N.Y. Insurance Law Section 3240*2
Student accident and health insurance


(a)

In this section:

(1)

(A) “Student accident and health insurance” means a policy or contract of hospital, medical, or surgical expense insurance delivered or issued for delivery in this state on or after January first, two thousand fourteen, by an insurer or a corporation, to an institution of higher education covering students enrolled in the institution and the students’ dependents. (B) “Student accident and health insurance” shall not include:

(i)

a policy or contract that provides limited scope dental or vision benefits meeting the definition of “excepted benefits” set forth in section 2791 of the public health service act, 42 U.S.C. § 300gg-91(c);

(ii)

an accident policy or contract that provides benefits meeting the definition of “excepted benefits” set forth in section 2791 of the public health service act, 42 U.S.C. § 300gg-91(c), if the policy or contract: (I) is limited to coverage for intercollegiate sports injuries only; (II) provides benefits to diagnose and treat any intercollegiate sports injury and does not include a benefit dollar maximum amount per injury that is less than the overall benefit dollar maximum amount per student under the intercollegiate sports injury policy or contract; (III) provides benefits on an expense incurred basis; (IV) provides that premiums are paid in full by the institution of higher education; (V) includes prominent disclosure to the student that the accident policy is not a substitute for comprehensive hospital and medical coverage; (VI) provides coverage for intercollegiate sports injuries primary to any student accident and health insurance policy or contract or any student health plan issued pursuant to § 1124 (Institutions of higher education exempt)section one thousand one hundred twenty-four of this chapter; except that a policy or contract meeting the requirements of this item may be excess or secondary to any other policy or contract of accident and health insurance; and (VII) includes a maximum benefit amount that is no less than the deductible under the separate athletic association policy or contract if designed to coordinate with a separate policy or contract issued to an athletic association that extends coverage for intercollegiate sports injuries;

(iii)

an accident policy or contract that provides benefits meeting the definition of “excepted benefits” set forth in section 2791 of the public health service act, 42 U.S.C. § 300gg-91(c)(1)(A), if the policy or contract: (I) is limited to transportation expenses in the event an insured student incurs a covered sickness or accident, including transportation expenses for a medical escort to travel with the student and transportation expenses for returning the student to the student’s domicile; (II) provides that premiums are paid in full by the institution of higher education; (III) covers students enrolled in the institution of higher education; (IV) includes prominent disclosure to the student that the accident policy is not a substitute for comprehensive hospital and medical coverage; and (V) provides coverage for a period of twelve months; or

(iv)

an insurance policy, contract, or certificate that provides hospital, medical, or surgical expense coverage for a student while studying outside the United States for a period of twelve months or less that is issued to a student, provided that the student is also covered by comprehensive hospital and medical coverage within the United States and the insurance policy, contract, or certificate: (I) is subject to the requirements of subsections (b), (c), (d), (e), (h), and

(i)

of this section; (II) meets the definition of “expatriate health plan” set forth in 42 U.S.C. § 18014(d)(2); (III) excludes coverage within the United States; (IV) may offer coverage for global evacuation and repatriation in the event of the insured student’s sickness or accident; and (V) may offer coverage for trip cancellation, trip interruption, baggage, personal effects, or global evacuation and repatriation, including evacuation in the event of a natural or man-made disaster, such as an epidemic, political event, war, terrorist act, riot, or civil insurrection, pursuant to § 3452 (Group property travel insurance policies)section three thousand four hundred fifty-two of this chapter.

(2)

“Institution of higher education” or “institution” shall have the meaning set forth in the higher education act of 1965, 20 U.S.C. § 1001.

(3)

“Insurer” means an insurer licensed to write accident and health insurance pursuant to this chapter.

(4)

“Corporation” means a corporation organized in accordance with article 43 (Non-profit Medical and Dental Indemnity, or Health and Hospital Service Corporations)article forty-three of this chapter.

(5)

“Intercollegiate sport” means a sport that has been designated as an intercollegiate sport by the institution of higher education in which a student is enrolled and that is organized or sponsored by an institution of higher education.

(6)

“Intercollegiate sports injury” means an injury sustained by a student member of an athletics team during participation in an intercollegiate sport.

(b)

An insurer or corporation shall not impose any pre-existing condition exclusion in a student accident and health insurance policy or contract. An insurer or corporation shall not condition eligibility, including continued eligibility, for a student accident and health insurance policy or contract on health status, medical condition, including both physical and mental illnesses, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, including conditions arising out of acts of domestic violence, or disability.

(c)

An insurer or corporation shall condition eligibility including continuing eligibility, on the covered individual being enrolled as a student in an institution of higher education to which the student accident and health insurance policy or contract is issued.

(d)

A student accident and health insurance policy or contract shall provide coverage for essential health benefits as defined in subsection (a) of section three thousand two hundred seventeen-i or subsection (a) of § 4306-H (Essential health benefits package and limit on cost-sharing)section four thousand three hundred six-h of this chapter, as applicable.

(e)

An insurer or corporation shall not refuse to renew or otherwise terminate a student accident and health insurance policy or contract except for one or more of the reasons set forth in:

(1)

subparagraphs (A), (B), (D) or (G) of paragraph two of subsection (p) of § 3221 (Group or blanket accident and health insurance policies)section three thousand two hundred twenty-one of this article; or

(2)

subparagraphs (A), (B), (D) or (G) of paragraph two of subsection (j) of § 4305 (Group contracts)section four thousand three hundred five of this chapter.

(f)

Other than the provisions herein also required by article 43 (Non-profit Medical and Dental Indemnity, or Health and Hospital Service Corporations)article forty-three of this chapter, this section shall not apply to coverage under a student health plan issued pursuant to section one thousand one hundred twenty-four of this chapter.

(g)

The superintendent may promulgate regulations regarding student accident and health insurance, which may include minimum standards for the form, content and sale of the policies and contracts and, notwithstanding the provisions of section three thousand two hundred thirty-one and four thousand three hundred eight of this chapter, the establishment of rating methodology to be applied to the policies and contracts; provided that any such regulations shall be no less favorable to the insured than that which is provided under federal law and state law applicable to individual insurance.

(h)

The ratio of benefits to premiums shall be not less than eighty-two percent as calculated in a manner to be determined by the superintendent.

(i)

Every insurer or corporation shall report to the superintendent annually, on a date specified by the superintendent in a regulation, claims experience and other data in a manner acceptable to the superintendent that shall demonstrate the insurer’s or corporation’s compliance with the applicable rules and regulations, including the minimum loss ratio required by subsection (h) of this section. Failure to comply with subsection (h) of this section is subject to corrective action, which may include the submission, to the superintendent, of an appropriate rate filing or form and rate filing to reduce future premiums, increase benefits, issue dividends, issue premium refunds or credits, or any combination of these such that the minimum loss ratio can reasonably be expected to be achieved.

(j)

With respect to benefits for treatment relating to an intercollegiate sports injury, as defined in paragraph six of subsection (a) of this section, a policy or contract of student accident and health insurance or a student health plan issued pursuant to § 1124 (Institutions of higher education exempt)section one thousand one hundred twenty-four of this chapter shall be secondary to a separate accident policy or contract meeting the requirements of clauses (I) through (VII) of item (ii) of subparagraph (B) of paragraph one of subsection (a) of this section. * NB There are 2 § 3240’s

Source: Section 3240*2 — Student accident and health insurance, https://www.­nysenate.­gov/legislation/laws/ISC/3240*2 (updated Apr. 10, 2020; accessed Jun. 15, 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

Accessed:
Jun. 15, 2024

Last modified:
Apr. 10, 2020

§ 3240*2’s source at nysenate​.gov

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