§ 3218. Medicare supplemental insurance policies. (a) In this section: (1) “Medicare” means the coverage of health care costs provided under subchapter XVIII of the federal Social Security Act, 42 U.S.C. §§ 1395 et seq. (2) “Medicare supplemental insurance” means any individual or group accident and health policy issued for delivery in this state on […]
§ 3219. Annuity and pure endowment contracts and certain group annuity certificates; standard provisions as to contractual rights and responsibilities of contract holders, certificate holders and insurers. (a) Except as provided in section four thousand two hundred forty of this chapter, every annuity or pure endowment contract except a group annuity contract, and every group […]
§ 3220. Group life insurance policies; standard provisions. (a) No policy of group life insurance shall be delivered or issued for delivery in this state unless it contains in substance the following provisions or provisions which in the opinion of the superintendent are more favorable to certificate holders or not less favorable to certificate holders […]
§ 3221. Group or blanket accident and health insurance policies; standard provisions. (a) No policy of group or blanket accident and health insurance shall, except as provided in subsection (d) hereof, be delivered or issued for delivery in this state unless it contains in substance the following provisions or provisions which in the opinion of […]
§ 3222. Funding agreements. (a) Any insurer authorized to deliver or issue for delivery annuity contracts in the state may deliver or issue for delivery one or more funding agreements. The issuance or delivery of such funding agreements shall not be deemed to be doing a kind of business specifically authorized by section one thousand […]
§ 3223. Group annuity contracts; standard provisions as to contractual rights and responsibilities of contract holders, certificate holders and annuitants, and insurers. Except as otherwise provided in section four thousand two hundred forty of this chapter, every group annuity contract delivered or issued for delivery in this state and every certificate used in connection therewith, […]
§ 3224. Standard claim forms; accident and health insurance. (a) The superintendent shall establish standard claim forms for the services of hospitals, physicians and other health care providers to be used for all accident and health insurance claims. All insurers providing such insurance shall accept said standard claim forms when submitted by a hospital, physician […]
§ 3224-a. Standards for prompt, fair and equitable settlement of claims for health care and payments for health care services. In the processing of all health care claims submitted under contracts or agreements issued or entered into pursuant to this article and articles forty-two, forty-three and forty-seven of this chapter and article forty-four of the […]
§ 3224-b. Rules relating to the processing of health claims and overpayments to physicians. (a) Processing of health care claims. This subsection is intended to provide uniformity and consistency in the reporting of medical services and procedures as they relate to the processing of health care claims and is not intended to dictate reimbursement policy. […]
§ 3224-c. Coordination of benefits. An insurer or organization or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall not deny a claim, either in whole or in part, on the basis that it is coordinating benefits and another insurer or organization […]
§ 3224-d. Prescription synchronization. (a) Every individual or group health insurance policy providing prescription drug coverage when applicable to permit synchronization shall permit and apply a daily pro-rated cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty day supply, when it is agreed among the covered individual, a […]
§ 3225. Eligibility for health insurance in cases of exposure to DES. No policy of accident or health insurance, or group or blanket accident or health insurance or renewals thereof shall be denied or cancelled by the insurer, solely because the insured person has been exposed to diethylstilbestrol, commonly referred to as DES.
§ 3226. Reinsurance contracts excepted. The provisions of this article shall not apply to contracts of reinsurance, except as otherwise provided by law.
§ 3227. Interest upon surrenders, policy loans and other funds. (a) Interest, at the rate provided for in section three thousand two hundred fourteen of this article, shall be payable by life insurers, fraternal benefit societies, and life insurance departments of savings banks upon: (1) the value of policies surrendered by policyholders for cash values, […]
§ 3228. Individual accident and health insurance policies; premium refund at death of insured. If the death of the insured or a covered dependent occurs during a period for which the premium under an individual accident and health insurance policy has been paid, the insurer shall refund the premium or the portion of the premium […]
§ 3229. Minimum benefit standards for certain long term care plans. (a) The minimum standards for an insurance plan, which may qualify under the partnership for long term care program pursuant to section three hundred sixty-seven-f of the social services law, shall be established by regulations of the superintendent, in consultation with the commissioner of […]
§ 3230. Accelerated payment of the death benefit or special surrender value under a life insurance policy. (a) The application for a life insurance policy or policy rider which provides for accelerated payment of death benefits or a special surrender value shall: (1) contain a notice, prominently displayed, to read as follows: “Receipt of accelerated […]
* § 3231. Rating of individual and small group health insurance policies; approval of superintendent. (a) (1) No individual health insurance policy and no group health insurance policy covering between one and fifty employees or members of the group or between one and one hundred employees or members of the group for policies issued or […]
* § 3231. Health insurance policies and subscriber contracts; prohibited claims. (a) For the purposes of this section the terms health care provider, practitioner, clinical laboratory services, pharmacy services, radiation therapy services, physical therapy services or x-ray or imaging services shall have the same meanings as are set forth in section two hundred thirty-eight of […]
§ 3232. Pre-existing condition provisions in health policies. Every individual health insurance policy and every group or blanket accident and health insurance policy issued or issued for delivery in this state which includes a pre-existing condition provision shall contain in substance the following provision or provisions which in the opinion of the superintendent are more […]
