N.Y. Insurance Law Section 3224-C
Coordination of benefits

An insurer or organization or corporation licensed or certified pursuant to article forty-three or forty-seven of this chapter or article forty-four of the public health law shall not deny a claim, either in whole or in part, on the basis that it is coordinating benefits and another insurer or organization or corporation or other entity is liable for the payment of the claim, unless it has a reasonable basis to believe that the insured has other health insurance coverage which is primary for that benefit. If an insurer or organization or corporation does not have current information from the insured regarding other coverage, and requests such information in accordance with subsection (b) of § 3224-A (Standards for prompt, fair and equitable settlement of claims for health care and payments for health care services)section three thousand two hundred twenty-four-a of this article, and no information is received within forty-five days, the claim shall be adjudicated provided, however, the claim shall not be denied based on the insurer, or organization or corporation not having received such information.

Source: Section 3224-C — Coordination of benefits, https://www.­nysenate.­gov/legislation/laws/ISC/3224-C (updated Sep. 22, 2014; accessed Oct. 26, 2024).

3201
Approval of life, accident and health, credit unemployment, and annuity policy forms 3202
Withdrawal of approval of policy forms 3203
Individual life insurance policies 3204
Policy to contain entire contract 3205
Insurable interest in the person 3206
Policies which provide for an adjustable maximum rate of interest on policy loans 3207
Life insurance contracts by or for the benefit of minors 3208
Antedating of life insurance policies and burial agreements prohibited 3209
Life insurance, annuities and funding agreements disclosure requirements 3210
Incontestability after reinstatement 3211
Notice of premium due under life or disability insurance policy 3212
Exemption of proceeds and avails of certain insurance and annuity contracts 3213
Payment of proceeds 3214
Interest upon proceeds of life insurance policies and annuity contracts 3215
Disability benefits in connection with life insurance and annuities 3216
Individual accident and health insurance policy provisions 3217
Minimum standards in the form, content and sale of accident and health insurance 3217‑A
Disclosure of information 3217‑B
Prohibitions 3217‑C
Primary and preventive obstetric and gynecologic care 3217‑D
Grievance procedure and access to specialty care 3217‑E
Choice of health care provider 3217‑F
Prohibition on lifetime and annual limits 3217‑G
Maternal depression screenings 3217‑H
Telehealth delivery of services 3217‑I
Essential health benefits package and limit on cost-sharing 3217‑J
Utilization review determinations for medically fragile children 3218
Medicare supplemental insurance policies 3219
Annuity and pure endowment contracts and certain group annuity certificates 3220
Group life insurance policies 3221
Group or blanket accident and health insurance policies 3222
Funding agreements 3223
Group annuity contracts 3224
Standard claim forms 3224‑A
Standards for prompt, fair and equitable settlement of claims for health care and payments for health care services 3224‑B
Rules relating to the processing of health claims and overpayments to physicians 3224‑C
Coordination of benefits 3224‑D
Prescription synchronization 3225
Eligibility for health insurance in cases of exposure to DES 3226
Reinsurance contracts excepted 3227
Interest upon surrenders, policy loans and other funds 3228
Individual accident and health insurance policies 3229
Minimum benefit standards for certain long term care plans 3230
Accelerated payment of the death benefit or special surrender value under a life insurance policy 3231
Rating of individual and small group health insurance policies 3231*2
Health insurance policies and subscriber contracts 3232
Pre-existing condition provisions in health policies 3232‑A
Certification of creditable coverage 3233
Stabilization of health insurance markets and premium rates 3234
Pre-existing condition provisions in group and blanket disability policies 3234*2
Limitations on administrative services and stop-loss coverage 3235
Explanation of benefits forms relating to claims under medicare supplemental insurance policies and limited benefits health insurance pol... 3236
Public health law assessments 3237
Health insurance coverage for full-time students on medical leaves of absence 3238
Pre-authorization of health care services 3239
Wellness programs 3240
Unclaimed benefits 3240*2
Student accident and health insurance 3241
Network coverage 3242
Prescription drug coverage 3243
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance 3244
Explanation of benefits forms relating to claims under certain accident and health insurance policies 3245
Liability to providers in the event of an insolvency
Green check means up to date. Up to date

Accessed:
Oct. 26, 2024

Last modified:
Sep. 22, 2014

§ 3224-C’s source at nysenate​.gov

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