New York Codes, Rules and Regulations
Title 10 - DEPARTMENT OF HEALTH
Chapter II - Administrative Rules and Regulations
Subchapter R - Health Maintenance Organizations
Part 98 - Health Maintenance Organizations
Subpart 98-1 - Managed Care Organizations
Section 98-1.22 - Warning statements

Universal Citation: 10 NY Comp Codes Rules and Regs § 98-1.22

Current through Register Vol. 47, No. 12, March 26, 2025

(a) All paper claim forms for health insurance delivered to any person residing or located in this State, in connection with health insurance policies, except health insurance policies for title XVIII of the Federal Social Security Act, or State or local department of social services contracts to be issued or issued for delivery in this state shall, as of the date 90 days from the effective date of these regulations, contain the following statement: "Any person who, knowingly and with intent to defraud any MCO or other person, files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, is guilty of committing a fraudulent insurance act, which is a crime and shall be subject to a civil penalty not to exceed $5,000 and the stated value of the claim for each such violation."

(b) Location of warning statements and type size.

(1) The warning statements required by subdivisions (a) and (c) of this section shall be placed immediately above the space provided for the signature of the person executing the claim form and shall be printed in type which will produce a warning statement of conspicuous size. On claim forms which require execution by a person other than the claimant, or in addition to the claimant, the warning statements required by subdivisions (a) and (c) of this section shall be placed at the top of the first page of the claim form or on the page containing instructions, either in print, by stamp or by attachments and shall be in type size which will produce a warning statement of conspicuous size.

(2) Notwithstanding the provisions of paragraph (1) of this subdivision, MCOs may affix the warning statements required by this Subpart to all claim forms by means of labels and/or stamps or by attachment during the 90-day period following the effective date of these regulations.

(c) Notwithstanding the provisions of subdivision (a) of this section, MCOs may use substantially similar warning statements, provided such warning statements are submitted to the commissioner for prior approval.

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