§ 3453*3 — Employer sponsored group personal excess insurance

* § 3453. Employer sponsored group personal excess insurance. (a) For\npurposes of this section, the following definitions shall apply:\n (1) "Certificate" or "certificate of insurance" means any policy,\ncontract or other evidence of insurance, or rider or endorsement\nthereto, issued to a group member under an employer sponsored group\npersonal excess insurance policy.\n (2) "Conditional renewal" means any change of limits, change in type\nof coverage, reduction or elimination of coverage, increased deductible\nor addition of exclusion, or increased premiums in excess of ten percent\n(exclusive of any premium increase generated as a result of experience\nrating, loss rating or retrospective rating).\n (3) "Employee" means a director of the employer, or an individual or\npartner who receives or has received income, wages or salaries from the\nemployer.\n (4) "Employer" means a person, partnership, corporation or other\nentity which pays or has paid income, wages or salaries to a person or\npersons.\n (5) "Employer sponsored group personal excess insurance" means a group\npolicy of insurance providing the kind of insurance defined in paragraph\nthirteen or fourteen of subsection (a) of section one thousand one\nhundred thirteen of this chapter, written as an excess policy with\npremiums remitted by the employer, insuring groups of active and/or\nretired employees designated by the employer.\n (6) "Group member" means a designated active or retired employee\ninsured under this section and also may include the employee's domestic\npartner or any person related to the employee by blood, marriage,\nadoption, or operation of law, who resides in the same household\n(including a ward or foster child) or who is a dependent child away at\nschool.\n (7) "Group policy" means employer sponsored group personal excess\ninsurance written for the designated employees of an employer or other\ngroup members as defined in this section.\n (b) Employer sponsored group personal excess insurance may be written\nin this state pursuant to this section.\n (c) The premium for the group policy may be paid by the employer from\nfunds contributed:\n (1) wholly by the employer;\n (2) wholly by the employees or group members; or\n (3) jointly by the employer and employees or group members.\n (d) An employee or group member shall have the right to refuse\ncoverage offered by an employer under this section.\n (e) Each policy written pursuant to this section shall provide\nseparate limits of coverage for each group member.\n (f)(1) The insurer shall be responsible for the mailing or delivery to\nthe employer a group policy and certificates of insurance for each group\nmember insured under the group policy. The insurer shall also be\nresponsible for the mailing or delivery to the employer for each group\nmember any amended certificate of insurance, or endorsement to the\ncertificate, whenever there is a change of limits; addition, reduction,\nor elimination of coverage; or addition of an exclusion, under the group\npolicy or certificate.\n (2) The certificate shall contain in substance all material terms and\nconditions of coverage afforded to the group member, including, but not\nlimited to, the disclosure in clear and easily understandable language\nof any limitations, exclusions or required underlying coverages, unless\nthe group policy is incorporated by reference and a copy of the group\npolicy accompanies the certificate.\n (g)(1) A group policy or certificate shall not be subject to section\nthree thousand four hundred twenty-five or section three thousand four\nhundred twenty-six of this article. The following requirements shall\napply to authorized insurers in regard to termination of coverage.\n (2) A group policy or certificate may be cancelled by an insurer only\nif cancellation is based on one or more of the reasons set forth in\nparagraph one of subsection (c) of section three thousand four hundred\ntwenty-six of this article, provided, however, that an individual group\nmember may also be canceled upon termination of his or her employment\nwith the employer.\n (3) An insurer's cancellation of a group policy, or any certificate,\nshall not become effective until forty-five days, or twenty days if\nbased upon non-payment of premium, after the insurer mails or delivers\nwritten notice of cancellation to the employer at the mailing address\nshown in the policy. The employer shall mail or deliver written notice\nof such cancellation to each affected group member within ten days of\nreceiving a cancellation notice from the insurer advising the group\nmember of the cancellation and the effective date of the cancellation.\n (h) An authorized insurer may nonrenew or conditionally renew a group\npolicy, or any certificate, under this section, for any reason upon\nforty-five days written notice to the employer. The employer shall mail\nor deliver written notice of such nonrenewal or conditional renewal to\neach affected group member within ten days of receiving such notice from\nthe insurer.\n (i) An employer may cancel a group policy, or any certificate, for any\nreason upon thirty days written notice to the insurer and each affected\ngroup member.\n (j) Unless a group policy provides for a longer policy period, the\npolicy and all certificates shall be issued or renewed for a one-year\npolicy period commencing with a common inception date. A new employee\nmay be added to the group policy for less than one year to conform with\na common expiration date.\n (k) No policy form shall be delivered or issued for delivery by an\nauthorized insurer unless it has been filed with the superintendent and\nthe superintendent has either approved it, or thirty days have elapsed\nand the superintendent has not disapproved such form as misleading or\nviolative of public policy. The initial rate of filing pursuant to this\nsection shall be subject to the prior approval of the superintendent,\nand any subsequent rate filing shall not be subject to prior approval.\n * NB There are 3 § 3453's\n