2013 New York Consolidated Laws
ISC - Insurance
Article 11 - (1101 - 1125) LICENSING OF INSURERS
1120 - Child health insurance plan.

 
    § 1120. Child health insurance plan. (a) An authorized insurer subject
  to  the  provisions  of  this chapter and organized to write the kind of
  health insurance specified in  paragraph  three  of  subsection  (a)  of
  section  one  thousand  one  hundred  thirteen  of  this  article, and a
  corporation or health maintenance organization  authorized  pursuant  to
  article forty-three of this chapter or a health maintenance organization
  certified  pursuant  to article forty-four of the public health law, may
  be authorized by the superintendent  to  issue  contracts  or  otherwise
  enter  into  arrangements with approved organizations for the purpose of
  providing child health insurance plan  policies  for  eligible  children
  pursuant  to  title I-A of article twenty-five of the public health law.
  Such contracts or arrangements shall satisfy the criteria set  forth  in
  subsection  (b)  of  this  section and the superintendent shall make the
  determinations set forth in subsection (e) of this section.
    (b) The superintendent may authorize such  contracts  or  arrangements
  pursuant to the following criteria:
    (1) the provisions are not misleading or confusing;
    (2)  the  provisions are consistent with the needs of the child health
  insurance plan; and
    (3) the materials describing the contract  or  arrangement  fully  and
  clearly   state  the  benefits  and  limitations  of  such  contract  or
  arrangement.
    (c) The duration of such contracts or arrangements and the  extent  of
  exposure  thereunder  by  insurers,  article forty-three corporations or
  health  maintenance   organizations   shall   be   determined   by   the
  superintendent.
    (d)  Notwithstanding  any  provisions of this chapter or the financial
  services law to the contrary, the superintendent may  waive,  modify  or
  suspend  any  provisions  of this chapter, the financial services law or
  regulations  promulgated  thereunder  as  applicable  to  the  insurers,
  article  forty-three  corporations  or  health maintenance organizations
  that issue coverage pursuant to  this  section,  provided  such  waiver,
  modification  or  suspension  is  based  on  the  criteria  set forth in
  subsection (e) of this section.
    (e) The superintendent may take the actions set forth  in  subsections
  (a) and (d) of this section upon the superintendent's judgment that:
    (1)  the  contract  or  arrangement  is  a  reasonable and appropriate
  approach to expand the availability of health care coverage to children;
    (2) the sources  of  funding  for  the  contract  or  arrangement  are
  reasonably  related  to  the benefits provided and sufficient to support
  the contract arrangement;
    * (3) any waiver, modification or suspension of the provisions of this
  chapter,  the  financial  services  law   or   regulations   promulgated
  thereunder  is  essential to the operation of the child health insurance
  plan and to the rational development  of  programs  to  provide  covered
  services to children; and
    * NB Effective until July 1, 2014
    * (3)  any  waiver,  modification  or suspension of provisions of this
  chapter,  the  financial  services  law   or   regulations   promulgated
  thereunder  is  essential to the operation of the child health insurance
  plan and to the rational development of programs to provide primary  and
  preventive  health  care  coverage  and  inpatient  health care services
  coverage to children; and
    * NB Effective July 1, 2014
    (4) any waiver, modification  or  suspension  of  provisions  of  this
  chapter,   the   financial   services  law  or  regulations  promulgated
  thereunder  will  not  impair  the  ability  of  the  insurer,   article
  forty-three  corporation  or  health maintenance organization to satisfy

  its existing and anticipated contracts and other obligations,  including
  such standards as the superintendent shall prescribe concerning adequate
  capital and financial requirements.
    (f)  Each  application  used  by an authorized insurer for purposes of
  enrolling  eligible  children  into  the  child  health  insurance  plan
  pursuant  to  this section and section twenty-five hundred eleven of the
  public  health  law  shall  include  the  notice  required  pursuant  to
  subsection (d) of section four hundred three of this chapter.