N.Y. Insurance Law § 3453*3: Employer sponsored group personal excess insurance

* § 3453. Employer sponsored group personal excess insurance. (a) For

purposes of this section, the following definitions shall apply:

(1) "Certificate" or "certificate of insurance" means any policy,

contract or other evidence of insurance, or rider or endorsement

thereto, issued to a group member under an employer sponsored group

personal excess insurance policy.

(2) "Conditional renewal" means any change of limits, change in type

of coverage, reduction or elimination of coverage, increased deductible

or addition of exclusion, or increased premiums in excess of ten percent

(exclusive of any premium increase generated as a result of experience

rating, loss rating or retrospective rating).

(3) "Employee" means a director of the employer, or an individual or

partner who receives or has received income, wages or salaries from the

employer.

(4) "Employer" means a person, partnership, corporation or other

entity which pays or has paid income, wages or salaries to a person or

persons.

(5) "Employer sponsored group personal excess insurance" means a group

policy of insurance providing the kind of insurance defined in paragraph

thirteen or fourteen of subsection (a) of section one thousand one

hundred thirteen of this chapter, written as an excess policy with

premiums remitted by the employer, insuring groups of active and/or

retired employees designated by the employer.

(6) "Group member" means a designated active or retired employee

insured under this section and also may include the employee's domestic

partner or any person related to the employee by blood, marriage,

adoption, or operation of law, who resides in the same household

(including a ward or foster child) or who is a dependent child away at

school.

(7) "Group policy" means employer sponsored group personal excess

insurance written for the designated employees of an employer or other

group members as defined in this section.

(b) Employer sponsored group personal excess insurance may be written

in this state pursuant to this section.

(c) The premium for the group policy may be paid by the employer from

funds contributed:

(1) wholly by the employer;

(2) wholly by the employees or group members; or

(3) jointly by the employer and employees or group members.

(d) An employee or group member shall have the right to refuse

coverage offered by an employer under this section.

(e) Each policy written pursuant to this section shall provide

separate limits of coverage for each group member.

(f)(1) The insurer shall be responsible for the mailing or delivery to

the employer a group policy and certificates of insurance for each group

member insured under the group policy. The insurer shall also be

responsible for the mailing or delivery to the employer for each group

member any amended certificate of insurance, or endorsement to the

certificate, whenever there is a change of limits; addition, reduction,

or elimination of coverage; or addition of an 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, including, but not

limited to, the disclosure in clear and easily understandable language

of any limitations, exclusions or required underlying coverages, unless

the group policy is incorporated by reference and a copy of the group

policy accompanies the certificate.

(g)(1) 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 to authorized insurers in regard to termination of coverage.

(2) A group policy or certificate may be cancelled by an insurer only

if cancellation is based on one or more of the reasons set forth in

paragraph one of subsection (c) of section three thousand four hundred

twenty-six of this article, provided, however, that an individual group

member may also be canceled upon termination of his or her employment

with the employer.

(3) An insurer's cancellation of a group policy, or any certificate,

shall not become effective until forty-five days, or twenty days if

based upon non-payment of premium, after the insurer mails or delivers

written notice of cancellation to the employer at the mailing address

shown in the policy. The employer shall mail or deliver written notice

of such cancellation to each affected group member within ten days of

receiving a cancellation notice from the insurer advising the group

member of the cancellation and the effective date of the cancellation.

(h) An authorized insurer may nonrenew or conditionally renew a group

policy, or any certificate, under this section, for any reason upon

forty-five days written notice to the employer. The employer shall mail

or deliver written notice of such nonrenewal or conditional renewal to

each affected group member within ten days of receiving such notice from

the insurer.

(i) An employer may cancel a group policy, or any certificate, for any

reason upon thirty days written notice to the insurer and each affected

group member.

(j) 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 commencing with a common inception date. A new employee

may be added to the group policy for less than one year to conform with

a common expiration date.

(k) No policy form shall be delivered or issued for delivery by an

authorized insurer unless it has been filed with the superintendent and

the superintendent has either approved it, or thirty days have elapsed

and the superintendent has not disapproved such form as misleading or

violative of public policy. The initial rate of filing pursuant to this

section shall be subject to the prior approval of the superintendent,

and any subsequent rate filing shall not be subject to prior approval.

* NB There are 3 § 3453's