N.Y. Insurance Law Section 3234*2
Limitations on administrative services and stop-loss coverage

* § 3234. Limitations on administrative services and stop-loss coverage. No insurer, subsidiary of an insurer, or controlled person of a holding company system may act as an administrator or claims paying agent, as opposed to an insurer, on behalf of a group which denies or limits benefits for a specific disease or condition or for a procedure or treatment unique to a specific disease or condition in a manner which would be inconsistent with this chapter or regulations promulgated by the superintendent had the group purchased insurance. No insurer, subsidiary of an insurer, or controlled person of a holding company may provide stop loss, catastrophic or reinsurance coverage to groups which deny or limit benefits for a specific disease or condition or for a procedure or treatment unique to a specific disease or condition in a manner which would be inconsistent with this chapter or regulations promulgated by the superintendent had the group purchased insurance. A limit, maximum, or other mechanism that controls total coverage without regard to a specific disease or condition shall not be deemed one that denies or limits benefits for a specific disease or condition, or for a procedure or treatment unique to a specific disease or condition. Nothing herein shall be construed to mandate the inclusion of specified benefits in an employer group plan, if such plan is not subject to the provisions of this chapter. * NB There are 2 § 3234’s

Source: Section 3234*2 — Limitations on administrative services and stop-loss coverage, https://www.­nysenate.­gov/legislation/laws/ISC/3234*2 (updated Dec. 24, 2021; 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:
Dec. 24, 2021

§ 3234*2’s source at nysenate​.gov

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