N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.21 - Rules relating to content of forms for blanket insurance
The following provisions shall apply to blanket insurance:
(a) The provisions of
section 52.18 of this Part, where
relevant, shall apply to blanket insurance.
(b) Hospital, surgical and medical expense
coverage may be written for authorized groups under the definition of total or
partial disability as used in section
4237
(a)(1)-(3) of the Insurance Law.
(c) Coverage under section 222(1)(c) of the
Insurance Law shall be provided only in connection with the sponsored activity,
except where the policyholder is a school, school district, board of education
or school principal, in which case 24-hour coverage may be written.
(d) Coordination of benefits provisions may
be included in a policy issued under section
4237
(a)(3)(c) of the Insurance Law.
(e) Groups defined solely as guests of the
policyholder, employees selected by the policyholder, key men and others
similarly defined are too vague and are not permissible groups under section
4237 of the
Insurance Law.
(f) An insurer may
not make a binding commitment to issue a student blanket health insurance
policy to any school prior to approval of such policy and premium rates.
Solicitation material, brochures, certificates or applications prepared or
approved by the insurer may not be distributed by any person or organization
prior to approval of the blanket policy.
(g) Insurers planning to sell student blanket
health insurance policies shall submit for approval a basic policy, any riders
providing variable benefits, and premium rates for each benefit before offering
to sell any coverage under such policies. Where the premium on transfer or
renewal cases is based in part on prior experience, the experience rating
formula shall be filed as part of the general rating structure.
(h) An insurer may not offer for sale any
"tailor-made" student blanket health insurance policy until the insurer has
approval of the language and rate for each benefit provision of the
policy.
(i) For any student blanket
health insurance program not previously approved, a licensed insurer may bid on
the risk subject to the approval of the Superintendent of Insurance, but no
solicitation or enrollment of students may be made prior to such
approval.
(j) Student blanket
health policies are subject to section
3221
(k)(5) of the Insurance Law. The statutory
coverage must be provided for pregnancies which commenced while the insured was
covered under the policy, even after all other coverage under the policy is
terminated.
(k) No payment of any
sums of money may be made to the policyholder, or to any person designated by
the policyholder, as a condition for the purchase of a student blanket health
insurance policy. This does not prohibit an insurer from hiring students or any
other persons to assist in the enrollment and servicing of the
insurance.
(l) The premium charged
to the insured may not be greater than the premium approved by the
superintendent. Any additional charge added to the premium by the policyholder
subjects the policyholder to the allegation of doing an insurance business
without a license. Any brochure or certificate must include a complete
statement of the premiums to be charged.
(m) A student blanket health policy shall be
deemed mandatory for purposes of section
52.16(f) of this
Part if 75 percent of the eligible students and a minimum of 300 students are
insured.
Notes
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