New York Consolidated Laws, Insurance Law - ISC § 4306. Required contract provisions

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Every contract issued by any corporation pursuant to the provisions of section four thousand three hundred four of this article, shall be in writing and shall state the terms and conditions thereof.  No such contract shall be made, issued or delivered in this state unless it contains the following provisions:

(a) a statement of the amount payable to the corporation by the individual to whom the contract is issued and the times at which and manner in which such amount is to be paid;

(b) a statement of the nature of the benefits to be furnished and the period during which they will be furnished;  and if there are any benefits to be excepted, a detailed statement of such exceptions printed as hereinafter specified;

(c) a statement of the terms and conditions, if any, upon which the contract may be terminated at the option of the individual, or otherwise terminated at the option of either party as permitted by subsection (b) or (c) of section four thousand three hundred four of this article;

(d) a statement that the contract includes the endorsements thereon and attached papers, if any;

(e) a statement that no statement by the individual in his application for a contract shall avoid the contract or be used in any legal proceeding thereunder, unless such application or an exact copy thereof is included in or attached to such contract, and that no agent or representative of such corporation and no broker, other than an officer or officers designated therein, is authorized to change the contract or waive any of its provisions;

(f) a statement that if the individual defaults in making any payment under the contract, the subsequent acceptance of a payment by the corporation or by one of its duly authorized agents or by a duly authorized broker shall reinstate the contract, but with respect to sickness and injury, only to cover such sickness as may be first manifested more than ten days after the date of such acceptance;

(g) a statement of the period of grace which will be allowed the individual for making any payment due under the contract which period shall not be less than ten days;

(h) a statement on the first page of the contract or in a notice attached to the contract that during a specified period of time, which shall not be less than ten days nor more than twenty days from the date the contract is delivered to the individual, it may be surrendered to the corporation together with a written request for cancellation of the contract and that in such event the corporation will refund any premium paid therefor including any contract fees or other charges;  provided, however, that a contract sold by mail order and a contract providing medicare supplemental insurance or long-term care insurance must contain a provision permitting the individual a thirty day period for such surrender;

(i) the age limit or date or period, if any, after which the coverage provided by the contract will not be effective, or renewed, is stated in a renewal provision set forth on the first page of the contract or as a separate provision bearing an appropriate caption on the first page on the contract or in a brief description in not less than fourteen point bold face type set forth on the first page of the contract;  nothing herein contained shall limit or restrict the right of the corporation to continue the contract after the age or period so stated;

(j) a statement under the caption “CONVERSION PRIVILEGE” which shall set forth in substance the conversion privileges and related provisions required by subsections (d) and (e) of section four thousand three hundred four of this article;

(k) the exceptions of the contract shall appear with the same prominence as the benefits to which they apply;

(l) if the contract contains any provision purporting to make any portion of the articles, constitution or by-laws of the corporation a part of the contract, such portion shall be set forth in full;  and

(m) in every such contract made, issued or delivered in this state there shall be a brief description of the contract on its first page and on its filing back.

(n) a statement that a health care claim from a subscriber shall be submitted within one hundred twenty days from the date of service;  provided, however, that if it was not reasonably possible for the subscriber to submit the claim within that timeframe, then the claim shall be submitted as soon as reasonably possible.

Cite this article: - New York Consolidated Laws, Insurance Law - ISC § 4306. Required contract provisions - last updated January 01, 2021 |

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