State RegulationsNY specificDifficulty 1/5
Under a group accident and health policy issued to an eligible group in New York, whom may the coverage extend to in addition to the eligible employees or members themselves?
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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, group accident and health coverage issued to an eligible group may extend not only to the employees or members themselves but also to their dependents, including spouses and dependent children. This is how family members obtain coverage through a working insured's group plan, subject to the dependent provisions of New York law.
Why the other options are wrong
- A) Group coverage is not limited to the employees themselves; dependent family members may also be included under the policy.
- B) Neighbors and other community residents have no relationship to the eligible group and cannot be covered under it.
- D) The insurer's own workforce has nothing to do with the eligible group that is actually insured by the policy.
Memory hook
Group coverage wraps around the family: spouses and dependent children ride along.