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This entry was published on 2014-09-22
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SECTION 1120
Child health insurance plan
Insurance (ISC) CHAPTER 28, ARTICLE 11
§ 1120. Child health insurance plan. (a) An authorized insurer subject
to the provisions of this chapter and organized to write the kind of
health insurance specified in paragraph three of subsection (a) of
section one thousand one hundred thirteen of this article, and a
corporation or health maintenance organization authorized pursuant to
article forty-three of this chapter or a health maintenance organization
certified pursuant to 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 for the purpose of
providing child health insurance plan policies for eligible children
pursuant to title I-A of article twenty-five of the public health law.
Such contracts or arrangements shall 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.

(b) The superintendent may authorize such contracts or arrangements
pursuant to the following criteria:

(1) the provisions are not misleading or confusing;

(2) the provisions are consistent with the needs of the child health
insurance plan; and

(3) the materials describing the contract or arrangement fully and
clearly state the benefits and limitations of such contract or
arrangement.

(c) The duration of such contracts or arrangements and the extent of
exposure thereunder by insurers, article forty-three corporations 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 provisions of this chapter, the financial services law or
regulations promulgated thereunder as applicable to the insurers,
article forty-three corporations or health maintenance organizations
that issue coverage pursuant to this section, 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 contract or arrangement is a reasonable and appropriate
approach to expand the availability of health care coverage to children;

(2) the sources of funding for the contract or arrangement are
reasonably related to the benefits provided and sufficient to support
the contract arrangement;

(3) any waiver, modification or suspension of the provisions of this
chapter, the financial services law or regulations promulgated
thereunder is essential to the operation of the child health insurance
plan and to the rational development of programs to provide covered
services to children; 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, article
forty-three corporation 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.

(f) Each application used by an authorized insurer for purposes of
enrolling eligible children into the child health insurance plan
pursuant to this section and section twenty-five hundred eleven of the
public health law shall include the notice required pursuant to
subsection (d) of section four hundred three of this chapter.