§ 1117. Health insurance plans for long term care. (a) An authorized\ninsurer subject to the provisions of this chapter and organized to write\nthe kind of insurance specified in paragraph three of subsection (a) of\nsection one thousand one hundred thirteen of this article, a corporation\nor health maintenance organization authorized pursuant to article\nforty-three of this chapter or article forty-four of the public health\nlaw, and a fraternal benefit society organized under article forty-five\nof this chapter, may be authorized by the superintendent to issue\ncontracts in connection with plans providing benefits for long term\ncare, provided such plans satisfy the criteria set forth in subsection\n(b) of this section and the superintendent has made the determinations\nset forth in subsection (f) of this section.\n (b) The superintendent may authorize such contracts in connection with\na plan for long term care pursuant to the following criteria:\n (1) the plan's provisions are not misleading or confusing;\n (2) the plan's provisions are not inconsistent with the needs of the\npublic;\n (3) the plan's benefit structure provides options for use of long term\ncare services;\n (4) the plan, the contract and other materials describing the plan\nfully and clearly state the benefits and limitations of such plan;\n (5) the authorized insurer, health maintenance organization, or\nfraternal benefit society agrees to provide such reports of the\nexperience of the plan as may be requested by the superintendent. The\nsuperintendent may prepare abstracts and summaries of such reports at\nthe request of other government agencies for purposes of research and\nstudies related to long term care financing, provided however that the\ninsurer, health maintenance organization, or fraternal benefit society\nmay request that specified information included in the report be\nconsidered confidential; and\n (6) prior to the earlier of the execution of a policy or certificate\nin connection with a plan providing a home care benefit and/or a nursing\nhome benefit, or the payment of any premium or fee related to such a\npolicy or certificate, the authorized insurer, corporation, health\nmaintenance organization or fraternal benefit society shall provide the\nprospective insured or his or her representative with a disclosure\nstatement, which contains the following:\n (A) The maximum daily and lifetime benefit levels, if applicable,\nprovided by the policy or certificate for home care services and nursing\nhome services;\n (B) The percentage of coverage provided for home care services and\nnursing home services, if applicable, and an explanation of the\nmethodology on which the reasonable charge used in conjunction with such\npercentage amount is based;\n (C) A description of any inflation protection feature included in or\navailable for purchase under the policy or certificate and the\nadditional premium required to purchase such option or options;\n (D) (i) If available and accessible by the insurer or other entity\nfrom the department of health, the most recently-published average,\nstatewide rate for care in a nursing home, as well as the average rates\nfor care in nursing homes for both the New York city-metropolitan and\nupstate regions of the state; or\n (ii) If available and accessible by the insurer or other entity from\nthe department of health, the most recently-published map of the\nestimated average regional rates in New York state for nursing home\ncare;\n (E) A graphic demonstration of the maximum daily nursing home benefit\nlevel provided by the policy or certificate, and the impact that the\nselection of any inflation protection options would have on such maximum\ndaily nursing home benefit level;\n (F) The right of the prospective insured, upon attaining the age of\nsixty-five years, to designate a third party who will receive a copy of\nany notices of nonpayment of premiums due or notice of cancellation for\nnonpayment of
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