New York Codes, Rules and Regulations
Title 11 - INSURANCE
Chapter XIV - Individual And Small Group Health Insurance
Part 362 - The Healthy New York Program And The Direct Payment Stop Loss Relief Program
Subpart 362-2 - Rules Generally Applicable To The Healthy New York Program
Section 362-2.5 - Annual recertification of eligibility
Current through Register Vol. 46, No. 39, September 25, 2024
(a) Health maintenance organizations and participating insurers shall, at least 90 days prior to the annual renewal date, provide any forms necessary for recertification.
(b) Health maintenance organizations and participating insurers shall annually collect certifications of continued eligibility for the Healthy New York Program and shall be responsible for examination of such certifications to verify that small employers and individuals participating in the program continue to meet eligibility requirements and continue to comply with the terms of the program. Health maintenance organizations and participating insurers shall determine whether the small employer and individual participants continue to meet the requirements for participation in the Healthy New York Program and shall provide written notice of such determination within two weeks of receipt of the annual recertification.
(c) The failure of an employer or individual to provide written certification demonstrating continued eligibility and continued compliance with the terms of the Healthy New York Program shall be a basis for nonrenewal of a qualifying health insurance contract.
(d) Health maintenance organizations and participating insurers shall provide no less than 45 days written notice to the contract holder and any covered employees of a nonrenewal. Such notice of nonrenewal or termination shall set forth the basis for the nonrenewal and include a description of any applicable conversion rights. Such notice shall also include a description of other coverage options available for purchase from the health maintenance organization or participating insurer.
(e) Healthy New York Program enrollees who have transferred into the program from other public programs pursuant to section 4326 (p) of the Insurance Law shall not be required to demonstrate satisfaction of the eligibility requirements set forth in section 4326 (c) of the Insurance Law at the time of annual recertification.
