State RegulationsNY specificDifficulty 2/5
In the middle of the calendar year, a newly formed Troy company that qualifies as a small employer applies for small employer health coverage. The carrier tells the owner to come back during the next open enrollment season. Under Reg 145, what is the correct result?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under Reg 145 (11 NYCRR Part 360 (Reg 145)), New York's small-group market offers year-round open enrollment, and every qualifying small employer group that applies must be offered coverage. A carrier cannot put a small employer off until a future season; it must make coverage available when the employer applies, whenever during the year that application occurs.
Why the other options are wrong
- A) There is no enrollment season in the New York small-group market; the carrier's deferral violates the regulation.
- C) Claims history is irrelevant both to the timing of availability and to the carrier's obligation to offer coverage.
- D) Indefinite delay of the effective date is a refusal by another name; coverage must be made available to the employer on a timely basis.
Memory hook
No 'come back next season': small-group doors stay open all year in New York.