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This entry was published on 2014-09-22
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SECTION 1118
Regional pilot projects for the uninsured
Insurance (ISC) CHAPTER 28, ARTICLE 11
§ 1118. Regional pilot projects for the uninsured. (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 this chapter or the financial
services law to the contrary, the superintendent may waive, modify or
suspend any provision of this chapter, the financial services law or
regulations promulgated thereunder as applicable to the insurers or
health maintenance organizations that 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 this
chapter, the financial services law or regulations promulgated
thereunder 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 this
chapter, the financial services law or regulations promulgated
thereunder 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.