N.Y. Insurance Law § 4306: Required contract provisions

§ 4306. Required contract provisions. Every contract issued by any

corporation pursuant to the provisions of section four thousand three

hundred four of this article, shall be in writing and shall state the

terms and conditions thereof. No such contract shall be made, issued or

delivered in this state unless it contains the following provisions:

(a) a statement of the amount payable to the corporation by the

individual to whom the contract is issued and the times at which and

manner in which such amount is to be paid;

(b) a statement of the nature of the benefits to be furnished and the

period during which they will be furnished; and if there are any

benefits to be excepted, a detailed statement of such exceptions printed

as hereinafter specified;

(c) a statement of the terms and conditions, if any, upon which the

contract may be terminated at the option of the individual, or otherwise

terminated at the option of either party as permitted by subsection (b)

or (c) of section four thousand three hundred four of this article;

(d) a statement that the contract includes the endorsements thereon

and attached papers, if any;

(e) a statement that no statement by the individual in his application

for a contract shall avoid the contract or be used in any legal

proceeding thereunder, unless such application or an exact copy thereof

is included in or attached to such contract, and that no agent or

representative of such corporation and no broker, other than an officer

or officers designated therein, is authorized to change the contract or

waive any of its provisions;

(f) a statement that if the individual defaults in making any payment

under the contract, the subsequent acceptance of a payment by the

corporation or by one of its duly authorized agents or by a duly

authorized broker shall reinstate the contract, but with respect to

sickness and injury, only to cover such sickness as may be first

manifested more than ten days after the date of such acceptance;

(g) a statement of the period of grace which will be allowed the

individual for making any payment due under the contract which period

shall not be less than ten days;

(h) a statement on the first page of the contract or in a notice

attached to the contract that during a specified period of time, which

shall not be less than ten days nor more than twenty days from the date

the contract is delivered to the individual, it may be surrendered to

the corporation together with a written request for cancellation of the

contract and that in such event the corporation will refund any premium

paid therefor including any contract fees or other charges; provided,

however, that a contract sold by mail order and a contract providing

medicare supplemental insurance or long-term care insurance must contain

a provision permitting the individual a thirty day period for such

surrender;

(i) the age limit or date or period, if any, after which the coverage

provided by the contract will not be effective, or renewed, is stated in

a renewal provision set forth on the first page of the contract or as a

separate provision bearing an appropriate caption on the first page on

the contract or in a brief description in not less than fourteen point

bold face type set forth on the first page of the contract; nothing

herein contained shall limit or restrict the right of the corporation to

continue the contract after the age or period so stated;

(j) a statement under the caption "CONVERSION PRIVILEGE" which shall

set forth in substance the conversion privileges and related provisions

required by subsections (d) and (e) of section four thousand three

hundred four of this article;

(k) the exceptions of the contract shall appear with the same

prominence as the benefits to which they apply;

(l) if the contract contains any provision purporting to make any

portion of the articles, constitution or by-laws of the corporation a

part of the contract, such portion shall be set forth in full; and

(m) in every such contract made, issued or delivered in this state

there shall be a brief description of the contract on its first page and

on its filing back.

(n) a statement that a health care claim from a subscriber shall be

submitted within one hundred twenty days from the date of service;

provided, however, that if it was not reasonably possible for the

subscriber to submit the claim within that timeframe, then the claim

shall be submitted as soon as reasonably possible.

(o) Every contract delivered or issued for delivery in this state

which provides major medical or similar comprehensive-type coverage

shall provide space on any enrollment, renewal or initial online portal

process setup forms required of a subscriber or applicant for coverage,

except forms issued by the NY State of Health, the official Health Plan

Marketplace, other than those specifically referenced in subparagraph

(iv) of paragraph (a) of subdivision five of section forty-three hundred

ten and paragraph (v) of subdivision one of section two hundred six of

the public health law, so that the subscriber or applicant for coverage

shall register or decline registration in the donate life registry for

organ, eye and tissue donations under this section of the enrollment,

renewal or initial online portal process setup forms and that the

following is stated on the form in clear and conspicuous type:

"You must fill out the following section: Would you like to be added

to the Donate Life Registry? Check box for 'yes' or 'skip this

question'."