§ 4306-E — Prohibition on lifetime and annual limits

New York § 4306-E

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

Text

§ 4306-e. Prohibition on lifetime and annual limits. (a) A corporation\nshall not establish a lifetime limit on the dollar amount of essential\nhealth benefits in an individual, group or blanket contract of hospital,\nmedical, surgical or prescription drug expense insurance.\n (b) A corporation shall not establish an annual limit on the dollar\namount of essential health benefits in an individual, group or blanket\ncontract of hospital, medical, surgical or prescription drug expense\ninsurance for contract years beginning on and after January one, two\nthousand fourteen.\n (c) For contract years beginning prior to January one, two thousand\nfourteen, a corporation may establish restricted annual limits on the\ndollar amount of essential health benefits in an individual, group or\nblanket contract of hospital, medical, surgical or prescription drug\nexpense insurance consistent with section 2711 of the Public Health\nService Act, 42 U.S.C. § 300gg-11 or any regulations thereunder.\n (d) The requirements of subsections (b) and (c) of this section shall\nnot be applicable to any individual contract that is a grandfathered\nhealth plan. For purposes of this section, "grandfathered health plan"\nmeans coverage provided by a corporation in which an individual was\nenrolled on March twenty-third, two thousand ten for as long as the\ncoverage maintains grandfathered status in accordance with section\n1251(e) of the Affordable Care Act, 42 U.S.C. § 18011(e).\n (e) For purposes of this section, "essential health benefits" shall\nhave the meaning ascribed by section 1302(b) of the Affordable Care Act,\n42 U.S.C. § 18022(b).\n