New York Codes, Rules and Regulations
Title 9 - EXECUTIVE DEPARTMENT
Subtitle KK - Program for Elderly Pharmaceutical Insurance Coverage
Part 9610 - Application And Determination Of Eligibility
Section 9610.6 - Notification

Universal Citation: 9 NY Comp Codes Rules and Regs ยง 9610.6

Current through Register Vol. 46, No. 12, March 20, 2024

(a) Applicants have the right to adequate notice of their determination of eligibility.

(1) Notification shall be given within three days of the decision to accept or deny an application (except during the 120-day period beginning July 1, 1987, when notification of denial shall be given within 10 days of a decision to deny.)

(2) Notification of denial shall clearly set forth the decision of the contractor and the specific reason why the application was denied. Notification of acceptance shall clearly set forth the decision and the cost-sharing responsibilities of the applicant.

(b) Participants are entitled to timely and adequate notice of any change affecting their coverage, except for mass changes.

(c) Participants are entitled to adequate notice of any adjustment to the copayment schedule 30 days prior to the effective date of the change.

(d) Participants also have the right to adequate notice 30 days prior to the due date of any quarterly or annual registration fee or premium. The notice shall state the amount due, the date on which payment is to be received and that his/her coverage shall expire 30 days after the due date if payment is not received.

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