S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         7182
                              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
       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
   24  for care in nursing homes for both the New  York  city-metropolitan  and
   25  upstate regions of the state; or
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD00936-01-5
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    1    (ii)  If  available and accessible by the insurer or other entity from
    2  the department of health, the most recently-published map of  the  esti-
    3  mated  average  regional  rates in New York state for nursing home care;
    4  [and]
    5    (E)  A graphic demonstration of the maximum daily nursing home benefit
    6  level provided by the policy or certificate, and  the  impact  that  the
    7  selection of any inflation protection options would have on such maximum
    8  daily nursing home benefit level[.]; AND
    9    (F)  THE  RIGHT  OF THE PROSPECTIVE INSURED, UPON ATTAINING THE AGE OF
   10  SIXTY-FIVE YEARS, TO DESIGNATE A THIRD PARTY WHO WILL RECEIVE A COPY  OF
   11  ANY  NOTICES OF NONPAYMENT OF PREMIUMS DUE OR NOTICE OF CANCELLATION FOR
   12  NONPAYMENT OF PREMIUMS THAT IS SENT TO THE PROSPECTIVE INSURED.
   13  For the purpose of this paragraph, "home care services" shall  have  the
   14  same meaning as defined in subdivision one of section thirty-six hundred
   15  two  of  the  public  health law. The prospective insured, or his or her
   16  representative, shall acknowledge that the required disclosure has  been
   17  made  by  signing the disclosure statement prior to or contemporaneously
   18  with the effective date of the policy or certificate.
   19  Failure to provide information required  by  subparagraph  (D)  of  this
   20  paragraph  shall not be construed as a violation of this section if such
   21  information has not been made available by the department of health.
   22    S 2. Subsection (e) of section 3111 of the insurance law, as added  by
   23  section  30  of  part B of chapter 58 of the laws of 2004, is amended to
   24  read as follows:
   25    (e) Every insurer that has in force a long-term care insurance  policy
   26  as defined in section one thousand one hundred seventeen of this chapter
   27  the  premiums  for  which are paid directly to the insurer by the senior
   28  citizen insured, except a policy that  qualifies  as  a  long-term  care
   29  insurance  contract  as defined in Section 7702B of the Internal Revenue
   30  Code, shall permit senior citizen insureds to designate a third party to
   31  whom the insurer shall transmit notices of nonpayment of premiums due or
   32  notice of cancellation for nonpayment of premiums[, as determined by the
   33  insurer]; PROVIDED THAT NOTICE OF CANCELLATION FOR NONPAYMENT OF PREMIUM
   34  SHALL BE SENT NO LATER THAN THIRTY DAYS BEFORE  THE  EFFECTIVE  DATE  OF
   35  SUCH  CANCELLATION.   The senior [citizens] CITIZEN INSURED shall notify
   36  the insurer that a third party has been so designated. Such notification
   37  shall be delivered to the insurer EITHER IN THE  SAME  ENVELOPE  AS  THE
   38  SENIOR  CITIZEN  INSURED'S  PREMIUM PAYMENT OR by certified mail, return
   39  receipt requested, and shall be effective not later  than  ten  business
   40  days  from  the  date  of  receipt by the insurer. The notification must
   41  contain, in writing, an  acceptance  by  the  third  party  designee  to
   42  receive  such  notices  of cancellation. Should the third party designee
   43  desire to terminate his or her status as a third  party  designee,  such
   44  designee shall provide written notice to both the insurer and the senior
   45  citizen  insured.  Should the senior citizen insured desire to terminate
   46  the third party designation, the insured shall provide written notice to
   47  the insurer. The transmission to the third party designee  of  any  such
   48  notice  of  cancellation shall be in addition to a copy of such document
   49  transmitted to the senior citizen insured and when a third party  is  so
   50  designated  all  such  notices  shall  be  mailed in an envelope clearly
   51  marked on its face with the  following:    "IMPORTANT  INSURANCE  POLICY
   52  INFORMATION:  OPEN  IMMEDIATELY". Designation as a third party shall not
   53  constitute acceptance of any liability on the third party  for  services
   54  provided  to  such  senior  citizen. The insurer shall notify its senior
   55  citizen insureds NOT LESS THAN annually in writing of  the  availability
   56  of  the third party designee notice procedure and provide information on
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    1  how the insured can commence this procedure[; however, such notice  need
    2  not  be  provided  once  a senior citizen has made a designation].  IF A
    3  SENIOR CITIZEN INSURED HAS NOT  MADE  A  THIRD  PARTY  DESIGNATION,  THE
    4  INSURER  SHALL  INCLUDE  A COPY OF THE THIRD PARTY DESIGNATION FORM WITH
    5  EACH PREMIUM STATEMENT SENT TO THE SENIOR CITIZEN INSURED. IF  A  SENIOR
    6  CITIZEN  INSURED  HAS MADE A DESIGNATION, THE INSURER SHALL CONFIRM WITH
    7  THE SENIOR CITIZEN INSURED  THAT  THE  THIRD  PARTY  DESIGNEE'S  CONTACT
    8  INFORMATION  IS CORRECT. UPON RECEIPT OF A DESIGNATION OR TERMINATION OF
    9  A DESIGNATION, THE INSURER SHALL VERIFY THE DESIGNATION OR  CANCELLATION
   10  OF  DESIGNATION  WITH THE SENIOR CITIZEN INSURED. SUCH VERIFICATION MAY,
   11  BUT IS NOT REQUIRED TO BE, WRITTEN AND THE INSURER MAY USE TELEPHONY  TO
   12  OBTAIN  AN  ORAL CONFIRMATION FROM THE SENIOR CITIZEN INSURED SO LONG AS
   13  THE INSURER PROVIDES THE SENIOR CITIZEN INSURED WITH  WRITTEN  CONFIRMA-
   14  TION OF THE ORAL VERIFICATION.
   15    S  3.  This  act  shall take effect on the sixtieth day after it shall
   16  have become a law.