NEW YORK STATE
INSURANCE DEPARTMENT

TWENTY-EIGHTH AMENDMENT TO REGULATION NO. 62
(11 NYCRR 52)

MINIMUM STANDARDS FOR THE FORM, CONTENT AND SALE OF HEALTH INSURANCE, INCLUDING STANDARDS FOR FULL AND FAIR DISCLOSURE

          I, GREGORY V. SERIO, Superintendent of Insurance of the State of New York, pursuant to the authority granted by the federal Social Security Act (42 U.S.C. section 1395ss) and by Sections 201, 301, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 4235, 4237 and Article 43 of the Insurance Law, do hereby promulgate the following Twenty-eighth amendment to Part 52 of Title 11 of the Official Compilation of Codes, Rules and Regulations of the State of New York (Regulation No. 62), to take effect upon publication in the State Register.

(NEW MATTER UNDERLINED; DELETED MATTER IN BRACKETS)

          Paragraph (34) of subdivision (a) of section 52.17 is amended to read as follows:

          (34) At the time of an event described in 42 U.S.C. section 1395ss(s)(3)(B) or (F)* because of which an individual loses coverage or benefits due to the termination of the policy or the individual ceases enrollment under the policy, the insurer of the policy from which termination or disenrollment occurs shall provide the individual with written notification of his or her rights and of the obligations of issuers of Medicare supplement insurance policies under section 52.22(b)(3) and (k) of this Part. If an individual loses coverage or benefits due to termination of the policy, such notification must be provided contemporaneously with the notification of termination. If an individual ceases enrollment under the policy, such notification must be provided within 10 working days of the insurer receiving notification of disenrollment.

          Paragraph (9) of subdivision (a) of section 52.18 is amended to read as follows:

          (9) At the time of an event described in 42 U.S.C. section 1395ss(s)(3)(B) or (F)* because of which an individual loses coverage or benefits due to the termination of the policy or the individual ceases enrollment under the policy, the insurer of the policy from which termination or disenrollment occurs shall provide the individual with written notification of his or her rights and of the obligations of issuers of Medicare supplement insurance policies under section 52.22(b)(3) and (k) of this Part. If an individual loses coverage or benefits due to termination of the policy, such notification must be provided contemporaneously with the notification of termination. If an individual ceases enrollment under the policy, such notification must be provided within 10 working days of the insurer receiving notification of disenrollment.

          Subparagraph (iii) of paragraph (7) of subdivision (c) of section 52.22 is amended to read as follows:

          (iii) Each Medicare supplement policy or certificate shall provide that benefits and premiums under the policy or certificate shall be suspended (for [the] any period that may be provided by Federal regulation) at the request of the policyholder or certificateholder if the policyholder or certificateholder is entitled to benefits under 42 U.S.C. section 426(b) and is covered under a group health plan (as defined in 42 U.S.C. section 1395y(b)(1)(A)(v)). If suspension occurs and if the policyholder or certificateholder loses coverage under the group health plan, the policy or certificate shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder or certificateholder provides notice of loss of coverage within 90 days after the date of [such] the loss and pays the premium attributable to [that] the period, effective as of the date of termination of [entitlement] enrollment in the group health plan.

          Subparagraph (v) of paragraph (5) of subdivision (d) of section 52.22 is amended to read as follows:

          (v) coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible.          Paragraph (4) of subdivision (k) of section 52.22 is amended to read as follows:

          (4) The issuer of a Medicare supplement insurance policy or certificate may not impose an exclusion of benefits based upon a preexisting condition under such policy or certificate in the case of an individual described in 42 U.S.C. section 1395ss(s)(3)(B) or (F)* who seeks to enroll under the Medicare supplement insurance policy or certificate [not later than 63 days after the date of the termination of enrollment described in 42 U.S.C. section 1395ss(s)(3)(B)] during the period specified in 42 U.S.C. section 1395ss(s)(3)(E)* and who submits evidence of the date of termination or disenrollment along with the application for such Medicare supplement insurance policy or certificate.

* 42 United States Code 1395ss (2001) published by Office of Law Revision Counsel, United States House of Representatives. It is available from the New York State Insurance Department, Office of General Counsel, 25 Beaver Street, New York NY 10004.

 

          I, GREGORY V. SERIO, Superintendent of Insurance of the State of New York, do hereby certify that the foregoing Twenty-eighth Amendment to 11 NYCRR Part 52 (Regulation 62) was duly adopted by me on this day pursuant to the authority granted by the federal Social Security Act (42 U.S.C. section 1395ss) and Sections 201, 301, 3201, 3216, 3217, 3218, 3221, 3231, 3232, 4235, 4237 and Article 43 of the Insurance Law, to take effect upon publication in the State Register.

          A prior notice of this regulation amendment was published in the State Register on March 27, 2002 as a Notice of Proposed Rulemaking. No other publication or prior notice is required by statute.

JUNE 3, 2002

__________________________________________

Gregory V. Serio
Superintendent of Insurance