N.Y. Comp. Codes R. & Regs. tit. 11 § 153.6

Current through Register Vol. 46, No. 50, December 11, 2024

Section 153.6 - Form and rate filing requirements

Every authorized insurer issuing or renewing in this State any group policy or (except for subdivision [e] of this section) any quasi-group policy on risks or operations in this State, in connection with State law or a Federal purchasing group, shall comply with the following requirements:

(a) All such policy forms, rating classifications and territories shall be approved by the superintendent pursuant to section 2307 of the Insurance Law.

(b) All such rates, rating plans or rating rules shall be submitted to the superintendent pursuant to the applicable provisions of article 23 of the Insurance Law.

(c) No group or quasi-group policy shall qualify for exemption from filing under section 6301 of the Insurance Law.

(d) In complying with subdivisions (a) and (b) of this section, the insurer shall describe the nature and all material components of the group or quasi-group approach for which the forms, rating classifications, territories, rates, rating plans or rating rules are proposed for use.

(e) Subject to the superintendent's approval, pursuant to section 2307 of the Insurance Law, of:

(1) an enrollment period, a group policy may provide for a stated enrollment period; and

(2) an options plan, a group policy may be based upon a plan that precludes or otherwise restricts individual selection of insurance coverages and limits by group members.

(f) Group and quasi-group policy forms and rates shall comply with article 23 standards, and no such rates shall be excessive, inadequate, unfairly discriminatory, destructive of competition, detrimental to solvency, or otherwise unreasonable, subject to the following factors:

(1) advantages may be considered, based on actual or reasonably anticipated loss and expense experience of the group or its members, or of the quasi-group or its participants, where such advantages and experience can be fairly demonstrated;

(2) rates shall not be deemed unfairly discriminatory in the event different premiums result for group members with like loss exposure but different expense factors, or like expense factors but different loss exposures, where such differences can be fairly demonstrated; and

(3) rates, rating plans or rating rules recognizing loss or expense experience differences an a group or quasi-group basis, in comparison to like risks not in the group or quasi-group, shall be deemed rating classifications subject to the superintendent's approval pursuant to section 2307 of the Insurance Law.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 153.6