§ 4306 — Required contract provisions

New York § 4306

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 43: Non-profit Medical and Dental Indemnity, or Health and Hospital Service Corporations

Text

§ 4306. Required contract provisions. Every contract issued by any\ncorporation pursuant to the provisions of section four thousand three\nhundred four of this article, shall be in writing and shall state the\nterms and conditions thereof. No such contract shall be made, issued or\ndelivered in this state unless it contains the following provisions:\n (a) a statement of the amount payable to the corporation by the\nindividual to whom the contract is issued and the times at which and\nmanner in which such amount is to be paid;\n (b) a statement of the nature of the benefits to be furnished and the\nperiod during which they will be furnished; and if there are any\nbenefits to be excepted, a detailed statement of such exceptions printed\nas hereinafter specified;\n (c) a statement of the terms and conditions, if any, upon which the\ncontract may be terminated at the option of the individual, or otherwise\nterminated at the option of either party as permitted by subsection (b)\nor (c) of section four thousand three hundred four of this article;\n (d) a statement that the contract includes the endorsements thereon\nand attached papers, if any;\n (e) a statement that no statement by the individual in his application\nfor a contract shall avoid the contract or be used in any legal\nproceeding thereunder, unless such application or an exact copy thereof\nis included in or attached to such contract, and that no agent or\nrepresentative of such corporation and no broker, other than an officer\nor officers designated therein, is authorized to change the contract or\nwaive any of its provisions;\n (f) a statement that if the individual defaults in making any payment\nunder the contract, the subsequent acceptance of a payment by the\ncorporation or by one of its duly authorized agents or by a duly\nauthorized broker shall reinstate the contract, but with respect to\nsickness and injury, only to cover such sickness as may be first\nmanifested more than ten days after the date of such acceptance;\n (g) a statement of the period of grace which will be allowed the\nindividual for making any payment due under the contract which period\nshall not be less than ten days;\n (h) a statement on the first page of the contract or in a notice\nattached to the contract that during a specified period of time, which\nshall not be less than ten days nor more than twenty days from the date\nthe contract is delivered to the individual, it may be surrendered to\nthe corporation together with a written request for cancellation of the\ncontract and that in such event the corporation will refund any premium\npaid therefor including any contract fees or other charges; provided,\nhowever, that a contract sold by mail order and a contract providing\nmedicare supplemental insurance or long-term care insurance must contain\na provision permitting the individual a thirty day period for such\nsurrender;\n (i) the age limit or date or period, if any, after which the coverage\nprovided by the contract will not be effective, or renewed, is stated in\na renewal provision set forth on the first page of the contract or as a\nseparate provision bearing an appropriate caption on the first page on\nthe contract or in a brief description in not less than fourteen point\nbold face type set forth on the first page of the contract; nothing\nherein contained shall limit or restrict the right of the corporation to\ncontinue the contract after the age or period so stated;\n (j) a statement under the caption "CONVERSION PRIVILEGE" which shall\nset forth in substance the conversion privileges and related provisions\nrequired by subsections (d) and (e) of section four thousand three\nhundred four of this article;\n (k) the exceptions of the contract shall appear with the same\nprominence as the benefits to which they apply;\n (l) if the contract contains any provision purporting to make any\nportion of the articles, constitution or by-laws of the corporation a\npart of the contract, such portion shall be set forth in full; and\n (m) in every such contract made, issued or delivered in this state\nthere shall be a brief description of the contract on its first page and\non its filing back.\n (n) a statement that a health care claim from a subscriber shall be\nsubmitted within one hundred twenty days from the date of service;\nprovided, however, that if it was not reasonably possible for the\nsubscriber to submit the claim within that timeframe, then the claim\nshall be submitted as soon as reasonably possible.\n (o) Every contract delivered or issued for delivery in this state\nwhich provides major medical or similar comprehensive-type coverage\nshall provide space on any enrollment, renewal or initial online portal\nprocess setup forms required of a subscriber or applicant for coverage,\nexcept forms issued by the NY State of Health, the official Health Plan\nMarketplace, other than those specifically referenced in subparagraph\n(iv) of paragraph (a) of subdivision five of section forty-three hundred\nten and paragraph (v) of subdivision one of section two hundred six of\nthe public health law, so that the subscriber or applicant for coverage\nshall register or decline registration in the donate life registry for\norgan, eye and tissue donations under this section of the enrollment,\nrenewal or initial online portal process setup forms and that the\nfollowing is stated on the form in clear and conspicuous type:\n "You must fill out the following section: Would you like to be added\nto the Donate Life Registry? Check box for 'yes' or 'skip this\nquestion'."\n