N.Y. Insurance Law Section 4306-E
Prohibition on lifetime and annual limits


(a)

A corporation shall not establish a lifetime limit on the dollar amount of essential health benefits in an individual, group or blanket contract of hospital, medical, surgical or prescription drug expense insurance.

(b)

A corporation shall not establish an annual limit on the dollar amount of essential health benefits in an individual, group or blanket contract of hospital, medical, surgical or prescription drug expense insurance for contract years beginning on and after January one, two thousand fourteen.

(c)

For contract years beginning prior to January one, two thousand fourteen, a corporation may establish restricted annual limits on the dollar amount of essential health benefits in an individual, group or blanket contract of hospital, medical, surgical or prescription drug expense insurance consistent with section 2711 of the Public Health Service Act, 42 U.S.C. § 300gg-11 or any regulations thereunder.

(d)

The requirements of subsections (b) and (c) of this section shall not be applicable to any individual contract that is a grandfathered health plan. For purposes of this section, “grandfathered health plan” means coverage provided by a corporation in which an individual was enrolled on March twenty-third, two thousand ten for as long as the coverage maintains grandfathered status in accordance with section 1251(e) of the Affordable Care Act, 42 U.S.C. § 18011(e).

(e)

For purposes of this section, “essential health benefits” shall have the meaning ascribed by section 1302(b) of the Affordable Care Act, 42 U.S.C. § 18022(b).

Source: Section 4306-E — Prohibition on lifetime and annual limits, https://www.­nysenate.­gov/legislation/laws/ISC/4306-E (updated Sep. 22, 2014; accessed Dec. 2, 2023).

4301
Organization of corporation
4302
Permit and license to do business
4303
Benefits
4303–A
Prescription synchronization
4304
Individual contracts
4305
Group contracts
4306
Required contract provisions
4306–A
Health insurance coverage for full-time students on medical leaves of absence
4306–B
Primary and preventive obstetric and gynecologic care
4306–C
Grievance procedure and access to specialty care
4306–D
Choice of health care provider
4306–E
Prohibition on lifetime and annual limits
4306–F
Maternal depression screenings
4306–G
Telehealth delivery of services
4306–H
Essential health benefits package and limit on cost-sharing
4306–I
Coverage for medically fragile children
4307
Providers of services
4308
Supervision of superintendent
4309
Limitation on expenses
4310
Investments
4312
Employment of solicitors
4313
Applicability of other provisions of this chapter
4314
Not to affect provisions of workers’ compensation law
4315
Arbitration
4316
Individual contracts
4317
Rating of individual and small group health insurance contracts
4318
Pre-existing condition provisions
4318–A
Certification of creditable coverage by corporations organized under this article
4320
Limitations on administrative services and stop-loss coverage
4321
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations prior to October first, two t...
4321–A
Fund for standardized individual enrollee direct payment contracts
4322
Standardization of individual enrollee direct payment contracts offered by health maintenance organizations which provide out-of-plan ben...
4322–A
Fund for standardized individual enrollee direct payment contracts which provide out-of-plan benefits
4323
Marketing materials
4324
Disclosure of information
4325
Prohibitions
4326
Standardized health insurance contracts for qualifying small employers and individuals
4327
Stop loss funds for standardized health insurance contracts issued to qualifying small employers and qualifying individuals
4328
Individual enrollee direct payment contracts offered by health maintenance organization on and after October first, two thousand thirteen
4329
Prescription drug coverage
4330
Discrimination because of sex or marital status in hospital, surgical or medical expense insurance

Accessed:
Dec. 2, 2023

Last modified:
Sep. 22, 2014

§ 4306-E’s source at nysenate​.gov

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