§ 7705 — Definitions

New York § 7705

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 77: The Life and Health Insurance Company Guaranty Corporation of New York Act

Text

§ 7705. Definitions. As used in this article:\n (a) "Account" means any of the two accounts created under section\nseven thousand seven hundred six of this article.\n (b) "Contractual obligations" means any obligation under covered\npolicies, but shall not include any obligation with respect to\npolicyholder dividends unpaid or unapplied, retrospective rate credits\nor similar benefits or provisions.\n (c) "Corporation" means The Life and Health Insurance Company Guaranty\nCorporation of New York created under section seven thousand seven\nhundred six of this article unless the context otherwise requires.\n (d) "Covered policy" means any of the kinds of insurance specified in\nparagraph one, two or three of subsection (a) of section one thousand\none hundred thirteen of this chapter, any supplemental contract, or any\nfunding agreement referred to in section three thousand two hundred\ntwenty-two of this chapter, or any portion or part thereof, within the\nscope of this article under section seven thousand seven hundred three\nof this article, except that any certificate issued to an individual\nunder any group or blanket policy or contract shall be considered to be\na separate covered policy for purposes of section seven thousand seven\nhundred eight of this article.\n (e) "Health insurance" means the kinds of insurance specified under\nitems (i) and (ii) of paragraph three and paragraph thirty-one of\nsubsection (a) of section one thousand one hundred thirteen of this\nchapter, and section one thousand one hundred seventeen of this chapter;\nmedical expense indemnity, dental expense indemnity, hospital service,\nor health service under article forty-three of this chapter; and\ncomprehensive health services under article forty-four of the public\nhealth law. "Health insurance" shall not include hospital, medical,\nsurgical, prescription drug, or other health care benefits pursuant to:\n(1) part C of title XVIII of the social security act (42 U.S.C. §\n1395w-21 et seq.) or part D of title XVIII of the social security act\n(42 U.S.C. § 1395w-101 et seq.), commonly known as Medicare parts C and\nD, or any regulations promulgated thereunder; (2) titles XIX and XXI of\nthe social security act (42 U.S.C. § 1396 et seq.), commonly known as\nthe Medicaid and child health insurance programs, or any regulations\npromulgated thereunder; (3) the basic health program under section three\nhundred sixty-nine-gg of the social services law; (4) chapter 55 of part\nII of subtitle A of title X (10 U.S.C §§ 1071-1110(b)), commonly known\nas TRICARE, or any regulations promulgated thereunder; or (5) subpart G\nof part III of title V (5 U.S.C. §§ 8101-9009), commonly known as the\nFederal Employees Program, or any regulations promulgated thereunder.\n (f) "Impaired insurer" means a member insurer which after the\neffective date of this article is found to be impaired for the purposes\nof section one thousand three hundred ten or one thousand three hundred\neleven of this chapter and is consequently placed under an order of\nliquidation, rehabilitation or conservation under article seventy-four\nof this chapter.\n (g) "Insolvent insurer" means a member insurer which after the\neffective date of this article becomes insolvent for the purposes of\nsection one thousand three hundred nine of this chapter and is placed\nunder a final order of liquidation, rehabilitation or conservation by a\ncourt of competent jurisdiction.\n (h) (1) "Member insurer" means:\n (A) any life insurance company licensed to transact in this state any\nkind of insurance to which this article applies under section seven\nthousand seven hundred three of this article; provided, however, that\nthe term "member insurer" also means any life insurance company formerly\nlicensed to transact in this state any kind of insurance to which this\narticle applies under section seven thousand seven hundred three of this\narticle; and\n (B) an insurer licensed or formerly licensed to write accident and\nhealth insurance or salary protection insurance in this state,\ncorporation organized pursuant to article forty-three of this chapter,\nreciprocal insurer organized pursuant to article sixty-one of this\nchapter, cooperative property/casualty insurance company operating under\nor subject to article sixty-six of this chapter, nonprofit\nproperty/casualty insurance company organized pursuant to article\nsixty-seven of this chapter, and health maintenance organization\ncertified pursuant to article forty-four of the public health law.\n (2) "Member insurer" shall not include a municipal cooperative health\nbenefit plan established pursuant to article forty-seven of this\nchapter, an employee welfare fund registered under article forty-four of\nthis chapter, a fraternal benefit society organized under article\nforty-five of this chapter, an institution of higher education with a\ncertificate of authority under section one thousand one hundred\ntwenty-four of this chapter, or a continuing care retirement community\nwith a certificate of authority under article forty-six or forty-six-A\nof the public health law.\n (i) "Premiums" means direct gross insurance premiums and annuity and\nfunding agreement considerations received on covered policies, less\nreturn premiums and considerations thereon and dividends paid or\ncredited to policyholders or contract holders on such direct business,\nsubject to such modifications as the superintendent may establish by\nregulation or order as necessary to facilitate the equitable\nadministration of this article. Premiums do not include premiums and\nconsiderations on contracts between insurers and reinsurers. For the\npurposes of determining the assessment for an insurer under this\narticle, the term "premiums", with respect to a group annuity contract\n(or portion of any such contract) that does not guarantee annuity\nbenefits to any specific individual identified in the contract and with\nrespect to any funding agreement issued to fund benefits under any\nemployee benefit plan, means the lesser of one million dollars or the\npremium attributable to that portion of such group contract that does\nnot guarantee benefits to any specific individuals or such agreements\nthat fund benefits under any employee benefit plan.\n (j) "Person" means any individual or legal entity, including a\ncorporation, partnership, association, limited liability company, trust,\nor voluntary organization.\n (k) "Resident" means a person to whom a contractual obligation is owed\nand who either: (1) resides in this state on the date of entry of a\ncourt order of liquidation or rehabilitation with respect to a member\ninsurer that is an impaired or insolvent insurer; or (2) resided in this\nstate at the time a member insurer issued a covered policy to such\nperson.\n (l) "Supplemental contract" means an agreement or any other mechanism\nfor the distribution of proceeds under a life insurance policy, health\ninsurance policy, annuity contract, or funding agreement.\n (m) "Long-term care insurance" means an insurance policy, rider, or\ncertificate advertised, marketed, offered, or designed to provide\ncoverage, subject to eligibility requirements, for not less than\ntwenty-four consecutive months for each covered person on an expense\nincurred, indemnity, prepaid or other basis and provides at least the\nbenefits set forth in part fifty-two of title eleven of the official\ncompilation of codes, rules and regulations of this state.\n