September 27, 1965
Circular Letter 14 (1965)
To All Article IX-C Non-profit Medical and Dental Indemnity and Hospital Service Corporations and all Authorized Accident and Health Insurers.
Re: Chapter 1026 of the Laws of 1965, in Relation to Coverage of Mentally Retarded and Physically Handicapped Children.
Chapter 1026 of the Laws of 1965, introduced at the request of the Joint Legislative Committee on Mental Retardation and the Physically Handicapped, amended statutory provisions relating to mandatory coverage under the "family contract" and group contracts issued by non-profit Article IX-C and commercial accident and health insurers in the following manner:
(a) Section 253(2) broadened the definition of dependent children under the "family contract" to include any"--* * * unmarried child, regardless of age, who is incapable of self-sustaining employment by reason of mental retardation or physical handicap and who became so incapable prior to attainment of age nineteen* * *."
(b) Section (6)(a) amended group coverage provisions dealing with termination of coverage of a dependent at a specified age to provide that there shall be no termination" * * * with respect to an unmarried child who is incapable of self-sustaining employment by reason of mental retardation or physical handicap and who became so incapable prior to attainment of age nineteen and who is chiefly dependent upon such member for support and maintenance * * * while the contract remains in force and the dependent remains in such condition, if the member has within thirty-one days of such dependent's attainment of the termination age submitted proof of such dependent's incapacity as described herein."
(c) Section 164(2)(B)(3) was amended to provide for continuous coverage under the "family contract" issued by all authorized commercial accident and health insurers of dependent mentally retarded and physically handicapped children under provisions similar to those applicable to Article IX-C contracts under the Section 253(2) amendment discussed in paragraph (a), except for the addition of a thirty-one day notice requirement similar to that contained in Section 253(6).
(d) Section 221(5) was amended to include termination provisions for commercial group health and accident policies similar to those which were added to Section 253(6) discussed in paragraph (b).
Chapter 1026 thus broadens the definition of dependent to provide for coverage under the "family contract" and group contracts of dependent mentally retarded and physically handicapped children regardless of age. After October 1, 1965 such extended coverage will be mandatory with respect to all such children thereafter attaining the age of nineteen and all such children who have previously attained the age of nineteen whose parents are covered under "family contracts" and group contracts in force as of October 1, 1965.
Insurance Law provisions with respect to accident and health coverages (e.g., § 253(3)) require that all coverages and requirements be set forth in the contract and endorsements thereon. The requirement in Chapter 1026 that the insurer be notified within thirty-one days of a retarded or physically handicapped dependent's attainment of the termination age shall not apply to the insured or member until thirty-one days after the insured or member is notified in writing, by a form of notice to be approved by the Superintendent, of the applicable provisions of Chapter 1026, including the requirement of notification.
Appropriate personnel should be advised of the foregoing and receipt of this letter should be acknowledged at your earliest convenience, noting your reply for attention of Office of General Counsel.
Very truly yours,
Henry Root Stern, Jr.
Superintendent of Insurance