S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        7182--A
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                    April 27, 2015
                                      ___________
       Introduced  by  M.  of  A.  CYMBROWITZ  -- read once and referred to the
         Committee on Insurance -- committee discharged, bill amended,  ordered
         reprinted as amended and recommitted to said committee
       AN  ACT  to  amend  the insurance law, in relation to the designation of
         third parties to receive notification of cancellation
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Paragraph 6 of subsection (b) of section 1117 of the insur-
    2  ance  law,  as  added  by chapter 572 of the laws of 2008, is amended to
    3  read as follows:
    4    (6) prior to the earlier of the execution of a policy  or  certificate
    5  in connection with a plan providing a home care benefit and/or a nursing
    6  home  benefit,  or  the  payment of any premium or fee related to such a
    7  policy or certificate, the authorized insurer, corporation, health main-
    8  tenance organization or fraternal  benefit  society  shall  provide  the
    9  prospective  insured  or  his  or  her  representative with a disclosure
   10  statement, which contains the following:
   11    (A) The maximum daily and  lifetime  benefit  levels,  if  applicable,
   12  provided by the policy or certificate for home care services and nursing
   13  home services;
   14    (B)  The  percentage  of  coverage provided for home care services and
   15  nursing home services, if applicable, and an explanation of the  method-
   16  ology  on  which  the  reasonable  charge  used in conjunction with such
   17  percentage amount is based;
   18    (C) A description of any inflation protection feature included  in  or
   19  available  for  purchase  under  the policy or certificate and the addi-
   20  tional premium required to purchase such option or options;
   21    (D) (i) If available and accessible by the  insurer  or  other  entity
   22  from  the  department  of  health,  the most recently-published average,
   23  statewide rate for care in a nursing home, as well as the average  rates
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD00936-02-5
       A. 7182--A                          2
    1  for  care  in  nursing homes for both the New York city-metropolitan and
    2  upstate regions of the state; or
    3    (ii)  If  available and accessible by the insurer or other entity from
    4  the department of health, the most recently-published map of  the  esti-
    5  mated  average  regional  rates in New York state for nursing home care;
    6  [and]
    7    (E) A graphic demonstration of the maximum daily nursing home  benefit
    8  level  provided  by  the  policy or certificate, and the impact that the
    9  selection of any inflation protection options would have on such maximum
   10  daily nursing home benefit level[.];
   11    (F) THE RIGHT OF THE PROSPECTIVE INSURED, UPON ATTAINING  THE  AGE  OF
   12  SIXTY-FIVE  YEARS, TO DESIGNATE A THIRD PARTY WHO WILL RECEIVE A COPY OF
   13  ANY NOTICES OF NONPAYMENT OF PREMIUMS DUE OR NOTICE OF CANCELLATION  FOR
   14  NONPAYMENT OF PREMIUMS THAT IS SENT TO THE PROSPECTIVE INSURED; AND
   15    (G)  A  LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE SHALL INCLUDE A
   16  PROVISION THAT PROVIDES FOR REINSTATEMENT OF COVERAGE, IN THE  EVENT  OF
   17  LAPSE, IF THE INSURER IS PROVIDED PROOF THAT THE POLICY HOLDER OR CERTI-
   18  FICATEHOLDER WAS COGNITIVELY IMPAIRED OR HAD A LOSS OF FUNCTIONAL CAPAC-
   19  ITY BEFORE THE GRACE PERIOD CONTAINED IN THE POLICY EXPIRED. THIS OPTION
   20  SHALL  BE  AVAILABLE  TO  THE  INSURED, IF REQUESTED, WITHIN FIVE MONTHS
   21  AFTER TERMINATION AND SHALL ALLOW FOR THE COLLECTION OF PAST DUE  PREMI-
   22  UM,  WHERE APPROPRIATE. THE STANDARD OF PROOF OF COGNITIVE IMPAIRMENT OR
   23  LOSS OF FUNCTIONAL CAPACITY SHALL NOT BE MORE STRINGENT THAN THE BENEFIT
   24  ELIGIBILITY CRITERIA ON COGNITIVE IMPAIRMENT OR THE LOSS  OF  FUNCTIONAL
   25  CAPACITY CONTAINED IN THE POLICY AND CERTIFICATE.
   26  For  the  purpose of this paragraph, "home care services" shall have the
   27  same meaning as defined in subdivision one of section thirty-six hundred
   28  two of the public health law. The prospective insured,  or  his  or  her
   29  representative,  shall acknowledge that the required disclosure has been
   30  made by signing the disclosure statement prior to  or  contemporaneously
   31  with the effective date of the policy or certificate.
   32  Failure  to  provide  information  required  by subparagraph (D) of this
   33  paragraph shall not be construed as a violation of this section if  such
   34  information has not been made available by the department of health.
   35    S  2. Subsection (e) of section 3111 of the insurance law, as added by
   36  section 30 of part B of chapter 58 of the laws of 2004,  is  amended  to
   37  read as follows:
   38    (e)  Every insurer that has in force a long-term care insurance policy
   39  as defined in section one thousand one hundred seventeen of this chapter
   40  the premiums for which are paid directly to the insurer  by  the  senior
   41  citizen  insured,  except  a  policy  that qualifies as a long-term care
   42  insurance contract as defined in Section 7702B of the  Internal  Revenue
   43  Code, shall permit senior citizen insureds to designate a third party to
   44  whom the insurer shall transmit notices of nonpayment of premiums due or
   45  notice of cancellation for nonpayment of premiums[, as determined by the
   46  insurer]; PROVIDED THAT NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
   47  SHALL  BE  SENT  NO  LATER THAN THIRTY DAYS BEFORE THE EFFECTIVE DATE OF
   48  SUCH CANCELLATION.  The senior [citizens] CITIZEN INSURED  shall  notify
   49  the insurer that a third party has been so designated. Such notification
   50  shall  be  delivered  to  the insurer [by certified mail, return receipt
   51  requested,] IN THE SAME ENVELOPE AS THE SENIOR CITIZEN INSURED'S PREMIUM
   52  PAYMENT and shall be effective not later than ten business days from the
   53  date of receipt by the insurer. The notification must contain, in  writ-
   54  ing,  an  acceptance by the third party designee to receive such notices
   55  of cancellation. Should the third party designee desire to terminate his
   56  or her status as a third party designee,  such  designee  shall  provide
       A. 7182--A                          3
    1  written  notice  to  both  the  insurer  and the senior citizen insured.
    2  Should the senior citizen insured desire to terminate  the  third  party
    3  designation,  the  insured  shall provide written notice to the insurer.
    4  The  transmission  to  the  third  party  designee of any such notice of
    5  cancellation shall be in addition to a copy of such document transmitted
    6  to the senior citizen insured and when a third party  is  so  designated
    7  all  such  notices  shall be mailed in an envelope clearly marked on its
    8  face with the following:  "IMPORTANT INSURANCE POLICY INFORMATION:  OPEN
    9  IMMEDIATELY".  Designation as a third party shall not constitute accept-
   10  ance of any liability on the third party for services provided  to  such
   11  senior citizen. The insurer shall notify its senior citizen insureds NOT
   12  LESS  THAN  annually  in  writing of the availability of the third party
   13  designee notice procedure and [provide] INCLUDE information on  how  the
   14  insured  can  commence this procedure[; however, such notice need not be
   15  provided once a senior citizen has  made  a  designation].  THE  INSURER
   16  SHOULD  ALSO  INCLUDE  A  COPY  OF THE THIRD PARTY DESIGNATION FORM WHEN
   17  PROVIDING SUCH INFORMATION.
   18    S 3. This act shall take effect on the sixtieth  day  after  it  shall
   19  have become a law.