New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter IV - Financial Condition Of Insurer and Reports to Superintendent
Subchapter B - Life Insurers
Part 101 - Standards For Financial Risk Transfer Between Insurers And Health Care Providers
Section 101.6 - Provider stop loss insurance
Universal Citation: 11 NY Comp Codes Rules and Regs ยง 101.6
Current through Register Vol. 46, No. 39, September 25, 2024
(a) No stop loss insurer may issue or deliver in this State a policy of provider stop loss insurance unless the insurer is authorized to issue a provider stop loss insurance policy in this State; pursuant to the provisions of section 4237-a of the Insurance Law.
(b) No policy of provider stop loss insurance shall permit the stop loss insurer to rescind the policy and no insurer shall rescind such policy.
(c) No policy of provider stop loss insurance may be issued or delivered in this State unless the policy, in substance provides:
(1) that the termination of the
policy shall not affect or reduce the stop loss insurer's obligation to, or
responsibility for, coverage to health care providers for covered claims which
occurred during the term of the policy;
(2) that in the event of the termination of
the financial risk transfer agreement by the superintendent, pursuant to the
provisions of section
101.9(a)(7) of
this Part, the insurer is the designated beneficiary for subscribers covered by
the stop loss insurance coverage for incurred but unpaid benefits for the time
frame for which in-network capitation payments were received by the health care
provider; and
(3) that the stop
loss insurer will provide notice (whether initiated by insured or the stop loss
insurer) of termination, cancellation, nonrenewal, or material change to the
terms of the coverage, to the health care provider and insurer at least 90 days
prior (or 45 days notice of cancellation for nonpayment of premium) to the
effective date of the notice.
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