N.Y. Insurance Law Section 4320
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.

Source: Section 4320 — Limitations on administrative services and stop-loss coverage, https://www.­nysenate.­gov/legislation/laws/ISC/4320 (updated Sep. 22, 2014; accessed Apr. 13, 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:
Apr. 13, 2024

Last modified:
Sep. 22, 2014

§ 4320’s source at nysenate​.gov

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