New York Codes, Rules and Regulations › Title 11 - INSURANCE › Chapter XIV - Individual And Small Group Health Insurance › Part 362 - The Healthy New York Program And The Direct Payment Stop Loss Relief Program › Subpart 362-3 - Rules Relating To Small Employer Participation (other Than Individual Proprietors) › Section 362-3.2 - Small employer participation (other than individual proprietors)

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Qualifying
				  small employers must have 50 or fewer eligible employees.
(b) Qualifying small employers must offer
				  coverage to all employees, as defined in this Part, who are earning annual
				  wages of $30,000 or less (adjusted annually as per section
				  4326[c][1][F] of the
				  Insurance Law).
(c) Qualifying
				  small employers must offer coverage to all persons who are considered to be
				  eligible employees for the purpose of determining the employer's eligibility to
				  purchase a qualifying group health insurance contract.
(d) Qualifying small employers may, but shall
				  not be required to, offer coverage to part-time workers who work less than the
				  required number of work hours to qualify as employees. However, if part-time
				  workers are included as eligible employees for the purpose of meeting the
				  eligibility requirements set forth in section 4326 (c)(1)(B)(iii)  of the
				  Insurance Law, then the coverage must be offered to part-time
				  workers.
(e) At least 30 percent of
				  eligible employees must earn annual wages of $30,000 or less (adjusted annually
				  as per section
				  4326[c][1][F] of the
				  Insurance Law).
(f) At least 50
				  percent of eligible employees must participate in group health insurance
				  coverage through the Healthy New York Program.
(g) At least one eligible employee earning
				  annual wages of $30,000 or less (adjusted annually as per section
				  4326[c][1][F] of the
				  Insurance Law) must participate in group health insurance coverage through the
				  Healthy New York Program.
(h) On
				  behalf of participating employees, qualifying small employers must contribute
				  at least 50 percent of the premium for the qualifying group health insurance
				  contract. Qualifying small employers choosing to offer coverage to part-time
				  workers may choose the level of premium contribution on behalf of part-time
				  workers.
(i) An employer's place of
				  business must be located within New York State in order to be eligible to
				  purchase a qualifying group health insurance contract.
(j) Qualifying small employers shall in no
				  case include employers who have provided group health insurance covering their
				  employees during the 12-month period preceding the date of application. Small
				  employer applicants shall be considered to have provided group health insurance
				  if they have arranged for group health insurance coverage (insured or
				  self-insured) on behalf of their employees and contributed more than a de
				  minimus amount towards the cost of coverage on behalf of their employees.
				  Through January 31, 2005, de minimus contributions are those that do not exceed
				  an average of $50 per employee per month. Beginning February 1, 2005, de
				  minimus contributions are those that do not exceed an average of $75 per
				  employee per month for employers in the counties of Bronx, Kings, Nassau, New
				  York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk and Westchester or an
				  average of $50 per employee per month for employers in all other counties. De
				  minimus contributions shall not prevent small employers from qualifying to
				  purchase health insurance coverage through the Healthy New York
				  Program.
(k) Mid-year fluctuations
				  in group size, wage levels and employee participation shall not serve as a
				  basis for termination of a qualifying group health insurance
				  contract.
(l) Qualifying group
				  health insurance contracts shall be subject to all applicable continuation and
				  conversion rights including those described in sections 3216 (c)(5), 3221 (m), 4304 (e), 4304 (h), 4305 (d) and
				  4305 (e)  of the Insurance
				  Law. A member covered under a qualifying group health insurance contract who
				  elects to exercise a statutory conversion right shall be provided with the
				  option of converting directly to a qualifying individual health insurance
				  contract if such member satisfies the eligibility criteria set forth in section 4326 (c)(3)(A)(ii)-(iv)  of
				  the Insurance Law.
(m) Upon initial
				  application, health maintenance organizations and participating insurers shall
				  collect and examine certifications of eligibility and any supporting
				  documentation to determine eligibility for a qualifying group health insurance
				  contract and compliance with the terms of the Healthy New York
				  Program.
(n) Qualifying group
				  health insurance contracts shall include a provision providing for a 30-day
				  grace period for payment of premiums.
(o) Qualifying small employers may, in their
				  discretion, impose waiting periods which newly hired workers must satisfy in
				  advance of obtaining coverage under the small employer's qualifying group
				  health insurance contract. However, the waiting period shall not exceed 45 days
				  from the date of hire and it must be the same for all newly hired
				  workers.