NEW YORK STATE
INSURANCE DEPARTMENT

FIFTH AMENDMENT T0 REGULATION 145
(11 NYCRR 360)

RULES TO ASSURE AN ORDERLY IMPLEMENTATION AND ONGOING
OPERATION OF OPEN ENROLLMENT AND COMMUNITY RATING
OF INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE

I, Neil Levin, Superintendent of Insurance of the State of New York, pursuant to the authority granted by Sections 201, 301, 1109, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 3233, 4235, 4237, 4501 and Article 43 of the Insurance Law, do hereby promulgate the following Fifth Amendment to Part 360 of Title 11 of the Official Compilation of Codes, Rules and Regulations of the State of New York (Regulation No. 145), to take effect upon publication in the State Register:

(NEW MATTER UNDERLINED; DELETED MATTER IN BRACKETS)

Subdivisions (c) and (f) of Section 360.2 of Part 360 of Title 11 of the Official Compilation of Codes, Rules and Regulations are hereby amended to read as follows:

(c) Individual health insurance policy means an insurance policy written by an insurer under the provisions of sections 3216, 4304 and 4501(o) of the Insurance Law, issued directly to an individual (not on a group or group remittance basis), except for policies covering only: long term care benefits, nursing home benefits, home care benefits, dental or vision care services, hospital or surgical indemnity benefits with specific dollar amounts unless the dollar amounts exceed the amounts required to meet the definitions of basic hospital and basic medical insurance in sections 52.5 and 52.6 of this Title, accident only indemnity benefits, accidental death and dismemberment benefits, prescription drug benefits [or], disability income benefits or specified disease benefits.

(f) Small group health insurance policy means a group remittance policy written by an insurer pursuant to section 4304 of the Insurance Law and a group health insurance policy covering from two to 50 employees or members, exclusive of dependents and spouses, and policies issued to or through association groups as defined in subdivision (a) of this section. In determining the size of a small group reference should be made to subdivisions (i) and (j) of section 360.4 of this Part. Insurers may choose to classify individual proprietors within the small group category provided that any such classification is applied consistently to all individual proprietors. A small group health insurance policy does not include a policy covering only: long term care benefits, nursing home benefits, home care benefits, dental or vision care services, hospital or surgical indemnity benefits with specific dollar amounts unless the dollar amounts exceed the amounts required to meet the definitions of basic hospital and basic medical insurance in sections 52.5 and 52.6 of this Title, accident only indemnity benefits, accidental death and dismemberment benefits, prescription drug benefits [or], disability income benefits or specified disease benefits.

 

CERTIFICATION

I, Neil D. Levin, Superintendent of Insurance of the State of New York, do hereby certify that the foregoing Fifth Amendment to Regulation No. 145 (11 NYCRR 360) was duly adopted by me on this day of the month of

of 1998, pursuant to the authority granted by Sections 201, 301, 1109, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 3233, 4235, 4237, 4501 and Article 43 of the Insurance Law to take effect upon publication in the State Register.

The Notice of Proposed Rule Making for this amendment was published in the State Register on May 27, 1998, I.D. # INS-21-98-00029-P. No other publication or prior notice is required by statute.

________________________
Neil D. Levin
Superintendent of Insurance

November 2, 1998