State RegulationsNY specificDifficulty 2/5
A policyholder in Albany files a claim under her individual accident and health policy for a benefit that the insurer's promotional flyer described, but the policy itself contains no such benefit. Under N.Y. Ins. Law §3216(d)(1)(A), the insurer:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under N.Y. Ins. Law §3216(d)(1)(A), the entire contract is the policy, including its endorsements and attached papers; sales flyers and advertising are not part of it. The insurer's contractual obligation is measured by the policy's terms, so a benefit that appears only in promotional material creates no enforceable coverage. The flyer may still be an advertising violation the Department of Financial Services can pursue, but it cannot enlarge the policy's benefits.
Why the other options are wrong
- A) The insurer's approval of the flyer for distribution does not convert sales material into contract terms; the entire contract remains the policy and its attached papers.
- B) That the agent was the insurer's representative when using the flyer does not make the flyer a contract document; the policy's terms control.
- D) Advertising materials never supersede inconsistent policy terms; they sit outside the entire contract.
Memory hook
Promised only in the brochure? Not in the contract, not covered.