Provision of group service coverage before approval of forms.
1. A corporation subject to the provisions of this chapter is permitted to provide group hospital or group medical or dental service coverage prior to the approval of the form of the contract or certificate if all the conditions of subsection 2 of this section are met prior thereto and if thereafter it acts as required by subsection 3.
2. The conditions referred to in subsection 1 are that:
(a) The group is one eligible for coverage pursuant to the provisions of this chapter.
(b) An executed memorandum has been or is concurrently delivered to the subscriber containing a provision that unless a group hospital or group medical or dental service certificate, the form of which has been approved by the Commissioner, which is issued under a group hospital or group medical or dental service contract the form of which has been approved by the Commissioner, and which embodies the coverage, has been issued and delivered to the subscriber within 90 days after the date on which the coverage is provided or agreed to be provided, the coverage provided pursuant to such memorandum terminates 120 days after such date. The memorandum shall contain a specification in either complete or summary form of:
(1) The class or classes of employees eligible for coverage.
(2) The benefits to be provided.
(3) The exceptions and reductions to such benefits, if any.
3. A corporation subject to the provisions of this chapter providing coverage pursuant to this section shall:
(a) Within 60 days after the date on which the coverage is provided or agreed to be provided, submit to the Commissioner for approval a form of a group hospital or group medical or dental service contract, and a form of a certificate of individual coverage, drafted to provide the coverage provided by such memorandum and to meet all requirements of law.
(b) Make such revisions in the contract and certificate submitted as the Commissioner may lawfully require.
(c) Terminate such coverage in accordance with the provisions of paragraph (b) of subsection 2 of this section if approval of such contract and certificate is not secured within the time specified therein.
Last modified: February 27, 2006