State RegulationsNY specificDifficulty 2/5
A New York insurer is asked to issue a group health policy to an organization that is not one of the groups specifically listed in the statute. Under N.Y. Ins. Law §4235, what is required for this group to become eligible?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under N.Y. Ins. Law §4235(c)(1)(M), a group health policy may be issued to any other group approved by the superintendent of financial services upon findings that the members share a common enterprise or economic or social affinity or relationship, that the premiums charged are reasonable in relation to the benefits provided, and that issuance would be actuarially sound and consistent with the public interest. Groups not specifically listed in §4235 become eligible only through this approval process.
Why the other options are wrong
- A) Having multiple paying applicants does not itself create eligibility; the group must fit a listed description or obtain the superintendent's approval.
- C) No judicial declaration can substitute for the findings and approval the statute assigns to the superintendent.
- D) The insurer's board cannot create eligibility; the determination belongs to the superintendent of financial services.
Memory hook
Unlisted group? Only the Superintendent's stamp of approval makes it eligible.