Bill Summary: A11341 - New York Health Benefit Exchange Act

• Establishes the New York Health Benefit Exchange as a public benefit corporation governed by a 9-member board of directors, including the Commissioner of Health and Superintendent of Financial Services as ex officio members, with 7 appointed directors selected by the Governor and legislative leaders.

• Requires the exchange to facilitate enrollment in qualified health plans for individuals and small businesses, operate a Small Business Health Options Program (SHOP), and provide enrollment assistance, premium tax credit calculations, and navigator grants beginning January 1, 2018.

• Mandates certification of qualified health plans and dental plans that meet essential health benefits requirements, cost-sharing limits, and network adequacy standards, with insurers required to justify premium increases and disclose claims practices, enrollment data, and denied claims information.

• Creates five regional advisory committees composed of health plan advocates, small business representatives, providers, insurers, and labor representatives to provide recommendations on exchange operations and regional variations.

• Requires the exchange to achieve financial self-sufficiency by January 1, 2019, and prohibits use of administrative funds for staff retreats, promotional giveaways, excessive executive compensation, or legislative advocacy; exempts the exchange from most state and local taxes as a public benefit corporation.