2023 New York Laws › PBH - Public Health › Article 44 - Health Maintenance Organizations › 4407 - Health Maintenance Organizations; Employer Requirements.

§  4407.  Health  maintenance organizations; employer requirements. 1.
All employers subject to the provisions of  the  unemployment  insurance
law,  except  for those employers with fewer than twenty-five employees,
shall include in any health benefits plan offered  to  their  employees,
the  option  of  membership  in  a health maintenance organization which
provides or offers a comprehensive health services  plan  in  accordance
with  the  provisions  of  this article, but only if such plan serves an
area in which twenty-five of such employer's employees  reside  and  the
organization   has  been  issued  a  certificate  of  authority  by  the
commissioner.
2. For those employees of an  employer  represented  by  a  bargaining
representative,   the  offer  of  the  health  maintenance  organization
alternative shall be subject only to the collective bargaining  process;
for  those employees not represented by a bargaining representative, the
offer of the health maintenance organization alternative shall  be  made
directly to the employee.
3.  (a)  If  there  is  more  than one health maintenance organization
engaged in the provision of health services in the  area  in  which  the
employees of the employer reside, and if:
(i)  one  or more of such organizations provides more than one-half of
its comprehensive health services through  physicians  or  other  health
professionals  who  are members of the staff of the organization or of a
medical group (or groups) which contracts with the organization, and
(ii) one or more of  such  organizations  provides  its  comprehensive
health   services   through   contracts   with  an  individual  practice
association (or associations), individual physicians  and  other  health
professionals  under  contract  directly  with  the  organization,  or a
combination of an individual  practice  association  (or  associations),
medical  group  (or  groups), physicians who are members of the staff of
the  organization,  and   individual   physicians   and   other   health
professionals under contract directly with the organization,
then   the  employer  shall,  in  accordance  with  regulations  of  the
commissioner, be required to offer the option of enrollment in at  least
one  organization described in subparagraph (i) of this paragraph and at
least one organization described in subparagraph (ii) of this  paragraph
if  the  employer  has  twenty-five  or  more but fewer than two hundred
employees. If the employer has two hundred or  more  employees  and  the
employer's  principal  office  in  this  state is located outside of the
metropolitan region then the employer shall be  required  to  offer  the
option  of  enrollment  in  at  least  two  organizations  described  in
subparagraph (i) of  this  paragraph  and  at  least  two  organizations
described  in  subparagraph  (ii) of this paragraph. If the employer has
two hundred or more employees and the  employer's  principal  office  in
this  state  is located within the metropolitan region then the employer
shall be required to offer the option of  enrollment  in  at  least  two
organizations  described  in  subparagraph  (i) of this paragraph and at
least two organizations described in subparagraph (ii) of this paragraph
and an additional  organization  from  either  subparagraph.    For  the
purposes  of  this  section  the  metropolitan  region is defined as the
counties of Westchester, Rockland, New York,  Kings,  Queens,  Richmond,
Bronx, Nassau and Suffolk.
(b)  If  within  any  particular  area  of the state in which at least
twenty-five of such employer's employees reside there are  fewer  health
maintenance  organizations  described  in  subparagraph  (i)  or (ii) of
paragraph (a) of this subdivision  than  the  employer  is  required  to
offer,   then   additional   health   maintenance   organizations   from
subparagraph (i) or (ii) of paragraph (a) of this subdivision  shall  be
offered; provided, however, that no employer with fewer than two hundred

employees  shall  be  required  to offer more than a total of two health
maintenance organizations, and no employer  with  two  hundred  or  more
employees  shall  be  required to offer more than a total of four health
maintenance  organizations (or five such organizations if the employer's
principal office is located  within  the  metropolitan  region)  in  any
particular  area  of  the  state.   In the event fewer than the required
total minimum number of health maintenance organizations  are  available
in   an   area,   the   employer  shall  offer  all  health  maintenance
organizations then certified to issue subscriber contracts in that area.
Nothing in this subdivision shall be deemed to prohibit an employer from
choosing to offer more health maintenance organizations to its employees
than are required under this subdivision.
4. No employer shall be required to pay more for health benefits as  a
result  of  the  application  of  this  section  than would otherwise be
required by any prevailing  collective  bargaining  agreement  or  other
legally  enforceable  contract  for  the  provision  of  health benefits
between an employer and his employees.