2023 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 gross monthly household income at
or below four hundred percent of the non-farm federal poverty level  (as
defined  and  updated  by  the  federal  department  of health and human
services);
(D) is not eligible for employer provided coverage; and
(E) maintains the same level of insurance coverage as when  they  were
employed.
(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 seventy-five
percent of the premium  for  the  period  covered  by  such  assistance.
Continuation  assistance  shall  not  be  provided  for more than twelve
months within a five-year period.
(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 seventy-five percent of the premium for a period of
twelve months within five years; 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  seventy-five
percent  of  the  premium  for  the  period  covered by such assistance.
Continuation assistance shall not  be  provided  for  more  than  twelve
months within a five-year period.
(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 seventy-five percent of the premium for a  period  of
twelve  months  within five years; 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, 2025