§ 4224 — Life, accident and health insurance; discrimination and rebating; prohibited inducements and interdependent sales

New York § 4224

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 42: Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies

Text

§ 4224. Life, accident and health insurance; discrimination and\nrebating; prohibited inducements and interdependent sales. (a) No life\ninsurance company doing business in this state and no savings and\ninsurance bank shall:\n (1) make or permit any unfair discrimination between individuals of\nthe same class and of equal expectation of life, in the amount or\npayment or return of premiums, or rates charged for policies of life\ninsurance or annuity contracts, or in the dividends or other benefits\npayable thereon, or in any of the terms and conditions thereof;\n (2) refuse to insure, refuse to continue to insure or limit the\namount, extent or kind of coverage available to an individual, or charge\na different rate for the same coverage solely because of the physical or\nmental disability, impairment or disease, or prior history thereof, of\nthe insured or potential insured, except where the refusal, limitation\nor rate differential is permitted by law or regulation and is based on\nsound actuarial principles or is related to actual or reasonably\nanticipated experience, in which case the insurer, subject to the\nlimitations contained in section twenty-six hundred eleven of this\nchapter, shall notify the insured or potential insured of the right to\nreceive, or to designate a medical professional to receive, the specific\nreason or reasons for such refusal, limitation or rate differential;\n (3) refuse to insure, refuse to continue to insure or limit the\namount, extent or kind of coverage available to an individual, or charge\na different rate for the same coverage solely because the insured or\npotential insured was prescribed pre-exposure prophylaxis (PrEP)\nmedication for the prevention of HIV infection;\n (4) knowingly permit, and no agent thereof and no licensed insurance\nbroker shall offer to make or make, any policy of life insurance or\nannuity contract or agreement as to such policy or contract other than\nas plainly expressed in the policy or contract.\n (b) No insurer doing in this state the business of accident and health\ninsurance, as specified in paragraph three of subsection (a) of section\none thousand one hundred thirteen of this chapter, and no officer or\nagent of such insurer and no licensed insurance broker, and no employee\nor other representative of such insurer, agent or broker shall:\n (1) make or permit any unfair discrimination between individuals of\nthe same class in the amount of premiums, policy fees, or rates charged\nfor any policy of accident and health insurance, or in the benefits\npayable thereon, or in any of the terms or conditions of such policies,\nor in any other manner whatsoever;\n (2) refuse to insure, refuse to continue to insure or limit the\namount, extent or kind of coverage available to an individual, or charge\na different rate for the same coverage solely because of the physical or\nmental disability, impairment or disease, or prior history thereof, of\nthe insured or potential insured, except where the refusal, limitation\nor rate differential is permitted by law or regulation and is based on\nsound actuarial principles or is related to actual or reasonably\nanticipated experience, in which case the insurer, subject to the\nlimitations contained in section twenty-six hundred eleven of this\nchapter shall notify the insured or potential insured of the right to\nreceive, or to designate a medical professional to receive, the specific\nreason or reasons for such refusal, limitation or rate differential;\n (3) refuse to insure, refuse to continue to insure or limit the\namount, extent or kind of coverage available to an individual, or charge\na different rate for the same coverage solely because the insured or\npotential insured was prescribed pre-exposure prophylaxis (PrEP)\nmedication for the prevention of HIV infection;\n (4) knowingly permit or offer to make or make, any policy of accident\nand health insurance, other than as plainly expressed in the policy.\n (c) Except as permitted by section three thousand two hundred\nthirty-nine of this chapter or subsection (f) of this section, no such\nlife insurance company and no such savings and insurance bank and no\nofficer, agent, solicitor or representative thereof and no such insurer\ndoing in this state the business of accident and health insurance and no\nofficer, agent, solicitor or representative thereof, and no licensed\ninsurance broker and no employee or other representative of any such\ninsurer, agent or broker, shall pay, allow or give, or offer to pay,\nallow or give, directly or indirectly, as an inducement to any person to\ninsure, or shall give, sell or purchase, or offer to give, sell or\npurchase, as such inducement, or interdependent with any policy of life\ninsurance or annuity contract or policy of accident and health\ninsurance, any stocks, bonds, or other securities, or any dividends or\nprofits accruing or to accrue thereon, or any valuable consideration or\ninducement whatever not specified in such policy or contract other than\nany valuable consideration, including but not limited to merchandise or\nperiodical subscriptions, not exceeding twenty-five dollars in value;\nnor shall any person in this state knowingly receive as such inducement,\nany rebate of premium or policy fee or any special favor or advantage in\nthe dividends or other benefits to accrue on any such policy or\ncontract, or knowingly receive any paid employment or contract for\nservices of any kind, or any valuable consideration or inducement\nwhatever which is not specified in such policy or contract.\n (d) (1) No insurer authorized to do one or more of the kinds of\ninsurance business specified in paragraph one, two or three of\nsubsection (a) of section one thousand one hundred thirteen of this\nchapter or authorized to do the kind of insurance business specified in\nsection three thousand two hundred twenty-two of this chapter shall\ndirectly or indirectly, or by any of its agents or representatives, or\nby any broker or brokers, participate in any plan to offer or effect any\nkind or kinds of such insurance business in this state as an inducement\nto, or interdependent with, the purchase by the public of any goods,\nsecurities, commodities, housing, services or subscriptions to\nperiodicals, except as provided by subsection (e) of section three\nthousand four hundred thirty-six, paragraph three of subsection (b) of\nsection four thousand two hundred sixteen of this article, by\nsubparagraph (E) of paragraph one of subsection (c) of section four\nthousand two hundred thirty-five of this article or by article forty-six\nof the public health law.\n (2) This subsection shall not prohibit payment plans which are\notherwise in compliance with this subsection and this chapter.\n (e) This section shall not prohibit the giving by any company, in its\ndiscretion, of medical examinations and diagnoses and of nursing\nservices to all or any part of its policyholders, under reasonable rules\nand regulations.\n (f) (1) This subsection shall apply only with respect to a group or\nblanket accident and health insurance policy issued by an insurer\nlicensed to write accident and health insurance in this state or a group\ncontract issued by a corporation organized pursuant to article\nforty-three of this chapter, or a health maintenance organization\ncertified pursuant to article forty-four of the public health law.\n (2) Notwithstanding subsection (c) of this section, a licensed agent\nor insurance broker may develop, implement, and administer wellness\nprograms established in accordance with section three thousand two\nhundred thirty-nine of this chapter without charging a service fee or,\nin the case of a licensed insurance broker, for a reduced service fee\npursuant to a written memorandum made in accordance with subsection (c)\nof section two thousand one hundred nineteen of this chapter, if such\nprograms are provided in a fair and nondiscriminatory manner and\nincidental to a group or blanket policy or contract sold by the\ninsurance agent or insurance broker.\n