NEW YORK STATE
INSURANCE DEPARTMENT

SECOND AMENDMENT TO REGULATION 146
(11 NYCRR 361)

ESTABLISHMENT AND OPERATION OF MARKET STABILIZATION
MECHANISMS FOR INDIVIDUAL AND SMALL GROUP HEALTH
INSURANCE AND MEDICARE SUPPLEMENT 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, 4501 and Article 43 of the Insurance Law, do hereby promulgate the following Second Amendment to Part 361 of Title 11 of the Official Compilation of Codes, Rules and Regulations of the State of New York (Regulation No. 146), to take effect upon publication in the State Register:

(NEW MATTER UNDERLINED; DELETED MATTER IN BRACKETS)

Subdivisions (j) and (o) of Section 361.2 of Part 361 of Title 11 of the Official Compilation of Codes, Rules and Regulations are hereby amended to read as follows:

(j) Individual health insurance policy means an insurance policy written by a carrier 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.

(o) Small group health insurance policy means a group remittance policy written by a carrier 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 section 360.2(a) of this Title. In determining the size of a small group, reference should be made to section 360.4(i) and (j) of this Title. 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 Second Amendment to Regulation No. 146 (11 NYCRR 361) was duly adopted by me on the 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, 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-21-98-00030-P. No other publication or prior notice is required by statute.

________________________
Neil D. Levin
Superintendent of Insurance

November 2, 1998