State RegulationsNY specificDifficulty 2/5
An insurer submits an individual health policy form for approval that excludes all routine preventive services, including well-child checkups. What is the likely result when the Superintendent of Financial Services reviews the form?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under N.Y. Ins. Law §4303(j), New York requires accident and health policies to provide coverage for preventive care services, so a form excluding routine preventive services such as well-child checkups conflicts with statute and would not win approval from the Superintendent of Financial Services. Typographical prominence, a reduced premium, or the group-market label cannot cure a statutory violation. Form filing is the Department of Financial Services' frontline mechanism for enforcing mandated coverage.
Why the other options are wrong
- B) Bold type cannot save a form that excludes coverage the statute requires; conspicuous drafting does not override N.Y. Ins. Law §4303(j).
- C) The preventive care requirement is not limited to individual forms, and a group form with the same exclusion would fail as well.
- D) A cheaper premium cannot buy out a statutory coverage mandate; the exclusion itself is the defect.
Memory hook
No DFS approval for forms that carve out prevention - the mandate is not for sale.