N.Y. Insurance Law § 1109: Limited exemption for health maintenance organizations

§ 1109. Limited exemption for health maintenance organizations. (a) An

organization complying with the provisions of article forty-four of the

public health law may operate without being licensed under this chapter

and without being subject to any provisions of this chapter, except: (1)

to the extent that such organization must comply with the provisions of

this chapter by virtue of such article, and (2) the provisions of

sections three hundred eight, one thousand three hundred one, one

thousand three hundred two, one thousand three hundred seven, one

thousand three hundred twenty-two, with regard to health maintenance

organizations that are domiciled in this state and certified or

operating in at least one other state, two thousand one hundred three,

two thousand one hundred twelve, two thousand one hundred fourteen, two

thousand one hundred fifteen, two thousand one hundred seventeen, two

thousand one hundred twenty-three, two thousand six hundred eight-a, two

thousand six hundred twelve, three thousand two hundred twenty-four-a,

four thousand three hundred eight, four thousand three hundred

seventeen, four thousand three hundred eighteen, four thousand three

hundred twenty, four thousand three hundred twenty-one, four thousand

three hundred twenty-two and four thousand three hundred twenty-three of

this chapter.

(b) An organization which provides health care services for a periodic

fee paid in advance but which does not comply with the provisions of

article forty-four of the public health law shall be deemed to be

engaged in the business of insurance and may not operate without being

licensed under this chapter.

(c) An organization referred to in subsection (a) or (b) hereof shall

be subject to article seventy-four of this chapter.

(d) A health maintenance organization may make any investment

permitted for a health service corporation organized pursuant to article

forty-three of this chapter provided that the superintendent, after

consultation with the commissioner of health, may modify such investment

requirements, if such modification would permit the organization to more

effectively implement its program without incurring undue risk to its

subscribers.

(e) The superintendent may promulgate regulations in effectuating the

purposes and provisions of this chapter and article forty-four of the

public health law and may modify requirements applicable to the

contracts between a health maintenance organization and its subscribers,

subject to such limitations as the superintendent shall deem necessary

or proper to insure the performance of such contracts.