§ 4321. Standardization of individual enrollee direct payment\ncontracts offered by health maintenance organizations prior to October\nfirst, two thousand thirteen. (a) On and after January first, nineteen\nhundred ninety-six, and until September thirtieth, two thousand thirteen\nall health maintenance organizations issued a certificate of authority\nunder article forty-four of the public health law or licensed under this\narticle shall offer a standardized individual enrollee contract on an\nopen enrollment basis as prescribed by section forty-three hundred\nseventeen of this article and section forty-four hundred six of the\npublic health law, and regulations promulgated thereunder, provided,\nhowever, that such requirements shall not apply to a health maintenance\norganization exclusively serving individuals enrolled pursuant to title\neleven of article five of the social services law, title eleven-D of\narticle five of the social services law, title one-A of article\ntwenty-five of the public health law or title eighteen of the federal\nSocial Security Act. On and after January first, nineteen hundred\nninety-six, and until September thirtieth, two thousand thirteen, the\nenrollee contracts issued pursuant to this section and section four\nthousand three hundred twenty-two of this article shall be the only\ncontracts offered by health maintenance organizations to individuals.\nThe enrollee contracts issued by a health maintenance organization under\nthis section and section four thousand three hundred twenty-two of this\narticle shall also be the only contracts issued by health maintenance\norganizations for purposes of conversion pursuant to sections four\nthousand three hundred four and four thousand three hundred five of this\narticle. However, nothing in this section shall be deemed to require\nhealth maintenance organizations to terminate individual direct payment\ncontracts issued prior to January first, nineteen hundred ninety-six or\nprevent health maintenance organizations from terminating individual\ndirect payment contracts issued prior to January first, nineteen hundred\nninety-six.\n (b) The standardized individual enrollee direct payment contract shall\nprovide coverage for all health services which an enrolled population in\na health maintenance organization might require in order to be\nmaintained in good health, rendered without limitation as to time and\ncost, except to the extent permitted by this chapter; provided however\nthat no individual enrollee and no family unit enrolled in such\norganization shall incur out-of-pocket costs in excess of fifteen\nhundred dollars and three thousand dollars, respectively, in any\ncalendar year. Such covered services shall be identical to the in-plan\ncovered benefits of the standardized individual direct payment enrollee\ncontract described in section four thousand three hundred twenty-two of\nthis article, except as otherwise provided in subsections (c), (d) and\n(e) of this section.\n (c) The health maintenance organization shall impose a fifteen dollar\ncopayment on all visits to a physician or other provider with the\nexception of visits for pre-natal and post-natal care, well child visits\nprovided pursuant to paragraph two of subsection (j) of section four\nthousand three hundred three of this article, preventive health services\nprovided pursuant to subparagraph (F) of paragraph four of subsection\n(b) of section four thousand three hundred twenty-two of this article,\nor items or services for bone mineral density provided pursuant to\nsubparagraph (D) of paragraph twenty-six of subsection (b) of section\nfour thousand three hundred twenty-two of this article for which no\ncopayment shall apply. A copayment of fifteen dollars shall be imposed\non equipment, supplies and self-management education for the treatment\nof diabetes. A fifty dollar copayment shall be imposed on emergency\nservices rendered in the emergency room of a hospital; however, this\ncopaym
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