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Insurance Department Issues Guidance Regarding Obligations of Health Insurers and HMO's

Governor George E. Pataki today announced that the State Insurance Department is providing guidance and recommendations to the insurance industry to help ensure that all New York members of the U.S. Military Reserves who are ordered to active duty continue to receive their health benefits.

"The courageous men and women in our military reserves are willing to place their lives on the line in defense of our country," Governor Pataki said. "We will continue to do everything we can to ensure that any reservist called to active duty receives the full rights and benefits they and their families are entitled to under New York law."

The Insurance Department has issued a Circular Letter advising Health Insurers and Health Maintenance Organizations (HMOs) of their obligations under the New York Insurance Law. Military personnel are afforded additional rights of conversion, continuation and suspension of health insurance coverage.

State Insurance Department Superintendent Gregory V. Serio said, "New York's Insurance Law creates supplementary rights for our U.S. Military Reserves on active duty. The Department remains steadfast in its efforts to protect the rights of our reservists to continued coverage."

Members of the Reserves, including the National Guard, who hold individual health insurance policies and who enter active duty or have their duty extended, are afforded supplemental rights to suspend their coverage during such period of active duty and have unearned premiums for the period returned. Furthermore, reservists are entitled to resume their coverage upon termination of active duty. With limited exceptions, no limitations or conditions may be imposed upon resumption of coverage.

Reservists, including the National Guard, who are covered under group policies and who enter active duty or have their active duty extended, are also afforded supplemental rights. A reservist called into active duty may elect to continue or suspend group coverage including family coverage. Upon return to work after active duty, reservists who suspended policies are entitled to resume coverage. With limited exceptions, no limitations or conditions may be imposed upon resumption of coverage. Additionally, if a reservist elects continuation of coverage and passes away while on active duty, the surviving spouse and children are entitled to conversion rights.

Sections 3216(c)(13) and (14); 3221(n) and (o); 4304(i) and (j); and 4305(g) and (h) of the Insurance Law lay out these protections. The Circular Letter is available on the Insurance Department's Web site at


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