Skip to Content

Accident and Health Product Filing

Return to Health Information for Insurers

2016-2017 Model Language

Subject Model Language

Cover Page

01/15/2016

Table of Contents

04/02/2015

Definitions

01/15/2016

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

01/15/2016

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

04/02/2015

Cost-Sharing Expenses and Allowed Amount

04/02/2015

Who Is Covered (Eligibility)

01/15/2016

Preventive Care (Well-Baby and Well-Child Care, Adult Annual Physical Examinations, Adult Immunizations, Well-Woman Examinations, Mammograms, Family Planning & Reproductive Health Services, Bone Mineral Density Measurements or Testing, Screening for Prostate Cancer)

01/15/2016

Ambulance and Pre-Hospital Emergency Medical Services

04/02/2015

Emergency Services and Urgent Care

01/15/2016

Outpatient and Professional Services (Acupuncture, Advanced Imaging Services, Allergy Testing and Treatment, Ambulatory Surgery Center, Chemotherapy, Chiropractic Services, Clinical Trials, Dialysis, Habilitation Services, Home Health Care, Infertility Treatment, Infusion Therapy, Interruption of Pregnancy, Laboratory Procedures, Diagnostic testing and Radiology Services, Maternity and Newborn Care, Medications for Use in the Office, Office Visits, Outpatient Hospital Services, Preadmission Testing, Rehabilitation Services, Second Opinions, Surgical Services, Oral Surgery, Reconstructive Breast Surgery, Other Reconstructive and Corrective Surgery, Transplants)

01/15/2016

Additional Benefits, Equipment and Devices (Autism Spectrum Disorder, Diabetic Equipment, Supplies and Self-Management Education, Durable Medical Equipment and Braces, Hearing Aids, Hospice, Prosthetics, Orthotics)

06/15/2015

Inpatient Services (Hospital Services, Observation Services, Inpatient Medical Services, Inpatient Stay for Maternity Care, Inpatient Stay for Mastectomy Care, Autologous Blood Banking Services, Rehabilitation Services, Skilled Nursing Facility, End of Life Care)

04/02/2015

Mental Health Care and Substance Use Services

01/15/2016

Prescription Drug Coverage

01/15/2016

Wellness Benefits

04/02/2015

Pediatric Vision Care

04/02/2015

Pediatric Dental Care

04/06/2016

Exclusions

04/02/2015

Claim Determinations

04/02/2015

Grievance

01/15/2016

Utilization Review

01/15/2016

External Appeal

01/15/2016

Termination

04/02/2015

Extension of Benefits

04/02/2015

Continuation

04/02/2015

Temporary Suspension Rights for Members of the Armed Forces

04/02/2015

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

01/15/2016

Schedule of Benefits

04/02/2015

Age 29 Rider

04/02/2015

Updated 04/06/2016

 

Link to DFS Portal

About DFS

Contact DFS

Reports & Publications

Licensing

Laws and Regs

Connect With DFS

DFS Facebook page

Follow NYDFS on Twitter