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Individual Life Insurance Application Outline
(Last Updated November 18, 2021)
Table of Contents
I) Scope ............................................................................................................................................................... 1
II) Filing Process .................................................................................................................................................. 1
II.A) General Information ................................................................................................................................ 1
A.1) Prior Approval Requirement ............................................................................................................... 1
A.2) Discretionary Authority for Disapproval ............................................................................................ 1
A.3) No filing fee required. ......................................................................................................................... 2
A.4) Filings Must Be Submitted Through State Electronic Rate and Forms Filing system (“SERFF”) .... 2
II.B) Types of Filings ...................................................................................................................................... 2
B.1) Prior Approval .................................................................................................................................... 2
B.2) Alternative Approval Procedure ......................................................................................................... 2
B.3) Prior Approval with Certification Procedure ...................................................................................... 3
B.4) Filing of Non-English Versions of Forms .......................................................................................... 3
II.C) Preparation of Forms............................................................................................................................... 4
C.1) Form Numbers .................................................................................................................................... 4
C.2) Hypothetical Data ............................................................................................................................... 4
C.3) Numbering Variable Material ............................................................................................................. 4
C.4) Final Format ........................................................................................................................................ 4
C.5) Regulation 152 .................................................................................................................................... 4
C.6) Submissions Made on Behalf of the Insurer ....................................................................................... 5
C.7) Circular Letter No. 14 (1997) ............................................................................................................. 5
C.8) Circular Letter No. 8 (1999) ............................................................................................................... 5
II.D) SERFF Filing Description/Requested Filing Mode ................................................................................ 5
D.1) Filing Basis ......................................................................................................................................... 6
D.2) Compliance with Section I.G of Circular Letter No. 6 (1963) ........................................................... 6
D.3) Explanation of Unique Features and Markets ..................................................................................... 7
D.4) Extension of Approval ........................................................................................................................ 8
D.5) Resubmissions..................................................................................................................................... 8
D.6) Noncompliance Explanation ............................................................................................................... 8
II.E) Attachments ............................................................................................................................................ 8
E.1) Readability Certification ..................................................................................................................... 8
E.2) Variable Material ................................................................................................................................ 9
E.3) Screen Shots ........................................................................................................................................ 9
E.4) Electronic/Telephonic Procedures ...................................................................................................... 9
II.F) Key References ....................................................................................................................................... 9
III) Individual Life Insurance Applications .................................................................................................... 10
New York State Department of Financial Services Individual Life Insurance Application Outline
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III.A) Format ................................................................................................................................................... 10
III.B) Questions Personal/Health .................................................................................................................... 11
III.C) Application Statements Regarding the Insurance Product .................................................................... 12
III.D) Disclosure Requirements ...................................................................................................................... 13
III.E) Authorizations/Agreements .................................................................................................................. 16
III.F) Entire Contract ...................................................................................................................................... 17
IV) Attachments/Ancillary Forms ................................................................................................................... 17
IV.A) Statement of Good Health ..................................................................................................................... 17
IV.B) Conditional Receipts/Temporary Insurance Agreements ..................................................................... 18
IV.C) Fair Credit Reporting Act and MIB Notices ......................................................................................... 18
IV.D) Producer Compensation Disclosure ...................................................................................................... 19
IV.E) Suitability/Best Interest Attestations ..................................................................................................... 19
V) Non-Paper Applications ................................................................................................................................ 20
V.A) Disclosures and Notices ........................................................................................................................ 20
V.B) Telephone Applications ........................................................................................................................ 20
V.C) Electronic Applications ......................................................................................................................... 22
VI) Testing....................................................................................................................................................... 24
VI.A) HIV Testing .......................................................................................................................................... 24
VI.B) Genetic Testing ..................................................................................................................................... 25
VII) Life Settlement Issues ............................................................................................................................... 25
VII.A) Section 7812 permits the following to appear in life insurance applications: ...................................... 25
VII.B) Insurable Interest ................................................................................................................................... 25
New York State Department of Financial Services Individual Life Insurance Application Outline
(Version: 11/18/2021)
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Individual Life Insurance Application Outline
(Last Updated November 18, 2021)
This outline is current as of November 18, 2021. Subsequent changes to statutes, regulations, circular letters,
etc., may not be reflected in the outline. In case of any doubt, please contact the Life Bureau.
I) Scope
This product outline applies to all applications for individual life insurance policies delivered or issued for
delivery in New York. This Outline replaces the document entitled “Individual Life Insurance Application
Outline (Last Updated February 19, 2020)”.
An application is any form signed by an applicant that is used to obtain information from the applicant for
use in determining acceptance or rejection of the request for insurance or for determining premium class of
the proposed insured, regardless of whether the form is described as an application, a health/lifestyle
questionnaire, a preliminary application, a trial application, a preliminary inquiry, an agent’s preliminary
report, an informal inquiry, a request for information or something similar. Circular Letter No. 2 (1975). If
an insurer has any doubt about whether a particular form constitutes an application, the insurer should
contact the Department.
II) Filing Process
II.A) General Information
A.1) Prior Approval Requirement
(a) Section 3201(b)(1) provides that no policy form shall be delivered or issued for delivery
in this state unless it has been filed with and approved by the superintendent as
conforming to the requirements of the Insurance Law (standard and generally applicable
provisions) and not inconsistent with law (federal and state statutory, regulatory and
decisional law).
(b) Section 3201(a) provides that "policy form" means any policy, contract, certificate, or
evidence of insurance and any application therefor, or rider or endorsement thereto,
affording benefits of the kinds of insurance specified in section 1113(a)(1), (2), (3), or
(24). Note that a document that has the effect of amending the terms, provisions or
benefits of a policy, contract or certificate constitutes a policy form and must be
submitted for approval.
A.2) Discretionary Authority for Disapproval
Sections 3201(c)(1) and (2) permit the superintendent to disapprove any policy form that
contains provisions that are misleading, unfair, unjust, or inequitable or if its issuance would be
prejudicial to the interests of policyholders or members. See also Sections 2123 and 4224.
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A.3) No filing fee required.
A.4) Filings Must Be Submitted Through State Electronic Rate and Forms Filing system
(“SERFF”)
(a) Effective May 25, 2020, 11 NYCRR 6 (Insurance Regulation 195) will require that
policy form, rate, and compensation filings must be submitted through SERFF. As of
May 25, 2020, the Department will no longer accept paper filings or filings made in any
manner other than SERFF, except where an exemption has been granted for a specific
submission pursuant to section 6.3 of Regulation 195.
(b) For general guidelines regarding SERFF submissions, please see the guidance for SERFF
filings available on the Department’s website at
https://www.dfs.ny.gov/apps_and_licensing/life_insurers/general_serff_guidelines_for_f
orm_filings.
(c) Exemption from SERFF Submission Requirement
An insurer that is required to make a submission using SERFF pursuant to Regulation
195 may apply for an exemption from the requirement that a particular filing be made
electronically by submitting a written request that complies with the requirements set
forth in Section 6.3 of Regulation 195. Guidance on requesting an exemption may be
found on the Department’s website at https://www.dfs.ny.gov/apps_and_licensing/life
_insurers/reg195_filing_guidance.
II.B) Types of Filings
B.1) Prior Approval
Application forms submitted under Section 3201(b)(1) of the Insurance Law are subject to the
submission rules noted herein, especially Circular Letter Nos. 6 (1963) and 14 (1997).
B.2) Alternative Approval Procedure
(a) Section 3201(b)(6) and Circular Letter No. 2 (1998) provide for an expedited approval
procedure designed to prevent delays by deeming forms to be approved or denied if the
Department or insurer fails to act in a timely manner.
(b) Circular Letter No. 2 (1998) provides that the certification of compliance should make
reference to any law or regulation that specifically applies or is unique to the type of
policy form submitted. An alternative would be to submit a certification of compliance
with the applicable laws and regulations cited in this Outline. A statement that the filing
is in compliance with all applicable laws and regulations is not acceptable.
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B.3) Prior Approval with Certification Procedure
(a) Circular Letter No. 6 (2004) provides for an expedited approval procedure based on an
appropriate certification of compliance signed by an officer of the insurer in the format
provided by Circular Letter No. 6 (2004). Certifications that have altered or otherwise
modified the language of the certification will not be accepted.
(b) The original signed certification must be provided. The form number of each form and
the memorandum of variable material for each form must be listed in the body of the
certification, rather than in an attached list. For a certification pertaining to a large
number of forms, the list may begin in the body of the certification and continue in list
form on the second page.
(c) The SERFF Filing Description must comply with applicable circular letter and Outline
guidance.
(d) Substitution filings/follow-up correspondence with post-approval form changes requested
prior to initial issuance of forms will not be permitted for Circular Letter No. 6 (2004)
filings.
B.4) Filing of Non-English Versions of Forms
(a) The English version of the form must be approved before the non-English version can be
approved. The SERFF Filing Description must identify, by form number, date of
approval and Department file number, the previously approved form that is being
translated into a non-English version.
(b) The non-English version must have a different form number to distinguish it from the
English version (e.g., the Spanish version of form App-123 could be App-123-S).
(c) An original certification by a translator must be provided indicating that the text of the
form is an accurate and complete translation of the English version of the form. The
certification must reference the specific form numbers of both the English and non-
English forms and must reference the memorandum of variable material. The certification
should not use qualifying language such as “to the best of my knowledge and belief.”
(d) An original certification by an officer of the insurer must be provided indicating that the
officer has exercised due diligence in choosing a competent translator or translation
service. The certification must reference the specific form numbers of both the English
and non-English forms. The certification must state that the underlying English language
policy form achieves a minimum Flesch score of 45 in accordance with Section
3102(c)(1)(D). Section 3102(b)(H)(3).
(e) If the approval of the English version of the form was subject to any conditions or
limitations, then the non-English language version of the form will be subject to the same
conditions or limitations.
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(f) If the non-English version of the form contains variable material, a memorandum of
variable material must be provided. The exact language of any non-English alternate text
must be set forth.
II.C) Preparation of Forms
C.1) Form Numbers
Form numbers must appear in the lower left corner of the first page of the application. Section
I.D of Circular Letter No. 6 (1963). The lower left corner of the subsequent pages of the
application should either contain the same form number as the first page or should be left blank.
The subsequent pages should not contain form numbers that differ from the form number on the
first page.
C.2) Hypothetical Data
Completion of the application form with hypothetical data is not required. Section I.E.1 of
Circular Letter No. 6 (1963).
C.3) Numbering Variable Material
If variable material within the policy form is numbered to identify the corresponding entry in
the memorandum of variability (Department recommends this as a best practice), this numbered
version of the policy form should be attached as the policy form under the Form Schedule in
SERFF. The insurer does not need to submit a separate “clean” copy of the application with the
numbers removed. If an insurer elects to include a “clean” version in the submission, it should
be included under the Supporting Documentation tab in SERFF.
C.4) Final Format
Application forms submitted for approval should be submitted in the form intended for actual
issue. Section I.F.1 of Circular Letter No. 6 (1963). Revisions to font style, paper, weight and
ink color are permitted provided that the forms continue to comply with all applicable laws,
including but not limited to Sections 3102 and 3201(c)(4).
An insurer may not reserve the right to make additional revisions outside of those specifically
listed above.
C.5) Regulation 152
The insurer must retain information in its records concerning which approved application is
being used or has been used with each policy form and the type of underwriting utilized. Such
information must be available upon Department request. See Regulation 152.
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C.6) Submissions Made on Behalf of the Insurer
If the filing is made on behalf of the insurer by another party, the “SERFF Filing Company”
field must identify the name of the insurer on whose behalf the filing is being made and a letter
authorizing the third party to act on behalf of the insurer must be provided. The letter must be:
(a) on insurer letterhead or include the insurer name in the subject line of the letter;
(b) specifically addressed to the New York State Department of Financial Services;
(c) properly executed by an authorized officer of the insurer;
(d) dated; and
(e) either
(i) specific to the file submitted for approval by including form number(s); or
(ii) generally applicable to all policy forms filed on behalf of the insurer as long as
copy of such authorization is included in each submission.
It is the insurer’s responsibility to ensure that their authorizations are accurate and reflect their
current relationship with the third party filer.
C.7) Circular Letter No. 14 (1997)
Filings which are incomplete or do not comply with laws and regulations will be returned. See
Circular Letter No. 14 (1997). Note that if an application does not comply with a specific
requirement of this Outline, or is considered substantively non-complying with applicable law,
then the file may be closed.
C.8) Circular Letter No. 8 (1999)
For SERFF submissions, the Form Schedule will replace the “RE” requirement of Circular
Letter No. 8 (1999). See Special Forms Schedule Handling of the General SERFF Guidelines
for Forms Filings.
II.D) SERFF Filing Description/Requested Filing Mode
All relevant information regarding the submission, including the specified information set forth
below, must be included in the SERFF Filing Description.
Note: References in this outline to Filing Description requirements are also applicable to submission
letters for non-SERFF filings made pursuant to an exemption, unless otherwise noted. For non-
SERFF filings, any information that would ordinarily be included in the Filing Description must be
included in a separate signed cover letter.
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D.1) Filing Basis
The first sentence of the SERFF Filing Description should identify the type of filing, such as
prior approval, Circular Letter No. 6 (2004) certified filing, etc., (see Filing Basis section of
the General SERFF Guidelines for Form Filings) and must be consistent with the Requested
Filing Mode in SERFF.
D.2) Compliance with Section I.G of Circular Letter No. 6 (1963)
(a) Identify form number of each form submitted.
(b) Indicate whether (1) the form is replacing a previously approved form (provide the form
number and date of approval); (2) the form will be issued in addition to other similar
forms (provide form numbers and dates of approval); or (3) the form is a new form unlike
any previously approved form.
(c) Provide the form numbers of the policy form or forms with which the submitted
application will be used. Provide the corresponding approval dates, Department file
numbers and a brief description of the type of products (e.g., whole life, universal life).
Please note these forms in particular must be approved by the Department and the above
information must be provided for each:
• Conditional receipts or temporary insurance agreements (Section IV.B),
• Statements of good health (Section IV.A),
• MIB and Fair Credit Reporting Act notices (Section IV.C),
Questionnaires used with the application, and
Forms used to amend the application
(d) Substitution
If an insurer wishes to replace a very recently approved policy form because of an error
found after approval, the insurer may request to make a substitution in the original file. A
substitution is available if the approved policy form has not been issued and the insurer is
only fixing a minor error. To request a substitution, the insurer should submit a Note to
Reviewer in SERFF in the original file in which the form was approved. The request
should confirm that the form has not been issued and identify the correction the insurer
wishes to make. If the reviewer determines that a substitution is appropriate, the reviewer
will reopen the SERFF file and the insurer will need to “amend” the SERFF file to
replace the previously approved policy form with the corrected form in the SERFF Form
Schedule. The insurer may, under these circumstances, use the same form number on the
corrected form.
If a substitution in the original file is not available (e.g., policy form was issued,
significant revisions being made, etc.) or the insurer does not wish to do a substitution,
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then the insurer would need to submit the new version of the policy form, with a new
form number, in a new filing.
Note: The substitution process is not available for policy forms approved under the
Circular Letter No. 6 (2004) procedure. Any change to a form previously approved under
the Circular Letter No. 6 (2004) procedure requires a separate new filing and new form
number.
(e) For paper submissions:
(i) Submit in duplicate. Section I.E.7 of Circular Letter No. 6 (1963).
(ii) The submission letter must be signed by a representative of the insurer authorized
to submit forms for filing or approval for the insurer.
D.3) Explanation of Unique Features and Markets
(a) Identify any special markets where the application will be used, including, but not limited
to, employer-employee payroll deduction, senior citizen, juvenile, military, mail-order,
COLI, BOLI, pre-need, and private placements. Advise whether the application will be
used for fully underwritten, simplified issue, or guaranteed issue products.
(b) State whether the application will be completed by telephone, on the internet, or by other
electronic means (e.g., agent’s laptop) or will employ telephonic voice signatures or
electronic signatures. If so, please see Sections II.E.4 and V of this Outline.
(c) If electronic signatures or telephonic voice signatures will be used, the insurer must
confirm compliance with New York’s Electronic Signatures and Records Act and the
federal Electronic Signatures in Global and National Commerce Act as well as Circular
Letter No. 33 (1999).
(d) If HIV testing or genetic testing will be required in conjunction with the application, this
must be stated in the SERFF Filing Description. See Section VI of this Outline.
(e) If payment is accepted at the time of application, provide the form number and approval
date of the conditional receipt or temporary insurance agreement that will be used in
conjunction with the application. If the conditional receipt or temporary insurance
agreement is pending approval, provide the Department file number.
(f) Fully explain any feature that has not been previously approved by the Department for
the insurer or is new to the marketplace in New York.
(g) When applicable, state whether the application will be used in a field issue or instant
issue situation.
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D.4) Extension of Approval
(a) If an insurer intends to use a form in a manner that was not originally approved, the
extension of approval must be submitted by the insurer in a new file. An extension of
approval is only available when there are no changes to the originally approved form.
(b) An extension of approval filing does not require a new form number.
(c) Use of a previously approved application in a non-paper format is considered an
extension of approval when there are no changes to the paper application, but an
electronic signature, including voice, is obtained, or when the application will be used in
a different electronic manner (e.g., changing from completion on an agent’s laptop
computer to use for internet sales). A submission seeking the extension of approval for
this purpose must address the information required at Section V as applicable.
(d) If an approved form is simply displayed and completed on a computer screen in an
agent’s presence, with no changes to the form, and a wet signature is obtained from the
applicant, no additional approval or filing is necessary.
D.5) Resubmissions
If the form has been previously submitted to the Department and the file was closed, any
resubmission of the form to the Department must reference the file number of the previously
closed file and address all outstanding issues in the new SERFF Filing Description. The
submission must be complete in and of itself and may not incorporate previously submitted
material by reference.
D.6) Noncompliance Explanation
If the application form does not comply with a specific provision of this Outline, the SERFF
Filing Description must identify the provision and provide a complete explanation of the
insurer’s position on the issue. Such submissions may not be submitted through the Circular
Letter 6 (2004) certified process unless the Department has given permission.
II.E) Attachments
E.1) Readability Certification
(a) Provide a Flesch score certification signed by an officer of the insurer in accordance with
Section 3102. The Flesch score must be at least 45. Please refer to the Department’s
February 18, 1982 letter, available on the Department’s website, for a sample
certification at https://www.dfs.ny.gov/apps and licensing/life insurers/guidance readab
ility_Feb_1982. All fields in the certification must be completed. Please note that the
Memorandum of Variable Material for each form must be listed separately in the Flesch
score certification. The certification should be attached under Supporting Documentation
in SERFF.
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(b) The application may be scored in conjunction with the policy to achieve a score of 45.
Section 3102(c)(5).
E.2) Variable Material
The submission must include a separate detailed memorandum of variability for any variable
material. The memorandum of variability is subject to approval, must comply with the filing
guidance on the Department’s website, and should be submitted under the Form Schedule in
SERFF.
E.3) Screen Shots
(a) If an insurer is seeking an extension of approval in accordance with section II.D.4 of this
outline, provide screen shots of the application process under Supporting Documentation
in SERFF. Include any pop-ups, drop downs, FAQs, or linked material that could appear
in the application process either within the screen shots or as a supporting document.
(b) If an insurer is seeking approval of an application not previously approved that will only
be available in an electronic format (i.e., automated online process available to the public
to self-apply for insurance) and there is no corresponding paper application, then screen
shots must be submitted for approval as the application form under the Form Schedule in
SERFF. In this case, the screen shots must contain a distinct form number in the lower
left corner in accordance with Section I.D. of the Department’s Circular Letter No. 6
(1963) and must comply with all applicable requirements of this Outline. Reflexive
material, including drop down options, must be submitted for approval in a corresponding
Memorandum of Variable Material. Include any FAQs, pop-ups, or linked material that
could appear in the application process under the Supporting Documentation tab in
SERFF.
E.4) Electronic/Telephonic Procedures
If the application is for use electronically (internet or on screen) or telephonically, then the
exact use must be described. General descriptions, such as use in “an electronic format,” are not
sufficient. The insurer’s procedure for collecting, transmitting, storing and protecting electronic
information must be provided. See Section V of this Outline.
II.F) Key References
F.1) Insurance Law: Sections 321, 403(d), 2611, 2612, 3201, 3203(a)(4), 3204, 3209, 3111, 3211,
4224, and Article 78.
F.2) Other New York Law: General Obligations Law § 5-701 and 15-301, Executive Law §
296(16), Public Health Law § 2782, General Business Law § 380-c, State Technology Law §
309.
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F.3) Regulations: Regulation 19 (11 NYCRR § 45), Regulation 60 (11 NYCRR § 51), Regulation
62 (11 NYCRR § 52), Regulation 74 (11 NYCRR § 53), Regulation 77 (11 NYCRR § 54),
Regulation 152 (11 NYCRR § 243), Regulation 169 (11 NYCRR § 420), Regulation 187 (11
NYCRR § 224), Regulation 195 (11 NYCRR § 6), Regulation 200 (11 NYCRR § 226).
F.4) Circular Letters: CL 4 (1963), CL 6 (1963), CL 2 (1975), CL 5 (1997), CL 14 (1997), CL 2
(1998), CL 8 (1999), CL 33 (1999), CL 2 (2001), CL6 (2004), CL 1 (2019).
F.5) Federal Law and Regulation: Internal Revenue Code Section 403(b), 15 U.S.C. §7001, 42
U.S.C. § 290dd-2(b), 45 C.F.R. § 164.508(a)(2) and (b)(3).
III) Individual Life Insurance Applications
III.A) Format
A.1) Insurer Name
(a) The name of the licensed New York insurer must appear on the top portion of the
application and be prominently displayed. The insurer’s name must be at least as
prominent as any marketing name or logo used on the application. See Section
3201(c)(1).
(b) If the application will be used for two or more affiliated licensed New York insurers, the
names of all licensed insurers may appear on the application form with a check box next
to each insurer’s name to designate the issuing insurer. The check box should appear on
each form making up the application. Note: Insurer names may not be variable.
(c) Marketing names, corporate logos, trademarks, or affiliations on an application may not
be used if they would have a tendency to mislead or deceive as to the true identity of the
insurer or create the impression that someone other than the insurer would have any
responsibility for the financial obligations under the policy. Section 3201(c)(1). A
marketing name may be used in the application form only if it appears in addition to a
generic description of the policy.
(d) No unlicensed insurer name can appear anywhere on the form. Section 3201(c)(1).
A.2) A form identification number (consisting of numerical digits, letters, or both) must appear in
the lower left corner in accordance with Section I.D of the Department’s Circular Letter No. 6
(1963).
A.3) A single application may not be used to apply for both individual life insurance products and
group life insurance products.
A.4) The use of bar codes is permitted provided that the bar code does not appear in the body of the
form or in the lower left corner of the form.
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III.B) Questions Personal/Health
B.1) Questions must comply with Section V of Circular Letter No. 4 (1963).
B.2) The phrase “to the best of your knowledge and belief” must qualify questions requiring
applicant’s opinion regarding the past or present health of the applicant or any person
proposed for coverage. Section V.B.2 of Circular Letter No. 4 (1963).
B.3) If the applicant is requested to provide additional details about a question relating to the health
of the proposed insured, there must be language stating that an additional sheet of paper may
be attached if necessary.
B.4) If an application has questions or provides testing to determine an applicant’s cognition, an
insurer must be prepared to demonstrate how each such test or question produces a clear,
consistent and specific basis for refusal, limitation, or rate differential based on mortality
risks. Section 4224.
B.5) Questions concerning an applicant’s past lawful travel history are prohibited. Section 2614.
B.6) An insurer may inquire about a past conviction or a pending legal matter, but may not ask
about a past arrest, plea, or imprisonment. See Executive Law § 296(16).
B.7) See Section VII of this Outline for guidance relating to an applicant’s source of financing the
premiums for the applied for policy.
B.8) Questions pertaining to AIDS/HIV
(a) Any question pertaining to past or future testing (blood or diagnostic) must specifically
exclude HIV tests. Section 3201.
(b) The application may not ask if the applicant has tested positive for HIV. Section 3201.
(c) Questions about AIDS or HIV infections are permissible only if phrased to ask if the
applicant has ever been diagnosed or treated for AIDS and/or HIV infection by a licensed
member of the medical profession. Section 3201.
B.9) Prior to a policy’s issuance, the insurer must request the information necessary to ensure that
all benefits will be distributed to the beneficiary upon the death of the insured, including, at a
minimum, the name, address, social security number, and telephone number of every owner,
insured, and beneficiary of the policy applied for. Section 226.4 (a) of Regulation 200. The
application may contain this information.
B.10) The application may contain a question to determine if premium due notices are to be mailed
to a person other than the policyowner and if so the name and address of the person so
designated. Section 3211(b)(1).
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B.11) For reinstatement applications, evidence of insurability should be comparable to the original
application. Sections 3201(c)(2) and 3203(a)(10).
III.C) Application Statements Regarding the Insurance Product
C.1) Questions and election of features must not be phrased to require the negative consent of the
applicant.
C.2) Questions about replacement of existing insurance policies in accordance with Regulation 60
must inquire about applicant’s intent to replace an existing policy.
C.3) All currently available plans of insurance must be set forth on the application or in the
corresponding Memorandum of Variable Material (for example: 10-year term, 15-year term,
20-year pay whole life, etc.). Section 3201.
C.4) The application may not make any references to policy forms that have not been approved
(including riders).
Note: If a policy form is submitted for approval with an application and is approved at the
time the application is approved, then the policy form is considered an approved form that
may appear on the application.
C.5) Only available riders may appear on the application. A rider is not available if it has not yet
been approved. It is permissible to provide a space to write in the rider(s) selected by the
applicant; however, all possible choices of riders must appear on the memorandum of variable
material.
Note: If a rider is submitted for approval with an application and is approved at the time the
application is approved, then the rider is considered an approved rider that may appear on the
application.
C.6) A question regarding an automatic premium loan must be asked with a “yes” or “no” response
or an affirmative election to choose the automatic premium loan feature. An automatic
premium loan may not be a default option.
C.7) Questions pertaining to the use of dividends for participating policies must set forth all
available options for selection by the applicant. Section 4231.
C.8) If a policy offers a choice between a fixed interest rate and an adjustable loan interest rate, the
choice must be provided on the application. Section 3201.
C.9) If the application/policy change form will be used to apply for, increase or add coverage for
minors, include a question regarding the amount of insurance in force on the minor and the
amount in force on the applicant to ensure compliance with the monetary limitations of
Section 3207.
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C.10) Riders
(a) New Issues
If there is no separate premium charge or cost of insurance charge for attachment of a
rider to a policy, then the rider must be made available to all new issues of the policy or
automatically attached at issue of the policy, if eligibility requirements are met. If the
rider is not automatically attached to the policy, the rider must be listed in the application
as available for election and there should be disclosure provided to the applicant
indicating there is no charge for the rider. The written disclosure may appear on the
application form or may be separately provided to the applicant.
(b) In Force Business
(i) If there is no separate premium charge or cost of insurance charge for attachment of
a rider to a policy, then the rider must be made available to all existing policy
owners of that policy form, if eligibility requirements are met. If no underwriting is
required, the insurer must either automatically send the rider to all existing policy
owners of that policy form or provide written notification of the availability of the
rider, including disclosure that there is no charge for the rider, to all existing policy
owners of that policy form. If additional underwriting is required for a rider, then
written disclosure of the availability of the rider, including disclosure that there is
no charge for the rider, should be sent to all existing policy owners of that policy
form.
(ii) If there is a separate premium charge or cost of insurance charge for a rider, the
rider may be offered to all existing policy owners by written notification, including
disclosure of the charge for the rider. Written acceptance by the policy owner is
required for all riders that have a separate charge or cost of insurance charge.
(iii) Exclusion and limitation riders such as aviation limitation riders, military and naval
limitation riders, and special hazard exclusion riders are not subject to Section
III.C.10.
III.D) Disclosure Requirements
D.1) If a follow-up telephone call in conjunction with the application may occur, the application
must so state.
D.2) War Exclusion
If the product applied for includes an exclusion from coverage in the event of war, the
exclusion must be disclosed in the application. Regulation 19.
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D.3) Accelerated Death Benefit
If the product applied for includes an accelerated death benefit, the application must include
the disclosures required by Section 3230(a) and Regulation 143. See the Accelerated
Payment of Death Benefit Outline for additional guidance on requirements for accelerated
death benefits.
D.4) Waiver of Specified Premium
If a flexible premium product applied for includes a waiver of specified premium in the event
of disability, notice must be provided with or in the application that the policy may lapse
despite this benefit. If the notice is separately provided at the time of application, it must be
submitted for approval as a separate form.
D.5) Indeterminate Premium
An application for a policy with an indeterminate premium must include language to the
effect that the initial or current premiums may change and the maximum guaranteed
premiums can be charged. If the language does not appear in the application, a separate signed
notice can be used. The notice must be submitted for approval. Section 3201(c)(2).
D.6) Endowment
If an endowment policy does not qualify as life insurance under the Internal Revenue Code
the following language should appear directly above the signature line in bold print:
IMPORTANT: The increase in cash value of this endowment policy will eventually
create annual taxable income for the policy owner.
D.7) Graded Death Benefit Life Insurance
Applications for insurance with a graded death benefit issued between ages 50 and 75 must
have a prominent notice on or with the application containing the following or substantially
similar language approved by the superintendent:
Since this policy is issued with minimal or no medical underwriting, the premium rate
charged includes an extra mortality risk charge. If you are healthy enough to qualify
as a “standard” risk, premiums would likely have been lower if you had applied for a
fully underwritten policy.
This notice may be included as part of a sales illustration summary if the summary is used in
place of preliminary information. Sections 53-2.3(a)(1) and (2) of Regulation 74.
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D.8) Universal Life
(a) The initial premium amount and the planned premium amount must appear on the
application. Section 3201.
(b) The available death benefit options must be set forth on the application. Section 3201.
(c) If the applicant may choose between the guideline premium test and the cash value
accumulation test, the options must be set forth on the application. Section 3201.
D.9) Variable Life
(a) The following prominent statements must appear on the application for variable products
as applicable:
(i) The amount or duration of the death benefit may vary under specified conditions.
(ii) Policy values may increase or decrease in accordance with the experience of the
separate account.
(iii) In the case of a variable endowment policy, the amount of the endowment payable
at maturity is not guaranteed but is dependent upon the cash surrender value
(subject to any specified minimum guarantees).
(iv) A notice must appear in the application that the following are available upon
request: Illustrations of benefits, including death benefits, policy values and cash
surrender values. Such illustrations shall be in a form and content acceptable to the
superintendent.
Section 54.10 of Regulation 77.
(v) In the case of a private placement variable life policy, a prominent statement that
due to the illiquid nature of the investment options, the payment of the death
benefit, the cash surrender value, policy loans, partial withdrawals or partial
surrenders, as applicable, may be delayed. The statement shall advise the applicant
to refer to the policy for further details on any delay of payments.
Section 54.10(d) of Regulation 77.
(b) Investment options/list of funds
(i) The investment options of a separate account initially listed in the application or
application supplement are subject to approval. Investment options may be
variable. The SERFF Filing Description must state whether or not the plan of
operation has been approved or, if awaiting approval, the date filed. If the plan of
operation is not yet approved, the Filing Description must state that the investment
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options will not be implemented until the plan of operation has been approved by
the New York City office of the Life Bureau.
(ii) Any change in the investment options must be filed for informational purposes.
This filing must be made no later than 60 days after the amended plan of operation
for the separate account. Section 3201(b)(7)(A). A plan of operation must be
approved before filing a fund change only submission. See filing guidance on
Department’s website.
(c) To avoid misleading disclosure, both the initial premium amount and the planned
premium amount need to be set forth in the application. Section 3201(c)(1).
III.E) Authorizations/Agreements
E.1) The application may not include fraud statements or warnings unless the application is also
used to apply for accident and/or health insurance in which case the fraud statement or
warning must specifically state that it does not apply to the life insurance portion of the
application (or that it only applies to the accident and/or health portion of the application).
Section 403(d). Such fraud statements or warnings may also appear if the application is used
in states in addition to New York as long as the statement or warning specifically states that it
does not apply to applicants in New York.
E.2) If the release of mental health records is sought, the authorization should specifically exclude
psychotherapy notes from the release. Such notes may only be released by a separate specific
authorization. See 45 CFR § 164.508(a)(2) and (b)(3).
E.3) The authorization may include authorization for release of substance abuse diagnosis and
treatment records if the language pertaining to the release of the substance abuse diagnosis
and treatment records complies with 42 U.S.C. § 290dd-2 and 42 C.F.R. § 2.31. See Circular
Letter No. 8 (2017).
E.4) The authorization must include the additional authorization required by Section 380-c(a)(2) of
the New York General Business Law if an investigative consumer report is required as part of
the application process.
E.5) An authorization for the release of medical records must specify a length of time, no longer
than 24 months, for which the authorization shall remain valid. The authorization must also
state that it may be revoked at any time and must state the procedure for making a revocation.
Sections 420.18(a)(5) and (b) of Regulation 169.
E.6) Reference to the insurer’s liability in the event of disagreement is not permitted.
E.7) The signature of any proposed insured over the age of majority is required if the release of
medical records, personal information or authorization of an investigative consumer report is
sought.
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E.8) All statements made by, or by the authority of, the applicant for the issuance, reinstatement or
renewal of a life insurance policy are deemed representations and not warranties. Section
3204(c).
E.9) The application may not contain a statement regarding the health of the proposed insured
between the time the application is signed and the time the policy is delivered unless a
statement of good health is provided at the time of policy delivery. See Section IV.A of this
Outline.
E.10) The application must be signed by any proposed insured over the age of 14 ½ unless
specifically excepted by Section 3205(c).
E.11) Any certification with respect to the Taxpayer Identification Number (TIN) and backup
withholding must be clearly stated. If there is a separate signature line just for the certification
then the requirement that the certification be clearly stated is satisfied. If a single signature
line is used for the certification and other provisions in the application, then the certification
must be highlighted, boxed, printed in bold-face type, or presented in some other manner that
causes the language to stand out from all other information contained on the application.
Section 3201(c)(1). See also IRS Instructions for Substitute Form W-9.
E.12) Any authorizations, certifications, or acknowledgments by the applicant must be in
compliance with Circular Letter No. 1 (2019).
III.F) Entire Contract
F.1) If a copy of the application will be attached to the policy when it is issued, there must be
language in the application to the effect that the application is to be attached to and made part
of the policy. Sections 3203(a)(4) and 3204. Information provided by an applicant in the
application cannot be used to contest the policy unless the application is attached at issue.
F.2) No changes or corrections may be made to a signed application except administrative
insertions may be made by the insurer only in such manner as to indicate clearly that the
insertions are not to be subscribed to the applicant. Section 3204(d). Any other changes must
be made using a signed application supplement or application change form that has been
approved by the Department.
IV) Attachments/Ancillary Forms
IV.A) Statement of Good Health
If the applicant is required to report changes in the health of the proposed insured between the date of
application and policy delivery, or to certify to the health of the proposed insured at the time of policy
delivery, the insurer must provide a statement of good health at the time of delivery. The statement of
good health form must be submitted for approval. The following requirements apply:
A.1) The statement must be made to the best of applicant’s knowledge and belief.
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A.2) The statement of good health must be signed by the applicant.
A.3) A statement of good health may not be used when a conditional receipt has been issued.
IV.B) Conditional Receipts/Temporary Insurance Agreements
B.1) If payment is accepted with an application that requires evidence of insurability, the insurer
must issue a conditional receipt or temporary insurance agreement (“TIA”) to the applicant.
B.2) A conditional receipt must comply with Section VI of Circular Letter No. 4 (1963). See
Circular Letter No. 3 (1969).
B.3) Although only required for health insurance products, guidance for TIAs may be found at
Regulation 62 (11 NYCRR § 52.53).
B.4) An insurer may only require a maximum of two medical exams at the time of application
when a conditional receipt or TIA is issued.
B.5) No conditional receipt or TIA is required for mail order situations.
B.6) The conditional receipt will provide for coverage subject to a monetary limit specified in the
receipt, contingent upon insurability as a condition precedent. The monetary limit may not
consider any insurance coverage already in force, but may refer to pending applications.
B.7) If a conditional receipt is used with an application the insurer may not use a statement of good
health, and there may not be a statement on the application certifying to the applicant’s health
at the time of policy delivery or requiring that the applicant report changes in health after
application and before policy delivery.
B.8) If payment is accepted with an application that requires evidence of insurability for a joint life
survivorship policy and the insurer issues a conditional receipt, the conditional receipt must
provide coverage for the surviving insured in the event that one of the proposed insureds dies
during the period that the conditional receipt is in effect. If the first-to-die had completed the
initial application requirements and was found to be insurable, the insurer must offer the
survivorship policy to the surviving insured if that insured was also found to be insurable. If
the first-to-die died prior to completing the underwriting requirements or was found to be
uninsurable, then the insurer may refund the premium paid and decline to issue the policy.
IV.C) Fair Credit Reporting Act and MIB Notices
If an insurer utilizes MIB, Inc, (formerly known as the Medical Information Bureau) or conducts an
investigation pursuant to the Fair Credit Reporting Act (“FCRA”) in connection with an application
for insurance, statutory notices must be provided to the applicant at the time of application. Any
affirmation signed by the applicant must prominently note that the applicant has read and received a
copy of the notices.
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C.1) The Fair Credit Reporting Act notice must include the language required by Section 380-c (b)
of the New York General Business Law.
C.2) MIB Notices
(a) The MIB notice must include the language required by Section 321 of the New York
Insurance Law, as well as the language set forth in MIB General Rule C.3.
(b) The MIB’s toll free telephone number must appear on the notice form effective
December 1, 2004.
(c) The address to which consumers may write to request copies of their MIB file must be set
forth in the Notice as 50 Braintree Hill Park, Suite 400, Braintree, MA. 02184-8734.
(d) The MIB, Inc. requests that the authorization forms include the language “I authorize
XYZ insurance companies or its reinsurers to make a brief report of my personal health
information (or protected health information for member companies that are HIPAA
covered entities) to MIB, Inc.(or “MIB” or Medical Information Bureau” for insurers that
have not updated their forms to reflect MIB, Inc.).
C.3) Detachable FCRA and MIB notices require separate and distinct form numbers from the
application form and must be submitted for approval.
IV.D) Producer Compensation Disclosure
If the disclosure required to be provided at or prior to the time of application by Section 30.3 of
Regulation 194 is included in the application form, the following language is acceptable:
The agent represents Blank Insurance Company in connection with the placement of
insurance policies and services provided on behalf of Blank Insurance Company. For selling
insurance policies, the agent will receive compensation from Blank Insurance Company based
in whole or in part on the insurance contract the agent sells. This compensation may vary
depending on a number of factors, including the type and amount of the insurance contract
and the overall volume of business placed by the agent. The applicant may obtain information
about the compensation expected to be received based in whole or in part on the sale of this
policy or others shown, by requesting such information from the agent.
IV.E) Suitability/Best Interest Attestations
Producer attestations regarding Suitability/Best Interest in connection with Regulation 187 may be
included in the producer section of applications. However, the application may not require the
consumer to attest to Suitability/Best Interest.
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V) Non-Paper Applications
V.A) Disclosures and Notices
The disclosures required by Section 3209, Regulation 74 and Regulation 60 as well as FCRA and
MIB notices must be provided to all applicants at or prior to the time of application. Insurers must be
able to demonstrate how they meet these requirements upon request.
A.1) The insurer must be able to show that the applicant agreed to receive disclosures in the
manner chosen or that the applicant acknowledged receipt of the material. All procedures
used by the insurer must be auditable.
A.2) If a wet signature is used, then disclosures and notices may be provided in paper format along
with the application at the time of signature.
A.3) If an electronic or voice signature is used, this information may be provided as follows:
(a) During the interview via email or online; or
(b) Halting the interview while information is provided via regular mail, facsimile or email.
A.4) A completed “Definition of Replacement” form must be signed by the applicant and obtained
with or as part of each application. Section 51.5 of Regulation 60. Even if a policy will not be
issued in replacement situations, this document is required and must be signed by the
applicant. The insurer must advise the New York City office of the Life Bureau when notices
are provided in a non-paper format.
V.B) Telephone Applications
B.1) Procedures
If a telephone interview is used in the application process, the submission must include a
detailed description of the process. The description must be attached as a standalone
Supporting Document in SERFF. The description must include the following:
(a) Whether the telephone interview will be conducted by a licensed agent. Any questions
involving the type and amount of insurance must be asked by an agent licensed in New
York. Follow-up questions or questions in a “Part B” consisting of only medical
questions need not be asked by a New York licensee.
(b) The criteria used to determine which, if not all, applicants receive a telephone interview
in conjunction with a written application and confirmation that such criteria and the
questions asked of each applicant are non-discriminatory in accordance with Section
4224.
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(c) Whether or not the applicant’s responses obtained in the telephone interview will be
made part of the application and used to contest the policy.
(d) Whether or not a script is used during the telephone interview. See Section V.B.4 of this
Outline for requirements if a script is used.
(e) Confirmation that any questions asked during a telephone interview that do not appear on
a signed application form will not be used to contest the policy.
(f) Confirmation that if questions other than those that appear on the application form are
asked during the telephone interview process and coverage is denied or rated other than
as applied for due to those responses, that the applicant will be provided with a copy of
the questions asked and the responses provided and the opportunity to correct.
(g) Advise how questions asked and responses to the telephone interview are maintained by
the insurer (i.e., recorded or otherwise). See Regulation 152 at 11 NYCRR 243.2.
(h) The process by which the applicant is given an opportunity to review and revise answers
prior to signature.
(i) How and when the applicant’s signature is obtained on the completed application.
(j) Compliance confirmation with the record retention requirements of Regulation 152 at 11
NYCRR 243.2
B.2) All questions asked of the applicant in a telephone interview must be in compliance with all
applicable statutes, regulations and circular letters. Questions that would be prohibited on an
application may not be asked in the telephone interview, whether or not the responses become
a part of the application.
B.3) Scripts Used With Telephone Interviews
(a) When scripts are used to request information of an applicant on the telephone, and the
responses to the questions are not signed by the applicant and are not made a part of the
application form, the scripts need not be filed with the Department for approval. In this
case, information obtained from the applicant pursuant to the telephone script cannot be
used to contest coverage. Telephone scripts must be maintained by the insurer along with
the policy form identification numbers of each application that will be used in
conjunction with the script and must be available upon Department request. Insurers are
required to maintain all information necessary for reconstructing the underwriting of the
policy pursuant to Section 243.2(b)(1)(iv) of Regulation 152.
(b) If a script is not used, but an applicant is interviewed via telephone, the insurer must
nonetheless comply with the record retention requirements of Section 243.2(b)(1)(iv) of
Regulation 152.
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(c) When scripts are used that elicit information from an applicant which is made a part of
the application form, the scripts are subject to the Department’s prior approval and should
be attached under the Form Schedule in SERFF. The telephone script must have a
separate form identification number in the lower left hand corner. Such telephone scripts
when submitted for approval must be accompanied by a certification of compliance
signed by an officer of the insurer that to the best of the officer’s knowledge and belief
the telephone script complies with all applicable statutes, regulations and circular letters.
The Department will rely entirely on the certification of compliance for the approval of
the telephone script.
V.C) Electronic Applications
C.1) Types of Filings
(a) No Filing Required
No filing would be required where the application is printed out by the consumer in the
exact form of the approved paper application, the application is populated in paper, and a
wet signature is applied. The completed and signed paper application could then be
returned to the producer by fax, by scan and e-mail or by regular paper mail.
Similarly, no filing would be required where the previously approved paper application is
populated either by hand or electronically by the producer based on answers being
received from the applicant, then the completed application is converted to PDF and sent
to the applicant to be printed out and a wet signature applied. The completed and signed
paper application could then be returned to the producer by fax, by scan and e-mail or by
regular paper mail.
However, if the consumer interacts with an electronic process (other than just printing the
previously approved paper application), or applies electronic signatures, then a filing
would be needed. See Section V.C.1(b)(i) below.
(b) Extension of Approval Filing
If an insurer intends to use an electronic version of a previously approved or pending
paper application form, the insurer must submit a request for extension of approval (see
Section II.D.5 of this Outline) and provide screenshots of the application process as it
appears on screen (see Section II.E.3(a) of this Outline). The screenshots for an extension
of approval should be submitted under Supporting Documentation in SERFF. A new
form number is not required. Some examples of where an extension of approval would be
needed include where the application would be:
(i) populated electronically by an agent based on answers being received from an
applicant, and an electronic signature is obtained; or
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(ii) completed electronically by the applicant, and either signed electronically or
printed out and a wet signature is obtained; or
(iii) accessed and printed from the internet by the applicant, and a wet signature is
obtained;
(c) Policy Form Filing
If an insurer is seeking approval of a new electronic application, which does not have a
corresponding paper application or differs from any approved paper application and will
only be in an electronic format (i.e., automated online process available to the public to
self-apply for insurance), the insurer must submit the screen shots of the electronic
application as the form, with a distinct form number, under the Form Schedule in SERFF.
The screenshots, which are the policy form, must comply with all applicable
requirements of this Outline. See Section II.E.3(b) of this Outline.
C.2) For all electronic application submissions, include a separate document, attached as
supporting documentation, which describes the electronic application process in detail.
Information that should be included in this document includes the following:
(a) Describe in detail how the application is completed (i.e., the agent populates the
applicant’s answers on a computer; the applicant fills out the application on a computer;
the applicant receives an e-mail link to the application or accesses the application over
the internet; the applicant communicates with the agent by telephone and the agent fills in
the applicant’s answers, etc.)
(b) Describe the process by which the applicant is given an opportunity to review and revise
the answers prior to signature (i.e., the questions and answers are read back to the
applicant by the agent; the applicant has to click through review screens showing all the
questions and answers before proceeding to the signature, etc.)
(c) Describe how and when the applicant’s signature is obtained on the completed
application. Please also note the requirements of N.Y. State Technology Law § 309 that
the use of electronic signatures must be voluntary.
(d) For submissions that include an electronic application process in which no agent is
involved, and which can be used by an applicant to procure insurance upon another
person, please describe:
(i) how the insurer determines the existence of insurable interest;
(ii) how consent is obtained from the insured in the absence of an exception under N.Y.
Insurance Law Section 3205(c); and
(iii) how the insurer verifies the identity of the insured when the insured signs the
consent.
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C.3) For applications that are accessed, completed and/or submitted by an applicant to the insurer
via the internet, in addition to the information required for all electronic applications, include
the following information in the electronic process document:
(a) The process whereby the applicant accesses the insurer’s website. For example: the
webpage for the application is linked to a banner advertisement, the page comes up as a
result of a search, or the internet application is only provided to an applicant on request.
(b) Whether assistance is available to the applicant as the application is completed. If so,
describe in detail how assistance is accessed and who provides assistance. For example:
links to FAQs and explanations of terms, live chat, telephone help line.
(c) Whether any information is obtained in the application process that does not become part
of the application.
(d) Describe any questionnaires or other ancillary material that may be accessed on the
application website.
(e) How the internet application record is stored. See Regulation 152 at 11 NYCRR 243.2.
(f) Any other process involved in creating and maintaining electronic communications
relating to the applicant or application. For example, if the insurer creates a web based
‘account’ for information or documents pertaining to the application, how is it accessed?
VI) Testing
VI.A) HIV Testing
A.1) The insurer must create, follow and retain objective criteria that will be used to determine
which applicants are subject to testing. Section 4224.
A.2) The insurer must create, follow and retain written procedures to ensure the confidentiality of
HIV testing. Section 3201.
A.3) The insurer must create, follow and retain a consent form that is in compliance with Section
2611 of the Insurance Law.
A.4) Urine testing may be used to detect HIV antibodies for insurance underwriting purposes in
accordance with Circular Latter No. 2 (2001) if the requirements of Section 2611 of the
Insurance Law and Section 2782 of the Public Health Law are met.
A.5) Oral fluid testing may be used to detect HIV antibodies for insurance underwriting purposes
in accordance with circular Letter No. 5 (1997) if the requirements of Section 2611 of the
Insurance Law are met.
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VI.B) Genetic Testing
B.1) The insurer must create, follow and retain objective criteria to determine which applicants are
subject to testing. Section 4224.
B.2) The insurer must create, follow and retain written procedures to ensure confidentiality of
genetic testing.
B.3) The insurer must create, use and retain a consent form that is in compliance with Section
2615.
VII) Life Settlement Issues
VII.A) Section 7812 permits the following to appear in life insurance applications:
A.1) The insurer may inquire as to whether the proposed owner intends to pay premiums with the
assistance of financing from a lender that will use the policy as collateral to support the
financing. Section 7812(a).
A.2) The insurer may include the following notice to the applicant and the insured, or other notice
acceptable to the superintendent, on the application or as an amendment thereto: “If you enter
into a loan arrangement where the policy is used as collateral, and the policy changes
ownership at some point in the future in satisfaction of the loan, then the following may be
true: (1) a change of ownership may lead to a person unknown to you owning an interest in
the insured’s life; (2) a change of ownership may limit your ability to purchase insurance in
the future on the insured’s life because there is a limit on how much coverage insurers will
issue on one life; (3) if ownership of the life insurance policy changes, and you wish to obtain
more insurance coverage on the insured’s life in the future, the insured’s higher issue age, a
change in health status, and/or other factors may reduce the ability to obtain coverage and/or
may result in significantly higher premiums; and (4) you should consult a professional
advisor, since a change in ownership in satisfaction of the loan may result in tax consequences
to the owner.” Section 7812(b).
VII.B) Insurable Interest
Life insurance applications may also include questions to ascertain whether or not an insurable
interest exists at the time of policy issuance as required by Sections 3205 and 7815. The
following are examples of application questions that are generally permissible:
B.1) Whether the proposed insured or policyowner has entered or has made plans to enter into a
non-recourse or other type of premium financing agreement or arrangement in conjunction
with the policy being applied for.
B.2) Whether the proposed insured or the policyowner has entered or has made plans to enter into
a contract, agreement or arrangement to sell, transfer or assign the ownership of or a
beneficial interest in the policy being applied for to an unrelated third party.
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B.3) Whether the proposed insured or the policyowner has obtained or has made plans to obtain a
loan secured by the life insurance policy being applied for as collateral.
B.4) Whether the proposed insured or the policyowner was offered “free insurance” in connection
with the policy being applied for.
B.5) Whether the proposed insured or the policyowner is applying for this policy as a result of a
solicitation to obtain life insurance for the purpose of selling or assigning the policy.
B.6) Whether any financing arrangement or pending financing arrangement grants a creditor,
investor, lender or other person an interest in the death benefit of the policy that is greater
than the amount loaned plus applicable interest and charges.
B.7) Whether there are existing life insurance policies on the life of the proposed insured and the
amount(s) of any such policies.
B.8) Whether the proposed insured or policyowner has sold, transferred, assigned or settled any
life insurance policy or beneficial interest in a life insurance policy.
B.9) Whether the proposed insured or policyowner was offered, has received or plans to receive
any inducement, money or other consideration in connection with the life insurance
application.
B.10) Whether the proposed insured or policyowner has ever received any inducement, fee or
compensation in connection with the application for or purchase, sale, transfer or assignment
of a life insurance policy or a beneficial interest in a life insurance policy.
B.11) Whether the life insurance premiums for the policy being applied for will be paid by any
individual or entity other than the proposed insured or policyowner, his or her employer or
immediate family members.
B.12) Whether the beneficiary has an insurable interest in the proposed insured.