New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XIV - Individual And Small Group Health Insurance
Part 360 - Rules To Assure An Orderly Implementation And Ongoing Operation Of Open Enrollment And Community Rating Of Individual And Small Group Health Insurance
Section 360.5 - Prohibited underwriting practices and eligibility rules affecting individual and small group health insurance
Current through Register Vol. 46, No. 12, March 20, 2024
(a) In addition to the specific prohibitions set forth in sections 3221(q) and 4305(k) of the Insurance Law, the following underwriting practices are prohibited in regard to an insurer's decision whether to offer or accept health insurance applications:
(b) Insurers shall not provide coverage to groups where medical underwriting which affects eligibility for coverage under the policy has been performed by the group or anyone acting on the group's behalf.
(c) Actively at work rules, which delay eligibility of coverage under a group plan until the insured returns to the normal duties of employment for a specified period of time are prohibited.
(d) Applicants for group or individual insurance may not be denied coverage based upon eligibility for coverage under another group or individual plan unless the applicant is actually covered by another plan. However, applicants for an individual health insurance policy may be denied coverage where the individual is eligible for comparable group coverage through an employer.
(e) Notwithstanding any provisions of Part 52 of this Title to the contrary, no application for individual and small group policies of Medicare supplement insurance, as that term is defined in section 52.11 of Part 52 of this Title, shall include questions dealing with the health or health history of applicants.
