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 52.32 - Conditions for prefiled group coverage

Universal Citation: 11 NY Comp Codes Rules and Regs ยง 52.32

Current through Register Vol. 46, No. 39, September 25, 2024

Group insurance coverage, except coverage filed to specifically comply with article 9 of the Workers' Compensation Law, may be provided prior to the filing or approval of forms, provided that the conditions contained in this section are met. Failure to meet any of the conditions within the time specified shall be a violation of the Insurance Law, unless reasons for delay, including its probable extent, satisfactory to the department are submitted to the department within the respective times specified.

(a) A copy of a letter of confirmation sent to the policyholder by the insurer shall be submitted to the department within 30 days after the date the insurer agrees to provide insurance, setting forth, inter alia:

(1) the effective date of coverage;

(2) the nature and extent of the benefits or change in benefits as then known;

(3) that the contractual forms may be executed and issued for delivery only after filing with or approval thereof by the department; and

(4) an understanding that, if such forms are not filed or approved or are disapproved, the parties will be returned to the status quo insofar as possible, or the coverage will be modified retroactively to meet all requirements necesssary for approval.

(b) At the time the insurer agrees to provide such insurance:

(1) it is not reasonably possible to obtain approval prior to the effective date of coverage because the policyholder has requested the insurer to provide immediate coverage specifically designed to meet the needs of the policyholder; and

(2) the insurer has reasonable expectation of approval of the appropriate forms by the department.

(c) The actual forms are submitted for approval within six months from the date the insurer agreed to provide insurance.

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