Group insurance coverage, except coverage filed to
specifically comply with article 9 of the Workers' Compensation Law, may be
provided prior to the filing or approval of forms, provided that the conditions
contained in this section are met. Failure to meet any of the conditions within
the time specified shall be a violation of the Insurance Law, unless reasons
for delay, including its probable extent, satisfactory to the department are
submitted to the department within the respective times specified.
(a) A copy of a letter of confirmation sent
to the policyholder by the insurer shall be submitted to the department within
30 days after the date the insurer agrees to provide insurance, setting forth,
inter alia:
(1) the effective date of
coverage;
(2) the nature and extent
of the benefits or change in benefits as then known;
(3) that the contractual forms may be
executed and issued for delivery only after filing with or approval thereof by
the department; and
(4) an
understanding that, if such forms are not filed or approved or are disapproved,
the parties will be returned to the status quo insofar as possible, or the
coverage will be modified retroactively to meet all requirements necesssary for
approval.
(b) At the
time the insurer agrees to provide such insurance:
(1) it is not reasonably possible to obtain
approval prior to the effective date of coverage because the policyholder has
requested the insurer to provide immediate coverage specifically designed to
meet the needs of the policyholder; and
(2) the insurer has reasonable expectation of
approval of the appropriate forms by the department.
(c) The actual forms are submitted for
approval within six months from the date the insurer agreed to provide
insurance.
