™Your Policy Risk Impact Agent
0 chapters · 1,072 sections in this title.
N.Y. Insurance Law § 4607 Exemption from taxation; trusts; higher education loans
1.5K chars
§ 4607. Exemption from taxation; trusts; higher education loans. (a)\nThe property of a system, the portion of wages or salary of an employee\ndeducted or to be deducted, the right of an employee to a pension\nbenefit, and all his rights in the funds of the system, shall be exem…
N.Y. Insurance Law § 4608 Application
1.6K chars
§ 4608. Application. (a) Every system organized or created under this\nchapter shall be subject to the provisions of this article, to\nsubsection (g) of section one thousand one hundred two of this chapter,\nto the appropriate provisions of articles one, three and seventy-four o…
N.Y. Insurance Law § 4701 Legislative findings
1.8K chars
§ 4701. Legislative findings. (a) Cooperative health risk-sharing\nagreements allow public entities to: share, in whole or part, the costs\nof self-funding employee health benefit plans; provide municipal\ncorporations, school districts and other public employers with an\naltern…
N.Y. Insurance Law § 4702 Definitions
3.0K chars
§ 4702. Definitions. As used in this article: (a) "Community rating"\nmeans a rating methodology in which the premium equivalent rate for all\npersons covered under a municipal cooperative health benefit plan is the\nsame, based upon the experience of the entire pool of risks co…
N.Y. Insurance Law § 4703 Application for certificate of authority
4.5K chars
§ 4703. Application for certificate of authority. (a) No municipal\ncorporation shall establish, maintain or otherwise participate in a\nmunicipal cooperative health benefit plan in this state which provides\nbenefits, in whole or part, on a shared-funding basis, unless the\nmun…
N.Y. Insurance Law § 4704 Conditions for issuance of certificate of authority
4.6K chars
§ 4704. Conditions for issuance of certificate of authority. (a) The\nsuperintendent shall issue a certificate of authority to a municipal\ncooperative health benefit plan if all of the following conditions,\nafter examination and investigation, have been met to the\nsuperintend…
N.Y. Insurance Law § 4705 Municipal cooperation agreements
9.7K chars
§ 4705. Municipal cooperation agreements. (a) The municipal\ncooperation agreement, under which the municipal cooperative health\nbenefit plan is established and maintained, and any amendment thereto,\nshall be approved by each participating municipal corporation by\nmajority vo…
N.Y. Insurance Law § 4706 Reserve and surplus requirements
4.4K chars
§ 4706. Reserve and surplus requirements. (a) Notwithstanding any\nprovision of law, the governing board of a municipal cooperative health\nbenefit plan shall establish a reserve fund, and the plan's chief fiscal\nofficer shall cause to be paid into the reserve fund the amounts\…
N.Y. Insurance Law § 4707 Stop-loss requirements
2.1K chars
§ 4707. Stop-loss requirements. (a) The governing board of a municipal\ncooperative health benefit plan shall obtain and maintain on behalf of\nthe plan a stop-loss insurance policy or policies delivered in this\nstate and issued by a licensed insurer, providing:\n (1) aggregate…
N.Y. Insurance Law § 4708 Contingent liability
1.9K chars
§ 4708. Contingent liability. (a) The municipal cooperation agreement\nand the plan document delivered to each participating municipal\ncorporation shall provide that every municipal corporation participating\nin the municipal cooperative health benefit plan shall be liable in t…
N.Y. Insurance Law § 4709 Plan benefits and disclosure
1.6K chars
§ 4709. Plan benefits and disclosure. (a) The governing board of the\nmunicipal cooperative health benefit plan shall deliver or cause to be\ndelivered the plan document to all participating municipal corporations\nand to unions which are the exclusive collective bargaining\nrep…
N.Y. Insurance Law § 4710 Additional filing requirements and annual report
1.3K chars
§ 4710. Additional filing requirements and annual report. (a) The\ngoverning board of the municipal cooperative health benefit plan shall:\n (1) file for approval with the superintendent a description of\nmaterial changes in any information provided in the application for\ncerti…
N.Y. Insurance Law § 4711 Examinations
1.1K chars
§ 4711. Examinations. (a) The superintendent may examine the affairs\nof a municipal cooperative health benefit plan as often as deemed\nnecessary, but not less than once in every three years, except that the\nsuperintendent may extend the three-year interval to no more than fiv…
N.Y. Insurance Law § 4712 Suspension or revocation of certificate of authority
2.6K chars
§ 4712. Suspension or revocation of certificate of authority. (a) The\nsuperintendent may suspend or revoke a certificate of authority issued\nto a municipal cooperative health benefit plan under the following\ncircumstances:\n (1) for any cause that would be a basis for denial …
N.Y. Insurance Law § 4713 Plan dissolution
1.0K chars
§ 4713. Plan dissolution. (a) In any case in which the governing board\nof a municipal cooperative health benefit plan determines that there is\nreason to believe that the plan will terminate, the governing board\nshall so inform the superintendent and submit a plan for the\nsup…
N.Y. Insurance Law § 4714 Transition
2.2K chars
§ 4714. Transition. For municipal cooperative health benefit plans\nthat provided medical, surgical or hospital services on or before\nJanuary first, nineteen hundred ninety-three pursuant to a municipal\ncooperation agreement authorized under article five-G of the general\nmuni…
N.Y. Insurance Law § 4801 Application
2.6K chars
§ 4801. Application. The provisions of this article shall apply to all\nmanaged care products, as defined in subsection (c) of this section,\nwhich are delivered or issued for delivery in this state by insurers\nlicensed under this chapter; provided, however, that none of the\np…
N.Y. Insurance Law § 4802 Grievance procedure
9.1K chars
§ 4802. Grievance procedure. (a) An insurer which offers a managed\ncare product shall establish and maintain a grievance procedure with\nregard to such managed care product. Pursuant to such procedure,\ninsureds shall be entitled to seek a review of determinations by the\ninsur…
N.Y. Insurance Law § 4803 Health care professional applications and terminations
13.3K chars
§ 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
10.9K chars
§ 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
3.2K chars
§ 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
1.7K chars
§ 4806. Health care facility applications. (a) An insurer that offers\na managed care product shall, upon request, make available and disclose\nto facilities written application procedures and minimum qualification\nrequirements that a facility must meet in order to be considere…
N.Y. Insurance Law § 4900 Definitions
26.4K chars
§ 4900. Definitions. For purposes of this article:\n (a) "Adverse determination" means a determination by a utilization\nreview agent that an admission, extension of stay, or other health care\nservice, upon review based on the information provided, is not medically\nnecessary.\…
N.Y. Insurance Law § 4901 Reporting requirements for utilization review agents
4.7K chars
§ 4901. Reporting requirements for utilization review agents. (a)\nEvery utilization review agent shall biennially report to the\nsuperintendent of financial services, in a statement subscribed and\naffirmed as true under the penalties of perjury, the information\nrequired pursu…
N.Y. Insurance Law § 4902 Utilization review program standards
11.9K chars
§ 4902. Utilization review program standards. (a) Each utilization\nreview agent shall adhere to utilization review program standards\nconsistent with the provisions of this title which shall, at a minimum,\ninclude:\n (1) Appointment of a medical director, who is a licensed phy…
N.Y. Insurance Law § 4903 Utilization review determinations
17.1K chars
§ 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
10.7K chars
§ 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
6.9K chars
§ 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
0.6K chars
§ 4906. Waiver. (a) Any agreement which purports to waive, limit,\ndisclaim, or in any way diminish the rights set forth in this article,\nexcept as provided pursuant to section four thousand nine hundred ten of\nthis article shall be void as contrary to public policy.\n (b) Not…
N.Y. Insurance Law § 4907 Rights and remedies
0.2K chars
§ 4907. Rights and remedies. The rights and remedies conferred in this\narticle upon insureds and health care providers shall be cumulative and\nin addition to and not in lieu of any other rights or remedies available\nunder law.\n
N.Y. Insurance Law § 4908 Applicability to ERISA Plans
0.3K chars
§ 4908. Applicability to ERISA Plans. Notwithstanding the foregoing,\nthe provisions of this article shall not apply to any utilization review\nconducted by, or on behalf of, a self-insured employee welfare benefit\nplan, as defined in the employee retirement income security act…
N.Y. Insurance Law § 4909 Site of service clinical review
7.9K chars
§ 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
8.1K chars
§ 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
1.0K chars
§ 4911. Powers of the superintendent. (a) The superintendent shall\nhave the power to grant and revoke certifications of external appeal\nagents to conduct external appeals requested pursuant to paragraph one\nor two of subsection (b) of section four thousand nine hundred ten of…
N.Y. Insurance Law § 4912 Standards for certification
6.0K chars
§ 4912. Standards for certification. (a) The superintendent shall\ndevelop an application for certification. At a minimum, applicants shall\nprovide:\n (1) a description of the qualifications of the clinical peer reviewers\nretained to conduct external appeals of final adverse d…
N.Y. Insurance Law § 4913 Conflict of interest
1.2K chars
§ 4913. Conflict of interest. (a) No external appeal agent or officer,\ndirector, or management employee thereof; or clinical peer reviewer\nemployed or engaged thereby to conduct any external appeal pursuant to\nthis title, shall have any material professional affiliation, mate…
N.Y. Insurance Law § 4914 Procedures for external appeals of adverse determinations
16.7K chars
§ 4914. Procedures for external appeals of adverse determinations. (a)\nThe superintendent shall establish procedures by regulation to randomly\nassign an external appeal agent to conduct an external appeal, provided\nthat the superintendent may establish a maximum fee which may…
N.Y. Insurance Law § 4915 Prohibited practices
0.5K chars
§ 4915. Prohibited practices. An external appeal agent shall not, with\nrespect to external appeal activities, permit or provide compensation or\nanything of value to its employees, agents, or contractors based on:\n (a) either a percentage of the amount by which a claim is redu…
N.Y. Insurance Law § 4916 Oversight and surveillance of the external appeal process
1.1K chars
§ 4916. Oversight and surveillance of the external appeal process. (a)\nThe superintendent shall have the power to:\n (1) review the activities of the health care plans and external appeal\nagents pursuant to this title, including the extent to which such plans\nand agents adher…
N.Y. Insurance Law § 4917 Hold harmless
0.4K chars
§ 4917. Hold harmless. A health care provider requesting an external\nappeal of a concurrent adverse determination, including when the health\ncare provider requests an external appeal as the insured's designee,\nshall not pursue reimbursement from the insured for services deter…
N.Y. Insurance Law § 501 Definitions
2.2K chars
§ 501. Definitions. For purposes of this article:\n (a) "Certificate" or "certificate of insurance" means any document or\ninstrument, or addendum thereto no matter how titled or described,\nprepared or issued by an insurer or insurance producer as evidence of\nproperty/casualty…
N.Y. Insurance Law § 502 Prohibitions
2.3K chars
§ 502. Prohibitions. In this state:\n (a) With respect to a certificate of insurance evidencing that a\npolicy provides personal injury liability insurance or property damage\nliability insurance, as defined in paragraphs thirteen and fourteen of\nsubsection (a) of section one t…
N.Y. Insurance Law § 503 Enforcement
0.4K chars
§ 503. Enforcement. If the superintendent finds, after notice and\nhearing, that any person, other than a governmental entity, has wilfully\nviolated this article, then the superintendent may order the person to\npay to the people of this state a penalty in a sum of one thousand…
N.Y. Insurance Law § 504 Rules and regulations
0.2K chars
§ 504. Rules and regulations. The superintendent may adopt rules or\nregulations as the superintendent considers appropriate to carry out the\nprovisions of this article.\n
N.Y. Insurance Law § 5101 Title
0.1K chars
§ 5101. Title. This article shall be known and may be cited as the\n"Comprehensive Motor Vehicle Insurance Reparations Act".\n
N.Y. Insurance Law § 5102 Definitions
6.9K chars
§ 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
9.9K chars
§ 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
3.4K chars
§ 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
2.1K chars
§ 5105. Settlement between insurers. (a) Any insurer liable for the\npayment of first party benefits to or on behalf of a covered person and\nany compensation provider paying benefits in lieu of first party\nbenefits which another insurer would otherwise be obligated to pay\npur…
N.Y. Insurance Law § 5106 Fair claims settlement
5.4K chars
§ 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…