11 CRR-NY 362-2.7NY-CRR

STATE COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK
TITLE 11. INSURANCE
CHAPTER XIV. INDIVIDUAL AND SMALL GROUP HEALTH INSURANCE AND FAMILY LEAVE BENEFITS COVERAGE
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
11 CRR-NY 362-2.7
11 CRR-NY 362-2.7
362-2.7 Healthy New York benefit adjustments.
(a) Beginning June 1, 2003, there shall be no copayment applied to preventive and primary health care services for routine well child visits and necessary immunizations.
(b) Beginning June 1, 2003, health plans shall offer an additional Healthy New York benefit package at a reduced premium rate. Such additional benefit package shall contain all of the benefits set forth in section 4326(d)(1) through (13) of the Insurance Law. The prescription drug benefit set forth in section 4326(d)(14) shall not be included in the additional benefit package. Qualifying small employers and qualifying individuals shall have the option of choosing among the benefit packages. Qualifying small employers must elect to provide the same benefit package to all of their employees participating in Healthy New York. Once enrolled in the program, any change in the selection of benefit package may occur at the time of annual recertification or at anytime the premium rate changes. Notice of this option shall be included with any notice of rate change.
(c) Individuals who are eligible for a Federal tax credit under the Federal Trade Adjustment Act of 2002, who have three months or more of creditable coverage shall be deemed to have sufficient creditable coverage to satisfy the 12-month pre-existing condition waiting period in full.
(d) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for up to 40 post-hospital or post-surgical home health care visits per calendar year.
(e) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for up to 30 post-hospital or post-surgical physical therapy visits per calendar year.
(f) Beginning January 1, 2007, qualifying health insurance contracts shall include a benefit for diagnostic screening for prostatic cancer consistent with the benefit set forth in section 4303(z-1) of the Insurance Law.
11 CRR-NY 362-2.7
Current through May 31, 2021
End of Document

IMPORTANT NOTE REGARDING CONTENT CURRENCY: JULY 31, 2023, is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Admisnistrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of the NYS Rules.