N.Y. Comp. Codes R. & Regs. tit. 11 § 57.5

Current through Register Vol. 46, No. 51, December 18, 2024

Section 57.5 - Classification and reclassification

(a) An insured may only be treated as a smoker for rating and benefit purposes if:

(1) the insurer has determined that the insured is a smoker in accordance with subdivision (b) of this section; and

(2) subject to underwriting in accordance with subdivision (b) of this section, the insurer treats any other insured who is not determined to be a smoker as a non-smoker for rating and benefit purposes.

(b) If, based on its underwriting procedures, an insurer determines, at the time of policy application or at the time of a request for an increase in insurance coverage where evidence of insurability is required under the terms of the policy with respect to the amount of the increase, that an insured is a smoker, the policy must specify when the rates or benefits of the policy will be based on the insured's classification as a smoker.

(c) A policy on an insured classified as a smoker must identify any amounts of coverage to which the smoker classification is being applied and, if applicable, any amounts of coverage to which the smoker classification does not apply.

(d) If the insurer has any procedures for the insured to seek a more favorable underwriting classification, then the insurer must describe those procedures in any policy issued after the effective date of this section. Amounts of coverage issued on an insured may not subsequently be reclassified to a less favorable underwriting classification. This subdivision does not apply to any increases in insurance coverage for which evidence of insurability is required.

(e) For any policy issued under the 2001 CSO Mortality Table at ages for which the table does not have distinct mortality rates for smokers and nonsmokers, an insurer may either:

(1) use the composite mortality table for all attained ages; or

(2) use the composite mortality table for attained ages up to an age identified in the policy between ages 15 and 18, inclusive, and thereafter use smoker and non-smoker tables in accordance with Part 100 of this Title (Insurance Regulation 179) and as provided in this section.

(f) This section applies to all policies issued on or after the effective date of this section.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 57.5