Bill Text: NY A05285 | 2019-2020 | General Assembly | Introduced
Bill Title: Amends the definition of "small group" for purposes of health insurance policies and contracts to fifty employees or fewer; and repeals provisions requiring the superintendent to conduct an impact study.
Spectrum: Moderate Partisan Bill (Democrat 11-3)
Status: (Introduced - Dead) 2020-07-06 - enacting clause stricken [A05285 Detail]
Download: New_York-2019-A05285-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 5285 2019-2020 Regular Sessions IN ASSEMBLY February 8, 2019 ___________ Introduced by M. of A. CRESPO -- Multi-Sponsored by -- M. of A. BARCLAY, HEVESI, HUNTER, JONES, LUPARDO, MORINELLO, RAIA, SCHIMMINGER, STECK, THIELE -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to the definition of small group; and to repeal section 7 of chapter 12 of the laws of 2016 relating to directing the superintendent of financial services to contract with an independent entity to conduct an assessment regarding the impact of the prohibition on the sale of stop loss, catastrophic and reinsurance coverage to the small group market relating thereto 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 [or between one and one hundred employees or members of the group7for policies issued or renewed on or after January first, two thousand8sixteen] exclusive of spouses and dependents, hereinafter referred to as 9 a small group, providing hospital and/or medical benefits, including 10 medicare supplemental insurance, shall be issued in this state unless 11 such policy is community rated and, notwithstanding any other provisions 12 of law, the underwriting of such policy involves no more than the impo- 13 sition of a pre-existing condition limitation if otherwise permitted by 14 this article. 15 § 2. Paragraph 3 of subsection (a) of section 3231 of the insurance 16 law, as amended by section 69 of part D of chapter 56 of the laws of 17 2013, is amended to read as follows: 18 (3) Once accepted for coverage, an individual or small group cannot be 19 terminated by the insurer due to claims experience. Termination of an 20 individual or small group shall be based only on one or more of the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD08894-01-9A. 5285 2 1 reasons set forth in subsection (g) of section three thousand two 2 hundred sixteen or subsection (p) of section three thousand two hundred 3 twenty-one of this article. Group hospital and/or medical coverage, 4 including medicare supplemental insurance, obtained through an out-of- 5 state trust covering a group of fifty or fewer employees, [or between6one and one hundred employees for policies issued or renewed on or after7January first, two thousand sixteen,] or participating persons who are 8 residents of this state must be community rated regardless of the situs 9 of delivery of the policy. Notwithstanding any other provisions of law, 10 the underwriting of such policy may involve no more than the imposition 11 of a pre-existing condition limitation if permitted by this article, and 12 once accepted for coverage, an individual or small group cannot be 13 terminated due to claims experience. Termination of an individual or 14 small group shall be based only on one or more of the reasons set forth 15 in subsection (p) of section three thousand two hundred twenty-one of 16 this article. 17 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance 18 law, as amended by chapter 12 of the laws of 2016, is amended to read as 19 follows: 20 (1) Notwithstanding any other provision of this chapter, no insurer, 21 subsidiary of an insurer, or controlled person of a holding company 22 system may act as an administrator or claims paying agent, as opposed to 23 an insurer, on behalf of small groups which, if they purchased insur- 24 ance, would be subject to this section. No insurer may provide stop 25 loss, catastrophic or reinsurance coverage to small groups which, if 26 they purchased insurance, would be subject to this section. [Provided,27however, the provisions of this paragraph shall not apply to: (A) the28renewal of stop loss, catastrophic or reinsurance coverage issued and in29effect on January first, two thousand fifteen to small groups covering30between fifty-one and one hundred employees or members of the group; and31(B) the issuance between January first, two thousand sixteen and Decem-32ber thirty-first, two thousand sixteen, of stop loss, catastrophic or33reinsurance coverage, and any renewal thereof, to a small group covering34between fifty-one and one hundred employees or members of the group,35provided that such group had stop loss, catastrophic or reinsurance36coverage issued and in effect on January first, two thousand fifteen.] 37 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance 38 law, as amended by section 72 of part D of chapter 56 of the laws of 39 2013, is amended to read as follows: 40 (1) No individual health insurance contract and no group health insur- 41 ance contract covering between one and fifty employees or members of the 42 group, [or between one and one hundred employees or members of the group43for policies issued or renewed on or after January first, two thousand44sixteen] exclusive of spouses and dependents, including contracts for 45 which the premiums are paid by a remitting agent for a group, hereinaft- 46 er referred to as a small group, providing hospital and/or medical bene- 47 fits, including Medicare supplemental insurance, shall be issued in this 48 state unless such contract is community rated and, notwithstanding any 49 other provisions of law, the underwriting of such contract involves no 50 more than the imposition of a pre-existing condition limitation if 51 otherwise permitted by this article. 52 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance 53 law, as amended by chapter 12 of the laws of 2016, is amended to read as 54 follows: 55 (1) Notwithstanding any other provision of this chapter, no insurer, 56 subsidiary of an insurer, or controlled person of a holding companyA. 5285 3 1 system may act as an administrator or claims paying agent, as opposed to 2 an insurer, on behalf of small groups which, if they purchased insur- 3 ance, would be subject to this section. No insurer may provide stop 4 loss, catastrophic or reinsurance coverage to small groups which, if 5 they purchased insurance, would be subject to this section. [Provided,6however, the provisions of this paragraph shall not apply to: (A) the7renewal of stop loss, catastrophic or reinsurance coverage issued and in8effect on January first, two thousand fifteen to small groups covering9between fifty-one and one hundred employees or members of the group; and10(B) the issuance between January first, two thousand sixteen, and Decem-11ber thirty-first, two thousand sixteen, of stop loss, catastrophic or12reinsurance coverage, and any renewal thereof, to a small group covering13between fifty-one and one hundred employees or members of the group,14provided that such group had stop loss, catastrophic or reinsurance15coverage issued and in effect on January first, two thousand fifteen.] 16 § 6. Paragraph 1 of subsection (g) 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: 19 (1) [(A)] This section shall also apply to policies issued to a group 20 defined in subsection (c) of section four thousand two hundred thirty- 21 five of this chapter, including but not limited to an association or 22 trust of employers, if the group includes one or more member employers 23 or other member groups having [one hundred] fifty or fewer employees or 24 members exclusive of spouses and dependents. For a policy issued or 25 renewed on or after January first, two thousand fourteen, if the group 26 includes one or more member small group employers eligible for coverage 27 subject to this section, then such member employers shall be classified 28 as small groups for rating purposes and the remaining members shall be 29 rated consistent with the rating rules applicable to such remaining 30 members pursuant to paragraph two of this subsection. [(B) Subparagraph31A of this paragraph shall not apply to either the renewal of a policy32issued to a group or the issuance, between January first, two thousand33sixteen and December thirty-first, two thousand sixteen, of a policy,34and any renewal thereof, to a group, provided that the following three35requirements are met: (I) the group had been issued a policy that was in36effect on July first, two thousand fifteen; (II) the group had member37employers, who, on or after July first, two thousand fifteen, have38between fifty-one and one hundred employees, exclusive of spouses and39dependents; and (III) the group is either: (i) comprised entirely of one40or more municipal corporations or districts (as such terms are defined41in section one hundred nineteen-n of the general municipal law); or (ii)42comprised entirely of nonpublic schools providing education in any grade43from pre-kindergarten through twelfth grade.] 44 § 7. Paragraph 1 of subsection (d) of section 4317 of the insurance 45 law, as amended by chapter 12 of the laws of 2016, is amended to read as 46 follows: 47 (1) [(A)] This section shall also apply to a contract issued to a 48 group defined in subsection (c) of section four thousand two hundred 49 thirty-five of this chapter, including but not limited to an association 50 or trust of employers, if the group includes one or more member employ- 51 ers or other member groups having [one hundred] fifty or fewer employees 52 or members exclusive of spouses and dependents. For a contract issued or 53 renewed on or after January first, two thousand fourteen, if the group 54 includes one or more member small group employers eligible for coverage 55 subject to this section, then such member employers shall be classified 56 as small groups for rating purposes and the remaining members shall beA. 5285 4 1 rated consistent with the rating rules applicable to such remaining 2 members pursuant to paragraph two of this subsection. [(B) Subparagraph3A of this paragraph shall not apply to either the renewal of a contract4issued to a group or the issuance, between January first, two thousand5sixteen and December thirty-first, two thousand sixteen, of a contract,6and any renewal thereof, to a group, provided that the following three7requirements are met: (I) the group had been issued a contract that was8in effect on July first, two thousand fifteen; (II) the group had member9employers, who, on or after July first, two thousand fifteen, have10between fifty-one and one hundred employees, exclusive of spouses and11dependents; and (III) the group is either: (i) comprised entirely of one12or more municipal corporations or districts (as such terms are defined13in section one hundred nineteen-n of the general municipal law); or (ii)14comprised entirely of nonpublic schools providing education in any grade15from pre-kindergarten through twelfth grade.] 16 § 8. Section 7 of chapter 12 of the laws of 2016 relating to directing 17 the superintendent of financial services to contract with an independent 18 entity to conduct an assessment regarding the impact of the prohibition 19 on the sale of stop loss, catastrophic and reinsurance coverage to the 20 small group market, is REPEALED. 21 § 9. This act shall take effect immediately; provided, however that 22 the amendments to paragraph 1 of subsection (g) and paragraph 1 of 23 subsection (h) of section 3231, and paragraph 1 of subsection (d) and 24 paragraph 1 of subsection (e) of section 4317 of the insurance law made 25 by sections six, three, seven and five of this act respectively shall 26 not affect the expiration and reversion of such paragraphs and shall 27 expire and be deemed repealed therewith.