State RegulationsNY specificDifficulty 2/5
An insured under a New York individual accident and health policy has filed substantial claims for a chronic condition that was diagnosed after the policy was issued. At renewal, the insurer may refuse to renew the policy:
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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(g)(1), refusal to renew an individual accident and health policy is limited to the statutory grounds, such as nonpayment of premium, fraud, market exit with the required notice, or the insured's move out of a network service area. Claims experience, deteriorating health, and unprofitability are not among them, so the insurer must offer renewal here.
Why the other options are wrong
- B) Loss experience is never a permitted ground for nonrenewal of individual health coverage.
- C) The health status of the insured can never drive a nonrenewal decision.
- D) Profitability is not a statutory ground; the renewal right belongs to the insured.
Memory hook
Big claims still renew - only the listed grounds can end the policy.