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This entry was published on 2014-09-22
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SECTION 3217
Minimum standards in the form, content and sale of accident and health insurance; policies and subscriber contracts
Insurance (ISC) CHAPTER 28, ARTICLE 32
§ 3217. Minimum standards in the form, content and sale of accident
and health insurance; policies and subscriber contracts. (a) The
superintendent shall issue such regulations he deems necessary or
desirable to establish minimum standards, including standards of full
and fair disclosure, for the form, content and sale of accident and
health insurance policies and subscriber contracts of corporations
organized under this article and article forty-three of this chapter or
entities licensed pursuant to article forty-four of the public health
law. With regard to contracts issued pursuant to such articles which
incorporate a usual and customary or reasonable form of reimbursement,
such regulations shall require such schedules to be updated
periodically, to accurately reflect geographic differences in costs and
that information be furnished to insureds regarding the method upon
which the usual and customary or reasonable charge is determined and the
percentile of charges upon which the schedule is based. Such regulations
shall also require, in addition to such other information as the
superintendent deems necessary, the disclosure of the reimbursement for
a particular elective surgical procedure or treatment, upon written
request by an insured, subscriber or enrollee. Such regulations may
apply to all, any portion or reasonable classifications of such policies
or contracts.

(b) The purposes of such minimum standards shall include any or all of
the following:

(1) reasonable standardization and simplification of coverages to
facilitate understanding and comparisons;

(2) elimination of provisions which may be misleading or unreasonably
confusing, in connection either with the purchase of such policies or
contracts or with the settlement of claims;

(3) elimination of deceptive practices in connection with the sale of
such policies or contracts;

(4) elimination of provisions which may be contrary to the health care
needs of the public, as certified to the superintendent by the
commissioner of health; and

(5) elimination of coverages which are so limited in scope as to be of
no substantial economic value to the holders.

(c) Prior to the issuance of regulations pursuant to this section, the
superintendent shall afford the public, including the companies affected
thereby, reasonable opportunity for comment and shall obtain the views,
in writing, of the commissioner of health and the secretary of state.

(d) When a regulation adopted pursuant to this section so provides,
all forms of such policies or contracts which are not in compliance with
such regulation shall be deemed to be disapproved for use without any
further or additional notice after a date to be specified in such
regulation which date shall not be less than sixty days following its
effective date.

(e) When a regulation adopted pursuant to this section so provides,
any such policy or contract which does not comply with the regulation
shall, when issued after a date not less than sixty days from the
effective date of such regulation, be construed, and the insurer or
corporation shall be liable, as if the policy or contract did comply
with the regulation.

(f) Violation of any regulation adopted pursuant to this section shall
be a violation of this chapter for purposes of section one hundred nine
of this chapter.