Legislation

Search OpenLegislation Statutes

This entry was published on 2023-05-12
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 7705
Definitions
Insurance (ISC) CHAPTER 28, ARTICLE 77
§ 7705. Definitions. As used in this article:

(a) "Account" means any of the two accounts created under section
seven thousand seven hundred six of this article.

(b) "Contractual obligations" means any obligation under covered
policies, but shall not include any obligation with respect to
policyholder dividends unpaid or unapplied, retrospective rate credits
or similar benefits or provisions.

(c) "Corporation" means The Life and Health Insurance Company Guaranty
Corporation of New York created under section seven thousand seven
hundred six of this article unless the context otherwise requires.

(d) "Covered policy" means any of the kinds of insurance specified in
paragraph one, two or three of subsection (a) of section one thousand
one hundred thirteen of this chapter, any supplemental contract, or any
funding agreement referred to in section three thousand two hundred
twenty-two of this chapter, or any portion or part thereof, within the
scope of this article under section seven thousand seven hundred three
of this article, except that any certificate issued to an individual
under any group or blanket policy or contract shall be considered to be
a separate covered policy for purposes of section seven thousand seven
hundred eight of this article.

(e) "Health insurance" means the kinds of insurance specified under
items (i) and (ii) of paragraph three and paragraph thirty-one of
subsection (a) of section one thousand one hundred thirteen of this
chapter, and section one thousand one hundred seventeen of this chapter;
medical expense indemnity, dental expense indemnity, hospital service,
or health service under article forty-three of this chapter; and
comprehensive health services under article forty-four of the public
health law. "Health insurance" shall not include hospital, medical,
surgical, prescription drug, or other health care benefits pursuant to:
(1) part C of title XVIII of the social security act (42 U.S.C. §
1395w-21 et seq.) or part D of title XVIII of the social security act
(42 U.S.C. § 1395w-101 et seq.), commonly known as Medicare parts C and
D, or any regulations promulgated thereunder; (2) titles XIX and XXI of
the social security act (42 U.S.C. § 1396 et seq.), commonly known as
the Medicaid and child health insurance programs, or any regulations
promulgated thereunder; (3) the basic health program under section three
hundred sixty-nine-gg of the social services law; (4) chapter 55 of part
II of subtitle A of title X (10 U.S.C §§ 1071-1110(b)), commonly known
as TRICARE, or any regulations promulgated thereunder; or (5) subpart G
of part III of title V (5 U.S.C. §§ 8101-9009), commonly known as the
Federal Employees Program, or any regulations promulgated thereunder.

(f) "Impaired insurer" means a member insurer which after the
effective date of this article is found to be impaired for the purposes
of section one thousand three hundred ten or one thousand three hundred
eleven of this chapter and is consequently placed under an order of
liquidation, rehabilitation or conservation under article seventy-four
of this chapter.

(g) "Insolvent insurer" means a member insurer which after the
effective date of this article becomes insolvent for the purposes of
section one thousand three hundred nine of this chapter and is placed
under a final order of liquidation, rehabilitation or conservation by a
court of competent jurisdiction.

(h) (1) "Member insurer" means:

(A) any life insurance company licensed to transact in this state any
kind of insurance to which this article applies under section seven
thousand seven hundred three of this article; provided, however, that
the term "member insurer" also means any life insurance company formerly
licensed to transact in this state any kind of insurance to which this
article applies under section seven thousand seven hundred three of this
article; and

(B) an insurer licensed or formerly licensed to write accident and
health insurance or salary protection insurance in this state,
corporation organized pursuant to article forty-three of this chapter,
reciprocal insurer organized pursuant to article sixty-one of this
chapter, cooperative property/casualty insurance company operating under
or subject to article sixty-six of this chapter, nonprofit
property/casualty insurance company organized pursuant to article
sixty-seven of this chapter, and health maintenance organization
certified pursuant to article forty-four of the public health law.

(2) "Member insurer" shall not include a municipal cooperative health
benefit plan established pursuant to article forty-seven of this
chapter, an employee welfare fund registered under article forty-four of
this chapter, a fraternal benefit society organized under article
forty-five of this chapter, an institution of higher education with a
certificate of authority under section one thousand one hundred
twenty-four of this chapter, or a continuing care retirement community
with a certificate of authority under article forty-six or forty-six-A
of the public health law.

(i) "Premiums" means direct gross insurance premiums and annuity and
funding agreement considerations received on covered policies, less
return premiums and considerations thereon and dividends paid or
credited to policyholders or contract holders on such direct business,
subject to such modifications as the superintendent may establish by
regulation or order as necessary to facilitate the equitable
administration of this article. Premiums do not include premiums and
considerations on contracts between insurers and reinsurers. For the
purposes of determining the assessment for an insurer under this
article, the term "premiums", with respect to a group annuity contract
(or portion of any such contract) that does not guarantee annuity
benefits to any specific individual identified in the contract and with
respect to any funding agreement issued to fund benefits under any
employee benefit plan, means the lesser of one million dollars or the
premium attributable to that portion of such group contract that does
not guarantee benefits to any specific individuals or such agreements
that fund benefits under any employee benefit plan.

(j) "Person" means any individual or legal entity, including a
corporation, partnership, association, limited liability company, trust,
or voluntary organization.

(k) "Resident" means a person to whom a contractual obligation is owed
and who either: (1) resides in this state on the date of entry of a
court order of liquidation or rehabilitation with respect to a member
insurer that is an impaired or insolvent insurer; or (2) resided in this
state at the time a member insurer issued a covered policy to such
person.

(l) "Supplemental contract" means an agreement or any other mechanism
for the distribution of proceeds under a life insurance policy, health
insurance policy, annuity contract, or funding agreement.

(m) "Long-term care insurance" means an insurance policy, rider, or
certificate advertised, marketed, offered, or designed to provide
coverage, subject to eligibility requirements, for not less than
twenty-four consecutive months for each covered person on an expense
incurred, indemnity, prepaid or other basis and provides at least the
benefits set forth in part fifty-two of title eleven of the official
compilation of codes, rules and regulations of this state.