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.
                                                                   LBD01398-03-8

        A. 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 to

        A. 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.
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