Ineligibility Notification

October 28, 2015

Dear Payor:

Re: New York Health Care Reform Act of 2000 (HCRA)


This notice is being sent to you because your organization is a payor of health care services and has filed an election application to pay certain health care services surcharges directly to the HCRA Public Goods Pools. Although your organization was deemed eligible as an annual filer for the 2015 report year, you do not meet the criteria below to be deemed an annual filer for the 2016 report year. Therefore, you must submit monthly Public Goods Pool reports commencing with the report for the month of January 2016, which is due to the Office of Pool Administration (OPA) on March 1, 2016. If you use a third party administrator (TPA) for claims processing and your TPA files Public Goods Pool reports on your behalf, please advise your TPA that you have received this notice.

HCRA 2000 provides that the Commissioner may permit payors, who have at least one full year of pool payment experience and whose annual liability is not expected to exceed $25,000, to submit Public Goods Pool reports and related surcharge and covered lives assessment obligations on an annual basis. The Department has set the following criteria for payors to be eligible for annual filing for 2016:

  1. A payor´s election must have been effective on or before July 1, 2014;
  2. A payor must have filed at least twelve monthly reports through the June 2015 report period; and
  3. A payor´s average annual pool payment liability must not exceed $25,000 based on reports filed through the above referenced period.

The Public Goods Pool reports are required to be submitted electronically by accessing the OPA´s Web site at Please note that to electronically submit reports, access information pertinent to your election, request/view delinquencies, and view HCRA designated providers by Federal Employer Identification Number through the OPA´s Web site, you will need to have a User ID/Password on file. If you do not have one on file, we encourage you to complete the DOH-4264, Electronic Filing User ID Application which can be found on the OPA´s Web site. In addition, the e-mail address that you provide on this form will be used to send you important information regarding the HCRA and your election.

If you use a TPA for claims processing, and your TPA files Public Goods Pool reports on your behalf, you should contact them directly with any questions you may have regarding this notice. Payors not represented by a TPA that have questions should contact the Office of Pool Administration at (315) 671-3800.


Ann Foster
Deputy Director
Division of Finance and Rate Setting
Office of Health Insurance Programs