N.Y. Insurance Law § 1120: Child health insurance plan

§ 1120. Child health insurance plan. (a) An authorized insurer subject

to the provisions of this chapter and organized to write the kind of

health insurance specified in paragraph three of subsection (a) of

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

corporation or health maintenance organization authorized pursuant to

article forty-three of this chapter or a health maintenance organization

certified pursuant to 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 for the purpose of

providing child health insurance plan policies for eligible children

pursuant to title I-A of article twenty-five of the public health law.

Such contracts or arrangements shall 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.

(b) The superintendent may authorize such contracts or arrangements

pursuant to the following criteria:

(1) the provisions are not misleading or confusing;

(2) the provisions are consistent with the needs of the child health

insurance plan; and

(3) the materials describing the contract or arrangement fully and

clearly state the benefits and limitations of such contract or

arrangement.

(c) The duration of such contracts or arrangements and the extent of

exposure thereunder by insurers, article forty-three corporations 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 provisions of this chapter, the financial services law or

regulations promulgated thereunder as applicable to the insurers,

article forty-three corporations or health maintenance organizations

that issue coverage pursuant to this section, 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 contract or arrangement is a reasonable and appropriate

approach to expand the availability of health care coverage to children;

(2) the sources of funding for the contract or arrangement are

reasonably related to the benefits provided and sufficient to support

the contract arrangement;

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

chapter, the financial services law or regulations promulgated

thereunder is essential to the operation of the child health insurance

plan and to the rational development of programs to provide covered

services to children; 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, article

forty-three corporation 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.

(f) Each application used by an authorized insurer for purposes of

enrolling eligible children into the child health insurance plan

pursuant to this section and section twenty-five hundred eleven of the

public health law shall include the notice required pursuant to

subsection (d) of section four hundred three of this chapter.