N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-3.2

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

Section 362-3.2 - Small employer participation (other than individual proprietors)

(a) Qualifying small employers must have 50 or fewer eligible employees.

(b) Qualifying small employers must offer coverage to all employees, as defined in this Part, who are earning annual wages of $30,000 or less (adjusted annually as per section 4326[c][1][F] of the Insurance Law).

(c) Qualifying small employers must offer coverage to all persons who are considered to be eligible employees for the purpose of determining the employer's eligibility to purchase a qualifying group health insurance contract.

(d) Qualifying small employers may, but shall not be required to, offer coverage to part-time workers who work less than the required number of work hours to qualify as employees. However, if part-time workers are included as eligible employees for the purpose of meeting the eligibility requirements set forth in section 4326 (c)(1)(B)(iii) of the Insurance Law, then the coverage must be offered to part-time workers.

(e) At least 30 percent of eligible employees must earn annual wages of $30,000 or less (adjusted annually as per section 4326[c][1][F] of the Insurance Law).

(f) At least 50 percent of eligible employees must participate in group health insurance coverage through the Healthy New York Program.

(g) At least one eligible employee earning annual wages of $30,000 or less (adjusted annually as per section 4326[c][1][F] of the Insurance Law) must participate in group health insurance coverage through the Healthy New York Program.

(h) On behalf of participating employees, qualifying small employers must contribute at least 50 percent of the premium for the qualifying group health insurance contract. Qualifying small employers choosing to offer coverage to part-time workers may choose the level of premium contribution on behalf of part-time workers.

(i) An employer's place of business must be located within New York State in order to be eligible to purchase a qualifying group health insurance contract.

(j) Qualifying small employers shall in no case include employers who have provided group health insurance covering their employees during the 12-month period preceding the date of application. Small employer applicants shall be considered to have provided group health insurance if they have arranged for group health insurance coverage (insured or self-insured) on behalf of their employees and contributed more than a de minimus amount towards the cost of coverage on behalf of their employees. Through January 31, 2005, de minimus contributions are those that do not exceed an average of $50 per employee per month. Beginning February 1, 2005, de minimus contributions are those that do not exceed an average of $75 per employee per month for employers in the counties of Bronx, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk and Westchester or an average of $50 per employee per month for employers in all other counties. De minimus contributions shall not prevent small employers from qualifying to purchase health insurance coverage through the Healthy New York Program.

(k) Mid-year fluctuations in group size, wage levels and employee participation shall not serve as a basis for termination of a qualifying group health insurance contract.

(l) Qualifying group health insurance contracts shall be subject to all applicable continuation and conversion rights including those described in sections 3216 (c)(5), 3221 (m), 4304 (e), 4304 (h), 4305 (d) and 4305 (e) of the Insurance Law. A member covered under a qualifying group health insurance contract who elects to exercise a statutory conversion right shall be provided with the option of converting directly to a qualifying individual health insurance contract if such member satisfies the eligibility criteria set forth in section 4326 (c)(3)(A)(ii)-(iv) of the Insurance Law.

(m) Upon initial application, health maintenance organizations and participating insurers shall collect and examine certifications of eligibility and any supporting documentation to determine eligibility for a qualifying group health insurance contract and compliance with the terms of the Healthy New York Program.

(n) Qualifying group health insurance contracts shall include a provision providing for a 30-day grace period for payment of premiums.

(o) Qualifying small employers may, in their discretion, impose waiting periods which newly hired workers must satisfy in advance of obtaining coverage under the small employer's qualifying group health insurance contract. However, the waiting period shall not exceed 45 days from the date of hire and it must be the same for all newly hired workers.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-3.2