§ 1118 — Regional pilot projects for the uninsured

§ 1118. Regional pilot projects for the uninsured. (a) An authorized\ninsurer subject to the provisions of this chapter and organized to write\nthe kind of insurance specified in paragraph three of subsection (a) of\nsection one thousand one hundred thirteen of this article, and a health\nmaintenance organization authorized pursuant to article forty-three of\nthis chapter or article forty-four of the public health law, may be\nauthorized by the superintendent to issue contracts or otherwise enter\ninto arrangements with approved organizations in connection with\nregional pilot projects to test models for the purpose of providing\ninsurance and equivalent coverage mechanisms for the uninsured. Such\nplans must satisfy the criteria set forth in subsection (b) of this\nsection and the superintendent shall make the determinations set forth\nin subsection (e) of this section. For the purpose of this section,\nregional pilot projects shall mean projects authorized pursuant to the\nexpanded health care coverage act of nineteen hundred eighty-eight.\n (b) The superintendent may authorize such contracts or arrangements\nfor regional pilot projects pursuant to the following criteria:\n (1) the plan's provisions are not misleading or confusing;\n (2) the plan's provisions are consistent with the needs of the\nregional pilot projects; and\n (3) the plan, the contract and other materials describing the plan\nfully and clearly state the benefits, limitations of the plan.\n (c) The duration of such contracts and the extent of exposure\nthereunder by insurers or health maintenance organizations shall be\ndetermined by the superintendent.\n (d) Notwithstanding any provisions of this chapter or the financial\nservices law to the contrary, the superintendent may waive, modify or\nsuspend any provision of this chapter, the financial services law or\nregulations promulgated thereunder as applicable to the insurers or\nhealth maintenance organizations that conduct the regional pilot\nprojects, except as to mandatory benefits, provided such waiver,\nmodification or suspension is based on the criteria set forth in\nsubsection (e) of this section.\n (e) The superintendent may take the actions set forth in subsections\n(a) and (d) of this section upon the superintendent's judgment that:\n (1) the plan is a reasonable and appropriate approach to expand the\navailability of health care coverage or equivalent coverage mechanisms\nfor the uninsured;\n (2) the premium rates and other sources of funding for the regional\npilot project is reasonably related to the benefits provided and\nsufficient to support the program;\n (3) any waiver, modification or suspension of provisions of this\nchapter, the financial services law or regulations promulgated\nthereunder is essential to the operation of the regional pilot project\nand to the rational development of programs to provide health care\ncoverage or equivalent coverage mechanisms to the uninsured; and\n (4) any waiver, modification or suspension of provisions of this\nchapter, the financial services law or regulations promulgated\nthereunder will not impair the ability of the insurer or health\nmaintenance organization to satisfy its existing and anticipated\ncontracts and other obligations, including such standards as the\nsuperintendent shall prescribe concerning adequate capital and financial\nrequirements.\n