Prohibits misleading statements regarding benefit maximums and limitations of benefits, either orally or in writing and requires such benefit maximums and limitations to be stated in clear and plain language in the insurance contract or certificate.
STATE OF NEW YORK
________________________________________________________________________
5419
2015-2016 Regular Sessions
IN ASSEMBLY
February 23, 2015
___________
Introduced by M. of A. O'DONNELL -- Multi-Sponsored by -- M. of A. SCHI-
MEL -- read once and referred to the Committee on Insurance
AN ACT to amend the insurance law, in relation to prohibiting misleading
statements regarding benefit maximums and limitations of benefits,
either orally or in writing and requiring such benefit maximums and
limitations to be stated in clear and plain language in the insurance
contract or certificate
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 1 of subsection (a) of section 2123 of the insur-
2 ance law, as amended by section 37-a of part D of chapter 56 of the laws
3 of 2013, is amended to read as follows:
4 (1) No agent or representative of any insurer or health maintenance
5 organization authorized to transact life, accident or health insurance
6 or health maintenance organization business in this state, insurance
7 broker, person who has received a grant from and has been certified by
8 the health benefit exchange established pursuant to section 1311 of the
9 Affordable Care Act, 42 U.S.C. § 18031, to act as a navigator, including
10 any person employed by a certified navigator, or other person, firm,
11 association or corporation, shall issue or circulate or cause or permit
12 to be issued or circulated, any illustration, circular, statement or
13 memorandum misrepresenting the terms, benefits or advantages of any
14 policy or contract of life, accident or health insurance, any annuity
15 contract or any health maintenance organization contract, delivered or
16 issued for delivery or to be delivered or issued for delivery, in this
17 state, or shall make any misleading statement orally or in writing as to
18 the terms of coverage of such policy including but not limited to bene-
19 fit maximums and limitations of benefits, or shall make any misleading
20 estimate as to the dividends or share of surplus or additional amounts
21 to be received in the future on such policy or contract, or shall make
22 any false or misleading statement as to the dividends or share of
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD07581-01-5
A. 5419 2
1 surplus or additional amounts previously paid by any such insurer or
2 health maintenance organization on similar policies or contracts, or
3 shall make any misleading representation, or any misrepresentation, as
4 to the financial condition of any such insurer or health maintenance
5 organization, or as to the legal reserve system upon which such insurer
6 or health maintenance organization operates.
7 § 2. Paragraph 1 of subsection (a) of section 3217-a of the insurance
8 law, as added by chapter 705 of the laws of 1996, is amended to read as
9 follows:
10 (1) a description of coverage provisions; health care benefits; bene-
11 fit maximums, including benefit limitations, and any such benefit maxi-
12 mums and limitations shall be described in clear and plain language and
13 printed in a font size and type style to make them clearly visible to
14 the consumer; and exclusions of coverage, including the definition of
15 medical necessity used in determining whether benefits will be covered;
16 § 3. This act shall take effect immediately; provided, however that
17 section two of this act shall take effect on the one hundred eightieth
18 day after it shall have become a law.
