N.Y. Insurance Law § 1122: New York state health insurance continuation assistance demonstration project

* § 1122. New York state health insurance continuation assistance

demonstration project. (a) Definitions. For the purposes of this

section, unless the context clearly requires otherwise:

(1) "Continuation assistance" means payments made by the

superintendent to an eligible individual, a health plan or insurer, a

participating employer, or a labor-management health benefits fund to

allow an eligible individual to obtain or maintain continuation

coverage.

(2) "Continuation coverage" means group health insurance coverage

which a participating employer or labor-management health benefits fund

is obligated to offer to an individual pursuant to the 1985 Consolidated

Omnibus Budget Reconciliation Act (COBRA), as amended by the Tax Reform

Act of 1986, or continuation provisions pursuant to subsection (m) of

section three thousand two hundred twenty-one, subsection (k) of section

four thousand three hundred four or subsection (e) of section four

thousand three hundred five of this chapter.

(3) "Displaced worker" means an individual that is a resident of New

York state and has been terminated or has received a notice of

termination as a result of increased imports from, or shifts in

production to, foreign countries as described in the Trade Act programs,

Trade Adjustment Assistance (TAA) and Alternative Trade Adjustment

Assistance (ATAA).

(4) "Eligible individual" means a person who is an entertainment

industry employee or displaced worker and who:

(A) is not eligible for health insurance coverage or medical benefits

pursuant to part A or B of title XVIII of the Social Security Act or

title eleven of article five of the social services law;

(B) is eligible for or is currently enrolled under continuation

coverage (and, with respect to an entertainment industry employee, is

eligible for or enrolled under continuation coverage through a

collectively bargained plan covering entertainment industry employees),

where such eligible individual is not covered under continuation already

subsidized through continuation assistance pursuant to the public health

law;

(C) resides in a household having a gross monthly household income at

or below four hundred percent of the non-farm federal poverty level (as

defined and updated by the federal department of health and human

services);

(D) is not eligible for employer provided coverage; and

(E) maintains the same level of insurance coverage as when they were

employed.

(5) "Entertainment industry employee" means an individual who is a

resident of New York state and is employed in the entertainment

industry, as defined by the commissioner, including, but not limited to,

the film, motion picture, television, theater, music, music recording,

dance, radio, and circus industries.

(6) "Individual payment" means the amount of premium required for

continuation coverage, less the amount of a continuation assistance

payment made by the superintendent, to be paid by an eligible

individual.

(7) "New York state health insurance continuation assistance

demonstration project" means the pilot program for the entertainment

industry employees and the pilot program for displaced workers.

(8) "Participating employer" means an employer who is obligated to

continue coverage for an eligible individual pursuant to the 1985

Consolidated Omnibus Budget Reconciliation Act (COBRA), or subsection

(m) of section three thousand two hundred twenty-one, subsection (k) of

section four thousand three hundred four, or subsection (e) of section

four thousand three hundred five of this chapter.

(9) "Pilot program for displaced workers" means the program which

assists eligible individuals who are displaced workers in obtaining or

maintaining continuation coverage pursuant to this section.

(10) "Pilot program for entertainment industry employees" means the

program which assists eligible individuals who are entertainment

industry employees in obtaining or maintaining continuation coverage

pursuant to this section.

(b) Pilot program for entertainment industry employees. (1) The pilot

program for entertainment industry employees shall assist eligible

individuals who are entertainment industry workers in maintaining or

obtaining continuation coverage.

(2) An eligible individual may apply to the superintendent for

continuation assistance by submitting an application therefor on a form

prescribed by the superintendent. The information required on the

application shall include, but not be limited to:

(A) the name and address of the entertainment industry employee;

(B) the name, address, and telephone number of the participating

employer;

(C) the date the eligible individual became or will become eligible

for continuation coverage, the date such eligibility ends, and, when

available, correspondence to an entertainment industry employee from a

labor-management health benefits fund proving eligibility;

(D) the names of all dependents who are covered or are to be covered

under the continuation policy; and

(E) documentation establishing the household income of an eligible

individual, which may include annual income tax returns and, if not

prohibited by federal law for purposes of income verification, social

security numbers, paycheck stubs, written documentation of income from

all employers, or such other documentation as the superintendent may

require.

(3) The superintendent shall review the applications and advise the

applicants as to their eligibility to participate in the pilot program.

Within amounts available for such purpose, the superintendent shall

provide continuation assistance. Such assistance shall be issued, to the

extent of funds available therefor, which is equivalent to seventy-five

percent of the premium for the period covered by such assistance.

Continuation assistance shall not be provided for more than twelve

months within a five-year period.

(4) In approving applications from eligible individuals, the

superintendent shall:

(A) make a determination as to the extent of available funds for the

pilot program so as to assure, to the extent possible, that the funding

will be available to provide continuation assistance to the applicant in

an amount equal to seventy-five percent of the premium for a period of

twelve months within five years; if the superintendent determines that

such funding may not be available due to the level of enrollment in the

pilot program at the time of the eligible individual's application, the

superintendent shall deny such application; and

(B) require eligible individuals who are awarded continuation

assistance to sign an acknowledgement that recipients who later become

eligible for health insurance coverage through another employer are no

longer eligible to receive assistance under this section and that the

state may seek to recover assistance provided after the date of such

eligibility.

(5) The superintendent shall make continuation assistance payments

available pursuant to this subsection directly to the collectively

bargained labor-management health benefits fund on behalf of eligible

individuals. The fund must provide the superintendent such information

as the superintendent may reasonably require to enable the

superintendent to administer the terms and conditions of the pilot

program.

(6) The superintendent may promulgate rules and regulations necessary

to the administration of this pilot program.

(7) The superintendent may contract with an organization to assist in

the administration of this pilot program. If the superintendent deems it

appropriate to utilize an organization to assist in the administration

of this pilot program, the organization shall submit reports to the

superintendent in such form and at such times as required by the

superintendent. An organization approved to assist with program

administration shall maintain records in a form prescribed by the

superintendent and which shall be available for inspection by or at the

request of the superintendent.

(c) Pilot program for displaced workers. (1) The pilot program for

displaced workers shall assist eligible individuals who are displaced

workers in maintaining or obtaining continuation coverage.

(2) An eligible individual may apply to the superintendent for

continuation assistance by submitting an application therefor on a form

prescribed by the superintendent. The information required on the

application shall include, but not be limited to:

(A) the name and address of the displaced worker;

(B) the name, address, and telephone number of the participating

employer;

(C) the date the eligible individual became or will become eligible

for continuation coverage, the date such eligibility ends, and, when

available, correspondence to a displaced worker from a participating

employer or labor-management health benefits fund proving eligibility;

(D) the names of all dependents who are covered or are to be covered

under the continuation policy; and

(E) documentation establishing the household income of an eligible

individual, which may include annual income tax returns and, if not

prohibited by federal law for purposes of income verification, social

security numbers, paycheck stubs, written documentation of income from

all employers, or such other documentation as the superintendent may

require.

(3) The superintendent shall review the applications and advise the

applicants as to their eligibility to participate in the pilot program.

Within amounts available for such purpose, the superintendent shall

provide continuation assistance. Such assistance shall be issued, to the

extent of funds available therefor, which is equivalent to seventy-five

percent of the premium for the period covered by such assistance.

Continuation assistance shall not be provided for more than twelve

months within a five-year period.

(4) In approving applications from eligible individuals, the

superintendent shall:

(A) make a determination as to the extent of available funds for the

pilot program so as to assure, to the extent possible, that the funding

will be available to provide continuation assistance to the applicant in

an amount equal to seventy-five percent of the premium for a period of

twelve months within five years; if the superintendent determines that

such funding may not be available due to the level of enrollment in the

pilot program at the time of the eligible individual's application, the

superintendent shall deny such application; and

(B) require eligible individuals who were awarded continuation

assistance to sign an acknowledgement that recipients who later become

eligible for health insurance coverage through another employer are no

longer eligible to receive assistance under this section and that the

state may seek to recover assistance provided after the date of such

eligibility.

(5) The superintendent shall make continuation assistance payments

available pursuant to this subsection directly to the individual or to

the health plan or insurer, labor-management health benefits fund, or

participating employer on behalf of eligible individuals. The fund or

employer must provide the superintendent such information as the

superintendent may reasonably require to enable the superintendent to

administer the terms and conditions of the pilot program.

(6) The superintendent may promulgate rules and regulations necessary

to administer this pilot program.

(7) The superintendent may contract with an organization to assist in

the administration of this pilot program. If the superintendent deems it

appropriate to utilize an organization to assist in the administration

of this pilot program, the organization shall submit reports to the

superintendent in such form and at such times as required by the

superintendent. An organization approved to assist with program

administration shall maintain records in a form prescribed by the

superintendent and which shall be available for inspection by or at the

request of the superintendent.

(d) The superintendent shall complete a study of the New York state

health insurance continuation assistance demonstration project set forth

in this section. Such study shall examine the efficacy of the project in

impacting the insurance marketplace in New York state and the impact of

the demonstration project in reducing the large number of uninsured

individuals in the entertainment industry and other industries in New

York characterized by seasonal and episodic employment. The

superintendent may contract with an organization for the completion of

the study. The study shall be provided to the temporary president of the

senate and the speaker of the assembly.

* NB Repealed July 1, 2027