New York Laws
Article 43 - Non-Profit Medical and Dental Indemnity, or Health and Hospital Service Corporations
4306 - Required Contract Provisions.

(a) a statement of the amount payable to the corporation by the
individual to whom the contract is issued and the times at which and
manner in which such amount is to be paid;
(b) a statement of the nature of the benefits to be furnished and the
period during which they will be furnished; and if there are any
benefits to be excepted, a detailed statement of such exceptions printed
as hereinafter specified;
(c) a statement of the terms and conditions, if any, upon which the
contract may be terminated at the option of the individual, or otherwise
terminated at the option of either party as permitted by subsection (b)
or (c) of section four thousand three hundred four of this article;
(d) a statement that the contract includes the endorsements thereon
and attached papers, if any;
(e) a statement that no statement by the individual in his application
for a contract shall avoid the contract or be used in any legal
proceeding thereunder, unless such application or an exact copy thereof
is included in or attached to such contract, and that no agent or
representative of such corporation and no broker, other than an officer
or officers designated therein, is authorized to change the contract or
waive any of its provisions;
(f) a statement that if the individual defaults in making any payment
under the contract, the subsequent acceptance of a payment by the
corporation or by one of its duly authorized agents or by a duly
authorized broker shall reinstate the contract, but with respect to
sickness and injury, only to cover such sickness as may be first
manifested more than ten days after the date of such acceptance;
(g) a statement of the period of grace which will be allowed the
individual for making any payment due under the contract which period
shall not be less than ten days;
(h) a statement on the first page of the contract or in a notice
attached to the contract that during a specified period of time, which
shall not be less than ten days nor more than twenty days from the date
the contract is delivered to the individual, it may be surrendered to
the corporation together with a written request for cancellation of the
contract and that in such event the corporation will refund any premium
paid therefor including any contract fees or other charges; provided,
however, that a contract sold by mail order and a contract providing
medicare supplemental insurance or long-term care insurance must contain
a provision permitting the individual a thirty day period for such
surrender;
(i) the age limit or date or period, if any, after which the coverage
provided by the contract will not be effective, or renewed, is stated in
a renewal provision set forth on the first page of the contract or as a
separate provision bearing an appropriate caption on the first page on
the contract or in a brief description in not less than fourteen point
bold face type set forth on the first page of the contract; nothing
herein contained shall limit or restrict the right of the corporation to
continue the contract after the age or period so stated;
(j) a statement under the caption "CONVERSION PRIVILEGE" which shall
set forth in substance the conversion privileges and related provisions
required by subsections (d) and (e) of section four thousand three
hundred four of this article;
(k) the exceptions of the contract shall appear with the same
prominence as the benefits to which they apply;
(l) if the contract contains any provision purporting to make any
portion of the articles, constitution or by-laws of the corporation a
part of the contract, such portion shall be set forth in full; and
(m) in every such contract made, issued or delivered in this state
there shall be a brief description of the contract on its first page and
on its filing back.
(n) a statement that a health care claim from a subscriber shall be
submitted within one hundred twenty days from the date of service;
provided, however, that if it was not reasonably possible for the
subscriber to submit the claim within that timeframe, then the claim
shall be submitted as soon as reasonably possible.
* (o) Space shall be provided on any enrollment, renewal or initial
online portal process setup forms required of a subscriber or applicant
for coverage, except forms issued by the NY State of Health, the
official Health Plan Marketplace, other than those specifically
referenced in subparagraph (iv) of paragraph (a) of subdivision five of
section forty three hundred ten and paragraph (v) of subdivision one of
section two hundred six of the public health law, so that the subscriber
or applicant for coverage shall register or decline registration in the
donate life registry for organ, eye and tissue donations under this
section of the enrollment, renewal or initial online portal process
setup forms and that the following is stated on the form in clear and
conspicuous type:
"You must fill out the following section: Would you like to be added
to the Donate Life Registry? Check box for 'yes' or 'skip this
question'."
* NB Effective June 23, 2024