New York Law Continues to Apply to Limited Benefits Health Insurance Policies

On Nov. 1, 2018, Health Bureau Chief Johnson issued Ins. Circular Letter No. 14 (2018) to remind insurers authorized to write accident and health insurance in NY that limited benefits health insurance policies or contracts must comply with all NY statutory and regulatory requirements.

This letter is a result of the NY Dept. of Financial Services (DFS) becoming aware that some insurers continue to market and issue expense-incurred limited benefits health insurance policies that cover hospital, surgical or medical care. These policies are not permitted under NY law. Specifically, insurance policies that provide hospital, surgical or medical care on an expense-incurred basis must comply with the state’s minimum standards and consumer protections applicable to comprehensive hospital, surgical and medical insurance coverage. This includes mandated benefits, minimum loss ratios, community rating for individual and small groups, prohibitions on annual and lifetime limits, and prohibitions on pre-existing condition limitations.

Insurers that have issued policies or contracts in-force must contact DFS and will either discontinue the policies and contracts upon renewal or amend the policies and contracts so that they meet all NY statutory and regulatory requirements.

This law does not directly impact employers but is another reminder that NY state requirements are independent of federal law.

Insurance Circular Letter No. 14 (2018) »