S T A T E O F N E W Y O R K
________________________________________________________________________
5419
2015-2016 Regular Sessions
I N A S S E M B L Y
February 23, 2015
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Introduced by M. of A. O'DONNELL -- Multi-Sponsored by -- M. of A. SCHI-
MEL -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to prohibiting misleading
statements regarding benefit maximums and limitations of benefits,
either orally or in writing and requiring such benefit maximums and
limitations to be stated in clear and plain language in the insurance
contract or certificate
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 1 of subsection (a) of section 2123 of the insur-
ance law, as amended by section 37-a of part D of chapter 56 of the laws
of 2013, is amended to read as follows:
(1) No agent or representative of any insurer or health maintenance
organization authorized to transact life, accident or health insurance
or health maintenance organization business in this state, insurance
broker, person who has received a grant from and has been certified by
the health benefit exchange established pursuant to section 1311 of the
Affordable Care Act, 42 U.S.C. S 18031, to act as a navigator, including
any person employed by a certified navigator, or other person, firm,
association or corporation, shall issue or circulate or cause or permit
to be issued or circulated, any illustration, circular, statement or
memorandum misrepresenting the terms, benefits or advantages of any
policy or contract of life, accident or health insurance, any annuity
contract or any health maintenance organization contract, delivered or
issued for delivery or to be delivered or issued for delivery, in this
state, OR SHALL MAKE ANY MISLEADING STATEMENT ORALLY OR IN WRITING AS TO
THE TERMS OF COVERAGE OF SUCH POLICY INCLUDING BUT NOT LIMITED TO BENE-
FIT MAXIMUMS AND LIMITATIONS OF BENEFITS, or shall make any misleading
estimate as to the dividends or share of surplus or additional amounts
to be received in the future on such policy or contract, or shall make
any false or misleading statement as to the dividends or share of
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD07581-01-5
A. 5419 2
surplus or additional amounts previously paid by any such insurer or
health maintenance organization on similar policies or contracts, or
shall make any misleading representation, or any misrepresentation, as
to the financial condition of any such insurer or health maintenance
organization, or as to the legal reserve system upon which such insurer
or health maintenance organization operates.
S 2. Paragraph 1 of subsection (a) of section 3217-a of the insurance
law, as added by chapter 705 of the laws of 1996, is amended to read as
follows:
(1) a description of coverage provisions; health care benefits; bene-
fit maximums, including benefit limitations, AND ANY SUCH BENEFIT MAXI-
MUMS AND LIMITATIONS SHALL BE DESCRIBED IN CLEAR AND PLAIN LANGUAGE AND
PRINTED IN A FONT SIZE AND TYPE STYLE TO MAKE THEM CLEARLY VISIBLE TO
THE CONSUMER; and exclusions of coverage, including the definition of
medical necessity used in determining whether benefits will be covered;
S 3. This act shall take effect immediately; provided, however that
section two of this act shall take effect on the one hundred eightieth
day after it shall have become a law.