N.Y. Insurance Law § 4236: Joint underwriting of group health insurance for persons aged sixty-five and over

§ 4236. Joint underwriting of group health insurance for persons aged

sixty-five and over. (a) It is the concern of the legislature that many

residents of this state of advanced years do not have readily available

to them health insurance adequate to their needs. It is the

legislature's intent to encourage and facilitate the writing of such

insurance by private insurers on a non-profit group basis in order to

make available to such persons broader coverage at lower rates than is

possible on a regular commercial basis. It is, therefore, the purpose of

the legislature to authorize and regulate, in the public interest,

cooperative action among such insurers in the preparation and issuance

of policies of health insurance, the making of rates to be charged

therefor and other matters within the scope of this section.

(b) In this section, unless the context otherwise requires,

(1) "Association" means a voluntary unincorporated non-profit

association formed for the sole purpose of enabling cooperative action

to provide health insurance in accordance with this section.

(2) "Health insurance" means hospital, surgical and medical expense

insurance, provided by a group health insurance policy or contract

issued in accordance with this section.

(3) "Insurer" means any insurance company authorized to do the

business of accident and health insurance in this state.

(4) "Insured" means a person covered under a group policy or contract

issued pursuant to this section.

(c) (1) Notwithstanding any other provision of this chapter or of any

other law which may be inconsistent herewith, any insurer may join with

one or more other insurers, on a uniform basis with respect to premium

rates, policy provisions, commissions and other matters within the scope

of this section, to offer, sell and issue to a policyholder group health

insurance covering residents of this state who are sixty-five years of

age or older and the spouses of such residents.

(2) Such insurance may also cover an employer's non-resident employees

and non-resident retired employees sixty-five years of age or older and

their spouses, provided such employees are regularly employed within

this state or were so employed at the time of their retirement.

(3) Such insurance may be offered, issued and administered jointly by

two or more such insurers through an association formed by such insurers

solely for the purpose of offering, selling, issuing and administering

such insurance in accordance with this section. Membership in such

association shall be open to any insurer.

(d) (1) Such association shall offer health insurance coverage to all

residents of this state who are sixty-five years of age or over and

their spouses, subject to reasonable underwriting restrictions to be set

forth in the plan of the association.

(2) Such coverage may consist of one or more of the following types:

(i) basic hospital and surgical coverage, (ii) basic medical coverage,

(iii) major medical coverage, and any combination of those types;

provided, however, that if coverage of the first or second type is

offered, it shall not be required as a condition of obtaining same that

coverage of the third type also be obtained.

(e) (1) Such association shall file with the superintendent its plan

for offering, selling, issuing and administering health insurance which

plan shall be subject to his approval as conforming to the purpose and

requirements of this section, and any policy, contract, certificate or

other evidence of insurance, application or other forms pertaining to

such insurance together with the premium rates to be charged therefor.

(2) No such policy, contract, certificate or other evidence of

insurance, application or other form shall be sold, issued or used and

no endorsement shall be attached to or printed or stamped thereon unless

the form thereof and the premium rates to be charged therefor shall have

been approved by the superintendent.

(3) The superintendent shall, within a reasonable time after the

filing of any such premium rates, policies, contracts, endorsements,

applications or other forms, notify the association filing the same of

his approval or disapproval thereof.

(4) The superintendent may disapprove such premium rates if he finds

them to be unfairly discriminatory or unreasonable in relation to the

benefits provided and he may disapprove such policies, contracts,

certificates, applications, endorsements or other forms if in his

judgment they contain provisions which he finds to be unjust, unfair,

inequitable, misleading, deceptive, prejudicial to the insured or

otherwise contrary to law or to the public policy of this state.

(5) The superintendent may, after notice and hearing, withdraw an

approval previously given, if the use thereof is contrary to the legal

requirements applicable thereto at the time of such withdrawal, or the

premiums are unfairly discriminatory or unreasonable in relation to the

benefits provided, or in his judgment they contain provisions which are,

or the continued use thereof would be, unjust, unfair, inequitable,

misleading, deceptive, prejudicial to the insured or otherwise contrary

to law or to the public policy of this state. Any such withdrawal of

approval shall be effective at the expiration of such period, not less

than ninety days after the giving of notice of withdrawal, as the

superintendent shall in such notice prescribe.

(6) In exercising the powers conferred upon him by this subsection the

superintendent shall not be bound by any other requirement of this

chapter with respect to standard provisions to be included in accident

and health policies or forms.

(7) The name of such association or any advertising and other

promotional and solicitation material used in connection with health

insurance offered, sold or delivered pursuant to this section shall not

be such as to mislead or deceive the public.

(f) Such association may solicit the sale of such health insurance

through any insurance agent licensed pursuant to section two thousand

one hundred three of this chapter and any insurance broker licensed

pursuant to section two thousand one hundred four of this chapter. It

shall not pay to such agent or broker or any other person any

commission, compensation or other fee or allowance not in accordance

with a schedule thereof which shall have been filed by it with and

approved by the superintendent. Except as aforesaid, it shall not pay

any commission, compensation, fee or allowance to any person but it may

pay a salary or compensation to persons regularly employed by it.

(g) Such association shall file annually with the superintendent, on

such date and in such form as he may prescribe, a statement with respect

to its operations.

(h) Notwithstanding any other provision of this chapter, an

association may offer, sell, issue or administer such a group policy or

contract of health insurance on a non-participating basis, provided,

however, that the excess, if any, of premiums received by it from

insureds over the cost of providing such insurance benefits shall be

used solely for the benefit of the insureds.

(i) Premiums for policies issued pursuant to this section shall not be

included in "premiums" for purposes of section five hundred fifty-two of

the former insurance law in effect immediately preceding the effective

date of this chapter and former section one hundred eighty-seven of the

tax law, nor shall section one thousand one hundred twelve of this

chapter be construed as subjecting the premiums for such policies to

taxation; nor shall such premiums be subject to any other tax imposed by

any other governmental subdivision.