N.Y. Insurance Law § 3217: 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 secretary of state.

(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.