§ 161 — Health insurance

New York § 161

• Jurisdiction: New York
• Law CVS: Civil Service
• Art. 11: Health Benefits For State and Retired State Employees

Text

§ 161. Health insurance. 1. The president is hereby authorized and\ndirected to establish a health benefit plan for state officers and\nemployees and their dependents and officers and employees of the state\ncolleges of agriculture, home economics, industrial labor relations and\nveterinary medicine, the state agricultural experiment station at\nGeneva, and any other institution or agency under the management and\ncontrol of Cornell university as the representative of the board of\ntrustees of the state university of New York, and the state college of\nceramics under the management and control of Alfred university as the\nrepresentative of the board of trustees of the state university of New\nYork and their dependents which, subject to the conditions and\nlimitations contained in this article, and in the regulations of the\npresident, will provide for group hospitalization, surgical and medical\ninsurance against the financial costs of hospitalization, surgery,\nmedical treatment and care, and may include, among other things\nprescribed drugs, medicines, prosthetic appliances, hospital in-patient\nand out-patient service benefits and medical expense indemnity benefits.\n 2. Such health insurance shall not include expenses incurred by or on\naccount of an individual prior to the effective date of the plan as to\nhim or her; cosmetic surgery or treatment except to the extent necessary\nfor correction of damage caused by accidental injury while covered by\nthe plan or as direct result of diseases covered by the plan; services\nreceived because of illness or injury arising out of or in the course of\nemployment and entitling the individual to benefits under a workers'\ncompensation or occupational disease law; services received in a\nhospital owned or operated by the United States government for which no\ncharge is made; services received for injury or sickness due to war or\nany act of war, whether declared or undeclared, which war or act of war\nshall have occurred after the effective date of this plan; expenses for\nwhich the individual is not required to make payment; expenses to the\nextent of benefits provided under any employer group plan other than\nthis plan, and such other expenses as may be excluded by regulations of\nthe president.\n 3. The health benefit plan shall be designed by the president (1) to\nprovide a reasonable relationship between the hospital, surgical and\nmedical benefits to be included, and the expected distribution of\nexpenses of each such type to be incurred by the covered employees and\ndependents, and (2) to include reasonable controls, which may include\ndeductible and coinsurance provisions applicable to some or all of the\nbenefits, to reduce unnecessary utilization of the various hospital,\nsurgical and medical services to be provided and to provide reasonable\nassurance of stability in future years of the plan, and (3) to provide\nbenefits on a non-discriminatory basis to the extent possible, to active\nmembers throughout the state, wherever located.\n