2013 New York Consolidated Laws
ISC - Insurance
Article 34 - (3401 - 3454) INSURANCE CONTRACTS-PROPERTY/CASUALTY
3453 - Group policy for service providers listed in a commercial directory.

 
    * §  3453.  Group  policy for service providers listed in a commercial
  directory. (a) For purposes of this section, the  following  definitions
  shall apply:
    (1) "Commercial directory" means any listing of businesses in print or
  electronic  form  that  is issued by an entity that publishes both white
  and yellow page directories.
    (2) "Group member" means a service provider that is insured under  the
  group policy.
    (3)  "Group  policyholder"  means  an entity that publishes commercial
  directories.
    (4) "Service provider" means any individual or business entity who  is
  listed  in a commercial directory; purchases advertising services from a
  publisher of a commercial  directory;  and  provides  certain  types  of
  services as specified by the publisher of the commercial directory.
    (b)  A group policy may be issued or issued for delivery in this state
  to a group policyholder only in accordance with the provisions  of  this
  section.
    (c)  Coverage  under  a  group  policy  shall  extend  only to service
  providers, and shall be associated with  the  performance  of  contracts
  entered into by service providers.
    (d)  A  group  policy  may  provide coverage for the kind of insurance
  authorized by  paragraph  sixteen  of  subsection  (a)  of  section  one
  thousand  one  hundred  thirteen  of  this  chapter,  and  the amount of
  coverage shall not  exceed  five  thousand  dollars  for  each  contract
  guaranteed by the coverage.
    (e)  The  premium for the group policy, including certificates, may be
  paid by the group policyholder from the funds contributed:
    (1) wholly by the group policyholder;
    (2) wholly by the group members; or
    (3) jointly by the group policyholder and the group members.
    (f)(1) A group policy, including certificates, on which all or part of
  the premium is to be derived from funds contributed by the group members
  specifically for their insurance may be placed  in  force  only  if  the
  group  policy  insures  not less than fifty percent of the then eligible
  service providers, or, if less, one hundred or  more  of  such  eligible
  service  providers  excluding  any  as  to  whom  evidence of individual
  insurability is  not  satisfactory  to  the  insurer.  A  group  policy,
  including certificates, on which no part of the premium is to be derived
  from  funds  contributed  by  the  group  members specifically for their
  insurance must insure all eligible service providers, excluding  any  as
  to  whom  evidence of individual insurability is not satisfactory to the
  insurer.
    (2) The group  policy  shall  insure  at  least  one  hundred  service
  providers  at date of issue, except that if part of the premium is to be
  derived from funds to be contributed by the group  members  specifically
  for  their  insurance,  then  the group policy shall insure at least two
  hundred service providers at date of issue.
    (g)  (1)  Any  policy  dividend,  retrospective  premium  credit,   or
  retrospective  premium  refund  in respect of premiums paid by the group
  policyholder may:
    (A) be applied  to  reduce  the  premium  contribution  of  the  group
  policyholder,  but  not in excess of the proportion to its contribution;
  or
    (B) be retained by the group policyholder.
    (2)  Any   policy   dividend,   retrospective   premium   credit,   or
  retrospective premium refund not distributed under paragraph one of this
  subsection shall be:

    (A)  applied  to  reduce  future  premiums  and,  accordingly,  future
  contributions, of existing or future group members, or both; or
    (B)  paid  or  refunded to those group members insured on the date the
  payment or refund is made to the group policyholder, if  distributed  by
  the  group  policyholder,  or  on  the  date  of mailing, if distributed
  directly by the insurer, subject to the following requirements:
    (i) the insurer shall be responsible for determining the allocation of
  the payment or refund to the group members;
    (ii) if the group policyholder distributes the payment or refund,  the
  insurer  shall be responsible for audit to ascertain that the payment or
  refund is actually made in accordance with the allocation procedure; and
    (iii) if the group policyholder fails to make the payment  or  refund,
  the  insurer shall make the payment or refund directly or use the method
  provided in subparagraph (A) of this paragraph.
    (3) Notwithstanding paragraphs one and two of this  subsection,  if  a
  dividend  accrues upon termination of coverage under a group policy, the
  premium for which was paid out of funds  contributed  by  group  members
  specifically  for  the  coverage,  then  the  dividend  shall be paid or
  refunded by the group policyholder to the group members insured  on  the
  date  the  payment  or  refund  is made to the group policyholder net of
  reasonable expenses incurred by the  group  policyholder  in  paying  or
  refunding the dividend to such group members.
    (4)  For the purposes of this subsection, "dividend" means a return by
  an insurer to a group policyholder of excess premiums paid by that group
  policyholder  in  light  of   favorable   loss   experience,   including
  retrospective premium credits or retrospective premium refunds. The term
  "dividend"  does  not include reimbursements or fees received by a group
  policyholder in connection with the operation  or  administration  of  a
  group policy, including administrative reimbursements, fees for services
  provided by the group policyholder, or transactional service fees.
    (h)  The  insurer must treat in like manner all eligible group members
  of the same class and status.
    (i) A group policy or certificate shall not be eligible for  placement
  by an excess line broker licensed pursuant to article twenty-one of this
  chapter.
    (j)(1) The insurer shall be responsible for the mailing or delivery of
  a  certificate of insurance to each group member. The insurer also shall
  be responsible for the mailing or delivery to each group  member  of  an
  amended  certificate  of  insurance,  or endorsement to the certificate,
  whenever there is a change  of  limits;  change  in  type  of  coverage;
  addition,   reduction,  or  elimination  of  coverage;  or  addition  of
  exclusion, under the group policy or certificate.
    (2) The certificate shall contain in substance all material terms  and
  conditions  of  coverage  afforded to the group member, unless the group
  policy is incorporated by reference and  a  copy  of  the  group  policy
  accompanies the certificate.
    (3)  If  coverage  afforded  to the group member is in excess of other
  applicable insurance coverage, then  the  certificate  shall  contain  a
  notice  advising the group member that if the member has other insurance
  coverage, specified coverages under the group policy will be excess over
  the other insurance.
    (k) A group policyholder shall comply with the provisions  of  section
  two  thousand one hundred twenty-two of this chapter, in the same manner
  as an agent or broker, in any advertisement, sign,  pamphlet,  circular,
  card,  or  other public announcement referring to coverage under a group
  policy or certificate.
    (l) A group policy or certificate shall  not  be  subject  to  section
  three  thousand  four hundred twenty-five or section three thousand four

  hundred twenty-six of this article.  The  following  requirements  shall
  apply in regard to termination of coverage:
    (1)(A)  An insurer may terminate a group policy or certificate only if
  cancellation is based on one  or  more  of  the  reasons  set  forth  in
  subparagraphs  (A)  through  (D)  or (F) through (H) of paragraph one of
  subsection (c) of section three thousand four hundred twenty-six of this
  article; provided, however, that an act or omission by  a  group  member
  that  would  constitute  the  basis  for  cancellation  of an individual
  certificate shall not constitute the basis for cancellation of the group
  policy.
    (B) Where the premium is derived wholly from funds contributed by  the
  group policyholder, an insurer may cancel an individual certificate only
  if  cancellation  is  based  on  one or more of the reasons set forth in
  subparagraph (B), (C) or (H) of  paragraph  one  of  subsection  (c)  of
  section three thousand four hundred twenty-six of this article.
    (2)(A)  An  insurer's  cancellation  of  a group policy, including all
  certificates, shall not become effective until fifteen  days  after  the
  insurer  mails  or  delivers written notice of cancellation to the group
  policyholder at the mailing address shown in the policy.
    (i) Where all or part of the premium is derived from funds contributed
  by the group member specifically for  the  coverage,  the  insurer  also
  shall mail or deliver written notice of cancellation of the group policy
  to the group member at the group member's mailing address.
    (ii)  Where none of the premium is derived from funds contributed by a
  group member specifically for the coverage, the group policyholder shall
  mail or deliver written notice to the group member  advising  the  group
  member of the cancellation of the account group policy and the effective
  date  of  cancellation. The group policyholder shall mail or deliver the
  written notice within ninety days after receiving notice of cancellation
  from the insurer.
    (B) An insurer's cancellation of an individual certificate  shall  not
  become  effective until fifteen days after the insurer mails or delivers
  written notice of cancellation to the group member at the group member's
  mailing address and to the group policyholder  at  the  mailing  address
  shown in the group policy.
    (C)(i)  A  group policyholder may cancel a group policy, including all
  certificates, or any individual certificate, for any reason upon  thirty
  days written notice to the insurer and each group member; and
    (ii)  The  group  policyholder shall mail or deliver written notice to
  each affected group member of the group policyholder's  cancellation  of
  the  group policy or certificate and the effective date of cancellation.
  The group policyholder shall mail or deliver the written notice  to  the
  group  member's  mailing  address  at  least  thirty  days  prior to the
  effective date of cancellation.
    (3)(A) Unless a group policy provides for a longer policy period,  the
  policy  and  all  certificates shall be issued or renewed for a one-year
  policy period.
    (B) The group policyholder shall be entitled to renew the group policy
  and all certificates upon timely payment of the premium  billed  to  the
  group policyholder for the renewal, unless:
    (i)  the  insurer  mails or delivers to the group policyholder and all
  group members written notice of nonrenewal, or conditional renewal; and
    (ii) the insurer mails or delivers the written notice at least thirty,
  but not more than one hundred twenty days prior to the  expiration  date
  specified  in  the  policy  or,  if  no  date  is  specified,  the  next
  anniversary date of the policy.
    (4) Where the group policyholder nonrenews the group policy, the group
  policyholder shall mail or deliver written notice to each  group  member

  advising  the  group  member  of  nonrenewal of the group policy and the
  effective date of nonrenewal.  The  group  policyholder  shall  mail  or
  deliver written notice at least thirty days prior to the nonrenewal.
    (5)  Every  notice of cancellation, nonrenewal, or conditional renewal
  shall set  forth  the  specific  reason  or  reasons  for  cancellation,
  nonrenewal, or conditional renewal.
    (6)(A)  An insurer shall not be required under this subsection to give
  notice to a group member if the insurer has been advised by  either  the
  group   policyholder  or  another  insurer  that  substantially  similar
  coverage has been obtained from  the  other  insurer  without  lapse  of
  coverage.
    (B)  A  group policyholder shall not be required under this subsection
  to give notice to a group member if substantially similar  coverage  has
  been obtained from another insurer without lapse of coverage.
    (7)(A) If, prior to the effective date of cancellation, nonrenewal, or
  conditional  renewal  of  the  group  policy,  or a certificate, whether
  initiated by the insurer, group policyholder or by the group  member  in
  regard  to the group member's certificate, coverage attaches pursuant to
  the terms of a group policy, then the coverage shall be effective  until
  expiration  of  the  applicable period of coverage provided in the group
  policy  notwithstanding  the  cancellation,  nonrenewal  or  conditional
  nonrenewal of the group policy.
    (B) Notwithstanding subparagraph (A) of this paragraph, an insurer may
  terminate coverage under an individual certificate on the effective date
  of  cancellation, if the certificate is cancelled in accordance with the
  provisions of subparagraph (B) of paragraph one of this subsection.
    (m) Notwithstanding any regulation to the contrary,  rates  and  forms
  for  any  group  policy  issued  or  issued  for  delivery in this state
  pursuant to this section shall  be  filed  with  the  superintendent  in
  accordance with article twenty-three of this chapter.
    * NB There are 3 § 3453's