Section 1118. Regional pilot projects for the uninsured  


Latest version.
  • (a) An authorized
      insurer subject to the provisions of this chapter and organized to write
      the kind of insurance specified in paragraph three of subsection (a)  of
      section  one thousand one hundred thirteen of this article, and a health
      maintenance organization authorized pursuant to article  forty-three  of
      this  chapter  or  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  in  connection  with
      regional pilot projects to test models  for  the  purpose  of  providing
      insurance  and  equivalent  coverage  mechanisms for the uninsured. Such
      plans must 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. For  the  purpose  of  this  section,
      regional  pilot  projects shall mean projects authorized pursuant to the
      expanded health care coverage act of nineteen hundred eighty-eight.
        (b) The superintendent may authorize such  contracts  or  arrangements
      for regional pilot projects pursuant to the following criteria:
        (1) the plan's provisions are not misleading or confusing;
        (2)  the  plan's  provisions  are  consistent  with  the  needs of the
      regional pilot projects; and
        (3) the plan, the contract and other  materials  describing  the  plan
      fully and clearly state the benefits, limitations of the plan.
        (c)  The  duration  of  such  contracts  and  the  extent  of exposure
      thereunder by insurers or  health  maintenance  organizations  shall  be
      determined by the superintendent.
        (d)  Notwithstanding  any  provisions  of  the  insurance  law  to the
      contrary, the superintendent may waive, modify or suspend any  provision
      of  the  insurance law or insurance department regulations as applicable
      to the insurers or health maintenance organizations  which  conduct  the
      regional  pilot projects, except as to mandatory benefits, 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  plan  is a reasonable and appropriate approach to expand the
      availability of health care coverage or equivalent  coverage  mechanisms
      for the uninsured;
        (2)  the  premium  rates and other sources of funding for the regional
      pilot project  is  reasonably  related  to  the  benefits  provided  and
      sufficient to support the program;
        (3)  any  waiver,  modification  or  suspension  of  provisions of the
      insurance law or insurance department regulations is  essential  to  the
      operation  of the regional pilot project and to the rational development
      of programs to provide  health  care  coverage  or  equivalent  coverage
      mechanisms to the uninsured; and
        (4)  any  waiver,  modification  or  suspension  of  provisions of the
      insurance law or insurance department regulations will  not  impair  the
      ability of the insurer 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.