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This entry was published on 2014-09-22
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Limited exemption for health maintenance organizations
Insurance (ISC) CHAPTER 28, ARTICLE 11
§ 1109. Limited exemption for health maintenance organizations. (a) An
organization complying with the provisions of article forty-four of the
public health law may operate without being licensed under this chapter
and without being subject to any provisions of this chapter, except: (1)
to the extent that such organization must comply with the provisions of
this chapter by virtue of such article, and (2) the provisions of
sections three hundred eight, one thousand three hundred one, one
thousand three hundred two, one thousand three hundred seven, one
thousand three hundred twenty-two, with regard to health maintenance
organizations that are domiciled in this state and certified or
operating in at least one other state, two thousand one hundred three,
two thousand one hundred twelve, two thousand one hundred fourteen, two
thousand one hundred fifteen, two thousand one hundred seventeen, two
thousand one hundred twenty-three, two thousand six hundred eight-a, two
thousand six hundred twelve, three thousand two hundred twenty-four-a,
four thousand three hundred eight, four thousand three hundred
seventeen, four thousand three hundred eighteen, four thousand three
hundred twenty, four thousand three hundred twenty-one, four thousand
three hundred twenty-two and four thousand three hundred twenty-three of
this chapter.

(b) An organization which provides health care services for a periodic
fee paid in advance but which does not comply with the provisions of
article forty-four of the public health law shall be deemed to be
engaged in the business of insurance and may not operate without being
licensed under this chapter.

(c) An organization referred to in subsection (a) or (b) hereof shall
be subject to article seventy-four of this chapter.

(d) A health maintenance organization may make any investment
permitted for a health service corporation organized pursuant to article
forty-three of this chapter provided that the superintendent, after
consultation with the commissioner of health, may modify such investment
requirements, if such modification would permit the organization to more
effectively implement its program without incurring undue risk to its

(e) The superintendent may promulgate regulations in effectuating the
purposes and provisions of this chapter and article forty-four of the
public health law and may modify requirements applicable to the
contracts between a health maintenance organization and its subscribers,
subject to such limitations as the superintendent shall deem necessary
or proper to insure the performance of such contracts.