N.Y. Insurance Law § 4306-e: Prohibition on lifetime and annual limits

§ 4306-e. Prohibition on lifetime and annual limits. (a) A corporation

shall not establish a lifetime limit on the dollar amount of essential

health benefits in an individual, group or blanket contract of hospital,

medical, surgical or prescription drug expense insurance.

(b) A corporation shall not establish an annual limit on the dollar

amount of essential health benefits in an individual, group or blanket

contract of hospital, medical, surgical or prescription drug expense

insurance for contract years beginning on and after January one, two

thousand fourteen.

(c) For contract years beginning prior to January one, two thousand

fourteen, a corporation may establish restricted annual limits on the

dollar amount of essential health benefits in an individual, group or

blanket contract of hospital, medical, surgical or prescription drug

expense insurance consistent with section 2711 of the Public Health

Service Act, 42 U.S.C. § 300gg-11 or any regulations thereunder.

(d) The requirements of subsections (b) and (c) of this section shall

not be applicable to any individual contract that is a grandfathered

health plan. For purposes of this section, "grandfathered health plan"

means coverage provided by a corporation in which an individual was

enrolled on March twenty-third, two thousand ten for as long as the

coverage maintains grandfathered status in accordance with section

1251(e) of the Affordable Care Act, 42 U.S.C. § 18011(e).

(e) For purposes of this section, "essential health benefits" shall

have the meaning ascribed by section 1302(b) of the Affordable Care Act,

42 U.S.C. § 18022(b).