Recently, the New York Department of Financial Services (“NYDFS”) has taken a stricter examination of the minimum loss ratio standards for premiums. These standards require a reasonable premium relative to the claims paid under a policy. Failing to meet the minimum standards exposes insurance companies to heavy fines and penalties.
The NYDFS sets forth the required loss ratio for blanket and group health insurance in N.Y. Comp. Codes R. & Regs. tit. 11, § 52.45(f), which states that the minimum loss ratio for group insurance is 65 percent. Among other exceptions, for groups of less than 50 persons at inception, the minimum loss ratio is 60 percent.
The NYDFS monitors insurers’ rates and loss ratio through periodic examinations of each domestic insurance company and reports conducted by other jurisdictions on all foreign insurers. Additionally, the NYDFS may conduct their own examination into any foreign insurer licensed in New York. If these investigations display any deviation from these standards, the NYDFS may impose a civil penalty in addition to any refund to policyholders.
For any questions regarding the loss ratio standards of New York or any other jurisdiction, please contact Westmont Associates, Inc.
Westmont Associates, Inc. tracks developments affecting the insurance industry, in addition to our other services. If you have any questions, please contact us.