Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 18 Topic 2 Discussion
Insurance Licensing New York Life, Accident and Health Insurance Agent/Broker Examination Series 17-55 NY-Life-Accident-and-Health Question # 18 Topic 2 Discussion
Multiple policies that are rated for different communities and have substantially similar benefits as determined by the superintendent will be required to:
The correct answer is pool experience . Under New York insurance rating rules , when an insurer has multiple policies that are community rated in different communities but provide substantially similar benefits , the Superintendent may require the insurer to pool the experience of those policies. Pooling experience means combining the claims and loss experience of the similar policies for rating purposes rather than allowing the insurer to separate them in a way that could distort rates or create unfair differences among insured groups.
This requirement supports the regulatory goal of fair and consistent community rating . Community rating is intended to prevent insurers from charging significantly different premiums to similarly situated insureds based on claims experience or selective grouping. If substantially similar plans were kept artificially separate, it could undermine the integrity of the rating system. By requiring pooled experience, New York helps ensure that premiums more accurately reflect the combined risk of comparable policy forms.
The other options are incorrect because the regulation does not automatically require insurers to merge plans , change benefits , or refile rates as the principal action in this circumstance. The specific regulatory requirement tested here is to pool experience .
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