State RegulationsNY specificDifficulty 1/5
Which of the following is a type of group to which a New York insurer may issue a group accident and health policy under N.Y. Ins. Law §4235?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under N.Y. Ins. Law §4235(c)(1)(A), a group accident and health policy may be issued to an employer, or to a trustee of a fund established by an employer, which is deemed the policyholder, insuring the employees with or without evidence of insurability. The employer-employee group is the classic eligible group under §4235, so the insurer may issue the policy with the employer holding it for the benefit of its workforce.
Why the other options are wrong
- A) A group assembled solely to purchase coverage is not among the groups §4235(c) lists as eligible; eligibility requires a substantive group relationship such as employment or union membership.
- B) Covering a single applicant is individual coverage; a group policy must fit one of the eligible group descriptions in §4235(c).
- D) Merely covering more than one person does not make a group eligible; the group must still conform to one of the §4235(c) descriptions.
Memory hook
Section 4235 = employer first: the boss holds the policy, the employees are the insureds.