§ 4235. Group accident and health insurance. (a) (1) Any policy of\ninsurance against death or injury resulting from an accident which\ncovers more than one person, except blanket accident insurance policies\nas defined in section four thousand two hundred thirty-seven of this\narticle and accident and health insurance policies conforming to\nsubsections (a), (b) and (c) of section three thousand two hundred\nsixteen of this chapter, shall be deemed a group accident insurance\npolicy.\n (2) Any policy which insures against disablement, disease or sickness\n(excluding disablement which results from accident), and which covers\nmore than one person, except blanket health insurance policies as\ndefined in section four thousand two hundred thirty-seven of this\narticle and accident and health insurance policies conforming to\nsubsections (a), (b) and (c) of section three thousand two hundred\nsixteen of this chapter, shall be deemed a group health insurance\npolicy.\n (3) Any policy of insurance which combines the coverage of group\naccident insurance and of group health insurance shall be deemed a group\naccident and health insurance policy.\n (b) No policy of group accident, group health or group accident and\nhealth insurance, and no certificate thereunder, shall be delivered or\nissued for delivery in this state unless it conforms to the requirements\nof section three thousand two hundred twenty-one of this chapter and\nwith the exception of a group policy or contract of insurance issued\npursuant to article nine of the workers' compensation law, unless it\nconforms to the requirements of subsection (c) of this section.\n (c) (1) No policy of group accident, group health or group accident\nand health insurance shall be delivered or issued for delivery in this\nstate unless it conforms to one of the following descriptions:\n (A) A policy issued to an employer or to a trustee or trustees of a\nfund established by an employer, which employer or trustee or trustees\nshall be deemed the policyholder, insuring with or without evidence of\ninsurability satisfactory to the insurer, employees of such employer,\nand insuring, except as hereinafter provided, all of such employees or\nall of any class or classes thereof determined by conditions pertaining\nto the employment or a combination of such conditions and conditions\npertaining to the family status of the employee, for insurance coverage\non each person insured based upon some plan which will preclude\nindividual selection. However, such a plan may permit a limited number\nof selections by employees if the selections offered utilize consistent\nplans of coverage for individual group members so that the resulting\nplans of coverage are reasonable. The premium for the policy shall be\npaid by the policyholder, either from the employer's funds, or from\nfunds contributed by the insured employees, or from funds contributed\njointly by the employer and employees. If all or part of the premium is\nto be derived from funds contributed by the insured employees, then such\npolicy must insure not less than fifty percent of such eligible\nemployees or, if less, fifty or more of such employees when such policy\nis providing coverage for group hospital, medical, major medical or\nsimilar comprehensive types of expense reimbursed insurance and, for all\nother types of group accident and health insurance, must insure a\nminimum of fifty percent or five of such eligible employees, whichever\nis fewer.\n (B) A policy issued to a trustee or trustees of a fund established by,\nor participated in, by the employer members of a trade association,\nwhich trustees shall be deemed the policyholder, for the sole benefit of\nthe employees of such employers, the policy must conform subject to the\nfollowing requirements:\n (i) The policy may be issued only if:\n (I) the association has been in existence for at least two years and\nwas formed for purposes principally other than obtaining insurance, an
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.