New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter III - Policy and Certificate Provisions
Subchapter A - Life, Accident and Health Insurance
Part 59 - Minimum Standards For The Form, Content And Sale Of Group And Blanket Insurance Certificates Deemed To Have Been Delivered In This State Pursuant To Section 3201(b) Of The Insurance Law
Section 59.1 - Definitions

Universal Citation: 11 NY Comp Codes Rules and Regs § 59.1

Current through Register Vol. 46, No. 12, March 20, 2024

As used in this Part, the following terms shall have the meanings hereinafter ascribed to them:

(a) Substantially comply shall mean:

(1) compliance with New York group law standards, except that reasonable deviations may be permitted in benefit levels, conversion privileges, preexisting condition limitations and Flesch test standards;

(2) provisions prohibited by law or regulations are not included in the certificate;

(3) for accident and health and blanket insurance, compliance with at least the individual loss ratio standards established by New York regulation; and

(4) for life insurance, compliance with at least the minumum benefit ratio standards set forth in section 59.5(a) of this Part, reduced by 10 percentage points.

(b) Afford insureds protections substantially similar shall mean:

(1) providing all mandated coverages at a reasonable level of benefits, but not necessarily at the same level prescribed by law for policies and certificates actually delivered in New York;

(2) providing conversion rights and continuation rights prescribed by law for policies and certificates actually delivered in New York;

(3) compliance with laws and regulations which prohibit a specific benefit or policy provision;

(4) compliance with benefit ratio standards set forth in section 59.5 of this Part;

(5) including provisions which are at least as favorable as provisions contained in policies and certificates delivered in New York;

(6) providing readable language in certificates, with full compliance with statutory readability standards applicable to policies and certificates actually delivered in New York no later than January 1, 1987.

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