NY Ins L § 1122 (2021)
2021 New York Laws ISC - Insurance Article 11 - Licensing of Insurers 1122 - New York State Health Insurance Continuation Assistance Demonstration Project.

* §  1122.  New  York  state  health insurance continuation assistance demonstration  project.  (a)  Definitions.  For  the  purposes  of  this section, unless the context clearly requires otherwise:  (1)   "Continuation   assistance"   means   payments   made   by   the superintendent to an eligible individual, a health plan  or  insurer,  a participating  employer,  or  a labor-management health benefits fund to allow  an  eligible  individual  to  obtain  or  maintain   continuation coverage.  (2)  "Continuation  coverage"  means  group  health insurance coverage which a participating employer or labor-management health benefits  fund is obligated to offer to an individual pursuant to the 1985 Consolidated Omnibus  Budget Reconciliation Act (COBRA), as amended by the Tax Reform Act of 1986, or continuation provisions pursuant to  subsection  (m)  of section three thousand two hundred twenty-one, subsection (k) of section four  thousand  three  hundred  four  or  subsection (e) of section four thousand three hundred five of this chapter.  (3) "Displaced worker" means an individual that is a resident  of  New York  state  and  has  been  terminated  or  has  received  a  notice of termination as  a  result  of  increased  imports  from,  or  shifts  in production to, foreign countries as described in the Trade Act programs, Trade  Adjustment  Assistance  (TAA)  and  Alternative  Trade Adjustment Assistance (ATAA).  (4) "Eligible individual" means  a  person  who  is  an  entertainment industry employee or displaced worker and who:  (A)  is not eligible for health insurance coverage or medical benefits pursuant to part A or B of title XVIII of the  Social  Security  Act  or title eleven of article five of the social services law;  (B)  is  eligible  for  or  is  currently  enrolled under continuation coverage (and, with respect to an entertainment  industry  employee,  is eligible   for   or  enrolled  under  continuation  coverage  through  a collectively bargained plan covering entertainment industry  employees), where such eligible individual is not covered under continuation already subsidized through continuation assistance pursuant to the public health law;  (C)  resides  in a household having a net household income at or below two hundred eight percent of the  non-farm  federal  poverty  level  (as defined  and  updated  by  the  federal  department  of health and human services) or the gross equivalent of such net income; and  (D) is not eligible for employer provided coverage.  (5) "Entertainment industry employee" means an  individual  who  is  a resident  of  New  York  state  and  is  employed  in  the entertainment industry, as defined by the commissioner, including, but not limited to, the film, motion picture, television, theater, music,  music  recording, dance, radio, and circus industries.  (6)  "Individual  payment"  means  the  amount of premium required for continuation coverage, less the  amount  of  a  continuation  assistance payment   made  by  the  superintendent,  to  be  paid  by  an  eligible individual.  (7)  "New  York  state  health   insurance   continuation   assistance demonstration  project"  means  the  pilot program for the entertainment industry employees and the pilot program for displaced workers.  (8) "Participating employer" means an employer  who  is  obligated  to continue  coverage  for  an  eligible  individual  pursuant  to the 1985 Consolidated Omnibus Budget Reconciliation Act  (COBRA),  or  subsection (m)  of section three thousand two hundred twenty-one, subsection (k) of section four thousand three hundred four, or subsection (e)  of  section four thousand three hundred five of this chapter.  (9)  "Pilot  program  for  displaced  workers" means the program which assists eligible individuals who are displaced workers in  obtaining  or maintaining continuation coverage pursuant to this section.  (10)  "Pilot  program  for entertainment industry employees" means the program  which  assists  eligible  individuals  who  are   entertainment industry  employees  in  obtaining  or maintaining continuation coverage pursuant to this section.  (b) Pilot program for entertainment industry employees. (1) The  pilot program  for  entertainment  industry  employees  shall  assist eligible individuals who are entertainment industry  workers  in  maintaining  or obtaining continuation coverage.  (2)  An  eligible  individual  may  apply  to  the  superintendent for continuation assistance by submitting an application therefor on a  form prescribed  by  the  superintendent.  The  information  required  on the application shall include, but not be limited to:  (A) the name and address of the entertainment industry employee;  (B) the name, address,  and  telephone  number  of  the  participating employer;  (C)  the  date  the eligible individual became or will become eligible for continuation coverage, the date such  eligibility  ends,  and,  when available,  correspondence  to an entertainment industry employee from a labor-management health benefits fund proving eligibility;  (D) the names of all dependents who are covered or are to  be  covered under the continuation policy; and  (E)  documentation  establishing  the  household income of an eligible individual, which may include annual income  tax  returns  and,  if  not prohibited  by  federal  law for purposes of income verification, social security numbers, paycheck stubs, written documentation of  income  from all  employers,  or  such  other documentation as the superintendent may require.  (3) The superintendent shall review the applications  and  advise  the applicants  as to their eligibility to participate in the pilot program. Within amounts available for  such  purpose,  the  superintendent  shall provide continuation assistance. Such assistance shall be issued, to the extent of funds available therefor, which is equivalent to fifty percent of  the  premium for the period covered by such assistance. Continuation assistance shall not be provided for more than twelve months.  (4)  In  approving  applications  from   eligible   individuals,   the superintendent shall:  (A)  make  a determination as to the extent of available funds for the pilot program so as to assure, to the extent possible, that the  funding will be available to provide continuation assistance to the applicant in an  amount  equal to fifty percent of the premium for a period of twelve months; if the superintendent determines that such funding  may  not  be available  due  to  the  level of enrollment in the pilot program at the time of the eligible individual's application, the superintendent  shall deny such application; and  (B)   require   eligible  individuals  who  are  awarded  continuation assistance to sign an acknowledgement that recipients who  later  become eligible  for  health insurance coverage through another employer are no longer eligible to receive assistance under this section  and  that  the state  may  seek  to  recover assistance provided after the date of such eligibility.  (5) The superintendent shall  make  continuation  assistance  payments available  pursuant  to  this  subsection  directly  to the collectively bargained labor-management health benefits fund on  behalf  of  eligible individuals.  The  fund must provide the superintendent such information as  the  superintendent   may   reasonably   require   to   enable   the  superintendent  to  administer  the  terms  and  conditions of the pilot program.  (6)  The superintendent may promulgate rules and regulations necessary to the administration of this pilot program.  (7) The superintendent may contract with an organization to assist  in the administration of this pilot program. If the superintendent deems it appropriate  to  utilize an organization to assist in the administration of this pilot program, the organization  shall  submit  reports  to  the superintendent  in  such  form  and  at  such  times  as required by the superintendent.  An  organization  approved  to  assist   with   program administration  shall  maintain  records  in  a  form  prescribed by the superintendent and which shall be available for inspection by or at  the request of the superintendent.  (c)  Pilot  program  for  displaced workers. (1) The pilot program for displaced workers shall assist eligible individuals  who  are  displaced workers in maintaining or obtaining continuation coverage.  (2)  An  eligible  individual  may  apply  to  the  superintendent for continuation assistance by submitting an application therefor on a  form prescribed  by  the  superintendent.  The  information  required  on the application shall include, but not be limited to:  (A) the name and address of the displaced worker;  (B) the name, address,  and  telephone  number  of  the  participating employer;  (C)  the  date  the eligible individual became or will become eligible for continuation coverage, the date such  eligibility  ends,  and,  when available,  correspondence  to  a  displaced worker from a participating employer or labor-management health benefits fund proving eligibility;  (D) the names of all dependents who are covered or are to  be  covered under the continuation policy; and  (E)  documentation  establishing  the  household income of an eligible individual, which may include annual income  tax  returns  and,  if  not prohibited  by  federal  law for purposes of income verification, social security numbers, paycheck stubs, written documentation of  income  from all  employers,  or  such  other documentation as the superintendent may require.  (3) The superintendent shall review the applications  and  advise  the applicants  as to their eligibility to participate in the pilot program. Within amounts available for  such  purpose,  the  superintendent  shall provide continuation assistance. Such assistance shall be issued, to the extent of funds available therefor, which is equivalent to fifty percent of  the  premium for the period covered by such assistance. Continuation assistance shall not be provided for more than twelve months.  (4)  In  approving  applications  from   eligible   individuals,   the superintendent shall:  (A)  make  a determination as to the extent of available funds for the pilot program so as to assure, to the extent possible, that the  funding will be available to provide continuation assistance to the applicant in an  amount  equal to fifty percent of the premium for a period of twelve months; if the superintendent determines that such funding  may  not  be available  due  to  the  level of enrollment in the pilot program at the time of the eligible individual's application, the superintendent  shall deny such application; and  (B)   require  eligible  individuals  who  were  awarded  continuation assistance to sign an acknowledgement that recipients who  later  become eligible  for  health insurance coverage through another employer are no longer eligible to receive assistance under this section  and  that  the state  may  seek  to  recover assistance provided after the date of such eligibility.  (5) The superintendent shall  make  continuation  assistance  payments available  pursuant  to this subsection directly to the individual or to the health plan or insurer, labor-management health  benefits  fund,  or participating  employer  on  behalf of eligible individuals. The fund or employer  must  provide  the  superintendent  such  information  as  the superintendent may reasonably require to enable  the  superintendent  to administer the terms and conditions of the pilot program.  (6)  The superintendent may promulgate rules and regulations necessary to administer this pilot program.  (7) The superintendent may contract with an organization to assist  in the administration of this pilot program. If the superintendent deems it appropriate  to  utilize an organization to assist in the administration of this pilot program, the organization  shall  submit  reports  to  the superintendent  in  such  form  and  at  such  times  as required by the superintendent.  An  organization  approved  to  assist   with   program administration  shall  maintain  records  in  a  form  prescribed by the superintendent and which shall be available for inspection by or at  the request of the superintendent.  (d)  The  superintendent  shall complete a study of the New York state health insurance continuation assistance demonstration project set forth in this section. Such study shall examine the efficacy of the project in impacting the insurance marketplace in New York state and the impact  of the  demonstration  project  in  reducing  the large number of uninsured individuals in the entertainment industry and other  industries  in  New York   characterized   by   seasonal   and   episodic   employment.  The superintendent may contract with an organization for the  completion  of the study. The study shall be provided to the temporary president of the senate and the speaker of the assembly.   * NB Repealed July 1, 2022