N.Y. Public Health Law § 922: New York state small business health insurance partnership program

§ 922. New York state small business health insurance partnership

program. 1. The commissioner is authorized to the extent of funds

available therefor to establish the New York state small business health

insurance partnership program.

2. New York state small business health insurance partnership program.

(a) A small business health insurance partnership program shall assist

eligible employers in purchasing small group health insurance policies

for their full-time employees and dependents.

(b) An eligible employer may apply to the commissioner for approval in

the small business health insurance partnership program by submitting an

application on a form prescribed by the commissioner. The information

required on such application shall include, but not be limited to:

(i) the name and address of the employer and the nature of the

business;

(ii) the names and salaries of the employer and employees;

(iii) an affidavit by the employer that employer-provided health

insurance benefits have not been provided to employees in the

twelve-month period prior to the effective date of this article; and

(iv) such other information as the commissioner may require.

(c) Upon reviewing the applications from eligible small employers, the

commissioner shall, within the amount appropriated for such purpose,

award partnership certificates to employers which meet the eligibility

requirements; provided however, no partnership certificates will be

awarded by the commissioner on and after January first, two thousand.

In addition to evidencing approval of an eligible employer, the

certificate shall state the amount of a small business health insurance

partnership incentive payment for a small group health insurance policy,

which in no event may exceed forty-five percent of the premium costs for

group health care coverage for employees and their dependents. Employees

may be required to make contributions to the payment of premium costs

under this program at the option of the employer, but in no event shall

such contribution exceed ten percent of the premium costs. Premium costs

incurred by an employer for small group health insurance coverage for

officers and directors of an employer and others with a proprietary or

ownership interest in the employer may be eligible for an incentive

payment to offset premium costs; provided, however, that the gross

household income of such officers and directors or others with a

proprietary or ownership interest is at or below two hundred twenty-two

percent of the non-farm federal poverty level and provided further that

one or more employees and their dependents proposed to be covered by

such group health care coverage are unrelated to such officers,

directors or other persons with a proprietary or ownership interest. If

after joining the program an employer participating in a small business

insurance partnership program hires more employees so that the employer

has more than fifty full-time employees at any one time, the employer

may continue in the program but the premium costs attributable to the

additional employees in excess of fifty or their families shall not be

eligible for incentive payments.

(d) In approving partnership certificates for eligible small employers

prior to January first, two thousand, the commissioner shall:

(i) first approve applications from eligible employers currently

receiving assistance through a small business health insurance program

created by the expanded health care coverage act authorized pursuant to

chapter seven hundred three of the laws of nineteen hundred

eighty-eight; and

(ii) give preference to eligible employers with the lowest average

salaries and base the amount of the certificate on the salaries received

by the employer and employees in order to maximize the impact of the

small business partnership premium payments.

(e) Upon receipt of a partnership certificate from the commissioner,

an approved eligible employer may obtain a small group health insurance

policy from the insurer, health maintenance organization or corporation

of its choice. No such insurer, health maintenance organization or

corporation shall refuse to accept a small employer holding a valid

partnership certificate and such insurer, organization or corporation

shall arrange for the payment of the small employer's share of the small

group health insurance policy or comprehensive health services plan

premium. The approved applicant shall make available upon request from

the commissioner information regarding continued eligibility in the

program.

The commissioner shall, within amounts available therefor, on a

competitive bid process, contract with organizations for purposes of

public education, outreach and recruitment of eligible businesses,

including the distribution of applications and information regarding

enrollment. The organizations shall include, but not be limited to:

community based organizations such as chambers of commerce or trade

organizations, diagnostic and treatment centers, hospitals, and other

such organizations which engage in outreach and marketing activities. In

no event shall the amount available for education, outreach, and

recruitment exceed two percent of the total amount available for the

purposes of this section.

(f) The commissioner, by rules and regulations, adopted by the

commissioner shall establish the procedure by which insurers,

corporations and organizations issuing small group health insurance

policies under this article may redeem a certificate or certificates for

the portion of the premium not paid by the employer, but in no event

shall such redemption occur on less than a quarterly basis.

Any business which, with the intent to obtain benefits, willfully

misstates information required for application for participation in the

New York state health insurance partnership program or willfully fails

to notify the commissioner or the commissioner's designee of any change

in status which makes the business ineligible for the program, shall

repay such incentive payments paid on behalf of its employees or program

participants for health coverage through the New York state health

insurance partnership program.

(g) Notwithstanding any inconsistent provision of law or regulation to

the contrary, benefits under the small business health insurance

partnership program shall be considered secondary to any other plan of

insurance or benefit program under which a person may have coverage.

(h) On or before April first, nineteen hundred ninety-seven, and

annually thereafter through April first, two thousand, the commissioner

shall submit a report on the small business health insurance partnership

program to the governor, the speaker of the assembly and the majority

leader of the senate. Such report shall include, but not be limited to:

(i) the number of employers and employees able to purchase small group

health insurance policies under the program;

(ii) the location and the nature of the business of such employers;

and

(iii) recommendations for any changes which would improve the program.