2006 New York Code - Health Maintenance Organizations; Employer Requirements.

 
    §  4407.  Health  maintenance organizations; employer requirements. 1.
  All employers subject to the provisions of  the  unemployment  insurance
  law,  except  for those employers with fewer than twenty-five employees,
  shall include in any health benefits plan offered  to  their  employees,
  the  option  of  membership  in  a health maintenance organization which
  provides or offers a comprehensive health services  plan  in  accordance
  with  the  provisions  of  this article, but only if such plan serves an
  area in which twenty-five of such employer's employees  reside  and  the
  organization   has  been  issued  a  certificate  of  authority  by  the
  commissioner.
    2. For those employees of an  employer  represented  by  a  bargaining
  representative,   the  offer  of  the  health  maintenance  organization
  alternative shall be subject only to the collective bargaining  process;
  for  those employees not represented by a bargaining representative, the
  offer of the health maintenance organization alternative shall  be  made
  directly to the employee.
    3.  (a)  If  there  is  more  than one health maintenance organization
  engaged in the provision of health services in the  area  in  which  the
  employees of the employer reside, and if:
    (i)  one  or more of such organizations provides more than one-half of
  its comprehensive health services through  physicians  or  other  health
  professionals  who  are members of the staff of the organization or of a
  medical group (or groups) which contracts with the organization, and
    (ii) one or more of  such  organizations  provides  its  comprehensive
  health   services   through   contracts   with  an  individual  practice
  association (or associations), individual physicians  and  other  health
  professionals  under  contract  directly  with  the  organization,  or a
  combination of an individual  practice  association  (or  associations),
  medical  group  (or  groups), physicians who are members of the staff of
  the  organization,  and   individual   physicians   and   other   health
  professionals under contract directly with the organization,
  then   the  employer  shall,  in  accordance  with  regulations  of  the
  commissioner, be required to offer the option of enrollment in at  least
  one  organization described in subparagraph (i) of this paragraph and at
  least one organization described in subparagraph (ii) of this  paragraph
  if  the  employer  has  twenty-five  or  more but fewer than two hundred
  employees. If the employer has two hundred or  more  employees  and  the
  employer's  principal  office  in  this  state is located outside of the
  metropolitan region then the employer shall be  required  to  offer  the
  option  of  enrollment  in  at  least  two  organizations  described  in
  subparagraph (i) of  this  paragraph  and  at  least  two  organizations
  described  in  subparagraph  (ii) of this paragraph. If the employer has
  two hundred or more employees and the  employer's  principal  office  in
  this  state  is located within the metropolitan region then the employer
  shall be required to offer the option of  enrollment  in  at  least  two
  organizations  described  in  subparagraph  (i) of this paragraph and at
  least two organizations described in subparagraph (ii) of this paragraph
  and an additional  organization  from  either  subparagraph.    For  the
  purposes  of  this  section  the  metropolitan  region is defined as the
  counties of Westchester, Rockland, New York,  Kings,  Queens,  Richmond,
  Bronx, Nassau and Suffolk.
    (b)  If  within  any  particular  area  of the state in which at least
  twenty-five of such employer's employees reside there are  fewer  health
  maintenance  organizations  described  in  subparagraph  (i)  or (ii) of
  paragraph (a) of this subdivision  than  the  employer  is  required  to
  offer,   then   additional   health   maintenance   organizations   from
  subparagraph (i) or (ii) of paragraph (a) of this subdivision  shall  be
  offered; provided, however, that no employer with fewer than two hundred
  employees  shall  be  required  to offer more than a total of two health
  maintenance organizations, and no employer  with  two  hundred  or  more
  employees  shall  be  required to offer more than a total of four health
  maintenance  organizations (or five such organizations if the employer's
  principal office is located  within  the  metropolitan  region)  in  any
  particular  area  of  the  state.   In the event fewer than the required
  total minimum number of health maintenance organizations  are  available
  in   an   area,   the   employer  shall  offer  all  health  maintenance
  organizations then certified to issue subscriber contracts in that area.
  Nothing in this subdivision shall be deemed to prohibit an employer from
  choosing to offer more health maintenance organizations to its employees
  than are required under this subdivision.
    4. No employer shall be required to pay more for health benefits as  a
  result  of  the  application  of  this  section  than would otherwise be
  required by any prevailing  collective  bargaining  agreement  or  other
  legally  enforceable  contract  for  the  provision  of  health benefits
  between an employer and his employees.