2017 New York Laws
ISC - Insurance
Article 32 - Insurance Contracts - Life, Accident and Health, Annuities
3240*2 - Student Accident and Health Insurance.

*  3240. Student accident and health insurance. (a) In this section:
(1)(A)  "Student  accident  and  health  insurance"  means a policy or
  contract of hospital, medical, or surgical expense  insurance  delivered
  or  issued  for  delivery  in  this state on or after January first, two
  thousand fourteen, by an insurer or a corporation, to an institution  of
  higher  education  covering students enrolled in the institution and the
  students' dependents.
(B) "Student accident and health insurance" shall not include:
(i) a policy or contract that provides limited scope dental or  vision
  benefits  meeting  the  definition  of  "excepted benefits" set forth in
  section 2791 of the public health service act, 42 U.S.C.   300gg-91(c);
  or
(ii) an accident policy or contract that provides benefits meeting the
  definition  of  "excepted  benefits"  set  forth  in section 2791 of the
  public health service act, 42 U.S.C.  300gg-91(c),  if  the  policy  or
  contract:
(I) is limited to coverage for intercollegiate sports injuries only;
(II)  provides  benefits  to  diagnose  and  treat any intercollegiate
  sports injury and does not include a benefit dollar maximum  amount  per
  injury  that  is less than the overall benefit dollar maximum amount per
  student under the intercollegiate sports injury policy or contract;
(III) provides benefits on an expense incurred basis;
(IV) provides that premiums are paid in full  by  the  institution  of
  higher education;
(V)  includes  prominent  disclosure  to the student that the accident
  policy is not  a  substitute  for  comprehensive  hospital  and  medical
  coverage;
(VI)  provides coverage for intercollegiate sports injuries primary to
  any student accident and health insurance  policy  or  contract  or  any
  student  health plan issued pursuant to section one thousand one hundred
  twenty-four of this chapter; except that a policy  or  contract  meeting
  the  requirements  of  this item may be excess or secondary to any other
  policy or contract of accident and health insurance; and
(VII) includes a maximum benefit amount  that  is  no  less  than  the
  deductible under the separate athletic association policy or contract if
  designed  to  coordinate with a separate policy or contract issued to an
  athletic association that extends coverage  for  intercollegiate  sports
  injuries.
(2)  "Institution of higher education" or "institution" shall have the
  meaning set forth in the higher education act of 1965, 20 U.S.C.  1001.
(3) "Insurer" means an insurer licensed to write accident  and  health
  insurance pursuant to this chapter.
(4)  "Corporation"  means  a  corporation organized in accordance with
  article forty-three of this chapter.
(5) "Intercollegiate sport" means a sport that has been designated  as
  an intercollegiate sport by the institution of higher education in which
  a  student  is  enrolled  and  that  is  organized  or  sponsored  by an
  institution of higher education.
(6) "Intercollegiate sports injury" means an  injury  sustained  by  a
  student   member  of  an  athletics  team  during  participation  in  an
  intercollegiate sport.
(b) An insurer  or  corporation  shall  not  impose  any  pre-existing
  condition exclusion in a student accident and health insurance policy or
  contract.  An  insurer  or  corporation shall not condition eligibility,
  including continued eligibility,  for  a  student  accident  and  health
  insurance  policy  or  contract  on  health  status,  medical condition,
  including both physical and mental illnesses, claims experience, receipt
  of health  care,  medical  history,  genetic  information,  evidence  of

  insurability,  including  conditions  arising  out  of  acts of domestic
  violence, or disability.
(c)  An  insurer  or corporation shall condition eligibility including
  continuing eligibility, on the covered individual being  enrolled  as  a
  student  in  an  institution  of  higher  education to which the student
  accident and health insurance policy or contract is issued.
(d) A student accident and health insurance policy or  contract  shall
  provide  coverage  for  essential  health benefits as defined in section
  1302(b) of the affordable care act, 42 U.S.C.  18022(b).
(e) An insurer or corporation shall not refuse to renew  or  otherwise
  terminate  a  student  accident  and health insurance policy or contract
  except for one or more of the reasons set forth in:
(1) subparagraphs (A), (B), (D) or (G) of paragraph two of  subsection
  (p) of section three thousand two hundred twenty-one of this article; or
(2)  subparagraphs (A), (B), (D) or (G) of paragraph two of subsection
  (j) of section four thousand three hundred five of this chapter.
(f)  Other  than  the  provisions  herein  also  required  by  article
  forty-three  of  this  chapter, this section shall not apply to coverage
  under a student health plan issued pursuant to section one thousand  one
  hundred twenty-four of this chapter.
(g)  The  superintendent  may promulgate regulations regarding student
  accident and health insurance, which may include minimum  standards  for
  the   form,  content  and  sale  of  the  policies  and  contracts  and,
  notwithstanding the provisions of section  three  thousand  two  hundred
  thirty-one  and  four  thousand three hundred eight of this chapter, the
  establishment of rating methodology to be applied to  the  policies  and
  contracts; provided that any such regulations shall be no less favorable
  to  the  insured than that which is provided under federal law and state
  law applicable to individual insurance.
(h) The  ratio  of  benefits  to  premiums  shall  be  not  less  than
  eighty-two  percent  as  calculated  in a manner to be determined by the
  superintendent.
(i) Every insurer or corporation shall report  to  the  superintendent
  annually,  on  a  date  specified by the superintendent in a regulation,
  claims  experience  and  other  data  in  a  manner  acceptable  to  the
  superintendent  that  shall  demonstrate  the insurer's or corporation's
  compliance with the applicable  rules  and  regulations,  including  the
  minimum  loss  ratio required by subsection (h) of this section. Failure
  to comply with subsection (h) of this section is subject  to  corrective
  action,  which  may include the submission, to the superintendent, of an
  appropriate rate filing  or  form  and  rate  filing  to  reduce  future
  premiums,  increase  benefits, issue dividends, issue premium refunds or
  credits, or any combination of these such that the  minimum  loss  ratio
  can reasonably be expected to be achieved.
(j)   With   respect   to   benefits  for  treatment  relating  to  an
  intercollegiate sports injury, as defined in paragraph six of subsection
  (a) of this section, a policy or contract of student accident and health
  insurance or a student  health  plan  issued  pursuant  to  section  one
  thousand one hundred twenty-four of this chapter shall be secondary to a
  separate accident policy or contract meeting the requirements of clauses
  (I)  through  (VII) of item (ii) of subparagraph (B) of paragraph one of
  subsection (a) of this section.
* NB There are 2  3240's