Bill Text: NY A00099 | 2017-2018 | General Assembly | Amended
Bill Title: Redefines "small group" for the purposes of certain provisions of sections 3231 and 4317 of the insurance law.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2018-05-30 - print number 99a [A00099 Detail]
Download: New_York-2017-A00099-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 99--A 2017-2018 Regular Sessions IN ASSEMBLY (Prefiled) January 4, 2017 ___________ Introduced by M. of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI, ZEBROWSKI, STECK, QUART, RAIA, BRINDISI, OAKS, FRIEND, KOLB -- Multi- Sponsored by -- M. of A. FITZPATRICK, STEC -- read once and referred to the Committee on Insurance -- recommitted to the Committee on Insurance in accordance with Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the insurance law, in relation to rating of individual and small group health insurance contracts and policies The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 1 of subsection (a) of section 3231 of the insur- 2 ance law, as amended by section 69 of part D of chapter 56 of the laws 3 of 2013, is amended to read as follows: 4 (1) No individual health insurance policy and no group health insur- 5 ance policy covering between one and fifty employees or members of the 6 group, except as set forth in subsection (h) of this section, or between 7 one and one hundred employees or members of the group for policies 8 issued or renewed on or after January first, two thousand sixteen exclu- 9 sive of spouses and dependents, hereinafter referred to as a small 10 group, providing hospital and/or medical benefits, including medicare 11 supplemental insurance, shall be issued in this state unless such policy 12 is community rated and, notwithstanding any other provisions of law, the 13 underwriting of such policy involves no more than the imposition of a 14 pre-existing condition limitation if otherwise permitted by this arti- 15 cle. 16 § 2. Paragraph 1 of subsection (h) of section 3231 of the insurance 17 law, as amended by chapter 12 of the laws of 2016, is amended to read as 18 follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01398-03-8A. 99--A 2 1 (1) Notwithstanding any other provision of this chapter, no insurer, 2 subsidiary of an insurer, or controlled person of a holding company 3 system may act as an administrator or claims paying agent, as opposed to 4 an insurer, on behalf of small groups which, if they purchased insur- 5 ance, would be subject to this section. No insurer may provide stop 6 loss, catastrophic or reinsurance coverage to small groups which, if 7 they purchased insurance, would be subject to this section. Provided, 8 however, the provisions of this paragraph shall not apply to: (A) the 9 renewal of stop loss, catastrophic or reinsurance coverage issued and in 10 effect on January first, two thousand fifteen to small groups covering 11 between fifty-one and one hundred employees or members of the group; and 12 (B) the issuance between January first, two thousand sixteen and Decem- 13 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or 14 reinsurance coverage, and any renewal thereof, to a small group covering 15 between fifty-one and one hundred employees or members of the group, 16 provided that such group had stop loss, catastrophic or reinsurance 17 coverage issued and in effect on January first, two thousand fifteen. 18 For purposes of this subsection, "small group" shall mean a group 19 comprised of between one and fifty employees or members, exclusive of 20 spouses and dependents. 21 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance 22 law, as added by chapter 501 of the laws of 1992, is amended to read as 23 follows: 24 (1) Notwithstanding any other provision of this chapter, no insurer, 25 subsidiary of an insurer, or controlled person of a holding company 26 system may act as an administrator or claims paying agent, as opposed to 27 an insurer, on behalf of small groups which, if they purchased insur- 28 ance, would be subject to this section. No insurer, subsidiary of an 29 insurer, or controlled person of a holding company may provide stop 30 loss, catastrophic or reinsurance coverage to small groups which, if 31 they purchased insurance, would be subject to this section. For purposes 32 of this subsection, "small group" shall mean a group comprised of 33 between one and fifty employees or members, exclusive of spouses and 34 dependents. 35 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance 36 law, as amended by section 72 of part D of chapter 56 of the laws of 37 2013, is amended to read as follows: 38 (1) No individual health insurance contract and no group health insur- 39 ance contract covering between one and fifty employees or members of the 40 group, except as set forth in subsection (e) of this section, or between 41 one and one hundred employees or members of the group for policies 42 issued or renewed on or after January first, two thousand sixteen exclu- 43 sive of spouses and dependents, including contracts for which the premi- 44 ums are paid by a remitting agent for a group, hereinafter referred to 45 as a small group, providing hospital and/or medical benefits, including 46 Medicare supplemental insurance, shall be issued in this state unless 47 such contract is community rated and, notwithstanding any other 48 provisions of law, the underwriting of such contract involves no more 49 than the imposition of a pre-existing condition limitation if otherwise 50 permitted by this article. 51 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance 52 law, as amended by chapter 12 of the laws of 2016, is amended to read as 53 follows: 54 (1) Notwithstanding any other provision of this chapter, no insurer, 55 subsidiary of an insurer, or controlled person of a holding company 56 system may act as an administrator or claims paying agent, as opposed toA. 99--A 3 1 an insurer, on behalf of small groups which, if they purchased insur- 2 ance, would be subject to this section. No insurer may provide stop 3 loss, catastrophic or reinsurance coverage to small groups which, if 4 they purchased insurance, would be subject to this section. Provided, 5 however, the provisions of this paragraph shall not apply to: (A) the 6 renewal of stop loss, catastrophic or reinsurance coverage issued and in 7 effect on January first, two thousand fifteen to small groups covering 8 between fifty-one and one hundred employees or members of the group; and 9 (B) the issuance between January first, two thousand sixteen, and Decem- 10 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or 11 reinsurance coverage, and any renewal thereof, to a small group covering 12 between fifty-one and one hundred employees or members of the group, 13 provided that such group had stop loss, catastrophic or reinsurance 14 coverage issued and in effect on January first, two thousand fifteen. 15 For purposes of this subsection, "small group" shall mean a group 16 comprised of between one and fifty employees or members, exclusive of 17 spouses and dependents. 18 § 6. Paragraph 1 of subsection (e) of section 4317 of the insurance 19 law, as amended by section 72 of part D of chapter 56 of the laws of 20 2013, is amended to read as follows: 21 (1) Notwithstanding any other provision of this chapter, no insurer, 22 subsidiary of an insurer, or controlled person of a holding company 23 system may act as an administrator or claims paying agent, as opposed to 24 an insurer, on behalf of small groups which, if they purchased insur- 25 ance, would be subject to this section. No insurer, subsidiary of an 26 insurer, or controlled person of a holding company may provide stop 27 loss, catastrophic or reinsurance coverage to small groups which, if 28 they purchased insurance, would be subject to this section. For 29 purposes of this subsection, "small group" shall mean a group comprised 30 of between one and fifty employees or members, exclusive of spouses and 31 dependents. 32 § 7. This act shall take effect immediately; provided, however the 33 amendments to paragraph 1 of subsection (h) of section 3231 of the 34 insurance law made by section two of this act shall be subject to the 35 expiration and reversion of such paragraph pursuant to section 5 of 36 chapter 588 of the laws of 2015, as amended, when upon such date the 37 provisions of section three of this act shall take effect; and provided, 38 further, the amendments to paragraph 1 of subsection (e) of section 4317 39 of the insurance law made by section five of this act shall be subject 40 to the expiration and reversion of such paragraph pursuant to section 5 41 of chapter 588 of the laws of 2015, as amended, when upon such date the 42 provisions of section six of this act shall take effect.