New York Insurance Code § 3232

Pre-existing condition provisions in health policies
Open in Lexace · Ask the AI about this section
§ 3232. Pre-existing condition provisions in health policies. Every\nindividual health insurance policy and every group or blanket accident\nand health insurance policy issued or issued for delivery in this state\nwhich includes a pre-existing condition provision shall contain in\nsubstance the following provision or provisions which in the opinion of\nthe superintendent are more favorable to the individuals, members of the\ngroup and their eligible dependents:\n  (a) In determining whether a pre-existing condition provision applies\nto a covered person, the group or blanket accident and health insurance\npolicy or individual health insurance policy shall credit the time the\ncovered person was previously covered under creditable coverage, if the\nprevious creditable coverage was continuous to a date not more than\nsixty-three days prior to the enrollment date of the new coverage. In\nthe case of previous health maintenance organization coverage, any\naffiliation period prior to that previous coverage becoming effective\nshall also be credited pursuant to this subsection.\n  (b) No pre-existing condition provision shall exclude coverage for a\nperiod in excess of twelve months following the enrollment date of\ncoverage for the covered person and may only relate to a condition\n(whether physical or mental), regardless of the cause of the condition,\nfor which medical advice, diagnosis, care or treatment was recommended\nor received within the six-month period ending on the enrollment date.\nFor purposes of this section "enrollment date" means the first day of\ncoverage of the individual under the policy or, if earlier, the first\nday of the waiting period that must pass with respect to an individual\nbefore such individual is eligible to be covered for benefits. If an\nindividual seeks and obtains coverage in the individual market, any\nperiod after the date the individual files a substantially complete\napplication for coverage and before the first day of coverage is a\nwaiting period. For purposes of this section genetic information shall\nnot be treated as a pre-existing condition in the absence of a diagnosis\nof the condition related to such information. No pre-existing condition\nlimitation provision shall exclude coverage in the case of:\n  (1) an individual who, as of the last day of the thirty-day period\nbeginning with the date of birth, is covered under creditable coverage\nas defined in subsection (c) of this section;\n  (2) a child who is adopted or placed for adoption before attaining\neighteen years of age and who, as of the last day of the thirty-day\nperiod beginning on the date of the adoption or placement for adoption,\nis covered under creditable coverage as defined in subsection (c) of\nthis section;\n  (3) pregnancy (except in an individual health insurance policy or a\nstudent blanket accident and health insurance policy in which an insurer\nmay exclude coverage, subject to a credit for previous creditable\ncoverage, for a period not to exceed ten months for a pregnancy existing\non the enrollment date); or\n  (4) an individual, and any dependent of such individual, who is\neligible for a federal tax credit under the federal Trade Adjustment\nAssistance Reform Act of 2002 and who has three months or more of\ncreditable coverage.\n  Paragraphs one and two of this subsection shall no longer apply to an\nindividual after the end of the first sixty-three day period during all\nof which the individual was not covered under any creditable coverage.\n  (c) For purposes of this section "creditable coverage" means, with\nrespect to an individual, coverage of the individual under any of the\nfollowing:\n  (1) A group health plan;\n  (2) Health insurance coverage;\n  (3) Part A or B of title XVIII of the Social Security Act;\n  (4) Title XIX of the Social Security Act, other than coverage\nconsisting solely of benefits under section 1928;\n  (5) Chapter 55 of title 10, United States Code;\n  (6) A medical care progr

‹ Prev All New York sections Next ›


Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.