N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-4.3

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

Section 362-4.3 - Verification of net household income

(a) To qualify for coverage under the Healthy New York Program, individual proprietors and working uninsured individuals must satisfy the household income criteria set forth in section 4326 (c)(1)(A)(ii) and (3)(A)(iii) of the Insurance Law. For the purpose of determining household income eligibility, household members shall include the applicant, the applicant's legal spouse if residing in the household and any children eligible for coverage under the policy. Income received by the applicant and the applicant's legal spouse residing in the household shall be counted.

(b) Income shall include, but shall not be limited to, the following:

(1) monetary compensation for services including wages, salary, commissions, overtime compensation, fees or tips;

(2) net income from farm and nonfarm self-employment;

(3) social security payments or benefits;

(4) dividends, interest on savings or bonds, regular income from estates or trusts, or net rental income;

(5) unemployment compensation;

(6) government, civilian employee or military retirement or pension or veteran's payments;

(7) private pension or annuity;

(8) alimony;

(9) regular contributions from persons not living in the household;

(10) net royalties; and

(11) such other income as determined by the superintendent.

(c) Income shall not include public assistance; SSI; foster care payments; capital gains; any assets drawn down as withdrawals from a bank; receipts from the sale of property; or payments for compensation for injury. Also excluded are noncash benefits, such as employee fringe benefits, food or housing received in lieu of wages, and receipts from Federal noncash benefit programs.

(d) Health maintenance organizations and participating insurers shall collect such documentation as is necessary and sufficient to initially verify that the household income requirements of the Healthy New York Program have been satisfied. Such documentation may include, but not be limited to one or more of the following:

(1) income tax returns and, if not prohibited by Federal law for purposes of income verification, the social security account number;

(2) paycheck stubs;

(3) written documentation of income from all employers; or

(4) other documentation of income (earned or unearned) as determined by the superintendent to be acceptable, provided however, such documentation shall set forth the source of such income.

N.Y. Comp. Codes R. & Regs. Tit. 11 §§ 362-4.3