New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter A - Life, Accident and Health Insurance
Part 55 - Notice To Employees Concerning Termination Of Group And Health Insurance Policies
Section 55.2 - Notice

Universal Citation: 11 NY Comp Codes Rules and Regs ยง 55.2

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

(a) An insurer who intends to terminate a group policy or contract of accident, or health, or accident and health insurance issued to a policyholder, covering individuals who because of their employee status are certificate holders under a group policy shall give the policyholder at least 30 days' prior written notice of its intent to terminate coverage. The notice to the policyholder shall set forth in detail the policyholder's obligation under Labor Law, section 217, and under this Part, to notify each certificate holder resident in New York State of the intended termination of the group policy.

(b) In its notice of intent to terminate coverage, the insurer shall set forth in full the rights of the certificate holders under the terminating policy as to coverage for illness, accident and treatment occurring prior to and subsequent to the termination date, and such other rights of certificate holders as may exist under the contract or policy (e.g.,conversion rights).

(c) The insurer shall advise the policyholder that the policyholder must give written notice of the intended termination to each certificate holder resident in New York State insured under the group policy by hand-delivering or mailing to the certificate holder a copy of the insurer's notice of termination and a covering letter advising the certificate holders of the intended termination.

(d) The insurer shall advise the policyholder that the policyholder's notice to the certificate holder shall be either:

(1) hand-delivered by the policyholder to the certificate holder at the certificate holder's place of employment (e.g., by including the notice in the certificate holder's pay envelope) at least nine days prior to the intended date of termination; or

(2) mailed by the policyholder to each certificate holder at the certificate holder's last known residential address at least nine days prior to the intended date of termination.

(e) The insurer shall advise the policyholder that the policyholder must also post a copy of the insurer's notice of intent to terminate and the required covering letter in conspicuous locations chosen as most likely to give notice to the certificate holders. The notice shall be posted at least nine days prior to the intended date of termination.

(f) The insurer shall advise the policyholder that in accordance with the provisions of Labor Law, section 217 (4), the provisions of this Part and Labor Law, section 217 (3) shall not be deemed to apply if, at least 10 days prior to the date of the intended termination, as specified in the insurer's notice of intent to terminate, the policyholder has:

(1) taken necessary steps whereby the intended termination is rendered null and void; or

(2) contracted with another insurer to replace the existing insurer for the providing of similar coverage for the same certificate holders, and filed an affidavit with the Commissioner of Labor and Superintendent of Insurance to that effect;
(i) affidavits filed with the Commissioner of Labor shall refer to Labor Law, section 217, and be addressed to:

Director of Labor Standards

Department of Labor

Agency Building 12

State Office Building Campus

Albany, NY 12240

(ii) affidavits filed with the Superintendent of Insurance shall refer to Labor Law, section 217 and this Part, and shall be addressed to:

Chief, Health Bureau

New York State Insurance Department

One Commerce Plaza

Albany, NY 12257

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