N.Y. Insurance Law § 4224: Life, accident and health insurance; discrimination and rebating; prohibited inducements and interdependent sales

§ 4224. Life, accident and health insurance; discrimination and

rebating; prohibited inducements and interdependent sales. (a) No life

insurance company doing business in this state and no savings and

insurance bank shall:

(1) make or permit any unfair discrimination between individuals of

the same class and of equal expectation of life, in the amount or

payment or return of premiums, or rates charged for policies of life

insurance or annuity contracts, or in the dividends or other benefits

payable thereon, or in any of the terms and conditions thereof;

(2) refuse to insure, refuse to continue to insure or limit the

amount, extent or kind of coverage available to an individual, or charge

a different rate for the same coverage solely because of the physical or

mental disability, impairment or disease, or prior history thereof, of

the insured or potential insured, except where the refusal, limitation

or rate differential is permitted by law or regulation and is based on

sound actuarial principles or is related to actual or reasonably

anticipated experience, in which case the insurer, subject to the

limitations contained in section twenty-six hundred eleven of this

chapter, shall notify the insured or potential insured of the right to

receive, or to designate a medical professional to receive, the specific

reason or reasons for such refusal, limitation or rate differential;

(3) refuse to insure, refuse to continue to insure or limit the

amount, extent or kind of coverage available to an individual, or charge

a different rate for the same coverage solely because the insured or

potential insured was prescribed pre-exposure prophylaxis (PrEP)

medication for the prevention of HIV infection;

(4) knowingly permit, and no agent thereof and no licensed insurance

broker shall offer to make or make, any policy of life insurance or

annuity contract or agreement as to such policy or contract other than

as plainly expressed in the policy or contract.

(b) No insurer doing in this state the business of accident and health

insurance, as specified in paragraph three of subsection (a) of section

one thousand one hundred thirteen of this chapter, and no officer or

agent of such insurer and no licensed insurance broker, and no employee

or other representative of such insurer, agent or broker shall:

(1) make or permit any unfair discrimination between individuals of

the same class in the amount of premiums, policy fees, or rates charged

for any policy of accident and health insurance, or in the benefits

payable thereon, or in any of the terms or conditions of such policies,

or in any other manner whatsoever;

(2) refuse to insure, refuse to continue to insure or limit the

amount, extent or kind of coverage available to an individual, or charge

a different rate for the same coverage solely because of the physical or

mental disability, impairment or disease, or prior history thereof, of

the insured or potential insured, except where the refusal, limitation

or rate differential is permitted by law or regulation and is based on

sound actuarial principles or is related to actual or reasonably

anticipated experience, in which case the insurer, subject to the

limitations contained in section twenty-six hundred eleven of this

chapter shall notify the insured or potential insured of the right to

receive, or to designate a medical professional to receive, the specific

reason or reasons for such refusal, limitation or rate differential;

(3) refuse to insure, refuse to continue to insure or limit the

amount, extent or kind of coverage available to an individual, or charge

a different rate for the same coverage solely because the insured or

potential insured was prescribed pre-exposure prophylaxis (PrEP)

medication for the prevention of HIV infection;

(4) knowingly permit or offer to make or make, any policy of accident

and health insurance, other than as plainly expressed in the policy.

(c) Except as permitted by section three thousand two hundred

thirty-nine of this chapter or subsection (f) of this section, no such

life insurance company and no such savings and insurance bank and no

officer, agent, solicitor or representative thereof and no such insurer

doing in this state the business of accident and health insurance and no

officer, agent, solicitor or representative thereof, and no licensed

insurance broker and no employee or other representative of any such

insurer, agent or broker, shall pay, allow or give, or offer to pay,

allow or give, directly or indirectly, as an inducement to any person to

insure, or shall give, sell or purchase, or offer to give, sell or

purchase, as such inducement, or interdependent with any policy of life

insurance or annuity contract or policy of accident and health

insurance, any stocks, bonds, or other securities, or any dividends or

profits accruing or to accrue thereon, or any valuable consideration or

inducement whatever not specified in such policy or contract other than

any valuable consideration, including but not limited to merchandise or

periodical subscriptions, not exceeding twenty-five dollars in value;

nor shall any person in this state knowingly receive as such inducement,

any rebate of premium or policy fee or any special favor or advantage in

the dividends or other benefits to accrue on any such policy or

contract, or knowingly receive any paid employment or contract for

services of any kind, or any valuable consideration or inducement

whatever which is not specified in such policy or contract.

(d) (1) No insurer authorized to do one or more of the kinds of

insurance business specified in paragraph one, two or three of

subsection (a) of section one thousand one hundred thirteen of this

chapter or authorized to do the kind of insurance business specified in

section three thousand two hundred twenty-two of this chapter shall

directly or indirectly, or by any of its agents or representatives, or

by any broker or brokers, participate in any plan to offer or effect any

kind or kinds of such insurance business in this state as an inducement

to, or interdependent with, the purchase by the public of any goods,

securities, commodities, housing, services or subscriptions to

periodicals, except as provided by subsection (e) of section three

thousand four hundred thirty-six, paragraph three of subsection (b) of

section four thousand two hundred sixteen of this article, by

subparagraph (E) of paragraph one of subsection (c) of section four

thousand two hundred thirty-five of this article or by article forty-six

of the public health law.

(2) This subsection shall not prohibit payment plans which are

otherwise in compliance with this subsection and this chapter.

(e) This section shall not prohibit the giving by any company, in its

discretion, of medical examinations and diagnoses and of nursing

services to all or any part of its policyholders, under reasonable rules

and regulations.

(f) (1) This subsection shall apply only with respect to a group or

blanket accident and health insurance policy issued by an insurer

licensed to write accident and health insurance in this state or a group

contract issued by a corporation organized pursuant to article

forty-three of this chapter, or a health maintenance organization

certified pursuant to article forty-four of the public health law.

(2) Notwithstanding subsection (c) of this section, a licensed agent

or insurance broker may develop, implement, and administer wellness

programs established in accordance with section three thousand two

hundred thirty-nine of this chapter without charging a service fee or,

in the case of a licensed insurance broker, for a reduced service fee

pursuant to a written memorandum made in accordance with subsection (c)

of section two thousand one hundred nineteen of this chapter, if such

programs are provided in a fair and nondiscriminatory manner and

incidental to a group or blanket policy or contract sold by the

insurance agent or insurance broker.