§ 4328. Individual enrollee direct payment contracts offered by health\nmaintenance organization on and after October first, two thousand\nthirteen. (a) On and after October first, two thousand thirteen, every\nhealth maintenance organization issued a certificate of authority under\narticle forty-four of the public health law or licensed under this\narticle shall offer an individual enrollee direct payment contract in\naccordance with the requirements of this section; provided, however,\nthat this requirement shall not apply to a holder of a special purpose\ncertificate of authority issued pursuant to section four thousand four\nhundred three-a of the public health law, except as otherwise required\nunder subsection (l) of section four thousand three hundred four of this\narticle, or a health maintenance organization exclusively serving\nindividuals enrolled pursuant to title eleven of article five of the\nsocial services law, title eleven-D of article five of the social\nservices law, title one-A of article twenty-five of the public health\nlaw or title eighteen of the federal social security act. The\nsuperintendent may, after giving consideration to the public interest,\nexempt a health maintenance organization from the requirements of this\nsection provided that another health insurer or health maintenance\norganization within the health maintenance organization's same holding\ncompany system, as defined in article fifteen of this chapter, including\na health maintenance organization operated as a line of business of a\nhealth service corporation licensed under this article, offers an\nindividual enrollee direct payment contract that, at a minimum, complies\nwith this section and provides all of the consumer protections required\nto be provided by a health maintenance organization pursuant to the\npublic health law and regulations, including those consumer protections\ncontained in sections four thousand four hundred three and four thousand\nfour hundred eight-a of the public health law. The enrollee contracts\nissued by a health maintenance organization under this section also\nshall be the only contracts issued by the health maintenance\norganization for purposes of conversion pursuant to sections four\nthousand three hundred four and four thousand three hundred five of this\narticle.\n (b) (1) The individual enrollee direct payment contract offered\npursuant to this section shall provide coverage for the essential health\nbenefits package as defined in paragraph three of subsection (e) of\nsection four thousand three hundred six-h of this article.\n (2) A health maintenance organization shall offer at least one\nindividual enrollee direct payment contract at each level of coverage as\ndefined in subsection (b) of section four thousand three hundred six-h\nof this article. A health maintenance organization also shall offer one\nchild-only plan, as required by section 1302(f) of the affordable care\nact, 42 U.S.C. § 18022(f), at each level of coverage.\n (3) Within the health benefit exchange established by this state, a\nhealth maintenance organization may offer an individual enrollee direct\npayment contract that is a catastrophic health plan as defined in\nsection 1302(e) of the affordable care act, 42 U.S.C. § 18022(e), or any\nregulations promulgated thereunder.\n (4) (A) The individual enrollee direct payment contract offered\npursuant to this section shall have the same enrollment periods,\nincluding special enrollment periods, as required for an individual\ndirect payment contract offered within the health benefit exchange\nestablished by this state.\n (B) In addition to the enrollment periods required in subparagraph (A)\nof this paragraph, an individual enrollee direct payment contract\noffered pursuant to this section shall allow for the enrollment of a\npregnant individual. Such individual may enroll at any time after a\nhealth care professional licensed pursuant to title eight of the\neducation law and a
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