N.Y. Public Health Law § 268-a: Definitions

§ 268-a. Definitions. For purposes of this title, the following

definitions shall apply:

1. "Commissioner" means the commissioner of health of the state of New

York.

2. "Marketplace" means the "NY State of Health, The official health

plan Marketplace" or "Marketplace" established as a health benefit

exchange or "marketplace" within the department of health pursuant to

Executive Order 42 (Cuomo) issued April 12, 2012 and this title.

3. "Federal act" means the patient protection and affordable care act,

public law 111-148, as amended by the health care and education

reconciliation act of 2010, public law 111-152, and any regulations or

guidance issued thereunder.

4. "Health plan" means a policy, contract or certificate, offered or

issued by an insurer to provide, deliver, arrange for, pay for or

reimburse any of the costs of health care services. Health plan shall

not include the following:

(a) accident insurance or disability income insurance, or any

combination thereof;

(b) coverage issued as a supplement to liability insurance;

(c) liability insurance, including general liability insurance and

automobile liability insurance;

(d) workers' compensation or similar insurance;

(e) automobile no-fault insurance;

(f) credit insurance;

(g) other similar insurance coverage, as specified in federal

regulations, under which benefits for medical care are secondary or

incidental to other insurance benefits;

(h) limited scope dental or vision benefits, benefits for long-term

care insurance, nursing home insurance, home care insurance, or any

combination thereof, or such other similar, limited benefits health

insurance as specified in federal regulations, if the benefits are

provided under a separate policy, certificate or contract of insurance

or are otherwise not an integral part of the plan;

(i) coverage only for a specified disease or illness, hospital

indemnity, or other fixed indemnity coverage;

(j) Medicare supplemental insurance as defined in section 1882(g)(1)

of the federal social security act, coverage supplemental to the

coverage provided under chapter 55 of title 10 of the United States

Code, or similar supplemental coverage provided under a group health

plan if it is offered as a separate policy, certificate or contract of

insurance; or

(k) the New York state medical indemnity fund established pursuant to

title four of article twenty-nine-D of the public health law.

5. "Insurer" means an insurance company subject to article forty-two

or a corporation subject to article forty-three of the insurance law, or

a health maintenance organization certified pursuant to article

forty-four of the public health law that contracts or offers to contract

to provide, deliver, arrange, pay or reimburse any of the costs of

health care services.

6. "Stand-Alone dental plan" means a dental services plan that has

been issued pursuant to applicable law and certified by the Marketplace

in accordance with section two hundred sixty-eight-d of this title.

7. "Qualified health plan" means a health plan that is issued pursuant

to applicable law and certified by the Marketplace in accordance with

section two hundred sixty-eight-d of this title, including a stand-alone

dental plan.

8. "Insurance affordability program" means Medicaid, child health

plus, the basic health program, the 1332 state innovation program,

post-partum extended coverage and any other health insurance subsidy

program designated as such by the commissioner.

9. "Eligible individual" means an individual, including a minor, who

is eligible to enroll in an insurance affordability program or other

health insurance program as determined by the commissioner.

10. "Qualified individual" means, with respect to qualified health

plans, an individual, including a minor, who:

(a) is eligible to enroll in a qualified health plan offered to

individuals through the Marketplace;

(b) resides in this state;

(c) at the time of enrollment, is not incarcerated, other than

incarceration pending the disposition of charges; and

(d) is, and is reasonably expected to be, for the entire period for

which enrollment is sought, a citizen or national of the United States

or a noncitizen lawfully present in the United States.

11. "Secretary" means the secretary of the United States department of

health and human services.

12. "SHOP" means the small business health options program operated by

the Marketplace to assist eligible small employers in this state in

selecting qualified health plans and/or other or additional health plans

certified by the Marketplace and to determine small employer eligibility

for purposes of small employer tax credits in accordance with applicable

federal and state laws and regulations.

13. "Small employer" means an employer which offers coverage where the

coverage such employer offers would be considered small group coverage

under the insurance law and regulations promulgated thereunder, provided

that it is not otherwise prohibited under the federal act.

14. "Small group market" means the health insurance market under which

individuals receive health insurance coverage on behalf of themselves

and their dependents through a group health plan maintained by a small

employer.

15. "Superintendent" means the superintendent of financial services.

16. "Essential health benefits" shall mean the categories of benefits

defined in subsection (a) of section three thousand two hundred

seventeen-i and subsection (a) of section four thousand three hundred

six-h of the insurance law.