2022 New York Laws
ISC - Insurance
Article 11 - Licensing of Insurers
1109 - Limited Exemption for Health Maintenance Organizations.

Universal Citation: NY Ins L § 1109 (2022)
§ 1109. Limited exemption for health maintenance organizations. (a) An
organization  complying with the provisions of article forty-four of the
public health law may operate without being licensed under this  chapter
and without being subject to any provisions of this chapter, except: (1)
to  the extent that such organization must comply with the provisions of
this chapter by virtue of  such  article,  and  (2)  the  provisions  of
sections  three  hundred  eight,  one  thousand  three  hundred one, one
thousand three hundred  two,  one  thousand  three  hundred  seven,  one
thousand  three  hundred  twenty-two,  with regard to health maintenance
organizations  that  are  domiciled  in  this  state  and  certified  or
operating  in  at least one other state, two thousand one hundred three,
two thousand one hundred twelve, two thousand one hundred fourteen,  two
thousand  one  hundred  fifteen, two thousand one hundred seventeen, two
thousand one hundred twenty-three, two thousand six hundred eight-a, two
thousand six hundred twelve, three thousand two  hundred  twenty-four-a,
four   thousand   three  hundred  eight,  four  thousand  three  hundred
seventeen, four thousand three hundred  eighteen,  four  thousand  three
hundred  twenty,  four  thousand three hundred twenty-one, four thousand
three hundred twenty-two and four thousand three hundred twenty-three of
this chapter.

(b) An organization which provides health care services for a periodic fee paid in advance but which does not comply with the provisions of article forty-four of the public health law shall be deemed to be engaged in the business of insurance and may not operate without being licensed under this chapter.

(c) An organization referred to in subsection (a) or (b) hereof shall be subject to article seventy-four of this chapter.

(d) A health maintenance organization may make any investment permitted for a health service corporation organized pursuant to article forty-three of this chapter provided that the superintendent, after consultation with the commissioner of health, may modify such investment requirements, if such modification would permit the organization to more effectively implement its program without incurring undue risk to its subscribers.

(e) The superintendent may promulgate regulations in effectuating the purposes and provisions of this chapter and article forty-four of the public health law and may modify requirements applicable to the contracts between a health maintenance organization and its subscribers, subject to such limitations as the superintendent shall deem necessary or proper to insure the performance of such contracts.

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