N.Y. ISC Law § 1122 — New York Code / Act ISC / Article 11 / Section 1122
New York state health insurance continuation assistance demonstration project
Status: in_force

* § 1122. New York state health insurance continuation assistance\ndemonstration project. (a) Definitions. For the purposes of this\nsection, unless the context clearly requires otherwise:\n  (1) "Continuation assistance" means payments made by the\nsuperintendent to an eligible individual, a health plan or insurer, a\nparticipating employer, or a labor-management health benefits fund to\nallow an eligible individual to obtain or maintain continuation\ncoverage.\n  (2) "Continuation coverage" means group health insurance coverage\nwhich a participating employer or labor-management health benefits fund\nis obligated to offer to an individual pursuant to the 1985 Consolidated\nOmnibus Budget Reconciliation Act (COBRA), as amended by the Tax Reform\nAct of 1986, or continuation provisions pursuant to subsection (m) of\nsection three thousand two hundred twenty-one, subsection (k) of section\nfour thousand three hundred four or subsection (e) of section four\nthousand three hundred five of this chapter.\n  (3) "Displaced worker" means an individual that is a resident of New\nYork state and has been terminated or has received a notice of\ntermination as a result of increased imports from, or shifts in\nproduction to, foreign countries as described in the Trade Act programs,\nTrade Adjustment Assistance (TAA) and Alternative Trade Adjustment\nAssistance (ATAA).\n  (4) "Eligible individual" means a person who is an entertainment\nindustry employee or displaced worker and who:\n  (A) is not eligible for health insurance coverage or medical benefits\npursuant to part A or B of title XVIII of the Social Security Act or\ntitle eleven of article five of the social services law;\n  (B) is eligible for or is currently enrolled under continuation\ncoverage (and, with respect to an entertainment industry employee, is\neligible for or enrolled under continuation coverage through a\ncollectively bargained plan covering entertainment industry employees),\nwhere such eligible individual is not covered under continuation already\nsubsidized through continuation assistance pursuant to the public health\nlaw;\n  (C) resides in a household having a gross monthly household income at\nor below four hundred percent of the non-farm federal poverty level (as\ndefined and updated by the federal department of health and human\nservices);\n  (D) is not eligible for employer provided coverage; and\n  (E) maintains the same level of insurance coverage as when they were\nemployed.\n  (5) "Entertainment industry employee" means an individual who is a\nresident of New York state and is employed in the entertainment\nindustry, as defined by the commissioner, including, but not limited to,\nthe film, motion picture, television, theater, music, music recording,\ndance, radio, and circus industries.\n  (6) "Individual payment" means the amount of premium required for\ncontinuation coverage, less the amount of a continuation assistance\npayment made by the superintendent, to be paid by an eligible\nindividual.\n  (7) "New York state health insurance continuation assistance\ndemonstration project" means the pilot program for the entertainment\nindustry employees and the pilot program for displaced workers.\n  (8) "Participating employer" means an employer who is obligated to\ncontinue coverage for an eligible individual pursuant to the 1985\nConsolidated Omnibus Budget Reconciliation Act (COBRA), or subsection\n(m) of section three thousand two hundred twenty-one, subsection (k) of\nsection four thousand three hundred four, or subsection (e) of section\nfour thousand three hundred five of this chapter.\n  (9) "Pilot program for displaced workers" means the program which\nassists eligible individuals who are displaced workers in obtaining or\nmaintaining continuation coverage pursuant to this section.\n  (10) "Pilot program for entertainment industry employees" means the\nprogram which assists eligible individuals who are entertainment\nindustry employees in obtaining or maintaining continuation coverage\npursuant to this section.\n  (b) Pilot program for entertainment industry employees. (1) The pilot\nprogram for entertainment industry employees shall assist eligible\nindividuals who are entertainment industry workers in maintaining or\nobtaining continuation coverage.\n  (2) An eligible individual may apply to the superintendent for\ncontinuation assistance by submitting an application therefor on a form\nprescribed by the superintendent. The information required on the\napplication shall include, but not be limited to:\n  (A) the name and address of the entertainment industry employee;\n  (B) the name, address, and telephone number of the participating\nemployer;\n  (C) the date the eligible individual became or will become eligible\nfor continuation coverage, the date such eligibility ends, and, when\navailable, correspondence to an entertainment industry employee from a\nlabor-management health benefits fund proving eligibility;\n  (D) the names of all dependents who are covered or are to be covered\nunder the continuation policy; and\n  (E) documentation establishing the household income of an eligible\nindividual, which may include annual income tax returns and, if not\nprohibited by federal law for purposes of income verification, social\nsecurity numbers, paycheck stubs, written documentation of income from\nall employers, or such other documentation as the superintendent may\nrequire.\n  (3) The superintendent shall review the applications and advise the\napplicants as to their eligibility to participate in the pilot program.\nWithin amounts available for such purpose, the superintendent shall\nprovide continuation assistance. Such assistance shall be issued, to the\nextent of funds available therefor, which is equivalent to seventy-five\npercent of the premium for the period covered by such assistance.\nContinuation assistance shall not be provided for more than twelve\nmonths within a five-year period.\n  (4) In approving applications from eligible individuals, the\nsuperintendent shall:\n  (A) make a determination as to the extent of available funds for the\npilot program so as to assure, to the extent possible, that the funding\nwill be available to provide continuation assistance to the applicant in\nan amount equal to seventy-five percent of the premium for a period of\ntwelve months within five years; if the superintendent determines that\nsuch funding may not be available due to the level of enrollment in the\npilot program at the time of the eligible individual's application, the\nsuperintendent shall deny such application; and\n  (B) require eligible individuals who are awarded continuation\nassistance to sign an acknowledgement that recipients who later become\neligible for health insurance coverage through another employer are no\nlonger eligible to receive assistance under this section and that the\nstate may seek to recover assistance provided after the date of such\neligibility.\n  (5) The superintendent shall make continuation assistance payments\navailable pursuant to this subsection directly to the collectively\nbargained labor-management health benefits fund on behalf of eligible\nindividuals. The fund must provide the superintendent such information\nas the superintendent may reasonably require to enable the\nsuperintendent to administer the terms and conditions of the pilot\nprogram.\n  (6) The superintendent may promulgate rules and regulations necessary\nto the administration of this pilot program.\n  (7) The superintendent may contract with an organization to assist in\nthe administration of this pilot program. If the superintendent deems it\nappropriate to utilize an organization to assist in the administration\nof this pilot program, the organization shall submit reports to the\nsuperintendent in such form and at such times as required by the\nsuperintendent. An organization approved to assist with program\nadministration shall maintain records in a form prescribed by the\nsuperintendent and which shall be available for inspection by or at the\nrequest of the superintendent.\n  (c) Pilot program for displaced workers. (1) The pilot program for\ndisplaced workers shall assist eligible individuals who are displaced\nworkers in maintaining or obtaining continuation coverage.\n  (2) An eligible individual may apply to the superintendent for\ncontinuation assistance by submitting an application therefor on a form\nprescribed by the superintendent. The information required on the\napplication shall include, but not be limited to:\n  (A) the name and address of the displaced worker;\n  (B) the name, address, and telephone number of the participating\nemployer;\n  (C) the date the eligible individual became or will become eligible\nfor continuation coverage, the date such eligibility ends, and, when\navailable, correspondence to a displaced worker from a participating\nemployer or labor-management health benefits fund proving eligibility;\n  (D) the names of all dependents who are covered or are to be covered\nunder the continuation policy; and\n  (E) documentation establishing the household income of an eligible\nindividual, which may include annual income tax returns and, if not\nprohibited by federal law for purposes of income verification, social\nsecurity numbers, paycheck stubs, written documentation of income from\nall employers, or such other documentation as the superintendent may\nrequire.\n  (3) The superintendent shall review the applications and advise the\napplicants as to their eligibility to participate in the pilot program.\nWithin amounts available for such purpose, the superintendent shall\nprovide continuation assistance. Such assistance shall be issued, to the\nextent of funds available therefor, which is equivalent to seventy-five\npercent of the premium for the period covered by such assistance.\nContinuation assistance shall not be provided for more than twelve\nmonths within a five-year period.\n  (4) In approving applications from eligible individuals, the\nsuperintendent shall:\n  (A) make a determination as to the extent of available funds for the\npilot program so as to assure, to the extent possible, that the funding\nwill be available to provide continuation assistance to the applicant in\nan amount equal to seventy-five percent of the premium for a period of\ntwelve months within five years; if the superintendent determines that\nsuch funding may not be available due to the level of enrollment in the\npilot program at the time of the eligible individual's application, the\nsuperintendent shall deny such application; and\n  (B) require eligible individuals who were awarded continuation\nassistance to sign an acknowledgement that recipients who later become\neligible for health insurance coverage through another employer are no\nlonger eligible to receive assistance under this section and that the\nstate may seek to recover assistance provided after the date of such\neligibility.\n  (5) The superintendent shall make continuation assistance payments\navailable pursuant to this subsection directly to the individual or to\nthe health plan or insurer, labor-management health benefits fund, or\nparticipating employer on behalf of eligible individuals. The fund or\nemployer must provide the superintendent such information as the\nsuperintendent may reasonably require to enable the superintendent to\nadminister the terms and conditions of the pilot program.\n  (6) The superintendent may promulgate rules and regulations necessary\nto administer this pilot program.\n  (7) The superintendent may contract with an organization to assist in\nthe administration of this pilot program. If the superintendent deems it\nappropriate to utilize an organization to assist in the administration\nof this pilot program, the organization shall submit reports to the\nsuperintendent in such form and at such times as required by the\nsuperintendent. An organization approved to assist with program\nadministration shall maintain records in a form prescribed by the\nsuperintendent and which shall be available for inspection by or at the\nrequest of the superintendent.\n  (d) The superintendent shall complete a study of the New York state\nhealth insurance continuation assistance demonstration project set forth\nin this section. Such study shall examine the efficacy of the project in\nimpacting the insurance marketplace in New York state and the impact of\nthe demonstration project in reducing the large number of uninsured\nindividuals in the entertainment industry and other industries in New\nYork characterized by seasonal and episodic employment. The\nsuperintendent may contract with an organization for the completion of\nthe study. The study shall be provided to the temporary president of the\nsenate and the speaker of the assembly.\n  * NB Repealed July 1, 2027\n