Section 4306. Required contract provisions

Every contract issued by any
  corporation pursuant to the provisions of section  four  thousand  three
  hundred  four  of  this article, shall be in writing and shall state the
  terms and conditions thereof. No such contract shall be made, issued  or
  delivered in this state unless it contains the following provisions:
    (a)  a  statement  of  the  amount  payable  to the corporation by the
  individual to whom the contract is issued and the  times  at  which  and
  manner in which such amount is to be paid;
    (b)  a statement of the nature of the benefits to be furnished and the
  period during which they  will  be  furnished;  and  if  there  are  any
  benefits to be excepted, a detailed statement of such exceptions printed
  as hereinafter specified;
    (c)  a  statement  of the terms and conditions, if any, upon which the
  contract may be terminated at the option of the individual, or otherwise
  terminated at the option of either party as permitted by subsection  (b)
  or (c) of section four thousand three hundred four of this article;
    (d)  a  statement  that the contract includes the endorsements thereon
  and attached papers, if any;
    (e) a statement that no statement by the individual in his application
  for a contract shall  avoid  the  contract  or  be  used  in  any  legal
  proceeding  thereunder, unless such application or an exact copy thereof
  is included in or attached to  such  contract,  and  that  no  agent  or
  representative  of such corporation and no broker, other than an officer
  or officers designated therein, is authorized to change the contract  or
  waive any of its provisions;
    (f)  a statement that if the individual defaults in making any payment
  under the contract, the  subsequent  acceptance  of  a  payment  by  the
  corporation  or  by  one  of  its  duly  authorized  agents or by a duly
  authorized broker shall reinstate the  contract,  but  with  respect  to
  sickness  and  injury,  only  to  cover  such  sickness  as may be first
  manifested more than ten days after the date of such acceptance;
    (g) a statement of the period of  grace  which  will  be  allowed  the
  individual  for  making  any payment due under the contract which period
  shall not be less than ten days;
    (h) a statement on the first page of  the  contract  or  in  a  notice
  attached  to  the contract that during a specified period of time, which
  shall not be less than ten days nor more than twenty days from the  date
  the  contract  is  delivered to the individual, it may be surrendered to
  the corporation together with a written request for cancellation of  the
  contract  and that in such event the corporation will refund any premium
  paid therefor including any contract fees or  other  charges;  provided,
  however,  that  a  contract  sold by mail order and a contract providing
  medicare supplemental insurance or long-term care insurance must contain
  a provision permitting the individual  a  thirty  day  period  for  such
  surrender;
    (i)  the age limit or date or period, if any, after which the coverage
  provided by the contract will not be effective, or renewed, is stated in
  a renewal provision set forth on the first page of the contract or as  a
  separate  provision  bearing an appropriate caption on the first page on
  the contract or in a brief description in not less than  fourteen  point
  bold  face  type  set  forth  on the first page of the contract; nothing
  herein contained shall limit or restrict the right of the corporation to
  continue the contract after the age or period so stated;
    (j) a statement under the caption "CONVERSION PRIVILEGE"  which  shall
  set  forth in substance the conversion privileges and related provisions
  required by subsections (d) and  (e)  of  section  four  thousand  three
  hundred four of this article;

    (k)  the  exceptions  of  the  contract  shall  appear  with  the same
  prominence as the benefits to which they apply;
    (l)  if  the  contract  contains  any provision purporting to make any
  portion of the articles, constitution or by-laws of  the  corporation  a
  part of the contract, such portion shall be set forth in full; and
    (m)  in  every  such  contract made, issued or delivered in this state
  there shall be a brief description of the contract on its first page and
  on its filing back.
    * (n) a statement that a health care claim from a subscriber shall  be
  submitted  within  one  hundred  twenty  days  from the date of service;
  provided, however, that if  it  was  not  reasonably  possible  for  the
  subscriber  to  submit  the  claim within that timeframe, then the claim
  shall be submitted as soon as reasonably possible.
    * NB Effective January 1, 2011