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This entry was published on 2022-04-22
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SECTION 1122
New York state health insurance continuation assistance demonstration project
Insurance (ISC) CHAPTER 28, ARTICLE 11
* § 1122. New York state health insurance continuation assistance
demonstration project. (a) Definitions. For the purposes of this
section, unless the context clearly requires otherwise:

(1) "Continuation assistance" means payments made by the
superintendent to an eligible individual, a health plan or insurer, a
participating employer, or a labor-management health benefits fund to
allow an eligible individual to obtain or maintain continuation
coverage.

(2) "Continuation coverage" means group health insurance coverage
which a participating employer or labor-management health benefits fund
is obligated to offer to an individual pursuant to the 1985 Consolidated
Omnibus Budget Reconciliation Act (COBRA), as amended by the Tax Reform
Act of 1986, or continuation provisions pursuant to subsection (m) of
section three thousand two hundred twenty-one, subsection (k) of section
four thousand three hundred four or subsection (e) of section four
thousand three hundred five of this chapter.

(3) "Displaced worker" means an individual that is a resident of New
York state and has been terminated or has received a notice of
termination as a result of increased imports from, or shifts in
production to, foreign countries as described in the Trade Act programs,
Trade Adjustment Assistance (TAA) and Alternative Trade Adjustment
Assistance (ATAA).

(4) "Eligible individual" means a person who is an entertainment
industry employee or displaced worker and who:

(A) is not eligible for health insurance coverage or medical benefits
pursuant to part A or B of title XVIII of the Social Security Act or
title eleven of article five of the social services law;

(B) is eligible for or is currently enrolled under continuation
coverage (and, with respect to an entertainment industry employee, is
eligible for or enrolled under continuation coverage through a
collectively bargained plan covering entertainment industry employees),
where such eligible individual is not covered under continuation already
subsidized through continuation assistance pursuant to the public health
law;

(C) resides in a household having a gross monthly household income at
or below four hundred percent of the non-farm federal poverty level (as
defined and updated by the federal department of health and human
services);

(D) is not eligible for employer provided coverage; and

(E) maintains the same level of insurance coverage as when they were
employed.

(5) "Entertainment industry employee" means an individual who is a
resident of New York state and is employed in the entertainment
industry, as defined by the commissioner, including, but not limited to,
the film, motion picture, television, theater, music, music recording,
dance, radio, and circus industries.

(6) "Individual payment" means the amount of premium required for
continuation coverage, less the amount of a continuation assistance
payment made by the superintendent, to be paid by an eligible
individual.

(7) "New York state health insurance continuation assistance
demonstration project" means the pilot program for the entertainment
industry employees and the pilot program for displaced workers.

(8) "Participating employer" means an employer who is obligated to
continue coverage for an eligible individual pursuant to the 1985
Consolidated Omnibus Budget Reconciliation Act (COBRA), or subsection
(m) of section three thousand two hundred twenty-one, subsection (k) of
section four thousand three hundred four, or subsection (e) of section
four thousand three hundred five of this chapter.

(9) "Pilot program for displaced workers" means the program which
assists eligible individuals who are displaced workers in obtaining or
maintaining continuation coverage pursuant to this section.

(10) "Pilot program for entertainment industry employees" means the
program which assists eligible individuals who are entertainment
industry employees in obtaining or maintaining continuation coverage
pursuant to this section.

(b) Pilot program for entertainment industry employees. (1) The pilot
program for entertainment industry employees shall assist eligible
individuals who are entertainment industry workers in maintaining or
obtaining continuation coverage.

(2) An eligible individual may apply to the superintendent for
continuation assistance by submitting an application therefor on a form
prescribed by the superintendent. The information required on the
application shall include, but not be limited to:

(A) the name and address of the entertainment industry employee;

(B) the name, address, and telephone number of the participating
employer;

(C) the date the eligible individual became or will become eligible
for continuation coverage, the date such eligibility ends, and, when
available, correspondence to an entertainment industry employee from a
labor-management health benefits fund proving eligibility;

(D) the names of all dependents who are covered or are to be covered
under the continuation policy; and

(E) documentation establishing the household income of an eligible
individual, which may include annual income tax returns and, if not
prohibited by federal law for purposes of income verification, social
security numbers, paycheck stubs, written documentation of income from
all employers, or such other documentation as the superintendent may
require.

(3) The superintendent shall review the applications and advise the
applicants as to their eligibility to participate in the pilot program.
Within amounts available for such purpose, the superintendent shall
provide continuation assistance. Such assistance shall be issued, to the
extent of funds available therefor, which is equivalent to seventy-five
percent of the premium for the period covered by such assistance.
Continuation assistance shall not be provided for more than twelve
months within a five-year period.

(4) In approving applications from eligible individuals, the
superintendent shall:

(A) make a determination as to the extent of available funds for the
pilot program so as to assure, to the extent possible, that the funding
will be available to provide continuation assistance to the applicant in
an amount equal to seventy-five percent of the premium for a period of
twelve months within five years; if the superintendent determines that
such funding may not be available due to the level of enrollment in the
pilot program at the time of the eligible individual's application, the
superintendent shall deny such application; and

(B) require eligible individuals who are awarded continuation
assistance to sign an acknowledgement that recipients who later become
eligible for health insurance coverage through another employer are no
longer eligible to receive assistance under this section and that the
state may seek to recover assistance provided after the date of such
eligibility.

(5) The superintendent shall make continuation assistance payments
available pursuant to this subsection directly to the collectively
bargained labor-management health benefits fund on behalf of eligible
individuals. The fund must provide the superintendent such information
as the superintendent may reasonably require to enable the
superintendent to administer the terms and conditions of the pilot
program.

(6) The superintendent may promulgate rules and regulations necessary
to the administration of this pilot program.

(7) The superintendent may contract with an organization to assist in
the administration of this pilot program. If the superintendent deems it
appropriate to utilize an organization to assist in the administration
of this pilot program, the organization shall submit reports to the
superintendent in such form and at such times as required by the
superintendent. An organization approved to assist with program
administration shall maintain records in a form prescribed by the
superintendent and which shall be available for inspection by or at the
request of the superintendent.

(c) Pilot program for displaced workers. (1) The pilot program for
displaced workers shall assist eligible individuals who are displaced
workers in maintaining or obtaining continuation coverage.

(2) An eligible individual may apply to the superintendent for
continuation assistance by submitting an application therefor on a form
prescribed by the superintendent. The information required on the
application shall include, but not be limited to:

(A) the name and address of the displaced worker;

(B) the name, address, and telephone number of the participating
employer;

(C) the date the eligible individual became or will become eligible
for continuation coverage, the date such eligibility ends, and, when
available, correspondence to a displaced worker from a participating
employer or labor-management health benefits fund proving eligibility;

(D) the names of all dependents who are covered or are to be covered
under the continuation policy; and

(E) documentation establishing the household income of an eligible
individual, which may include annual income tax returns and, if not
prohibited by federal law for purposes of income verification, social
security numbers, paycheck stubs, written documentation of income from
all employers, or such other documentation as the superintendent may
require.

(3) The superintendent shall review the applications and advise the
applicants as to their eligibility to participate in the pilot program.
Within amounts available for such purpose, the superintendent shall
provide continuation assistance. Such assistance shall be issued, to the
extent of funds available therefor, which is equivalent to seventy-five
percent of the premium for the period covered by such assistance.
Continuation assistance shall not be provided for more than twelve
months within a five-year period.

(4) In approving applications from eligible individuals, the
superintendent shall:

(A) make a determination as to the extent of available funds for the
pilot program so as to assure, to the extent possible, that the funding
will be available to provide continuation assistance to the applicant in
an amount equal to seventy-five percent of the premium for a period of
twelve months within five years; if the superintendent determines that
such funding may not be available due to the level of enrollment in the
pilot program at the time of the eligible individual's application, the
superintendent shall deny such application; and

(B) require eligible individuals who were awarded continuation
assistance to sign an acknowledgement that recipients who later become
eligible for health insurance coverage through another employer are no
longer eligible to receive assistance under this section and that the
state may seek to recover assistance provided after the date of such
eligibility.

(5) The superintendent shall make continuation assistance payments
available pursuant to this subsection directly to the individual or to
the health plan or insurer, labor-management health benefits fund, or
participating employer on behalf of eligible individuals. The fund or
employer must provide the superintendent such information as the
superintendent may reasonably require to enable the superintendent to
administer the terms and conditions of the pilot program.

(6) The superintendent may promulgate rules and regulations necessary
to administer this pilot program.

(7) The superintendent may contract with an organization to assist in
the administration of this pilot program. If the superintendent deems it
appropriate to utilize an organization to assist in the administration
of this pilot program, the organization shall submit reports to the
superintendent in such form and at such times as required by the
superintendent. An organization approved to assist with program
administration shall maintain records in a form prescribed by the
superintendent and which shall be available for inspection by or at the
request of the superintendent.

(d) The superintendent shall complete a study of the New York state
health insurance continuation assistance demonstration project set forth
in this section. Such study shall examine the efficacy of the project in
impacting the insurance marketplace in New York state and the impact of
the demonstration project in reducing the large number of uninsured
individuals in the entertainment industry and other industries in New
York characterized by seasonal and episodic employment. The
superintendent may contract with an organization for the completion of
the study. The study shall be provided to the temporary president of the
senate and the speaker of the assembly.

* NB Repealed July 1, 2023