State RegulationsNY specificDifficulty 2/5
An eligible small employer with 12 employees applies for medical coverage in the middle of the calendar year, having never carried group coverage before. The insurer tells the employer to come back during the next open enrollment season. Under Reg 145, what is the insurer's obligation?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under Reg 145 (11 NYCRR Part 360), availability of coverage in the small group market is year-round: an eligible small employer may apply at any time, and the insurer must make coverage available to the group rather than deferring it to an enrollment season. The mid-year date and the absence of prior coverage do not defeat the application.
Why the other options are wrong
- B) Deferring the application to an enrollment season contradicts the year-round structure of the small group market.
- C) A conversion policy is a vehicle for an individual whose group coverage ended; it is not a substitute for group coverage a small employer applies for.
- D) No special permission is needed; the obligation to make coverage available applies throughout the year.
Memory hook
No closed season: small employers may apply in any month of the year.