2013 New York Consolidated Laws
PBH - Public Health
Article 9-A - (921 - 922) NEW YORK STATE SMALL BUSINESS HEALTH INSURANCE PARTNERSHIP PROGRAM
922 - New York state small business health insurance partnership program.

 
    §  922.  New  York  state  small business health insurance partnership
  program. 1. The commissioner  is  authorized  to  the  extent  of  funds
  available therefor to establish the New York state small business health
  insurance partnership program.
    2. New York state small business health insurance partnership program.
  (a)  A  small business health insurance partnership program shall assist
  eligible employers in purchasing small group health  insurance  policies
  for their full-time employees and dependents.
    (b) An eligible employer may apply to the commissioner for approval in
  the small business health insurance partnership program by submitting an
  application  on  a  form prescribed by the commissioner. The information
  required on such application shall include, but not be limited to:
    (i) the name and address  of  the  employer  and  the  nature  of  the
  business;
    (ii) the names and salaries of the employer and employees;
    (iii)  an  affidavit  by  the  employer  that employer-provided health
  insurance  benefits  have  not  been  provided  to  employees   in   the
  twelve-month period prior to the effective date of this article; and
    (iv) such other information as the commissioner may require.
    (c) Upon reviewing the applications from eligible small employers, the
  commissioner  shall,  within  the  amount appropriated for such purpose,
  award partnership certificates to employers which meet  the  eligibility
  requirements;  provided  however,  no  partnership  certificates will be
  awarded by the commissioner on and after January  first,  two  thousand.
  In  addition  to  evidencing  approval  of  an  eligible  employer,  the
  certificate shall state the amount of a small business health  insurance
  partnership incentive payment for a small group health insurance policy,
  which in no event may exceed forty-five percent of the premium costs for
  group health care coverage for employees and their dependents. Employees
  may  be  required  to make contributions to the payment of premium costs
  under this program at the option of the employer, but in no event  shall
  such contribution exceed ten percent of the premium costs. Premium costs
  incurred  by  an  employer for small group health insurance coverage for
  officers and directors of an employer and others with a  proprietary  or
  ownership  interest  in  the  employer  may be eligible for an incentive
  payment to offset premium  costs;  provided,  however,  that  the  gross
  household  income  of  such  officers  and  directors  or  others with a
  proprietary or ownership interest is at or below two hundred  twenty-two
  percent  of the non-farm federal poverty level and provided further that
  one or more employees and their dependents proposed  to  be  covered  by
  such  group  health  care  coverage  are  unrelated  to  such  officers,
  directors or other persons with a proprietary or ownership interest.  If
  after  joining the program an employer participating in a small business
  insurance partnership program hires more employees so that the  employer
  has  more  than  fifty full-time employees at any one time, the employer
  may continue in the program but the premium costs  attributable  to  the
  additional  employees  in excess of fifty or their families shall not be
  eligible for incentive payments.
    (d) In approving partnership certificates for eligible small employers
  prior to January first, two thousand, the commissioner shall:
    (i) first  approve  applications  from  eligible  employers  currently
  receiving  assistance  through a small business health insurance program
  created by the expanded health care coverage act authorized pursuant  to
  chapter   seven   hundred   three   of  the  laws  of  nineteen  hundred
  eighty-eight; and
    (ii) give preference to eligible employers  with  the  lowest  average
  salaries and base the amount of the certificate on the salaries received

  by  the  employer  and  employees in order to maximize the impact of the
  small business partnership premium payments.
    (e)  Upon  receipt of a partnership certificate from the commissioner,
  an approved eligible employer may obtain a small group health  insurance
  policy  from the insurer, health maintenance organization or corporation
  of its choice. No  such  insurer,  health  maintenance  organization  or
  corporation  shall  refuse  to  accept  a small employer holding a valid
  partnership certificate and such insurer,  organization  or  corporation
  shall arrange for the payment of the small employer's share of the small
  group  health  insurance  policy  or  comprehensive health services plan
  premium. The approved applicant shall make available upon  request  from
  the  commissioner  information  regarding  continued  eligibility in the
  program.
    The commissioner  shall,  within  amounts  available  therefor,  on  a
  competitive  bid  process,  contract  with organizations for purposes of
  public education,  outreach  and  recruitment  of  eligible  businesses,
  including  the  distribution  of  applications and information regarding
  enrollment. The organizations shall include,  but  not  be  limited  to:
  community  based  organizations  such  as  chambers of commerce or trade
  organizations, diagnostic and treatment centers,  hospitals,  and  other
  such organizations which engage in outreach and marketing activities. In
  no  event  shall  the  amount  available  for  education,  outreach, and
  recruitment exceed two percent of the total  amount  available  for  the
  purposes of this section.
    (f)  The  commissioner,  by  rules  and  regulations,  adopted  by the
  commissioner  shall  establish  the   procedure   by   which   insurers,
  corporations  and  organizations  issuing  small  group health insurance
  policies under this article may redeem a certificate or certificates for
  the portion of the premium not paid by the employer,  but  in  no  event
  shall such redemption occur on less than a quarterly basis.
    Any  business  which,  with  the  intent to obtain benefits, willfully
  misstates information required for application for participation in  the
  New  York  state health insurance partnership program or willfully fails
  to notify the commissioner or the commissioner's designee of any  change
  in  status  which  makes  the business ineligible for the program, shall
  repay such incentive payments paid on behalf of its employees or program
  participants for health coverage  through  the  New  York  state  health
  insurance partnership program.
    (g) Notwithstanding any inconsistent provision of law or regulation to
  the  contrary,  benefits  under  the  small  business  health  insurance
  partnership program shall be considered secondary to any other  plan  of
  insurance or benefit program under which a person may have coverage.
    (h)  On  or  before  April  first,  nineteen hundred ninety-seven, and
  annually thereafter through April first, two thousand, the  commissioner
  shall submit a report on the small business health insurance partnership
  program  to  the  governor, the speaker of the assembly and the majority
  leader of the senate. Such report shall include, but not be limited to:
    (i) the number of employers and employees able to purchase small group
  health insurance policies under the program;
    (ii) the location and the nature of the business  of  such  employers;
  and
    (iii) recommendations for any changes which would improve the program.