4512 - Accident and Health and Disability Insurance Certificates; Compliance With Rules and Regulations.

NY Ins L § 4512 (2019) (N/A)
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(b) Anything in this article to the contrary notwithstanding, each certificate of hospitalization expense benefits or surgical or medical expense benefits delivered or issued for delivery in this state to any member individually or as the head of a family shall:

(1) stipulate a premium determined on the basis of the age of the member, which premium shall be subject to change only if the premiums on all outstanding certificates in the same class are changed in accordance with the standards which shall have been established prior to the issuance of the certificate for the determination of the increase or decrease in the premiums and are on file with and approved by the superintendent,

(2) contain the following provisions under the caption "Incontestable and Guaranteed Renewable": "After this certificate has been in force for a period of one year from the date of issue, it shall become incontestable as to the statements contained in the application and the member shall have the right to continue the same in force, subject to the timely payment of premiums and the conditions of the certificate relating to military service;" and

(3) in the case of such certificates written at issue age above sixty-five years, contain the following provision: "No claim for benefits provided in this certificate shall be reduced or denied on the ground that a disease or physical condition had existed prior to the effective date of coverage of this certificate, except only such disease or physical condition which is specifically eliminated by rider, attached to this certificate, a copy which shall have been furnished to the member and its receipt evidenced by a signed amendment to the application for such certificate."