§ 268-A — Definitions

§ 268-a. Definitions. For purposes of this title, the following\ndefinitions shall apply:\n 1. "Commissioner" means the commissioner of health of the state of New\nYork.\n 2. "Marketplace" means the "NY State of Health, The official health\nplan Marketplace" or "Marketplace" established as a health benefit\nexchange or "marketplace" within the department of health pursuant to\nExecutive Order 42 (Cuomo) issued April 12, 2012 and this title.\n 3. "Federal act" means the patient protection and affordable care act,\npublic law 111-148, as amended by the health care and education\nreconciliation act of 2010, public law 111-152, and any regulations or\nguidance issued thereunder.\n 4. "Health plan" means a policy, contract or certificate, offered or\nissued by an insurer to provide, deliver, arrange for, pay for or\nreimburse any of the costs of health care services. Health plan shall\nnot include the following:\n (a) accident insurance or disability income insurance, or any\ncombination thereof;\n (b) coverage issued as a supplement to liability insurance;\n (c) liability insurance, including general liability insurance and\nautomobile liability insurance;\n (d) workers' compensation or similar insurance;\n (e) automobile no-fault insurance;\n (f) credit insurance;\n (g) other similar insurance coverage, as specified in federal\nregulations, under which benefits for medical care are secondary or\nincidental to other insurance benefits;\n (h) limited scope dental or vision benefits, benefits for long-term\ncare insurance, nursing home insurance, home care insurance, or any\ncombination thereof, or such other similar, limited benefits health\ninsurance as specified in federal regulations, if the benefits are\nprovided under a separate policy, certificate or contract of insurance\nor are otherwise not an integral part of the plan;\n (i) coverage only for a specified disease or illness, hospital\nindemnity, or other fixed indemnity coverage;\n (j) Medicare supplemental insurance as defined in section 1882(g)(1)\nof the federal social security act, coverage supplemental to the\ncoverage provided under chapter 55 of title 10 of the United States\nCode, or similar supplemental coverage provided under a group health\nplan if it is offered as a separate policy, certificate or contract of\ninsurance; or\n (k) the New York state medical indemnity fund established pursuant to\ntitle four of article twenty-nine-D of the public health law.\n 5. "Insurer" means an insurance company subject to article forty-two\nor a corporation subject to article forty-three of the insurance law, or\na health maintenance organization certified pursuant to article\nforty-four of the public health law that contracts or offers to contract\nto provide, deliver, arrange, pay or reimburse any of the costs of\nhealth care services.\n 6. "Stand-Alone dental plan" means a dental services plan that has\nbeen issued pursuant to applicable law and certified by the Marketplace\nin accordance with section two hundred sixty-eight-d of this title.\n 7. "Qualified health plan" means a health plan that is issued pursuant\nto applicable law and certified by the Marketplace in accordance with\nsection two hundred sixty-eight-d of this title, including a stand-alone\ndental plan.\n 8. "Insurance affordability program" means Medicaid, child health\nplus, the basic health program, the 1332 state innovation program,\npost-partum extended coverage and any other health insurance subsidy\nprogram designated as such by the commissioner.\n 9. "Eligible individual" means an individual, including a minor, who\nis eligible to enroll in an insurance affordability program or other\nhealth insurance program as determined by the commissioner.\n 10. "Qualified individual" means, with respect to qualified health\nplans, an individual, including a minor, who:\n (a) is eligible to enroll in a qualified health plan offered to\nindividuals through the Marketplace;\n (b) resides in this state;\n (c) at the time of enrollment, is not incarcerated, other than\nincarceration pending the disposition of charges; and\n (d) is, and is reasonably expected to be, for the entire period for\nwhich enrollment is sought, a citizen or national of the United States\nor a noncitizen lawfully present in the United States.\n 11. "Secretary" means the secretary of the United States department of\nhealth and human services.\n 12. "SHOP" means the small business health options program operated by\nthe Marketplace to assist eligible small employers in this state in\nselecting qualified health plans and/or other or additional health plans\ncertified by the Marketplace and to determine small employer eligibility\nfor purposes of small employer tax credits in accordance with applicable\nfederal and state laws and regulations.\n 13. "Small employer" means an employer which offers coverage where the\ncoverage such employer offers would be considered small group coverage\nunder the insurance law and regulations promulgated thereunder, provided\nthat it is not otherwise prohibited under the federal act.\n 14. "Small group market" means the health insurance market under which\nindividuals receive health insurance coverage on behalf of themselves\nand their dependents through a group health plan maintained by a small\nemployer.\n 15. "Superintendent" means the superintendent of financial services.\n 16. "Essential health benefits" shall mean the categories of benefits\ndefined in subsection (a) of section three thousand two hundred\nseventeen-i and subsection (a) of section four thousand three hundred\nsix-h of the insurance law.\n