§ 4407 — Health maintenance organizations; employer requirements

§ 4407. Health maintenance organizations; employer requirements. 1.\nAll employers subject to the provisions of the unemployment insurance\nlaw, except for those employers with fewer than twenty-five employees,\nshall include in any health benefits plan offered to their employees,\nthe option of membership in a health maintenance organization which\nprovides or offers a comprehensive health services plan in accordance\nwith the provisions of this article, but only if such plan serves an\narea in which twenty-five of such employer's employees reside and the\norganization has been issued a certificate of authority by the\ncommissioner.\n 2. For those employees of an employer represented by a bargaining\nrepresentative, the offer of the health maintenance organization\nalternative shall be subject only to the collective bargaining process;\nfor those employees not represented by a bargaining representative, the\noffer of the health maintenance organization alternative shall be made\ndirectly to the employee.\n 3. (a) If there is more than one health maintenance organization\nengaged in the provision of health services in the area in which the\nemployees of the employer reside, and if:\n (i) one or more of such organizations provides more than one-half of\nits comprehensive health services through physicians or other health\nprofessionals who are members of the staff of the organization or of a\nmedical group (or groups) which contracts with the organization, and\n (ii) one or more of such organizations provides its comprehensive\nhealth services through contracts with an individual practice\nassociation (or associations), individual physicians and other health\nprofessionals under contract directly with the organization, or a\ncombination of an individual practice association (or associations),\nmedical group (or groups), physicians who are members of the staff of\nthe organization, and individual physicians and other health\nprofessionals under contract directly with the organization,\nthen the employer shall, in accordance with regulations of the\ncommissioner, be required to offer the option of enrollment in at least\none organization described in subparagraph (i) of this paragraph and at\nleast one organization described in subparagraph (ii) of this paragraph\nif the employer has twenty-five or more but fewer than two hundred\nemployees. If the employer has two hundred or more employees and the\nemployer's principal office in this state is located outside of the\nmetropolitan region then the employer shall be required to offer the\noption of enrollment in at least two organizations described in\nsubparagraph (i) of this paragraph and at least two organizations\ndescribed in subparagraph (ii) of this paragraph. If the employer has\ntwo hundred or more employees and the employer's principal office in\nthis state is located within the metropolitan region then the employer\nshall be required to offer the option of enrollment in at least two\norganizations described in subparagraph (i) of this paragraph and at\nleast two organizations described in subparagraph (ii) of this paragraph\nand an additional organization from either subparagraph. For the\npurposes of this section the metropolitan region is defined as the\ncounties of Westchester, Rockland, New York, Kings, Queens, Richmond,\nBronx, Nassau and Suffolk.\n (b) If within any particular area of the state in which at least\ntwenty-five of such employer's employees reside there are fewer health\nmaintenance organizations described in subparagraph (i) or (ii) of\nparagraph (a) of this subdivision than the employer is required to\noffer, then additional health maintenance organizations from\nsubparagraph (i) or (ii) of paragraph (a) of this subdivision shall be\noffered; provided, however, that no employer with fewer than two hundred\nemployees shall be required to offer more than a total of two health\nmaintenance organizations, and no employer with two hundred or more\nemployees shall be required to offer more than a total of four health\nmaintenance organizations (or five such organizations if the employer's\nprincipal office is located within the metropolitan region) in any\nparticular area of the state. In the event fewer than the required\ntotal minimum number of health maintenance organizations are available\nin an area, the employer shall offer all health maintenance\norganizations then certified to issue subscriber contracts in that area.\nNothing in this subdivision shall be deemed to prohibit an employer from\nchoosing to offer more health maintenance organizations to its employees\nthan are required under this subdivision.\n 4. No employer shall be required to pay more for health benefits as a\nresult of the application of this section than would otherwise be\nrequired by any prevailing collective bargaining agreement or other\nlegally enforceable contract for the provision of health benefits\nbetween an employer and his employees.\n