LBD01307-01-9
S. 989 2
STATE, AND ENROLL INDIVIDUALS IN HEALTH COVERAGE FOR WHICH THEY ARE
ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW. THE EXCHANGE ALSO SHALL INCOR-
PORATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") TO ASSIST QUALI-
FIED EMPLOYERS IN FACILITATING THE ENROLLMENT OF THEIR EMPLOYEES IN
QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET. IT IS THE INTENT OF
THE LEGISLATURE, THROUGH THE ESTABLISHMENT OF THE EXCHANGE, TO PROMOTE
QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE, REDUCE THE NUMBER OF
UNINSURED PERSONS, PROVIDE A TRANSPARENT MARKETPLACE, EDUCATE CONSUMERS
AND ASSIST INDIVIDUALS WITH ACCESS TO COVERAGE, PREMIUM ASSISTANCE TAX
CREDITS AND COST-SHARING REDUCTIONS.
§ 3981. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING DEFI-
NITIONS SHALL APPLY:
1. "BOARD" OR "BOARD OF DIRECTORS" MEANS THE BOARD OF DIRECTORS OF THE
EXCHANGE.
2. "REGIONAL ADVISORY COMMITTEES" MEANS THE NEW YORK HEALTH BENEFIT
EXCHANGE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO THIS ARTI-
CLE.
3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
4. "EXCHANGE" MEANS THE NEW YORK HEALTH BENEFIT EXCHANGE ESTABLISHED
PURSUANT TO THIS ARTICLE.
5. "HEALTH PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR
ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR REIM-
BURSE ANY OF THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT
INCLUDE THE FOLLOWING:
(A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
TION 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 REGU-
LATIONS, UNDER WHICH BENEFITS FOR MEDICAL CARE ARE SECONDARY OR INCI-
DENTAL 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 INDEM-
NITY, 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 COVER-
AGE 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 MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO TITLE FOUR OF
ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
6. "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE THIRTY-TWO
OR FORTY-THREE OF THE INSURANCE LAW, OR A HEALTH MAINTENANCE ORGANIZA-
TION 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.
S. 989 3
7. "QUALIFIED DENTAL PLAN" MEANS A LIMITED SCOPE DENTAL PLAN THAT IS
ISSUED BY AN INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION THIRTY-
NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE.
8. "QUALIFIED EMPLOYER" MEANS A SMALL EMPLOYER THAT ELECTS TO MAKE ITS
FULL-TIME EMPLOYEES ELIGIBLE FOR ONE OR MORE QUALIFIED HEALTH PLANS
THROUGH THE EXCHANGE.
9. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS ISSUED BY AN
INSURER AND CERTIFIED IN ACCORDANCE WITH SECTION THIRTY-NINE HUNDRED
EIGHTY-FIVE OF THIS ARTICLE.
10. "QUALIFIED INDIVIDUAL" MEANS AN INDIVIDUAL, INCLUDING A MINOR,
WHO:
(A) IS SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO INDI-
VIDUALS THROUGH THE EXCHANGE;
(B) RESIDES IN THIS STATE;
(C) AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN INCAR-
CERATION 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 AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
11. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM DESIGNED TO
ASSIST QUALIFIED EMPLOYERS IN THIS STATE IN FACILITATING THE ENROLLMENT
OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET
IN THIS STATE.
12. "SMALL EMPLOYER" MEANS, FOR PLAN YEARS PRIOR TO JANUARY FIRST, TWO
THOUSAND SIXTEEN, AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT LEAST ONE
BUT NOT MORE THAN FIFTY EMPLOYEES ON BUSINESS DAYS DURING THE PRECEDING
CALENDAR YEAR. FOR PLAN YEARS BEGINNING ON AND AFTER JANUARY FIRST, TWO
THOUSAND SIXTEEN, SMALL EMPLOYER MEANS AN EMPLOYER THAT EMPLOYED AN
AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES ON BUSI-
NESS DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PURPOSES OF THE DEFI-
NITION OF SMALL EMPLOYER:
(A) ALL PERSONS TREATED AS A SINGLE EMPLOYER UNDER SUBSECTION (B),
(C), (M) OR (O) OF SECTION 414 OF THE INTERNAL REVENUE CODE OF 1986
SHALL BE TREATED AS A SINGLE EMPLOYER;
(B) AN EMPLOYER AND ANY PREDECESSOR EMPLOYER SHALL BE TREATED AS A
SINGLE EMPLOYER;
(C) ALL EMPLOYEES SHALL BE COUNTED, INCLUDING PART-TIME EMPLOYEES AND
EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE THROUGH THE EMPLOYER;
(D) IF AN EMPLOYER WAS NOT IN EXISTENCE THROUGHOUT THE PRECEDING
CALENDAR YEAR, THEN THE DETERMINATION OF WHETHER THAT EMPLOYER IS A
SMALL EMPLOYER SHALL BE BASED UPON THE AVERAGE NUMBER OF EMPLOYEES THAT
THE EMPLOYER REASONABLY EXPECTS TO EMPLOY ON BUSINESS DAYS IN THE
CURRENT CALENDAR YEAR;
(E) IF A QUALIFIED EMPLOYER THAT MAKES ENROLLMENT IN QUALIFIED HEALTH
PLANS AVAILABLE TO ITS EMPLOYEES THROUGH THE EXCHANGE CEASES TO BE A
SMALL EMPLOYER BY REASON OF AN INCREASE IN THE NUMBER OF ITS EMPLOYEES,
THEN THE EMPLOYER SHALL CONTINUE TO BE TREATED AS A QUALIFIED EMPLOYER
FOR PURPOSES OF THIS ARTICLE FOR THE PERIOD BEGINNING WITH THE INCREASE
AND ENDING WITH THE FIRST DAY ON WHICH THE EMPLOYER DOES NOT MAKE SUCH
ENROLLMENT AVAILABLE TO ITS EMPLOYEES; AND
(F) NOTWITHSTANDING PARAGRAPHS (A) THROUGH (E) OF THIS SUBDIVISION, AN
EMPLOYER ALSO SHALL BE CONSIDERED A SMALL EMPLOYER IF THE COVERAGE IT
OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE UNDER THE INSURANCE LAW
AND REGULATIONS PROMULGATED THEREUNDER.
13. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
INDIVIDUALS RECEIVE HEALTH INSURANCE COVERAGE ON BEHALF OF THEMSELVES
S. 989 4
AND THEIR DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY A SMALL
EMPLOYER.
14. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
§ 3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE. 1.
THERE IS HEREBY CREATED A PUBLIC BENEFIT CORPORATION TO BE KNOWN AS THE
NEW YORK HEALTH BENEFIT EXCHANGE. SUCH CORPORATION SHALL BE A BODY
CORPORATE AND POLITIC.
2. THE PURPOSE OF THE EXCHANGE IS TO FACILITATE THE PURCHASE AND SALE
OF QUALIFIED HEALTH PLANS, ASSIST QUALIFIED EMPLOYERS IN FACILITATING
THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS THROUGH THE
SMALL BUSINESS HEALTH OPTIONS PROGRAM, ENROLL INDIVIDUALS IN HEALTH
COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW AND
CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS ARTICLE.
3. (A) THE EXCHANGE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSIST-
ING OF NINE VOTING DIRECTORS, INCLUDING THE COMMISSIONER AND THE SUPER-
INTENDENT, WHO SHALL SERVE AS EX OFFICIO DIRECTORS.
(B) SEVEN DIRECTORS SHALL BE APPOINTED BY THE GOVERNOR, TWO OF WHOM
SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
THE SENATE AND TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF
THE SPEAKER OF THE ASSEMBLY. EACH PERSON APPOINTED AS A DIRECTOR PURSU-
ANT TO THIS PARAGRAPH SHALL HAVE EXPERTISE IN ONE OR MORE OF THE FOLLOW-
ING AREAS:
(I) INDIVIDUAL HEALTH CARE COVERAGE;
(II) SMALL EMPLOYER HEALTH CARE COVERAGE;
(III) HEALTH BENEFITS ADMINISTRATION;
(IV) HEALTH CARE FINANCE;
(V) PUBLIC OR PRIVATE HEALTH CARE DELIVERY SYSTEMS; AND
(VI) PURCHASING HEALTH PLAN COVERAGE.
(C) RECOMMENDATIONS AND APPOINTMENTS SHALL TAKE INTO CONSIDERATION THE
EXPERTISE OF OTHER DIRECTORS RECOMMENDED AND APPOINTED PURSUANT TO THIS
SUBDIVISION, SO THAT THE BOARD COMPOSITION REFLECTS A DIVERSITY OF EXPE-
RIENCE.
(D) RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE
SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
DATE OF THIS ARTICLE, WITHIN SIXTY DAYS OF THE OCCURRENCE OF A VACANCY
OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM.
4. THE GOVERNOR SHALL APPOINT A CHAIR OF THE BOARD FROM AMONG THE
DIRECTORS WHO SHALL BE SUBJECT TO THE ADVICE AND CONSENT OF THE SENATE.
ANY DIRECTOR APPOINTED BY THE GOVERNOR AS CHAIR OF THE BOARD MAY SERVE
AS ACTING CHAIR UNTIL SUCH TIME AS A VOTE FOR CONFIRMATION IS TAKEN BY
THE SENATE. NO DIRECTOR APPOINTED AS CHAIR SHALL SERVE AS CHAIR, OR
CONTINUE TO SERVE AS ACTING CHAIR, IF THE SENATE HAS VOTED NOT TO
CONFIRM SUCH DIRECTOR AS CHAIR.
5. (A) THE TERMS OF THE DIRECTORS, OTHER THAN THE EX OFFICIO DIREC-
TORS, SHALL BE THREE YEARS, PROVIDED, HOWEVER, THAT THE INITIAL TERMS OF
ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDATION OF THE TEMPORARY
PRESIDENT OF THE SENATE, ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDA-
TION OF THE SPEAKER OF THE ASSEMBLY, AND ONE OF THE DIRECTORS APPOINTED
BY THE GOVERNOR WITHOUT RECOMMENDATION SHALL BE FOR TWO YEARS.
(B) VACANCIES OCCURRING OTHERWISE THAN BY EXPIRATION OF TERM OF OFFICE
SHALL BE FILLED FOR THE UNEXPIRED TERM IN THE MANNER PROVIDED FOR
ORIGINAL APPOINTMENT.
6. THE DIRECTORS SHALL NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES
AS DIRECTORS.
7. (A) EACH DIRECTOR SHALL HAVE THE RESPONSIBILITY AND DUTY TO MEET
THE REQUIREMENTS OF THIS ARTICLE AND ALL APPLICABLE STATE AND FEDERAL
S. 989 5
LAWS AND REGULATIONS TO SERVE THE PUBLIC INTEREST OF THE INDIVIDUALS AND
SMALL BUSINESSES SEEKING HEALTH CARE COVERAGE THROUGH THE EXCHANGE,
CONSISTENT WITH SECTION TWENTY-EIGHT HUNDRED TWENTY-FOUR OF THIS CHAP-
TER.
(B) EACH DIRECTOR SHALL BE A STATE OFFICER OR EMPLOYEE FOR THE
PURPOSES OF SECTIONS SEVENTY-THREE AND SEVENTY-FOUR OF THE PUBLIC OFFI-
CERS LAW.
(C) NO DIRECTOR MAY BE EMPLOYED OR OTHERWISE RETAINED BY THE EXCHANGE.
8. (A) THE BOARD MAY CREATE SUCH COMMITTEES AS THE BOARD DEEMS NECES-
SARY. THE FIRST MEETING OF THE BOARD SHALL BE HELD WITHIN THIRTY DAYS
AFTER ALL DIRECTORS ARE INITIALLY APPOINTED. AT THE FIRST MEETING OF
THE BOARD, AND AT THE FIRST MEETING IN EACH SUBSEQUENT YEAR, THE BOARD
SHALL ELECT FROM AMONG ITS MEMBERS A SECRETARY AND A TREASURER. THE
BOARD ALSO SHALL ELECT SUCH OTHER OFFICERS AS IT SHALL DEEM NECESSARY.
THE OFFICERS SO ELECTED SHALL HAVE SUCH POWERS AND DUTIES AS ARE
ASSIGNED BY THE BY-LAWS AND THIS CHAPTER.
(B) THE BOARD, AND ANY COMMITTEE THEREOF, MAY HOLD MEETINGS BY ELEC-
TRONIC MEANS CONSISTENT WITH ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW.
§ 3983. GENERAL POWERS OF THE EXCHANGE. THE EXCHANGE SHALL HAVE THE
FOLLOWING POWERS TO BE USED IN FURTHERANCE OF ITS CORPORATE PURPOSES:
1. TO SUE AND BE SUED AND TO PARTICIPATE IN ACTIONS AND PROCEEDINGS,
WHETHER JUDICIAL, ADMINISTRATIVE, ARBITRATIVE OR OTHERWISE;
2. TO HAVE A CORPORATE SEAL, AND TO ALTER SUCH SEAL AT PLEASURE, AND
TO USE IT BY CAUSING IT OR A FACSIMILE TO BE AFFIXED OR IMPRESSED OR
REPRODUCED IN ANY OTHER MANNER;
3. TO PURCHASE, RECEIVE, TAKE BY GRANT, GIFT, DEVISE, BEQUEST OR
OTHERWISE, LEASE, OR OTHERWISE ACQUIRE, OWN, HOLD, IMPROVE, EMPLOY, USE
AND OTHERWISE DEAL IN AND WITH, REAL OR PERSONAL PROPERTY, OR ANY INTER-
EST THEREIN, WHEREVER SITUATED;
4. TO SELL, CONVEY, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF,
OR MORTGAGE OR PLEDGE, OR CREATE A SECURITY INTEREST IN, ALL OR ANY OF
ITS PROPERTY, OR ANY INTEREST THEREIN, WHEREVER SITUATED;
5. TO MAKE CONTRACTS, GIVE GUARANTEES AND INCUR LIABILITIES, AND
BORROW MONEY; PROVIDED, HOWEVER, THAT THE EXCHANGE SHALL NOT ISSUE
BONDS;
6. TO INVEST AND REINVEST ITS FUNDS, AND TAKE AND HOLD REAL AND
PERSONAL PROPERTY AS SECURITY FOR THE PAYMENT OF FUNDS SO LOANED OR
INVESTED;
7. TO MAKE AND ALTER BY-LAWS FOR ITS ORGANIZATION AND MANAGEMENT;
8. TO MAKE AND ALTER RULES AND REGULATIONS AS NECESSARY TO IMPLEMENT
THE PROVISIONS OF THIS ARTICLE, SUBJECT TO THE PROVISIONS OF THE STATE
ADMINISTRATIVE PROCEDURE ACT;
9. TO HIRE EMPLOYEES, CONSISTENT WITH SECTION THIRTY-NINE HUNDRED
EIGHTY-NINE OF THIS ARTICLE;
10. TO DESIGNATE THE DEPOSITORIES OF ITS MONEY;
11. TO ESTABLISH ITS FISCAL YEAR;
12. TO INSURE OR OTHERWISE PROVIDE FOR THE INSURANCE OF THE EXCHANGE'S
PROPERTY OR OPERATIONS AND AGAINST SUCH OTHER RISKS AS THE EXCHANGE MAY
DEEM ADVISABLE;
13. TO RECEIVE AND SPEND MONEY FOR ANY OF ITS CORPORATE PURPOSES IN
ACCORDANCE WITH THIS ARTICLE; AND
14. TO APPLY FOR, ACCEPT THE AWARD OF, AND SPEND ANY AVAILABLE GRANT
MONEY.
§ 3984. FUNCTIONS OF THE EXCHANGE. THE EXCHANGE SHALL:
1. (A) MAKE AVAILABLE QUALIFIED HEALTH PLANS TO QUALIFIED INDIVIDUALS
AND QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOU-
S. 989 6
SAND TWENTY, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED PLANS SHALL NOT
BECOME EFFECTIVE PRIOR TO SUCH DATE AND SHALL NOT MAKE AVAILABLE ANY
HEALTH PLAN THAT IS NOT A QUALIFIED HEALTH PLAN;
(B) MAKE AVAILABLE QUALIFIED DENTAL PLANS TO QUALIFIED INDIVIDUALS AND
QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOUSAND
TWENTY, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED DENTAL PLANS SHALL
NOT BECOME EFFECTIVE PRIOR TO SUCH DATE, EITHER SEPARATELY OR IN
CONJUNCTION WITH A QUALIFIED HEALTH PLAN, IF SUCH PLAN PROVIDES PEDIA-
TRIC DENTAL BENEFITS;
2. ASSIGN A RATING TO EACH QUALIFIED HEALTH PLAN OFFERED THROUGH THE
EXCHANGE, AND DETERMINE EACH QUALIFIED HEALTH PLAN'S LEVEL OF COVERAGE;
3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
IN THE EXCHANGE, INCLUDING THE USE OF THE UNIFORM OUTLINE OF COVERAGE
ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT;
4. PROVIDE FOR ENROLLMENT PERIODS PURSUANT TO THE INSURANCE LAW,
WHICHEVER IS IN THE BEST INTEREST OF QUALIFIED INDIVIDUALS AND QUALIFIED
EMPLOYERS;
5. IMPLEMENT PROCEDURES FOR THE CERTIFICATION, RECERTIFICATION AND
DECERTIFICATION OF HEALTH PLANS AS QUALIFIED HEALTH PLANS, CONSISTENT
WITH GUIDELINES DEVELOPED BY THE SUPERINTENDENT;
6. REQUIRE QUALIFIED HEALTH PLANS TO OFFER THOSE BENEFITS DETERMINED
BY THE SUPERINTENDENT TO BE ESSENTIAL HEALTH BENEFITS AND SUCH ADDI-
TIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO THE INSURANCE LAW;
7. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE EXCHANGE DO
NOT CHARGE AN INDIVIDUAL A FEE OR PENALTY FOR TERMINATION OF COVERAGE;
8. PROVIDE FOR THE OPERATION OF A TOLL-FREE TELEPHONE HOTLINE TO
RESPOND TO REQUESTS FOR ASSISTANCE;
9. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES AND PROSPEC-
TIVE ENROLLEES OF QUALIFIED HEALTH PLANS MAY OBTAIN STANDARDIZED COMPAR-
ATIVE INFORMATION ON SUCH PLANS AND PUBLIC HEALTH PROGRAMS;
10. ESTABLISH AND MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO
DETERMINE THE ACTUAL COST OF COVERAGE AFTER THE APPLICATION OF ANY
PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF
1986 AND ANY COST-SHARING REDUCTION;
11. ESTABLISH A PROGRAM UNDER WHICH THE EXCHANGE AWARDS GRANTS TO
ENTITIES TO SERVE AS NAVIGATORS;
12. INFORM INDIVIDUALS OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID
PROGRAM UNDER TITLE XIX OF THE SOCIAL SECURITY ACT, THE CHILDREN'S
HEALTH INSURANCE PROGRAM (CHIP) UNDER TITLE XXI OF THE SOCIAL SECURITY
ACT OR ANY APPLICABLE STATE OR LOCAL PUBLIC HEALTH INSURANCE PROGRAM AND
IF, THROUGH SCREENING OF THE APPLICATION BY THE EXCHANGE, THE EXCHANGE
DETERMINES THAT SUCH INDIVIDUALS ARE ELIGIBLE FOR ANY SUCH PROGRAM,
ENROLL SUCH INDIVIDUALS IN SUCH PROGRAM;
13. GRANT A CERTIFICATION ATTESTING THAT, FOR PURPOSES OF THE INDI-
VIDUAL RESPONSIBILITY PENALTY UNDER SECTION 5000A OF THE INTERNAL REVEN-
UE CODE OF 1986, AN INDIVIDUAL IS EXEMPT FROM THE INDIVIDUAL RESPONSI-
BILITY REQUIREMENT OR FROM THE PENALTY IMPOSED BY THAT SECTION BECAUSE:
(A) THERE IS NO AFFORDABLE QUALIFIED HEALTH PLAN AVAILABLE THROUGH THE
EXCHANGE OR THE INDIVIDUAL'S EMPLOYER, COVERING THE INDIVIDUAL; OR
(B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR PENALTY;
14. TRANSMIT TO THE COMPTROLLER:
(A) A LIST OF THE INDIVIDUALS TO WHOM THE EXCHANGE GRANTED A CERTIF-
ICATION UNDER SUBDIVISION THIRTEEN OF THIS SECTION, INCLUDING THE NAME
AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL;
S. 989 7
(B) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL WHO
WAS AN EMPLOYEE OF AN EMPLOYER WHO WAS DETERMINED TO BE ELIGIBLE FOR THE
PREMIUM TAX CREDIT UNDER SECTION 36B OF THE INTERNAL REVENUE CODE OF
1986 BECAUSE:
(I) THE EMPLOYER DID NOT PROVIDE MINIMUM ESSENTIAL COVERAGE AS DETER-
MINED BY THE SUPERINTENDENT; OR
(II) THE EMPLOYER PROVIDED THE MINIMUM ESSENTIAL COVERAGE AS DETER-
MINED BY THE SUPERINTENDENT, BUT IT WAS DETERMINED UNDER SECTION
36B(C)(2)(C) OF THE INTERNAL REVENUE CODE OF 1986 TO EITHER BE UNAFFORD-
ABLE TO THE EMPLOYEE OR TO NOT PROVIDE THE REQUIRED MINIMUM ACTUARIAL
VALUE; AND
(C) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF:
(I) EACH INDIVIDUAL WHO NOTIFIES THE EXCHANGE THAT HE OR SHE HAS
CHANGED EMPLOYERS; AND
(II) EACH INDIVIDUAL WHO CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN
DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THAT CESSATION;
15. PROVIDE TO EACH EMPLOYER THE NAME OF EACH EMPLOYEE OF THE EMPLOYER
DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION FOURTEEN OF THIS SECTION WHO
CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE
EFFECTIVE DATE OF THE CESSATION;
16. OPERATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") THROUGH
WHICH QUALIFIED EMPLOYERS ACCESS COVERAGE FOR THEIR EMPLOYEES, AND MAY:
(A) PERMIT QUALIFIED EMPLOYERS TO SPECIFY A LEVEL OF COVERAGE SO THEIR
EMPLOYEES MAY ENROLL IN ANY QUALIFIED HEALTH PLAN OFFERED THROUGH THE
SHOP AT THE SPECIFIED LEVEL OF COVERAGE OR PROVIDE A SPECIFIC AMOUNT OR
OTHER PAYMENT FORMULATED TO BE USED AS PART OF AN EMPLOYEE CHOICE PLAN;
AND
(B) PROVIDE PREMIUM AGGREGATION AND OTHER RELATED SERVICES TO MINIMIZE
ADMINISTRATIVE BURDENS FOR QUALIFIED EMPLOYERS;
17. ENTER INTO AGREEMENTS AS NECESSARY WITH: (A) FEDERAL AND STATE
AGENCIES AND OTHER STATE EXCHANGES TO CARRY OUT ITS RESPONSIBILITIES
UNDER THIS ARTICLE, PROVIDED SUCH AGREEMENTS INCLUDE ADEQUATE
PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE
SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; AND
(B) LOCAL DEPARTMENTS OF SOCIAL SERVICES TO COORDINATE ENROLLMENT IN
OTHER SOCIAL SERVICES PROGRAMS, AS APPROPRIATE, PROVIDED SUCH AGREEMENTS
INCLUDE ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY
INFORMATION TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND
REGULATIONS;
18. PERFORM DUTIES REQUIRED BY THE SUPERINTENDENT OR THE SECRETARY OF
THE UNITED STATES DEPARTMENT OF THE TREASURY RELATED TO DETERMINING
ELIGIBILITY FOR PREMIUM TAX CREDITS, REDUCED COST-SHARING, OR INDIVIDUAL
RESPONSIBILITY REQUIREMENT EXEMPTIONS;
19. MEET FINANCIAL INTEGRITY REQUIREMENTS OF THIS CHAPTER, INCLUDING:
(A) KEEPING AN ACCURATE ACCOUNTING OF ALL ACTIVITIES, RECEIPTS, AND
EXPENDITURES AND ANNUALLY SUBMITTING TO THE SUPERINTENDENT A REPORT
CONCERNING SUCH ACCOUNTINGS, WITH A COPY OF SUCH REPORT PROVIDED TO THE
GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER OF THE
ASSEMBLY; AND
(B) FULLY COOPERATING WITH ANY INVESTIGATION CONDUCTED BY THE SUPER-
INTENDENT PURSUANT TO HIS OR HER AUTHORITY AND ALLOWING THE SUPERINTEN-
DENT TO:
(I) INVESTIGATE THE AFFAIRS OF THE EXCHANGE;
(II) EXAMINE THE PROPERTIES AND RECORDS OF THE EXCHANGE; AND
(III) REQUIRE PERIODIC REPORTS IN RELATION TO THE ACTIVITIES UNDERTAK-
EN BY THE EXCHANGE;
S. 989 8
20. (A) CONSULT WITH THE REGIONAL ADVISORY COMMITTEES ESTABLISHED
PURSUANT TO SECTION THIRTY-NINE HUNDRED EIGHTY-SIX OF THIS ARTICLE; AND
(B) CONSULT WITH STAKEHOLDERS RELEVANT TO CARRYING OUT THE ACTIVITIES
REQUIRED UNDER THIS ARTICLE, INCLUDING BUT NOT LIMITED TO:
(I) HEALTH CARE CONSUMERS WHO ARE ENROLLEES IN HEALTH PLANS;
(II) INDIVIDUALS AND ENTITIES WITH EXPERIENCE IN FACILITATING ENROLL-
MENT IN HEALTH PLANS;
(III) REPRESENTATIVES OF SMALL BUSINESSES AND SELF-EMPLOYED INDIVID-
UALS;
(IV) STATE MEDICAID OFFICES, INCLUDING LOCAL DEPARTMENTS OF SOCIAL
SERVICES;
(V) ADVOCATES FOR ENROLLING HARD TO REACH POPULATIONS;
(VI) HEALTH CARE PROVIDERS; AND
(VII) INSURERS;
21. SUBMIT INFORMATION PROVIDED BY EXCHANGE APPLICANTS FOR VERIFICA-
TION;
22. ESTABLISH RULES AND REGULATIONS, PURSUANT TO SUBDIVISION EIGHT OF
SECTION THIRTY-NINE HUNDRED EIGHTY-THREE OF THIS ARTICLE, THAT DO NOT
CONFLICT WITH OR PREVENT THE APPLICATION OF REGULATIONS PROMULGATED BY
THE SUPERINTENDENT; AND
23. DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE OPPORTUNITIES
FOR APPEAL AND REDETERMINATION.
§ 3985. SPECIAL FUNCTIONS OF THE EXCHANGE RELATED TO HEALTH PLAN
CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT. 1. HEALTH PLANS
CERTIFIED BY THE EXCHANGE SHALL MEET THE FOLLOWING REQUIREMENTS:
(A) THE INSURER OFFERING THE HEALTH PLAN:
(I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER;
(II) OFFERS AT LEAST ONE QUALIFIED HEALTH PLAN IN EACH OF THE SILVER
AND GOLD LEVELS;
(III) HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT OF
ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
LAW AND THE PUBLIC HEALTH LAW;
(IV) DOES NOT CHARGE ANY CANCELLATION FEES OR PENALTIES IN VIOLATION
OF SUBDIVISION SEVEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS
ARTICLE; AND
(V) COMPLIES WITH THE REGULATIONS DEVELOPED BY THE SUPERINTENDENT AND
SUCH OTHER REQUIREMENTS AS THE EXCHANGE MAY ESTABLISH;
(B) THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS PACK-
AGE AND INCLUDES SUCH ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO
THE INSURANCE LAW, EXCEPT THAT THE HEALTH PLAN SHALL NOT BE REQUIRED TO
PROVIDE ESSENTIAL BENEFITS THAT DUPLICATE THE MINIMUM BENEFITS OF QUALI-
FIED DENTAL PLANS IF:
(A) THE EXCHANGE HAS DETERMINED THAT AT LEAST ONE QUALIFIED DENTAL
PLAN IS AVAILABLE TO SUPPLEMENT THE HEALTH PLAN'S COVERAGE; AND
(B) THE INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT OFFERS THE
HEALTH PLAN, IN A FORM APPROVED BY THE EXCHANGE, THAT THE PLAN DOES NOT
PROVIDE THE FULL RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT QUALI-
FIED DENTAL PLANS PROVIDING THOSE BENEFITS AND OTHER DENTAL BENEFITS NOT
COVERED BY THE PLAN ARE OFFERED THROUGH THE EXCHANGE;
(II) PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE, UNLESS THE PLAN IS
CERTIFIED AS A QUALIFIED CATASTROPHIC PLAN, AND SHALL ONLY BE OFFERED TO
INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE;
(III) HAS COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES, WHICH DO
NOT EXCEED THE LIMITS ESTABLISHED AND ANY REQUIREMENTS OF THE EXCHANGE;
(IV) COMPLIES WITH REGULATIONS PROMULGATED BY THE SUPERINTENDENT,
WHICH INCLUDE MINIMUM STANDARDS IN THE AREAS OF MARKETING PRACTICES,
S. 989 9
NETWORK ADEQUACY, ESSENTIAL COMMUNITY PROVIDERS IN UNDERSERVED AREAS,
ACCREDITATION, QUALITY IMPROVEMENT, UNIFORM ENROLLMENT FORMS AND
DESCRIPTIONS OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH
BENEFIT PLAN PERFORMANCE;
(V) COMPLIES WITH THE INSURANCE LAW AND THE PUBLIC HEALTH LAW REQUIRE-
MENTS APPLICABLE TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGU-
LATIONS PROMULGATED PURSUANT THERETO THAT DO NOT CONFLICT WITH OR
PREVENT THE APPLICATION OF FEDERAL REQUIREMENTS; AND
(C) THE EXCHANGE DETERMINES THAT MAKING THE HEALTH PLAN AVAILABLE
THROUGH THE EXCHANGE IS IN THE INTEREST OF QUALIFIED INDIVIDUALS AND
QUALIFIED EMPLOYERS IN THIS STATE.
2. THE EXCHANGE SHALL NOT EXCLUDE A HEALTH PLAN:
(A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
(B) THROUGH THE IMPOSITION OF PREMIUM PRICE CONTROLS BY THE EXCHANGE;
OR
(C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE EXCHANGE DETERMINES ARE
INAPPROPRIATE OR TOO COSTLY.
3. THE EXCHANGE SHALL REQUIRE EACH INSURER CERTIFIED OR SEEKING
CERTIFICATION OF A HEALTH PLAN AS A QUALIFIED HEALTH PLAN TO:
(A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE TO THE EXCHANGE
PRIOR TO IMPLEMENTATION OF SUCH INCREASE. THE INSURER SHALL PROMINENTLY
POST THE INFORMATION ON ITS INTERNET WEBSITE; PROVIDED, HOWEVER, THAT IF
INFORMATION SUBMITTED TO THE SUPERINTENDENT AS A JUSTIFICATION FOR A
PREMIUM RATE ADJUSTMENT PURSUANT TO THE INSURANCE LAW, OR INFORMATION
POSTED TO AN INSURER'S INTERNET WEBSITE, OTHERWISE MEETS FEDERAL
REQUIREMENTS, THEN SUBMISSION OF A COPY OF THE SAME JUSTIFICATION TO THE
EXCHANGE OR USE OF THE SAME POSTING SHALL BE DEEMED SUFFICIENT TO MEET
THE REQUIREMENTS OF THIS SECTION. THE EXCHANGE SHALL TAKE THIS INFORMA-
TION, AND THE INFORMATION AND THE RECOMMENDATIONS PROVIDED TO THE
EXCHANGE BY THE SUPERINTENDENT RELATING TO PATTERNS OR PRACTICES OF
EXCESSIVE OR UNJUSTIFIED PREMIUM INCREASES, INTO CONSIDERATION WHEN
DETERMINING WHETHER TO ALLOW THE INSURER TO MAKE HEALTH PLANS AVAILABLE
THROUGH THE EXCHANGE. SUCH RATE INCREASES SHALL BE SUBJECT TO THE PRIOR
APPROVAL OF THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW;
(B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE EXCHANGE AND THE
SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
(A) CLAIMS PAYMENT POLICIES AND PRACTICES;
(B) PERIODIC FINANCIAL DISCLOSURES;
(C) DATA ON ENROLLMENT AND DISENROLLMENT;
(D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
(E) DATA ON RATING PRACTICES;
(F) INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT-
OF-NETWORK COVERAGE;
(G) INFORMATION ON ENROLLEE AND PARTICIPANT RIGHTS; AND
(H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY THE SUPERINTENDENT;
(II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE AND IN GUID-
ANCE JOINTLY ISSUED THEREUNDER BY THE SUPERINTENDENT AND THE FEDERAL
SECRETARY OF LABOR; AND
(C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
INDIVIDUAL, THE AMOUNT OF COST-SHARING, INCLUDING DEDUCTIBLES, COPAY-
MENTS, AND COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN OR COVERAGE
THAT THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO THE
FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
A MINIMUM, THIS INFORMATION SHALL BE MADE AVAILABLE TO THE INDIVIDUAL
S. 989 10
THROUGH AN INTERNET WEBSITE AND THROUGH OTHER MEANS FOR INDIVIDUALS
WITHOUT ACCESS TO THE INTERNET.
4. (A) THE PROVISIONS OF THIS ARTICLE THAT APPLY TO QUALIFIED HEALTH
PLANS ALSO SHALL APPLY TO THE EXTENT RELEVANT TO QUALIFIED DENTAL PLANS
EXCEPT AS MODIFIED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPHS (B)
AND (C) OF THIS SUBDIVISION OR OTHERWISE REQUIRED BY THE EXCHANGE.
(B) THE QUALIFIED DENTAL PLAN SHALL BE LIMITED TO DENTAL AND ORAL
HEALTH BENEFITS, WITHOUT SUBSTANTIALLY DUPLICATING THE BENEFITS TYPICAL-
LY OFFERED BY HEALTH BENEFIT PLANS WITHOUT DENTAL COVERAGE, AND SHALL
INCLUDE, AT A MINIMUM, THE ESSENTIAL PEDIATRIC DENTAL BENEFITS
PRESCRIBED BY THE SUPERINTENDENT AND SUCH OTHER DENTAL BENEFITS AS THE
EXCHANGE OR THE SUPERINTENDENT MAY SPECIFY IN REGULATIONS.
(C) INSURERS MAY JOINTLY OFFER A COMPREHENSIVE PLAN THROUGH THE
EXCHANGE IN WHICH AN INSURER PROVIDES THE DENTAL BENEFITS THROUGH A
QUALIFIED DENTAL PLAN AND AN INSURER PROVIDES THE OTHER BENEFITS THROUGH
A QUALIFIED HEALTH PLAN, PROVIDED THAT THE PLANS ARE PRICED SEPARATELY
AND ALSO ARE MADE AVAILABLE FOR PURCHASE SEPARATELY AT THE SAME PRICE.
§ 3986. REGIONAL ADVISORY COMMITTEES. 1. THERE ARE HEREBY CREATED THE
NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ("ADVISORY
COMMITTEES"). ONE REGIONAL ADVISORY COMMITTEE SHALL BE ESTABLISHED WITH-
IN EACH OF FIVE REGIONS, TO BE KNOWN AS THE "NEW YORK CITY REGION,"
"METROPOLITAN SUBURBAN REGION," "NORTHERN REGION," "CENTRAL REGION" AND
"WESTERN REGION." THE BOARD SHALL DETERMINE THE COUNTIES THAT MAKE UP
SUCH REGIONS.
2. EACH REGIONAL ADVISORY COMMITTEE SHALL BE COMPRISED OF FIVE MEMBERS
APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED UPON THE
RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND ONE OF WHOM
SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEM-
BLY.
3. TERMS SHALL BE THREE YEARS. MEMBERS SHALL SERVE UNTIL THEIR
SUCCESSORS ARE APPOINTED. MEMBERS MAY SERVE UP TO TWO CONSECUTIVE TERMS.
4. VACANCIES SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL APPOINT-
MENTS, AND SUCCESSORS SHALL SERVE FOR THE REMAINDER OF THE UNEXPIRED
TERM TO WHICH THEY ARE APPOINTED.
5. RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE AND THE
SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
DATE OF THIS ARTICLE OR THE OCCURRENCE OF A VACANCY, OR WITHIN SIXTY
DAYS PRIOR TO THE EXPIRATION OF A TERM.
6. THE MEMBERS OF EACH REGIONAL ADVISORY COMMITTEE SHALL INCLUDE:
(A) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
TWO FROM ANY SINGLE CATEGORY:
(I) HEALTH PLAN CONSUMER ADVOCATES;
(II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
(III) HEALTH CARE PROVIDER REPRESENTATIVES;
(IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
(B) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
ONE FROM EITHER CATEGORY:
(I) LICENSED INSURANCE PRODUCERS; AND
(II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
7. THE BOARD SHALL SELECT THE CHAIR OF EACH REGIONAL ADVISORY COMMIT-
TEE FROM AMONG THE MEMBERS OF SUCH COMMITTEE. THE BOARD SHALL ADOPT
RULES FOR THE GOVERNANCE OF THE REGIONAL ADVISORY COMMITTEES AND EACH
REGIONAL ADVISORY COMMITTEE SHALL MEET AT LEAST ONCE EACH QUARTER AND AT
SUCH OTHER TIMES AS DETERMINED BY THE BOARD TO BE NECESSARY.
8. MEMBERS OF THE REGIONAL ADVISORY COMMITTEES SHALL SERVE WITHOUT
COMPENSATION.
S. 989 11
9. THE REGIONAL ADVISORY COMMITTEES SHALL MAKE FINDINGS AND RECOMMEN-
DATIONS REGARDING REGIONAL VARIATIONS IN THE OPERATION OF THE EXCHANGE,
WHICH SHALL BE SUBMITTED TO THE BOARD OF DIRECTORS, POSTED ON THE
WEBSITE OF THE EXCHANGE, AND CONSIDERED BY THE BOARD IN A REASONABLY
TIMELY FASHION. SUCH FINDINGS AND RECOMMENDATIONS SHALL BE MADE ON AN
ANNUAL BASIS, ON A DATE DETERMINED BY THE BOARD, AND AT SUCH OTHER TIMES
AS THE BOARD OR ANY REGIONAL ADVISORY COMMITTEE DEEMS APPROPRIATE.
§ 3987. FUNDING OF THE EXCHANGE. 1. THE EXCHANGE SHALL BE FINANCIALLY
SELF-SUFFICIENT BY JANUARY FIRST, TWO THOUSAND TWENTY-ONE.
2. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND
SHALL REPORT ITS FINDINGS AND RECOMMENDATIONS UPON, THE OPTIONS TO
GENERATE FUNDING FOR THE ONGOING OPERATION OF THE EXCHANGE.
3. THE EXCHANGE SHALL PUBLISH ON ITS INTERNET WEBSITE THE FEES AND
ANY OTHER PAYMENTS REQUIRED BY THE EXCHANGE, AND THE ADMINISTRATIVE
COSTS OF THE EXCHANGE, TO EDUCATE CONSUMERS ON SUCH COSTS AND THE AMOUNT
OF MONIES LOST TO WASTE, FRAUD AND ABUSE.
4. THE EXCHANGE SHALL NOT UTILIZE ANY FUNDS INTENDED FOR THE ADMINIS-
TRATIVE AND OPERATIONAL EXPENSES OF THE EXCHANGE FOR STAFF RETREATS,
PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE COMPENSATION, OR PROMOTION OF
FEDERAL OR STATE LEGISLATIVE AND REGULATORY MODIFICATIONS.
5. THE MONEYS OF THE EXCHANGE SHALL, EXCEPT AS OTHERWISE PROVIDED IN
THIS SECTION, BE DEPOSITED IN A GENERAL ACCOUNT CALLED THE NEW YORK
HEALTH BENEFIT EXCHANGE ACCOUNT AND SUCH OTHER ACCOUNTS AS THE EXCHANGE
MAY DEEM NECESSARY, PURSUANT TO RESOLUTION OF THE BOARD, FOR THE TRANS-
ACTION OF ITS BUSINESS AND SHALL BE PAID OUT AS AUTHORIZED BY THE CHAIR
OF THE BOARD OR BY SUCH OTHER PERSON OR PERSONS AS THE CHAIR MAY DESIG-
NATE.
6. NO FUNDS OF THE EXCHANGE SHALL BE TRANSFERRED TO THE GENERAL FUND
OR ANY SPECIAL REVENUE FUND OR SHALL BE USED FOR ANY PURPOSE OTHER THAN
THE PURPOSES SET FORTH IN THIS ARTICLE. NO FUNDS SHALL BE TRANSFERRED
FROM THE GENERAL FUND OR ANY SPECIAL REVENUE FUND TO THE EXCHANGE WITH-
OUT AN APPROPRIATION.
7. THE ACCOUNTS OF THE EXCHANGE SHALL BE SUBJECT TO SUPERVISION OF THE
COMPTROLLER AND SUCH ACCOUNTS SHALL INCLUDE RECEIPTS, EXPENDITURES,
CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
EXCHANGE.
8. NOTWITHSTANDING ANY LAW TO THE CONTRARY, AND IN ACCORDANCE WITH
SECTION FOUR OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
THE BUDGET, IN CONSULTATION WITH THE COMMISSIONER, THE SUPERINTENDENT
AND THE CHAIR OF THE BOARD, THE COMPTROLLER IS HEREBY AUTHORIZED AND
DIRECTED TO SUBALLOCATE OR TRANSFER SPECIAL REVENUE FEDERAL FUNDS APPRO-
PRIATED TO THE DEPARTMENT OF HEALTH FOR PLANNING AND IMPLEMENTING VARI-
OUS HEALTHCARE AND INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL
LEGISLATION TO THE NEW YORK STATE HEALTH BENEFIT EXCHANGE. MONEYS SUBAL-
LOCATED OR TRANSFERRED PURSUANT TO THIS SECTION SHALL BE PAID OUT OF THE
FUND UPON AUDIT AND WARRANT OF THE STATE COMPTROLLER ON VOUCHERS CERTI-
FIED OR APPROVED BY THE EXCHANGE.
§ 3988. TAX EXEMPTION AND TAX CONTRACT BY THE STATE. 1. IT IS HEREBY
DETERMINED THAT THE CREATION OF THE EXCHANGE AND THE FULFILLMENT OF ITS
CORPORATE PURPOSES IS IN ALL RESPECTS FOR THE BENEFIT OF THE PEOPLE OF
THIS STATE AND IS A PUBLIC PURPOSE. ACCORDINGLY, THE EXCHANGE SHALL BE
REGARDED AS PERFORMING AN ESSENTIAL GOVERNMENTAL FUNCTION IN THE EXER-
CISE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, AND THE EXCHANGE
SHALL NOT BE REQUIRED TO PAY ANY FEES, TAXES, SPECIAL AD VALOREM LEVIES
OR ASSESSMENTS OF ANY KIND, WHETHER STATE OR LOCAL, INCLUDING BUT NOT
LIMITED TO FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS ON REAL
S. 989 12
PROPERTY, FRANCHISE TAXES, SALES TAXES, TRANSFER TAXES, MORTGAGE TAXES
OR OTHER TAXES, UPON OR WITH RESPECT TO ANY PROPERTY OWNED BY IT OR
UNDER ITS JURISDICTION, CONTROL OR SUPERVISION, OR UPON THE USES THERE-
OF, OR UPON OR WITH RESPECT TO ITS ACTIVITIES OR OPERATIONS IN FURTHER-
ANCE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, OR UPON OR WITH
RESPECT TO ANY FARES, TOLLS, RENTALS, RATES, CHARGES, FEES, REVENUES OR
OTHER INCOME RECEIVED BY THE EXCHANGE.
2. THE EXCHANGE MAY PAY, OR MAY ENTER INTO AGREEMENTS WITH ANY COUNTY
OR MUNICIPALITY TO PAY, A SUM OR SUMS ANNUALLY OR OTHERWISE OR TO
PROVIDE OTHER CONSIDERATIONS WITH RESPECT TO REAL PROPERTY OWNED BY THE
EXCHANGE LOCATED WITHIN SUCH COUNTY OR MUNICIPALITY.
§ 3989. OFFICERS AND EMPLOYEES. 1. THE BOARD SHALL HAVE THE POWER TO
APPOINT EMPLOYEES TO SERVE AS SENIOR MANAGERIAL STAFF OF THE EXCHANGE AS
NECESSARY, WHO SHALL BE DESIGNATED TO BE IN THE EXEMPT CLASS OF CIVIL
SERVICE. THE BOARD SHALL ALSO HAVE THE POWER TO FIX THE SALARIES OF SUCH
EMPLOYEES.
2. ANY NEWLY HIRED EMPLOYEES WHO ARE NOT DESIGNATED TO BE IN THE
EXEMPT CLASS OF CIVIL SERVICE PURSUANT TO SUBDIVISION ONE OF THIS
SECTION AND WHO ARE NOT SUBJECT TO THE TRANSFER PROVISIONS SET FORTH IN
SUBDIVISIONS FOUR, FIVE AND SIX OF THIS SECTION SHALL BE CONSIDERED FOR
PURPOSES OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW TO BE PUBLIC
EMPLOYEES IN THE CIVIL SERVICE OF THE STATE, AND SHALL BE ASSIGNED TO
THE APPROPRIATE COLLECTIVE BARGAINING UNIT BY THE EXCHANGE IN THE SAME
MANNER AND CONSISTENT WITH THOSE EMPLOYEES DESCRIBED IN SUBDIVISION SIX
OF THIS SECTION.
3. ANY PUBLIC OFFICER OR EMPLOYEE OF A STATE DEPARTMENT, AGENCY OR
COMMISSION MAY BE TRANSFERRED TO THE EXCHANGE WITHOUT EXAMINATION AND
WITHOUT LOSS OF ANY CIVIL SERVICE STATUS OR RIGHTS TO A COMPARABLE
OFFICE, POSITION OR EMPLOYMENT WITH THE EXCHANGE; PROVIDED, HOWEVER, NO
SUCH TRANSFER MAY BE MADE WITHOUT THE CONSENT OF THE HEAD OF THE DEPART-
MENT, AGENCY OR COMMISSION. TRANSFERS SHALL BE MADE PURSUANT TO SUBDI-
VISION TWO OF SECTION SEVENTY OF THE CIVIL SERVICE LAW.
4. THE SALARY OR COMPENSATION OF ANY SUCH OFFICER OR EMPLOYEE, AFTER
SUCH TRANSFER, SHALL BE PAID BY THE EXCHANGE.
5. ANY OFFICER OR EMPLOYEE TRANSFERRED TO THE EXCHANGE PURSUANT TO
THIS SECTION, WHO ARE MEMBERS OF OR BENEFIT UNDER ANY EXISTING PENSION
OR RETIREMENT FUND OR SYSTEM, SHALL CONTINUE TO HAVE ALL RIGHTS, PRIVI-
LEGES, OBLIGATIONS AND STATUS WITH RESPECT TO SUCH FUND OR SYSTEM AS ARE
NOW PRESCRIBED BY LAW, BUT DURING THE PERIOD OF THEIR EMPLOYMENT BY THE
EXCHANGE, ALL CONTRIBUTIONS TO SUCH FUNDS OR SYSTEMS TO BE PAID BY THE
EMPLOYER ON ACCOUNT OF SUCH OFFICERS OR EMPLOYEES SHALL BE PAID BY THE
EXCHANGE.
6. A TRANSFERRED EMPLOYEE SHALL REMAIN IN THE SAME COLLECTIVE BARGAIN-
ING UNIT AS WAS THE CASE PRIOR TO HIS OR HER TRANSFER; SUCCESSOR EMPLOY-
EES TO THE POSITIONS HELD BY SUCH TRANSFERRED EMPLOYEES SHALL, CONSIST-
ENT WITH THE PROVISIONS OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW, BE
INCLUDED IN THE SAME UNIT AS THEIR PREDECESSORS. EMPLOYEES SERVING IN
POSITIONS IN NEWLY CREATED TITLES SHALL BE ASSIGNED TO THE SAME COLLEC-
TIVE BARGAINING UNIT AS THEY WOULD HAVE BEEN ASSIGNED TO WERE SUCH
TITLES CREATED PRIOR TO THE ESTABLISHMENT OF THE EXCHANGE. NOTHING
CONTAINED IN THIS ARTICLE SHALL BE CONSTRUED (A) TO DIMINISH THE RIGHTS
OF EMPLOYEES PURSUANT TO A COLLECTIVE BARGAINING AGREEMENT OR (B) TO
AFFECT EXISTING LAW WITH RESPECT TO AN APPLICATION TO THE PUBLIC EMPLOY-
MENT RELATIONS BOARD SEEKING A DESIGNATION BY THE BOARD THAT CERTAIN
PERSONS ARE MANAGERIAL OR CONFIDENTIAL.
S. 989 13
§ 3990. LIMITATION OF LIABILITY; INDEMNIFICATION. THE PROVISIONS OF
SECTIONS SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW SHALL BE
APPLICABLE TO EXCHANGE EMPLOYEES, AS SUCH TERM IS DEFINED IN SECTIONS
SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS LAW; PROVIDED, HOWEVER,
THAT NOTHING CONTAINED WITHIN THIS SECTION SHALL BE DEEMED TO PERMIT THE
EXCHANGE TO EXTEND THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF
THE PUBLIC OFFICERS LAW UPON ANY INDEPENDENT CONTRACTOR.
§ 3991. CONSTRUCTION. NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
THE EXCHANGE PURSUANT HERETO, SHALL BE CONSTRUED TO:
1. PREEMPT OR SUPERSEDE THE AUTHORITY OF THE SUPERINTENDENT OR THE
COMMISSIONER; OR
2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
THE PUBLIC HEALTH LAW OR THE INSURANCE LAW AND REGULATIONS PROMULGATED
THEREUNDER.
§ 3. Subdivision 1 of section 17 of the public officers law is amended
by adding a new paragraph (aa) to read as follows:
(AA) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
LAW.
§ 4. Subdivision 1 of section 19 of the public officers law is amended
by adding a new paragraph (k) to read as follows:
(K) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE" SHALL INCLUDE
DIRECTORS, OFFICERS AND EMPLOYEES OF THE NEW YORK HEALTH BENEFIT
EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
LAW.
§ 5. If any provision or application of this act shall be held to be
invalid, or to violate or be inconsistent with any applicable federal
law or regulation, that shall not affect other provisions or applica-
tions of this act which can be given effect without that provision or
application; and to that end, the provisions and applications of this
act are severable.
§ 6. The superintendent of the department of financial services is
authorized to promulgate rules and regulations, and may promulgate emer-
gency regulations, necessary for the implementation of the provisions of
this act on or before its effective date.
§ 7. This act shall take effect upon the occurrence of the earlier of:
(a) the repeal of the Patient Protection and Affordable Care Act, 42
U.S.C. § 18001 et seq. (2010); or
(b) the rescinding of Executive Order {Cuomo} No. 42 {9 NYCRR 8.42},
Establishing the New York Health Benefit Exchange; provided that the
governor of the state of New York shall notify the legislative bill
drafting commission upon the occurrence of the rescinding of Executive
Order {Cuomo} No. 42 {9 NYCRR 8.42}, Establishing the New York Health
Benefit Exchange in order that the commission may maintain an accurate
and timely effective data base of the official text of the laws of the
state of New York in furtherance of effecting the provisions of section
44 of the legislative law and section 70-b of the public officers law.