State RegulationsNY specificDifficulty 2/5
An individual accident and health policy in New York is reinstated after a lapse for nonpayment. Which statement correctly describes coverage after reinstatement?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under N.Y. Ins. Law §3216(d)(1)(D), a reinstated individual health policy pays accident benefits immediately, but sickness that begins within ten days after reinstatement is not covered. The waiting period discourages insureds from waiting until they are ill to reinstate the policy, while genuine accidents are not penalized.
Why the other options are wrong
- B) The rule is the reverse: accidents are immediate and sickness waits.
- C) Accidents are never subject to the ten-day wait.
- D) The ten-day sickness waiting period applies after every reinstatement.
Memory hook
Accidents now, sickness in ten.