N.Y. Public Health Law § 4407: Health maintenance organizations; employer requirements

§ 4407. Health maintenance organizations; employer requirements. 1.

All employers subject to the provisions of the unemployment insurance

law, except for those employers with fewer than twenty-five employees,

shall include in any health benefits plan offered to their employees,

the option of membership in a health maintenance organization which

provides or offers a comprehensive health services plan in accordance

with the provisions of this article, but only if such plan serves an

area in which twenty-five of such employer's employees reside and the

organization has been issued a certificate of authority by the

commissioner.

2. For those employees of an employer represented by a bargaining

representative, the offer of the health maintenance organization

alternative shall be subject only to the collective bargaining process;

for those employees not represented by a bargaining representative, the

offer of the health maintenance organization alternative shall be made

directly to the employee.

3. (a) If there is more than one health maintenance organization

engaged in the provision of health services in the area in which the

employees of the employer reside, and if:

(i) one or more of such organizations provides more than one-half of

its comprehensive health services through physicians or other health

professionals who are members of the staff of the organization or of a

medical group (or groups) which contracts with the organization, and

(ii) one or more of such organizations provides its comprehensive

health services through contracts with an individual practice

association (or associations), individual physicians and other health

professionals under contract directly with the organization, or a

combination of an individual practice association (or associations),

medical group (or groups), physicians who are members of the staff of

the organization, and individual physicians and other health

professionals under contract directly with the organization,

then the employer shall, in accordance with regulations of the

commissioner, be required to offer the option of enrollment in at least

one organization described in subparagraph (i) of this paragraph and at

least one organization described in subparagraph (ii) of this paragraph

if the employer has twenty-five or more but fewer than two hundred

employees. If the employer has two hundred or more employees and the

employer's principal office in this state is located outside of the

metropolitan region then the employer shall be required to offer the

option of enrollment in at least two organizations described in

subparagraph (i) of this paragraph and at least two organizations

described in subparagraph (ii) of this paragraph. If the employer has

two hundred or more employees and the employer's principal office in

this state is located within the metropolitan region then the employer

shall be required to offer the option of enrollment in at least two

organizations described in subparagraph (i) of this paragraph and at

least two organizations described in subparagraph (ii) of this paragraph

and an additional organization from either subparagraph. For the

purposes of this section the metropolitan region is defined as the

counties of Westchester, Rockland, New York, Kings, Queens, Richmond,

Bronx, Nassau and Suffolk.

(b) If within any particular area of the state in which at least

twenty-five of such employer's employees reside there are fewer health

maintenance organizations described in subparagraph (i) or (ii) of

paragraph (a) of this subdivision than the employer is required to

offer, then additional health maintenance organizations from

subparagraph (i) or (ii) of paragraph (a) of this subdivision shall be

offered; provided, however, that no employer with fewer than two hundred

employees shall be required to offer more than a total of two health

maintenance organizations, and no employer with two hundred or more

employees shall be required to offer more than a total of four health

maintenance organizations (or five such organizations if the employer's

principal office is located within the metropolitan region) in any

particular area of the state. In the event fewer than the required

total minimum number of health maintenance organizations are available

in an area, the employer shall offer all health maintenance

organizations then certified to issue subscriber contracts in that area.

Nothing in this subdivision shall be deemed to prohibit an employer from

choosing to offer more health maintenance organizations to its employees

than are required under this subdivision.

4. No employer shall be required to pay more for health benefits as a

result of the application of this section than would otherwise be

required by any prevailing collective bargaining agreement or other

legally enforceable contract for the provision of health benefits

between an employer and his employees.