2023 New York Laws › PBH - Public Health › Article 2 - The Department of Health › Title 7 - Ny State of Health › 268-A - Definitions.

§  268-a.  Definitions.  For  purposes  of  this  title, the following
definitions shall apply:
1. "Commissioner" means the commissioner of health of the state of New
York.
2. "Marketplace" means the "NY State of Health,  The  official  health
plan  Marketplace"  or  "Marketplace"  established  as  a health benefit
exchange or "marketplace" within the department of  health  pursuant  to
Executive Order 42 (Cuomo) issued April 12, 2012 and this title.
3. "Federal act" means the patient protection and affordable care act,
public  law  111-148,  as  amended  by  the  health  care  and education
reconciliation act of 2010, public law 111-152, and any  regulations  or
guidance issued thereunder.
4.  "Health  plan" means a policy, contract or certificate, offered or
issued by an insurer to  provide,  deliver,  arrange  for,  pay  for  or
reimburse  any  of  the costs of health care services. Health plan shall
not include the following:
(a)  accident  insurance  or  disability  income  insurance,  or   any
combination thereof;
(b) coverage issued as a supplement to liability insurance;
(c)  liability  insurance,  including  general liability insurance and
automobile liability insurance;
(d) workers' compensation or similar insurance;
(e) automobile no-fault insurance;
(f) credit insurance;
(g)  other  similar  insurance  coverage,  as  specified  in   federal
regulations,  under  which  benefits  for  medical care are secondary or
incidental to other insurance benefits;
(h) limited scope dental or vision benefits,  benefits  for  long-term
care  insurance,  nursing  home  insurance,  home care insurance, or any
combination thereof, or such  other  similar,  limited  benefits  health
insurance  as  specified  in  federal  regulations,  if the benefits are
provided under a separate policy, certificate or contract  of  insurance
or are otherwise not an integral part of the plan;
(i)  coverage  only  for  a  specified  disease  or  illness, hospital
indemnity, or other fixed indemnity coverage;
(j) Medicare supplemental insurance as defined in  section  1882(g)(1)
of  the  federal  social  security  act,  coverage  supplemental  to the
coverage provided under chapter 55 of title  10  of  the  United  States
Code,  or  similar  supplemental  coverage provided under a group health
plan if it is offered as a separate policy, certificate or  contract  of
insurance; or
(k)  the New York state medical indemnity fund established pursuant to
title four of article twenty-nine-D of the public health law.
5. "Insurer" means an insurance company subject to  article  forty-two
or a corporation subject to article forty-three of the insurance law, or
a   health   maintenance  organization  certified  pursuant  to  article
forty-four of the public health law that contracts or offers to contract
to provide, deliver, arrange, pay or  reimburse  any  of  the  costs  of
health care services.
6.  "Stand-Alone  dental  plan"  means a dental services plan that has
been issued pursuant to applicable law and certified by the  Marketplace
in accordance with section two hundred sixty-eight-d of this title.
7. "Qualified health plan" means a health plan that is issued pursuant
to  applicable  law  and certified by the Marketplace in accordance with
section two hundred sixty-eight-d of this title, including a stand-alone
dental plan.
8. "Insurance affordability  program"  means  Medicaid,  child  health
plus,  the  basic  health  program,  the  1332 state innovation program,

post-partum extended coverage and any  other  health  insurance  subsidy
program designated as such by the commissioner.
9.  "Eligible  individual" means an individual, including a minor, who
is eligible to enroll in an insurance  affordability  program  or  other
health insurance program as determined by the commissioner.
10.  "Qualified  individual"  means,  with respect to qualified health
plans, an individual, including a minor, who:
(a) is eligible to enroll  in  a  qualified  health  plan  offered  to
individuals through the Marketplace;
(b) resides in this state;
(c)  at  the  time  of  enrollment,  is  not  incarcerated, other than
incarceration pending the disposition of charges; and
(d) is, and is reasonably expected to be, for the  entire  period  for
which  enrollment  is sought, a citizen or national of the United States
or a noncitizen lawfully present in the United States.
11. "Secretary" means the secretary of the United States department of
health and human services.
12. "SHOP" means the small business health options program operated by
the Marketplace to assist eligible small  employers  in  this  state  in
selecting qualified health plans and/or other or additional health plans
certified by the Marketplace and to determine small employer eligibility
for purposes of small employer tax credits in accordance with applicable
federal and state laws and regulations.
13. "Small employer" means an employer which offers coverage where the
coverage  such  employer offers would be considered small group coverage
under the insurance law and regulations promulgated thereunder, provided
that it is not otherwise prohibited under the federal act.
14. "Small group market" means the health insurance market under which
individuals receive health insurance coverage on  behalf  of  themselves
and  their  dependents through a group health plan maintained by a small
employer.
15. "Superintendent" means the superintendent of financial services.
16. "Essential health benefits" shall mean the categories of  benefits
defined  in  subsection  (a)  of  section  three  thousand  two  hundred
seventeen-i and subsection (a) of section four  thousand  three  hundred
six-h of the insurance law.