Sec. 52.41. Gross premium differentials based on sex

(a) The following requirements are established to limit maximum gross premium differentials between males and females for all accident and health policies or coverages where the insurance premium is paid by the insured:

(1) Net or gross premium assumptions may differentiate between the sexes only for factors based on differences in morbidity or mortality between males and females.

(2) Lapse and average size assumptions may not differ between males and females unless the insurer demonstrates to the satisfaction of the superintendent that the difference has a relationship to the morbidity or mortality assumptions such that the resulting rates are not unfairly discriminatory.

(b) Net premium differentials shall be determined on one or more of the following bases:

(1) a statistical analysis of the company's own experience, if credible;

(2) published credible experience, such as the morbidity studies of the Society of Actuaries and the studies made by the New York Department of Financial Services or the former New York State Insurance Department;

(3) any other valid data; or

(4) any combination of paragraph (1), (2) or (3) of this subdivision.

(c) Gross premium differentials between sexes in the same premium cell may reflect only the net premium differentials and those expenses which are directly related to the amount of premiums or claims (e.g., premium taxes, commissions, some claims administration expense). All other loadings for expenses shall be in the same amounts in dollars for both sexes. A company may utilize a simplified loading system if it can demonstrate that such system does not produce gross premium differentials which are generally greater than those generated by the method prescribed in this section, nor appreciably greater for any cell in the premium scale.

(d) Unisex rates are approvable for individual accident and health insurance if all rates for such individual insurance coverages offered by the company are charged on a unisex basis, unless the insurer demonstrates to the satisfaction of the superintendent that use of unisex rates for only some coverages is not unfairly discriminatory. This limitation does not apply to group, blanket or franchise insurance.