N.Y. Comp. Codes R. & Regs. Tit. 11 § 98.4 - General requirements for all life insurance policies subject to this part unless stated otherwise

(a) Basic reserves.
(1) Basic reserves actually held shall never be less than the greatest of:
(i) the tabular cost of insurance (i.e., the valuation mortality rate multiplied by the death benefit and discounted using the valuation interest rate) for:
(a) the balance of the policy year, if mean reserves are used, based on the 1980 CSO table with or without 10-year select mortality factors and the valuation interest rate used for basic reserves; or
(b) the balance of the current modal period or to the paid-to-date, if later, if mid-terminal reserves are used, based on the 1980 CSO table with or without 10-year select mortality factors and the valuation interest rate used for basic reserves; or
(ii) the unitary reserves; or
(iii) for policies issued after the relevant dates of section 98.2(d) and subject to section 98.6 of this Part, basic segmented reserves.

The balance referred to in subparagraph (i) of this paragraph may be exact for each policy or an average based on an assumed average anniversary date.

(2) Special optional minimum mortality standard for basic reserves for policies issued before January 1, 2000. At the election of the company for policies issued on or after the relevant date of section 98.2(d) of this Part, but before January 1, 2000, under any one or more specified plans of life insurance, the minimum mortality standard for basic unitary and basic segmented reserves (but not for tabular cost of insurance) may be calculated using the 1980 CSO tables without 10-year select mortality factors and:
(i) 150 percent of the base valuation selection factors shown in Appendix 23 to this Part, infra, but round the result to the nearest integer (e.g., 52.7 percent becomes 53 percent) and set equal to 100 percent any factor that exceeds 100 percent; or
(ii) alternative sets of mortality select factors subject to the approval of the superintendent so long as:
(a) such sets of factors do not exceed 15 years;
(b) such sets of factors do not decrease with duration;
(c) each factor is not less than the corresponding factor in accordance with subparagraph (i) of this paragraph; and
(d) each factor is not greater than 100 percent.
(3) Special optional minimum mortality standard for basic reserves for policies issued on January 1, 2000 or later. At the election of the company for policies issued on or after January 1, 2000, under any one or more specified plans of life insurance, the minimum mortality standard for basic reserves (but not for tabular cost of insurance) may be calculated using the 1980 CSO tables without 10-year select mortality factors and the select mortality factors shown in Appendix 24, infra to this Part.
(4) Basic reserves for indeterminate premium policies shall be based on the guaranteed gross premium scale.
(5) Reserve for immediate payment of claims.
(i) Reserves based on either fully continuous functions or on semi-continuous functions where the death portion reflects approximately one half of one year's interest at the valuation rate of interest are considered as making appropriate provision for immediate payment of claims.
(ii) Where basic reserves are based on curtate functions with no provision for immediate payment of claims:
(a) For any policy where the contract or company practice calls for payment of death claims immediately upon receipt of due proof of death of the insured, the death portion of curtate reserves shall be increased by one-third of one year's interest at the valuation rate of interest. Approximations may be used to split the total curtate reserves into the death portion and the pure endowment portion.
(b) For any policy where the contract or company practice provides for payment of interest on the death proceeds from date of death to date of payment, the death portion of curtate reserves shall be increased by one-half of one year's interest at the valuation rate of interest. Approximations may be used to split the total curtate reserves into the death portion and the pure endowment portion.
(iii) The reserve for immediate payment of claims shall be considered a part of basic reserves.
(b) Deficiency reserves.
(1) This subdivision shall apply to any policy for which the gross premium at any future duration is less than the corresponding modified net premium calculated on the basis of the commissioners reserve valuation method, and using the maximum allowable valuation interest rate and the minimum mortality standards allowable for deficiency reserve purposes.
(2) Deficiency reserves shall be calculated for each policy subject to this subdivision as the excess, if greater than zero, of quantity A, as defined in paragraph (3) of this subdivision, over basic reserves.
(3) Quantity A shall be determined by recalculating the basic reserves for the policy:
(i) using:
(a) the commissioners reserve valuation method;
(b) the maximum allowable valuation interest rate; and
(c) the minimum mortality standards allowable for calculating deficiency reserves; and
(ii) replacing the modified net premium by the gross premium for the policy in each contract year for which the modified net premium exceeds the gross premium.
(4) Special optional minimum mortality standards for deficiency reserves for policies issued before January 1, 2000. At the election of the company, for policies issued after the relevant date of section 98.2(d) of this Part, but before January 1, 2000, under any one or more specified plans of insurance, the minimum mortality standard for quantity A may be calculated using the 1980 CSO tables without 10-year select mortality factors; and
(i) 120 percent of the base valuation selection factors shown in Appendix 23 infra, to this Part, but round the result to the nearest integer and set equal to 100 percent any factor that exceeds 100 percent; or
(ii) 150 percent of the base valuation selection factors shown in Appendix 23 infra, to this Part, but round the result to the nearest integer and set equal to 100 percent any factor that exceeds 100 percent; or
(iii) alternative sets of mortality factors subject to the approval of the superintendent so long as:
(a) such sets of factors do not exceed 15 years;
(b) such sets of factors do not decrease with duration;
(c) each factor is not less than the corresponding factor in accordance with subparagraph (i) of this paragraph; and
(d) each factor is not greater than 100 percent.
(5) Special optional minimum mortality standard for deficiency reserves for policies issued on or after January 1, 2000. At the election of the company, for policies issued on or after January 1, 2000 under any one or more specified plans of insurance, the minimum mortality standard for quantity A may be calculated using the 1980 CSO tables without 10-year select mortality factors and the select mortality factors shown in the Appendix 24 infra. For all such specified plans of insurance on which the company made this election, the company may choose to multiply the resulting mortality rates in the first segment by X percent (X which refers to a percentage is not the same as x which refers to issue age), subject to the following conditions:
(i) X may vary by policy year, policy form, underwriting classification, issue age, or any other policy factor expected to affect mortality experience;
(ii) X is such that, when using the valuation interest rate used for basic reserves, the actuarial present value of future death benefits calculated using the mortality rates resulting from the application of X is greater than or equal to:
(a) except for a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, as provided in clause (b) of this subparagraph, the actuarial present value of future death benefits calculated using anticipated mortality experience without recognition of mortality improvement beyond the valuation date; or
(b) for a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, the actuarial present value of future death benefits calculated using anticipated mortality experience with recognition of mortality improvement beyond the valuation date as specified in section 100.11 or 100.12 of this Title (Insurance Regulation 179) as applicable;
(iii)
(a) Except for a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, as provided in clause (b) of this subparagraph, X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, without recognition of mortality improvement beyond the valuation date, in each of the first five years after the valuation date; or
(b) For a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, X is such that the mortality rates resulting from the application of X are at least as great as the anticipated mortality experience, with recognition of mortality improvement beyond the valuation date, in each of the first five years after the valuation date, as specified in section 100.11 or 100.12 of this Title (Insurance Regulation 179) as applicable;
(iv) the appointed actuary shall increase X at any valuation date where it is necessary to continue to meet all the requirements of this paragraph;
(v) the appointed actuary may decrease X at any valuation date as long as X continues to meet all the requirements of this paragraph;
(vi) the appointed actuary shall specifically take into account the adverse effect on expected mortality and lapsation of any anticipated or actual increase in gross premiums;
(vii) if X is less than 100 percent at any duration for any policy, the following requirements shall be met:
(a) the appointed actuary shall annually prepare an actuarial opinion and memorandum for the entire company for all reserves and related actuarial items tabulated in section 95.8(b)(2) of this Title in conformance with the requirements of section 95.8 of this Title;
(b)
(1) the appointed actuary shall annually opine separately for:
(i) all policies subject to this Part issued prior to January 1, 2000; and
(ii) all policies subject to this Part issued on or after January 1, 2000, as to whether the mortality rates resulting from the application of X meet the requirements of this paragraph.
(2) The opinion required by this clause shall be supported by an actuarial report, subject to appropriate actuarial standards of practice promulgated by the Actuarial Standards Board of the American Academy of Actuaries. Except for a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, the opinion shall reflect future mortality, without recognition of mortality improvement beyond the valuation date, taking into account relevant emerging experience. For a varying premium term life insurance policy or a universal life policy that guarantees that coverage will remain in force as long as the accumulation of premiums paid satisfies the secondary guarantee requirement, issued on or after January 1, 2015 and prior to January 1, 2017, or on or after January 1, 2015 and prior to January 1, 2020 if optionally elected under section 100.11(b) or 100.12(b) of this Title (Insurance Regulation 179), respectively, the opinion shall reflect future mortality, with recognition of mortality improvement beyond the valuation date, as specified in section 100.11 or 100.12 of this Title (Insurance Regulation 179) as applicable, taking into account relevant emerging experience.
(6) Approved select mortality factors may be used for determining quantity A even if such are not used to determine basic reserves.
(7) Approved smoker/nonsmoker valuation mortality tables may be used for determining quantity A so long as actual gross premiums are charged based on smoking status, even if basic reserves are not determined based on smoking status. However, this paragraph does not prohibit the use of smoker valuation mortality tables in calculating reserves for substandard nonsmoker lives if appropriate and justifiable.
(8) For indeterminate premium policies, the guaranteed gross premium scale shall be used for purposes of determining quantity A.
(c) Policies sold on an age last birthday basis. In applying the mortality selection factors as derived from the base valuation selection factors shown in the Appendices to this Part (see Appendices 23 and 24, infra) to determine reserves for a policy sold on an age last birthday (ALB) basis, the following methodologies are acceptable:
(1) apply the derived selection factors directly to the ALB version of the 1980 CSO table without 10-year select mortality factors; or
(2) apply the derived selection factors to the age nearest birthday (ANB) version of the 1980 CSO table without 10-year select mortality factors and use the resulting ANB valuation mortality rates to derive the ALB valuation mortality rates.
(d) Cash surrender value floor.
(1) The reserve actually held for each policy, other than a variable life insurance policy, (including basic reserves, deficiency reserves, and any reserves held for supplemental benefits that would expire upon contract termination) prior to any reinsurance reserve credit or other reinsurance adjustment must not be less than the cash surrender value at the same duration (including the cash surrender value of the supplemental benefits referred to above) prior to any deductions for policy loans.
(2) For variable life insurance, the reserve held for each policy (including basic reserves, deficiency reserves, and any reserves held for supplemental benefits that would expire upon contract termination) prior to any reinsurance reserve credit or other reinsurance adjustment must not be less than the sum of the cash surrender value prior to any deductions for policy loans (including the cash surrender value of the supplemental benefits referred to above) plus the greater of the one year term reserve required by section 98.8(d)(1) of this Part or the attained age level reserve required by section 98.8(d)(2) of this Part at the same duration.
(e) Policies with unusual patterns of guaranteed cash surrender values.
(1) For purposes of this subdivision, a policy is considered to have an unusual pattern of guaranteed cash surrender values if any future guaranteed cash surrender value exceeds the prior year's guaranteed cash surrender value by more than the sum of:
(i) 110 percent of the scheduled gross premium for that year;
(ii) 110 percent of one year's accrued interest on the sum of the prior year's guaranteed cash surrender value and the scheduled gross premium using the nonforfeiture interest rate used for calculating policy guaranteed cash surrender values; and
(iii) five percent of the first policy year's surrender charge, if any.

This determination is made at policy issue based on policy guarantees.

(2) For any policy with an unusual pattern of guaranteed cash surrender values, the reserves actually held prior to the first unusual guaranteed cash surrender value shall not be less than the reserves according to the commissioners reserve valuation method, as defined in section 4217(c)(6)(A) of the Insurance Law treating the first unusual guaranteed cash surrender value as a pure endowment and treating the policy as an n year policy providing term insurance plus a pure endowment equal to such cash surrender value, where n is the number of years from the date of issue to the date such cash surrender value is scheduled. The reserves actually held after the first unusual guaranteed cash surrender value shall not be less than the reserves according to the net level premium method treating the first unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date as a pure endowment and treating the policy as an n year policy providing term insurance plus a pure endowment equal to such cash surrender value, where:
(i) n is the number of years from the date of the last unusual guaranteed cash surrender value prior to the valuation date to the earlier of:
(a) the date of the first unusual guaranteed cash surrender value, if any, that is scheduled after the valuation date; or
(b) the mandatory expiry date of the policy; and
(ii) the net level premium for a given year during the n year period is equal to the product of the net to gross ratio and the respective gross premium; and
(iii) the net to gross ratio is equal to clause (a) divided by clause (b) of this subparagraph as follows:
(a) the present value, at the beginning of the n year period, of death and endowment benefits payable during the n year period plus the present value, at the beginning of the n year period, of the next unusual guaranteed cash surrender value, if any, minus the amount of the last unusual guaranteed cash surrender value, scheduled at the beginning of the n year period; and
(b) the present value, at the beginning of the n year period, of the scheduled gross premiums payable during the n year period.
(3) All present values shall be calculated using the same valuation mortality and interest rates used to calculate basic reserves otherwise required in accordance with this Part.
(f) Special optional exemption for yearly renewable term reinsurance.
(1) At the option of the company, for reserves for yearly renewable term (YRT) reinsurance, the following methodology may be used as an alternative to the requirements of paragraph (a)(1) and subdivision (b) of this section and section 98.6 of this Part:
(i) Calculate the valuation net premium for each future policy year as the tabular cost of insurance for such future year.
(ii) Basic reserves. Basic reserves shall never be less than the tabular cost of insurance as specified in subparagraph (a)(1)(i) of this section.
(iii) Deficiency reserves.
(a) For each future policy year in which the valuation net premium exceeds the respective gross premium, calculate the excess of the valuation net premium over the respective gross premium.
(b) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses determined in accordance with clause (a) of this subparagraph.
(iv) Reserves actually held shall never be less than the sum of the basic reserves and the deficiency reserves, as specified in this paragraph.
(2) In the application of subparagraphs (1)(ii)-(iii) of this subdivision:
(i) the mortality standard shall be the 1980 CSO table with or without 10-year select mortality factors;
(ii) the special optional minimum mortality standards for basic reserves and deficiency reserves as defined in this section shall not be used; and
(iii) the maximum valuation interest rates shall be used.
(3) If this election is made, the ceding insurer may not take reserve credit in excess of the reserve set up by the reinsurer.
(4) If this election is made for any reinsurance agreement with a given ceding insurer, this election must be made for all YRT reinsurance agreements effective on or after January 1, 2000 with such ceding insurer.
(5) A reinsurance agreement shall be considered YRT reinsurance for purposes of this subdivision if the mortality risk only is reinsured.
(g) Special optional exemption for certain policies issued prior to the relevant dates of section 98.2(d) of this Part and requirements for certain 1958 CSO policies.
(1) At the option of the company, for reserves for policies subject to this Part in accordance with section 98.2(e)(2) of this Part, issued prior to the relevant date of section 98.2(d) of this Part, the following methodology may be used as an alternative to the calculation of unitary reserves as required in paragraph (a)(1) of this section:
(i) Separate the policy into periods where a period is defined as the number of successive years for which gross premiums are level.
(ii) Basic reserves.
(a) Basic reserves shall never be less than the present value of guaranteed life insurance and endowment benefits for the current period less the present value of modified net premiums for such period.
(b) The commissioners reserve valuation method may be used for the first period only. For the second and subsequent periods, the net level premium method shall be used; that is, as of the beginning of given period, the present value of modified net premiums shall equal the present value of guaranteed life insurance and endowment benefits for the period.
(iii) Deficiency reserves.
(a) For each future period (including the current period) in which the modified net premium exceeds the gross premium, calculate the present value, at the date of valuation, of the excess of the modified net premiums for such period over the gross premiums for such period.
(b) Deficiency reserves shall never be less than the sum of the present values, at the date of valuation, of the excesses, determined in accordance with clause (a) of this subparagraph, for the current period and all future periods.
(iv) Reserves actually held shall never be less than the sum of the basic reserves and the deficiency reserves, as specified in this paragraph.
(v) If this election is made, the methodology in this paragraph shall be applied in determining reserves for all policies subject to this Part in accordance with section 98.2(e)(2) of this Part issued prior to the relevant date of section 98.2(d) of this Part.
(2) The procedures of subparagraphs (1)(i) through (iv) of this subdivision shall be applied in calculating reserves for all non-level premium term life insurance policies for which basic reserves are calculated using the 1958 CSO table. For deficiency reserves for such policies, the 1980 CSO table with or without select mortality factors may be used.
(h) In determining basic reserves or deficiency reserves under the unitary reserve method or the segmented reserve method (as described in section 98.6 of this Part), guaranteed gross premium without policy fee may be used where the calculation involves the guaranteed gross premium but only if the policy fee is a level dollar amount for the entire premium paying period of the policy. In testing for the need for deficiency reserves per paragraph (b)(1) of this section and section 98.6(b)(1) of this Part, the policy fee may be included even if not included in the actual calculation of basic reserves.
(i) The base valuation selection factors shown in the Appendices to this Part (see Appendices 23 and 24, infra) are sex-distinct. The actual selection factors used in determining basic reserves or deficiency reserves may be gender-blended in accordance with the provisions of Part 47 of this Title.
(j) Special optional exemption for attained-age-based yearly renewable term life insurance policies.
(1) At the option of the company, for reserves for attained-age-based yearly renewable term (YRT) life insurance policies, the methodology described in paragraph (f)(1) of this section may be used as an alternative to the requirements of paragraph (a)(1) and subdivision (b) of this section and section 98.6 of this Part.
(2) In applying paragraph (1) of this subdivision, the mortality standard shall be the 1980 CSO table with or without 10-year select mortality factors. The special optional minimum mortality standards for basic reserves and deficiency reserves as defined in this section shall not be used.
(3) If this election is made, the methodology of paragraph (f)(1) of this section shall be applied in determining reserves for all attained-age-based YRT life insurance policies, unless otherwise approved by the superintendent.
(4) A policy shall be considered an attained-age-based YRT life insurance policy for purposes of this subdivision if it conforms to subparagraphs (i) and (ii) of this paragraph.
(i) The premium rates (on both the initial current gross premium scale and the guaranteed gross premium scale) for any given year are based on the attained age of the insured such that the rate for any given policy at a given attained age of the insured is independent of the year the policy was issued. For example, the rate for an insured aged 55 in the current year would be the same whether the policy was issued at age 25 (30 years ago) or at age 50 (five years ago).
(ii) The premium rate (on both the initial current premium scale and the guaranteed premium scale) is the same as the premium rate for policies covering all insureds of the same sex, risk class, policy form, and attained age.
(5) For policies that become attained-age-based YRT policies after an initial period of coverage, the methodology of this subdivision may be used if:
(i) the initial period is constant for all insureds of the same sex, risk class, and plan of insurance or the initial period runs to a common attained age for all insureds of the same sex, risk class and plan of insurance; and
(ii) after the initial period of coverage, the policy meets the conditions of paragraph (4) of this subdivision.
(k) Policies containing market value adjustments. For policies containing market value adjustments, in addition to the requirements of this Part, the reserve requirements of Part 43 of this Title shall also apply.
(l) Reserves for policies that have changes to guaranteed gross premiums, guaranteed benefits, guaranteed charges, or guaranteed credits that are unilaterally made by the insurer after issue that are effective for more than one year after the date of the change shall be the greatest of the following:
(1) reserves calculated ignoring the guarantee;
(2) reserves assuming the guarantee was made at issue; and
(3) reserves assuming that the policy was issued on the date of the guarantee.
(m) The superintendent may require that the company document the extent of the adequacy of reserves for specified blocks, including but not limited to policies issued prior to the effective date of this regulation. This documentation may include a demonstration of the extent to which aggregation with other blocks of business is relied upon in the formation of the appointed actuary opinion pursuant to and consistent with the requirements of Regulation 126.
(n) Any provision that keeps the death benefit in force beyond the policy year when, under the other guaranteed terms of the policy, the policy would lapse or the policy values would be zero, must be valued consistently with the principles underlying this regulation. The methods of valuation, if other than those specified in this regulation, must be submitted to the superintendent for approval.
(o) For any policy which guarantees renewal, or conversion to another policy, without evidence of insurability, additional reserves shall be held that account for excess mortality due to antiselection with appropriate margins to cover expenses and risk of moderately adverse deviations in experience.
(p) For any policy for which, in the judgment of the appointed actuary, expected mortality is greater, at any duration, than the 1980 CSO table without 10-year select mortality factors, additional reserves shall be held that account for excess mortality with appropriate margins to cover expenses and risk of moderately adverse deviations in experience unless not holding such additional reserves is justified by an acceptable actuarial opinion and memorandum in accordance with sections 95.8 and 95.9 of this Title. The justification should be discussed in such memorandum.
(q) This subdivision shall apply to policies assumed under any reinsurance agreement that provides that if reinsurance premiums are increased there will be a corresponding increase in the expense allowance.
(1) For such policies, the reinsurer shall set the guaranteed premium scale to be used for reserve calculations equal to subparagraph (i) minus subparagraph (ii) of this paragraph, where:
(i) is the guaranteed reinsurance premium scale; and
(ii) is the corresponding guaranteed increase in expense allowance that would be paid if the guaranteed reinsurance premiums were charged.
(2) Notwithstanding any provision in this Part to the contrary, this subdivision shall apply to all such policies effective on or after January 1, 2000 regardless of the date of the reinsurance agreement.
(r) Where a rider provides for the waiver of future premiums, and/or mortality and expense charges, upon the first death of a last survivor base policy the total reserve for the base policy and rider shall not be less than the greater of:
(1) the sum of the reserve for the base policy and the reserve for the rider, treating each as if it were a separate policy; and
(2) the reserve determined by treating the base policy and the rider as if the combination were a single policy.
(s) For a policy which provides for whole life insurance with the amount of death benefit adjusted periodically with a cost of living index, the value of the minimum reserve at any time shall be based on the maximum valuation interest rate for the year of issue and an acceptable mortality table for life insurance statutory reserves and based on the death benefit and premium pattern adjusted as provided in the policy by reasonable annual increases based on the index. The present value of future benefits component shall be further adjusted each year by the ratio of the then current amount of death benefit to the initially projected amount of death benefit. If the policy provides for future premiums and such premiums are also adjusted periodically with a cost of living index, the present value of future premiums component shall likewise be further adjusted each year by the ratio of the then current amount of death benefit to the initially projected amount of death benefit. The assumption as to what is a reasonable annual increase in death benefits based on the index must not be less than the maximum valuation interest rate for the year of issue less one percent.
(t) A nonguaranteed premium or other policy cost factor for purposes of calculating reserves will be considered guaranteed if the company is in any way restricted from changing these premiums or other policy cost factors to recognize changes in actual or expected company experience related to this policy. Pre-filing of premiums or other policy cost factors with the superintendent or the insurance supervisor of another state is not considered to be a restriction for the purpose of this subdivision.
(u) All applications of this Part must be consistent with the principles of section 4217 of the Insurance Law and the principles and concepts of this Part. Section 98.9 of this Part shows examples of how to apply the principles to certain specified policy designs. An insurer shall hold additional reserves if the superintendent determines that the calculated reserves are less than those calculated by a proper interpretation of this Part.
(v) For policies that provide long-term care benefits through the acceleration of benefits under group or individual life policies or riders to such policies, the reserves for such benefits shall be determined in accordance with Part 94 of this Title (Regulation 56). The reserves for the life insurance benefits may take into account the reduction in life insurance benefits due to the payment of accelerated benefits. However, in no event shall the reserves for the long-term care benefit and the life insurance benefit be less than the reserves for the life insurance benefit assuming no long-term care benefit is available.
(w)
(1) For the purposes of this section, statistical agent means an entity with proven systems for protecting the confidentiality of individual insured and insurer information; demonstrated resources for, and history of, ongoing electronic communications and data transfer ensuring data integrity with insurers that are the statistical agent's members or subscribers; and a history of and means for aggregation of data and accurate promulgation of the experience modifications in a timely manner.
(2)
(i) This subdivision applies to insurers where the sum of the premiums received as specified in clauses (a), (b), (c), (d) of this subparagraph exceed ten million dollars for the previous calendar year;
(a) direct individual life insurance premiums;
(b) reinsurance assumed life insurance premiums;
(c) direct individually solicited group life insurance premiums; and
(d) reinsurance assumed individually solicited group life insurance premiums.
(ii) Every insurer subject to this subdivision shall annually file on or before July 1 with the superintendent, or at the direction of the superintendent, with either the National Association of Insurance Commissioners or with a statistical agent designated by the superintendent, a statistical report, in a form specified by the superintendent, showing mortality, expenses, lapses, and such other company experience information as the superintendent may deem necessary or expedient for the administration of the provisions of the Insurance Law or this Part, with respect to individual life insurance policies and individually solicited group life insurance certificates issued on or after January 1, 1990.

Notes

N.Y. Comp. Codes R. & Regs. Tit. 11 § 98.4
Amended, New York State Register December 10, 2014/Volume XXXVI, Issue 49, eff. 12/10/2014 Amended, New York State Register April 1, 2015/Volume XXXVII, Issue 13, eff. 4/1/2015 Amended New York State Register May 17, 2017/Volume XXXIX, Issue 20, eff. 5/17/2017 Amended New York State Register January 2, 2019/Volume XLI, Issue 01, eff. 1/2/2019 Amended New York State Register April 22, 2020/Volume XLII, Issue 16, eff. 4/22/2020

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