2006 New York Code - Minimum Standards In The Form, Content And Sale Of Accident And Health Insurance; Policies And Subscriber Contracts.

 
    §  3217.  Minimum  standards in the form, content and sale of accident
  and health insurance;  policies  and  subscriber  contracts.    (a)  The
  superintendent  shall  issue  such  regulations  he  deems  necessary or
  desirable to establish minimum standards, including  standards  of  full
  and  fair  disclosure,  for  the  form, content and sale of accident and
  health insurance  policies  and  subscriber  contracts  of  corporations
  organized  under this article and article forty-three of this chapter or
  entities licensed pursuant to article forty-four of  the  public  health
  law.  With  regard  to  contracts issued pursuant to such articles which
  incorporate a usual and customary or reasonable form  of  reimbursement,
  such   regulations   shall   require   such   schedules  to  be  updated
  periodically, to accurately reflect geographic differences in costs  and
  that  information  be  furnished  to  insureds regarding the method upon
  which the usual and customary or reasonable charge is determined and the
  percentile of charges upon which the schedule is based. Such regulations
  shall also require,  in  addition  to  such  other  information  as  the
  superintendent  deems necessary, the disclosure of the reimbursement for
  a particular elective surgical  procedure  or  treatment,  upon  written
  request  by  an  insured,  subscriber  or enrollee. Such regulations may
  apply to all, any portion or reasonable classifications of such policies
  or contracts.
    (b) The purposes of such minimum standards shall include any or all of
  the following:
    (1) reasonable standardization  and  simplification  of  coverages  to
  facilitate understanding and comparisons;
    (2)  elimination of provisions which may be misleading or unreasonably
  confusing, in connection either with the purchase of  such  policies  or
  contracts or with the settlement of claims;
    (3)  elimination of deceptive practices in connection with the sale of
  such policies or contracts;
    (4) elimination of provisions which may be contrary to the health care
  needs  of  the  public,  as  certified  to  the  superintendent  by  the
  commissioner of health; and
    (5) elimination of coverages which are so limited in scope as to be of
  no substantial economic value to the holders.
    (c)    Prior  to the issuance of regulations pursuant to this section,
  the superintendent shall afford  the  public,  including  the  companies
  affected  thereby,  reasonable  opportunity for comment and shall obtain
  the views, in writing, of the commissioner of health and the chairman of
  the consumer protection board.
    (d)  When a regulation adopted pursuant to this section  so  provides,
  all forms of such policies or contracts which are not in compliance with
  such  regulation  shall  be deemed to be disapproved for use without any
  further or additional notice after  a  date  to  be  specified  in  such
  regulation  which  date  shall not be less than sixty days following its
  effective date.
    (e) When a regulation adopted pursuant to this  section  so  provides,
  any  such  policy  or contract which does not comply with the regulation
  shall, when issued after a date  not  less  than  sixty  days  from  the
  effective  date  of  such  regulation,  be construed, and the insurer or
  corporation shall be liable, as if the policy  or  contract  did  comply
  with the regulation.
    (f) Violation of any regulation adopted pursuant to this section shall
  be  a violation of this chapter for purposes of section one hundred nine
  of this chapter.