§ 2510. Definitions. For the purpose of this title, unless the context
clearly requires otherwise:

1. "Applicant" means an eligible organization which submits a proposal
under subdivision six of section two thousand five hundred eleven of
this title.

1-a. "Applicant for insurance" means the person or persons applying
for insurance coverage for a child pursuant to this title.

2. "Approved organization" means an eligible organization approved by
the commissioner under subdivision seven of section two thousand five
hundred eleven of this title to underwrite a child health insurance plan
and an organization approved by the commissioner under subdivision
seven-a of section two thousand five hundred eleven of this title.

3. "Eligible organization" means:

(a) a commercial insurer;

(b) a corporation or health maintenance organization licensed under
article forty-three of the insurance law;

(c) a health maintenance organization certified under article
forty-four of this chapter; or

(d) a comprehensive health services plan operating pursuant to
regulations of the department of social services or the department of
health.

4. "Eligible child" or "eligible children" means a person or persons
under the age of thirteen years for the period January first, nineteen
hundred ninety-one through December thirty-first, nineteen hundred
ninety-three; born on or after June first, nineteen hundred eighty and
under the age of sixteen for a period commencing on or after January
first, nineteen hundred ninety-four through December thirty-first,
nineteen hundred ninety-six; and for a person or persons enrolled in the
program on the day before they are sixteen years of age, under the age
of seventeen for a period commencing on or after June first, nineteen
hundred ninety-five through December thirty-first, nineteen hundred
ninety-six; and under the age of nineteen for periods commencing on or
after January first, nineteen hundred ninety-seven, who meets or meet
the criteria in section two thousand five hundred eleven of this title.

5. "Child health insurance plan" means the written undertaking of an
approved organization to provide coverage for covered health care
services to eligible children under this title.

6. "Period of eligibility" means that period commencing on the first
day of the month during which a child is an eligible child and enrolled
or recertified for enrollment on an annual basis based on all required
information and documentation and ending on the last day of the twelfth
month following such date, provided, however:

(a) the period of eligibility for a child who ceases to be eligible
because he or she no longer resides in New York state or has access to
or obtained other health insurance coverage, as defined by the
commissioner in consultation with the superintendent pursuant to
paragraph (c) of subdivision two of section twenty-five hundred eleven
of this article, shall end the last day of the month in which the child
ceases to be an eligible child; and

(b) the period of eligibility for a child who becomes eligible for
medical assistance shall end the last day of the third month after the
child becomes eligible for medical assistance; and

(c) the period of eligibility for a child for whom an applicable
premium payment has not been paid shall end in accordance with time
frames and procedures determined by the commissioner.

(d) effective on or after March first, two thousand twenty-three
through March thirty-first, two thousand twenty-seven, subject to
extension under Title XXI of the federal social security act, the period
of eligibility for pregnant individuals enrolled in the child health
insurance plan shall include twelve months postpartum coverage
commencing on the first day of the month following the last day of
pregnancy and ending on the last day of the month in which the
twelve-month postpartum period ends; provided, however, such postpartum
coverage may end prior to the end of the twelve-month period only under
the following circumstances: (i) the individual requests voluntary
termination; (ii) the individual ceases to be a state resident; (iii)
eligibility was determined incorrectly because of error, fraud, abuse,
or perjury attributed to the individual; or (iv) the individual dies.

7. "Covered health care services" means: the services of physicians,
optometrists, nurses, nurse practitioners, midwives and other related
professional personnel which are provided on an outpatient basis,
including routine well-child visits; diagnosis and treatment of illness
and injury; inpatient health care services; laboratory tests; diagnostic
x-rays; prescription and non-prescription drugs, ostomy and other
medical supplies and durable medical equipment; radiation therapy;
chemotherapy; hemodialysis; outpatient blood clotting factor products
and other treatments and services furnished in connection with the care
of hemophilia and other blood clotting protein deficiencies; emergency
room services; ambulance services; hospice services; emergency,
preventive and routine dental care, including orthodontia but excluding
cosmetic surgery; emergency, preventive and routine vision care,
including eyeglasses; speech and hearing services; inpatient and
outpatient mental health, alcohol and substance abuse services,
including children and family treatment and support services, children's
home and community based services, assertive community treatment
services and residential rehabilitation for youth services which shall
be reimbursed in accordance with the ambulatory patient group (APG)
rate-setting methodology as utilized by the department of health, the
office of addiction services and supports, or the office of mental
health for rate-setting purposes or any such other fees established
pursuant to article forty-three of the mental hygiene law; and
health-related services provided by voluntary foster care agency health
facilities licensed pursuant to article twenty-nine-I of this chapter;
as defined by the commissioner. "Covered health care services" shall not
include drugs, procedures and supplies for the treatment of erectile
dysfunction when provided to, or prescribed for use by, a person who is
required to register as a sex offender pursuant to article six-C of the
correction law, provided that any denial of coverage of such drugs,
procedures or supplies shall provide the patient with the means of
obtaining additional information concerning both the denial and the
means of challenging such denial.

8. "Subsidy payment" means a payment made to an approved organization
for the cost of covered health care services coverage to an eligible
child or children.

9. "Premium payment" means: a payment made on behalf of an eligible
child for enrollment in the child health insurance plan equal to:

(a) for periods prior to October first, nineteen hundred ninety-seven,
twenty-five dollars per year for each child, but no more than one
hundred dollars per year per family; and

(b) for periods on or after October first, nineteen hundred
ninety-seven, amounts as follows:

(i) no payments are required for eligible children whose family net
household income is less than one hundred twenty-six percent of the
non-farm federal poverty level or the gross equivalent of such net
income;

(ii) nine dollars per month for each eligible child whose family net
household income is between one hundred twenty-six percent and one
hundred thirty-two percent of the non-farm federal poverty level or the
gross equivalent of such net income, but no more than thirty-six dollars
per month per family; and

(iii) thirteen dollars per month for each eligible child whose family
net household income is between one hundred thirty-three percent and one
hundred eighty-five percent of the non-farm federal poverty level or the
gross equivalent of such net income, but no more than fifty-two dollars
per month per family.

(c) for periods on or after January first, nineteen hundred
ninety-nine, amounts as follows:

(i) no payments are required for eligible children whose family net
household income is less than one hundred thirty-three percent of the
non-farm federal poverty level or the gross equivalent of such net
income and, effective August first, two thousand, no payments are
required for eligible children who are American Indians or Alaskan
Natives, as defined by the U.S. Department of Health and Human Services;
and

(ii) nine dollars per month for each eligible child whose family net
household income is between one hundred thirty-three percent and one
hundred eighty-five percent of the non-farm federal poverty level or the
gross equivalent of such net income, but no more than twenty-seven
dollars per month per family; and

*(iii) fifteen dollars per month for each eligible child whose family
net household income is between one hundred eighty-six percent and one
hundred ninety-two percent of the non-farm federal poverty level or the
gross equivalent of such net income, but no more than forty-five dollars
per month per family, and, effective July first, two thousand, fifteen
dollars per month for each eligible child whose family net household
income is between one hundred eighty-six percent and two hundred eight
percent of the non-farm federal poverty level or the gross equivalent of
such net income, but no more than forty-five dollars per month per
family; and

* NB Expires July 1, 2025

(iv) effective September first, two thousand eight, twenty dollars per
month for each eligible child whose family gross household income is
between two hundred fifty-one percent and three hundred percent of the
non-farm federal poverty level, but no more than sixty dollars per month
per family;

(v) effective September first, two thousand eight, thirty dollars per
month for each eligible child whose family gross household income is
between three hundred one percent and three hundred fifty percent of the
non-farm federal poverty level, but no more than ninety dollars per
month per family; and

(vi) effective September first, two thousand eight, forty dollars per
month for each eligible child whose family gross household income is
between three hundred fifty-one percent and four hundred percent of the
non-farm federal poverty level, but no more than one hundred twenty
dollars per month per family.

(d) for periods on or after July first, two thousand nine, amounts as
follows:

(i) no payments are required for eligible children whose family
household income is less than one hundred sixty percent of the non-farm
federal poverty level and for eligible children who are American Indians
or Alaskan Natives, as defined by the U.S. Department of Health and
Human Services, whose family household income is less than two hundred
fifty-one percent of the non-farm federal poverty level; and

(ii) nine dollars per month for each eligible child whose family
household income is between one hundred sixty percent and two hundred
twenty-two percent of the non-farm federal poverty level, but no more
than twenty-seven dollars per month per family; and

(iii) fifteen dollars per month for each eligible child whose family
household income is between two hundred twenty-three percent and two
hundred fifty percent of the non-farm federal poverty level, but no more
than forty-five dollars per month per family; and

(iv) thirty dollars per month for each eligible child whose family
household income is between two hundred fifty-one percent and three
hundred percent of the non-farm federal poverty level, but no more than
ninety dollars per month per family;

(v) forty-five dollars per month for each eligible child whose family
household income is between three hundred one percent and three hundred
fifty percent of the non-farm federal poverty level, but no more than
one hundred thirty-five dollars per month per family; and

(vi) sixty dollars per month for each eligible child whose family
household income is between three hundred fifty-one percent and four
hundred percent of the non-farm federal poverty level, but no more than
one hundred eighty dollars per month per family.

(e) for periods on or after October first, two thousand twenty-two,
amounts as follows:

(i) no payments are required for eligible children whose family
household income is less than two hundred twenty-three percent of the
non-farm federal poverty level and for eligible children who are
American Indians or Alaskan Natives, as defined by the United States
department of health and human services, whose family household income
is less than two hundred fifty-one percent of the non-farm federal
poverty level; and

(ii) fifteen dollars per month for each eligible child whose family
household income is between two hundred twenty-three percent and two
hundred fifty percent of the non-farm federal poverty level, but no more
than forty-five dollars per month per family; and

(iii) thirty dollars per month for each eligible child whose family
household income is between two hundred fifty-one percent and three
hundred percent of the non-farm federal poverty level, but no more than
ninety dollars per month per family; and

(iv) forty-five dollars per month for each eligible child whose family
household income is between three hundred one percent and three hundred
fifty percent of the non-farm federal poverty level, but no more than
one hundred thirty-five dollars per month per family; and

(v) sixty dollars per month for each eligible child whose family
household income is between three hundred fifty-one percent and four
hundred percent of the non-farm federal poverty level, but no more than
one hundred eighty dollars per month per family.

10. "Superintendent" means the superintendent of financial services.

11. "Inpatient health care services" means: inpatient hospital
services provided by a general hospital, as defined in article
twenty-eight of this chapter, a facility operated by the office of
mental health under section 7.17 of the mental hygiene law, a facility
issued an operating certificate pursuant to the provisions of article
twenty-three or thirty-one of the mental hygiene law and services
provided by physicians and other professional personnel on an inpatient
basis for covered inpatient services; as defined by the commissioner in
consultation with the superintendent.

12. "Group health plan" or "health insurance coverage" shall have the
same meanings as set forth in section twenty-one hundred ten of the
federal social security act.

13. "Household income" means the sum of the modified adjusted gross
income of every individual included in a child's household calculated in
accordance with applicable federal law and regulations, as may be
amended.

14. "State enrollment center" means the centralized system and
operation of eligibility determinations by the state or its contractor
for all insurance affordability programs, including the child health
insurance program established pursuant to this title.

15. "Insurance affordability programs" means those programs set forth
in section 435.4 of title 42 of the code of federal regulations.