N.Y. Comp. Codes R. & Regs. tit. 11 § 52.31

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

Section 52.31 - Preparation of forms for submission

(a) New policy forms shall comply with statutory requirements without the necessity of amendatory riders or endorsements, except to the extent that minor changes are necessitated by distinctive New York requirements or unless riders or endorsements are expressly permitted by statute. Riders may be approved for use with previously approved policies for the purpose of conforming such policies to changes in the law or in rules and regulations, unless the resulting policy in its entirety would have the tendency to mislead or confuse the policyholder.

(b) No form will be approved in which the printed text has been changed by striking out, except those effecting simple administrative alternatives, or except in the case of policies where changes are authorized by an approved rider or endorsement, and appropriate attention is called to the change.

(c) Forms submitted for either preliminary review or approval shall be submitted in duplicate, except for Medicare supplement and combination group life and accident and health forms which shall be in triplicate. Domestic insurers shall submit one copy of a form for filing for delivery exclusively outside New York.

(d) Each policy form shall be designated by a suitable form number which may be made up of numerical digits or letters, or both, in the lower left-hand corner of the first page. The form number shall distinguish the form from all others used by the insurer.

(e) Forms submitted for approval shall be in the form intended for actual use. A form which is not printed shall be permitted only when its use is too limited to justify other preparation, and shall be clear, legible and reasonably permanent, considering its probable lifetime.

(f) Blank spaces of forms shall be filled in and completed with hypothetical data. The purpose and use of the form may be explained in the submission letter required by section 52.33 of this Part.

(g) A new form which makes reference to the provisions of a form previously used, that did not require filing or approval, shall be accompanied by such previous form for reference purposes.

(h) A policy form to which a copy of the application will be attached when issued shall have a copy of the application attached when submitted for approval.

(i) If the form does not affect benefits, coverages, exclusions or rates, the filing shall so state.

(j) All endorsements to be applied by stamp shall be submitted on the insurer's letterhead.

(k) Variable material used with impairment, waiver or exclusion riders shall be submitted with the form for approval. Such variable material shall be confined to specific diseases, afflicted areas of the body or specific extra-hazardous activity. The use of such a rider shall be based on the known physical condition or extra-hazardous activity of the covered person. The use of variable fill-in material in any impairment, waiver or exclusion rider delivered in New York before approval by the department shall constitute the use of an unapproved form.

(l) Illustrative material may be used for items which may vary from case to case, such as names, dates, eligibility requirements, and premiums and schedules for determining the amount of insurance for each insured person. For group insurance plans, if an explanatory memorandum accompanying a covering letter, or appropriate reference to material filed with schedules of premium rates, clearly indicates the nature and scope of the variations to be used, portions of other provisions, such as insuring clauses, benefit provisions, restrictions and termination of coverage provisions, may be submitted as variable, if suitably indicated by red ink, underlining, bracketing or otherwise. For example, it may be indicated that variations will be made within the limits set out in the explanatory memorandum, or that any one of several alternative provisions may be used, or that a provision may be either included as submitted or else completely omitted. An explanation of variable material, that the variations "will conform to law" or "as requested by the policyholder" is not acceptable. The alternative language, if any, shall be supplied independent of the submission letter.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.31