S T A T E O F N E W Y O R K
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7182--A
2015-2016 Regular Sessions
I N A S S E M B L Y
April 27, 2015
___________
Introduced by M. of A. CYMBROWITZ -- read once and referred to the
Committee on Insurance -- committee discharged, bill amended, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to the designation of
third parties to receive notification of cancellation
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 6 of subsection (b) of section 1117 of the insur-
ance law, as added by chapter 572 of the laws of 2008, is amended to
read as follows:
(6) prior to the earlier of the execution of a policy or certificate
in connection with a plan providing a home care benefit and/or a nursing
home benefit, or the payment of any premium or fee related to such a
policy or certificate, the authorized insurer, corporation, health main-
tenance organization or fraternal benefit society shall provide the
prospective insured or his or her representative with a disclosure
statement, which contains the following:
(A) The maximum daily and lifetime benefit levels, if applicable,
provided by the policy or certificate for home care services and nursing
home services;
(B) The percentage of coverage provided for home care services and
nursing home services, if applicable, and an explanation of the method-
ology on which the reasonable charge used in conjunction with such
percentage amount is based;
(C) A description of any inflation protection feature included in or
available for purchase under the policy or certificate and the addi-
tional premium required to purchase such option or options;
(D) (i) If available and accessible by the insurer or other entity
from the department of health, the most recently-published average,
statewide rate for care in a nursing home, as well as the average rates
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD00936-02-5
A. 7182--A 2
for care in nursing homes for both the New York city-metropolitan and
upstate regions of the state; or
(ii) If available and accessible by the insurer or other entity from
the department of health, the most recently-published map of the esti-
mated average regional rates in New York state for nursing home care;
[and]
(E) A graphic demonstration of the maximum daily nursing home benefit
level provided by the policy or certificate, and the impact that the
selection of any inflation protection options would have on such maximum
daily nursing home benefit level[.];
(F) THE RIGHT OF THE PROSPECTIVE INSURED, UPON ATTAINING THE AGE OF
SIXTY-FIVE YEARS, TO DESIGNATE A THIRD PARTY WHO WILL RECEIVE A COPY OF
ANY NOTICES OF NONPAYMENT OF PREMIUMS DUE OR NOTICE OF CANCELLATION FOR
NONPAYMENT OF PREMIUMS THAT IS SENT TO THE PROSPECTIVE INSURED; AND
(G) A LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE SHALL INCLUDE A
PROVISION THAT PROVIDES FOR REINSTATEMENT OF COVERAGE, IN THE EVENT OF
LAPSE, IF THE INSURER IS PROVIDED PROOF THAT THE POLICY HOLDER OR CERTI-
FICATEHOLDER WAS COGNITIVELY IMPAIRED OR HAD A LOSS OF FUNCTIONAL CAPAC-
ITY BEFORE THE GRACE PERIOD CONTAINED IN THE POLICY EXPIRED. THIS OPTION
SHALL BE AVAILABLE TO THE INSURED, IF REQUESTED, WITHIN FIVE MONTHS
AFTER TERMINATION AND SHALL ALLOW FOR THE COLLECTION OF PAST DUE PREMI-
UM, WHERE APPROPRIATE. THE STANDARD OF PROOF OF COGNITIVE IMPAIRMENT OR
LOSS OF FUNCTIONAL CAPACITY SHALL NOT BE MORE STRINGENT THAN THE BENEFIT
ELIGIBILITY CRITERIA ON COGNITIVE IMPAIRMENT OR THE LOSS OF FUNCTIONAL
CAPACITY CONTAINED IN THE POLICY AND CERTIFICATE.
For the purpose of this paragraph, "home care services" shall have the
same meaning as defined in subdivision one of section thirty-six hundred
two of the public health law. The prospective insured, or his or her
representative, shall acknowledge that the required disclosure has been
made by signing the disclosure statement prior to or contemporaneously
with the effective date of the policy or certificate.
Failure to provide information required by subparagraph (D) of this
paragraph shall not be construed as a violation of this section if such
information has not been made available by the department of health.
S 2. Subsection (e) of section 3111 of the insurance law, as added by
section 30 of part B of chapter 58 of the laws of 2004, is amended to
read as follows:
(e) Every insurer that has in force a long-term care insurance policy
as defined in section one thousand one hundred seventeen of this chapter
the premiums for which are paid directly to the insurer by the senior
citizen insured, except a policy that qualifies as a long-term care
insurance contract as defined in Section 7702B of the Internal Revenue
Code, shall permit senior citizen insureds to designate a third party to
whom the insurer shall transmit notices of nonpayment of premiums due or
notice of cancellation for nonpayment of premiums[, as determined by the
insurer]; PROVIDED THAT NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
SHALL BE SENT NO LATER THAN THIRTY DAYS BEFORE THE EFFECTIVE DATE OF
SUCH CANCELLATION. The senior [citizens] CITIZEN INSURED shall notify
the insurer that a third party has been so designated. Such notification
shall be delivered to the insurer [by certified mail, return receipt
requested,] IN THE SAME ENVELOPE AS THE SENIOR CITIZEN INSURED'S PREMIUM
PAYMENT and shall be effective not later than ten business days from the
date of receipt by the insurer. The notification must contain, in writ-
ing, an acceptance by the third party designee to receive such notices
of cancellation. Should the third party designee desire to terminate his
or her status as a third party designee, such designee shall provide
A. 7182--A 3
written notice to both the insurer and the senior citizen insured.
Should the senior citizen insured desire to terminate the third party
designation, the insured shall provide written notice to the insurer.
The transmission to the third party designee of any such notice of
cancellation shall be in addition to a copy of such document transmitted
to the senior citizen insured and when a third party is so designated
all such notices shall be mailed in an envelope clearly marked on its
face with the following: "IMPORTANT INSURANCE POLICY INFORMATION: OPEN
IMMEDIATELY". Designation as a third party shall not constitute accept-
ance of any liability on the third party for services provided to such
senior citizen. The insurer shall notify its senior citizen insureds NOT
LESS THAN annually in writing of the availability of the third party
designee notice procedure and [provide] INCLUDE information on how the
insured can commence this procedure[; however, such notice need not be
provided once a senior citizen has made a designation]. THE INSURER
SHOULD ALSO INCLUDE A COPY OF THE THIRD PARTY DESIGNATION FORM WHEN
PROVIDING SUCH INFORMATION.
S 3. This act shall take effect on the sixtieth day after it shall
have become a law.