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 10-3)

Status: (Introduced) 2019-02-08 - referred to insurance [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 group
     7  for policies issued or renewed on or after January first,  two  thousand
     8  sixteen] 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.
                                                                   LBD08894-01-9

        A. 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  between
     6  one and one hundred employees for policies issued or renewed on or after
     7  January  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,
    27  however, the provisions of this paragraph shall not apply  to:  (A)  the
    28  renewal of stop loss, catastrophic or reinsurance coverage issued and in
    29  effect  on  January first, two thousand fifteen to small groups covering
    30  between fifty-one and one hundred employees or members of the group; and
    31  (B) the issuance between January first, two thousand sixteen and  Decem-
    32  ber  thirty-first,  two  thousand sixteen, of stop loss, catastrophic or
    33  reinsurance coverage, and any renewal thereof, to a small group covering
    34  between fifty-one and one hundred employees or  members  of  the  group,
    35  provided  that  such  group  had  stop loss, catastrophic or reinsurance
    36  coverage 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 group
    43  for policies issued or renewed on or after January first,  two  thousand
    44  sixteen]  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 company

        A. 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,
     6  however,  the  provisions  of this paragraph shall not apply to: (A) the
     7  renewal of stop loss, catastrophic or reinsurance coverage issued and in
     8  effect on January first, two thousand fifteen to small  groups  covering
     9  between fifty-one and one hundred employees or members of the group; and
    10  (B) the issuance between January first, two thousand sixteen, and Decem-
    11  ber  thirty-first,  two  thousand sixteen, of stop loss, catastrophic or
    12  reinsurance coverage, and any renewal thereof, to a small group covering
    13  between fifty-one and one hundred employees or  members  of  the  group,
    14  provided  that  such  group  had  stop loss, catastrophic or reinsurance
    15  coverage 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)  Subparagraph
    31  A  of  this  paragraph shall not apply to either the renewal of a policy
    32  issued to a group or the issuance, between January first,  two  thousand
    33  sixteen  and  December  thirty-first, two thousand sixteen, of a policy,
    34  and any renewal thereof, to a group, provided that the  following  three
    35  requirements are met: (I) the group had been issued a policy that was in
    36  effect  on  July  first, two thousand fifteen; (II) the group had member
    37  employers, who, on or after  July  first,  two  thousand  fifteen,  have
    38  between  fifty-one  and  one hundred employees, exclusive of spouses and
    39  dependents; and (III) the group is either: (i) comprised entirely of one
    40  or more municipal corporations or districts (as such terms  are  defined
    41  in section one hundred nineteen-n of the general municipal law); or (ii)
    42  comprised entirely of nonpublic schools providing education in any grade
    43  from 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  be

        A. 5285                             4
     1  rated  consistent  with  the  rating  rules applicable to such remaining
     2  members pursuant to paragraph two of this subsection. [(B)  Subparagraph
     3  A  of this paragraph shall not apply to either the renewal of a contract
     4  issued  to  a group or the issuance, between January first, two thousand
     5  sixteen and December thirty-first, two thousand sixteen, of a  contract,
     6  and  any  renewal thereof, to a group, provided that the following three
     7  requirements are met: (I) the group had been issued a contract that  was
     8  in effect on July first, two thousand fifteen; (II) the group had member
     9  employers,  who,  on  or  after  July  first, two thousand fifteen, have
    10  between fifty-one and one hundred employees, exclusive  of  spouses  and
    11  dependents; and (III) the group is either: (i) comprised entirely of one
    12  or  more  municipal corporations or districts (as such terms are defined
    13  in section one hundred nineteen-n of the general municipal law); or (ii)
    14  comprised entirely of nonpublic schools providing education in any grade
    15  from 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.
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