§ 4512 — Accident and health and disability insurance certificates; compliance with rules and regulations

New York § 4512

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 45: Fraternal Benefit Societies

Text

§ 4512. Accident and health and disability insurance certificates;\ncompliance with rules and regulations. (a) No certificate or other\nevidence of any contract of accident insurance, disability income\ninsurance, or health insurance or of any total and permanent disability\ninsurance and no application or rider or endorsement for use in\nconnection therewith shall be delivered or issued for delivery in this\nstate unless it conforms with reasonable rules and regulations\nprescribed by the superintendent and contains a provision that the\nrights or obligations of the insured member under any such certificate\nor other evidence of such contract, or of any person rightfully claiming\nthereunder, shall be governed by the laws of this state. Pursuant to the\nforegoing provisions the superintendent shall have power, from time to\ntime to make, alter and supersede reasonable rules and regulations\nprescribing the required, optional and prohibited provisions in such\ncontracts, and such rules and regulations shall conform, as far as\npracticable, to the provisions of section three thousand two hundred\nfifteen of this chapter or of section three thousand two hundred sixteen\nof this chapter, whichever shall be applicable. Where the superintendent\ndeems inapplicable, either in part or in their entirety, the provisions\nof the aforesaid sections, he may prescribe the portions, or a summary\nthereof, of the contract to be printed in the certificate issued to the\nmember.\n (b) Anything in this article to the contrary notwithstanding, each\ncertificate of hospitalization expense benefits or surgical or medical\nexpense benefits delivered or issued for delivery in this state to any\nmember individually or as the head of a family shall:\n (1) stipulate a premium determined on the basis of the age of the\nmember, which premium shall be subject to change only if the premiums on\nall outstanding certificates in the same class are changed in accordance\nwith the standards which shall have been established prior to the\nissuance of the certificate for the determination of the increase or\ndecrease in the premiums and are on file with and approved by the\nsuperintendent,\n (2) contain the following provisions under the caption "Incontestable\nand Guaranteed Renewable":\n "After this certificate has been in force for a period of one year\nfrom the date of issue, it shall become incontestable as to the\nstatements contained in the application and the member shall have the\nright to continue the same in force, subject to the timely payment of\npremiums and the conditions of the certificate relating to military\nservice;" and\n (3) in the case of such certificates written at issue age above\nsixty-five years, contain the following provision:\n "No claim for benefits provided in this certificate shall be reduced\nor denied on the ground that a disease or physical condition had existed\nprior to the effective date of coverage of this certificate, except only\nsuch disease or physical condition which is specifically eliminated by\nrider, attached to this certificate, a copy which shall have been\nfurnished to the member and its receipt evidenced by a signed amendment\nto the application for such certificate."\n