S T A T E   O F   N E W   Y O R K
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                                  5419

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                            February 23, 2015
                               ___________

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.