1118 - Regional pilot projects for the uninsured.
§ 1118. Regional pilot projects for the uninsured. (a) An authorized insurer subject to the provisions of this chapter and organized to write the kind of insurance specified in paragraph three of subsection (a) of section one thousand one hundred thirteen of this article, and a health maintenance organization authorized pursuant to article forty-three of this chapter or article forty-four of the public health law, may be authorized by the superintendent to issue contracts or otherwise enter into arrangements with approved organizations in connection with regional pilot projects to test models for the purpose of providing insurance and equivalent coverage mechanisms for the uninsured. Such plans must satisfy the criteria set forth in subsection (b) of this section and the superintendent shall make the determinations set forth in subsection (e) of this section. For the purpose of this section, regional pilot projects shall mean projects authorized pursuant to the expanded health care coverage act of nineteen hundred eighty-eight. (b) The superintendent may authorize such contracts or arrangements for regional pilot projects pursuant to the following criteria: (1) the plan's provisions are not misleading or confusing; (2) the plan's provisions are consistent with the needs of the regional pilot projects; and (3) the plan, the contract and other materials describing the plan fully and clearly state the benefits, limitations of the plan. (c) The duration of such contracts and the extent of exposure thereunder by insurers or health maintenance organizations shall be determined by the superintendent. (d) Notwithstanding any provisions of the insurance law to the contrary, the superintendent may waive, modify or suspend any provision of the insurance law or insurance department regulations as applicable to the insurers or health maintenance organizations which conduct the regional pilot projects, except as to mandatory benefits, provided such waiver, modification or suspension is based on the criteria set forth in subsection (e) of this section. (e) The superintendent may take the actions set forth in subsections (a) and (d) of this section upon the superintendent's judgment that: (1) the plan is a reasonable and appropriate approach to expand the availability of health care coverage or equivalent coverage mechanisms for the uninsured; (2) the premium rates and other sources of funding for the regional pilot project is reasonably related to the benefits provided and sufficient to support the program; (3) any waiver, modification or suspension of provisions of the insurance law or insurance department regulations is essential to the operation of the regional pilot project and to the rational development of programs to provide health care coverage or equivalent coverage mechanisms to the uninsured; and (4) any waiver, modification or suspension of provisions of the insurance law or insurance department regulations will not impair the ability of the insurer or health maintenance organization to satisfy its existing and anticipated contracts and other obligations, including such standards as the superintendent shall prescribe concerning adequate capital and financial requirements.