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 362-2 - Rules Generally Applicable To The Healthy New York Program › Section 362-2.3 - Enrollment

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Applications
				  for qualifying health insurance contracts shall be made directly to health
				  maintenance organizations and participating insurers.
(b) Health maintenance organizations and
				  participating insurers shall provide all necessary information and enrollment
				  forms when requested by applicants.
(c) Health maintenance organizations and
				  participating insurers shall collect the initial eligibility certifications
				  required by section 4326 (i)  of the Insurance
				  Law and necessary supporting documentation and shall be responsible for
				  examination of such certifications and supporting documentation for
				  verification that applicants meet applicable eligibility requirements. Health
				  maintenance organizations and participating insurers shall accept any
				  standardized application form that may be prescribed by the
				  superintendent.
(d) Unless the
				  superintendent suspends enrollment in the Healthy New York Program pursuant to
				  section 4327 (k)  of the Insurance
				  Law or approves a request to suspend qualifying individual enrollment pursuant
				  to subdivision (h) of this section, all applicants meeting eligibility criteria
				  shall be accepted and coverage must be issued on the first day of the month
				  next succeeding the date a complete application has been submitted for all
				  applications submitted on or prior to the 20th day of such month. For
				  applications submitted after the 20th day of a month, coverage shall be issued
				  no later than the first of the month next following. Dependent children up to
				  at least age 19 and full-time students up to at least age 23 shall be
				  considered eligible dependents under qualifying health insurance
				  contracts.
(e) Health maintenance
				  organizations and participating insurers shall provide applicants which have
				  failed to demonstrate eligibility with a written notice of denial which clearly
				  sets forth the basis for the denial.
(f) Health maintenance organizations and
				  participating insurers must submit monthly enrollment reports which detail
				  total enrollment in the Healthy New York Program in the format specified by the
				  superintendent. Such reports shall identify the health maintenance
				  organization's or participating insurer's total enrollment in the Healthy New
				  York Program as of the first day of the following month and must be submitted
				  to the superintendent no later than the 15th day of the following
				  month.
(g) In the event that the
				  enrollment in the small employer or individual Healthy New York Program is
				  suspended pursuant to section 4327 (k)  of the Insurance
				  Law, participating insurers and health maintenance organizations shall:
(1) notify applicants that enrollment has
				  been suspended; and
(2) maintain a
				  waiting list to be filled in the order of receipt in the event that enrollment
				  is reactivated.