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11 CRR-NY 52.90NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK

TITLE 11. INSURANCE

CHAPTER III. POLICY AND CERTIFICATE PROVISIONS

SUBCHAPTER A. LIFE, ACCIDENT AND HEALTH INSURANCE

PART 52. MINIMUM STANDARDS FOR FORM, CONTENT AND SALE OF HEALTH INSURANCE, INCLUDING STANDARDS OF FULL AND FAIR DISCLOSURE

11 CRR-NY 52.90

52.90 Applicability provisions.

(a) This Part shall apply to accident and health insurance, except insurance defined in section 3201(b)(4) of the Insurance Law.

(1) On January 1, 1983 with respect to provisions of this Part previously promulgated on April 1, 1982 affecting:

(i) policies delivered or issued for delivery in this State on or after January 1, 1983; and

(ii) any policies which are amended on or after January 1, 1983 to substantially alter or change benefits or coverages.

(2) Sections 52.40, 52.43, 52.44, 52.45 and 52.47 of this Part shall also apply to accident and health insurance, except insurance defined in section 3201(b)(4) of the Insurance Law on January 1, 1983 with respect to all existing in-force policies originally delivered or issued for delivery in this State.

(3) On September 14, 1984 with respect to amendments to section 52.40(c)(2)(vii) of this Part promulgated on September 14, 1984.

(4) On January 1, 1986 with respect to amendments to sections 52.16(c)(1), (f) and 52.18(a) of this Part promulgated on December 23, 1985 affecting (i) policies and certificates delivered or issued for delivery in this State on or after January 1, 1986; and (ii) certificates deemed to have been delivered in this State on or after January 1, 1986 and which are subject to approval under section 3201(b)(1) of the Insurance Law.

(5) On January 15, 1987 with respect to section 52.23 of this Part promulgated on December 23, 1986 affecting:

(i) policies delivered or issued and certificates deemed to be delivered in this State on or after January 1, 1988;

(ii) policies delivered or issued and certificates deemed to be delivered in this State prior to January 1, 1988 on the first anniversary date thereafter;

(iii) on an optional basis, any policies delivered or issued and certificates deemed to be delivered in this State on a specified date chosen by the policyholder or insurer which may not be prior to January 1, 1987 nor later than the date specified in subparagraph (i) or (ii) of this paragraph; and

(6) On September 4, 1987 with respect to section 52.27 of this Part affecting any underwriting, rating or administration of claims relating to new or existing policies or contracts providing hospital and/or medical expense or indemnity benefits.

(7) On October 7, 1988 with respect to amendments of this Part promulgated on October 7, 1988 other than amendments to sections 52.11(a), 52.22(b), (d), (j) and (l), 52.54(c)(2)(viii), and 52.63 of this Part which become effective on January 1, 1989.

(8) On October 1, 1989 with respect to amendments of this Part promulgated on September 1, 1989 other than amendments to sections 52.11(a) and 52.63 of this Part which become effective January 1, 1990.

(9) On January 1, 1990 with respect to amendments to sections 52.5, 52.6 and 52.7 of this Part promulgated on August 31, 1989, affecting:

(i) policies delivered or issued for delivery and certificates deemed to be delivered in this State on or after January 1, 1990;

(ii) any such policies or certificates amended on or after January 1, 1990 to substantially alter or change benefits or coverages;

(10) On January 1, 1991 with respect to amendments to sections 52.7 and 52.16(c)(2) of this Part promulgated on June 19, 1990 affecting:

(i) policies delivered or issued for delivery and certificates deemed to be delivered in this State on or after January 1, 1991; or

(ii) any such policies or certificates amended on or after January 1, 1991 to substantially alter or change benefits or coverages.

(11) On December 12, 1989 with respect to amendments of this Part other than amendments to sections 52.11(a) and 52.63 of this Part which become effective January 1, 1990.

(12) [Reserved]

(13) On May 1, 1991 with respect to amendments to sections 52.1 and 52.40(f) of this Part promulgated on January 29, 1991 affecting:

(i) New policies delivered and coverage effectuated by participating employers principally located in this State on or after May 1, 1991;

(ii) Existing in-force policies delivered in this State and existing coverage effectuated by participating employers principally located in this State on the first rating period which commences on or after January 1, 1992, provided that:

(a) In the case of any group with a premium rate on May 1, 1991 in excess of the maximum renewal rate computed in accordance with section 52.40(f)(2) or (3) of this Part, on the first rating period which commences on or after January 1, 1994, with no increase implemented until such time, provided, however, that the premium rate for any such group may be increased in accordance with section 52.40(f)(2) or (3) of this Part prior to January 1, 1994 on the first rating period when the group's rate falls below such maximum renewal rate.

(b) The disclosure requirement set forth in section 52.40(f)(3)(ii) of this Part shall be satisfied by providing the required disclosure to existing groups not later than 30 days prior to the first rating period for such group which commences on or after January 1, 1992.

(14) On January 1, 1992 with respect to sections 52.12, 52.13, 52.25, 52.29 and 52.65, and amendments to sections 52.2, 52.10, 52.16, 52.17, 52.43, 52.45 and 52.54 of this Part promulgated on July 2, 1991 affecting:

(i) policies delivered or issued for delivery and certificates deemed to be delivered in this State on or after January 1, 1992;

(ii) any such policies or certificates amended on or after January 1, 1992 to substantially alter or change benefits or coverages.

(15) Upon publication in the State Register with respect to amendments to sections 52.1, 52.11, 52.16, 52.17, 52.18, 52.22, 52.28, 52.31, 52.40, 52.43, 52.44, 52.45, 52.47, 52.54, 52.59 and 52.63 of this Part affecting policies and certificates delivered or issued for delivery in this State on or after May 1, 1992.

(16) Upon filing with the Secretary of State with respect to amendments to sections 52.11, 52.14, 52.17, 52.18, 52.22, 52.28, 52.40, 52.43, 52.44 and 52.63 of this Part, except that for insurers currently in the Medicare supplement insurance market, compliance with the amendments required by section 52.22(f)(6) and (g) of this Part shall be no later than July 1, 1996.

(17) On April 22, 1999 with respect to amendments to sections 52.2, 52.11, 52.17, 52.18, 52.22 and 52.63 of this Part, except that for insurers currently in the Medicare supplement insurance market, compliance with the amendments required by sections 52.22(f)(2), (6)(ii)(c), (g) and 52.63 of this Part shall be no later than June 30, 1999.

(18) Effective upon adoption, with respect to section 52.16(m) of this Part, except that a health maintenance organization or insurer shall have 60 days immediately following the effective date to implement its denial procedures pursuant to said section.

(19) Effective upon adoption, with respect to section 52.25(f) of this Part, affecting policies and certificates delivered or issued for delivery in this State six months or more from such effective date.

(b) Approval is hereby withdrawn on January 1, 1983 with respect to all forms of accident and health insurance previously approved which are not in compliance herewith.

(c) Section 52.24 of this Part shall apply to group (including group remittance policies issued by article 43 corporations) and school blanket health insurance policies which provide coverage for inpatient hospital care, as follows:

(1) with respect to inpatient hospital benefits for the diagnosis and treatment of alcoholism and alcohol abuse and the report to the superintendent required by section 52.24(d) of this Part, on September 1, 1984;

(2) with respect to outpatient visits for the diagnosis and treatment of alcoholism and alcohol abuse, when the policy is issued, renewed, modified, altered or amended on or after September 1, 1984; or

(3) with respect to the increase in outpatient visits from 5 to 20 for family members when the covered person has not received or is not receiving treatment for alcoholism or alcohol abuse, when the policy is issued, renewed, modified, altered or amended on or after January 1, 1988.

11 CRR-NY 52.90

Current through July 31, 2021

End of Document