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 52.41 - Gross premium differentials based on sex

Universal Citation: 11 NY Comp Codes Rules and Regs § 52.41

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

(a) The following requirements are established to limit maximum gross premium differentials between males and females for all accident and health policies or coverages where the insurance premium is paid by the insured:

(1) Net or gross premium assumptions may differentiate between the sexes only for factors based on differences in morbidity or mortality between males and females.

(2) Lapse and average size assumptions may not differ between males and females unless the insurer demonstrates to the satisfaction of the superintendent that the difference has a relationship to the morbidity or mortality assumptions such that the resulting rates are not unfairly discriminatory.

(b) Net premium differentials shall be determined on one or more of the following bases:

(1) a statistical analysis of the company's own experience, if credible;

(2) published credible experience, such as the morbidity studies of the Society of Actuaries and the studies made by the New York Insurance Department;

(3) any other valid data; or

(4) any combination of paragraph (1), (2) or (3) of this subdivision.

(c) Gross premium differentials between sexes in the same premium cell may reflect only the net premium differentials and those expenses which are directly related to the amount of premiums or claims (e.g., premium taxes, commissions, some claims administration expense). All other loadings for expenses shall be in the same amounts in dollars for both sexes. A company may utilize a simplified loading system if it can demonstrate that such system does not produce gross premium differentials which are generally greater than those generated by the method prescribed in this section, nor appreciably greater for any cell in the premium scale.

(d) Unisex rates are approvable for individual accident and health insurance if all rates for such individual insurance coverages offered by the company are charged on a unisex basis, unless the insurer demonstrates to the satisfaction of the superintendent that use of unisex rates for only some coverages is not unfairly discriminatory. This limitation does not apply to group, blanket or franchise insurance.

Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.