New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter A - Life, Accident and Health Insurance
Part 52 - Minimum Standards For Form, Content And Sale Of Health Insurance, Including Standards Of Full And Fair Disclosure
Section 52.26 - Rules relating to exclusion of medicare benefits
Current through Register Vol. 46, No. 39, September 25, 2024
Subject to sections 3216 (c), 4235 (f), 4304 (d), 4304 (e)(1)-(3) and 4305 (d)(1) of the Insurance Law, the following rules shall apply to provisions with respect to Medicare:
(a) Policies may provide for termination of coverage upon eligibility for Medicare by reason of age only. An exception to this rule is subject to approval by the superintendent, and will be considered only if:
(b) Policies may limit benefit periods with respect to a covered person, effective when such person is eligible for Medicare by reason of age. Changes in existing policies must be accompanied, where appropriate, by a suitable adjustment in the premiums.
(c) Policies may provide for the exclusion of Medicare benefits when coverage continues beyond the covered person's eligibility for Medicare benefits, provided appropriate adjustment is made in the premium.
(d) Where group coverage terminates upon retirement, insurers may insert a Medicare exclusion applicable to employees who continue to work after the date of eligibility for Medicare.
(e) Eligibility for coverage under Medicare by reason of age constitutes a proper basis, under sections 3221 (e), 3216 (c) (g), 4303, 4304, 4305 and 4306 of the Insurance Law, for determining overinsurance, or duplication of benefits, for purposes of refusal to renew, refusal to issue a conversion policy and for limiting renewals to the date of eligibility for Medicare.
