N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.53 - Conditional receipts and interim insurance agreements
Except as otherwise stated herein an insurer must issue either a conditional receipt or interim insurance agreement if premium is paid prior to delivery of the policy and the insurer requires a determination of insurability as a condition precedent to the issuance of a policy. The following rules shall apply to conditional receipts and interim insurance agreements:
(a) A conditional receipt
which requires a determination of insurability as a condition precedent to
coverage shall include an agreement:
(1) to
provide coverage subject to any reasonable limit regarding the amount of
insurance specified in the receipt, contingent upon insurability; and
(2) to provide that such insurability be
determined as of a date no later than the date of completion of all parts of
the application, including completion of the first medical examination if one
is required by the company's underwriting rules, and the required premium has
been paid. Completion of a second medical examination may be required as a
condition precedent to coverage if initially required by the company's
underwriting rules because of the amount of insurance applied for or the age of
the proposed insured.
(b) An interim insurance agreement which
provides immediate coverage shall include an agreement:
(1) to provide coverage in accordance with
the policy and plan of insurance described in the application subject to any
reasonable limit regarding the amount or duration of insurance specified in the
agreement; and
(2) to provide
coverage as of the date of application. The period of coverage must be at least
60 days unless the policy applied for is issued prior to such date or the
applicant receives actual notice that coverage under the agreement is cancelled
because the application has been declined. If notice is given by mail, it may
be deemed received on the fifth day after mailing such notice to the
applicant.
(c) A
determination of insurability means a determination by the company as to
whether the proposed insured is insurable under its underwriting rules and
practices for the plan and amount of insurance applied for and at the company's
standard premium rate.
(d) If the
proposed insured is insurable as of the date provided for in paragraph (a)(2)
of this section, coverage shall begin not later than such date, except as
provided in subdivision (f) of this section. If coverage is provided under a
conditional receipt or interim insurance agreement for two or more proposed
insureds, such coverage must be determined separately for each proposed
insured, except, however, all proposed insureds may be rejected in the event of
fraud or material misrepresentation.
(e) Although the proposed insured dies,
undergoes a change in health or otherwise becomes uninsurable according to the
company's underwriting standards for the plan of insurance for which
application was made after the date provided for in subdivision (a) of this
section but before the application is approved or rejected, and before the
expiration of any time limit specified in the receipt, a company may determine
that the proposed insured is not insurable only as of the date specified in
subdivision (a) of this section. Information relating to a event or physical
condition which is the subject of a question in any part of the company's
application cannot be considered for underwriting purposes if the event or
accident occurred or sickness first manifested itself after completion of that
part of the application.
(f) A
company may honor a written request from the applicant that coverage is to
commence as of a specified date later than the date provided for in either
subdivision (a) or (b) of this section. In other than replacement situations,
the written request must contain a statement signed by the applicant that he
understands that he may be waiving certain rights and guarantees under the
conditional receipt or interim insurance agreement.
(g) Only in mail order cases, and in cases
where a premium is paid in advance and certain participation requirements must
be met, is it permissible for a company to postpone the effective date of
coverage to the date of issuance of the policy.
(h) In franchise cases, the coverage under
the conditional receipt or interim insurance agreement may be made contingent
upon meeting specified participation requirements.
(i) If a policy is not issued within the time
specified in the conditional receipt or interim insurance agreement, the
application shall be deemed rejected and refund of all premiums shall be
made.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.