Section 217. Employee notification and remittance of premiums; group policies of accident and health insurance  


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  • 1.  Statement  of  public
      policy.  The  legislature  finds  that  in  today's  society  health and
      accident insurance coverage for medical care and treatment is  of  prime
      importance to all employees and their dependents within the state of New
      York. Adequate and prospective planning is necessary to insure that such
      coverage  is  in  effect  at  the  time  of commencement of the need for
      medical and health care. Many employees and their dependents in New York
      State are covered through group  policies  issued  to  their  employers,
      employee  organizations  or  trustees  of  employee welfare funds and no
      statutory provision has heretofore afforded these  employees  and  their
      dependents the right as certificate holders of a group accident or group
      health  policy  to  receive  notification of the intended termination or
      substitution of the group  policy  and  to  have  premiums  remitted  to
      insurers  on  their  behalf  should they choose to exercise continuation
      privileges available under law.
        Accordingly, it is the declared public policy of the state of New York
      that sufficient and timely notice  be  afforded  each  employee  covered
      under   a  group  accident  or  group  health  policy  of  the  intended
      termination or  substitution  of  such  policy  and  that  employers  be
      required  to  remit  premiums  to  insurers  on  behalf  of  individuals
      exercising their right to continuation coverage under the law.
        2. Definitions. As used in this section:
        (a) "Policyholder" shall mean any person, co-partnership, corporation,
      trade   association,   joint   stock   association,   incorporated    or
      unincorporated association, trustees or labor organization as defined in
      subsections  (c)  and  (g),  respectively, of section four thousand four
      hundred two of the insurance law or any other entity to whom a policy or
      contract of group accident, group health or group  accident  and  health
      insurance has been issued.
        For the purpose of this section, "policyholder" shall also include any
      group remitting agent.
        (b)  "Certificate  holder"  shall mean any person insured, on either a
      contributory or non-contributory basis, by a policy or contract of group
      accident, group health or group accident and health insurance,  as  well
      as persons covered by group remittance policies.
        3. Notification.  A policyholder shall, subsequent to receipt from the
      insurer  of  notice of termination pursuant to subsection (k) of section
      four thousand two hundred  thirty-five  of  the  insurance  law  provide
      written  notice  to  the  certificate  holders  of  such  policy of such
      termination. In any case where the  policyholder  is  substituting  such
      policy  with  another  policy  providing  similar  coverage for the same
      certificate holders, the policyholder shall provide certificate  holders
      with  a  written  notice  including  therein the name of the substituted
      insurer. Where the employees are represented by  a  labor  organization,
      such  notice  shall  be  given  to  the  representative  of  that  labor
      organization. Such written notice shall be in accordance with the  rules
      and regulations of the superintendent of insurance, promulgated pursuant
      to  subsection  (l)  of section four thousand two hundred thirty-five of
      the insurance law.
        4.  Exception. The provisions of subdivision  three  of  this  section
      shall  not  be deemed to apply if, within ten days subsequent to receipt
      of notice of termination from the insurer, the  policyholder  has  taken
      necessary  steps  whereby  the intended termination is rendered null and
      void.
        5. Where the policyholder  has  contracted  with  another  insurer  to
      replace the existing insurer for the providing of similar and continuous
      coverage  for  the  same  certificate holders he shall file an affidavit
    
      with the commissioner of labor and superintendent of insurance  to  that
      effect.
        6.  Remittance of premiums. Any policyholder who receives notification
      from an individual entitled to  exercise  a  right  to  continuation  of
      coverage  by  the  policyholder's  insurer  pursuant  to  section  three
      thousand two hundred twenty-one of the insurance law,  shall,  no  later
      than thirty days subsequent to receipt of premiums from such individual,
      remit  such  premiums  to  the  insurer on behalf of such individual and
      provide evidence to the individual that the premium has been remitted.
        6-a.   Residence location  to  accompany  enrollment  data.    When  a
      policyholder  provides  information  to an insurer or health maintenance
      organization certified under article forty-four of the public health law
      or licensed pursuant to the  insurance  law  regarding  the  initial  or
      continued  enrollment  eligibility  of  a certificate holder, the policy
      holder must include the current united states postal  service  zip  code
      and state in which the certificate holder currently resides.
        7.  Penalties.  (a)  Any  policyholder  who  fails to comply with this
      section, shall forfeit to the people of the  State  a  sum  up  to  five
      thousand dollars, to be recovered by the commissioner in a civil action.
      Where  the policyholder is a corporation, trade association, joint stock
      association, incorporated or unincorporated association, the  president,
      secretary and treasurer thereof shall be liable for any forfeiture.
        (b)  In addition to such penalty, where the failure to comply involves
      the failure to notify an employee of the termination of a group accident
      or group health policy pursuant to subdivision three of this section  or
      the  failure  to  remit  premiums  pursuant  to  subdivision six of this
      section, or  the  failure  to  provide  an  individual  with  notice  of
      termination   pursuant   to  subdivision  six  of  section  one  hundred
      ninety-five of this chapter, the policy holder shall also be liable,  in
      a  civil action brought by the individual entitled to receive the notice
      of termination or exercise the right to continuation of  coverage  in  a
      court  of  competent  jurisdiction,  to  appropriate damages which shall
      include reimbursement for medical expenses which were not covered by the
      policyholder's insurer by virtue of his termination  of  the  policy  or
      failure to remit such premiums.