N.Y. Comp. Codes R. & Regs. tit. 11 § 185.5

Current through Register Vol. 46, No. 50, December 11, 2024

Section 185.5 - Policy and certificate provisions and disclosure to debtors

(a) No credit life insurance or credit accident and health insurance shall be effected on a debtor unless evidenced by an individual policy or, in the case of group insurance, by a certificate of group insurance, which policy or certificate shall be delivered to the debtor within 30 days from the time the indebtedness is incurred or the election to purchase insurance coverage is made. Within such 30-day period, any cosigner or guarantor of the indebtedness shall be notified of the possible existence of this insurance by the use of a copy of the instrument of indebtedness, a copy of the loan application or a separate notice.

(b) If a separate charge is made to the debtor or debtors, then the signature of each debtor to be insured must be obtained requesting the coverage. However, in the case of married joint debtors, the insurer may allow one of the debtors to request joint coverage. If a debtor or debtors must satisfy an insurer's eligibility requirements for insurance including age, condition of health, employment status or other conditions for eligibility, the debtor's application for insurance, the notice of proposed group insurance, credit insurance disclosure statement or equivalent form shall set forth each such condition which would identify the debtor's eligibility or ineligibility and include a declaration for each debtor in regards to their eligibility. It is the responsibility of each insurer to ensure that every application, notice of proposed insurance, credit disclosure form and sales material provides an accurate description of the coverage provided in the policy and certificate and does not mislead the applicant as to the nature of the benefit.

(c) Each such individual policy or certificate of group insurance shall, in addition to other requirements of law, set forth:

(1) the name and home office address of the insurer;

(2) the identity of the debtor by name or otherwise;

(3) the amount and term of the coverage which, in the case of group insurance, may be by description rather than by stated amount and term;

(4) the amount of premium for an individual policy or the identifiable charge to the debtor, if any, under a group policy, stated separately in connection with credit life insurance, credit accident and health insurance and credit unemployment insurance when coverage is not packaged, unless in the case of group insurance, such identifiable charge has been disclosed to the debtor as hereinafter provided in subdivision (d) of this section;

(5) the circumstances and formula under which refunds of premiums or identifiable charges are payable pursuant to the provisions of section 185.8 of this Part;

(6) a description of the insurance coverage, including any exceptions, limitations or restrictions;

(7) a description of the eligibility requirements for the insurance, as referred to in subdivision (b) of this section; and

(8) that the benefits shall be paid to the creditor to reduce or extinguish any unpaid net indebtedness to the creditor and, where the amount of insurance exceeds any such unpaid net indebtedness, that any such excess shall be payable to the debtor or to a designated beneficiary, other than the creditor, or, if none designated, to the estate of the debtor or pursuant to the provision of a facility of payment clause.

Any such certificate shall appropriately describe the refund provision required pursuant to section 185.8 of this Part. The insurer shall be responsible to ascertain that appropriate procedures are set up by the creditor to implement the above. Where appropriate, the insurer may pay any such excess directly to such beneficiary or the estate of the debtor.

(d) If said individual policy or certificate of group insurance is not delivered to the debtor at the time the indebtedness is incurred, a copy of the application for such policy or a notice of proposed group insurance, signed by the debtor and setting forth:

(1) the name and home office address of the insurer;

(2) the name of the debtor;

(3) the amount of premium for an individual policy or the identifiable charge to the debtor, if any, under a group policy, separately in connection with credit life insurance, credit accident and health insurance and credit unemployment insurance when coverage is not packaged;

(4) the amount and term of the coverage provided which, in the case of group insurance, may be by description rather than by stated amount and term;

(5) a brief description of the coverage provided;

(6) a brief description of any limitations, reductions or exceptions, such as a preexisting condition limitation;

(7) a description of the eligibility requirements for the insurance, as referred to in subdivision (b) of this section (this requirement may be provided in the credit insurance disclosure statement or equivalent form); and

(8) that, if the insurance is declined by the insurer or otherwise does not become effective, any premium or identifiable charge will be refunded or credited to the debtor pursuant to the provisions of section 185.8 of this Part;

shall be delivered to the debtor at the time such indebtedness is incurred; provided, however, that where no identifiable charge is made to the debtor, the notice of proposed group insurance need not be signed by the debtor nor set forth the debtor's name except as provided in subdivision (b) of this section. The copy of the application for an individual policy and the notice of proposed group insurance shall refer exclusively to insurance coverage, and shall be separate and apart from the loan, sale or other credit statement of account, instrument or agreement, unless set forth therein in a separate provision with an appropriate and prominent caption on the face or reverse thereof in boldface type at least equal in size to the type used for the other provisions thereof; provided that the name of the debtor proposed for insurance, any figures relating to the amount and term of the coverage and the amount of the premium or identifiable charge to the debtor need not be contained in a separate provision of the instrument but may be set forth elsewhere in the instrument. The insurer shall be responsible for establishment of procedures for delivery of the individual policy or certificate of group insurance to the debtor upon the insurance becoming effective, or within 30 days of the date upon which the indebtedness is incurred. Said application or notice of proposed group insurance shall provide that, upon acceptance by the insurer, the insurance coverage provided shall become effective as specified in section 185.6(c) of this Part, unless the insurer has previously demonstrated to the satisfaction of the superintendent that in deferring the effective date of the insurance the contract conforms to the standards of section 3201(b) of the Insurance Law.

(e) An exclusion for preexisting conditions may only be used as described in paragraphs (1) through (3) of this subdivision.

(1) A policy of credit life insurance or credit accident and health insurance other than those subject to section 185.13 of this Part may contain a provision excluding or denying a claim for death or disability during the first six months of coverage resulting from a preexisting condition during the six month period immediately preceding the effective date of the debtor's coverage.

(2) For credit life insurance or credit accident and health insurance policies where the policy is subject to section 185.13 of this Part, the exclusion set forth in paragraph (1) of this subdivision may be used when the effective date of insurance is the certificate date.

(3) For credit accident and health insurance policies where the policy is subject to section 185.13 of this Part and each credit transaction is considered to have its own effective date of insurance, the policy may contain either:

(i) a provision limiting liability for a claim for disability for each credit transaction during the six months prior to the date of loss, where there was a preexisting condition during the six months prior to the date of the credit transaction; or

(ii) a provision limiting liability for a claim for disability for each credit transaction during the nine months prior to the date of loss, where there was a preexisting condition during the nine months prior to the date of loss and before the credit transaction.

The liability may not be reduced by more than the sum of the credit transactions subject to a preexisting condition less the excess of all payments made by the debtor to the account since the earliest credit transaction subject to a preexisting condition for this loss over the sum of the minimum payments which were required when each of these payments were made.

(f) Except as set forth in subdivision (e) of this section, no policy of credit insurance shall contain any provision that excludes or restricts liability for any reason other than:

(1) death by reason of suicide;

(2) disability by reason of intentionally self-inflicted injuries; or

(3) death or disability by reason of:

(i) war or special hazards to which a person in military service is exposed in the line of duty; or

(ii) such other exclusions which have been shown to the satisfaction of the superintendent not to be contrary to the standards prescribed in section 3201(b) of the Insurance Law.

(g) A credit insurance policy may exclude from the classes eligible for insurance, classes of debtors determined by age and provide for the cessation of insurance or reduction in the amount of insurance upon attainment of specified ages:

(1) no age for ineligibility shall be less than age 65 at date of indebtedness or age 66 at the maturity date; and

(2) no age for termination or reduction in the amount of insurance shall be less than age 66; except that for credit accident health insurance the use of a younger age may be approved by the superintendent.

(h) A group credit insurance policy which provides for payment of single premiums or of advance premiums to the insurer shall contain a provision that, in the event of termination of such policy by the insurer or creditor, insurance coverage with respect to any debtor insured under such policy shall be continued for the entire period for which a single premium or advance premium has been paid for such debtor, except as otherwise provided in section 185.6(c) of this Part, unless such coverage is immediately assumed by the same or another insurer. A group credit insurance policy under which premiums are paid to the insurer monthly on outstanding balances shall contain a provision that, in the event of termination of such policy by the insurer or creditor, 31 days' notice of such termination shall be given to any debtor insured under the policy by the insurer where practicable, otherwise by the creditor, unless there is immediate replacement of the coverage by the same or another insurer.

(i) No group policy of credit life insurance or credit accident and health insurance replacing a group policy of similar benefits with the same or another insurer shall be written unless all debtors insured under the prior policy are eligible without evidence of individual insurability or restrictions as to preexisting conditions, except those contained in the prior policy from which transfer is made. In the case of refinancing with the same creditor, any incontestable period or the periods of time subject to a preexisting condition exclusion shall be measured from the dates of the original transaction, with respect to loan amounts and durations in force immediately prior to such refinancing.

(j) A group credit insurance policy issued to a trustee, trustees or agent designated by two or more creditors shall set forth:

(1) the duties and obligations pertaining to the service and administration of said group policy of the trustee, trustees, or agent;

(2) the class or classes of creditors that may be included in the group policy and the condition for eligibility of any such class or classes;

(3) the method of computation and manner of charging and collecting premiums for each class or classes of creditors;

(4) the insurer's method and manner of computing and crediting dividends or experience rate adjustments if different for any class or classes of creditors or debtors;

(5) the class or classes of debtors to be insured under said group policy; and

(6) the method of computation and manner of charging and collecting premiums or identifiable charges for each class or classes of debtors.

No such policy shall be issued until after the trust or agency agreement has been filed with and found unobjectionable by the superintendent.

(k) A policy of credit life insurance covering a tenant's lease, or covering a lease of real or personal property shall comply with the provisions of this subdivision.

(1) A copy of the lease must be obtained and reviewed by the insurer.

(2) If the lease does not give the lessee's estate the right to continue the lease and/or purchase the leased property, credit life insurance may not be written.

(3) If the lease gives the lessee's estate the right to continue the lease by payment of the remaining lease payments in a lump sum exclusive of any unearned lease charges, the amount of insurance shall be for a lump sum equal to the sum of the lease payments excluding any unearned lease charges.

(4) If the lease allows for the lessee's estate to continue making payments, but does not meet the requirements of paragraph (3) of this subdivision, the amount of insurance shall equal the periodic payment of the scheduled lease payments as such payments become due.

(5) Any insurance payable in a lump sum in excess of the net amount due the lessor shall be paid to the insured's estate or a beneficiary other than the creditor. Notwithstanding anything to the contrary, the amount of insurance in connection with a tenant's lease shall be as permitted by section 4216(b)(3) of the Insurance Law.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 185.5