Statutes, codes, and regulations
New York Codes, Rules and Regulations
Title 11 - INSURANCEChapter XIV - Individual And Small Group Health InsurancePart 362 - The Healthy New York Program And The Direct Payment Stop Loss Relief Program
Subpart 362-2 - Rules Generally Applicable To The Healthy New York Program
Section 362-2.7 - Healthy new york benefit adjustments

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-2.7

Download
PDF
Current through Register Vol. 46, No. 43, October 23, 2024
Section 362-2.7 - Healthy new york benefit adjustments
(a) Beginning June 1, 2003, there shall be no copayment applied to preventive and primary health care services for routine well child visits and necessary immunizations.
(b) Beginning June 1, 2003, health plans shall offer an additional Healthy New York benefit package at a reduced premium rate. Such additional benefit package shall contain all of the benefits set forth in section 4326 (d)(1) through (13) of the Insurance Law. The prescription drug benefit set forth in section 4326(d)(14) shall not be included in the additional benefit package. Qualifying small employers and qualifying individuals shall have the option of choosing among the benefit packages. Qualifying small employers must elect to provide the same benefit package to all of their employees participating in Healthy New York. Once enrolled in the program, any change in the selection of benefit package may occur at the time of annual recertification or at anytime the premium rate changes. Notice of this option shall be included with any notice of rate change.
(c) Individuals who are eligible for a Federal tax credit under the Federal Trade Adjustment Act of 2002, who have three months or more of creditable coverage shall be deemed to have sufficient creditable coverage to satisfy the 12-month pre-existing condition waiting period in full.
(d) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for up to 40 post-hospital or post-surgical home health care visits per calendar year.
(e) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for up to 30 post-hospital or post-surgical physical therapy visits per calendar year.
(f) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for diagnostic screening for prostatic cancer consistent with the benefit set forth in section 4303(z-1) of the Insurance Law.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-2.7