N.Y. Comp. Codes R. & Regs. tit. 11 § 153.1

Current through Register Vol. 46, No. 43, October 23, 2024

Section 153.1 - Definitions

For purposes of this Part, the following definitions shall apply:

(a) Certificate means any policy, contract or other evidence of insurance, or rider or endorsement thereto, issued to a group member under a property/casualty or liability insurance group master policy.

(b) Commercial risk insurance has the meaning ascribed by section 107 (a)(47) of the Insurance Law.

(c) Family member means a person, related to the insured by blood, marriage, adoption or operation of law, who resides in the same household (including a ward or foster child) or who is a dependent child away at school.

(d) Group member means a person or entity to whom a policy or certificate has been issued in connection with a property/casualty or liability insurance group policy or master policy, and may include the group master policyholder.

(e) Group master policy means a group policy issued to a group master policyholder and under which certificates are issued to group members, but does not include such certificates.

(f) Group master policyholder means the person or entity to whom a property/casualty or liability insurance group master policy is issued.

(g) Group policy means:

(1) a policy underwritten and issued on a collective basis of:

(i) property/casualty insurance insuring the interests of two or more persons or entities; or

(ii) liability insurance insuring a Federal purchasing group or its members;

(2) Where an insurer elects to issue a single policy with a first-named insured and additional insureds, such policy shall not be considered a "group policy" in regard to the following:

(i) corporations or other entities under common control as defined in section 107 (a)(16) of the Insurance Law, with regard to their related interests;

(ii) franchisors and their franchisees, with regard to their related interests;

(iii) members of a partnership or joint venture, with regard to their related interests;

(iv) family members, but only for purposes of policies subject to section 3425 of the Insurance Law; or

(v) shared interests, provided that such shared interests exist among all additional insureds, and only to the extent of such shared interests.

(h) Issue includes issue for delivery.

(i) Liability insurance:

(1) means, except in connection with a Federal purchasing group, personal injury liability insurance, property damage liability insurance and employer's liability insurance, as such terms are defined in section 1113 (a)(13) (14) and (15) of the Insurance Law, and shall also include any type of insurance deemed by the superintendent to be substantially similar pursuant to section 1113(a)(30);

(2) means, in connection with a Federal purchasing group only, insurance against legal liability for damages (including costs of defense, legal costs and fees, and other claims expenses), because of injuries to other persons, damage to their property, or other damage or loss to such other persons resulting from or arising out of:

(i) any business (whether profit or nonprofit), trade, product, services (including professional services), premises or operations; or

(ii) any activity of any state or local government, or any agency or political subdivision thereof; and shall not include personal risk liability and an employer's liability with respect to its employees other than legal liability under the Federal Employer's Liability Act (45 U.S.C. § 51 et seq.); and

(3) as defined in paragraph (2) of this subdivision shall not include:

(i) any coverage not permitted pursuant to paragraph (1) of this subdivision; or

(ii) workers' compensation coverage.

(j) Mass merchandising means a method of marketing individually underwritten and issued property/casualty or liability insurance policies to participants that are employees of an employer, or members of an association or organization, that has agreed to promote or otherwise facilitate such coverage from an insurer to such participants, with reasonably anticipated economies of acquisition or administration.

(k) Nonprofit organization means:

(1) an organization described by section 501(c)(3) of the United States Internal Revenue Code;

(2) a Type B corporation formed pursuant to section 201 (b) of the Not-for-Profit Corporation Law; or

(3) an organization described by section 216-a of the Education Law.

(l) Personal risk liability, in connection with a Federal purchasing group only, means liability for damages because of injury to any person, damage to property, or other loss or damage resulting from any personal, familial or household responsibilities or activities, rather than from responsibilities or activities described in subparagraphs (i) and (ii) of paragraph (2) of subdivision (i) of this section.

(m) Policy means any policy, contract, certificate or other evidence of insurance, or rider or endorsement thereto.

(n) Property/casualty insurance means any type, or combination of types, of insurance authorized by section 1113 (a)(4) through (17) and (19) through (25) of the Insurance Law and shall also include any type of insurance deemed by the superintendent to be substantially similar pursuant to section 1113(a)(30).

(o) Public entity has the meaning ascribed by section 107 (a)(51) of the Insurance Law.

(p) Purchasing group has the meaning ascribed by section 5902 (m) of the Insurance Law.

(q) Quasi-group means any method of marketing individually underwritten and issued property/casualty or liability insurance policies in a group context to participants engaged in similar activities or organized in a common network, through a mass merchandising, safety group or similar program, in connection with State law or a Federal purchasing group.

(r) Safety group means a method of marketing individually underwritten and issued property/casualty or liability insurance policies to participants engaged in similar activities giving rise to similar risks, placing special emphasis on common safety controls and risk management measures among such participants to reduce such risks.

(s) Shared interests mean:

(1) for property insurance, insurable interest in the additional insured's property, including legal interest in or control of such property, so that physical loss or damage to such property may result in pecuniary loss to the first-named insured; or

(2) for liability insurance, ownership or control of an additional insured's operations and activities such that, if damages arise from such operations or activities, the first named insured and all insureds may be jointly liable.

(t) Sponsoring entity means the employer, association or other organization, including a Federal purchasing group, undertaking to coordinate, promote or otherwise facilitate a mass merchandising, safety group or other quasi-group program under which an insurer provides property/casualty or liability insurance.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 153.1