N.Y. Comp. Codes R. & Regs. tit. 11 § 52.21

Current through Register Vol. 46, No. 45, November 2, 2024

Section 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.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.21