State RegulationsNY specificDifficulty 2/5
Under N.Y. Ins. Law §4235, which of the following may be issued a group accident and health policy in New York?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under N.Y. Ins. Law §4235, group accident and health coverage may be issued to genuine groups, most commonly employer-employee groups, along with other eligible groups recognized by the statute, such as employee organizations and associations. The group must exist for purposes beyond simply buying insurance, and a single individual cannot purchase a group policy for himself alone. Small employer groups of 2 to 50 employees fall under the special small-group rules of Reg 145.
Why the other options are wrong
- B) One individual buying only for himself and his family is the individual market; a group policy requires a genuine group such as an employer's employees.
- C) A group formed principally to obtain insurance is not a bona fide eligible group; eligibility keys on groups that exist for non-insurance purposes.
- D) Insurers sharing data among themselves is not a covered group of persons; group policies protect a defined group of insured individuals, not carriers.
Memory hook
Real groups get group policies - employers, unions, associations; not one-man bands.