S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5648
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 14, 2019
                                ___________
 
 Introduced  by M. of A. ROZIC -- read once and referred to the Committee
   on Insurance
 
 AN ACT to amend the public authorities law and the public officers  law,
   in  relation  to  the  establishment  of  the  New York Health Benefit
   Exchange
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  This act shall be known and may be cited as the "New York
 Health Benefit Exchange Act".
   § 2. The public authorities law is amended by  adding  a  new  article
 10-E to read as follows:
                                ARTICLE 10-E
                     NEW YORK HEALTH BENEFIT EXCHANGE
 SECTION 3980. STATEMENT OF POLICY AND PURPOSES.
         3981. DEFINITIONS.
         3982. ESTABLISHMENT OF THE NEW YORK HEALTH BENEFIT EXCHANGE.
         3983. GENERAL POWERS OF THE EXCHANGE.
         3984. FUNCTIONS OF THE EXCHANGE.
         3985. SPECIAL  FUNCTIONS  OF THE EXCHANGE RELATED TO HEALTH PLAN
                  CERTIFICATION AND QUALIFIED HEALTH PLAN OVERSIGHT.
         3986. REGIONAL ADVISORY COMMITTEES.
         3987. FUNDING OF THE EXCHANGE.
         3988. TAX EXEMPTION AND TAX CONTRACT BY THE STATE.
         3989. OFFICERS AND EMPLOYEES.
         3990. LIMITATION OF LIABILITY; INDEMNIFICATION.
         3991. CONSTRUCTION.
   § 3980. STATEMENT OF POLICY AND PURPOSES. THE PURPOSE OF THIS  ARTICLE
 IS  TO  ESTABLISH  AN AMERICAN HEALTH BENEFIT EXCHANGE IN NEW YORK.  THE
 EXCHANGE SHALL FACILITATE ENROLLMENT IN HEALTH  COVERAGE,  THE  PURCHASE
 AND  SALE  OF  QUALIFIED  HEALTH  PLANS IN THE INDIVIDUAL MARKET IN THIS
 STATE, AND ENROLL INDIVIDUALS IN HEALTH  COVERAGE  FOR  WHICH  THEY  ARE
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD01307-01-9

 A. 5648                             2
 
 ELIGIBLE  IN ACCORDANCE WITH FEDERAL LAW. THE EXCHANGE ALSO SHALL INCOR-
 PORATE A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") TO ASSIST QUALI-
 FIED EMPLOYERS IN FACILITATING THE  ENROLLMENT  OF  THEIR  EMPLOYEES  IN
 QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET.  IT IS THE INTENT OF
 THE  LEGISLATURE,  THROUGH THE ESTABLISHMENT OF THE EXCHANGE, TO PROMOTE
 QUALITY AND AFFORDABLE HEALTH COVERAGE AND CARE, REDUCE  THE  NUMBER  OF
 UNINSURED  PERSONS, PROVIDE A TRANSPARENT MARKETPLACE, EDUCATE CONSUMERS
 AND ASSIST INDIVIDUALS WITH ACCESS TO COVERAGE, PREMIUM  ASSISTANCE  TAX
 CREDITS AND COST-SHARING REDUCTIONS.
   § 3981. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING DEFI-
 NITIONS SHALL APPLY:
   1. "BOARD" OR "BOARD OF DIRECTORS" MEANS THE BOARD OF DIRECTORS OF THE
 EXCHANGE.
   2.  "REGIONAL  ADVISORY  COMMITTEES" MEANS THE NEW YORK HEALTH BENEFIT
 EXCHANGE REGIONAL ADVISORY COMMITTEES ESTABLISHED PURSUANT TO THIS ARTI-
 CLE.
   3. "COMMISSIONER" MEANS THE COMMISSIONER OF HEALTH.
   4. "EXCHANGE" MEANS THE NEW YORK HEALTH BENEFIT  EXCHANGE  ESTABLISHED
 PURSUANT TO THIS ARTICLE.
   5.  "HEALTH  PLAN" MEANS A POLICY, CONTRACT OR CERTIFICATE, OFFERED OR
 ISSUED BY AN INSURER TO PROVIDE, DELIVER, ARRANGE FOR, PAY FOR OR  REIM-
 BURSE  ANY  OF  THE COSTS OF HEALTH CARE SERVICES. HEALTH PLAN SHALL NOT
 INCLUDE THE FOLLOWING:
   (A) ACCIDENT INSURANCE OR DISABILITY INCOME INSURANCE, OR ANY COMBINA-
 TION THEREOF;
   (B) COVERAGE ISSUED AS A SUPPLEMENT TO LIABILITY INSURANCE;
   (C) LIABILITY INSURANCE, INCLUDING  GENERAL  LIABILITY  INSURANCE  AND
 AUTOMOBILE LIABILITY INSURANCE;
   (D) WORKERS' COMPENSATION OR SIMILAR INSURANCE;
   (E) AUTOMOBILE NO-FAULT INSURANCE;
   (F) CREDIT INSURANCE;
   (G)  OTHER  SIMILAR  INSURANCE COVERAGE, AS SPECIFIED IN FEDERAL REGU-
 LATIONS, UNDER WHICH BENEFITS FOR MEDICAL CARE ARE  SECONDARY  OR  INCI-
 DENTAL TO OTHER INSURANCE BENEFITS;
   (H)  LIMITED  SCOPE  DENTAL OR VISION BENEFITS, BENEFITS FOR LONG-TERM
 CARE INSURANCE, NURSING HOME INSURANCE,  HOME  CARE  INSURANCE,  OR  ANY
 COMBINATION  THEREOF,  OR  SUCH  OTHER  SIMILAR, LIMITED BENEFITS HEALTH
 INSURANCE AS SPECIFIED IN  FEDERAL  REGULATIONS,  IF  THE  BENEFITS  ARE
 PROVIDED  UNDER  A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE
 OR ARE OTHERWISE NOT AN INTEGRAL PART OF THE PLAN;
   (I) COVERAGE ONLY FOR A SPECIFIED DISEASE OR ILLNESS, HOSPITAL  INDEM-
 NITY, OR OTHER FIXED INDEMNITY COVERAGE;
   (J)  MEDICARE  SUPPLEMENTAL INSURANCE AS DEFINED IN SECTION 1882(G)(1)
 OF THE FEDERAL SOCIAL SECURITY ACT, COVERAGE SUPPLEMENTAL TO THE  COVER-
 AGE  PROVIDED UNDER CHAPTER 55 OF TITLE 10 OF THE UNITED STATES CODE, OR
 SIMILAR SUPPLEMENTAL COVERAGE PROVIDED UNDER A GROUP HEALTH PLAN  IF  IT
 IS  OFFERED  AS A SEPARATE POLICY, CERTIFICATE OR CONTRACT OF INSURANCE;
 OR
   (K) THE MEDICAL INDEMNITY FUND ESTABLISHED PURSUANT TO TITLE  FOUR  OF
 ARTICLE TWENTY-NINE-D OF THE PUBLIC HEALTH LAW.
   6.  "INSURER" MEANS AN INSURANCE COMPANY SUBJECT TO ARTICLE THIRTY-TWO
 OR FORTY-THREE OF THE INSURANCE LAW, OR A HEALTH  MAINTENANCE  ORGANIZA-
 TION  CERTIFIED  PURSUANT TO ARTICLE FORTY-FOUR OF THE PUBLIC HEALTH LAW
 THAT CONTRACTS OR OFFERS TO CONTRACT TO PROVIDE, DELIVER,  ARRANGE,  PAY
 OR REIMBURSE ANY OF THE COSTS OF HEALTH CARE SERVICES.

 A. 5648                             3

   7.  "QUALIFIED  DENTAL PLAN" MEANS A LIMITED SCOPE DENTAL PLAN THAT IS
 ISSUED BY AN INSURER AND CERTIFIED IN ACCORDANCE  WITH  SECTION  THIRTY-
 NINE HUNDRED EIGHTY-FIVE OF THIS ARTICLE.
   8. "QUALIFIED EMPLOYER" MEANS A SMALL EMPLOYER THAT ELECTS TO MAKE ITS
 FULL-TIME  EMPLOYEES  ELIGIBLE  FOR  ONE  OR MORE QUALIFIED HEALTH PLANS
 THROUGH THE EXCHANGE.
   9. "QUALIFIED HEALTH PLAN" MEANS A HEALTH PLAN THAT IS  ISSUED  BY  AN
 INSURER  AND  CERTIFIED  IN  ACCORDANCE WITH SECTION THIRTY-NINE HUNDRED
 EIGHTY-FIVE OF THIS ARTICLE.
   10. "QUALIFIED INDIVIDUAL" MEANS AN  INDIVIDUAL,  INCLUDING  A  MINOR,
 WHO:
   (A)  IS  SEEKING TO ENROLL IN A QUALIFIED HEALTH PLAN OFFERED TO INDI-
 VIDUALS THROUGH THE EXCHANGE;
   (B) RESIDES IN THIS STATE;
   (C) AT THE TIME OF ENROLLMENT, IS NOT INCARCERATED, OTHER THAN  INCAR-
 CERATION PENDING THE DISPOSITION OF CHARGES; AND
   (D)  IS,  AND  IS REASONABLY EXPECTED TO BE, FOR THE ENTIRE PERIOD FOR
 WHICH ENROLLMENT IS SOUGHT, A CITIZEN OR NATIONAL OF THE  UNITED  STATES
 OR AN ALIEN LAWFULLY PRESENT IN THE UNITED STATES.
   11. "SHOP" MEANS THE SMALL BUSINESS HEALTH OPTIONS PROGRAM DESIGNED TO
 ASSIST  QUALIFIED EMPLOYERS IN THIS STATE IN FACILITATING THE ENROLLMENT
 OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS OFFERED IN THE GROUP MARKET
 IN THIS STATE.
   12. "SMALL EMPLOYER" MEANS, FOR PLAN YEARS PRIOR TO JANUARY FIRST, TWO
 THOUSAND SIXTEEN, AN EMPLOYER THAT EMPLOYED AN AVERAGE OF AT  LEAST  ONE
 BUT  NOT MORE THAN FIFTY EMPLOYEES ON BUSINESS DAYS DURING THE PRECEDING
 CALENDAR YEAR. FOR PLAN YEARS BEGINNING ON AND AFTER JANUARY FIRST,  TWO
 THOUSAND  SIXTEEN,  SMALL  EMPLOYER  MEANS  AN EMPLOYER THAT EMPLOYED AN
 AVERAGE OF AT LEAST ONE BUT NOT MORE THAN ONE HUNDRED EMPLOYEES ON BUSI-
 NESS DAYS DURING THE PRECEDING CALENDAR YEAR. FOR PURPOSES OF THE  DEFI-
 NITION OF SMALL EMPLOYER:
   (A)  ALL  PERSONS  TREATED  AS A SINGLE EMPLOYER UNDER SUBSECTION (B),
 (C), (M) OR (O) OF SECTION 414 OF THE  INTERNAL  REVENUE  CODE  OF  1986
 SHALL BE TREATED AS A SINGLE EMPLOYER;
   (B)  AN  EMPLOYER  AND  ANY PREDECESSOR EMPLOYER SHALL BE TREATED AS A
 SINGLE EMPLOYER;
   (C) ALL EMPLOYEES SHALL BE COUNTED, INCLUDING PART-TIME EMPLOYEES  AND
 EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE THROUGH THE EMPLOYER;
   (D)  IF  AN  EMPLOYER  WAS  NOT  IN EXISTENCE THROUGHOUT THE PRECEDING
 CALENDAR YEAR, THEN THE DETERMINATION OF  WHETHER  THAT  EMPLOYER  IS  A
 SMALL  EMPLOYER SHALL BE BASED UPON THE AVERAGE NUMBER OF EMPLOYEES THAT
 THE EMPLOYER REASONABLY EXPECTS  TO  EMPLOY  ON  BUSINESS  DAYS  IN  THE
 CURRENT CALENDAR YEAR;
   (E)  IF A QUALIFIED EMPLOYER THAT MAKES ENROLLMENT IN QUALIFIED HEALTH
 PLANS AVAILABLE TO ITS EMPLOYEES THROUGH THE EXCHANGE  CEASES  TO  BE  A
 SMALL  EMPLOYER BY REASON OF AN INCREASE IN THE NUMBER OF ITS EMPLOYEES,
 THEN THE EMPLOYER SHALL CONTINUE TO BE TREATED AS A  QUALIFIED  EMPLOYER
 FOR  PURPOSES OF THIS ARTICLE FOR THE PERIOD BEGINNING WITH THE INCREASE
 AND ENDING WITH THE FIRST DAY ON WHICH THE EMPLOYER DOES NOT  MAKE  SUCH
 ENROLLMENT AVAILABLE TO ITS EMPLOYEES; AND
   (F) NOTWITHSTANDING PARAGRAPHS (A) THROUGH (E) OF THIS SUBDIVISION, AN
 EMPLOYER  ALSO  SHALL  BE CONSIDERED A SMALL EMPLOYER IF THE COVERAGE IT
 OFFERS WOULD BE CONSIDERED SMALL GROUP COVERAGE UNDER THE INSURANCE  LAW
 AND REGULATIONS PROMULGATED THEREUNDER.
   13. "SMALL GROUP MARKET" MEANS THE HEALTH INSURANCE MARKET UNDER WHICH
 INDIVIDUALS  RECEIVE  HEALTH  INSURANCE COVERAGE ON BEHALF OF THEMSELVES

 A. 5648                             4
 
 AND THEIR DEPENDENTS THROUGH A GROUP HEALTH PLAN MAINTAINED BY  A  SMALL
 EMPLOYER.
   14. "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
   §  3982.  ESTABLISHMENT  OF  THE NEW YORK HEALTH BENEFIT EXCHANGE.  1.
 THERE IS HEREBY CREATED A PUBLIC BENEFIT CORPORATION TO BE KNOWN AS  THE
 NEW  YORK  HEALTH  BENEFIT  EXCHANGE.  SUCH  CORPORATION SHALL BE A BODY
 CORPORATE AND POLITIC.
   2. THE PURPOSE OF THE EXCHANGE IS TO FACILITATE THE PURCHASE AND  SALE
 OF  QUALIFIED  HEALTH  PLANS, ASSIST QUALIFIED EMPLOYERS IN FACILITATING
 THE ENROLLMENT OF THEIR EMPLOYEES IN QUALIFIED HEALTH PLANS THROUGH  THE
 SMALL  BUSINESS  HEALTH  OPTIONS  PROGRAM,  ENROLL INDIVIDUALS IN HEALTH
 COVERAGE FOR WHICH THEY ARE ELIGIBLE IN ACCORDANCE WITH FEDERAL LAW  AND
 CARRY OUT OTHER FUNCTIONS SET FORTH IN THIS ARTICLE.
   3. (A) THE EXCHANGE SHALL BE GOVERNED BY A BOARD OF DIRECTORS CONSIST-
 ING  OF NINE VOTING DIRECTORS, INCLUDING THE COMMISSIONER AND THE SUPER-
 INTENDENT, WHO SHALL SERVE AS EX OFFICIO DIRECTORS.
   (B) SEVEN DIRECTORS SHALL BE APPOINTED BY THE GOVERNOR,  TWO  OF  WHOM
 SHALL BE APPOINTED UPON THE RECOMMENDATION OF THE TEMPORARY PRESIDENT OF
 THE SENATE AND TWO OF WHOM SHALL BE APPOINTED UPON THE RECOMMENDATION OF
 THE SPEAKER OF THE ASSEMBLY.  EACH PERSON APPOINTED AS A DIRECTOR PURSU-
 ANT TO THIS PARAGRAPH SHALL HAVE EXPERTISE IN ONE OR MORE OF THE FOLLOW-
 ING AREAS:
   (I) INDIVIDUAL HEALTH CARE COVERAGE;
   (II) SMALL EMPLOYER HEALTH CARE COVERAGE;
   (III) HEALTH BENEFITS ADMINISTRATION;
   (IV) HEALTH CARE FINANCE;
   (V) PUBLIC OR PRIVATE HEALTH CARE DELIVERY SYSTEMS; AND
   (VI) PURCHASING HEALTH PLAN COVERAGE.
   (C) RECOMMENDATIONS AND APPOINTMENTS SHALL TAKE INTO CONSIDERATION THE
 EXPERTISE  OF OTHER DIRECTORS RECOMMENDED AND APPOINTED PURSUANT TO THIS
 SUBDIVISION, SO THAT THE BOARD COMPOSITION REFLECTS A DIVERSITY OF EXPE-
 RIENCE.
   (D) RECOMMENDATIONS BY THE TEMPORARY PRESIDENT OF THE SENATE  AND  THE
 SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
 DATE  OF  THIS ARTICLE, WITHIN SIXTY DAYS OF THE OCCURRENCE OF A VACANCY
 OR WITHIN SIXTY DAYS PRIOR TO THE EXPIRATION OF A TERM.
   4. THE GOVERNOR SHALL APPOINT A CHAIR OF  THE  BOARD  FROM  AMONG  THE
 DIRECTORS  WHO SHALL BE SUBJECT TO THE ADVICE AND CONSENT OF THE SENATE.
 ANY DIRECTOR APPOINTED BY THE GOVERNOR AS CHAIR OF THE BOARD  MAY  SERVE
 AS  ACTING  CHAIR UNTIL SUCH TIME AS A VOTE FOR CONFIRMATION IS TAKEN BY
 THE SENATE. NO DIRECTOR APPOINTED AS CHAIR  SHALL  SERVE  AS  CHAIR,  OR
 CONTINUE  TO  SERVE  AS  ACTING  CHAIR,  IF  THE SENATE HAS VOTED NOT TO
 CONFIRM SUCH DIRECTOR AS CHAIR.
   5. (A) THE TERMS OF THE DIRECTORS, OTHER THAN THE  EX  OFFICIO  DIREC-
 TORS, SHALL BE THREE YEARS, PROVIDED, HOWEVER, THAT THE INITIAL TERMS OF
 ONE  OF  THE  DIRECTORS  APPOINTED  UPON RECOMMENDATION OF THE TEMPORARY
 PRESIDENT OF THE SENATE, ONE OF THE DIRECTORS APPOINTED UPON RECOMMENDA-
 TION OF THE SPEAKER OF THE ASSEMBLY, AND ONE OF THE DIRECTORS  APPOINTED
 BY THE GOVERNOR WITHOUT RECOMMENDATION SHALL BE FOR TWO YEARS.
   (B) VACANCIES OCCURRING OTHERWISE THAN BY EXPIRATION OF TERM OF OFFICE
 SHALL  BE  FILLED  FOR  THE  UNEXPIRED  TERM  IN THE MANNER PROVIDED FOR
 ORIGINAL APPOINTMENT.
   6. THE DIRECTORS SHALL NOT RECEIVE ANY COMPENSATION FOR THEIR SERVICES
 AS DIRECTORS.
   7. (A) EACH DIRECTOR SHALL HAVE THE RESPONSIBILITY AND  DUTY  TO  MEET
 THE  REQUIREMENTS  OF  THIS ARTICLE AND ALL APPLICABLE STATE AND FEDERAL

 A. 5648                             5

 LAWS AND REGULATIONS TO SERVE THE PUBLIC INTEREST OF THE INDIVIDUALS AND
 SMALL BUSINESSES SEEKING HEALTH  CARE  COVERAGE  THROUGH  THE  EXCHANGE,
 CONSISTENT  WITH  SECTION TWENTY-EIGHT HUNDRED TWENTY-FOUR OF THIS CHAP-
 TER.
   (B)  EACH  DIRECTOR  SHALL  BE  A  STATE  OFFICER  OR EMPLOYEE FOR THE
 PURPOSES OF SECTIONS SEVENTY-THREE AND SEVENTY-FOUR OF THE PUBLIC  OFFI-
 CERS LAW.
   (C) NO DIRECTOR MAY BE EMPLOYED OR OTHERWISE RETAINED BY THE EXCHANGE.
   8.  (A) THE BOARD MAY CREATE SUCH COMMITTEES AS THE BOARD DEEMS NECES-
 SARY. THE FIRST MEETING OF THE BOARD SHALL BE HELD  WITHIN  THIRTY  DAYS
 AFTER  ALL  DIRECTORS  ARE INITIALLY APPOINTED.  AT THE FIRST MEETING OF
 THE BOARD, AND AT THE FIRST MEETING IN EACH SUBSEQUENT YEAR,  THE  BOARD
 SHALL  ELECT  FROM  AMONG  ITS  MEMBERS A SECRETARY AND A TREASURER. THE
 BOARD ALSO SHALL ELECT SUCH OTHER OFFICERS AS IT SHALL  DEEM  NECESSARY.
 THE  OFFICERS  SO  ELECTED  SHALL  HAVE  SUCH  POWERS  AND DUTIES AS ARE
 ASSIGNED BY THE BY-LAWS AND THIS CHAPTER.
   (B) THE BOARD, AND ANY COMMITTEE THEREOF, MAY HOLD MEETINGS  BY  ELEC-
 TRONIC MEANS CONSISTENT WITH ARTICLE SEVEN OF THE PUBLIC OFFICERS LAW.
   §  3983.  GENERAL  POWERS OF THE EXCHANGE. THE EXCHANGE SHALL HAVE THE
 FOLLOWING POWERS TO BE USED IN FURTHERANCE OF ITS CORPORATE PURPOSES:
   1. TO SUE AND BE SUED AND TO PARTICIPATE IN ACTIONS  AND  PROCEEDINGS,
 WHETHER JUDICIAL, ADMINISTRATIVE, ARBITRATIVE OR OTHERWISE;
   2.  TO  HAVE A CORPORATE SEAL, AND TO ALTER SUCH SEAL AT PLEASURE, AND
 TO USE IT BY CAUSING IT OR A FACSIMILE TO BE  AFFIXED  OR  IMPRESSED  OR
 REPRODUCED IN ANY OTHER MANNER;
   3.  TO  PURCHASE,  RECEIVE,  TAKE  BY  GRANT, GIFT, DEVISE, BEQUEST OR
 OTHERWISE, LEASE, OR OTHERWISE ACQUIRE, OWN, HOLD, IMPROVE, EMPLOY,  USE
 AND OTHERWISE DEAL IN AND WITH, REAL OR PERSONAL PROPERTY, OR ANY INTER-
 EST THEREIN, WHEREVER SITUATED;
   4. TO SELL, CONVEY, LEASE, EXCHANGE, TRANSFER OR OTHERWISE DISPOSE OF,
 OR  MORTGAGE  OR PLEDGE, OR CREATE A SECURITY INTEREST IN, ALL OR ANY OF
 ITS PROPERTY, OR ANY INTEREST THEREIN, WHEREVER SITUATED;
   5. TO MAKE CONTRACTS,  GIVE  GUARANTEES  AND  INCUR  LIABILITIES,  AND
 BORROW  MONEY;  PROVIDED,  HOWEVER,  THAT  THE  EXCHANGE SHALL NOT ISSUE
 BONDS;
   6. TO INVEST AND REINVEST ITS  FUNDS,  AND  TAKE  AND  HOLD  REAL  AND
 PERSONAL  PROPERTY  AS  SECURITY  FOR  THE PAYMENT OF FUNDS SO LOANED OR
 INVESTED;
   7. TO MAKE AND ALTER BY-LAWS FOR ITS ORGANIZATION AND MANAGEMENT;
   8. TO MAKE AND ALTER RULES AND REGULATIONS AS NECESSARY  TO  IMPLEMENT
 THE  PROVISIONS  OF THIS ARTICLE, SUBJECT TO THE PROVISIONS OF THE STATE
 ADMINISTRATIVE PROCEDURE ACT;
   9. TO HIRE EMPLOYEES,  CONSISTENT  WITH  SECTION  THIRTY-NINE  HUNDRED
 EIGHTY-NINE OF THIS ARTICLE;
   10. TO DESIGNATE THE DEPOSITORIES OF ITS MONEY;
   11. TO ESTABLISH ITS FISCAL YEAR;
   12. TO INSURE OR OTHERWISE PROVIDE FOR THE INSURANCE OF THE EXCHANGE'S
 PROPERTY  OR OPERATIONS AND AGAINST SUCH OTHER RISKS AS THE EXCHANGE MAY
 DEEM ADVISABLE;
   13. TO RECEIVE AND SPEND MONEY FOR ANY OF ITS  CORPORATE  PURPOSES  IN
 ACCORDANCE WITH THIS ARTICLE; AND
   14.  TO  APPLY FOR, ACCEPT THE AWARD OF, AND SPEND ANY AVAILABLE GRANT
 MONEY.
   § 3984. FUNCTIONS OF THE EXCHANGE.  THE EXCHANGE SHALL:
   1. (A) MAKE AVAILABLE QUALIFIED HEALTH PLANS TO QUALIFIED  INDIVIDUALS
 AND  QUALIFIED EMPLOYERS BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOU-

 A. 5648                             6
 
 SAND TWENTY, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED PLANS SHALL NOT
 BECOME EFFECTIVE PRIOR TO SUCH DATE AND SHALL  NOT  MAKE  AVAILABLE  ANY
 HEALTH PLAN THAT IS NOT A QUALIFIED HEALTH PLAN;
   (B) MAKE AVAILABLE QUALIFIED DENTAL PLANS TO QUALIFIED INDIVIDUALS AND
 QUALIFIED  EMPLOYERS  BEGINNING ON OR BEFORE JANUARY FIRST, TWO THOUSAND
 TWENTY, PROVIDED THAT COVERAGE UNDER SUCH QUALIFIED DENTAL  PLANS  SHALL
 NOT  BECOME  EFFECTIVE  PRIOR  TO  SUCH  DATE,  EITHER  SEPARATELY OR IN
 CONJUNCTION WITH A QUALIFIED HEALTH PLAN, IF SUCH PLAN  PROVIDES  PEDIA-
 TRIC DENTAL BENEFITS;
   2.  ASSIGN  A RATING TO EACH QUALIFIED HEALTH PLAN OFFERED THROUGH THE
 EXCHANGE, AND DETERMINE EACH QUALIFIED HEALTH PLAN'S LEVEL OF COVERAGE;
   3. UTILIZE A STANDARDIZED FORMAT FOR PRESENTING HEALTH BENEFIT OPTIONS
 IN THE EXCHANGE, INCLUDING THE USE OF THE UNIFORM  OUTLINE  OF  COVERAGE
 ESTABLISHED UNDER SECTION 2715 OF THE FEDERAL PUBLIC HEALTH SERVICE ACT;
   4.  PROVIDE  FOR  ENROLLMENT  PERIODS  PURSUANT  TO THE INSURANCE LAW,
 WHICHEVER IS IN THE BEST INTEREST OF QUALIFIED INDIVIDUALS AND QUALIFIED
 EMPLOYERS;
   5. IMPLEMENT PROCEDURES FOR  THE  CERTIFICATION,  RECERTIFICATION  AND
 DECERTIFICATION  OF  HEALTH  PLANS AS QUALIFIED HEALTH PLANS, CONSISTENT
 WITH GUIDELINES DEVELOPED BY THE SUPERINTENDENT;
   6. REQUIRE QUALIFIED HEALTH PLANS TO OFFER THOSE  BENEFITS  DETERMINED
 BY  THE  SUPERINTENDENT  TO  BE ESSENTIAL HEALTH BENEFITS AND SUCH ADDI-
 TIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO THE INSURANCE LAW;
   7. ENSURE THAT INSURERS OFFERING HEALTH PLANS THROUGH THE EXCHANGE  DO
 NOT CHARGE AN INDIVIDUAL A FEE OR PENALTY FOR TERMINATION OF COVERAGE;
   8.  PROVIDE  FOR  THE  OPERATION  OF  A TOLL-FREE TELEPHONE HOTLINE TO
 RESPOND TO REQUESTS FOR ASSISTANCE;
   9. MAINTAIN AN INTERNET WEBSITE THROUGH WHICH ENROLLEES  AND  PROSPEC-
 TIVE ENROLLEES OF QUALIFIED HEALTH PLANS MAY OBTAIN STANDARDIZED COMPAR-
 ATIVE INFORMATION ON SUCH PLANS AND PUBLIC HEALTH PROGRAMS;
   10.  ESTABLISH  AND MAKE AVAILABLE BY ELECTRONIC MEANS A CALCULATOR TO
 DETERMINE THE ACTUAL COST OF  COVERAGE  AFTER  THE  APPLICATION  OF  ANY
 PREMIUM  TAX  CREDIT  UNDER  SECTION 36B OF THE INTERNAL REVENUE CODE OF
 1986 AND ANY COST-SHARING REDUCTION;
   11. ESTABLISH A PROGRAM UNDER WHICH  THE  EXCHANGE  AWARDS  GRANTS  TO
 ENTITIES TO SERVE AS NAVIGATORS;
   12.  INFORM  INDIVIDUALS  OF ELIGIBILITY REQUIREMENTS FOR THE MEDICAID
 PROGRAM UNDER TITLE XIX OF  THE  SOCIAL  SECURITY  ACT,  THE  CHILDREN'S
 HEALTH  INSURANCE  PROGRAM (CHIP) UNDER TITLE XXI OF THE SOCIAL SECURITY
 ACT OR ANY APPLICABLE STATE OR LOCAL PUBLIC HEALTH INSURANCE PROGRAM AND
 IF, THROUGH SCREENING OF THE APPLICATION BY THE EXCHANGE,  THE  EXCHANGE
 DETERMINES  THAT  SUCH  INDIVIDUALS  ARE  ELIGIBLE FOR ANY SUCH PROGRAM,
 ENROLL SUCH INDIVIDUALS IN SUCH PROGRAM;
   13.  GRANT A CERTIFICATION ATTESTING THAT, FOR PURPOSES OF  THE  INDI-
 VIDUAL RESPONSIBILITY PENALTY UNDER SECTION 5000A OF THE INTERNAL REVEN-
 UE  CODE  OF 1986, AN INDIVIDUAL IS EXEMPT FROM THE INDIVIDUAL RESPONSI-
 BILITY REQUIREMENT OR FROM THE PENALTY IMPOSED BY THAT SECTION BECAUSE:
   (A) THERE IS NO AFFORDABLE QUALIFIED HEALTH PLAN AVAILABLE THROUGH THE
 EXCHANGE OR THE INDIVIDUAL'S EMPLOYER, COVERING THE INDIVIDUAL; OR
   (B) THE INDIVIDUAL MEETS THE REQUIREMENTS FOR ANY OTHER SUCH EXEMPTION
 FROM THE INDIVIDUAL RESPONSIBILITY REQUIREMENT OR PENALTY;
   14. TRANSMIT TO THE COMPTROLLER:
   (A) A LIST OF THE INDIVIDUALS TO WHOM THE EXCHANGE GRANTED  A  CERTIF-
 ICATION  UNDER  SUBDIVISION THIRTEEN OF THIS SECTION, INCLUDING THE NAME
 AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL;

 A. 5648                             7

   (B) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF EACH INDIVIDUAL WHO
 WAS AN EMPLOYEE OF AN EMPLOYER WHO WAS DETERMINED TO BE ELIGIBLE FOR THE
 PREMIUM TAX CREDIT UNDER SECTION 36B OF THE  INTERNAL  REVENUE  CODE  OF
 1986 BECAUSE:
   (I)  THE EMPLOYER DID NOT PROVIDE MINIMUM ESSENTIAL COVERAGE AS DETER-
 MINED BY THE SUPERINTENDENT; OR
   (II) THE EMPLOYER PROVIDED THE MINIMUM ESSENTIAL  COVERAGE  AS  DETER-
 MINED  BY  THE  SUPERINTENDENT,  BUT  IT  WAS  DETERMINED  UNDER SECTION
 36B(C)(2)(C) OF THE INTERNAL REVENUE CODE OF 1986 TO EITHER BE UNAFFORD-
 ABLE TO THE EMPLOYEE OR TO NOT PROVIDE THE  REQUIRED  MINIMUM  ACTUARIAL
 VALUE; AND
   (C) THE NAME AND TAXPAYER IDENTIFICATION NUMBER OF:
   (I)  EACH  INDIVIDUAL  WHO  NOTIFIES  THE  EXCHANGE THAT HE OR SHE HAS
 CHANGED EMPLOYERS; AND
   (II) EACH INDIVIDUAL WHO CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN
 DURING A PLAN YEAR AND THE EFFECTIVE DATE OF THAT CESSATION;
   15. PROVIDE TO EACH EMPLOYER THE NAME OF EACH EMPLOYEE OF THE EMPLOYER
 DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION FOURTEEN OF THIS  SECTION  WHO
 CEASES COVERAGE UNDER A QUALIFIED HEALTH PLAN DURING A PLAN YEAR AND THE
 EFFECTIVE DATE OF THE CESSATION;
   16.  OPERATE  A SMALL BUSINESS HEALTH OPTIONS PROGRAM ("SHOP") THROUGH
 WHICH QUALIFIED EMPLOYERS ACCESS COVERAGE FOR THEIR EMPLOYEES, AND MAY:
   (A) PERMIT QUALIFIED EMPLOYERS TO SPECIFY A LEVEL OF COVERAGE SO THEIR
 EMPLOYEES MAY ENROLL IN ANY QUALIFIED HEALTH PLAN  OFFERED  THROUGH  THE
 SHOP  AT THE SPECIFIED LEVEL OF COVERAGE OR PROVIDE A SPECIFIC AMOUNT OR
 OTHER PAYMENT FORMULATED TO BE USED AS PART OF AN EMPLOYEE CHOICE  PLAN;
 AND
   (B) PROVIDE PREMIUM AGGREGATION AND OTHER RELATED SERVICES TO MINIMIZE
 ADMINISTRATIVE BURDENS FOR QUALIFIED EMPLOYERS;
   17.  ENTER  INTO  AGREEMENTS  AS NECESSARY WITH: (A) FEDERAL AND STATE
 AGENCIES AND OTHER STATE EXCHANGES TO  CARRY  OUT  ITS  RESPONSIBILITIES
 UNDER   THIS   ARTICLE,   PROVIDED   SUCH  AGREEMENTS  INCLUDE  ADEQUATE
 PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY INFORMATION TO BE
 SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS AND REGULATIONS; AND
   (B) LOCAL DEPARTMENTS OF SOCIAL SERVICES TO COORDINATE  ENROLLMENT  IN
 OTHER SOCIAL SERVICES PROGRAMS, AS APPROPRIATE, PROVIDED SUCH AGREEMENTS
 INCLUDE  ADEQUATE PROTECTIONS WITH RESPECT TO THE CONFIDENTIALITY OF ANY
 INFORMATION TO BE SHARED AND COMPLY WITH ALL STATE AND FEDERAL LAWS  AND
 REGULATIONS;
   18.  PERFORM DUTIES REQUIRED BY THE SUPERINTENDENT OR THE SECRETARY OF
 THE UNITED STATES DEPARTMENT OF  THE  TREASURY  RELATED  TO  DETERMINING
 ELIGIBILITY FOR PREMIUM TAX CREDITS, REDUCED COST-SHARING, OR INDIVIDUAL
 RESPONSIBILITY REQUIREMENT EXEMPTIONS;
   19. MEET FINANCIAL INTEGRITY REQUIREMENTS OF THIS CHAPTER, INCLUDING:
   (A)  KEEPING  AN  ACCURATE ACCOUNTING OF ALL ACTIVITIES, RECEIPTS, AND
 EXPENDITURES AND ANNUALLY SUBMITTING  TO  THE  SUPERINTENDENT  A  REPORT
 CONCERNING  SUCH ACCOUNTINGS, WITH A COPY OF SUCH REPORT PROVIDED TO THE
 GOVERNOR, THE TEMPORARY PRESIDENT OF THE SENATE AND THE SPEAKER  OF  THE
 ASSEMBLY; AND
   (B)  FULLY  COOPERATING WITH ANY INVESTIGATION CONDUCTED BY THE SUPER-
 INTENDENT PURSUANT TO HIS OR HER AUTHORITY AND ALLOWING THE  SUPERINTEN-
 DENT TO:
   (I) INVESTIGATE THE AFFAIRS OF THE EXCHANGE;
   (II) EXAMINE THE PROPERTIES AND RECORDS OF THE EXCHANGE; AND
   (III) REQUIRE PERIODIC REPORTS IN RELATION TO THE ACTIVITIES UNDERTAK-
 EN BY THE EXCHANGE;

 A. 5648                             8

   20.  (A)  CONSULT  WITH  THE  REGIONAL ADVISORY COMMITTEES ESTABLISHED
 PURSUANT TO SECTION THIRTY-NINE HUNDRED EIGHTY-SIX OF THIS ARTICLE; AND
   (B)  CONSULT WITH STAKEHOLDERS RELEVANT TO CARRYING OUT THE ACTIVITIES
 REQUIRED UNDER THIS ARTICLE, INCLUDING BUT NOT LIMITED TO:
   (I) HEALTH CARE CONSUMERS WHO ARE ENROLLEES IN HEALTH PLANS;
   (II) INDIVIDUALS AND ENTITIES WITH EXPERIENCE IN FACILITATING  ENROLL-
 MENT IN HEALTH PLANS;
   (III)  REPRESENTATIVES  OF SMALL BUSINESSES AND SELF-EMPLOYED INDIVID-
 UALS;
   (IV) STATE MEDICAID OFFICES, INCLUDING  LOCAL  DEPARTMENTS  OF  SOCIAL
 SERVICES;
   (V) ADVOCATES FOR ENROLLING HARD TO REACH POPULATIONS;
   (VI) HEALTH CARE PROVIDERS; AND
   (VII) INSURERS;
   21.  SUBMIT  INFORMATION PROVIDED BY EXCHANGE APPLICANTS FOR VERIFICA-
 TION;
   22. ESTABLISH RULES AND REGULATIONS, PURSUANT TO SUBDIVISION EIGHT  OF
 SECTION  THIRTY-NINE  HUNDRED  EIGHTY-THREE OF THIS ARTICLE, THAT DO NOT
 CONFLICT WITH OR PREVENT THE APPLICATION OF REGULATIONS  PROMULGATED  BY
 THE SUPERINTENDENT; AND
   23.  DETERMINE ELIGIBILITY, PROVIDE NOTICES, AND PROVIDE OPPORTUNITIES
 FOR APPEAL AND REDETERMINATION.
   § 3985. SPECIAL FUNCTIONS OF  THE  EXCHANGE  RELATED  TO  HEALTH  PLAN
 CERTIFICATION  AND  QUALIFIED  HEALTH  PLAN OVERSIGHT.   1. HEALTH PLANS
 CERTIFIED BY THE EXCHANGE SHALL MEET THE FOLLOWING REQUIREMENTS:
   (A) THE INSURER OFFERING THE HEALTH PLAN:
   (I) IS LICENSED OR CERTIFIED BY THE SUPERINTENDENT OR COMMISSIONER;
   (II) OFFERS AT LEAST ONE QUALIFIED HEALTH PLAN IN EACH OF  THE  SILVER
 AND GOLD LEVELS;
   (III)  HAS FILED WITH AND RECEIVED APPROVAL FROM THE SUPERINTENDENT OF
 ITS PREMIUM RATES AND POLICY OR CONTRACT FORMS PURSUANT TO THE INSURANCE
 LAW AND THE PUBLIC HEALTH LAW;
   (IV) DOES NOT CHARGE ANY CANCELLATION FEES OR PENALTIES  IN  VIOLATION
 OF  SUBDIVISION SEVEN OF SECTION THIRTY-NINE HUNDRED EIGHTY-FOUR OF THIS
 ARTICLE; AND
   (V) COMPLIES WITH THE REGULATIONS DEVELOPED BY THE SUPERINTENDENT  AND
 SUCH OTHER REQUIREMENTS AS THE EXCHANGE MAY ESTABLISH;
   (B)  THE HEALTH PLAN: (I) PROVIDES THE ESSENTIAL HEALTH BENEFITS PACK-
 AGE AND INCLUDES SUCH ADDITIONAL BENEFITS AS MAY BE REQUIRED PURSUANT TO
 THE INSURANCE LAW, EXCEPT THAT THE HEALTH PLAN SHALL NOT BE REQUIRED  TO
 PROVIDE ESSENTIAL BENEFITS THAT DUPLICATE THE MINIMUM BENEFITS OF QUALI-
 FIED DENTAL PLANS IF:
   (A)  THE  EXCHANGE  HAS  DETERMINED THAT AT LEAST ONE QUALIFIED DENTAL
 PLAN IS AVAILABLE TO SUPPLEMENT THE HEALTH PLAN'S COVERAGE; AND
   (B) THE INSURER MAKES PROMINENT DISCLOSURE AT THE TIME IT  OFFERS  THE
 HEALTH  PLAN, IN A FORM APPROVED BY THE EXCHANGE, THAT THE PLAN DOES NOT
 PROVIDE THE FULL RANGE OF ESSENTIAL PEDIATRIC BENEFITS, AND THAT  QUALI-
 FIED DENTAL PLANS PROVIDING THOSE BENEFITS AND OTHER DENTAL BENEFITS NOT
 COVERED BY THE PLAN ARE OFFERED THROUGH THE EXCHANGE;
   (II)  PROVIDES AT LEAST A BRONZE LEVEL OF COVERAGE, UNLESS THE PLAN IS
 CERTIFIED AS A QUALIFIED CATASTROPHIC PLAN, AND SHALL ONLY BE OFFERED TO
 INDIVIDUALS ELIGIBLE FOR CATASTROPHIC COVERAGE;
   (III) HAS COST-SHARING REQUIREMENTS, INCLUDING DEDUCTIBLES,  WHICH  DO
 NOT EXCEED THE LIMITS ESTABLISHED AND ANY REQUIREMENTS OF THE EXCHANGE;
   (IV)  COMPLIES  WITH  REGULATIONS  PROMULGATED  BY THE SUPERINTENDENT,
 WHICH INCLUDE MINIMUM STANDARDS IN THE  AREAS  OF  MARKETING  PRACTICES,

 A. 5648                             9
 
 NETWORK  ADEQUACY,  ESSENTIAL  COMMUNITY PROVIDERS IN UNDERSERVED AREAS,
 ACCREDITATION,  QUALITY  IMPROVEMENT,  UNIFORM  ENROLLMENT   FORMS   AND
 DESCRIPTIONS  OF COVERAGE AND INFORMATION ON QUALITY MEASURES FOR HEALTH
 BENEFIT PLAN PERFORMANCE;
   (V) COMPLIES WITH THE INSURANCE LAW AND THE PUBLIC HEALTH LAW REQUIRE-
 MENTS  APPLICABLE TO HEALTH INSURANCE ISSUED IN THIS STATE AND ANY REGU-
 LATIONS PROMULGATED PURSUANT  THERETO  THAT  DO  NOT  CONFLICT  WITH  OR
 PREVENT THE APPLICATION OF FEDERAL REQUIREMENTS; AND
   (C)  THE  EXCHANGE  DETERMINES  THAT  MAKING THE HEALTH PLAN AVAILABLE
 THROUGH THE EXCHANGE IS IN THE INTEREST  OF  QUALIFIED  INDIVIDUALS  AND
 QUALIFIED EMPLOYERS IN THIS STATE.
   2. THE EXCHANGE SHALL NOT EXCLUDE A HEALTH PLAN:
   (A) ON THE BASIS THAT THE HEALTH PLAN IS A FEE-FOR-SERVICE PLAN;
   (B)  THROUGH THE IMPOSITION OF PREMIUM PRICE CONTROLS BY THE EXCHANGE;
 OR
   (C) ON THE BASIS THAT THE HEALTH PLAN PROVIDES TREATMENTS NECESSARY TO
 PREVENT PATIENTS' DEATHS IN CIRCUMSTANCES THE  EXCHANGE  DETERMINES  ARE
 INAPPROPRIATE OR TOO COSTLY.
   3.  THE  EXCHANGE  SHALL  REQUIRE  EACH  INSURER  CERTIFIED OR SEEKING
 CERTIFICATION OF A HEALTH PLAN AS A QUALIFIED HEALTH PLAN TO:
   (A) SUBMIT A JUSTIFICATION FOR ANY PREMIUM INCREASE  TO  THE  EXCHANGE
 PRIOR TO IMPLEMENTATION OF SUCH INCREASE.  THE INSURER SHALL PROMINENTLY
 POST THE INFORMATION ON ITS INTERNET WEBSITE; PROVIDED, HOWEVER, THAT IF
 INFORMATION  SUBMITTED  TO  THE  SUPERINTENDENT AS A JUSTIFICATION FOR A
 PREMIUM RATE ADJUSTMENT PURSUANT TO THE INSURANCE  LAW,  OR  INFORMATION
 POSTED  TO  AN  INSURER'S  INTERNET  WEBSITE,  OTHERWISE  MEETS  FEDERAL
 REQUIREMENTS, THEN SUBMISSION OF A COPY OF THE SAME JUSTIFICATION TO THE
 EXCHANGE OR USE OF THE SAME POSTING SHALL BE DEEMED SUFFICIENT  TO  MEET
 THE REQUIREMENTS OF THIS SECTION.  THE EXCHANGE SHALL TAKE THIS INFORMA-
 TION,  AND  THE  INFORMATION  AND  THE  RECOMMENDATIONS  PROVIDED TO THE
 EXCHANGE BY THE SUPERINTENDENT RELATING  TO  PATTERNS  OR  PRACTICES  OF
 EXCESSIVE  OR  UNJUSTIFIED  PREMIUM  INCREASES,  INTO CONSIDERATION WHEN
 DETERMINING WHETHER TO ALLOW THE INSURER TO MAKE HEALTH PLANS  AVAILABLE
 THROUGH THE EXCHANGE.  SUCH RATE INCREASES SHALL BE SUBJECT TO THE PRIOR
 APPROVAL OF THE SUPERINTENDENT PURSUANT TO THE INSURANCE LAW;
   (B)(I) MAKE AVAILABLE TO THE PUBLIC AND SUBMIT TO THE EXCHANGE AND THE
 SUPERINTENDENT, ACCURATE AND TIMELY DISCLOSURE OF:
   (A) CLAIMS PAYMENT POLICIES AND PRACTICES;
   (B) PERIODIC FINANCIAL DISCLOSURES;
   (C) DATA ON ENROLLMENT AND DISENROLLMENT;
   (D) DATA ON THE NUMBER OF CLAIMS THAT ARE DENIED;
   (E) DATA ON RATING PRACTICES;
   (F)  INFORMATION ON COST-SHARING AND PAYMENTS WITH RESPECT TO ANY OUT-
 OF-NETWORK COVERAGE;
   (G) INFORMATION ON ENROLLEE AND PARTICIPANT RIGHTS; AND
   (H) OTHER INFORMATION AS DETERMINED APPROPRIATE BY THE SUPERINTENDENT;
   (II) THE INFORMATION SHALL BE PROVIDED IN PLAIN LANGUAGE AND IN  GUID-
 ANCE  JOINTLY  ISSUED  THEREUNDER  BY THE SUPERINTENDENT AND THE FEDERAL
 SECRETARY OF LABOR; AND
   (C) PROVIDE TO INDIVIDUALS, IN A TIMELY MANNER UPON THE REQUEST OF THE
 INDIVIDUAL, THE AMOUNT OF COST-SHARING,  INCLUDING  DEDUCTIBLES,  COPAY-
 MENTS,  AND  COINSURANCE, UNDER THE INDIVIDUAL'S HEALTH PLAN OR COVERAGE
 THAT THE INDIVIDUAL WOULD BE RESPONSIBLE FOR PAYING WITH RESPECT TO  THE
 FURNISHING OF A SPECIFIC ITEM OR SERVICE BY A PARTICIPATING PROVIDER. AT
 A  MINIMUM,  THIS  INFORMATION SHALL BE MADE AVAILABLE TO THE INDIVIDUAL

 A. 5648                            10
 
 THROUGH AN INTERNET WEBSITE AND  THROUGH  OTHER  MEANS  FOR  INDIVIDUALS
 WITHOUT ACCESS TO THE INTERNET.
   4.  (A)  THE PROVISIONS OF THIS ARTICLE THAT APPLY TO QUALIFIED HEALTH
 PLANS ALSO SHALL APPLY TO THE EXTENT RELEVANT TO QUALIFIED DENTAL  PLANS
 EXCEPT  AS  MODIFIED IN ACCORDANCE WITH THE PROVISIONS OF PARAGRAPHS (B)
 AND (C) OF THIS SUBDIVISION OR OTHERWISE REQUIRED BY THE EXCHANGE.
   (B) THE QUALIFIED DENTAL PLAN SHALL BE  LIMITED  TO  DENTAL  AND  ORAL
 HEALTH BENEFITS, WITHOUT SUBSTANTIALLY DUPLICATING THE BENEFITS TYPICAL-
 LY  OFFERED  BY  HEALTH BENEFIT PLANS WITHOUT DENTAL COVERAGE, AND SHALL
 INCLUDE,  AT  A  MINIMUM,  THE  ESSENTIAL  PEDIATRIC   DENTAL   BENEFITS
 PRESCRIBED  BY  THE SUPERINTENDENT AND SUCH OTHER DENTAL BENEFITS AS THE
 EXCHANGE OR THE SUPERINTENDENT MAY SPECIFY IN REGULATIONS.
   (C) INSURERS MAY  JOINTLY  OFFER  A  COMPREHENSIVE  PLAN  THROUGH  THE
 EXCHANGE  IN  WHICH  AN  INSURER  PROVIDES THE DENTAL BENEFITS THROUGH A
 QUALIFIED DENTAL PLAN AND AN INSURER PROVIDES THE OTHER BENEFITS THROUGH
 A QUALIFIED HEALTH PLAN, PROVIDED THAT THE PLANS ARE  PRICED  SEPARATELY
 AND ALSO ARE MADE AVAILABLE FOR PURCHASE SEPARATELY AT THE SAME PRICE.
   §  3986. REGIONAL ADVISORY COMMITTEES. 1. THERE ARE HEREBY CREATED THE
 NEW YORK HEALTH BENEFIT EXCHANGE REGIONAL ADVISORY COMMITTEES ("ADVISORY
 COMMITTEES"). ONE REGIONAL ADVISORY COMMITTEE SHALL BE ESTABLISHED WITH-
 IN EACH OF FIVE REGIONS, TO BE KNOWN AS  THE  "NEW  YORK  CITY  REGION,"
 "METROPOLITAN  SUBURBAN REGION," "NORTHERN REGION," "CENTRAL REGION" AND
 "WESTERN REGION." THE BOARD SHALL DETERMINE THE COUNTIES  THAT  MAKE  UP
 SUCH REGIONS.
   2. EACH REGIONAL ADVISORY COMMITTEE SHALL BE COMPRISED OF FIVE MEMBERS
 APPOINTED  BY  THE  GOVERNOR,  ONE  OF  WHOM SHALL BE APPOINTED UPON THE
 RECOMMENDATION OF THE TEMPORARY PRESIDENT OF THE SENATE AND ONE OF  WHOM
 SHALL  BE APPOINTED UPON THE RECOMMENDATION OF THE SPEAKER OF THE ASSEM-
 BLY.
   3. TERMS SHALL BE THREE  YEARS.    MEMBERS  SHALL  SERVE  UNTIL  THEIR
 SUCCESSORS ARE APPOINTED. MEMBERS MAY SERVE UP TO TWO CONSECUTIVE TERMS.
   4.  VACANCIES  SHALL BE FILLED IN THE SAME MANNER AS ORIGINAL APPOINT-
 MENTS, AND SUCCESSORS SHALL SERVE FOR THE  REMAINDER  OF  THE  UNEXPIRED
 TERM TO WHICH THEY ARE APPOINTED.
   5.  RECOMMENDATIONS  BY  THE TEMPORARY PRESIDENT OF THE SENATE AND THE
 SPEAKER OF THE ASSEMBLY SHALL BE MADE WITHIN SIXTY DAYS OF THE EFFECTIVE
 DATE OF THIS ARTICLE OR THE OCCURRENCE OF A  VACANCY,  OR  WITHIN  SIXTY
 DAYS PRIOR TO THE EXPIRATION OF A TERM.
   6. THE MEMBERS OF EACH REGIONAL ADVISORY COMMITTEE SHALL INCLUDE:
   (A)  REPRESENTATIVES  FROM THE FOLLOWING CATEGORIES, BUT NOT MORE THAN
 TWO FROM ANY SINGLE CATEGORY:
   (I) HEALTH PLAN CONSUMER ADVOCATES;
   (II) SMALL BUSINESS CONSUMER REPRESENTATIVES;
   (III) HEALTH CARE PROVIDER REPRESENTATIVES;
   (IV) REPRESENTATIVES OF THE HEALTH INSURANCE INDUSTRY;
   (B) REPRESENTATIVES FROM THE FOLLOWING CATEGORIES, BUT NOT  MORE  THAN
 ONE FROM EITHER CATEGORY:
   (I) LICENSED INSURANCE PRODUCERS; AND
   (II) REPRESENTATIVES OF LABOR ORGANIZATIONS.
   7.  THE BOARD SHALL SELECT THE CHAIR OF EACH REGIONAL ADVISORY COMMIT-
 TEE FROM AMONG THE MEMBERS OF SUCH  COMMITTEE.  THE  BOARD  SHALL  ADOPT
 RULES  FOR  THE  GOVERNANCE OF THE REGIONAL ADVISORY COMMITTEES AND EACH
 REGIONAL ADVISORY COMMITTEE SHALL MEET AT LEAST ONCE EACH QUARTER AND AT
 SUCH OTHER TIMES AS DETERMINED BY THE BOARD TO BE NECESSARY.
   8. MEMBERS OF THE REGIONAL ADVISORY  COMMITTEES  SHALL  SERVE  WITHOUT
 COMPENSATION.

 A. 5648                            11
 
   9.  THE REGIONAL ADVISORY COMMITTEES SHALL MAKE FINDINGS AND RECOMMEN-
 DATIONS REGARDING REGIONAL VARIATIONS IN THE OPERATION OF THE  EXCHANGE,
 WHICH  SHALL  BE  SUBMITTED  TO  THE  BOARD  OF DIRECTORS, POSTED ON THE
 WEBSITE OF THE EXCHANGE, AND CONSIDERED BY THE  BOARD  IN  A  REASONABLY
 TIMELY  FASHION.  SUCH  FINDINGS AND RECOMMENDATIONS SHALL BE MADE ON AN
 ANNUAL BASIS, ON A DATE DETERMINED BY THE BOARD, AND AT SUCH OTHER TIMES
 AS THE BOARD OR ANY REGIONAL ADVISORY COMMITTEE DEEMS APPROPRIATE.
   § 3987. FUNDING OF THE EXCHANGE.  1. THE EXCHANGE SHALL BE FINANCIALLY
 SELF-SUFFICIENT BY JANUARY FIRST, TWO THOUSAND TWENTY-ONE.
   2. THE EXCHANGE SHALL CONDUCT OR CAUSE TO BE CONDUCTED A STUDY OF, AND
 SHALL REPORT ITS FINDINGS  AND  RECOMMENDATIONS  UPON,  THE  OPTIONS  TO
 GENERATE FUNDING FOR THE ONGOING OPERATION OF THE EXCHANGE.
   3.    THE  EXCHANGE SHALL PUBLISH ON ITS INTERNET WEBSITE THE FEES AND
 ANY OTHER PAYMENTS REQUIRED BY  THE  EXCHANGE,  AND  THE  ADMINISTRATIVE
 COSTS OF THE EXCHANGE, TO EDUCATE CONSUMERS ON SUCH COSTS AND THE AMOUNT
 OF MONIES LOST TO WASTE, FRAUD AND ABUSE.
   4.  THE EXCHANGE SHALL NOT UTILIZE ANY FUNDS INTENDED FOR THE ADMINIS-
 TRATIVE AND OPERATIONAL EXPENSES OF THE  EXCHANGE  FOR  STAFF  RETREATS,
 PROMOTIONAL GIVEAWAYS, EXCESSIVE EXECUTIVE COMPENSATION, OR PROMOTION OF
 FEDERAL OR STATE LEGISLATIVE AND REGULATORY MODIFICATIONS.
   5.  THE  MONEYS OF THE EXCHANGE SHALL, EXCEPT AS OTHERWISE PROVIDED IN
 THIS SECTION, BE DEPOSITED IN A GENERAL  ACCOUNT  CALLED  THE  NEW  YORK
 HEALTH  BENEFIT EXCHANGE ACCOUNT AND SUCH OTHER ACCOUNTS AS THE EXCHANGE
 MAY DEEM NECESSARY, PURSUANT TO RESOLUTION OF THE BOARD, FOR THE  TRANS-
 ACTION  OF ITS BUSINESS AND SHALL BE PAID OUT AS AUTHORIZED BY THE CHAIR
 OF THE BOARD OR BY SUCH OTHER PERSON OR PERSONS AS THE CHAIR MAY  DESIG-
 NATE.
   6.  NO  FUNDS OF THE EXCHANGE SHALL BE TRANSFERRED TO THE GENERAL FUND
 OR ANY SPECIAL REVENUE FUND OR SHALL BE USED FOR ANY PURPOSE OTHER  THAN
 THE  PURPOSES  SET FORTH IN THIS ARTICLE.  NO FUNDS SHALL BE TRANSFERRED
 FROM THE GENERAL FUND OR ANY SPECIAL REVENUE FUND TO THE EXCHANGE  WITH-
 OUT AN APPROPRIATION.
   7. THE ACCOUNTS OF THE EXCHANGE SHALL BE SUBJECT TO SUPERVISION OF THE
 COMPTROLLER  AND  SUCH  ACCOUNTS  SHALL  INCLUDE RECEIPTS, EXPENDITURES,
 CONTRACTS AND OTHER MATTERS WHICH PERTAIN TO THE FISCAL SOUNDNESS OF THE
 EXCHANGE.
   8. NOTWITHSTANDING ANY LAW TO THE CONTRARY,  AND  IN  ACCORDANCE  WITH
 SECTION  FOUR  OF THE STATE FINANCE LAW, UPON REQUEST OF THE DIRECTOR OF
 THE BUDGET, IN CONSULTATION WITH THE  COMMISSIONER,  THE  SUPERINTENDENT
 AND  THE  CHAIR  OF  THE BOARD, THE COMPTROLLER IS HEREBY AUTHORIZED AND
 DIRECTED TO SUBALLOCATE OR TRANSFER SPECIAL REVENUE FEDERAL FUNDS APPRO-
 PRIATED TO THE DEPARTMENT OF HEALTH FOR PLANNING AND IMPLEMENTING  VARI-
 OUS  HEALTHCARE  AND  INSURANCE REFORM INITIATIVES AUTHORIZED BY FEDERAL
 LEGISLATION TO THE NEW YORK STATE HEALTH BENEFIT EXCHANGE. MONEYS SUBAL-
 LOCATED OR TRANSFERRED PURSUANT TO THIS SECTION SHALL BE PAID OUT OF THE
 FUND UPON AUDIT AND WARRANT OF THE STATE COMPTROLLER ON VOUCHERS  CERTI-
 FIED OR APPROVED BY THE EXCHANGE.
   § 3988. TAX  EXEMPTION AND TAX CONTRACT BY THE STATE.  1. IT IS HEREBY
 DETERMINED THAT THE CREATION OF THE EXCHANGE AND THE FULFILLMENT OF  ITS
 CORPORATE  PURPOSES  IS IN ALL RESPECTS FOR THE BENEFIT OF THE PEOPLE OF
 THIS STATE AND IS A PUBLIC PURPOSE. ACCORDINGLY, THE EXCHANGE  SHALL  BE
 REGARDED  AS  PERFORMING AN ESSENTIAL GOVERNMENTAL FUNCTION IN THE EXER-
 CISE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, AND  THE  EXCHANGE
 SHALL  NOT BE REQUIRED TO PAY ANY FEES, TAXES, SPECIAL AD VALOREM LEVIES
 OR ASSESSMENTS OF ANY KIND, WHETHER STATE OR LOCAL,  INCLUDING  BUT  NOT
 LIMITED TO FEES, TAXES, SPECIAL AD VALOREM LEVIES OR ASSESSMENTS ON REAL

 A. 5648                            12
 
 PROPERTY,  FRANCHISE  TAXES, SALES TAXES, TRANSFER TAXES, MORTGAGE TAXES
 OR OTHER TAXES, UPON OR WITH RESPECT TO ANY  PROPERTY  OWNED  BY  IT  OR
 UNDER  ITS JURISDICTION, CONTROL OR SUPERVISION, OR UPON THE USES THERE-
 OF,  OR UPON OR WITH RESPECT TO ITS ACTIVITIES OR OPERATIONS IN FURTHER-
 ANCE OF THE POWERS CONFERRED UPON IT BY THIS ARTICLE, OR  UPON  OR  WITH
 RESPECT  TO ANY FARES, TOLLS, RENTALS, RATES, CHARGES, FEES, REVENUES OR
 OTHER INCOME RECEIVED BY THE EXCHANGE.
   2. THE EXCHANGE MAY PAY, OR MAY ENTER INTO AGREEMENTS WITH ANY  COUNTY
 OR  MUNICIPALITY  TO  PAY,  A  SUM  OR  SUMS ANNUALLY OR OTHERWISE OR TO
 PROVIDE OTHER CONSIDERATIONS WITH RESPECT TO REAL PROPERTY OWNED BY  THE
 EXCHANGE LOCATED WITHIN SUCH COUNTY OR MUNICIPALITY.
   § 3989. OFFICERS  AND  EMPLOYEES. 1. THE BOARD SHALL HAVE THE POWER TO
 APPOINT EMPLOYEES TO SERVE AS SENIOR MANAGERIAL STAFF OF THE EXCHANGE AS
 NECESSARY, WHO SHALL BE DESIGNATED TO BE IN THE EXEMPT  CLASS  OF  CIVIL
 SERVICE. THE BOARD SHALL ALSO HAVE THE POWER TO FIX THE SALARIES OF SUCH
 EMPLOYEES.
   2.  ANY  NEWLY  HIRED  EMPLOYEES  WHO  ARE NOT DESIGNATED TO BE IN THE
 EXEMPT CLASS OF CIVIL  SERVICE  PURSUANT  TO  SUBDIVISION  ONE  OF  THIS
 SECTION  AND WHO ARE NOT SUBJECT TO THE TRANSFER PROVISIONS SET FORTH IN
 SUBDIVISIONS FOUR, FIVE AND SIX OF THIS SECTION SHALL BE CONSIDERED  FOR
 PURPOSES  OF  ARTICLE  FOURTEEN  OF  THE  CIVIL SERVICE LAW TO BE PUBLIC
 EMPLOYEES IN THE CIVIL SERVICE OF THE STATE, AND SHALL  BE  ASSIGNED  TO
 THE  APPROPRIATE  COLLECTIVE BARGAINING UNIT BY THE EXCHANGE IN THE SAME
 MANNER AND CONSISTENT WITH THOSE EMPLOYEES DESCRIBED IN SUBDIVISION  SIX
 OF THIS SECTION.
   3.  ANY  PUBLIC  OFFICER  OR EMPLOYEE OF A STATE DEPARTMENT, AGENCY OR
 COMMISSION MAY BE TRANSFERRED TO THE EXCHANGE  WITHOUT  EXAMINATION  AND
 WITHOUT  LOSS  OF  ANY  CIVIL  SERVICE  STATUS OR RIGHTS TO A COMPARABLE
 OFFICE, POSITION OR EMPLOYMENT WITH THE EXCHANGE; PROVIDED, HOWEVER,  NO
 SUCH TRANSFER MAY BE MADE WITHOUT THE CONSENT OF THE HEAD OF THE DEPART-
 MENT,  AGENCY OR COMMISSION.  TRANSFERS SHALL BE MADE PURSUANT TO SUBDI-
 VISION TWO OF SECTION SEVENTY OF THE CIVIL SERVICE LAW.
   4. THE SALARY OR COMPENSATION OF ANY SUCH OFFICER OR  EMPLOYEE,  AFTER
 SUCH TRANSFER, SHALL BE PAID BY THE EXCHANGE.
   5.  ANY  OFFICER  OR  EMPLOYEE TRANSFERRED TO THE EXCHANGE PURSUANT TO
 THIS SECTION, WHO ARE MEMBERS OF OR BENEFIT UNDER ANY  EXISTING  PENSION
 OR  RETIREMENT FUND OR SYSTEM, SHALL CONTINUE TO HAVE ALL RIGHTS, PRIVI-
 LEGES, OBLIGATIONS AND STATUS WITH RESPECT TO SUCH FUND OR SYSTEM AS ARE
 NOW PRESCRIBED BY LAW, BUT DURING THE PERIOD OF THEIR EMPLOYMENT BY  THE
 EXCHANGE,  ALL  CONTRIBUTIONS TO SUCH FUNDS OR SYSTEMS TO BE PAID BY THE
 EMPLOYER ON ACCOUNT OF SUCH OFFICERS OR EMPLOYEES SHALL BE PAID  BY  THE
 EXCHANGE.
   6. A TRANSFERRED EMPLOYEE SHALL REMAIN IN THE SAME COLLECTIVE BARGAIN-
 ING UNIT AS WAS THE CASE PRIOR TO HIS OR HER TRANSFER; SUCCESSOR EMPLOY-
 EES  TO THE POSITIONS HELD BY SUCH TRANSFERRED EMPLOYEES SHALL, CONSIST-
 ENT WITH THE PROVISIONS OF ARTICLE FOURTEEN OF THE CIVIL SERVICE LAW, BE
 INCLUDED IN THE SAME UNIT AS THEIR PREDECESSORS.  EMPLOYEES  SERVING  IN
 POSITIONS  IN NEWLY CREATED TITLES SHALL BE ASSIGNED TO THE SAME COLLEC-
 TIVE BARGAINING UNIT AS THEY WOULD  HAVE  BEEN  ASSIGNED  TO  WERE  SUCH
 TITLES  CREATED  PRIOR  TO  THE  ESTABLISHMENT  OF THE EXCHANGE. NOTHING
 CONTAINED IN THIS ARTICLE SHALL BE CONSTRUED (A) TO DIMINISH THE  RIGHTS
 OF  EMPLOYEES  PURSUANT  TO  A COLLECTIVE BARGAINING AGREEMENT OR (B) TO
 AFFECT EXISTING LAW WITH RESPECT TO AN APPLICATION TO THE PUBLIC EMPLOY-
 MENT RELATIONS BOARD SEEKING A DESIGNATION BY  THE  BOARD  THAT  CERTAIN
 PERSONS ARE MANAGERIAL OR CONFIDENTIAL.

 A. 5648                            13
 
   § 3990. LIMITATION  OF  LIABILITY; INDEMNIFICATION.  THE PROVISIONS OF
 SECTIONS SEVENTEEN AND NINETEEN OF THE  PUBLIC  OFFICERS  LAW  SHALL  BE
 APPLICABLE  TO  EXCHANGE  EMPLOYEES, AS SUCH TERM IS DEFINED IN SECTIONS
 SEVENTEEN AND NINETEEN OF THE PUBLIC OFFICERS  LAW;  PROVIDED,  HOWEVER,
 THAT NOTHING CONTAINED WITHIN THIS SECTION SHALL BE DEEMED TO PERMIT THE
 EXCHANGE  TO EXTEND THE PROVISIONS OF SECTIONS SEVENTEEN AND NINETEEN OF
 THE PUBLIC OFFICERS LAW UPON ANY INDEPENDENT CONTRACTOR.
   § 3991. CONSTRUCTION.  NOTHING IN THIS ARTICLE, AND NO ACTION TAKEN BY
 THE EXCHANGE PURSUANT HERETO, SHALL BE CONSTRUED TO:
   1. PREEMPT OR SUPERSEDE THE AUTHORITY OF  THE  SUPERINTENDENT  OR  THE
 COMMISSIONER; OR
   2. EXEMPT INSURERS, INSURANCE PRODUCERS OR QUALIFIED HEALTH PLANS FROM
 THE  PUBLIC  HEALTH LAW OR THE INSURANCE LAW AND REGULATIONS PROMULGATED
 THEREUNDER.
   § 3. Subdivision 1 of section 17 of the public officers law is amended
 by adding a new paragraph (aa) to read as follows:
   (AA) FOR PURPOSES OF THIS SECTION, THE TERM "EMPLOYEE"  SHALL  INCLUDE
 DIRECTORS,  OFFICERS  AND  EMPLOYEES  OF  THE  NEW  YORK  HEALTH BENEFIT
 EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
 LAW.
   § 4. Subdivision 1 of section 19 of the public officers law is amended
 by adding a new paragraph (k) to read as follows:
   (K) FOR PURPOSES OF THIS SECTION, THE TERM  "EMPLOYEE"  SHALL  INCLUDE
 DIRECTORS,  OFFICERS  AND  EMPLOYEES  OF  THE  NEW  YORK  HEALTH BENEFIT
 EXCHANGE ESTABLISHED PURSUANT TO ARTICLE TEN-E OF THE PUBLIC AUTHORITIES
 LAW.
   § 5. If any provision or application of this act shall be held  to  be
 invalid,  or  to  violate or be inconsistent with any applicable federal
 law or regulation, that shall not affect other  provisions  or  applica-
 tions  of  this  act which can be given effect without that provision or
 application; and to that end, the provisions and  applications  of  this
 act are severable.
   §  6.  The  superintendent  of the department of financial services is
 authorized to promulgate rules and regulations, and may promulgate emer-
 gency regulations, necessary for the implementation of the provisions of
 this act on or before its effective date.
   § 7. This act shall take effect upon the occurrence of the earlier of:
   (a) the repeal of the Patient Protection and Affordable Care  Act,  42
 U.S.C. § 18001 et seq. (2010); or
   (b)  the  rescinding of Executive Order {Cuomo} No. 42 {9 NYCRR 8.42},
 Establishing the New York Health Benefit  Exchange;  provided  that  the
 governor  of  the  state  of  New York shall notify the legislative bill
 drafting commission upon the occurrence of the rescinding  of  Executive
 Order  {Cuomo}  No.  42 {9 NYCRR 8.42}, Establishing the New York Health
 Benefit Exchange in order that the commission may maintain  an  accurate
 and  timely  effective data base of the official text of the laws of the
 state of New York in furtherance of effecting the provisions of  section
 44 of the legislative law and section 70-b of the public officers law.