N.Y. Insurance Law § 3201: 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 unallocated group annuity contract or funding agreement, or

policy form for accident and health insurance or any other policy form

specified by the superintendent pursuant to regulation shall be issued

by a domestic insurer or fraternal benefit society 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.

(7) Notwithstanding any other provision of this section, an approved

policy form that has been revised may continue to be delivered or issued

for delivery in this state without further approval from the

superintendent, provided that the policy form is revised solely to

reflect:

(A) a change in the investment options of a separate account offered

under the policy form, in accordance with an amended statement as to the

methods of operation of the separate account approved by the

superintendent pursuant to subsection (e) of section four thousand two

hundred forty of this chapter, and further provided that an

informational filing, in a form acceptable to the superintendent,

identifying the policy forms that have been revised and the investment

options offered in each policy form, is submitted to the superintendent

no later than sixty days after the amended statement as to the methods

of operation of the separate account has been approved; or

(B) any other type of change to a class or classes of policy forms for

which the superintendent waives or otherwise modifies the filing and

approval requirements of this section provided, however, that such

determination to waive or otherwise modify shall be published in written

guidance issued by the superintendent after such determination has been

made.

(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, or in an equally prominent manner

established at the discretion of the superintendent and promulgated

through regulations, the following:

"Read your policy (certificate) carefully.

"Certain (war, travel) risks are not assumed.

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(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) (a) The superintendent may disapprove any policy form specified in

paragraph two of subsection (b) of this section 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.

(b) Except for the policy forms specified in paragraph two of

subsection (b) of this section, every domestic life insurer and

fraternal benefit society shall file annually with the superintendent a

list identifying and describing the policy forms issued by the insurer

or fraternal benefit society for delivery outside the state in a form

prescribed by the superintendent. If the superintendent determines that

the issuance of a policy form has been or may be prejudicial to the

interests of policyholders or members, the superintendent may take any

action he or she deems appropriate, including issuing an order, after a

hearing, to cease and desist issuing the policy form.

(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 financial

services 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), (C), (D), (E) or (F) 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.