Skip to Content

Accident and Health Product Filing

Return to Health Information for Insurers

Model Language

Subject Model Language

Cover Page

04/01/2015

Individual - Table of Contents

04/01/2015

Group - Table of Contents

04/01/2015

Definitions

04/01/2015

How This Coverage Works (Introduction, Selecting a Primary Care Dentist, Preauthorization, Medically Necessary)

04/01/2015

Access to Care and Transitional Care (Referrals, Specialty Care Provider as a PCD)

04/01/2015

Cost-Sharing Expenses and Allowed Amount

04/01/2015

Individual - Who Is Covered (Eligibility) (pediatric only coverage)

06/04/2015

Individual - Who Is Covered (Eligibility)

06/04/2015

Group - Who Is Covered (Eligibility) (pediatric only coverage)

04/01/2015

Group - Who Is Covered (Eligibility)

04/01/2015

Pediatric Dental

04/01/2015

Exclusions

04/01/2015

Claim Determinations

04/01/2015

Grievance

04/01/2015

Utilization Review

06/04/2015

External Appeal

04/01/2015

Coordination of Benefits (Group Only)

04/01/2015

Termination

04/01/2015

Extension of Benefits

04/01/2015

Continuation (Group Only)

04/01/2015

Temporary Suspension Rights for Members of the Armed Forces (Individual Only)

04/01/2015

General Provisions (Incontestability, Legal Actions, Subrogation, Unilateral Modification)

04/01/2015

Schedule of Benefits

04/01/2015

Domestic Partner Rider (Group Only)

04/01/2015


Updated 06/04/2015

 

Link to DFS Portal

About DFS

Contact DFS

Reports & Publications

Licensing

Laws and Regs

Connect With DFS

DFS Facebook page

Follow NYDFS on Twitter