2023 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.