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 362-1 - Preamble › Section 362-1.1 - Preamble

Current through Register Vol. 46, No. 28, July 10, 2024
The programs described in this Part shall be known as the
					 Healthy New York Program and the Direct Payment Stop Loss Relief
					 Program.
(a) Chapter 1 of the Laws of
				  1999 establishes the Healthy New York Program which is a new initiative
				  designed to encourage small employers which do not provide health insurance
				  coverage for their employees to offer such coverage and also designed to make
				  coverage available to uninsured employees whose employers do not provide group
				  health insurance coverage.
(b) At
				  the time of enactment of chapter 1 of the Laws of 1999, a significant number of
				  New York residents were uninsured. Due in part to the rising cost of health
				  insurance coverage, many small employers were unable to provide health
				  insurance coverage to their employees. A significant portion of New York
				  State's uninsured population was made up of individuals employed in small
				  businesses.
(c) Through the
				  creation of a standardized health insurance benefit package to be offered by
				  all health maintenance organizations which is made more affordable through the
				  availability of State funded stop loss reimbursement, the Healthy New York
				  Program should encourage more small employers and uninsured employed
				  individuals to purchase health insurance coverage.
(d) Chapter 1 of the Laws of 1999 also
				  established the Direct Payment Market Stop Loss Relief Program designed to
				  provide premium and market stability to New York's direct payment health
				  insurance market through use of a stop loss mechanism.
(e) The rising cost of health care was a very
				  serious problem that New York State and the nation were facing at the time of
				  the enactment of chapter 1 of the Laws of 1999. Increases in health insurance
				  premiums were directly related to increases in the cost of health care. Such
				  rising costs were exacerbated in the individual insurance market where the pool
				  of insureds typically includes less healthy (higher risk) individuals than
				  those covered through their employers in the group insurance market.
(f) At the time of the enactment of chapter 1
				  of the Laws of 1999, sections 4321 and
				  4322  of the Insurance Law required all
				  health maintenance organizations to offer two distinct comprehensive
				  standardized individual enrollee direct payment contracts. This requirement was
				  mandated by law for the purpose of ensuring individual access to comprehensive
				  insurance to meet their health care needs. However, the premium rates for these
				  contracts were high and continuing to increase.
(g) Chapter 1 of the Laws of 1999 enacted
				  sections 4321-a and
				  4322-a  of the Insurance Law to create a
				  program designed to ensure that individual consumers have continued access to
				  comprehensive health insurance. The provisions require the establishment of two
				  stop loss funds from which health maintenance organizations may receive
				  reimbursement for certain claims paid on behalf of members covered under
				  individual enrollee direct payment contracts. The availability of reimbursement
				  through such stop loss funds should have a favorable impact on the cost of such
				  coverage for the benefit of both existing enrollees and currently uninsured
				  persons seeking to purchase such coverage.