N.Y. Insurance Law § 1118: Regional pilot projects for the uninsured

§ 1118. Regional pilot projects for the uninsured. (a) An authorized

insurer subject to the provisions of this chapter and organized to write

the kind of insurance specified in paragraph three of subsection (a) of

section one thousand one hundred thirteen of this article, and a health

maintenance organization authorized pursuant to article forty-three of

this chapter or article forty-four of the public health law, may be

authorized by the superintendent to issue contracts or otherwise enter

into arrangements with approved organizations in connection with

regional pilot projects to test models for the purpose of providing

insurance and equivalent coverage mechanisms for the uninsured. Such

plans must satisfy the criteria set forth in subsection (b) of this

section and the superintendent shall make the determinations set forth

in subsection (e) of this section. For the purpose of this section,

regional pilot projects shall mean projects authorized pursuant to the

expanded health care coverage act of nineteen hundred eighty-eight.

(b) The superintendent may authorize such contracts or arrangements

for regional pilot projects pursuant to the following criteria:

(1) the plan's provisions are not misleading or confusing;

(2) the plan's provisions are consistent with the needs of the

regional pilot projects; and

(3) the plan, the contract and other materials describing the plan

fully and clearly state the benefits, limitations of the plan.

(c) The duration of such contracts and the extent of exposure

thereunder by insurers or health maintenance organizations shall be

determined by the superintendent.

(d) Notwithstanding any provisions of this chapter or the financial

services law to the contrary, the superintendent may waive, modify or

suspend any provision of this chapter, the financial services law or

regulations promulgated thereunder as applicable to the insurers or

health maintenance organizations that conduct the regional pilot

projects, except as to mandatory benefits, provided such waiver,

modification or suspension is based on the criteria set forth in

subsection (e) of this section.

(e) The superintendent may take the actions set forth in subsections

(a) and (d) of this section upon the superintendent's judgment that:

(1) the plan is a reasonable and appropriate approach to expand the

availability of health care coverage or equivalent coverage mechanisms

for the uninsured;

(2) the premium rates and other sources of funding for the regional

pilot project is reasonably related to the benefits provided and

sufficient to support the program;

(3) any waiver, modification or suspension of provisions of this

chapter, the financial services law or regulations promulgated

thereunder is essential to the operation of the regional pilot project

and to the rational development of programs to provide health care

coverage or equivalent coverage mechanisms to the uninsured; and

(4) any waiver, modification or suspension of provisions of this

chapter, the financial services law or regulations promulgated

thereunder will not impair the ability of the insurer or health

maintenance organization to satisfy its existing and anticipated

contracts and other obligations, including such standards as the

superintendent shall prescribe concerning adequate capital and financial

requirements.