2020 New York Laws
ISC - Insurance
Article 11 - Licensing of Insurers
1118 - Regional Pilot Projects for the Uninsured.

§  1118.  Regional pilot projects for the uninsured. (a) An authorized
insurer subject to the provisions of this chapter and organized to write
the kind of insurance specified in paragraph three of subsection (a)  of
section  one thousand one hundred thirteen of this article, and a health
maintenance organization authorized pursuant to article  forty-three  of
this  chapter  or  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  in  connection  with
regional pilot projects to test models  for  the  purpose  of  providing
insurance  and  equivalent  coverage  mechanisms for the uninsured. Such
plans must 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. For  the  purpose  of  this  section,
regional  pilot  projects shall mean projects authorized pursuant to the
expanded health care coverage act of nineteen hundred eighty-eight.
  (b) The superintendent may authorize such  contracts  or  arrangements
for regional pilot projects pursuant to the following criteria:
  (1) the plan's provisions are not misleading or confusing;
  (2)  the  plan's  provisions  are  consistent  with  the  needs of the
regional pilot projects; and
  (3) the plan, the contract and other  materials  describing  the  plan
fully and clearly state the benefits, limitations of the plan.
  (c)  The  duration  of  such  contracts  and  the  extent  of exposure
thereunder by insurers 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  provision  of  this chapter, the financial services law or
regulations promulgated thereunder as  applicable  to  the  insurers  or
health   maintenance  organizations  that  conduct  the  regional  pilot
projects,  except  as  to  mandatory  benefits,  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  plan  is a reasonable and appropriate approach to expand the
availability of health care coverage or equivalent  coverage  mechanisms
for the uninsured;
  (2)  the  premium  rates and other sources of funding for the regional
pilot project  is  reasonably  related  to  the  benefits  provided  and
sufficient to support the program;
  (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 regional pilot project
and to the rational development  of  programs  to  provide  health  care
coverage or equivalent coverage mechanisms to the uninsured; and
  (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  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.