OGC Opinion No. 04-01-11
This Office of General Counsel issued the following information on January 8, 2004 representing the position of the New York State Insurance Department.
Re: Group Health Insurance and Out of State Employer Groups
Question Presented:
Does New York law pertain to a group life, health or disability insurance policy issued outside of New York by an unauthorized insurer to an employer who has some employees who either work, reside, or both in New York?
Conclusion:
If the group is of a type denominated in N.Y. Ins. Law § 3201(b)(1) (McKinney Supp. 2004), the insurer may issue group life, health or disability insurance policies and contracts outside of New York to such a group without having to comply with New York Law, even though some certificateholders either work, reside, or both in New York, if done in accordance with N.Y. Ins. Law § 1101 (McKinney Supp. 2004).
Facts:
The inquirer represents an insurer that is licensed in several states but not in New York. It issues group health, life and/or disability policies in the states in which it is licensed to employers of varying sizes. Many of these employers are headquartered outside of New York but have employees who work, reside, or both in New York.
Analysis:
N.Y. Ins. Law § 3201(b)(1) (McKinney Supp. 2004) provides in pertinent part:
(b) (1) No policy form shall be delivered or issued for delivery in this state unless it has been filed with and approved by the superintendent as conforming to the requirements of this chapter and not inconsistent with law. A group life, group accident, group health, group accident and health or blanket accident and health insurance certificate evidencing insurance coverage on a resident of this state shall be deemed to have been delivered in this state, regardless of the place of actual delivery, unless the insured group is of the type described in: (A) section four thousand two hundred sixteen, except paragraph four where the group policy is issued to a trustee or trustees of a fund established or participated in by two or more employers not in the same industry with respect to an employer principally located within the state, paragraph twelve, thirteen or fourteen of subsection (b) thereof; (B) section four thousand two hundred thirty-five except subparagraph (D) where the group policy is issued to a trustee or trustees of a fund established or participated in by two or more employers not in the same industry with respect to an employer principally located within the state, subparagraph (K), (L) or (M) of paragraph one of subsection (c) thereof. . . ..
The inquirer states that the group policies are issued outside of New York. Provided that they are issued to groups that come within the statutory exceptions denominated above, the policies would not be subject to New York law. Since the insurers that the inquirer represents are not licensed in New York, the inquirer was directed to review N.Y. Ins. Law § 1101(b) (McKinney Supp. 2004), which specifies those acts that do and do not constitute the doing of an insurance business in this state. The inquirer was also directed to review OGC opinions dated October 29, 2003, April 18, 1995, August 2, 1993 and March 25, 1991 and the Departments web site at www.ins.state.ny.us for additional guidance.
For further information you may contact Supervisory Attorney Joan Siegel at the New York City Office.