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0 chapters · 1,072 sections in this title.
N.Y. Insurance Law § 4607 Exemption from taxation; trusts; higher education loans
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§ 4607. Exemption from taxation; trusts; higher education loans. (a) The property of a system, the portion of wages or salary of an employee deducted or to be deducted, the right of an employee to a pension benefit, and all his rights in the funds of the system, shall be exempt …
N.Y. Insurance Law § 4608 Application
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§ 4608. Application. (a) Every system organized or created under this chapter shall be subject to the provisions of this article, to subsection (g) of section one thousand one hundred two of this chapter, to the appropriate provisions of articles one, three and seventy-four of t…
N.Y. Insurance Law § 4701 Legislative findings
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§ 4701. Legislative findings. (a) Cooperative health risk-sharing agreements allow public entities to: share, in whole or part, the costs of self-funding employee health benefit plans; provide municipal corporations, school districts and other public employers with an alternativ…
N.Y. Insurance Law § 4702 Definitions
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§ 4702. Definitions. As used in this article: (a) "Community rating" means a rating methodology in which the premium equivalent rate for all persons covered under a municipal cooperative health benefit plan is the same, based upon the experience of the entire pool of risks cover…
N.Y. Insurance Law § 4703 Application for certificate of authority
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§ 4703. Application for certificate of authority. (a) No municipal corporation shall establish, maintain or otherwise participate in a municipal cooperative health benefit plan in this state which provides benefits, in whole or part, on a shared-funding basis, unless the municip…
N.Y. Insurance Law § 4704 Conditions for issuance of certificate of authority
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§ 4704. Conditions for issuance of certificate of authority. (a) The superintendent shall issue a certificate of authority to a municipal cooperative health benefit plan if all of the following conditions, after examination and investigation, have been met to the superintendent'…
N.Y. Insurance Law § 4705 Municipal cooperation agreements
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§ 4705. Municipal cooperation agreements. (a) The municipal cooperation agreement, under which the municipal cooperative health benefit plan is established and maintained, and any amendment thereto, shall be approved by each participating municipal corporation by majority vote o…
N.Y. Insurance Law § 4706 Reserve and surplus requirements
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§ 4706. Reserve and surplus requirements. (a) Notwithstanding any provision of law, the governing board of a municipal cooperative health benefit plan shall establish a reserve fund, and the plan's chief fiscal officer shall cause to be paid into the reserve fund the amounts nec…
N.Y. Insurance Law § 4707 Stop-loss requirements
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§ 4707. Stop-loss requirements. (a) The governing board of a municipal cooperative health benefit plan shall obtain and maintain on behalf of the plan a stop-loss insurance policy or policies delivered in this state and issued by a licensed insurer, providing: (1) aggregate stop…
N.Y. Insurance Law § 4708 Contingent liability
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§ 4708. Contingent liability. (a) The municipal cooperation agreement and the plan document delivered to each participating municipal corporation shall provide that every municipal corporation participating in the municipal cooperative health benefit plan shall be liable in the …
N.Y. Insurance Law § 4709 Plan benefits and disclosure
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§ 4709. Plan benefits and disclosure. (a) The governing board of the municipal cooperative health benefit plan shall deliver or cause to be delivered the plan document to all participating municipal corporations and to unions which are the exclusive collective bargaining represe…
N.Y. Insurance Law § 4710 Additional filing requirements and annual report
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§ 4710. Additional filing requirements and annual report. (a) The governing board of the municipal cooperative health benefit plan shall: (1) file for approval with the superintendent a description of material changes in any information provided in the application for certificat…
N.Y. Insurance Law § 4711 Examinations
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§ 4711. Examinations. (a) The superintendent may examine the affairs of a municipal cooperative health benefit plan as often as deemed necessary, but not less than once in every three years, except that the superintendent may extend the three-year interval to no more than five y…
N.Y. Insurance Law § 4712 Suspension or revocation of certificate of authority
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§ 4712. Suspension or revocation of certificate of authority. (a) The superintendent may suspend or revoke a certificate of authority issued to a municipal cooperative health benefit plan under the following circumstances: (1) for any cause that would be a basis for denial of an…
N.Y. Insurance Law § 4713 Plan dissolution
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§ 4713. Plan dissolution. (a) In any case in which the governing board of a municipal cooperative health benefit plan determines that there is reason to believe that the plan will terminate, the governing board shall so inform the superintendent and submit a plan for the superin…
N.Y. Insurance Law § 4714 Transition
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§ 4714. Transition. For municipal cooperative health benefit plans that provided medical, surgical or hospital services on or before January first, nineteen hundred ninety-three pursuant to a municipal cooperation agreement authorized under article five-G of the general municipa…
N.Y. Insurance Law § 4801 Application
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§ 4801. Application. The provisions of this article shall apply to all managed care products, as defined in subsection (c) of this section, which are delivered or issued for delivery in this state by insurers licensed under this chapter; provided, however, that none of the provi…
N.Y. Insurance Law § 4802 Grievance procedure
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§ 4802. Grievance procedure. (a) An insurer which offers a managed care product shall establish and maintain a grievance procedure with regard to such managed care product. Pursuant to such procedure, insureds shall be entitled to seek a review of determinations by the insurer w…
N.Y. Insurance Law § 4803 Health care professional applications and terminations
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§ 4803. Health care professional applications and terminations. (a)\n(1) An insurer which offers a managed care product shall, upon request,\nmake available and disclose to health care professionals written\napplication procedures and minimum qualification requirements which a\n…
N.Y. Insurance Law § 4804 Access to specialty care
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§ 4804. Access to specialty care. (a) If an insurer offering a managed\ncare product determines that it does not have a health care provider in\nthe in-network benefits portion of its network with appropriate training\nand experience to meet the particular health care needs of a…
N.Y. Insurance Law § 4805 Access to end of life care
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§ 4805. Access to end of life care. (a) Every contract issued by an\ninsurer that provides coverage for hospital, surgical or medical care\nthat includes coverage for acute care services shall provide coverage\nfor an insured diagnosed with advanced cancer (with no hope of rever…
N.Y. Insurance Law § 4806 Health care facility applications
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§ 4806. Health care facility applications. (a) An insurer that offers a managed care product shall, upon request, make available and disclose to facilities written application procedures and minimum qualification requirements that a facility must meet in order to be considered b…
N.Y. Insurance Law § 4900 Definitions
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§ 4900. Definitions. For purposes of this article: (a) "Adverse determination" means a determination by a utilization review agent that an admission, extension of stay, or other health care service, upon review based on the information provided, is not medically necessary. (b) "…
N.Y. Insurance Law § 4901 Reporting requirements for utilization review agents
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§ 4901. Reporting requirements for utilization review agents. (a) Every utilization review agent shall biennially report to the superintendent of financial services, in a statement subscribed and affirmed as true under the penalties of perjury, the information required pursuant …
N.Y. Insurance Law § 4902 Utilization review program standards
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§ 4902. Utilization review program standards. (a) Each utilization review agent shall adhere to utilization review program standards consistent with the provisions of this title which shall, at a minimum, include: (1) Appointment of a medical director, who is a licensed physicia…
N.Y. Insurance Law § 4903 Utilization review determinations
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§ 4903. Utilization review determinations. (a) Utilization review\nshall be conducted by:\n (1) Administrative personnel trained in the principles and procedures\nof intake screening and data collection, provided however, that\nadministrative personnel shall only perform intake …
N.Y. Insurance Law § 4904 Appeal of adverse determinations by utilization review agents
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§ 4904. Appeal of adverse determinations by utilization review agents.\n(a) An insured, the insured's designee and, in connection with\nretrospective adverse determinations, an insured's health care provider,\nmay appeal an adverse determination rendered by a utilization review\…
N.Y. Insurance Law § 4905 Required and prohibited practices
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§ 4905. Required and prohibited practices. (a) Each utilization review\nagent shall have written procedures for assuring that patient-specific\ninformation obtained during the process of utilization review will be:\n (1) kept confidential in accordance with applicable state and …
N.Y. Insurance Law § 4906 Waiver
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§ 4906. Waiver. (a) Any agreement which purports to waive, limit, disclaim, or in any way diminish the rights set forth in this article, except as provided pursuant to section four thousand nine hundred ten of this article shall be void as contrary to public policy. (b) Notwiths…
N.Y. Insurance Law § 4907 Rights and remedies
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§ 4907. Rights and remedies. The rights and remedies conferred in this article upon insureds and health care providers shall be cumulative and in addition to and not in lieu of any other rights or remedies available under law.
N.Y. Insurance Law § 4908 Applicability to ERISA Plans
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§ 4908. Applicability to ERISA Plans. Notwithstanding the foregoing, the provisions of this article shall not apply to any utilization review conducted by, or on behalf of, a self-insured employee welfare benefit plan, as defined in the employee retirement income security act of…
N.Y. Insurance Law § 4909 Site of service clinical review
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§ 4909. Site of service clinical review. (a) For purposes of this\nsection:\n (1) "Free-standing ambulatory surgical center" shall mean a diagnostic\nand treatment center authorized pursuant to article twenty-eight of the\npublic health law and operated independently from a hosp…
N.Y. Insurance Law § 4910 Right to external appeal established
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§ 4910. Right to external appeal established. (a) There is hereby\nestablished an insured's right to an external appeal of a final adverse\ndetermination by a health plan.\n (b) An insured, the insured's designee and, in connection with\nconcurrent and retrospective adverse dete…
N.Y. Insurance Law § 4911 Powers of the superintendent
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§ 4911. Powers of the superintendent. (a) The superintendent shall have the power to grant and revoke certifications of external appeal agents to conduct external appeals requested pursuant to paragraph one or two of subsection (b) of section four thousand nine hundred ten of th…
N.Y. Insurance Law § 4912 Standards for certification
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§ 4912. Standards for certification. (a) The superintendent shall develop an application for certification. At a minimum, applicants shall provide: (1) a description of the qualifications of the clinical peer reviewers retained to conduct external appeals of final adverse determ…
N.Y. Insurance Law § 4913 Conflict of interest
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§ 4913. Conflict of interest. (a) No external appeal agent or officer, director, or management employee thereof; or clinical peer reviewer employed or engaged thereby to conduct any external appeal pursuant to this title, shall have any material professional affiliation, materia…
N.Y. Insurance Law § 4914 Procedures for external appeals of adverse determinations
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§ 4914. Procedures for external appeals of adverse determinations. (a) The superintendent shall establish procedures by regulation to randomly assign an external appeal agent to conduct an external appeal, provided that the superintendent may establish a maximum fee which may be…
N.Y. Insurance Law § 4915 Prohibited practices
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§ 4915. Prohibited practices. An external appeal agent shall not, with respect to external appeal activities, permit or provide compensation or anything of value to its employees, agents, or contractors based on: (a) either a percentage of the amount by which a claim is reduced …
N.Y. Insurance Law § 4916 Oversight and surveillance of the external appeal process
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§ 4916. Oversight and surveillance of the external appeal process. (a) The superintendent shall have the power to: (1) review the activities of the health care plans and external appeal agents pursuant to this title, including the extent to which such plans and agents adhere to …
N.Y. Insurance Law § 4917 Hold harmless
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§ 4917. Hold harmless. A health care provider requesting an external appeal of a concurrent adverse determination, including when the health care provider requests an external appeal as the insured's designee, shall not pursue reimbursement from the insured for services determin…
N.Y. Insurance Law § 501 Definitions
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§ 501. Definitions. For purposes of this article: (a) "Certificate" or "certificate of insurance" means any document or instrument, or addendum thereto no matter how titled or described, prepared or issued by an insurer or insurance producer as evidence of property/casualty insu…
N.Y. Insurance Law § 502 Prohibitions
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§ 502. Prohibitions. In this state: (a) With respect to a certificate of insurance evidencing that a policy provides personal injury liability insurance or property damage liability insurance, as defined in paragraphs thirteen and fourteen of subsection (a) of section one thousa…
N.Y. Insurance Law § 503 Enforcement
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§ 503. Enforcement. If the superintendent finds, after notice and hearing, that any person, other than a governmental entity, has wilfully violated this article, then the superintendent may order the person to pay to the people of this state a penalty in a sum of one thousand do…
N.Y. Insurance Law § 504 Rules and regulations
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§ 504. Rules and regulations. The superintendent may adopt rules or regulations as the superintendent considers appropriate to carry out the provisions of this article.
N.Y. Insurance Law § 5101 Title
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§ 5101. Title. This article shall be known and may be cited as the "Comprehensive Motor Vehicle Insurance Reparations Act".
N.Y. Insurance Law § 5102 Definitions
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§ 5102. Definitions. In this chapter:\n (a) "Basic economic loss" means, up to fifty thousand dollars per\nperson of the following combined items, subject to the limitations of\nsection five thousand one hundred eight of this article:\n (1) All necessary expenses incurred for: (…
N.Y. Insurance Law § 5103 Entitlement to first party benefits; additional financial security required
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§ 5103. Entitlement to first party benefits; additional financial\nsecurity required. (a) Every owner's policy of liability insurance\nissued on a motor vehicle in satisfaction of the requirements of article\nsix or eight of the vehicle and traffic law shall also provide for;\ne…
N.Y. Insurance Law § 5104 Causes of action for personal injury
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§ 5104. Causes of action for personal injury. (a) Notwithstanding any\nother law, in any action by or on behalf of a covered person against\nanother covered person for personal injuries arising out of negligence\nin the use or operation of a motor vehicle in this state, there sh…
N.Y. Insurance Law § 5105 Settlement between insurers
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§ 5105. Settlement between insurers. (a) Any insurer liable for the payment of first party benefits to or on behalf of a covered person and any compensation provider paying benefits in lieu of first party benefits which another insurer would otherwise be obligated to pay pursuan…
N.Y. Insurance Law § 5106 Fair claims settlement
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§ 5106. Fair claims settlement. (a) Payments of first party benefits\nand additional first party benefits shall be made as the loss is\nincurred. Such benefits are overdue if not paid within thirty days\nafter the claimant supplies proof of the fact and amount of loss\nsustained…