N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-2.1

Current through Register Vol. 46, No. 43, October 23, 2024

Section 362-2.1 - Definitions generally applicable to the healthy new york program

(a) Health insurance shall mean any coverage (whether insured or self-insured) providing both hospital and medical benefits on an expense-incurred or prepaid basis or any coverage providing hospital and medical indemnity benefits with specific dollar amounts if the dollar amounts exceed the amounts required to meet the definitions of basic hospital and basic medical insurance set forth in sections 52.5 and 52.6 of this Title. Health insurance shall not include health benefits offered through public benefit programs. Health insurance also shall not include coverage established by the continuation provisions of the Employee Retirement Income Security Act, 29 U.S.C. section 1161 et seq. and the Public Health Service Act, 42 U.S.C. section 300bb-1 et seq. established by the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended, or the continuation provisions of the New York State Insurance Law, sections 3221(m), 4304(k) and 4305(e).

(b) Health maintenance organization shall mean an organization (or line of business of an article 43 corporation) which has received a certificate of authority to operate as a health maintenance organization from the Commissioner of Health pursuant to article 44 of the Public Health Law.

(c) Insurer shall mean a corporation organized under article 43 of the Insurance Law or an organization licensed or organized under article 42 of the Insurance Law.

(d) Participating insurer means an insurer which voluntarily participates in the Healthy New York Program in accordance with section 4326 (b) of the Insurance Law.

(e) Qualifying group health insurance contract means a group contract or group remittance contract issued to a qualifying small employer pursuant to section 4326 (c)(2) of the Insurance Law.

(f) Qualifying health insurance contract shall mean a qualifying group health insurance contract or a qualifying individual health insurance contract.

(g) Qualifying individual health insurance contract means a contract issued directly to a qualifying individual pursuant to section 4326 (c)(4) of the Insurance Law.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-2.1