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This entry was published on 2020-04-10
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SECTION 4237
Blanket accident and health insurance
Insurance (ISC) CHAPTER 28, ARTICLE 42
§ 4237. Blanket accident and health insurance. (a) (1) Any policy or
contract of insurance against death or injury resulting from accident
which insures a group of persons conforming to the requirements of one
of the subparagraphs (A) through (F) of paragraph three hereof shall be
deemed a blanket accident policy.

(2) Any policy or contract which insures a group of persons conforming
to the requirements of subparagraph (C), (E) or (F) of paragraph three
hereof against total or partial disability, excluding such disability
from accident, shall be deemed a blanket health insurance policy.

(3) Any policy or contract of insurance which combines the coverage of
blanket accident insurance and of blanket health insurance on such a
group of persons shall be deemed a blanket accident and health insurance
policy:

(A) Under a policy or contract issued to any railroad, steamship,
motorbus or airplane carrier of passengers, which shall be deemed the
policyholder, a group defined as all persons who may become such
passengers may be insured against death or bodily injury either while,
or as a result of, being such passengers.

(B) Under a policy or contract issued to an employer, who shall be
deemed the policyholder, covering any group of employees defined by
reference to exceptional hazards incident to such employment, insuring
such employee against death or bodily injury resulting while, or from,
being exposed to such exceptional hazards.

(C) Under a policy or contract issued to an institution of higher
education, as defined in the higher education act of 1965, 20 U.S.C. §
1001, other school, or other institution of learning or to the head or
principal thereof, who or which shall be deemed the policyholder,
provided, with respect to a policy or contract issued to an institution
of higher education, the policy or contract shall be a policy or
contract:

(i) of hospital, medical, or surgical expense insurance that meets the
requirements of section three thousand two hundred forty of this
chapter;

(ii) that provides limited scope dental or vision benefits meeting the
definition of "excepted benefits" set forth in section 2791 of the
public health service act, 42 U.S.C. § 300gg-91(c); or

(iii) as described in item (ii), (iii) or (iv) of subparagraph (B) of
paragraph one of subsection (a) of section three thousand two hundred
forty of this chapter.

(D) Under a policy or contract issued in the name of

(i) any county, city, town, village or fire district,

(ii) any duly organized fire department, or fire company, of any such
municipal corporation or fire district, whether or not any such
corporation has been incorporated under any general or special law,

(iii) any fire corporation incorporated under or subject to the
provisions of section one thousand four hundred two of the
not-for-profit corporation law, or any general or special law, if such
corporation is by law under the general control of, or recognized as a
fire corporation by, the governing board of a city, town, village or
fire district, which municipal corporation, fire district, fire
department, fire company or fire corporation, as the case may be, shall
be deemed the policyholder, covering all, but not less than twenty-five,
volunteer members of such department, company or corporation. A district
corporation which has the general powers of and operates as a fire
district shall be considered a fire district for the purposes of this
paragraph. A volunteer firefighter whose services are offered and
accepted pursuant to the provisions of section two hundred nine-i of the
general municipal law shall be deemed a volunteer member of any such
fire department, fire company or fire corporation except for the purpose
of determining the minimum number of twenty-five volunteer members for
which any such policy or contract must provide coverage. Any such policy
or contract issued to a municipal corporation or a fire district shall
be subject to any limitations on the amount, coverage or benefits as are
set forth in any applicable general, special or local law or city or
village charter.

(E) Under a policy or contract issued to and in the name of an
incorporated or unincorporated association of persons having a common
interest or calling, which association shall be deemed the policyholder,
having not less than fifty members, covering all the members of such
association or if part or all of the premium is to be derived from funds
contributed by the insured members and if the opportunity to take such
insurance is offered to all eligible members, then such policy must
cover not less than seventy-five percent of any class or classes of
members determined by conditions pertaining to membership in the
association.

(F) Under a policy or contract issued to insure; (i) any other
substantially similar group approved by the superintendent as eligible
for insurance under a blanket accident and health insurance policy or
contract; or (ii) any other group approved by the superintendent upon a
finding that: (I) there is a common enterprise or economic or social
affinity or relationship; (II) the premiums charged are reasonable in
relation to the benefits provided; and (III) the issuance of the policy
would result in economies of acquisition or administration, would be
actuarially sound, and would not be contrary to the best interest of the
public. The superintendent shall promulgate regulations setting forth
any such groups that have been accepted as qualifying pursuant to this
subparagraph.

(b) All benefits under any blanket accident, blanket health or blanket
accident and health insurance policy shall be payable to the person
insured, or to his designated beneficiary or beneficiaries, or to his
estate, except that if the person insured be a minor, such benefits may
be made payable to his parent, guardian, or other person actually
supporting him, or to a person or persons chiefly dependent upon him for
support and maintenance.

(c) This section shall not affect the legal liability of policyholders
for the death of or injury to, any such member of such group.

(d) (1) Any dividend hereafter apportioned on any participating
blanket insurance policy, or any rate reduction hereafter made or
continued on any non-participating blanket policy for the first or any
subsequent year of insurance under any such policy heretofore or
hereafter issued under item (ii) of subparagraph (F) of paragraph three
of subsection (a) of this section may be applied to reduce the
policyholder's part of the cost of such policy, except that the excess,
if any, of the insured's aggregate contribution under the policy over
the net cost (gross premium less dividends or rate reductions) of the
insurance shall be applied at the discretion of the insurer either as a
cash payment to the insured or to reduce the insured's premium, unless
the insured assigns the dividend or rate reduction to the policyholder.
If a dividend or rate reduction is payable upon termination of the
policy the insurer shall either make payment to the insured or to the
policyholder upon receipt of a certification from the policyholder that
the dividend or rate reduction will be distributed by the policyholder
to the insureds or applied to reduce the insured's premium.

(2) The provisions of paragraph one of this subsection shall apply to
New York residents insured under a policy issued in any other
jurisdiction to a group which is not of the type described in
subparagraphs (A) through (E) and item (i) of subparagraph (F) of
paragraph three of subsection (a) of this section.

(e)(1) For the purposes of any policy or contract of insurance issued
pursuant to this section, the term "employees" may include officers,
managers, employees and retired employees of the employer, and of
subsidiary or affiliated corporations of a corporate employer; and the
individual proprietors, partners, employees and retired employees of
affiliated individuals and firms controlled by the insured employer
through stock ownership, contract or otherwise; and the individual
proprietor or partners if the employer is an individual proprietorship
or partnership.

(2) For purposes of subparagraph (B) of paragraph three of subsection
(a) of this section, the term "employees" may also include the directors
of the employer, and of subsidiary or affiliated corporations of a
corporate employer.