In a group accident and health policy, which two parties are primarily responsible for issuing and paying benefits under the policy?

• A. The insurer pays benefits directly to employees
• B. The insurer sets rates for the employer but does not issue contracts
• C. The insurer issues the contract and pays benefits to the employer or insured under policy terms
• D. The insurer is only responsible for marketing

Answer: (C)

In a group accident and health policy, the insurer is responsible for both issuing the policy contract and paying benefits under its terms. The master policy is issued by the insurer to the employer (the sponsor), and it outlines who is covered, what benefits are provided, and how claims are paid. The insurer administers and pays those claims according to the contract, either paying the benefits to the insured or to the employer for distribution to employees, depending on the plan design. This is why the best choice emphasizes that the insurer issues the contract and pays benefits under policy terms. Choices that focus only on marketing or on setting rates don’t capture who actually issues the contract and handles claim payments.