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 52.90 - Applicability provisions
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 52.90
Current through Register Vol. 46, No. 39, September 25, 2024
(a) This Part shall apply to accident and health insurance, except insurance defined in section 3201 (b)(4) of the Insurance Law.
(1) On January 1, 1983 with respect to
provisions of this Part previously promulgated on April 1, 1982 affecting:
(i) policies delivered or issued for delivery
in this State on or after January 1, 1983; and
(ii) any policies which are amended on or
after January 1, 1983 to substantially alter or change benefits or
coverages.
(2) Sections
52.40,
52.43,
52.44, 52.45 and
52.47 of this Part shall also
apply to accident and health insurance, except insurance defined in section
3201
(b)(4) of the Insurance Law on January 1,
1983 with respect to all existing in-force policies originally delivered or
issued for delivery in this State.
(3) On September 14, 1984 with respect to
amendments to section
52.40(c)(2)(vii)
of this Part promulgated on September 14, 1984.
(4) On January 1, 1986 with respect to
amendments to sections
52.16(c)(1), (f)
and 52.18(a) of this
Part promulgated on December 23, 1985 affecting (i) policies and certificates
delivered or issued for delivery in this State on or after January 1, 1986; and
(ii) certificates deemed to have been delivered in this State on or after
January 1, 1986 and which are subject to approval under section
3201
(b)(1) of the Insurance Law.
(5) On January 15, 1987 with respect to
section 52.23 of this Part promulgated on
December 23, 1986 affecting:
(i) policies
delivered or issued and certificates deemed to be delivered in this State on or
after January 1, 1988;
(ii)
policies delivered or issued and certificates deemed to be delivered in this
State prior to January 1, 1988 on the first anniversary date
thereafter;
(iii) on an optional
basis, any policies delivered or issued and certificates deemed to be delivered
in this State on a specified date chosen by the policyholder or insurer which
may not be prior to January 1, 1987 nor later than the date specified in
subparagraph (i) or (ii) of this paragraph; and
(6) On September 4, 1987 with respect to
section 52.27 of this Part affecting any
underwriting, rating or administration of claims relating to new or existing
policies or contracts providing hospital and/or medical expense or indemnity
benefits.
(7) On October 7, 1988
with respect to amendments of this Part promulgated on October 7, 1988 other
than amendments to sections
52.11(a),
52.22(b), (d), (j) and
(l),
52.54(c)(2)(viii),
and 52.63 of this Part which become
effective on January 1, 1989.
(8)
On October 1, 1989 with respect to amendments of this Part promulgated on
September 1, 1989 other than amendments to sections
52.11(a) and
52.63 of this Part which become
effective January 1, 1990.
(9) On
January 1, 1990 with respect to amendments to sections
52.5,
52.6 and
52.7 of this Part promulgated on
August 31, 1989, affecting:
(i) policies
delivered or issued for delivery and certificates deemed to be delivered in
this State on or after January 1, 1990;
(ii) any such policies or certificates
amended on or after January 1, 1990 to substantially alter or change benefits
or coverages;
(10) On
January 1, 1991 with respect to amendments to sections
52.7 and
52.16(c)(2) of
this Part promulgated on June 19, 1990 affecting:
(i) policies delivered or issued for delivery
and certificates deemed to be delivered in this State on or after January 1,
1991; or
(ii) any such policies or
certificates amended on or after January 1, 1991 to substantially alter or
change benefits or coverages.
(11) On December 12, 1989 with respect to
amendments of this Part other than amendments to sections
52.11(a) and
52.63 of this Part which become
effective January 1, 1990.
(12)
[Reserved]
(13) On May 1, 1991 with
respect to amendments to sections
52.1 and
52.40(f) of this
Part promulgated on January 29, 1991 affecting:
(i) New policies delivered and coverage
effectuated by participating employers principally located in this State on or
after May 1, 1991;
(ii) Existing
in-force policies delivered in this State and existing coverage effectuated by
participating employers principally located in this State on the first rating
period which commences on or after January 1, 1992, provided that:
(a) In the case of any group with a premium
rate on May 1, 1991 in excess of the maximum renewal rate computed in
accordance with section
52.40(f)(2) or
(3) of this Part, on the first rating period
which commences on or after January 1, 1994, with no increase implemented until
such time, provided, however, that the premium rate for any such group may be
increased in accordance with section
52.40(f)(2) or
(3) of this Part prior to January 1, 1994 on
the first rating period when the group's rate falls below such maximum renewal
rate.
(b) The disclosure
requirement set forth in section
52.40(f)(3)(ii)
of this Part shall be satisfied by providing the required disclosure to
existing groups not later than 30 days prior to the first rating period for
such group which commences on or after January 1, 1992.
(14) On January 1, 1992 with
respect to sections
52.12,
52.13,
52.25, 52.29 and
52.65, and amendments to sections
52.2,
52.10,
52.16,
52.17,
52.43, 52.45 and
52.54 of this Part promulgated on
July 2, 1991 affecting:
(i) policies
delivered or issued for delivery and certificates deemed to be delivered in
this State on or after January 1, 1992;
(ii) any such policies or certificates
amended on or after January 1, 1992 to substantially alter or change benefits
or coverages.
(15) Upon
publication in the State Register with respect to amendments to sections
52.1,
52.11,
52.16,
52.17,
52.18,
52.22,
52.28,
52.31,
52.40,
52.43,
52.44,
52.45,
52.47,
52.54, 52.59 and
52.63 of this Part affecting
policies and certificates delivered or issued for delivery in this State on or
after May 1, 1992.
(16) Upon filing
with the Secretary of State with respect to amendments to sections
52.11,
52.14,
52.17,
52.18,
52.22,
52.28,
52.40,
52.43, 52.44 and
52.63 of this Part, except that
for insurers currently in the Medicare supplement insurance market, compliance
with the amendments required by section
52.22(f)(6) and
(g) of this Part shall be no later than July
1, 1996.
(17) On April 22, 1999
with respect to amendments to sections
52.2,
52.11,
52.17,
52.18,
52.22 and
52.63 of this Part, except that
for insurers currently in the Medicare supplement insurance market, compliance
with the amendments required by sections
52.22(f)(2), (6)(ii)(c),
(g) and
52.63 of this Part shall be no
later than June 30, 1999.
(18)
Effective upon adoption, with respect to section
52.16(m) of this
Part, except that a health maintenance organization or insurer shall have 60
days immediately following the effective date to implement its denial
procedures pursuant to said section.
(19) Effective upon adoption, with respect to
section 52.25(f) of this
Part, affecting policies and certificates delivered or issued for delivery in
this State six months or more from such effective date.
(b) Approval is hereby withdrawn on January 1, 1983 with respect to all forms of accident and health insurance previously approved which are not in compliance herewith.
(c) Section 52.24 of this Part shall apply to group (including group remittance policies issued by article 43 corporations) and school blanket health insurance policies which provide coverage for inpatient hospital care, as follows:
(1) with
respect to inpatient hospital benefits for the diagnosis and treatment of
alcoholism and alcohol abuse and the report to the superintendent required by
section 52.24(d) of this
Part, on September 1, 1984;
(2)
with respect to outpatient visits for the diagnosis and treatment of alcoholism
and alcohol abuse, when the policy is issued, renewed, modified, altered or
amended on or after September 1, 1984; or
(3) with respect to the increase in
outpatient visits from 5 to 20 for family members when the covered person has
not received or is not receiving treatment for alcoholism or alcohol abuse,
when the policy is issued, renewed, modified, altered or amended on or after
January 1, 1988.
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