests of the people of this State.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 54 - Variable Life Insurance › Section 54.13 - Separability provision

Current through Register Vol. 46, No. 28, July 10, 2024
If any provision of this Part or the application thereof to
					 any person or circumstance is for any reason held to be invalid, the remainder
					 of the Part and the application of such provision to other persons or
					 circumstances shall not be affected thereby.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 55 - Notice To Employees Concerning Termination Of Group And Health Insurance Policies › Section 55.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Policyholder
				  shall have the meaning set forth in Labor Law, section
				  217(2)(a).
(b) Certificate holder shall have the meaning
				  set forth in Labor Law, section
				  217(2)(b).
(c) Terminate or termination shall mean
				  nonrenew or cancel.
(d) Group
				  accident insurance policy, group health insurance policy and group accident and
				  health insurance policy shall have the meanings set forth in subsection (a) of
				  Insurance Law section 4235 (group accident and health insurance
				  defined).
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 55 - Notice To Employees Concerning Termination Of Group And Health Insurance Policies › Section 55.2 - Notice

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insurer who
				  intends to terminate a group policy or contract of accident, or health, or
				  accident and health insurance issued to a policyholder, covering individuals
				  who because of their employee status are certificate holders under a group
				  policy shall give the policyholder at least 30 days' prior written notice of
				  its intent to terminate coverage. The notice to the policyholder shall set
				  forth in detail the policyholder's obligation under Labor Law, section
				  217, and under this Part, to notify each
				  certificate holder resident in New York State of the intended termination of
				  the group policy.
(b) In its notice
				  of intent to terminate coverage, the insurer shall set forth in full the rights
				  of the certificate holders under the terminating policy as to coverage for
				  illness, accident and treatment occurring prior to and subsequent to the
				  termination date, and such other rights of certificate holders as may exist
				  under the contract or policy (e.g.,conversion rights).
(c) The insurer shall advise the policyholder
				  that the policyholder must give written notice of the intended termination to
				  each certificate holder resident in New York State insured under the group
				  policy by hand-delivering or mailing to the certificate holder a copy of the
				  insurer's notice of termination and a covering letter advising the certificate
				  holders of the intended termination.
(d) The insurer shall advise the policyholder
				  that the policyholder's notice to the certificate holder shall be either:
(1) hand-delivered by the policyholder to the
				  certificate holder at the certificate holder's place of employment (e.g., by
				  including the notice in the certificate holder's pay envelope) at least nine
				  days prior to the intended date of termination; or
(2) mailed by the policyholder to each
				  certificate holder at the certificate holder's last known residential address
				  at least nine days prior to the intended date of termination.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 56 - Health Insurance Claims Processing And Procedures › Section 56.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
Section
					 52.16(c)(5) 
					 of this Title (Insurance Regulation No. 62), permits insurers and health
					 maintenance organizations (HMOs) that are required to provide coverage for
					 surgical services, to exclude coverage of cosmetic surgery. Part 52 of this
					 Title does not define cosmetic surgery, but does provide examples of two types
					 of reconstructive surgeries that may never be considered cosmetic. Subsequent
					 to the promulgation of Part 52 of this Title, titles I and II of article 49 of
					 the Insurance Law and Public Health Law were enacted that require medical
					 necessity denials to be subject to utilization review and external appeal. The
					 Department of Financial Services has found inconsistencies among insurers and
					 HMOs as to when denials of surgery are considered medical necessity denials and
					 subject to utilization review and external appeal. Section
					 56.3 
					 of this Part and an amended section
					 52.16(c)(5) 
					 of this Title clarify that, whenever surgery is a covered benefit under certain
					 policies, a determination that the surgery is cosmetic is a medical necessity
					 determination subject to the utilization review and external review
					 requirements of titles I and II of article 49 of the Insurance Law and Public
					 Health Law, except in certain cases when the claim or request for surgery is
					 identified by one of the codes in section
					 56.3(f) 
					 of this Part and is submitted without medical information.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 56 - Health Insurance Claims Processing And Procedures › Section 56.1 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall be applicable to policies that provide
					 hospital, surgical or medical expense coverage.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 56 - Health Insurance Claims Processing And Procedures › Section 56.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
The following words or terms shall have the following
					 meanings when used in this Part:
(a)
				  Health care professional means an appropriately licensed, registered or
				  certified health care professional pursuant to title 8 of the Education Law or
				  a health care professional comparably licensed, registered or certified by
				  another state.
(b) Health care
				  provider means a health care professional or a facility licensed pursuant to
				  article 28, 36, 44 or 47 of the Public Health Law or a facility licensed
				  pursuant to article 19, 23, 31 or 32 of the Mental Hygiene Law.
(c) Health plan means an insurer or health
				  maintenance organization (HMO) that has issued a policy that provides hospital,
				  surgical or medical expense coverage.
(d) Medical information means any medical
				  data, written explanation from a health care professional, or medical
				  record.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 56 - Health Insurance Claims Processing And Procedures › Section 56.3 - Claim review requirements for surgical services

Current through Register Vol. 46, No. 28, July 10, 2024
(a) A claim or request for coverage of
				  reconstructive surgery when such service is incidental to or follows surgery
				  resulting from trauma, infection or other diseases of the involved part, and
				  reconstructive surgery because of congenital disease or anomaly of a covered
				  dependent child that has resulted in a functional defect shall not be
				  considered by a health plan to be cosmetic. Reconstructive surgery may however
				  be reviewed for medical necessity subject to the requirements of titles I and
				  II of article 49 of the Insurance Law or Public Health Law.
(b) A claim or request for coverage of
				  surgery other than for the surgical services described in subdivision (a) or
				  (c) of this section that is considered by a health plan to be cosmetic shall be
				  reviewed for medical necessity subject to the requirements of titles I and II
				  of article 49 of the Insurance Law or Public Health Law.
(c) A claim or request for coverage of
				  surgery, other than a request for pre-authorization, that is solely identified
				  by one of the codes in subdivision (f) of this section and is submitted to a
				  health plan without any accompanying medical information, may be denied by a
				  health plan as cosmetic without subjecting the request to the requirements of
				  titles I and II of article 49 of the Insurance Law or Public Health Law,
				  provided that:
(1) notice of the denial
				  includes a clear statement describing the basis for the denial;
(2) notice of the denial includes a statement
				  that the insured has a right to a medical necessity review if the insured or
				  the insured's health care provider believes the claim or request involves
				  issues of medical necessity and submits medical information;
(3) if a medical necessity review is
				  requested and medical information is submitted, the health plan treats the
				  request as a utilization review appeal pursuant to section 4904  of the Insurance Law or Public Health
				  Law; and
(4) if the health plan
				  denies coverage of the procedure after receipt of medical information, the
				  health plan issues a final adverse determination in compliance with section 4904 (c)  of the Insurance
				  Law and section
				  410.9(e) 
				  of this Title (Regulation 166) or section 4904 (3)  of the Public
				  Health Law and 10 NYCRR 98-2.9(e), as applicable.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.1 - Purpose and applicability

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  The purpose of this Part is to establish standards and rules for classifying an
				  insured as a smoker or a nonsmoker and for reclassifying an insured in
				  accordance with section
				  57.5(d) 
				  of this Part and permit the use of mortality tables that reflect differences in
				  mortality between smokers and nonsmokers in determining minimum cash surrender
				  values, minimum amounts and minimum periods of paid-up nonforfeiture benefits,
				  and minimum reserve liabilities for plans of insurance with separate premium
				  rates for smokers and nonsmokers. This Part, as amended, clarifies that if an
				  insurer issues coverage to an insured not underwritten as a smoker at issue
				  then the insurer may not subsequently treat the insured as a smoker for that
				  coverage.
(b) This Part applies to
				  every authorized life insurance company and authorized fraternal benefit
				  society.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.2 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part:
(a) 1980 CS0 Table with or without Ten-Year
				  Select Mortality Factors means that mortality table, consisting of separate
				  rates of mortality for male and female lives, developed by the Society of
				  Actuaries Committee to Recommend New Mortality Tables for Valuation of Standard
				  Individual Ordinary Life Insurance, incorporated in the 1980 NAIC Amendments to
				  the Model Standard Nonforfeiture Law and Standard Valuation Law for Life
				  Insurance, and referred to in those models as the Commissioners 1980 Standard
				  Ordinary Mortality Table, with or without Ten-Year Select Mortality Factors.
				  The same select factors will be used for both smoker and nonsmoker
				  tables.
(b) 1980 CET Table means
				  that mortality table consisting of separate rates of mortality for male and
				  female lives, developed by the Society of Actuaries Committee to Recommend New
				  Mortality Tables for Valuation of Standard Individual Ordinary Life Insurance,
				  incorporated in the 1980 NAIC Amendments to the Model Standard Nonforfeiture
				  Law and Standard Valuation Law for Life Insurance, and referred to in those
				  models as the Commissioners 1980 Extended Term Insurance Table.
(c) 2001 CSO Mortality Table has the same
				  meaning as set forth in section
				  100.3  of
				  Part 100 of this Title (Insurance Regulation 179).
(d) Smoker and nonsmoker mortality tables
				  means mortality tables with separate rates of mortality for smokers and
				  nonsmokers.
(e) Composite mortality
				  tables means mortality tables that do not distinguish between smokers and
				  nonsmokers.
(f) Smoker means a
				  proposed insured or an insured who has been classified by an insurer, based on
				  current or past behavior within a specified timeframe in accordance with its
				  standard underwriting rules or procedures, as one who smokes, uses tobacco or
				  uses nicotine.
(g) Nonsmoker means
				  a proposed insured or an insured who is classified as a nonsmoker at the time
				  of application for life insurance or who at any subsequent time is reclassified
				  as a nonsmoker in accordance with the insurer's underwriting
				  procedures.
(h) Insurer means an
				  authorized life insurance company or authorized fraternal benefit
				  society.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.3 - Alternate tables

Current through Register Vol. 46, No. 28, July 10, 2024
(a) In
				  determining minimum cash surrender values, minimum amounts and minimum periods
				  of paid-up nonforfeiture benefits and minimum reserve liabilities, for any
				  policy of insurance delivered or issued for delivery in this State after the
				  operative date of Insurance Law section 4221(k) for that policy form, at the
				  option of the insurer and subject to the conditions stated in section
				  57.4  of
				  this Part:
(1) the 1980 CSO Smoker and
				  Nonsmoker Mortality Tables, with or without Ten-Year Select Mortality Factors,
				  may be substituted for the 1980 CSO Table, with or without Ten-Year Select
				  Mortality Factors; and
(2) the 1980
				  CET Smoker and Nonsmoker Mortality Tables may be substituted for the 1980 CET
				  Table.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.4 - Conditions

Current through Register Vol. 46, No. 28, July 10, 2024
(a) For each plan
				  of insurance with separate premium rates for smokers and nonsmokers, an insurer
				  may:
(1) use composite mortality tables to
				  determine minimum cash surrender values, minimum amounts and minimum periods of
				  paid-up nonforfeiture benefits and minimum reserve liabilities.
(2) use smoker and nonsmoker mortality tables
				  to determine the valuation net premiums and additional minimum reserves, if
				  any, required by Insurance Law section 4218, and use composite mortality tables
				  to determine minimum cash surrender values, and minimum amounts and minimum
				  period of paid-up nonforfeiture benefits and basic minimum reserve liabilities;
				  or
(3) use smoker and nonsmoker
				  mortality tables to determine minimum cash surrender values, minimum amounts
				  and minimum periods of paid-up nonforfeiture benefits and minimum reserve
				  liabilities.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.5 - Classification and reclassification

Current through Register Vol. 46, No. 28, July 10, 2024
(a) An insured may only be treated as a
				  smoker for rating and benefit purposes if:
(1) the insurer has determined that the
				  insured is a smoker in accordance with subdivision (b) of this section;
				  and
(2) subject to underwriting in
				  accordance with subdivision (b) of this section, the insurer treats any other
				  insured who is not determined to be a smoker as a non-smoker for rating and
				  benefit purposes.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 57 - Smoker/nonsmoker Mortality Tables And Underwriting Classifications › Section 57.6 - Determined violation

Current through Register Vol. 46, No. 28, July 10, 2024
A contravention of section
					 57.5 
					 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 Insurance Law section 2402(c), in violation
					 of Insurance Law section 2403.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 58 - Minimum Standards For Form, Content And Sale Of Medicare Supplement And Medicare Select Insurance, Including Standards Of Full And Fair Disclosure › Section 58.6 - Medicare select policies and certificates

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
(1)
				  This section shall apply to Medicare select policies and certificates, as
				  defined in section
				  52.14 
				  of this Title.
(2) No policy or
				  certificate may be advertised as a Medicare select policy or certificate unless
				  it meets the requirements of this section.
(3) Medicare select policies and certificates
				  are subject to all of the requirements of this Part pertaining to Medicare
				  supplement insurance except that benefits under the Medicare select policies
				  and certificates may be restricted to items and services furnished by network
				  providers or reduced benefits may be provided when items or services are
				  furnished by non-network providers.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.0 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
(a) One of the
				  major provisions of chapter 369 of the Laws of 1985 requires approval of
				  certificates by the Superintendent of Insurance in accordance with section 3201 (b)(1)  of the
				  Insurance Law when such certificates insure New York residents under a group
				  insurance policy delivered outside of New York to a group which, as of January
				  1, 1986, is a newly recognized group under New York law or is a group not
				  specifically described in section 4216 (b), 4235 (c)(1) or
				  4237 (a)(3)  of the
				  Insurance Law. This approval procedure was required to provide the basic
				  protection of New York law and regulations to residents of this State when they
				  purchase insurance coverage through out-of-state group arrangements where the
				  individual insured has no close association or afffiliation with the group
				  policyholder.
(b) In order to
				  provide the basic protections of New York law and regulations, the same
				  substantive standards applicable to traditional groups should apply to all
				  certificates deemed to have been delivered in this State pursuant to the above
				  statute. However, the provision that basic group standards be applied has been
				  modified in two instances:
(1) for existing
				  group contracts where solicitation occurs prior to April 1, 1986; and
(2) for certificates delivered in New York
				  under a group contract delivered to a group outside this State which is not
				  recognized as one of the groups enumerated in the law or as an eligible
				  discretionary group in New York.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.1 - Definitions

Current through Register Vol. 46, No. 28, July 10, 2024
As used in this Part, the following terms shall have the
					 meanings hereinafter ascribed to them:
(a) Substantially comply shall mean:
(1) compliance with New York group law
				  standards, except that reasonable deviations may be permitted in benefit
				  levels, conversion privileges, preexisting condition limitations and Flesch
				  test standards;
(2) provisions
				  prohibited by law or regulations are not included in the certificate;
(3) for accident and health and blanket
				  insurance, compliance with at least the individual loss ratio standards
				  established by New York regulation; and
(4) for life insurance, compliance with at
				  least the minumum benefit ratio standards set forth in section
				  59.5(a) 
				  of this Part, reduced by 10 percentage points.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.2 - Applicability

Current through Register Vol. 46, No. 28, July 10, 2024
This Part shall apply to all group life, group accident,
					 group health, group accident and health, or blanket accident and health
					 insurance certificates deemed to have been delivered in this State under
					 section 3201 (b)(1)  of the
					 Insurance Law, and, in addition, sections
					 59.5
					 and
					 59.7 
					 of this Part shall apply to certificates on New York residents covered under
					 group and blanket policies issued in this State pursuant to sections
					 4216(b)(12)-(14), 4235(c)(1)(D) where the group policy is issued to a trustee
					 or trustees of a fund established or participated in by two or more employers
					 not in the same industry with respect to an employer principally located within
					 the State, sections 4235 (c)(1)(K)-(M) and
					 4237 (a)(3)(F)(ii)  of the
					 Insurance Law.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.3 - Filing and approval of group insurance certificates delivered after january 1, 1986, where the master contract was delivered prior to january 1, 1986 and the solicitation of new york residents occurs prior to april l, 1986

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Certificates
				  delivered prior to July 1, 1986 shall not be subject to sections
				  59.4,
				  59.5
				  and
				  59.7 
				  of this Part, and shall be approved provided the following conditions are met:
(1) the insurer provides written
				  certification to the Insurance Department that the certificates substantially
				  comply with the standards applicable to group policies and certificates
				  delivered in this State;
(2) a
				  certification that the premium charged is reasonable in relation to the
				  benefits provided, including a statement of the expected benefit ratio, except
				  where the policyholder pays the entire premium; and
(3) a statement that the insurer will
				  retroactively modify such certificates, to the extent necessary, should it be
				  found by the superintendent that the certificate fails to meet the tests as
				  certified above.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.4 - Filing and approval requirements for certificates subject to approval under section 3201(b)(1) of the insurance law, other than those mentioned in section 59.3 of this part

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
				  Certificates subject to this section shall afford insureds protections
				  substantially similar to those provided by group policies and certificates
				  delivered in New York which comply with all group laws, regulations and rules,
				  except as provided in subdivision (b) of this section.
(b) Certificates subject to this Part
				  evidencing coverage under a policy delivered outside of New York to a group not
				  recognized under New York law and regulations must comply with the contract and
				  loss or benefit ratio requirements of individual or group insurance, whichever,
				  in the opinion of the superintendent, affords the certificate holder the
				  greatest protection. Such determination may require an insurer to comply with
				  contract standards on a basis different from the applicable loss or benefit
				  ratio standard.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.5 - Minimum benefit ratio standards

Current through Register Vol. 46, No. 28, July 10, 2024
Minimum benefit ratio standards shall apply to life,
					 accident and health, and blanket insurance certificates which are subject to
					 this Part. Monitoring procedures to assure that such standards are met are
					 contained in section
					 59.7 
					 of this Part.
(a) Life insurance. The
				  following standards will apply to group life insurance certificates, except
				  where the policyholder pays the entire premium.
(1) For certificates providing term
				  insurance, the following minimum benefit ratios are applicable:
(i) A 60-percent benefit ratio.
(ii) The minimum benefit ratio in
				  subparagraph (i) of this paragraph shall be modified as follows:
(a) If the expected average annual premium
				  per certificate is less than $210, the minimum benefit ratio shall be decreased
				  by five percentage points.
(b) If
				  the expected average annual premium per certificate exceeds $600, the minimum
				  benefit ratio shall be increased by five percentage points.
(c) In 1987 and subsequent years, the dollar
				  amounts in clauses (a) and (b) of this subparagraph will be multiplied by an
				  "inflation factor." The inflation factor shall be the ratio of the Consumer
				  Price Index for urban wage earners, as compiled by the U.S. Bureau of Labor
				  Statistics, of the current to the previous calendar year.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.6 - Accelerated approval procedure

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Any certificate, other than those subject
				  to section
				  59.4(b) 
				  of this Part, will be granted a conditional approval upon the insurer's
				  certification of full compliance with all applicable laws and regulations
				  relative to group insurance policies and certificates of the same type
				  delivered in this State.
(b) The
				  certification and the certificate must include a statement that the insurer
				  will retroactively modify such certificate form to the extent necessary, if it
				  is found by the superintendent that the certificate fails to comply in all
				  respects with the applicable law and regulations.
(c) Such certification shall include a
				  statement of the expected benefit ratio and, as an attachment, the actuarial
				  memorandum required by section
				  59.5 
				  of this Part.
(d) In the event the
				  superintendent determines, at the time of filing, that the certification is
				  incomplete or the certificate fails to meet the tests as certified above, no
				  conditional approval under this section will be given.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.7 - Experience monitoring, reporting and adjustment requirements

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Life
				  insurance
(1) By July 1, 1987 each
				  insurer, which has issued certificates subject to this Part, shall submit for
				  approval a plan for the monitoring of experience of these certificates. Such
				  monitoring plan shall include:
(i) Provision
				  for the combining of the experience of similar certificates. This may include,
				  subject to the approval of the superintendent, the use of nationwide
				  experience. Each such grouping shall be considered a monitoring unit. No
				  monitoring unit shall be less than 5,000 lives, unless it is the only
				  unit.
(ii) Provision for
				  demonstrating that the minimum benefit ratio requirements of section
				  59.5  of this Part are being
				  satisfied. Such demonstration shall compare as a ratio the actual experience to
				  the expected experience as anticipated by the filing memorandum required by
				  section 59.5  of this Part.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter A - Life, Accident and Health Insurance › Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law › Section 59.8 - Severability

Current through Register Vol. 46, No. 28, July 10, 2024
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.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 60 - Minimum Provisions For Automobile Liability Insurance Policies And Supplementary Uninsured Motorists Insurance › Subpart 60-1 - Minimum Provisions For Automobile Liability Insurance Policies › Section 60-1.2 - Exclusions

Current through Register Vol. 46, No. 28, July 10, 2024
Such an "owner's policy of liability insurance" may
						contain in substance the following exclusions:
(a) while the motor vehicle is used as a
					 public or livery conveyance;
(b)
					 liability assumed by the insured under any contract or agreement;
(c) while the motor vehicle is used for the
					 towing of any trailer or semitrailer owned or hired by the insured and not
					 covered by like insurance with the insurer; or while any trailer or semitrailer
					 covered by the policy is used with any motor vehicle owned or hired by the
					 insured and not covered by like insurance with the insurer.
(d) Bodily injury to or sickness, disease or
					 death of any employee of the insured arising out of and in the course of:
(1) domestic employment by the insured, if
					 benefits therefor are in whole or in part either payable or required to be
					 provided under any workers' compensation law; or
(2) other employment by the
					 insured.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 60 - Minimum Provisions For Automobile Liability Insurance Policies And Supplementary Uninsured Motorists Insurance › Subpart 60-1 - Minimum Provisions For Automobile Liability Insurance Policies › Section 60-1.3 - Discretionary provisions

Current through Register Vol. 46, No. 28, July 10, 2024
Such an "owner's policy of liability insurance" may also
						contain in substance the following provisions:
(a) that written notice of accident, claim or
					 suit is required;
(b) that the
					 insurer is subrogated to any rights of recovery of the insured;
(c) that the terms of the policy may not be
					 waived or changed except as stated in the policy;
(d) that the insurer's consent is necessary
					 to any assignment of interest under the policy;
(e) that the insured will cooperate with the
					 insurer;
(f) that no action shall
					 lie against the insurer unless the insured shall have complied with all the
					 terms of the policy, nor until the amount of the insured's obligation to pay
					 shall have been finally determined either by judgment against the insured after
					 actual trial or by written agreement of the insured, the claimant and the
					 insurer;
(g) that the insurer
					 issues the policy upon the reliance of the insured's declarations and that the
					 policy contains all agreements between the insured and the insurer and any of
					 its agents relating to the insurance;
(h) a provision relating to the insurer's own
					 method of doing business; and
(i)
					 that notice to the insurer of delivery of a newly acquired additional motor
					 vehicle or an election to insure it under a specific policy is
					 required.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 60 - Minimum Provisions For Automobile Liability Insurance Policies And Supplementary Uninsured Motorists Insurance › Subpart 60-1 - Minimum Provisions For Automobile Liability Insurance Policies › Section 60-1.4 - Payments to insured

Current through Register Vol. 46, No. 28, July 10, 2024
Such an "owner's policy of liability insurance" shall be
						subject to the applicable provisions of section 3420  of the Insurance Law, as amended. For
						the purpose of complying with the provisions of subsection (f)(1) of section
						3420, no policy subject to this Part shall be issued by any authorized insurer
						unless it contains coverage providing for payments to the insured, as defined
						in such coverage, by the New York Motor Vehicle Accident Indemnification
						Corporation, pursuant to the provisions of article 52 of the Insurance Law
						applicable to such payments.
New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter III - Policy and Certificate Provisions › Subchapter B - Property and Casualty Insurance › Part 60 - Minimum Provisions For Automobile Liability Insurance Policies And Supplementary Uninsured Motorists Insurance › Subpart 60-1 - Minimum Provisions For Automobile Liability Insurance Policies › Section 60-1.5 - Rental vehicle coverage

Current through Register Vol. 46, No. 28, July 10, 2024
Subject to the provisions of this section and
						notwithstanding other provisions of this Part, every motor vehicle liability
						insurance policy insuring at time of issuance or renewal less than five private
						passenger motor vehicles registered in this State shall provide, in the form
						prescribed by subdivision (h) of this section, separate rental vehicle coverage
						for the insured's obligation for actual damage to, or loss of, a rental
						vehicle, including loss of use, rented by the insured in the United States, its
						territories or possessions, and Canada under a rental agreement with a term of
						30 continuous days or less, regardless of where such rental vehicle may be
						registered, rented or operated.
(a)
					 Rental vehicle coverage shall be added by prescribed endorsement to all such
					 policies issued or renewed in this State on and after April 1, 1989.
(b) All such policyholders shall be sent the
					 notice prescribed by subdivision (i) of this section and shall be informed
					 that, in the event of a premium or a premium increase charged for rental
					 vehicle coverage, the policyholder shall then have an option to reject such
					 coverage within 10 calendar days following receipt of notice that such premium
					 or premium increase will be charged.
(c) The option to reject rental vehicle
					 coverage provided by subdivision (b) of this section shall apply only at new
					 policy issuance and upon initial policy renewal following the insurer's
					 determination to charge or increase a premium for this coverage.
(d) Rental vehicle coverage shall provide
					 protection:
(1) only with respect to rental
					 vehicles operated within the United States, its territories or possessions, and
					 Canada;
(2) regardless of whether
					 the rental vehicle is rented or operated for business or pleasure, unless used
					 for transporting persons or property for hire; and
(3) regardless of fault.