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General Health Insurance Filing Instructions

All insurers are encouraged to set their SERFF configuration to accept state generated messages from New York to receive notification of changes that affect filings.

Health Insurance Checklists, Model Language & Guidance

(comprehensive medical, accident, long term care, disability & specified disease)

New York State of Health (NYSOH) Coverage

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Rate Adjustment Filings - Instructions, Exhibits and Checklists

2015 Prior Approval NYSOH & Outside NYSOH

2014 NYSOH & Outside the NYSOH Checklists and Exhibits

Prior Approval Checklist and Exhibits

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Health Insurance Laws, Regulations, Circular Letters, Mandated & Make Available Benefits

  • Mandated & Make Available Benefits (Commercial, HMO & Article 43 Insurance Contracts) Listings | Listings (PDF)
  • Required Immunizations
  • Definition of Infertility
  • Emergency Services Procedure Codes Exempt from Independent Dispute Resolution    

    Article 6 of the Financial Services Law, effective March 31, 2015, establishes a dispute resolution process for emergency services.  The dispute resolution process does not apply to emergency services billed under American Medical Association current procedural terminology (CPT) codes 99281–99285, 99288, 99291–99292, 99217– 99220, 99224–99226, and 99234 –99236 when the following criteria are met:

    1. The amount billed for the CPT code does not exceed 120% of the usual and customary cost for the CPT code; and
    2. The amount billed is $613.50 or less after any applicable coinsurance, copayment and deductible.

    In no event shall an amount exceeding $1,200 for a specific CPT code billed be exempt from the dispute resolution process.

Updated 12/31/2014

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