Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 6 Topic 1 Discussion
Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 6 Topic 1 Discussion
The correct answer is B. Employee. In group health insurance, the master policy is issued to the policyholder or sponsor , which is typically the employer or organization sponsoring the plan. Individual members of the group—usually employees—are not issued the master policy itself. Instead, they receive a certificate of coverage that summarizes the benefits, limitations, and procedures for obtaining benefits under the group plan. This certificate serves as the individual’s proof of insurance coverage .
Under group insurance arrangements, each insured participant receives a certificate explaining the coverage provided under the master contract and outlining the essential features of the insurance. ( app.achievable.me )
The other options are incorrect because the sponsor or employer receives the master policy , not the certificate of coverage. The HMO or insurer is the entity providing the coverage and issuing the documents, not the party receiving the certificate as proof of coverage. Therefore, when health insurance is marketed to groups, the employee (or covered member) is issued a certificate as evidence of insurance coverage .
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