State RegulationsNY specificDifficulty 2/5
During a covered dependent's routine well-child visit, the insurer denies the claim because no illness was being diagnosed or treated. Under N.Y. Ins. Law §4303(j), how should this denial be characterized?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under N.Y. Ins. Law §4303(j), New York accident and health policies must provide coverage for preventive care services, which by definition are delivered before or apart from any diagnosed illness. Denying a well-child claim solely because nothing was being treated misreads the policy's required scope: prevention, not just treatment, is covered. The insurer's logic fails on its face for routine preventive visits, and the insured should appeal the denial.
Why the other options are wrong
- A) New York law rejects that narrow view; preventive care for a healthy patient is precisely what the statute requires policies to cover.
- C) Well-child visits are preventive, not emergency, services; miscategorizing them does not make the denial proper.
- D) Symptoms are irrelevant to preventive coverage; the visit is covered whether or not the child is ill at the time.
Memory hook
No illness, no problem - preventive visits are covered precisely because nothing is wrong yet.