New York Insurance Law Article 43 - NON-PROFIT MEDICAL AND DENTAL INDEMNITY, OR HEALTH AND HOSPITAL SERVICE CORPORATIONS
- 4301 - Organization of Corporation; Purposes; Board of Directors.
(a) A corporation may be organized under the not-for-profit corporation law, and a consumers' cooperative stock corporation may be organized under article two of the...
- 4302 - Permit and License to Do Business.
(a) Corporations subject to this article shall not solicit the purchase of, or enter into, any contract with any individual or group until it has...
- 4303 - Benefits.
(a) Every contract issued by a hospital service corporation or health service corporation which provides coverage for in-patient hospital care shall also provide coverage: (1)...
- 4304 - Individual Contracts.
(a) Every corporation subject to the provisions of this article may issue a contract to an individual the premiums for which may be paid to...
- 4305 - Group Contracts.
(a) A corporation subject to the provisions of this article may issue a group contract, provided the group of persons thereby covered conforms to the...
- 4306 - Required Contract Provisions.
Every contract issued by any corporation pursuant to the provisions of section four thousand three hundred four of this article, shall be in writing and...
- 4306-a - Health Insurance Coverage for Full-Time Students on Medical Leaves of Absence.
(a) Every contract issued by a medical expense indemnity corporation, hospital service corporation or health service corporation that provides coverage for dependent children who are...
- 4306-b - Primary and Preventive Obstetric and Gynecologic Care.
(a) No corporation subject to the provisions of this article shall by contract, written policy or procedure limit a female subscriber's direct access to primary...
- 4306-c - Grievance Procedure and Access to Specialty Care.
(a) A corporation, including a municipal cooperative health benefits plan certified pursuant to article forty-seven of this chapter, that issues a comprehensive contract that utilizes...
- 4306-d - Choice of Health Care Provider.
A corporation that is subject to the provisions of this article and requires or provides for designation by a subscriber of a participating primary care...
- 4306-e - Prohibition on Lifetime and Annual Limits.
(a) A corporation shall not establish a lifetime limit on the dollar amount of essential health benefits in an individual, group or blanket contract of...
- 4306-f - Maternal Depression Screenings.
To the extent a contract provides coverage for maternal depression screening, no corporation subject to this article shall by contract, written policy or procedure limit...
- 4306-g - Telehealth Delivery of Services.
(a) A corporation shall not exclude from coverage a service that is otherwise covered under a contract that provides comprehensive coverage for hospital, medical or...
- 4307 - Providers of Services.
(a) Any hospital service corporation or health service corporation may provide benefits for the rendering of hospital service to persons covered under its contracts (i)...
- 4308 - Supervision of Superintendent.
(a) No corporation subject to the provisions of this article shall enter into any contract unless and until it shall have filed with the superintendent...
- 4309 - Limitation on Expenses.
(a) No corporation subject to the provisions of this article shall, during any one year, disburse more than the percentages hereafter prescribed of the aggregate...
- 4310 - Investments; Financial Conditions; Reserves.
(a) Every corporation subject to the provisions of this article shall annually on or before the first day of March file in the office of...
- 4312 - Employment of Solicitors; Pension Plans.
(a) 1. Every corporation subject to the provisions of this article may employ solicitors or accept business from agents and brokers on a commission basis,...
- 4313 - Applicability of Other Provisions of This Chapter.
(a) Except as otherwise provided and except as the context otherwise requires, every medical expense indemnity corporation, dental expense indemnity corporation, health service corporation, and...
- 4314 - Not to Affect Provisions of Workers' Compensation Law.
No provisions of this article or any contract issued by a corporation subject to the provisions of this article shall in any way affect the...
- 4315 - Arbitration; Judicial Review.
(a) Any dispute arising between a hospital service corporation or health service corporation subject to the provisions of this article and any hospital with which...
- 4316 - Individual Contracts; Premium Refund At Death of Insured.
Under individual contracts for which premiums are paid directly to the corporation by the individual, if the death of the insured or a covered dependent...
- 4317 - Rating of Individual and Small Group Health Insurance Contracts.
(a) (1) No individual health insurance contract and no group health insurance contract covering between one and fifty employees or members of the group, or...
- 4318 - Pre-Existing Condition Provisions.
Every individual health insurance contract and every group or blanket accident and health insurance contract issued or issued for delivery in this state which includes...
- 4318-a - Certification of Creditable Coverage by Corporations Organized Under This Article.
(a) Every corporation subject to the provisions of this article that issues individual health insurance contracts or group or blanket accident and health insurance contracts...
- 4320 - Limitations on Administrative Services and Stop-Loss Coverage.
No insurer, subsidiary of an insurer, or controlled person of a holding company system may act as an administrator or claims paying agent, as opposed...
- 4321 - Standardization of Individual Enrollee Direct Payment Contracts Offered by Health Maintenance Organizations Prior to October First, Two Thousand Thirteen.
(a) On and after January first, nineteen hundred ninety-six, and until September thirtieth, two thousand thirteen all health maintenance organizations issued a certificate of authority...
- 4321-a - Fund for Standardized Individual Enrollee Direct Payment Contracts.
(a) The superintendent shall establish a fund from which health maintenance organizations may receive reimbursement, to the extent of funds available therefor, for claims paid...
- 4322 - Standardization of Individual Enrollee Direct Payment Contracts Offered by Health Maintenance Organizations Which Provide Out-Of-plan Benefits Prior to October First, Two Thousand Thirteen.
(a) On and after January first, nineteen hundred ninety-six, and until September thirtieth, two thousand thirteen, all health maintenance organizations issued a certificate of authority...
- 4322-a - Fund for Standardized Individual Enrollee Direct Payment Contracts Which Provide Out-Of-plan Benefits.
(a) The superintendent shall establish a fund from which health maintenance organizations may receive reimbursement, to the extent of funds available therefor, for claims paid...
- 4323 - Marketing Materials.
(a) All health maintenance organizations issued a certificate of authority under article forty-four of the public health law or licensed under this article shall prepare,...
- 4324 - Disclosure of Information.
The requirements of this section shall apply to all comprehensive, expense-reimbursed contracts; managed care products; or any other contract or product for which the superintendent...
- 4325 - Prohibitions.
(a) No corporation organized under this article shall by contract, written policy or written procedure prohibit or restrict any health care provider from disclosing to...
- 4326 - Standardized Health Insurance Contracts for Qualifying Small Employers and Individuals.
(a) A program is hereby established for the purpose of making standardized health insurance contracts available to qualifying small employers as defined in this section....
- 4327 - Stop Loss Funds for Standardized Health Insurance Contracts Issued to Qualifying Small Employers and Qualifying Individuals.
(a) The superintendent shall establish a fund from which health maintenance organizations, corporations or insurers may receive reimbursement, to the extent of funds available therefor,...
- 4328 - Individual Enrollee Direct Payment Contracts Offered by Health Maintenance Organization on and After October First, Two Thousand Thirteen.
(a) On and after October first, two thousand thirteen, every health maintenance organization issued a certificate of authority under article forty-four of the public health...
Last modified: February 3, 2019