State RegulationsNY specificDifficulty 1/5
A New York group accident and health policy includes a coordination of benefits provision. Under Reg 62, this provision applies when the insured is covered by more than one health plan, and its purpose is to:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under Reg 62 (11 NYCRR Part 52 (Reg 62)), when a person is covered under more than one group accident and health plan, the coordination of benefits provision determines which plan pays first and which pays second, so that the combined payments of all plans never exceed the total allowable covered expense. The provision prevents a person from profiting through duplicate recovery while still ensuring that legitimate unpaid balances are covered.
Why the other options are wrong
- A) Collecting full duplicate benefits from every plan is precisely what coordination of benefits forbids; the plans share the claim rather than each paying it in full.
- B) Conversion to an individual policy is a separate statutory privilege exercised when group coverage ends; it is not the function of a coordination of benefits provision.
- D) Reg 62 coordinates the order and amount of claim payments; it does not extend claims filing deadlines for secondary insurers.
Memory hook
COB coordinates, never duplicates: the plans share the bill without ever overpaying it.