§ 3240*2 — Student accident and health insurance

New York § 3240*2

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 32: Insurance Contracts - Life, Accident and Health, Annuities

Text

* § 3240. Student accident and health insurance. (a) In this section:\n (1)(A) "Student accident and health insurance" means a policy or\ncontract of hospital, medical, or surgical expense insurance delivered\nor issued for delivery in this state on or after January first, two\nthousand fourteen, by an insurer or a corporation, to an institution of\nhigher education covering students enrolled in the institution and the\nstudents' dependents.\n (B) "Student accident and health insurance" shall not include:\n (i) a policy or contract that provides limited scope dental or vision\nbenefits meeting the definition of "excepted benefits" set forth in\nsection 2791 of the public health service act, 42 U.S.C. § 300gg-91(c);\n (ii) an accident policy or contract that provides benefits meeting the\ndefinition of "excepted benefits" set forth in section 2791 of the\npublic health service act, 42 U.S.C. § 300gg-91(c), if the policy or\ncontract:\n (I) is limited to coverage for intercollegiate sports injuries only;\n (II) provides benefits to diagnose and treat any intercollegiate\nsports injury and does not include a benefit dollar maximum amount per\ninjury that is less than the overall benefit dollar maximum amount per\nstudent under the intercollegiate sports injury policy or contract;\n (III) provides benefits on an expense incurred basis;\n (IV) provides that premiums are paid in full by the institution of\nhigher education;\n (V) includes prominent disclosure to the student that the accident\npolicy is not a substitute for comprehensive hospital and medical\ncoverage;\n (VI) provides coverage for intercollegiate sports injuries primary to\nany student accident and health insurance policy or contract or any\nstudent health plan issued pursuant to section one thousand one hundred\ntwenty-four of this chapter; except that a policy or contract meeting\nthe requirements of this item may be excess or secondary to any other\npolicy or contract of accident and health insurance; and\n (VII) includes a maximum benefit amount that is no less than the\ndeductible under the separate athletic association policy or contract if\ndesigned to coordinate with a separate policy or contract issued to an\nathletic association that extends coverage for intercollegiate sports\ninjuries;\n (iii) an accident policy or contract that provides benefits meeting\nthe definition of "excepted benefits" set forth in section 2791 of the\npublic health service act, 42 U.S.C. § 300gg-91(c)(1)(A), if the policy\nor contract:\n (I) is limited to transportation expenses in the event an insured\nstudent incurs a covered sickness or accident, including transportation\nexpenses for a medical escort to travel with the student and\ntransportation expenses for returning the student to the student's\ndomicile;\n (II) provides that premiums are paid in full by the institution of\nhigher education;\n (III) covers students enrolled in the institution of higher education;\n (IV) includes prominent disclosure to the student that the accident\npolicy is not a substitute for comprehensive hospital and medical\ncoverage; and\n (V) provides coverage for a period of twelve months; or\n (iv) an insurance policy, contract, or certificate that provides\nhospital, medical, or surgical expense coverage for a student while\nstudying outside the United States for a period of twelve months or less\nthat is issued to a student, provided that the student is also covered\nby comprehensive hospital and medical coverage within the United States\nand the insurance policy, contract, or certificate:\n (I) is subject to the requirements of subsections (b), (c), (d), (e),\n(h), and (i) of this section;\n (II) meets the definition of "expatriate health plan" set forth in 42\nU.S.C. § 18014(d)(2);\n (III) excludes coverage within the United States;\n (IV) may offer coverage for global evacuation and repatriation in the\nevent of the insured student's sickness or accident; and\n (V) may offer coverage for trip cancellation, trip interruption,\nbaggage, personal effects, or global evacuation and repatriation,\nincluding evacuation in the event of a natural or man-made disaster,\nsuch as an epidemic, political event, war, terrorist act, riot, or civil\ninsurrection, pursuant to section three thousand four hundred fifty-two\nof this chapter.\n (2) "Institution of higher education" or "institution" shall have the\nmeaning set forth in the higher education act of 1965, 20 U.S.C. § 1001.\n (3) "Insurer" means an insurer licensed to write accident and health\ninsurance pursuant to this chapter.\n (4) "Corporation" means a corporation organized in accordance with\narticle forty-three of this chapter.\n (5) "Intercollegiate sport" means a sport that has been designated as\nan intercollegiate sport by the institution of higher education in which\na student is enrolled and that is organized or sponsored by an\ninstitution of higher education.\n (6) "Intercollegiate sports injury" means an injury sustained by a\nstudent member of an athletics team during participation in an\nintercollegiate sport.\n (b) An insurer or corporation shall not impose any pre-existing\ncondition exclusion in a student accident and health insurance policy or\ncontract. An insurer or corporation shall not condition eligibility,\nincluding continued eligibility, for a student accident and health\ninsurance policy or contract on health status, medical condition,\nincluding both physical and mental illnesses, claims experience, receipt\nof health care, medical history, genetic information, evidence of\ninsurability, including conditions arising out of acts of domestic\nviolence, or disability.\n (c) An insurer or corporation shall condition eligibility including\ncontinuing eligibility, on the covered individual being enrolled as a\nstudent in an institution of higher education to which the student\naccident and health insurance policy or contract is issued.\n (d) A student accident and health insurance policy or contract shall\nprovide coverage for essential health benefits as defined in subsection\n(a) of section three thousand two hundred seventeen-i or subsection (a)\nof section four thousand three hundred six-h of this chapter, as\napplicable.\n (e) An insurer or corporation shall not refuse to renew or otherwise\nterminate a student accident and health insurance policy or contract\nexcept for one or more of the reasons set forth in:\n (1) subparagraphs (A), (B), (D) or (G) of paragraph two of subsection\n(p) of section three thousand two hundred twenty-one of this article; or\n (2) subparagraphs (A), (B), (D) or (G) of paragraph two of subsection\n(j) of section four thousand three hundred five of this chapter.\n (f) Other than the provisions herein also required by article\nforty-three of this chapter, this section shall not apply to coverage\nunder a student health plan issued pursuant to section one thousand one\nhundred twenty-four of this chapter.\n (g) The superintendent may promulgate regulations regarding student\naccident and health insurance, which may include minimum standards for\nthe form, content and sale of the policies and contracts and,\nnotwithstanding the provisions of section three thousand two hundred\nthirty-one and four thousand three hundred eight of this chapter, the\nestablishment of rating methodology to be applied to the policies and\ncontracts; provided that any such regulations shall be no less favorable\nto the insured than that which is provided under federal law and state\nlaw applicable to individual insurance.\n (h) The ratio of benefits to premiums shall be not less than\neighty-two percent as calculated in a manner to be determined by the\nsuperintendent.\n (i) Every insurer or corporation shall report to the superintendent\nannually, on a date specified by the superintendent in a regulation,\nclaims experience and other data in a manner acceptable to the\nsuperintendent that shall demonstrate the insurer's or corporation's\ncompliance with the applicable rules and regulations, including the\nminimum loss ratio required by subsection (h) of this section. Failure\nto comply with subsection (h) of this section is subject to corrective\naction, which may include the submission, to the superintendent, of an\nappropriate rate filing or form and rate filing to reduce future\npremiums, increase benefits, issue dividends, issue premium refunds or\ncredits, or any combination of these such that the minimum loss ratio\ncan reasonably be expected to be achieved.\n (j) With respect to benefits for treatment relating to an\nintercollegiate sports injury, as defined in paragraph six of subsection\n(a) of this section, a policy or contract of student accident and health\ninsurance or a student health plan issued pursuant to section one\nthousand one hundred twenty-four of this chapter shall be secondary to a\nseparate accident policy or contract meeting the requirements of clauses\n(I) through (VII) of item (ii) of subparagraph (B) of paragraph one of\nsubsection (a) of this section.\n * NB There are 2 § 3240's\n