State RegulationsNY specificDifficulty 1/5
What is the primary purpose of the coordination of benefits provision that New York requires in group health plans under Reg 62?
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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), the coordination of benefits provision limits what two or more group health plans covering the same person pay in combination, so that total benefits do not exceed the covered expenses actually incurred. The provision designates which plan is primary and which is secondary, preserving insurance for catastrophic loss while eliminating double recovery. Without it, insureds could profit from claims, which would fuel overinsurance and higher premiums for everyone.
Why the other options are wrong
- A) Guaranteeing full payment from every plan is the opposite of coordination; the provision exists to stop duplicate recovery.
- B) Coordination addresses the order and amount of benefit payments, not the routing of claims according to premium levels.
- D) Converting group coverage to individual coverage on termination is the conversion privilege under N.Y. Ins. Law §3221(e), not coordination of benefits.
Memory hook
Reg 62 COB: two plans, one claim, no profit - expenses are the ceiling.