N.Y. Insurance Law § 3220: Group life insurance policies; standard provisions

§ 3220. Group life insurance policies; standard provisions. (a) No

policy of group life insurance shall be delivered or issued for delivery

in this state unless it contains in substance the following provisions

or provisions which in the opinion of the superintendent are more

favorable to certificate holders or not less favorable to certificate

holders and more favorable to policyholders:

(1) That the policy is incontestable after two years from its date of

issue, except for nonpayment of premiums by the policyholder; and that

no statement made by any person insured under the policy relating to his

insurability shall be used in contesting the validity of the insurance

with respect to which such statement was made after such insurance has

been in force prior to the contest for a period of two years during such

person's lifetime and in no event unless it is in a written instrument

signed by him, a copy of which is or has been furnished to such person

or to his beneficiary.

(2) That the rights of the policyholder or of any insured or

beneficiary thereunder shall not be affected by any provision other than

one contained in the policy or the riders or endorsements thereon or in

the amendments thereto signed by the policyholder and the insurer, or in

the copy of the policyholder's application attached to the policy or in

the individual statements, if any, submitted in connection therewith.

(3) For the equitable adjustment of the premium or if the amount of

insurance depends upon the age of the insured, for the equitable

adjustment of the amount of insurance and the premium in the event of a

misstatement of the age of the person insured.

(4) That the insurer will issue to the policyholder for delivery to

the person whose life is insured under such policy a certificate

containing a statement of the insurance protection to which he is

entitled including any changes in such protection depending on the age

of the person whose life is insured and the rights to which he is

entitled in accordance with paragraphs six and seven hereof.

(5) That the benefits payable under any such policy shall be payable

to the beneficiary or beneficiaries designated by the insured except,

where the policy contains conditions pertaining to family status, the

beneficiary may be the family member specified by the policy terms, but

if there is no such designated or specified beneficiary as to all or any

part of the insurance payable at the death of the insured, then the

amount of insurance so payable for which there is no such designated or

specified beneficiary shall be payable to the estate of the insured,

except that the policy may provide that the insurer may in such case, at

its option, pay such insurance to any one or more of the following

surviving relatives: wife, husband, mother, father, child or children,

brothers or sisters; and except that the policy may provide that the

insurer may, in any case, deduct from the aggregate sum payable under

such policy on account of the death of the insured, an amount not to

exceed five hundred dollars to be paid to any person or persons

appearing to the insurer to be equitably entitled to same by reason of

having incurred expenses on behalf of the insured or for his or her

burial. Payment in accordance with any of the foregoing provisions shall

completely discharge the insurer's liability with respect to the amount

of insurance so paid.

(6) That if the insurance on an employee or member covered under the

policy, other than one issued in accordance with paragraph three or

eight of subsection (b) of section four thousand two hundred sixteen of

this chapter, (A) ceases because of termination of (i) employment or of

membership in the class or classes eligible for coverage under the

policy, or (ii) the policy, or (B) is reduced (i) in the case of a

policy covering an employee or union member under a plan arranged by the

insured person's employer or union, on or after the employee's or union

member's attainment of age sixty in any increment or series of

increments aggregating twenty percent or more of the amount of coverage

in force before the first reduction on account of such age, (ii) in the

case of a policy covering any member other than as described in item (i)

of this subparagraph, at the time of the first reduction of insurance,

(iii) due to change in class or (iv) due to an amendment of the policy

to take effect immediately or at any subsequent date, such employee or

such member shall be entitled to have issued to him by the insurer,

without evidence of insurability, upon application made to the insurer

within thirty-one days after such termination or reduction of insurance

and payment of the premium applicable to the class of risk to which he

belongs and to the form and amount of the policy at his then attained

age, a policy of life insurance only, in any one of the forms

customarily issued by such insurer, except term insurance, in an amount

equal to the amount of his protection under such group insurance policy

at the time of such termination or reduction, less any amount of life

insurance remaining in force, except however, in the case of a reduction

in accordance with item (ii) of subparagraph (B) of this paragraph, in

an amount equal to eighty percent of his insurance coverage under such

group policy immediately prior to such reduction. Under a group policy

issued pursuant to paragraph twelve, thirteen or fourteen of subsection

(b) of section four thousand two hundred sixteen of this chapter, an

insured shall be entitled to convert, just as if he had terminated

membership in the class or classes eligible for coverage, within

thirty-one days after notice from the insurer that, in order to continue

his coverage under the group policy, he must contribute more than one

hundred thirty-three percent of the net premiums computed according to

the Commissioners 1960 Standard Group Mortality Table at three percent

interest. The group policy may contain a provision that if the

policyholder or insurer shall terminate the policy, the amount of life

insurance that may be converted shall in no event exceed the amount of

such employee's or member's life insurance protection less any amount of

life insurance for which he may be or may become eligible under any

group policy issued or reinstated by the same or another insurer within

forty-five days after the date of such cessation. However, at the option

of such employee or member, he shall be entitled to have issued to him

in accordance with the conditions prescribed above, a policy of life

insurance only, in any one of such forms, preceded by term insurance for

a period of one year with the premium payable, at the option of the

employee or member, in any mode customarily offered by the insurer. In

addition, the group policy shall contain a provision that if the

coverage of an employee or member ceases because of termination of

employment due to the employee's total and permanent disability or

termination of membership due to the member's total and permanent

disability, the employee or member, at the option of such employee or

member, shall be entitled to have issued to him, a policy of life

insurance only, in any one of such forms, preceded by term insurance for

a period of one year with the premium payable, at the option of the

employee or member, in any mode customarily offered by the insurer, in

the amount of such employee's or member's life insurance protection in

effect immediately before termination, less the amount of any life

insurance which is replaced with the same or another insurer within

forty-five days after cessation of the group life insurance protection.

Each such group policy shall contain a further provision to the effect

that upon the death of any such employee or member during such

thirty-one day period and before any such individual policy has become

effective, the amount of insurance for which such employee or member was

entitled to make application shall be payable as a death benefit by the

insurer; provided, however, each such policy may contain a provision

obligating the policyholder to pay a premium to the insurer for coverage

extended during such thirty-one day period in the event the extension of

coverage is a direct result of the policyholder's voluntary termination

of the policy and the policyholder replaces coverage under the policy

within six months of its termination either with the insurer or with

another insurer. The individual conversion policy may provide that any

statement made by the person insured under the group policy relating to

his insurability under such group policy may be used in contesting the

validity of the insurance under the individual conversion policy to the

same extent that such statement could have been used in contesting the

validity of his insurance under the group policy if his insurance under

the group policy had not ceased. An individual conversion policy shall

not exclude or restrict liability in the event of suicide of the insured

after two years from the date that the insured became covered under the

group policy. Notwithstanding the foregoing, the superintendent may

require conversion or continuation of insurance under conditions as set

forth in a regulation for insureds under a policy issued in accordance

with paragraph three of subsection (b) of section four thousand two

hundred sixteen of this chapter.

(7) At the option of the employee or member, any converted policy or

policies shall provide coverage for the dependents or class of

dependents of such employee or member who were insured under the group

policy. The effective date of the converted policy or policies shall be

the date of termination of the employee's or member's insurance under

the group policy. The conversion privilege shall be available (A) upon

termination or reduction of insurance as described in paragraph six of

this subsection, (B) upon the death of the employee or member to the

surviving spouse with respect to such spouse and children as are then

insured by the group policy, (C) to a child upon his attaining the

limiting age of coverage under the group policy while insured as a

dependent thereunder, and (D) upon the divorce or annulment of the

marriage of the employee or member to the spouse or former spouse of

such employee or member.

(8) That in the event a group life insurance policy issued for

delivery in this state permits a certificate holder to convert to

another type of life insurance within a specified time after the

happening of an event, such certificate holder shall be notified of such

privilege and its duration within fifteen days before or after the

happening of the event, provided that if such notice be given more than

fifteen days, but less than ninety days after the happening of such

event, the time allowed for the exercise of such privilege of conversion

shall be extended for forty-five days after the giving of such notice.

If such notice be not given within ninety days after the happening of

the event, the time allowed for the exercise of such conversion

privilege shall expire at the end of such ninety days. Written notice by

the policyholder given to the certificate holder or mailed to the

certificate holder at his last known address, or written notice by the

insurer mailed to the certificate holder at the last address furnished

to the insurer by the policyholder, shall be deemed full compliance with

the provisions of this paragraph for the giving of notice.

(9) That all new employees of the employer or all new members of the

labor union or other association or group as defined in this chapter, or

all new debtors of the vendor or creditor, as the case may be, in the

groups or classes eligible for such insurance must be added to such

groups or classes for which they are respectively eligible.

(10) In the case of a policy covering members of a labor union, or

other association or group as defined in this chapter (other than a

group as defined in paragraph one or three of subsection (b) of section

four thousand two hundred sixteen of this chapter, a notice in such

policy to the effect that the premium for the renewable term as therein

provided depends upon the attained ages of the members in the group and

increases with advancing ages.

(11) If the policy is in whole or in part on a plan of insurance other

than the term plan, it shall contain a nonforfeiture provision or

provisions which in the opinion of the superintendent is or are

equitable to the insured persons and to the policyholder, but this

paragraph does not require that such policy contain the same

nonforfeiture provisions required for individual life insurance

policies.

(12) In every group plan issued in accordance with paragraph three of

subsection (b) of section four thousand two hundred sixteen of this

chapter insuring loans made by production credit associations organized

pursuant to an Act of Congress of the United States, entitled the "Farm

Credit Act of 1933", approved June sixteenth, nineteen hundred

thirty-three as amended, or insuring loans made by a bank, trust company

or industrial bank to a borrower engaged in the business of farming,

crop production or the raising, breeding, fattening or marketing of

livestock for the purpose of such business and other requirements of the

borrower, a provision that, upon renewal of the loan commitment each

year prior to the attainment of age fifty by the certificate-holder,

coverage may be renewed by the certificate-holder without additional

requirements each year in an amount equal to the loan commitment or the

previous year's coverage, whichever is less, unless coverage has been

previously terminated by action of the certificate-holder, and further

provided that the group policy is in full force and effect on the date

of renewal.

(b) None of the provisions of subsection (a) hereof relating to a

certificate issued under any group life insurance policy shall be deemed

applicable to any such policy which is issued to a vendor or creditor,

as defined in section four thousand two hundred sixteen of this chapter

and under the provisions of which no individual certificates are issued

or are issuable.

(c) (1) Notwithstanding any provision of law, a person whose life is

insured under any policy of group life insurance, whether or not such

policy is otherwise subject to this section, is permitted to make an

assignment of all or any part of his incidents of ownership in such

insurance, including, without limitation, any right to designate a

beneficiary or beneficiaries thereunder and any right to have an

individual policy issued upon termination either of employment or of

said policy of group life insurance, provided that the insurer and the

group policyholder may prohibit or restrict such assignment by

appropriate policy provisions except as otherwise provided in paragraph

three of this subsection.

(2) Paragraph one of this subsection shall be construed as declaring

the law as it existed prior to its enactment and not as modifying it.

(3) A group policy that permits assignment of an insured person's

rights by gift shall also allow assignment for value to the same extent

that it allows assignment by gift.

(d) The provisions of paragraphs four, five, six, seven, eight, nine

and ten of subsection (a) of this section and paragraph one of

subsection (c) of this section shall not apply to policies issued under

the authority of subsection (d) or subparagraph (B) of paragraph (1) of

subsection (a) of section three thousand two hundred five of this

article.