N.Y. Insurance Law § 4512: Accident and health and disability insurance certificates; compliance with rules and regulations

§ 4512. Accident and health and disability insurance certificates;

compliance with rules and regulations. (a) No certificate or other

evidence of any contract of accident insurance, disability income

insurance, or health insurance or of any total and permanent disability

insurance and no application or rider or endorsement for use in

connection therewith shall be delivered or issued for delivery in this

state unless it conforms with reasonable rules and regulations

prescribed by the superintendent and contains a provision that the

rights or obligations of the insured member under any such certificate

or other evidence of such contract, or of any person rightfully claiming

thereunder, shall be governed by the laws of this state. Pursuant to the

foregoing provisions the superintendent shall have power, from time to

time to make, alter and supersede reasonable rules and regulations

prescribing the required, optional and prohibited provisions in such

contracts, and such rules and regulations shall conform, as far as

practicable, to the provisions of section three thousand two hundred

fifteen of this chapter or of section three thousand two hundred sixteen

of this chapter, whichever shall be applicable. Where the superintendent

deems inapplicable, either in part or in their entirety, the provisions

of the aforesaid sections, he may prescribe the portions, or a summary

thereof, of the contract to be printed in the certificate issued to the

member.

(b) Anything in this article to the contrary notwithstanding, each

certificate of hospitalization expense benefits or surgical or medical

expense benefits delivered or issued for delivery in this state to any

member individually or as the head of a family shall:

(1) stipulate a premium determined on the basis of the age of the

member, which premium shall be subject to change only if the premiums on

all outstanding certificates in the same class are changed in accordance

with the standards which shall have been established prior to the

issuance of the certificate for the determination of the increase or

decrease in the premiums and are on file with and approved by the

superintendent,

(2) contain the following provisions under the caption "Incontestable

and Guaranteed Renewable":

"After this certificate has been in force for a period of one year

from the date of issue, it shall become incontestable as to the

statements contained in the application and the member shall have the

right to continue the same in force, subject to the timely payment of

premiums and the conditions of the certificate relating to military

service;" and

(3) in the case of such certificates written at issue age above

sixty-five years, contain the following provision:

"No claim for benefits provided in this certificate shall be reduced

or denied on the ground that a disease or physical condition had existed

prior to the effective date of coverage of this certificate, except only

such disease or physical condition which is specifically eliminated by

rider, attached to this certificate, a copy which shall have been

furnished to the member and its receipt evidenced by a signed amendment

to the application for such certificate."