2006 New York Code - Approval Of Life, Accident And Health, Credit Unemployment, And Annuity Policy Forms.

 
    §  3201.  Approval  of life, accident and health, credit unemployment,
  and annuity policy forms. (a) In this article, "policy form"  means  any
  policy,   contract,  certificate,  or  evidence  of  insurance  and  any
  application  therefor,  or  rider  or  endorsement  thereto,   affording
  benefits  of  the  kinds  of  insurance specified in paragraph one, two,
  three or twenty-four of subsection  (a)  of  section  one  thousand  one
  hundred  thirteen  of this chapter, a group annuity certificate to which
  subsection (a) of section three thousand two hundred  nineteen  of  this
  article  applies,  and  a  funding agreement authorized by section three
  thousand two hundred twenty-two of this article. The term "policy  form"
  shall  not  include an agreement, special rider, or endorsement relating
  only to the manner of distribution of benefits or to the reservation  of
  rights  and benefits used at the request of the individual policyholder,
  contract holder or certificate holder.
    (b) (1) No policy form shall be delivered or issued  for  delivery  in
  this   state  unless  it  has  been  filed  with  and  approved  by  the
  superintendent as conforming to the requirements of this chapter and not
  inconsistent with law. A group life, group accident, group health, group
  accident and health or blanket accident and health insurance certificate
  evidencing insurance coverage on a  resident  of  this  state  shall  be
  deemed  to have been delivered in this state, regardless of the place of
  actual delivery, unless the insured group is of the type  described  in:
  (A)  section  four  thousand  two hundred sixteen, except paragraph four
  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, paragraph twelve, thirteen or fourteen of subsection (b) thereof;
  (B)  section  four  thousand two hundred thirty-five except subparagraph
  (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,  subparagraph  (K), (L) or (M) of paragraph one of subsection (c)
  thereof; or (C) section four thousand two hundred  thirty-seven  (except
  subparagraph  (F)  of paragraph three of subsection (a) thereof; of this
  chapter; and where the master policies or contracts were lawfully issued
  without this state in a jurisdiction where the insurer was authorized to
  do an insurance business. With regard to any certificate deemed to  have
  been   delivered  in  this  state  by  virtue  of  this  paragraph,  the
  superintendent shall (i) require that the premiums charged be reasonable
  in relation  to  the  benefits  provided,  except  in  cases  where  the
  policyholder   pays  the  entire  premium;  (ii)  have  power  to  issue
  regulations prescribing the required, optional and prohibited provisions
  in such certificates; (iii) establish an  accelerated  certificate  form
  approval procedure available to an insurer which includes a statement in
  its  policy form submission letter that it is the company's opinion that
  the certificate form or forms comply with applicable New  York  law  and
  regulations.  The  superintendent, upon receipt of such a filing letter,
  shall grant conditional approval of such certificate form  or  forms  in
  reliance  on  the  aforementioned  statement  by  the  company  upon the
  condition that the company will retroactively  modify  such  certificate
  form  or  forms,  to  the  extent  necessary,  if  it  is  found  by the
  superintendent that the certificate form fails to comply with applicable
  New York laws and regulations. The superintendent may,  with  regard  to
  the  approval  of  any certificate deemed to have been delivered in this
  state by virtue of this  paragraph,  approve  such  certificate  if  the
  superintendent  finds  that the certificate affords insureds protections
  substantially similar to those which have been provided by  certificates
  delivered  in  this  state. Any regulations issued by the superintendent
  pursuant to this paragraph may not  impose  stricter  requirements  than
  those applicable to similar policies and certificates actually delivered
  in this state.
    (2)  No policy form shall be issued by a domestic insurer for delivery
  outside this state unless it has been filed with the superintendent.
    (3) In exercising the authority granted  by  this  subsection  and  by
  subsection  (c)  hereof,  with  respect  to a policy or certificate form
  under which additional amounts may be credited  pursuant  to  subsection
  (b)  of  section  four  thousand  two hundred thirty-two or section four
  thousand five hundred eighteen of this chapter, the superintendent shall
  take into account the tax aspects of the policy form as they  relate  to
  all parties concerned.
    (4)  (A)  No  credit insurance or credit unemployment insurance policy
  form shall be issued unless it and its premium  rates  have  been  filed
  with  and  approved  by  the  superintendent.  In  this  section "credit
  insurance" and "credit  unemployment  insurance"  mean  insurance  on  a
  debtor, including an intended borrower, pursuant to a program as defined
  in  paragraph  three  of  subsection  (b)  of  section four thousand two
  hundred sixteen of this chapter for defraying the costs of attendance of
  a student at a college or university, in  connection  with  a  specified
  loan  or  other credit transaction to provide payment to the creditor in
  the event of the death of the debtor or indemnity to  the  creditor  for
  the  installment  payments  on  the  indebtedness becoming due while the
  debtor is disabled as defined in the policy, or payment to the  creditor
  for  the installment payments on the indebtedness becoming due while the
  debtor is unemployed as set forth in section three thousand four hundred
  thirty-six of this chapter.
    (B) The superintendent shall from time to time  prescribe  regulations
  which,  among  other  things,  shall  require  that, in the event of the
  termination of the insurance prior to the scheduled maturity date of the
  indebtedness or the last maturing instalment thereof, there shall be  an
  appropriate  refund  by  the  insurer  to the policyholder of any amount
  collected from or  charged  to  the  policyholder  for  such  terminated
  insurance,  and  an  appropriate refund or credit by the policyholder or
  creditor to the debtor of an amount collected from  or  charged  to  the
  debtor  for  such  terminated  insurance,  if such refund amounts to one
  dollar or more.
    (5) Notwithstanding the other provisions of this section, on and after
  June first, nineteen hundred eighty no policy form  of  industrial  life
  insurance,  industrial accident insurance or industrial health insurance
  shall be approved by the superintendent for  delivery  or  issuance  for
  delivery in this state.
    (6)  (A)  As  an  alternative  procedure  to  the  policy  form filing
  requirements of paragraph (1) of this subsection,  an  insurer  has  the
  option  to  file  an expedited policy form approval application with the
  superintendent pursuant to this paragraph. If this  option  is  elected,
  the  filing  shall  include the proposed policy form, including rates as
  required,  and  all  necessary  supporting  material  requested  by  the
  superintendent  pursuant  to  rule,  and  a  certification  signed by an
  officer of the insurer, who is knowledgeable with respect to the law and
  regulation applicable to the type of policy form, that such form  is  in
  compliance with the applicable law and regulations to the best of his or
  her knowledge and belief.
    Within  ninety  days of receipt of a filing, the superintendent shall,
  in writing, either approve,  submit  a  detailed  list  to  the  insurer
  requesting  all additional information necessary to make a determination
  on the filing, or deny such filing,  otherwise,  such  filing  shall  be
  deemed approved. Any denial issued by the superintendent shall state the
  reasons  for  such  disapproval.  If  an  insurer  does  not provide the
  additional information requested by the superintendent,  or  respond  to
  the  superintendent's  objections  within  forty-five days of receipt of
  such request or denial, then such filing shall be deemed denied and such
  filing  may  not  be  resubmitted for a period not to exceed ninety days
  from the date that such information or response was due. The  forty-five
  day  limit  for providing such additional information or response may be
  extended at the option of the superintendent.
    In  the  event  that  an  insurer  properly  submits  the   additional
  information  or  response,  then  such  filing  shall be deemed approved
  forty-five days after receipt of such information  or  response  by  the
  superintendent,  unless the insurer is notified in writing prior to such
  date that the filing has  been  denied.  Such  denial  shall  state  the
  reasons  for  such  disapproval and cannot be based on any objection not
  specified in the superintendent's initial review of the  filing,  unless
  the objection arises from a modification of the policy forms made by the
  insurer  in  addressing  the objections or new material submitted by the
  insurer.  Notwithstanding anything to the  contrary  contained  in  this
  section,  the  superintendent  may,  at  any  time, before the filing is
  either  deemed  approved,  affirmatively  approved,  or  denied,   raise
  objections to the policy form that is based on the explicit requirements
  of this chapter and any applicable regulations.
    The  superintendent  shall,  as soon as practicable, but no later than
  sixty days after receipt of the filing, notify the insurer if its filing
  is incomplete or fails to comply with applicable statutory or regulatory
  requirements. Such notice  shall  indicate  that  the  filing  is  being
  returned  with  no  action by the superintendent and that the period for
  the superintendent's substantive review has not commenced.
    (B)  Nothing  contained  in  this   paragraph   shall   prohibit   the
  superintendent  from  requiring  an  insurer  to retroactively modify or
  withdraw a form approved pursuant to the expedited filing  procedure  if
  such  form  is  found  to  fail to conform with the requirements of this
  chapter, provided that the order to withdraw  or  modify  such  form  is
  issued  in  accordance with the provisions of section three thousand one
  hundred ten or section three thousand two hundred two of this chapter.
    (C) In addition to any penalties  for  violations  contained  in  this
  chapter, any insurer which receives approval under this subsection for a
  form  which  is  found  to  fail  to  comply with the provisions of this
  chapter shall be ineligible to apply for an expedited review under  this
  subsection for a period not to exceed one year.
    (c) (1) The superintendent may disapprove any policy form for delivery
  or  issuance  for  delivery  in  this  state  if  he finds that the same
  contains any provision or has  any  title,  heading,  backing  or  other
  indication  of  the  contents  of any or all of its provisions, which is
  likely to mislead  the  policyholder,  contract  holder  or  certificate
  holder.
    (2)  The superintendent may disapprove any life insurance policy form,
  or any form of annuity contract or group  annuity  certificate,  or  any
  form  of funding agreement for delivery or issuance for delivery in this
  state, if  its  issuance  would  be  prejudicial  to  the  interests  of
  policyholders  or  members  or  it contains provisions which are unjust,
  unfair or inequitable.
    (3)  The  superintendent  may  disapprove  any  accident  and   health
  insurance  policy  form  for  delivery  or issuance for delivery in this
  state if the benefits provided therein are unreasonable in  relation  to
  the premium charged or any such form contains provisions which encourage
  misrepresentation   or  are  unjust,  unfair,  inequitable,  misleading,
  deceptive, or contrary to law or to the public policy of this state.
    (4) The superintendent shall not approve  any  life  insurance  policy
  form containing any war or travel exclusion or restriction, for delivery
  or  issuance  for  delivery in this state, unless such policy form shall
  have printed or stamped across its face in red and  in  capital  letters
  not smaller than twelve point type the following:
    "Read your policy (certificate) carefully.
    "Certain (war, travel) risks are not assumed.
    __________________________________
    (state which or both)
    In  case  of  any  doubt  write  your  company  (society)  for further
  explanation."
    (5) The superintendent shall not approve any annuity or life insurance
  policy form which is subject to the provisions of section four  thousand
  two  hundred  twenty,  four  thousand  two  hundred  twenty-one  or four
  thousand  five  hundred  eleven  of  this  chapter,  unless  a  detailed
  statement  of  the  method  used  by the insurer in calculating any cash
  surrender value and any paid-up nonforfeiture benefit in the policy form
  is stated therein or, in lieu thereof, a statement that such  method  of
  computation  has  been  filed with the insurance supervisory official of
  the state in which the policy form is delivered, and unless a  statement
  of  the  method  to  be used in calculating the cash surrender value and
  paid-up nonforfeiture benefit available on any  anniversary  beyond  the
  last  anniversary  for  which  such value and benefits are consecutively
  shown in the policy form is  included  therein,  and,  with  respect  to
  policy  forms under which additional amounts may be credited pursuant to
  subsection (b) of  section  four  thousand  two  hundred  thirty-two  or
  section four thousand five hundred eighteen of this chapter, the insurer
  shall also furnish such further information to the superintendent as the
  superintendent may require.
    (6)  The  superintendent  may  disapprove  any policy form issued by a
  domestic life insurer or fraternal benefit society for delivery  outside
  the  state  if its issuance would be prejudicial to the interests of its
  policyholders or members.
    (7) If any policy of  individual  accident  and  health  insurance  is
  issued  by  an  insurer domiciled in this state for delivery to a person
  residing in another state, and if the official having responsibility for
  the administration of the insurance laws of such other state shall  have
  advised  the  superintendent that any such policy form is not subject to
  approval or disapproval by such  official,  the  superintendent  may  by
  ruling  require  that  such  policy form meet the standards set forth in
  subsections (c) and (d) of section three thousand two hundred sixteen of
  this article.
    (8) Without limitation on his  other  powers  and  duties  under  this
  section,  the  superintendent  shall not approve any credit insurance or
  credit unemployment insurance policy  forms  or  premium  rates  if  the
  premium rates are unreasonable in relation to the benefits provided.
    (9)  Each  insurer shall file with the superintendent of insurance any
  change in the premium rates for policies authorized  under  subparagraph
  (J)  of  paragraph  one  of  subsection (c) of section four thousand two
  hundred thirty-five of this chapter, and the same shall  be  subject  to
  his approval.
    (10)  The  superintendent shall not approve any form of life insurance
  policy that is subject to the provisions of section  four  thousand  two
  hundred  twenty-one of this chapter or any form of annuity contract that
  is subject to the  provisions  of  section  four  thousand  two  hundred
  twenty-three of this chapter if such form of policy or contract provides
  for the adjustment of any cash surrender benefit or policy loan value in
  accordance  with  a  market-value adjustment formula, unless there shall
  have been filed with  the  superintendent  a  memorandum,  in  form  and
  substance   satisfactory   to   the   superintendent,   describing   the
  market-value adjustment formula and stating that, in the opinion of  the
  insurer,  the  formula  provides  reasonable  equity  to terminating and
  continuing policy and contract holders and to the insurer  and  complies
  with the nonforfeiture provisions of this chapter.
    (11)  (A) The superintendent shall not approve a life insurance policy
  which provides for accelerated payment  of  death  benefits  or  special
  surrender  values  pursuant  to  subparagraph (B) or subparagraph (C) or
  subparagraph (D) of paragraph one  of  subsection  (a)  of  section  one
  thousand  one  hundred  thirteen of this chapter unless it also provides
  for such accelerated payments or special surrender  values  pursuant  to
  subparagraph (A) of paragraph one of subsection (a) of such section.
    (B)  The  superintendent  shall  promulgate  a regulation establishing
  rules for advertising, disclosure, benefit levels, benefit  eligibility,
  payment  of  long  term  care  benefits, nonforfeiture, and reserves for
  accelerated payment  of  death  benefits  or  special  surrender  values
  provided  under  a life insurance policy. The regulation shall establish
  reasonable disclosure requirements  concerning  the  percentage  of  the
  death  benefit  payable when accelerated payment of the death benefit or
  special surrender value occurs, the impact of accelerated payment of the
  death benefit or special  surrender  value  on  eligibility  for  public
  assistance  (as  determined by the commissioner of social services), the
  prohibition that no health care facility as defined in section twenty of
  the public health law can require any person to accelerate payment of  a
  death  benefit  or  obtain  a  special surrender value as a condition of
  admission, providing or continuing care,  and  notice  of  possible  tax
  obligations.
    (12)  The  superintendent  shall  promulgate  a regulation relating to
  waiver of premium for unemployment as authorized  by  paragraph  one  of
  subsection  (a)  of  section  one  thousand one hundred thirteen of this
  chapter establishing minimum  standards  for  benefit  levels,  benefits
  eligibility  and  exclusions. The premium charged shall be reasonable in
  relation to the benefit provided.
    (d) The superintendent shall,  within  a  reasonable  time  after  the
  filing  of any policy form requiring approval, notify the insurer filing
  the form of his approval or disapproval of it.