§ 1120 — Child health insurance plan

§ 1120. Child health insurance plan. (a) An authorized insurer subject\nto the provisions of this chapter and organized to write the kind of\nhealth insurance specified in paragraph three of subsection (a) of\nsection one thousand one hundred thirteen of this article, and a\ncorporation or health maintenance organization authorized pursuant to\narticle forty-three of this chapter or a health maintenance organization\ncertified pursuant to article forty-four of the public health law, may\nbe authorized by the superintendent to issue contracts or otherwise\nenter into arrangements with approved organizations for the purpose of\nproviding child health insurance plan policies for eligible children\npursuant to title I-A of article twenty-five of the public health law.\nSuch contracts or arrangements shall satisfy the criteria set forth in\nsubsection (b) of this section and the superintendent shall make the\ndeterminations set forth in subsection (e) of this section.\n (b) The superintendent may authorize such contracts or arrangements\npursuant to the following criteria:\n (1) the provisions are not misleading or confusing;\n (2) the provisions are consistent with the needs of the child health\ninsurance plan; and\n (3) the materials describing the contract or arrangement fully and\nclearly state the benefits and limitations of such contract or\narrangement.\n (c) The duration of such contracts or arrangements and the extent of\nexposure thereunder by insurers, article forty-three corporations or\nhealth maintenance organizations shall be determined by the\nsuperintendent.\n (d) Notwithstanding any provisions of this chapter or the financial\nservices law to the contrary, the superintendent may waive, modify or\nsuspend any provisions of this chapter, the financial services law or\nregulations promulgated thereunder as applicable to the insurers,\narticle forty-three corporations or health maintenance organizations\nthat issue coverage pursuant to this section, 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 contract or arrangement is a reasonable and appropriate\napproach to expand the availability of health care coverage to children;\n (2) the sources of funding for the contract or arrangement are\nreasonably related to the benefits provided and sufficient to support\nthe contract arrangement;\n (3) any waiver, modification or suspension of the provisions of this\nchapter, the financial services law or regulations promulgated\nthereunder is essential to the operation of the child health insurance\nplan and to the rational development of programs to provide covered\nservices to children; 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, article\nforty-three corporation or health maintenance organization to satisfy\nits existing and anticipated contracts and other obligations, including\nsuch standards as the superintendent shall prescribe concerning adequate\ncapital and financial requirements.\n (f) Each application used by an authorized insurer for purposes of\nenrolling eligible children into the child health insurance plan\npursuant to this section and section twenty-five hundred eleven of the\npublic health law shall include the notice required pursuant to\nsubsection (d) of section four hundred three of this chapter.\n