Legislation

Search OpenLegislation Statutes
This entry was published on 2014-09-22
The selection dates indicate all change milestones for the entire volume, not just the location being viewed. Specifying a milestone date will retrieve the most recent version of the location before that date.
SECTION 4236
Joint underwriting of group health insurance for persons aged sixty-five and over
Insurance (ISC) CHAPTER 28, ARTICLE 42
§ 4236. Joint underwriting of group health insurance for persons aged
sixty-five and over. (a) It is the concern of the legislature that many
residents of this state of advanced years do not have readily available
to them health insurance adequate to their needs. It is the
legislature's intent to encourage and facilitate the writing of such
insurance by private insurers on a non-profit group basis in order to
make available to such persons broader coverage at lower rates than is
possible on a regular commercial basis. It is, therefore, the purpose of
the legislature to authorize and regulate, in the public interest,
cooperative action among such insurers in the preparation and issuance
of policies of health insurance, the making of rates to be charged
therefor and other matters within the scope of this section.

(b) In this section, unless the context otherwise requires,

(1) "Association" means a voluntary unincorporated non-profit
association formed for the sole purpose of enabling cooperative action
to provide health insurance in accordance with this section.

(2) "Health insurance" means hospital, surgical and medical expense
insurance, provided by a group health insurance policy or contract
issued in accordance with this section.

(3) "Insurer" means any insurance company authorized to do the
business of accident and health insurance in this state.

(4) "Insured" means a person covered under a group policy or contract
issued pursuant to this section.

(c) (1) Notwithstanding any other provision of this chapter or of any
other law which may be inconsistent herewith, any insurer may join with
one or more other insurers, on a uniform basis with respect to premium
rates, policy provisions, commissions and other matters within the scope
of this section, to offer, sell and issue to a policyholder group health
insurance covering residents of this state who are sixty-five years of
age or older and the spouses of such residents.

(2) Such insurance may also cover an employer's non-resident employees
and non-resident retired employees sixty-five years of age or older and
their spouses, provided such employees are regularly employed within
this state or were so employed at the time of their retirement.

(3) Such insurance may be offered, issued and administered jointly by
two or more such insurers through an association formed by such insurers
solely for the purpose of offering, selling, issuing and administering
such insurance in accordance with this section. Membership in such
association shall be open to any insurer.

(d) (1) Such association shall offer health insurance coverage to all
residents of this state who are sixty-five years of age or over and
their spouses, subject to reasonable underwriting restrictions to be set
forth in the plan of the association.

(2) Such coverage may consist of one or more of the following types:
(i) basic hospital and surgical coverage, (ii) basic medical coverage,
(iii) major medical coverage, and any combination of those types;
provided, however, that if coverage of the first or second type is
offered, it shall not be required as a condition of obtaining same that
coverage of the third type also be obtained.

(e) (1) Such association shall file with the superintendent its plan
for offering, selling, issuing and administering health insurance which
plan shall be subject to his approval as conforming to the purpose and
requirements of this section, and any policy, contract, certificate or
other evidence of insurance, application or other forms pertaining to
such insurance together with the premium rates to be charged therefor.

(2) No such policy, contract, certificate or other evidence of
insurance, application or other form shall be sold, issued or used and
no endorsement shall be attached to or printed or stamped thereon unless
the form thereof and the premium rates to be charged therefor shall have
been approved by the superintendent.

(3) The superintendent shall, within a reasonable time after the
filing of any such premium rates, policies, contracts, endorsements,
applications or other forms, notify the association filing the same of
his approval or disapproval thereof.

(4) The superintendent may disapprove such premium rates if he finds
them to be unfairly discriminatory or unreasonable in relation to the
benefits provided and he may disapprove such policies, contracts,
certificates, applications, endorsements or other forms if in his
judgment they contain provisions which he finds to be unjust, unfair,
inequitable, misleading, deceptive, prejudicial to the insured or
otherwise contrary to law or to the public policy of this state.

(5) The superintendent may, after notice and hearing, withdraw an
approval previously given, if the use thereof is contrary to the legal
requirements applicable thereto at the time of such withdrawal, or the
premiums are unfairly discriminatory or unreasonable in relation to the
benefits provided, or in his judgment they contain provisions which are,
or the continued use thereof would be, unjust, unfair, inequitable,
misleading, deceptive, prejudicial to the insured or otherwise contrary
to law or to the public policy of this state. Any such withdrawal of
approval shall be effective at the expiration of such period, not less
than ninety days after the giving of notice of withdrawal, as the
superintendent shall in such notice prescribe.

(6) In exercising the powers conferred upon him by this subsection the
superintendent shall not be bound by any other requirement of this
chapter with respect to standard provisions to be included in accident
and health policies or forms.

(7) The name of such association or any advertising and other
promotional and solicitation material used in connection with health
insurance offered, sold or delivered pursuant to this section shall not
be such as to mislead or deceive the public.

(f) Such association may solicit the sale of such health insurance
through any insurance agent licensed pursuant to section two thousand
one hundred three of this chapter and any insurance broker licensed
pursuant to section two thousand one hundred four of this chapter. It
shall not pay to such agent or broker or any other person any
commission, compensation or other fee or allowance not in accordance
with a schedule thereof which shall have been filed by it with and
approved by the superintendent. Except as aforesaid, it shall not pay
any commission, compensation, fee or allowance to any person but it may
pay a salary or compensation to persons regularly employed by it.

(g) Such association shall file annually with the superintendent, on
such date and in such form as he may prescribe, a statement with respect
to its operations.

(h) Notwithstanding any other provision of this chapter, an
association may offer, sell, issue or administer such a group policy or
contract of health insurance on a non-participating basis, provided,
however, that the excess, if any, of premiums received by it from
insureds over the cost of providing such insurance benefits shall be
used solely for the benefit of the insureds.

(i) Premiums for policies issued pursuant to this section shall not be
included in "premiums" for purposes of section five hundred fifty-two of
the former insurance law in effect immediately preceding the effective
date of this chapter and former section one hundred eighty-seven of the
tax law, nor shall section one thousand one hundred twelve of this
chapter be construed as subjecting the premiums for such policies to
taxation; nor shall such premiums be subject to any other tax imposed by
any other governmental subdivision.