NY Ins L § 4237 (2021)
2021 New York Laws ISC - Insurance Article 42 - Life Insurance Companies and Accident and Health Insurance Companies and Legal Services Insurance Companies 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.