N.Y. Insurance Law § 4237: Blanket accident and health insurance

§ 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.