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 Oct. 26, 2024).

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
Green check means up to date. Up to date

Accessed:
Oct. 26, 2024

Last modified:
Sep. 22, 2014

§ 4306-E’s source at nysenate​.gov

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