§ 4237 — Blanket accident and health insurance

New York § 4237

• Jurisdiction: New York
• Law ISC: Insurance
• Art. 42: Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies

Text

§ 4237. Blanket accident and health insurance. (a) (1) Any policy or\ncontract of insurance against death or injury resulting from accident\nwhich insures a group of persons conforming to the requirements of one\nof the subparagraphs (A) through (F) of paragraph three hereof shall be\ndeemed a blanket accident policy.\n (2) Any policy or contract which insures a group of persons conforming\nto the requirements of subparagraph (C), (E) or (F) of paragraph three\nhereof against total or partial disability, excluding such disability\nfrom accident, shall be deemed a blanket health insurance policy.\n (3) Any policy or contract of insurance which combines the coverage of\nblanket accident insurance and of blanket health insurance on such a\ngroup of persons shall be deemed a blanket accident and health insurance\npolicy:\n (A) Under a policy or contract issued to any railroad, steamship,\nmotorbus or airplane carrier of passengers, which shall be deemed the\npolicyholder, a group defined as all persons who may become such\npassengers may be insured against death or bodily injury either while,\nor as a result of, being such passengers.\n (B) Under a policy or contract issued to an employer, who shall be\ndeemed the policyholder, covering any group of employees defined by\nreference to exceptional hazards incident to such employment, insuring\nsuch employee against death or bodily injury resulting while, or from,\nbeing exposed to such exceptional hazards.\n (C) Under a policy or contract issued to an institution of higher\neducation, as defined in the higher education act of 1965, 20 U.S.C. §\n1001, other school, or other institution of learning or to the head or\nprincipal thereof, who or which shall be deemed the policyholder,\nprovided, with respect to a policy or contract issued to an institution\nof higher education, the policy or contract shall be a policy or\ncontract:\n (i) of hospital, medical, or surgical expense insurance that meets the\nrequirements of section three thousand two hundred forty of this\nchapter;\n (ii) that provides limited scope dental or vision benefits meeting the\ndefinition of "excepted benefits" set forth in section 2791 of the\npublic health service act, 42 U.S.C. § 300gg-91(c); or\n (iii) as described in item (ii), (iii) or (iv) of subparagraph (B) of\nparagraph one of subsection (a) of section three thousand two hundred\nforty of this chapter.\n (D) Under a policy or contract issued in the name of\n (i) any county, city, town, village or fire district,\n (ii) any duly organized fire department, or fire company, of any such\nmunicipal corporation or fire district, whether or not any such\ncorporation has been incorporated under any general or special law,\n (iii) any fire corporation incorporated under or subject to the\nprovisions of section one thousand four hundred two of the\nnot-for-profit corporation law, or any general or special law, if such\ncorporation is by law under the general control of, or recognized as a\nfire corporation by, the governing board of a city, town, village or\nfire district, which municipal corporation, fire district, fire\ndepartment, fire company or fire corporation, as the case may be, shall\nbe deemed the policyholder, covering all, but not less than twenty-five,\nvolunteer members of such department, company or corporation. A district\ncorporation which has the general powers of and operates as a fire\ndistrict shall be considered a fire district for the purposes of this\nparagraph. A volunteer firefighter whose services are offered and\naccepted pursuant to the provisions of section two hundred nine-i of the\ngeneral municipal law shall be deemed a volunteer member of any such\nfire department, fire company or fire corporation except for the purpose\nof determining the minimum number of twenty-five volunteer members for\nwhich any such policy or contract must provide coverage. Any such policy\nor contract issued to a municipal corporation or a fire district shall\nbe subject to any limitations on the amount, coverage or benefits as are\nset forth in any applicable general, special or local law or city or\nvillage charter.\n (E) Under a policy or contract issued to and in the name of an\nincorporated or unincorporated association of persons having a common\ninterest or calling, which association shall be deemed the policyholder,\nhaving not less than fifty members, covering all the members of such\nassociation or if part or all of the premium is to be derived from funds\ncontributed by the insured members and if the opportunity to take such\ninsurance is offered to all eligible members, then such policy must\ncover not less than seventy-five percent of any class or classes of\nmembers determined by conditions pertaining to membership in the\nassociation.\n (F) Under a policy or contract issued to insure; (i) any other\nsubstantially similar group approved by the superintendent as eligible\nfor insurance under a blanket accident and health insurance policy or\ncontract; or (ii) any other group approved by the superintendent upon a\nfinding that: (I) there is a common enterprise or economic or social\naffinity or relationship; (II) the premiums charged are reasonable in\nrelation to the benefits provided; and (III) the issuance of the policy\nwould result in economies of acquisition or administration, would be\nactuarially sound, and would not be contrary to the best interest of the\npublic. The superintendent shall promulgate regulations setting forth\nany such groups that have been accepted as qualifying pursuant to this\nsubparagraph.\n (b) All benefits under any blanket accident, blanket health or blanket\naccident and health insurance policy shall be payable to the person\ninsured, or to his designated beneficiary or beneficiaries, or to his\nestate, except that if the person insured be a minor, such benefits may\nbe made payable to his parent, guardian, or other person actually\nsupporting him, or to a person or persons chiefly dependent upon him for\nsupport and maintenance.\n (c) This section shall not affect the legal liability of policyholders\nfor the death of or injury to, any such member of such group.\n (d) (1) Any dividend hereafter apportioned on any participating\nblanket insurance policy, or any rate reduction hereafter made or\ncontinued on any non-participating blanket policy for the first or any\nsubsequent year of insurance under any such policy heretofore or\nhereafter issued under item (ii) of subparagraph (F) of paragraph three\nof subsection (a) of this section may be applied to reduce the\npolicyholder's part of the cost of such policy, except that the excess,\nif any, of the insured's aggregate contribution under the policy over\nthe net cost (gross premium less dividends or rate reductions) of the\ninsurance shall be applied at the discretion of the insurer either as a\ncash payment to the insured or to reduce the insured's premium, unless\nthe insured assigns the dividend or rate reduction to the policyholder.\nIf a dividend or rate reduction is payable upon termination of the\npolicy the insurer shall either make payment to the insured or to the\npolicyholder upon receipt of a certification from the policyholder that\nthe dividend or rate reduction will be distributed by the policyholder\nto the insureds or applied to reduce the insured's premium.\n (2) The provisions of paragraph one of this subsection shall apply to\nNew York residents insured under a policy issued in any other\njurisdiction to a group which is not of the type described in\nsubparagraphs (A) through (E) and item (i) of subparagraph (F) of\nparagraph three of subsection (a) of this section.\n (e)(1) For the purposes of any policy or contract of insurance issued\npursuant to this section, the term "employees" may include officers,\nmanagers, employees and retired employees of the employer, and of\nsubsidiary or affiliated corporations of a corporate employer; and the\nindividual proprietors, partners, employees and retired employees of\naffiliated individuals and firms controlled by the insured employer\nthrough stock ownership, contract or otherwise; and the individual\nproprietor or partners if the employer is an individual proprietorship\nor partnership.\n (2) For purposes of subparagraph (B) of paragraph three of subsection\n(a) of this section, the term "employees" may also include the directors\nof the employer, and of subsidiary or affiliated corporations of a\ncorporate employer.\n