2006 New York Code - Employee Notification And Remittance Of Premiums; Group Policies Of Accident And Health Insurance.

 
    §  217.    Employee  notification  and  remittance  of premiums; group
  policies of accident  and  health  insurance.  1.  Statement  of  public
  policy.  The  legislature  finds  that  in  today's  society  health and
  accident insurance coverage for medical care and treatment is  of  prime
  importance to all employees and their dependents within the state of New
  York. Adequate and prospective planning is necessary to insure that such
  coverage  is  in  effect  at  the  time  of commencement of the need for
  medical and health care. Many employees and their dependents in New York
  State are covered through group  policies  issued  to  their  employers,
  employee  organizations  or  trustees  of  employee welfare funds and no
  statutory provision has heretofore afforded these  employees  and  their
  dependents the right as certificate holders of a group accident or group
  health  policy  to  receive  notification of the intended termination or
  substitution of the group  policy  and  to  have  premiums  remitted  to
  insurers  on  their  behalf  should they choose to exercise continuation
  privileges available under law.
    Accordingly, it is the declared public policy of the state of New York
  that sufficient and timely notice  be  afforded  each  employee  covered
  under   a  group  accident  or  group  health  policy  of  the  intended
  termination or  substitution  of  such  policy  and  that  employers  be
  required  to  remit  premiums  to  insurers  on  behalf  of  individuals
  exercising their right to continuation coverage under the law.
    2. Definitions. As used in this section:
    (a) "Policyholder" shall mean any person, co-partnership, corporation,
  trade   association,   joint   stock   association,   incorporated    or
  unincorporated association, trustees or labor organization as defined in
  subsections  (c)  and  (g),  respectively, of section four thousand four
  hundred two of the insurance law or any other entity to whom a policy or
  contract of group accident, group health or group  accident  and  health
  insurance has been issued.
    For the purpose of this section, "policyholder" shall also include any
  group remitting agent.
    (b)  "Certificate  holder"  shall mean any person insured, on either a
  contributory or non-contributory basis, by a policy or contract of group
  accident, group health or group accident and health insurance,  as  well
  as persons covered by group remittance policies.
    3. Notification.  A policyholder shall, subsequent to receipt from the
  insurer  of  notice of termination pursuant to subsection (k) of section
  four thousand two hundred  thirty-five  of  the  insurance  law  provide
  written  notice  to  the  certificate  holders  of  such  policy of such
  termination. In any case where the  policyholder  is  substituting  such
  policy  with  another  policy  providing  similar  coverage for the same
  certificate holders, the policyholder shall provide certificate  holders
  with  a  written  notice  including  therein the name of the substituted
  insurer. Where the employees are represented by  a  labor  organization,
  such  notice  shall  be  given  to  the  representative  of  that  labor
  organization. Such written notice shall be in accordance with the  rules
  and regulations of the superintendent of insurance, promulgated pursuant
  to  subsection  (l)  of section four thousand two hundred thirty-five of
  the insurance law.
    4.  Exception. The provisions of subdivision  three  of  this  section
  shall  not  be deemed to apply if, within ten days subsequent to receipt
  of notice of termination from the insurer, the  policyholder  has  taken
  necessary  steps  whereby  the intended termination is rendered null and
  void.
    5. Where the policyholder  has  contracted  with  another  insurer  to
  replace the existing insurer for the providing of similar and continuous
  coverage  for  the  same  certificate holders he shall file an affidavit
  with the commissioner of labor and superintendent of insurance  to  that
  effect.
    6.  Remittance of premiums. Any policyholder who receives notification
  from an individual entitled to  exercise  a  right  to  continuation  of
  coverage  by  the  policyholder's  insurer  pursuant  to  section  three
  thousand two hundred twenty-one of the insurance law,  shall,  no  later
  than thirty days subsequent to receipt of premiums from such individual,
  remit  such  premiums  to  the  insurer on behalf of such individual and
  provide evidence to the individual that the premium has been remitted.
    6-a.   Residence location  to  accompany  enrollment  data.    When  a
  policyholder  provides  information  to an insurer or health maintenance
  organization certified under article forty-four of the public health law
  or licensed pursuant to the  insurance  law  regarding  the  initial  or
  continued  enrollment  eligibility  of  a certificate holder, the policy
  holder must include the current united states postal  service  zip  code
  and state in which the certificate holder currently resides.
    7.  Penalties.  (a)  Any  policyholder  who  fails to comply with this
  section, shall forfeit to the people of the  State  a  sum  up  to  five
  thousand dollars, to be recovered by the commissioner in a civil action.
  Where  the policyholder is a corporation, trade association, joint stock
  association, incorporated or unincorporated association, the  president,
  secretary and treasurer thereof shall be liable for any forfeiture.
    (b)  In addition to such penalty, where the failure to comply involves
  the failure to notify an employee of the termination of a group accident
  or group health policy pursuant to subdivision three of this section  or
  the  failure  to  remit  premiums  pursuant  to  subdivision six of this
  section, or  the  failure  to  provide  an  individual  with  notice  of
  termination   pursuant   to  subdivision  six  of  section  one  hundred
  ninety-five of this chapter, the policy holder shall also be liable,  in
  a  civil action brought by the individual entitled to receive the notice
  of termination or exercise the right to continuation of  coverage  in  a
  court  of  competent  jurisdiction,  to  appropriate damages which shall
  include reimbursement for medical expenses which were not covered by the
  policyholder's insurer by virtue of his termination  of  the  policy  or
  failure to remit such premiums.