Not-for-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations

What this document is

New York Insurance Law Article 43 - Not-for-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations (Secs. 4301-4327) is a state statute published by New York State Senate, NYS Open Legislation (nysenate.gov). It is one of the New York documents that insurance license exam questions are written from, including new york life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• N.Y. Ins. Law Article 43 § 4313(a) (Applicability of Other Provisions of This Chapter)

  “Except as otherwise provided and except as the context otherwise requires, every medical expense indemnity corporation, dental expense indemnity corporation, health service corporation, and hospital service corporation shall be subject to all requirements of this chapter made applicable to...”

• N.Y. Ins. Law Article 43 § 4317(a)(4) (Definition of "Community Rated")

  “For the purposes of this section, "community rated" means a rating methodology in which the premium for all persons covered by a policy or contract form is the same, based on the experience of the entire pool of risks of all individuals or small groups covered by the corporation without regard to...”

• N.Y. Ins. Law Article 43 § 4301(f) (Foreign and Alien Corporations Not Authorized)

  “No foreign or alien medical expense indemnity corporation, dental expense indemnity corporation, health service corporation, or hospital service corporation shall be authorized to do business in this state.”

• N.Y. Ins. Law Article 43 § 4305(a) (Group Contracts; Copy or Certificate to Each Member)

  “A corporation subject to the provisions of this article shall issue to the group contractholder, for delivery to each member of the insured group, a copy of the contract, or a certificate which can be in the form of a booklet setting forth in summary form a statement of the essential features of the insurance coverage.”

• N.Y. Ins. Law Article 43 § 4302(b) (Permit and License to Do Business)

  “No such corporation shall furnish medical expense indemnity, dental expense indemnity, hospital service or health service as set forth in section four thousand three hundred one of this article until it has obtained from the superintendent a license to do business.”

• N.Y. Ins. Law Article 43 § 4317(a)(2) (Open Enrollment for Individual and Small Group Coverage)

  “Any individual, and dependents of such individual, and any small group, including all employees or group members and dependents of employees or members, applying for individual or small group health insurance coverage including Medicare supplemental insurance, but not including coverage issued on...”

• N.Y. Ins. Law Article 43 § 4301(a) (Organization of Corporation; Purposes)

  “A corporation may be organized under the not-for-profit corporation law, and a consumers' cooperative stock corporation may be organized under article two of the cooperative corporations law, for the purpose of furnishing medical expense indemnity, dental expense indemnity, hospital service, or...”

• N.Y. Ins. Law Article 43 § 4308(b) (Premium and Rating Formula Approval Standard)

  “No corporation subject to the provisions of this article shall enter into any contract unless and until it shall have filed with the superintendent a schedule of the premiums or, if appropriate, rating formula from which premiums are determined, to be paid under the contracts and shall have...”

• N.Y. Ins. Law § 4306(e) (Required contract provisions: application and authority to waive)

  “(e) a statement that no statement by the individual in his application for a contract shall avoid the contract or be used in any legal proceeding thereunder, unless such application or an exact copy thereof is included in or attached to such contract, and that no agent or representative of such...”

• N.Y. Ins. Law § 4306(l) (Required contract provisions: articles, constitution or by-laws)

  “(l) if the contract contains any provision purporting to make any portion of the articles, constitution or by-laws of the corporation a part of the contract, such portion shall be set forth in full;”

• N.Y. Ins. Law § 4317(a)(4) (Rating of individual and small group contracts; "community rated" defined)

  “(4) For the purposes of this section, "community rated" means a rating methodology in which the premium for all persons covered by a policy or contract form is the same, based on the experience of the entire pool of risks of all individuals or small groups covered by the corporation without regard...”

• N.Y. Ins. Law § 4305(d)(1)(A) (Group contracts; conversion to an individual direct payment contract)

  “(d) (1) (A) A group contract issued pursuant to this section shall contain a provision to the effect that in case of a termination of coverage under such contract of any member of the group because of (i) termination for any reason whatsoever of the member's employment or membership, or (ii)...”

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