N.Y. Ins. Law § 1123

* § 1123. Health insurance demonstration program for independent\nworkers. (a) Purpose of the demonstration program. The legislature\nrecognizes that independent contractors, part-time workers, temporary\nworkers and other individuals who perform work outside the scope of a\nfull-time employment relationship with an employer frequently lack\naccess to employment-based group health insurance coverage. As a result,\nthese independent workers, who comprise a growing portion of the\nworkforce, are more likely than traditional employees to be uninsured.\nThe demonstration program authorized by this section is intended to test\nnew models for enabling independent workers to create their own group\nhealth insurance programs that meet their special needs, while ensuring\ncompliance with this chapter and any regulations promulgated thereunder,\nincluding solvency requirements, benefit mandates and other obligations\nimposed on insurers. The demonstration program will enable the\nlegislature and the superintendent to evaluate whether these new models\nfor delivering group health insurance benefits to independent workers\nare effective and should be expanded to other segments of the population\nthat lack access to employment-based health insurance.\n (b) Definitions. In this section:\n (1) "Eligible association" means an entity that: (A) is exempt from\nfederal taxation under section 501(c)(3) or (c)(4) of the Internal\nRevenue Code; (B) was incorporated on or before January first, two\nthousand nine; (C) meets the criteria set forth in subparagraph (K) of\nparagraph one of subsection (c) of section four thousand two hundred\nthirty-five of this chapter; and (D) has been issued one or more group\nhealth insurance policies by an eligible insurer that collectively cover\nat least ten thousand independent workers in this state, including their\nspouses and dependents, working in diverse and unrelated industries or\noccupations.\n (2) "Eligible insurer" means an insurer licensed under article\nforty-two of this chapter that is primarily owned by an eligible\nassociation. For purposes of this paragraph, an insurer shall be deemed\nto be primarily owned by an eligible association if the eligible\nassociation directly or indirectly owns more than fifty percent of the\nstock of the insurer or has the right to appoint more than fifty percent\nof the insurer's board of directors.\n (3) "Independent worker" means an individual who: (A) is an\nindependent contractor; (B) is self-employed; (C) works part-time; (D)\nobtains temporary work through an employment agency; (E) performs\ntemporary work for two or more employers simultaneously; (F) is a\ndomestic child care worker; or (G) is hired to work full-time for a\nsingle employer for a period not to exceed eighteen months if such\nemployer does not offer group health insurance coverage to employees\nemployed on such a temporary basis. An individual is not an independent\nworker if he or she is employed full-time by a single employer, with the\nexception of an individual who meets the requirements of clause (D), (F)\nor (G) of this paragraph.\n (4) "Group health insurance" means insurance providing hospital,\nsurgical or medical expense coverage or other similar comprehensive\nhealth insurance coverage that complies with paragraph three of\nsubsection (a) of section four thousand two hundred thirty-five of this\nchapter.\n (c) Demonstration program for independent workers. (1) Both the\neligible insurer and the group health insurance policies issued to the\neligible association shall be subject to the provisions of this chapter\nand any regulations promulgated thereunder, except that, the eligible\nassociation shall not be considered a small group under this chapter and\nthe eligible insurer shall not be required to offer group health\ninsurance policies to any group other than the eligible association that\nprimarily owns the eligible insurer.\n (2) Subject to paragraph three of this subsection, the superintendent\nmay issue an approval to an eligible insurer if: (A) the eligible\ninsurer demonstrates that it satisfies all financial, operational and\nother requirements of this chapter and regulations promulgated\nthereunder, other than any requirements expressly waived by this\nsection, and shall operate the demonstration program in accordance with\nthe requirements of this section; and (B) the superintendent determines\nthat the demonstration program furthers the public policy goals of this\nsection.\n (3) Any eligible insurer seeking the superintendent's approval under\nparagraph two of this subsection shall submit a written request to the\nsuperintendent within thirty days of the effective date of this section.\nThe eligible insurer's application shall: specify the identity and\ncomposition of the eligible association, the eligible association's\nmembership rules, and the terms under which the eligible insurer shall\nprovide group health insurance to the eligible association; demonstrate\nthat the eligible insurer and the eligible association meet the\nrequirements set forth in this section; and identify the group health\ninsurance policy forms that the eligible insurer will issue to the\neligible association. The superintendent shall make a determination on\nany request within ninety days of receipt of all necessary information.\nThe superintendent shall issue an approval to only one eligible insurer.\n (4) The superintendent may revoke an approval issued under paragraph\ntwo of this subsection if: the insurer that received such approval no\nlonger qualifies as an eligible insurer or is otherwise operating in a\nmanner inconsistent with the provisions of this chapter or regulations\npromulgated thereunder; or the association to which the eligible insurer\nissued the group health insurance policy no longer qualifies as an\neligible association. An eligible insurer that receives approval under\nparagraph two of this subsection shall submit periodic reports to the\nsuperintendent sufficient to enable the superintendent to evaluate the\neffectiveness of the demonstration program. Such reports shall include a\ncomparison of the cost of health insurance obtained under the program to\nother available insurance options, including group health insurance\npolicies delivered or issued for delivery in this state, an analysis of\nthe percentage of individuals covered by the program who were uninsured\nor receiving continuation benefits under the federal Consolidated\nOmnibus Budget Reconciliation Act at the time of enrollment, a\ndemographic and geographic analysis of the enrolled population and any\nother information required by the superintendent.\n * NB Repealed December 31, 2014\n