State RegulationsNY specificDifficulty 2/5
An insured's individual accident and health policy has premiums payable monthly. The monthly premium is due and unpaid, and the insured is hospitalized 3 days later for a covered sickness. Under N.Y. Ins. Law §3216(d)(1)(C), what is the result?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under N.Y. Ins. Law §3216(d)(1)(C), a monthly premium accident and health policy must grant a grace period of at least 10 days for each premium due after the initial premium, and the policy continues in force during that period. A loss occurring 3 days after the premium's due date falls within the 10-day grace period, so the claim is payable; the insurer may then deduct the overdue premium from the claim payment under the unpaid premium provision of §3216(d)(2)(G).
Why the other options are wrong
- A) Nonpayment at the due date does not defeat the claim; the policy remains in force throughout the grace period.
- B) Evidence of insurability relates to reinstatement after a lapse, not to claims arising while the policy is still in force during grace.
- D) The accident-versus-sickness distinction applies to coverage after reinstatement, not to claims during a grace period on a policy in force.
Memory hook
Grace keeps the policy alive: monthly mode means 10 days of continued coverage.