§ 268-c. Functions of the Marketplace. The Marketplace shall:\n 1. (a) Perform eligibility determinations for federal and state\ninsurance affordability programs including medical assistance in\naccordance with section three hundred sixty-six of the social services\nlaw, child health plus in accordance with section twenty-five hundred\neleven of this chapter, the basic health program in accordance with\nsection three hundred sixty-nine-gg of the social services law, the 1332\nstate innovation program in accordance with section three hundred\nsixty-nine-ii of the social services law, premium tax credits and\ncost-sharing reductions and qualified health plans in accordance with\napplicable law and other health insurance programs as determined by the\ncommissioner;\n (b) certify and make available to qualified individuals, qualified\nhealth plans, including dental plans, certified by the Marketplace\npursuant to applicable law, provided that coverage under such plans\nshall not become effective prior to certification by the Marketplace;\nand\n (c) certify and/or make available to eligible individuals, health\nplans certified by the Marketplace pursuant to applicable law, and/or\nparticipating in an insurance affordability program pursuant to\napplicable law, provided that coverage under such plans shall not become\neffective prior to certification by the Marketplace, and/or approval by\nthe commissioner.\n 2. Assign an actuarial value to each Marketplace certified plan\noffered through the Marketplace in accordance with the criteria\ndeveloped by the secretary pursuant to federal law or the superintendent\npursuant to the insurance law and/or requirements developed by the\nMarketplace, and determine each health plan's level of coverage in\naccordance with regulations issued by the secretary pursuant to federal\nlaw or the superintendent pursuant to the insurance law.\n 3. Utilize a standardized format for presenting health benefit options\nin the Marketplace, including the use of the uniform outline of coverage\nestablished under section 2715 of the federal public health service act\nor the insurance law.\n 4. Standardize the benefits available through the Marketplace at each\nlevel of coverage defined by the superintendent in the insurance law.\n 5. Maintain enrollment periods in the best interest of qualified\nindividuals consistent with federal and state law.\n 6. Implement procedures for the certification, recertification and\ndecertification of health plans as qualified health plans or health\nplans approved for sale by the department of financial services or\ndepartment of health and certified by the Marketplace, consistent with\nguidelines developed by the secretary pursuant to section 1311(c) of the\nfederal act and requirements developed by the Marketplace.\n 7. Contract for health care coverage offered to qualified individuals\nthrough the Marketplace, and in doing so shall seek to provide health\ncare coverage choices that offer the optimal combination of choice,\nvalue, quality, and service.\n 8. Contract for health care coverage offered to certain eligible\nindividuals through the Marketplace, pursuant to health insurance\nprograms as determined by the commissioner, and in doing so shall seek\nto provide health care coverage choices that offer the optimal\ncombination of choice, value, quality, and service;\n 9. Provide the minimum requirements an insurer shall meet to\nparticipate in the Marketplace, in the best interest of qualified\nindividuals or eligible individuals;\n 10. Require qualified health plans and/or other health plans certified\nby the Marketplace to offer those benefits determined to be essential\nhealth benefits pursuant to state law or as required by the Marketplace.\n 11. Ensure that insurers offering health plans through the Marketplace\ndo not charge an individual enrollee a fee or penalty for termination of\ncoverage.\n 12. Provide for the operation of a toll-free telephone hotlin
‹ Prev All New York sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.