§ 217 — Employee notification and remittance of premiums; group policies of accident and health insurance

§ 217. Employee notification and remittance of premiums; group\npolicies of accident and health insurance. 1. Statement of public\npolicy. The legislature finds that in today's society health and\naccident insurance coverage for medical care and treatment is of prime\nimportance to all employees and their dependents within the state of New\nYork. Adequate and prospective planning is necessary to insure that such\ncoverage is in effect at the time of commencement of the need for\nmedical and health care. Many employees and their dependents in New York\nState are covered through group policies issued to their employers,\nemployee organizations or trustees of employee welfare funds and no\nstatutory provision has heretofore afforded these employees and their\ndependents the right as certificate holders of a group accident or group\nhealth policy to receive notification of the intended termination or\nsubstitution of the group policy and to have premiums remitted to\ninsurers on their behalf should they choose to exercise continuation\nprivileges available under law.\n Accordingly, it is the declared public policy of the state of New York\nthat sufficient and timely notice be afforded each employee covered\nunder a group accident or group health policy of the intended\ntermination or substitution of such policy and that employers be\nrequired to remit premiums to insurers on behalf of individuals\nexercising their right to continuation coverage under the law.\n 2. Definitions. As used in this section:\n (a) "Policyholder" shall mean any person, co-partnership, corporation,\ntrade association, joint stock association, incorporated or\nunincorporated association, trustees or labor organization as defined in\nsubsections (c) and (g), respectively, of section four thousand four\nhundred two of the insurance law or any other entity to whom a policy or\ncontract of group accident, group health or group accident and health\ninsurance has been issued.\n For the purpose of this section, "policyholder" shall also include any\ngroup remitting agent.\n (b) "Certificate holder" shall mean any person insured, on either a\ncontributory or non-contributory basis, by a policy or contract of group\naccident, group health or group accident and health insurance, as well\nas persons covered by group remittance policies.\n 3. Notification. A policyholder shall, subsequent to receipt from the\ninsurer of notice of termination pursuant to subsection (k) of section\nfour thousand two hundred thirty-five of the insurance law provide\nwritten notice to the certificate holders of such policy of such\ntermination. In any case where the policyholder is substituting such\npolicy with another policy providing similar coverage for the same\ncertificate holders, the policyholder shall provide certificate holders\nwith a written notice including therein the name of the substituted\ninsurer. Where the employees are represented by a labor organization,\nsuch notice shall be given to the representative of that labor\norganization. Such written notice shall be in accordance with the rules\nand regulations of the superintendent of financial services, promulgated\npursuant to subsection (l) of section four thousand two hundred\nthirty-five of the insurance law.\n 4. Exception. The provisions of subdivision three of this section\nshall not be deemed to apply if, within ten days subsequent to receipt\nof notice of termination from the insurer, the policyholder has taken\nnecessary steps whereby the intended termination is rendered null and\nvoid.\n 5. Where the policyholder has contracted with another insurer to\nreplace the existing insurer for the providing of similar and continuous\ncoverage for the same certificate holders he shall file an affidavit\nwith the commissioner of labor and superintendent of financial services\nto that effect.\n 6. Remittance of premiums. Any policyholder who receives notification\nfrom an individual entitled to exercise a right to continuation of\ncoverage by the policyholder's insurer pursuant to section three\nthousand two hundred twenty-one of the insurance law, shall, no later\nthan thirty days subsequent to receipt of premiums from such individual,\nremit such premiums to the insurer on behalf of such individual and\nprovide evidence to the individual that the premium has been remitted.\n 6-a. Residence location to accompany enrollment data. When a\npolicyholder provides information to an insurer or health maintenance\norganization certified under article forty-four of the public health law\nor licensed pursuant to the insurance law regarding the initial or\ncontinued enrollment eligibility of a certificate holder, the policy\nholder must include the current united states postal service zip code\nand state in which the certificate holder currently resides.\n 7. Penalties. (a) Any policyholder who fails to comply with this\nsection, shall forfeit to the people of the State a sum up to five\nthousand dollars, to be recovered by the commissioner in a civil action.\nWhere the policyholder is a corporation, trade association, joint stock\nassociation, incorporated or unincorporated association, the president,\nsecretary and treasurer thereof shall be liable for any forfeiture.\n (b) In addition to such penalty, where the failure to comply involves\nthe failure to notify an employee of the termination of a group accident\nor group health policy pursuant to subdivision three of this section or\nthe failure to remit premiums pursuant to subdivision six of this\nsection, or the failure to provide an individual with notice of\ntermination pursuant to subdivision six of section one hundred\nninety-five of this chapter, the policy holder shall also be liable, in\na civil action brought by the individual entitled to receive the notice\nof termination or exercise the right to continuation of coverage in a\ncourt of competent jurisdiction, to appropriate damages which shall\ninclude reimbursement for medical expenses which were not covered by the\npolicyholder's insurer by virtue of his termination of the policy or\nfailure to remit such premiums.\n