N.Y. Comp. Codes R. & Regs. tit. 11 § 65-1.4
The Exclusion of Medical Expense from Mandatory Personal Injury Protection Endorsement (New York), set out below is approved and promulgated for use in accordance with the provisions of section 5103(g) of the Insurance Law. This endorsement may be used as a separate endorsement or appropriately added to the mandatory endorsement.
EXCLUSION OF MEDICAL EXPENSE FROM MANDATORY PERSONAL INJURY PROTECTION ENDORSEMENT (New York)
In consideration of a reduction in premium, it is agreed that:
If the Medical Expense element of Basic Economic Loss is identified as not applicable [in the declarations] 19 the Company shall not be liable for any items of such loss which would otherwise be covered under the Mandatory Personal Injury Protection Endorsement (New York) with respect to the named insured or named insured and any relative as specified [in the declarations] 19 Coverage for any such medical expense element of basic economic loss provided to such named insured, or such relative, by a Company or corporation in accordance with the provisions of section 5103(g) of the New York Insurance Law shall reduce the $50,000 aggregate limit of liability for basic economic loss to such person under this policy. This endorsement shall be effective during the term of this policy so long as the medical expense coverage provided by such Company or corporation remains in effect, notwithstanding any provisions [in the declarations] 19 of this policy to the contrary, and in the event this endorsement shall no longer be in effect the premium may be adjusted accordingly.
N.Y. Comp. Codes R. & Regs. Tit. 11 § 65-1.4