Section 4304. Individual contracts

(a) Every corporation subject to the
  provisions of this article may issue a contract  to  an  individual  the
  premiums  for  which  may  be  paid  to  the corporation directly by the
  individual or by a remitting agent for the group to which the individual
  belongs. If the premiums for a contract issued pursuant to this  section
  are paid to the corporation by a remitting agent, such contract shall be
  subject  to subsections (k) and (l) of section four thousand two hundred
  thirty-five of this chapter, and for the purposes of these  subsections,
  the remitting agent shall be treated as the policyholder.
    (b)(1) Any such contract shall be for a period not in excess of twelve
  months,  but  no  contract  shall be made providing for the inception of
  benefits at a date later than one year from the date of the contract.
    (2) Any such contract shall provide  that  it  will  be  automatically
  renewed from year to year unless there shall have been one month's prior
  written notice of termination by the subscriber.
    (3)  No corporation shall refuse to renew any such contract because of
  the physical or mental condition or the health  of  any  person  covered
  thereunder.  The  provisions of this subsection shall in no way diminish
  the rights of  individuals  pursuant  to  section  four  thousand  three
  hundred seventeen of this article.
    (c) Any such contract may be terminated in the following manner:
    (1)  At  the  option of the individual to whom the contract is issued,
  upon not less than one month's prior written notice.
    (2) At the option of the corporation, for one or more of the following
  reasons:
    (A) The individual has failed to  pay  premiums  or  contributions  in
  accordance  with  the  terms  of the contract or the corporation has not
  received timely premium payments.
    (B) The individual has performed an act or practice  that  constitutes
  fraud  or  made  an intentional misrepresentation of material fact under
  the terms of the contract, upon not less than one month's prior  written
  notice.
    (C)  (i) Discontinuance of a class of contract upon not less than five
  months' prior written notice, except for subscribers to direct pay major
  medical or similar comprehensive-type coverage issued by  a  corporation
  organized  pursuant  to  this  article,  or  any  successor  corporation
  organized through a conversion pursuant to  subsection  (j)  of  section
  four  thousand three hundred one of this article, and in effect prior to
  January  first,  nineteen  hundred  ninety-six  who  are  ineligible  to
  purchase  policies  offered  after  such  date  pursuant to section four
  thousand  three  hundred  twenty-one  or  four  thousand  three  hundred
  twenty-two  of this article due to the provisions of 42 U.S.C. 1395ss in
  effect on the effective date  of  this  item.  In  the  event  any  such
  subscriber  becomes  eligible  to  purchase policies offered pursuant to
  section four thousand three hundred twenty-one or  four  thousand  three
  hundred  twenty-two  of  this  article,  then  such  subscriber  may  be
  discontinued upon not less than five months' prior  written  notice.  In
  exercising the option to discontinue coverage pursuant to this item, the
  corporation   must   act   uniformly   without   regard  to  any  health
  status-related factor of enrolled individuals  or  individuals  who  may
  become eligible for such coverage and must offer to subscribers or group
  remitting  agents,  as  may  be  appropriate, the option to purchase all
  other individual health insurance coverage currently  being  offered  by
  the corporation to applicants in that market.
    (ii)  Discontinuance  of  all  hospital,  surgical  or medical expense
  coverage in the individual direct payment  market  in  this  state  upon
  written  notice  to  the  superintendent and to each subscriber not less
  than one hundred eighty days prior to the date of the expiration of such

  coverage. In the event of such a withdrawal from the  individual  direct
  payment  market,  the  corporation  must also provide the superintendent
  with a written plan to minimize potential disruption in the  marketplace
  occasioned  by  such  withdrawal.  In  addition, the corporation may not
  provide for the issuance of any hospital, surgical  or  medical  expense
  coverage  in  the  individual direct payment market in this state during
  the five-year period beginning on the date of the discontinuance of  the
  last health insurance coverage not so renewed.
    (iii)  Discontinuance  of all individual hospital, surgical or medical
  expense insurance contracts  for  which  the  premiums  are  paid  by  a
  remitting  agent  of  a  group,  in the small group market, or the large
  group market, or both markets, in this  state,  in  conjunction  with  a
  withdrawal  from  the  small group market, or the large group market, or
  both markets, in this state. Withdrawal from the small group market,  or
  the  large  group  market,  or  both  markets,  shall be governed by the
  requirements  of  subparagraphs  (B)  and  (C)  of  paragraph  three  of
  subsection  (j)  of  section  four  thousand  three hundred five of this
  article. For purposes of this item, "withdrawal"  from  a  market  means
  that no coverage is offered or maintained in such market under contracts
  issued  pursuant to this section or contracts issued pursuant to section
  four thousand three hundred five of this article.
    (D) In the case of a corporation that offers health insurance  in  the
  market  through  a network plan, the individual no longer resides, lives
  or works in the service area (or in an area for which the corporation is
  authorized to do business) but only if such coverage is terminated under
  this paragraph uniformly without regard  to  any  health  status-related
  factor  of  covered  individuals. For the purposes of this subparagraph,
  the term "network plan" means health insurance coverage of a corporation
  organized under this article under which the financing and  delivery  of
  health  care  (including  items  and services paid for as such care) are
  provided, in whole or in part, through a defined set of providers  under
  contract  either  with  the  corporation  or  another  entity  that  has
  contracted with the corporation.
    (E) In case of a contract  for  which  the  premiums  are  paid  by  a
  remitting   agent   of  a  group,  discontinuance  of  the  individual's
  membership in such group.
    (F)  Such  other  reasons  as  the  superintendent  may  approve   and
  authorized by the Health Insurance Portability and Accountability Act of
  1996,  Public  Law  104-191,  and  any  later  amendments  or  successor
  provisions, or by any federal regulations or rules  that  implement  the
  provisions  of  the  Act,  upon  not less than one month's prior written
  notice.
    (3) Every notice of termination shall be in a form satisfactory to the
  superintendent  and  shall  include  a  statement  of   the   conversion
  privileges, if any, upon such termination.
    (4)  In  the event of termination of a contract, the corporation shall
  return the unearned portion of the premium.
    (d) (1) (A) No contract issued pursuant to this section shall  entitle
  more  than  one  person  to  benefits  except that a contract issued and
  marked as  a  "family  contract"  may  provide  that  benefits  will  be
  furnished  to  a  husband and wife, or husband, wife and their dependent
  child or children, or any child or children not over nineteen  years  of
  age,  provided that an unmarried student at an accredited institution of
  learning may be considered a dependent  until  he  becomes  twenty-three
  years  of  age, provided that the coverage of any such "family contract"
  may include, at the option of the insurer,  any  unmarried  child  until
  attaining  age  twenty-five,  and provided also that the coverage of any
  such  "family  contract"  shall  include  any  other  unmarried   child,

  regardless  of  age,  who  is incapable of self-sustaining employment by
  reason of mental illness, developmental disability, mental  retardation,
  as  defined  in  the  mental  hygiene  law, or physical handicap and who
  became  so  incapable  prior to attainment of the age at which dependent
  coverage would otherwise terminate, so that such child may be considered
  a dependent.
    (B) In addition to  the  requirements  of  subparagraph  (A)  of  this
  paragraph,  every  corporation issuing a contract that provides coverage
  for dependent children must make  available  and  if  requested  by  the
  contractholder, extend coverage under the contract to an unmarried child
  through  age  twenty-nine, without regard to financial dependence who is
  not insured by or  eligible  for  coverage  under  any  employee  health
  benefit  plan as an employee or member, whether insured or self-insured,
  and who lives, works or resides in New York state or the service area of
  the corporation. Such coverage shall be made available at the  inception
  of  all  new  contracts,  at  the  first  anniversary  date  of a policy
  following the  effective  date  of  this  subparagraph,  and  for  group
  remittance  contracts  at  any  anniversary  date. Written notice of the
  availability of such coverage shall be delivered to  the  contractholder
  prior  to the inception of such group contract, thirty days prior to the
  first anniversary date of a policy following the effective date of  this
  subparagraph, and for group remittance contracts annually thereafter.
    (C)  Notwithstanding  any rule, regulation or law to the contrary, any
  "family contract"  shall  provide  that  coverage  of  newborn  infants,
  including  newly  born  infants  adopted by the insured or subscriber if
  such insured or subscriber takes physical custody  of  the  infant  upon
  such infant's release from the hospital and files a petition pursuant to
  section  one  hundred  fifteen-c  of  the  domestic relations law within
  thirty days of birth; and provided further that no notice of  revocation
  to the adoption has been filed pursuant to section one hundred fifteen-b
  of  the  domestic relations law and consent to the adoption has not been
  revoked, shall be effective from the  moment  of  birth  for  injury  or
  sickness  including  the  necessary  care  and  treatment  of  medically
  diagnosed congenital defects and birth abnormalities including premature
  birth, except that  in  cases  of  adoption,  coverage  of  the  initial
  hospital  stay  shall not be required where a birth parent has insurance
  coverage available for  the  infant's  care.  This  provision  regarding
  coverage  of  newborn infants shall not apply to two person coverage. In
  the case of individual or two person coverages the corporation must also
  permit the person to whom the policy is issued to elect such coverage of
  newborn infants from the moment of birth. If notification and/or payment
  of an additional premium or contribution is required  to  make  coverage
  effective  for  a  newborn  infant,  the  coverage may provide that such
  notice and/or payment be made within no less than thirty days of the day
  of birth to make coverage effective  from  the  moment  of  birth.  This
  election shall not be required in the case of student insurance or where
  the group remitting agent's plan does not provide coverage for dependent
  children.
    (2) Every "family contract" under which coverage of a dependent spouse
  or  contract  holder would terminate upon such spouse or contract holder
  attaining the age prescribed in subchapter XVIII of the Social  Security
  Act,  42  U.S.C.  §  1395  et  seq  ("Medicare"),  as  the  age of first
  eligibility  for  the  benefits  provided  by  such  law  shall  not  so
  terminate,  if  such  dependent  spouse  is not eligible for all of such
  benefits, for as  long  as  the  contract  remains  in  force  and  such
  dependent  spouse  remains  ineligible to receive any of such "medicare"
  benefits, provided proof of  such  ineligibility  is  submitted  to  the
  corporation  within thirty-one days of the date notice of termination of

  coverage is mailed by the corporation to the last known address  of  the
  such spouse or contract holder.
    (3)  Coverage  of  an  unmarried  dependent  child who is incapable of
  self-sustaining employment by reason of  mental  illness,  developmental
  disability  or mental retardation, as defined in the mental hygiene law,
  or physical handicap and who became so incapable prior to attainment  of
  the age at which dependent coverage would otherwise terminate and who is
  chiefly  dependent upon the contract holder for support and maintenance,
  shall not terminate while the policy remains in force and the  dependent
  remains  in  such  condition,  if the policyholder has within thirty-one
  days of such dependent's attainment of the limiting age submitted  proof
  of such dependent's incapacity as described herein.
    (e)  (1)  If  any  such  contract is terminated in accordance with the
  provisions of paragraph one  of  subsection  (c)  hereof,  or  any  such
  contract  is  terminated  because of a default by the remitting agent in
  the payment of premiums not  cured  within  the  grace  period  and  the
  remitting   agent  has  not  replaced  the  contract  with  similar  and
  continuous coverage for the same group whether insured or  self-insured,
  or  any such contract is terminated in accordance with the provisions of
  subparagraph (E) of paragraph two of subsection (c)  hereof,  or  if  an
  individual  other  than the contract holder is no longer covered under a
  "family contract" because he is no  longer  within  the  definition  set
  forth  in  the  contract,  or  a  spouse  is no longer covered under the
  contract because of divorce from the contract holder or annulment of the
  marriage, or any such contract is terminated because of the death of the
  contract holder, then such individual, former spouse, or in the case  of
  the  death  of  the  contract  holder  the  surviving  spouse  or  other
  dependents of the deceased contract holder covered under  the  contract,
  as  the  case  may be, shall be entitled to convert, without evidence of
  insurability, upon application therefor and  the  making  of  the  first
  payment  thereunder within thirty-one days after the date of termination
  of such contract, to a contract of a type which provides  coverage  most
  nearly  comparable to the type of coverage under the contract from which
  the individual converted, which coverage  shall  be  no  less  than  the
  minimum standards for basic hospital, basic medical, or major medical as
  provided for in insurance department regulation; provided, however, that
  if the corporation does not issue such a major medical contract, then to
  a  comprehensive  or  comparable type of coverage which is most commonly
  being sold to  group  remitting  agents.  Notwithstanding  the  previous
  sentence,  a  corporation  may  elect to issue a standardized individual
  enrollee contract  pursuant  to  section  four  thousand  three  hundred
  twenty-two  of  this  article  in  lieu  of  a  major  medical contract,
  comprehensive or comparable type of coverage required to be offered upon
  conversion from  an  indemnity  contract.  The  effective  date  of  the
  coverage  provided by the converted direct payment contract shall be the
  date of the termination  of  coverage  under  the  contract  from  which
  conversion was made.
    (2)  The corporation shall not be required to issue any such converted
  individual direct payment contract  if  its  issuance  would  result  in
  overinsurance  or duplication of benefits according to standards on file
  with the  superintendent  and  approved  by  him  with  regard  to  such
  contracts.   The  individual  direct  payment  contract  may  include  a
  provision whereby the  corporation  may  request  information  when  any
  payment is due under the contract of the person covered thereunder as to
  whether  he  is  then  covered  by another individual contract providing
  similar benefits or is then covered by a group contract policy providing
  similar benefits or is then provided with similar benefits  required  by
  any  statute  or  provided by any welfare plan or program which together

  with the converted individual direct payment contract  would  result  in
  overinsurance  or  duplication of benefits according to the standards on
  file with the superintendent relating to individual  contracts.  If  any
  such  person  is  so  covered  or  so  provided and fails to furnish the
  details of such coverage when requested, the benefits provided under the
  converted individual  direct  payment  contract  may  be  based  on  the
  hospital, surgical or medical expenses actually incurred after excluding
  expenses  to  the  extent  they are payable under such other coverage or
  provided under such statute, plan or program.
    (3) The converted individual direct payment contract may  exclude  any
  condition  excluded  by  the contract from which conversion was made for
  such person at the time of the termination of  the  benefits  thereunder
  and  such converted individual direct payment contract shall not exclude
  any  other  pre-existing  condition,  but  may  provide  that   benefits
  thereunder may be reduced by the benefits which have been provided under
  the  contract  from  which  conversion was made after the termination of
  such person's coverage thereunder and during the first contract year  of
  such  converted individual direct payment contract the benefits provided
  under the contract may be reduced so that they  are  not  in  excess  of
  those that would have been provided had such person's coverage under the
  contract from which conversion was made remained in force and effect.
    (4)  In  addition  to  the right of conversion herein, the employee or
  member insured under a contract for which the premiums  are  paid  by  a
  remitting  agent  of  a  group shall at his option, as an alternative to
  conversion, be entitled to have his coverage continued under  the  group
  remittance  contract  in  accordance with the conditions and limitations
  contained in subsection (k) of this section, and have issued at the  end
  of  the  period  of continuation an individual direct payment conversion
  contract subject to the terms of this subsection. The effective date for
  the conversion contract shall be the day following  the  termination  of
  insurance  under  the  group  remittance  contract,  or  if  there  is a
  continuation of coverage, on the day following the end of the period  of
  continuation.
    (f)  No  such  corporation shall require as a condition for renewal or
  for failure to cancel any individual contract any rider, endorsement  or
  other  attachment which shall limit the nature or extent of the benefits
  thereunder, except that a corporation may at  any  time  upon  at  least
  thirty  days'  prior  written  notice  amend  such contract to provide a
  different level of benefits thereunder if approved by the superintendent
  on finding, upon application by the corporation  at  least  four  months
  before the proposed effective date, that such level would exceed, in the
  aggregate,  the  level  of benefits theretofore provided and would be in
  the best interests of the corporation and the persons covered under such
  contracts.
    (g) The provisions of this section with respect to limitations on  the
  termination  of  an individual contract shall not apply to a contract or
  an endorsement or rider thereto which is issued by a corporation subject
  to the provisions of this article  pursuant  to  a  plan  providing  for
  experimentation  in  new  forms  of  benefits  in  the  field  of health
  insurance protection, which plan shall be submitted in  writing  to  the
  superintendent.  The  superintendent shall approve such plan if he finds
  that the benefits are of the type  heretofore  described  and  that  the
  issuance  of  such  contract,  endorsement  or  rider  is  in the public
  interest. Approval of such  contract,  rider  or  endorsement  shall  be
  subject to any conditions which may be prescribed by the superintendent,
  including,  but  not  limited  to,  the  maximum period during which the
  exemption  from  the  provisions  of  this  section  with   respect   to
  termination  shall  continue.  The  superintendent  may,  for good cause

  shown,  extend  such  period  of  exemption.  Any  termination  of  such
  contract,  rider  or  endorsement  during the period of exemption, other
  than for non-payment of premium and fraud in applying for the  contract,
  shall be subject to the approval of the superintendent. Upon termination
  of  such  contract,  or  termination of a rider or endorsement providing
  experimental benefits, as aforesaid, the contract holder thereunder  who
  has   at   the  time  of  such  termination  been  covered  continuously
  immediately preceding such termination for a period of two years or more
  under one or more contracts of the corporation shall be entitled to have
  issued to him by the corporation, without evidence of insurability, upon
  application therefor and the making  of  the  first  payment  thereunder
  within  thirty-one  days  after  the  date of termination, an individual
  direct payment contract of the type and class which  the  superintendent
  shall  determine  provides  benefits  most  nearly  comparable  to those
  currently provided  other  individuals.  If  the  corporation  does  not
  terminate  such  contract  or  a  rider or endorsement thereto providing
  experimental benefits as aforesaid during the period  of  exemption,  or
  any  extended  period provided herein, such contract shall thereafter be
  subject to the provisions of this section with respect to termination as
  of the original effective date of such contract.
    (h) Any  contract,  other  than  one  issued  in  fulfillment  of  the
  continuing  care  responsibilities  of  an operator of a continuing care
  retirement community in accordance with article forty-six of the  public
  health  law,  made  available  because  of  residence  in  a  particular
  facility, housing development, or community shall contain the  following
  notice in twelve point type in bold face on the first page:
    "NOTICE - THIS CONTRACT DOES NOT MEET THE REQUIREMENTS OF A CONTINUING
  CARE RETIREMENT CONTRACT. AVAILABILITY OF THIS COVERAGE WILL NOT QUALIFY
  A RESIDENTIAL FACILITY AS A CONTINUING CARE RETIREMENT COMMUNITY."
    (i)  Any  persons  covered  by  the contract who are also members of a
  reserve component of the armed forces of the  United  States,  including
  the  National  Guard,  shall  be entitled, upon written request, to have
  their coverage suspended during a period of  active  duty  as  described
  herein.  The  contract  shall  provide  that the insurer will refund any
  unearned premiums for the period of such suspension. Persons covered  by
  the  contract  shall be entitled to resumption of coverage, upon written
  application and payment of the required premium within sixty days  after
  the  date  of  termination  of  the  period  of  active  duty,  with  no
  limitations or conditions imposed as a result of such period  of  active
  duty  except  as  set  forth  in paragraphs one and two herein. Coverage
  shall be retroactive to the date of termination of the period of  active
  duty.  Such right of resumption provided for herein shall be in addition
  to other existing rights granted pursuant to state and federal laws  and
  regulations  and  shall not be deemed to qualify or limit such rights in
  any way. No exclusion or waiting period may  be  imposed  in  connection
  with  coverage of a health or physical condition of a person entitled to
  such right of resumption, or a health or physical condition of any other
  person who is covered by the contract unless:
    (1) the condition arose during the  period  of  active  duty  and  the
  condition has been determined by the secretary of veterans affairs to be
  a condition incurred in the line of duty; or
    (2)  a  waiting period was imposed and had not been completed prior to
  the period of suspension; in no event, however, shall  the  sum  of  the
  waiting  periods  imposed  prior  to  and  subsequent  to  the period of
  suspension exceed the length of the waiting period originally imposed.
    (j) To be entitled to the right defined  in  subsection  (i)  of  this
  section  a  person  must be a member of a reserve component of the armed
  forces of the United States, including the National Guard, who either:

    (1) voluntarily or involuntarily enters upon active duty  (other  than
  for  the  purpose  of  determining his or her physical fitness and other
  than for training), or
    (2)  has  his or her active duty voluntarily or involuntarily extended
  during a period when the president is authorized to order units  of  the
  ready reserve or members of a reserve component to active duty, provided
  that  such  additional  active  duty  is  at  the  request  and  for the
  convenience of the federal government, and
    (3) serves no more than four years of active duty.
    (k) A contract for which the premiums are paid by a remitting agent of
  a group issued by a hospital service, health service or medical  expense
  indemnity  corporation  shall  provide that if all or any portion of the
  insurance on an employee or member insured  under  the  contract  ceases
  because  of  termination  of  employment  or  membership in the class or
  classes eligible for coverage  under  the  contract,  such  employee  or
  member   shall   be  entitled  without  evidence  of  insurability  upon
  application to continue his or her insurance for himself or herself  and
  his  or  her eligible dependents, subject to all of the group remittance
  contract's terms and conditions applicable to those  forms  of  benefits
  and to the following conditions:
    (1)  Continuation  shall  not  be available for: (A) any person who is
  covered, becomes covered or could be  covered  by  title  XVIII  of  the
  United  States  Social Security Act (Medicare) as amended or superseded;
  or (B) an employee, member or dependent who is covered, becomes  covered
  or could become covered as an employee, member or dependent by any other
  insured  or  uninsured  arrangement which provides hospital, surgical or
  medical coverage for individuals in a group which does not  contain  any
  exclusion  or  limitation  with respect to any pre-existing condition of
  such employee, member or dependent, except the group insurance or  group
  remittance  contract  conversion  option  of  this  section shall not be
  considered as such an arrangement under which  an  employee,  member  or
  dependent could become covered.
    (2) (A) An employee or member who wishes continuation of coverage must
  request  such  continuation  in  writing  within  the  sixty  day period
  following the later of: (i) the date of such termination;  or  (ii)  the
  date the employee is given notice of the right of continuation by either
  his employer or the group remitting agent.
    (B)  An  employee  or member who wishes continuation of coverage under
  subparagraph (D) of paragraph four of this subsection must  give  notice
  to  the  employer  or  group  remitting  agent  within sixty days of the
  determination under title II or title XVI of the  United  States  Social
  Security  Act  that  such employee or member was disabled at the time of
  termination of employment or membership or at any time during the  first
  sixty days of continuation of coverage.
    (3)  An employee or member electing continuation must pay to the group
  remitting agent or his employer, but  not  more  frequently  than  on  a
  monthly  basis  in  advance, the amount of the required premium payment,
  but not more than one hundred two percent of  the  group  rate  for  the
  benefits  being continued under the group remittance contract on the due
  date of each payment. The employee's or  member's  written  election  of
  continuation,  together  with  the  first  premium  payment  required to
  establish premium payment on a monthly basis in advance, must  be  given
  to  the  group remitting agent or employer within sixty days of the date
  the employee's or member's benefits would otherwise terminate.
    (4) Subject to paragraph  one  of  this  subsection,  continuation  of
  benefits  under  the  group  remittance  contract  for  any person shall
  terminate at the first to occur of the following:

    (A) The date thirty-six  months  after  the  date  the  employee's  or
  member's  benefits  under  the  contract would otherwise have terminated
  because of termination of employment or membership; or
    (B) The end of the period for which premium payments were made, if the
  employee  or  member  fails to make timely payment of a required premium
  payment; or
    (C) In the case of an eligible dependent of an employee or member, the
  date thirty-six months after the date such person's benefits  under  the
  contract would otherwise have terminated by reason of:
    (i) the death of the employee or member;
    (ii)  the  divorce  or legal separation of the employee or member from
  his or her spouse;
    (iii) the employee or member becoming entitled to benefits under title
  XVIII of the United States Social Security Act (Medicare); or
    (iv) a dependent child ceasing to  be  a  dependent  child  under  the
  generally applicable requirements of the contract; or
    (D)  The  date  on  which  the  group  remittance  contract  with that
  remitting agent is terminated or, in the case of an employee,  the  date
  his   employer  terminates  participation  under  the  group  remittance
  contract.  However, if this clause applies and the coverage  ceasing  by
  reason of such termination is replaced by similar coverage under another
  group or group remittance contract, the following shall apply:
    (i)  The  employee  or  member  shall have the right to become covered
  under that other group or group remittance contract, for the balance  of
  the  period  that  he  would have remained covered under the prior group
  remittance  contract  in  accordance  with  this  subparagraph   had   a
  termination described in this subparagraph not occurred, and
    (ii)  The  minimum level of benefits to be provided by the other group
  or group remittance contract shall be the applicable level  of  benefits
  of  the  prior group remittance contract reduced by any benefits payable
  under that prior group remittance contract, and
    (iii) The prior group remittance contract shall  continue  to  provide
  benefits  to  the  extent  of  its  accrued liabilities and extension of
  benefits as if the replacement had not occurred.
    * (5)(A) Special enrollment period. An individual who does not have an
  election of continuation coverage as described  in  this  subsection  in
  effect  on  the effective date of the American Recovery and Reinvestment
  act of 2009, but who would be an assistance  eligible  individual  under
  Title  III  of  such  act  if  such  election  were in effect, may elect
  continuation coverage pursuant to this subsection. Such election must be
  made no later than sixty days after the date the  administrator  of  the
  group  health  plan  (or  other  entity  involved)  provides  the notice
  required by section 3001(a)(7) of the American Recovery and Reinvestment
  act of 2009. The administrator of the group health plan (or other entity
  involved) shall provide such individuals with additional notice  of  the
  right  to elect coverage pursuant to this paragraph within sixty days of
  the date of enactment of the American Recovery and Reinvestment  act  of
  2009.
    (B) Continuation coverage elected pursuant to subparagraph (A) of this
  paragraph  shall commence with the first period of coverage beginning on
  or after the  date  of  the  enactment  of  the  American  Recovery  and
  Reinvestment  act  of  2009  and  shall  not extend beyond the period of
  continuation coverage that would have been required if the coverage  had
  instead been elected pursuant to paragraph two of this subsection.
    (C)  With  respect  to  an individual who elects continuation coverage
  pursuant to subparagraph (A) of this paragraph, the period beginning  on
  the  date  of  the  qualifying event and ending on the date of the first
  period of coverage on or after the enactment of  the  American  Recovery

  and  Reinvestment  act  of  2009  shall  be  disregarded for purposes of
  determining the sixty-three day  period  referred  to  in  section  four
  thousand three hundred eighteen of this article.
    * NB There are 2 par (5)'s
    * (5)  A contract for which premiums are paid by a remitting agent for
  a group issued by a hospital service, health service or medical  expense
  indemnity  corporation  shall  offer  an  employee  or  member  who  has
  exhausted continuation coverage pursuant to Chapter 18 of  the  Employee
  Retirement  Income  Security Act, 29 U.S.C. § 1161 et seq. or Chapter 6A
  of the Public Health Service Act, 42 U.S.C. § 300 bb -  1  et  seq.  the
  opportunity  to  continue  coverage for up to thirty-six months from the
  date the employee's or  member's  continuation  coverage  began  if  the
  employee  or  member  is  entitled  to  less  than  thirty-six months of
  continuation benefits.
    * NB There are 2 par (5)'s
    (l) On and after January  first,  nineteen  hundred  ninety-seven,  no
  insurer  shall  offer  major  medical, comprehensive or other comparable
  individual contracts on a direct payment basis, other than for  purposes
  of   conversion,  unless  the  benefits  of  such  contracts,  including
  deductibles and coinsurance, are identical to the  out-of-plan  benefits
  of  the  contracts  described  in  section  four  thousand three hundred
  twenty-two of this article. Such contracts must include  a  prescription
  drug benefit complying with the requirements of such section.
    (m)(1)  As  used  in  this  subsection,  "dependent  child"  means  an
  unmarried child through age twenty-nine of an employee or member insured
  under a group remittance contract, regardless of  financial  dependence,
  who is not insured by or eligible for coverage under any employee health
  benefit  plan,  whether insured or self-insured, and who lives, works or
  resides in New York state or the service area of the corporation and who
  is not covered under title XVIII of the United  States  Social  Security
  Act (Medicare).
    (2) In addition to the conversion privilege afforded by subsection (e)
  of  this  section and the continuation privilege afforded by subsections
  (e) and (k) of this section,  a  hospital  service,  health  service  or
  medical  expense  corporation  or  health  maintenance organization that
  provides coverage for which the premiums are paid by the remitting agent
  of a group  that  provides  dependent  coverage  that  terminates  at  a
  specified  age  shall,  upon  application  of  the  employee,  member or
  dependent child, as set  forth  in  subparagraph  (B)  or  (C)  of  this
  paragraph,  provide coverage to the dependent child after that specified
  age and  through  age  twenty-nine  without  evidence  of  insurability,
  subject  to  all  of  the  terms  and conditions of the group remittance
  contract and the following:
    (A) An employer shall not be required to pay all or part of  the  cost
  of coverage for a dependent child provided pursuant to this subsection;
    (B)  An  employee,  member  or  dependent  child  who  wishes to elect
  continuation of coverage pursuant to this subsection shall  request  the
  continuation in writing:
    (i)  within  sixty  days  following  the date coverage would otherwise
  terminate due to reaching the specified  age  set  forth  in  the  group
  contract;
    (ii)  within  sixty  days after meeting the requirements for dependent
  child status set forth in paragraph one of this subsection when coverage
  for the dependent child previously terminated; or
    (iii) during an annual thirty-day open enrollment period as  described
  in the contract.
    (C)  For twelve months after the effective date of this subsection, an
  employee, member or dependent child may elect  prospective  continuation

  coverage  under  this  subsection  for  a dependent child whose coverage
  terminated under the terms of the group remittance contract prior to the
  initial effective date of this subsection;
    (D)  An  employee,  member or dependent child electing continuation as
  described in this subsection shall pay to the group remitting  agent  or
  employer,  but  not  more frequently than on a monthly basis in advance,
  the amount of the required premium payment  on  the  due  date  of  each
  payment.  The  written election of continuation, together with the first
  premium payment required to establish premium payment on a monthly basis
  in advance, shall be given to the  group  remitting  agent  or  employer
  within  the  time periods set forth in subparagraphs (B) and (C) of this
  paragraph. Any premium received within the thirty-day period  after  the
  due date shall be considered timely;
    (E) For any dependent child electing coverage within sixty days of the
  date the dependent child would otherwise lose coverage due to reaching a
  specified  age, the effective date of the continuation coverage shall be
  the date coverage would have otherwise  terminated.  For  any  dependent
  child  electing  to  resume  coverage  during  an annual open enrollment
  period  or  during  the  twelve-month  initial  open  enrollment  period
  described  in  subparagraph (C) of this paragraph, the effective date of
  the continuation coverage shall be prospective no later than thirty days
  after the election and payment of first premium;
    (F) Coverage for a dependent child pursuant to this  subsection  shall
  consist  of  coverage  that is identical to the coverage provided to the
  employee or member parent. If coverage is modified  under  the  contract
  for  any  group  of  similarly  situated  employees or members, then the
  coverage shall also be modified in the same  manner  for  any  dependent
  child;
    (G) Coverage shall terminate on the first to occur of the following:
    (i)  the  date the dependent child no longer meets the requirements of
  paragraph one of this subsection;
    (ii) the end of the period for which premium payments  were  made,  if
  there  is a failure to make payment of a required premium payment within
  the period of grace described in subparagraph (D) of this paragraph; or
    (iii) the date on which the group remittance  contract  is  terminated
  and  not  replaced  by  coverage under another group or group remittance
  contract; and
    (H) The corporation or health maintenance organization  shall  provide
  written  notification  of  the  continuation privilege described in this
  subsection and the time period in which to request continuation  to  the
  employee or member:
    (i) in each certificate of coverage;
    (ii)  at least sixty days prior to termination at the specified age as
  provided in the contract;
    (iii) within thirty days of the effective  date  of  this  subsection,
  with  respect to information concerning a dependent child's opportunity,
  for twelve months after the effective date of this subsection, to make a
  written election  to  obtain  coverage  under  a  contract  pursuant  to
  subparagraph (C) of this paragraph.
    (3)(A)  Corporations and health maintenance organizations shall submit
  such reports as may be requested by the superintendent to  evaluate  the
  effectiveness of coverage pursuant to this subsection including, but not
  limited to, quarterly enrollment reports.
    (B)  The  superintendent  may  promulgate  regulations  to  ensure the
  orderly  implementation  and  operation  of  the  continuation  coverage
  provided   pursuant   to   this   subsection,   including  premium  rate
  adjustments.