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This entry was published on 2014-09-22
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SECTION 4224
Life, accident and health insurance; discrimination and rebating; prohibited inducements and interdependent sales
Insurance (ISC) CHAPTER 28, ARTICLE 42
§ 4224. Life, accident and health insurance; discrimination and
rebating; prohibited inducements and interdependent sales. (a) No life
insurance company doing business in this state and no savings and
insurance bank shall:

(1) make or permit any unfair discrimination between individuals of
the same class and of equal expectation of life, in the amount or
payment or return of premiums, or rates charged for policies of life
insurance or annuity contracts, or in the dividends or other benefits
payable thereon, or in any of the terms and conditions thereof;

(2) refuse to insure, refuse to continue to insure or limit the
amount, extent or kind of coverage available to an individual, or charge
a different rate for the same coverage solely because of the physical or
mental disability, impairment or disease, or prior history thereof, of
the insured or potential insured, except where the refusal, limitation
or rate differential is permitted by law or regulation and is based on
sound actuarial principles or is related to actual or reasonably
anticipated experience, in which case the insurer, subject to the
limitations contained in section twenty-six hundred eleven of this
chapter, shall notify the insured or potential insured of the right to
receive, or to designate a medical professional to receive, the specific
reason or reasons for such refusal, limitation or rate differential;

(3) knowingly permit, and no agent thereof and no licensed insurance
broker shall offer to make or make, any policy of life insurance or
annuity contract or agreement as to such policy or contract other than
as plainly expressed in the policy or contract.

(b) No insurer doing in this state the business of accident and health
insurance, as specified in paragraph three of subsection (a) of section
one thousand one hundred thirteen of this chapter, and no officer or
agent of such insurer and no licensed insurance broker, and no employee
or other representative of such insurer, agent or broker shall:

(1) make or permit any unfair discrimination between individuals of
the same class in the amount of premiums, policy fees, or rates charged
for any policy of accident and health insurance, or in the benefits
payable thereon, or in any of the terms or conditions of such policies,
or in any other manner whatsoever;

(2) refuse to insure, refuse to continue to insure or limit the
amount, extent or kind of coverage available to an individual, or charge
a different rate for the same coverage solely because of the physical or
mental disability, impairment or disease, or prior history thereof, of
the insured or potential insured, except where the refusal, limitation
or rate differential is permitted by law or regulation and is based on
sound actuarial principles or is related to actual or reasonably
anticipated experience, in which case the insurer, subject to the
limitations contained in section twenty-six hundred eleven of this
chapter shall notify the insured or potential insured of the right to
receive, or to designate a medical professional to receive, the specific
reason or reasons for such refusal, limitation or rate differential;

(3) knowingly permit or offer to make or make, any policy of accident
and health insurance, other than as plainly expressed in the policy.

(c) Except as permitted by section three thousand two hundred
thirty-nine of this chapter or subsection (f) of this section, no such
life insurance company and no such savings and insurance bank and no
officer, agent, solicitor or representative thereof and no such insurer
doing in this state the business of accident and health insurance and no
officer, agent, solicitor or representative thereof, and no licensed
insurance broker and no employee or other representative of any such
insurer, agent or broker, shall pay, allow or give, or offer to pay,
allow or give, directly or indirectly, as an inducement to any person to
insure, or shall give, sell or purchase, or offer to give, sell or
purchase, as such inducement, or interdependent with any policy of life
insurance or annuity contract or policy of accident and health
insurance, any stocks, bonds, or other securities, or any dividends or
profits accruing or to accrue thereon, or any valuable consideration or
inducement whatever not specified in such policy or contract other than
any valuable consideration, including but not limited to merchandise or
periodical subscriptions, not exceeding twenty-five dollars in value;
nor shall any person in this state knowingly receive as such inducement,
any rebate of premium or policy fee or any special favor or advantage in
the dividends or other benefits to accrue on any such policy or
contract, or knowingly receive any paid employment or contract for
services of any kind, or any valuable consideration or inducement
whatever which is not specified in such policy or contract.

(d) (1) No insurer authorized to do one or more of the kinds of
insurance business specified in paragraph one, two or three of
subsection (a) of section one thousand one hundred thirteen of this
chapter or authorized to do the kind of insurance business specified in
section three thousand two hundred twenty-two of this chapter shall
directly or indirectly, or by any of its agents or representatives, or
by any broker or brokers, participate in any plan to offer or effect any
kind or kinds of such insurance business in this state as an inducement
to, or interdependent with, the purchase by the public of any goods,
securities, commodities, housing, services or subscriptions to
periodicals, except as provided by subsection (e) of section three
thousand four hundred thirty-six, paragraph three of subsection (b) of
section four thousand two hundred sixteen of this article, by
subparagraph (E) of paragraph one of subsection (c) of section four
thousand two hundred thirty-five of this article or by article forty-six
of the public health law.

(2) This subsection shall not prohibit payment plans which are
otherwise in compliance with this subsection and this chapter.

(e) This section shall not prohibit the giving by any company, in its
discretion, of medical examinations and diagnoses and of nursing
services to all or any part of its policyholders, under reasonable rules
and regulations.

(f) (1) This subsection shall apply only with respect to a group or
blanket accident and health insurance policy issued by an insurer
licensed to write accident and health insurance in this state or a group
contract issued by a corporation organized pursuant to article
forty-three of this chapter, or a health maintenance organization
certified pursuant to article forty-four of the public health law.

(2) Notwithstanding subsection (c) of this section, a licensed agent
or insurance broker may develop, implement, and administer wellness
programs established in accordance with section three thousand two
hundred thirty-nine of this chapter without charging a service fee or,
in the case of a licensed insurance broker, for a reduced service fee
pursuant to a written memorandum made in accordance with subsection (c)
of section two thousand one hundred nineteen of this chapter, if such
programs are provided in a fair and nondiscriminatory manner and
incidental to a group or blanket policy or contract sold by the
insurance agent or insurance broker.