N.Y. PBH Law § 922 — New York Code / Act PBH / Article 9-A / Section 922
New York state small business health insurance partnership program
Status: in_force

§ 922. New York state small business health insurance partnership\nprogram. 1. The commissioner is authorized to the extent of funds\navailable therefor to establish the New York state small business health\ninsurance partnership program.\n  2. New York state small business health insurance partnership program.\n(a) A small business health insurance partnership program shall assist\neligible employers in purchasing small group health insurance policies\nfor their full-time employees and dependents.\n  (b) An eligible employer may apply to the commissioner for approval in\nthe small business health insurance partnership program by submitting an\napplication on a form prescribed by the commissioner. The information\nrequired on such application shall include, but not be limited to:\n  (i) the name and address of the employer and the nature of the\nbusiness;\n  (ii) the names and salaries of the employer and employees;\n  (iii) an affidavit by the employer that employer-provided health\ninsurance benefits have not been provided to employees in the\ntwelve-month period prior to the effective date of this article; and\n  (iv) such other information as the commissioner may require.\n  (c) Upon reviewing the applications from eligible small employers, the\ncommissioner shall, within the amount appropriated for such purpose,\naward partnership certificates to employers which meet the eligibility\nrequirements; provided however, no partnership certificates will be\nawarded by the commissioner on and after January first, two thousand.\nIn addition to evidencing approval of an eligible employer, the\ncertificate shall state the amount of a small business health insurance\npartnership incentive payment for a small group health insurance policy,\nwhich in no event may exceed forty-five percent of the premium costs for\ngroup health care coverage for employees and their dependents. Employees\nmay be required to make contributions to the payment of premium costs\nunder this program at the option of the employer, but in no event shall\nsuch contribution exceed ten percent of the premium costs. Premium costs\nincurred by an employer for small group health insurance coverage for\nofficers and directors of an employer and others with a proprietary or\nownership interest in the employer may be eligible for an incentive\npayment to offset premium costs; provided, however, that the gross\nhousehold income of such officers and directors or others with a\nproprietary or ownership interest is at or below two hundred twenty-two\npercent of the non-farm federal poverty level and provided further that\none or more employees and their dependents proposed to be covered by\nsuch group health care coverage are unrelated to such officers,\ndirectors or other persons with a proprietary or ownership interest. If\nafter joining the program an employer participating in a small business\ninsurance partnership program hires more employees so that the employer\nhas more than fifty full-time employees at any one time, the employer\nmay continue in the program but the premium costs attributable to the\nadditional employees in excess of fifty or their families shall not be\neligible for incentive payments.\n  (d) In approving partnership certificates for eligible small employers\nprior to January first, two thousand, the commissioner shall:\n  (i) first approve applications from eligible employers currently\nreceiving assistance through a small business health insurance program\ncreated by the expanded health care coverage act authorized pursuant to\nchapter seven hundred three of the laws of nineteen hundred\neighty-eight; and\n  (ii) give preference to eligible employers with the lowest average\nsalaries and base the amount of the certificate on the salaries received\nby the employer and employees in order to maximize the impact of the\nsmall business partnership premium payments.\n  (e) Upon receipt of a partnership certificate from the commissioner,\nan approved eligible employer may obtain a small group health insurance\npolicy from the insurer, health maintenance organization or corporation\nof its choice. No such insurer, health maintenance organization or\ncorporation shall refuse to accept a small employer holding a valid\npartnership certificate and such insurer, organization or corporation\nshall arrange for the payment of the small employer's share of the small\ngroup health insurance policy or comprehensive health services plan\npremium. The approved applicant shall make available upon request from\nthe commissioner information regarding continued eligibility in the\nprogram.\n  The commissioner shall, within amounts available therefor, on a\ncompetitive bid process, contract with organizations for purposes of\npublic education, outreach and recruitment of eligible businesses,\nincluding the distribution of applications and information regarding\nenrollment. The organizations shall include, but not be limited to:\ncommunity based organizations such as chambers of commerce or trade\norganizations, diagnostic and treatment centers, hospitals, and other\nsuch organizations which engage in outreach and marketing activities. In\nno event shall the amount available for education, outreach, and\nrecruitment exceed two percent of the total amount available for the\npurposes of this section.\n  (f) The commissioner, by rules and regulations, adopted by the\ncommissioner shall establish the procedure by which insurers,\ncorporations and organizations issuing small group health insurance\npolicies under this article may redeem a certificate or certificates for\nthe portion of the premium not paid by the employer, but in no event\nshall such redemption occur on less than a quarterly basis.\n  Any business which, with the intent to obtain benefits, willfully\nmisstates information required for application for participation in the\nNew York state health insurance partnership program or willfully fails\nto notify the commissioner or the commissioner's designee of any change\nin status which makes the business ineligible for the program, shall\nrepay such incentive payments paid on behalf of its employees or program\nparticipants for health coverage through the New York state health\ninsurance partnership program.\n  (g) Notwithstanding any inconsistent provision of law or regulation to\nthe contrary, benefits under the small business health insurance\npartnership program shall be considered secondary to any other plan of\ninsurance or benefit program under which a person may have coverage.\n  (h) On or before April first, nineteen hundred ninety-seven, and\nannually thereafter through April first, two thousand, the commissioner\nshall submit a report on the small business health insurance partnership\nprogram to the governor, the speaker of the assembly and the majority\nleader of the senate. Such report shall include, but not be limited to:\n  (i) the number of employers and employees able to purchase small group\nhealth insurance policies under the program;\n  (ii) the location and the nature of the business of such employers;\nand\n  (iii) recommendations for any changes which would improve the program.\n