Bill Text: NY A08504 | 2023-2024 | General Assembly | Introduced

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Bill Title: Relates to provisions for wellness programs under life and accident and health insurance policies; provides that a "wellness program" shall not include limited benefits health insurance; authorizes an insurer to contract with a third party for purposes of administering or operating a wellness program on such insurer's behalf.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2024-01-26 - signed chap.3 [A08504 Detail]

Download: New_York-2023-A08504-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          8504

                   IN ASSEMBLY

                                     January 4, 2024
                                       ___________

        Introduced  by M. of A. MEEKS -- read once and referred to the Committee
          on Insurance

        AN ACT to amend the insurance law, in relation to wellness programs; and
          to amend a chapter of the laws of  2023  amending  the  insurance  law
          relating  to authorizing life insurers to establish wellness programs,
          as proposed in legislative bills numbers S. 5890-A and A.  2853-B,  in
          relation to the effectiveness thereof

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Section 3239 of the insurance law, as amended by a  chapter
     2  of  the  laws of 2023 amending the insurance law relating to authorizing
     3  life insurers to establish wellness programs, as proposed in legislative
     4  bills numbers S. 5890-A and A. 2853-B, is amended to read as follows:
     5    § 3239. Wellness programs. (a)  An  insurer  licensed  to  write  life
     6  insurance may establish a wellness program in conjunction with its issu-
     7  ance  of  life insurance policies and an insurer licensed to write acci-
     8  dent and health insurance, a corporation organized pursuant  to  article
     9  forty-three of this chapter, a health maintenance organization certified
    10  pursuant  to article forty-four of the public health law and a municipal
    11  cooperative health benefits plan may establish  a  wellness  program  in
    12  conjunction  with  its issuance of a group accident and health insurance
    13  policy or group subscriber contract. A "wellness program" is  a  program
    14  designed  to  promote  health,  longevity  or  prevent  disease that may
    15  contain rewards and incentives for participation.  A "wellness  program"
    16  shall  not  include  limited benefits health insurance. Participation in
    17  the wellness program shall be available to similarly-situated members of
    18  the group or with regard to  life insurance, to all insureds within  the
    19  same  class  [in a manner that is not unfairly discriminatory] and equal
    20  expectation of life and shall be voluntary on the part of the member  or
    21  insured.    With regard to life insurance, an insurer is prohibited from
    22  increasing premiums or charges stated in  the  policy  as  a  result  of
    23  participation  or  non-participation  in  the  program. The terms of the
    24  wellness program shall be set forth in the policy  or  contract.    With
    25  regard  to a wellness program established in connection with life insur-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07895-06-4
        A. 8504                             2

     1  ance, an insurer shall provide a prominent disclosure to an applicant at
     2  or prior to the time of application  that  the  program  is  not  health
     3  insurance  and  participants should not view the program as a substitute
     4  for the purchase of health insurance.
     5    (b) A wellness program may include, but is not limited to, the follow-
     6  ing programs or services:
     7    (1) the use of a health risk assessment tool;
     8    (2) a smoking cessation program;
     9    (3) a weight management program;
    10    (4) a stress and/or hypertension management program;
    11    (5) a worker injury prevention program;
    12    (6) a nutrition education program;
    13    (7) health or fitness incentive programs;
    14    (8)  a coordinated weight management, nutrition, stress management and
    15  physical fitness program to combat  the  high  incidence  of  adult  and
    16  childhood obesity, asthma and other chronic respiratory conditions;
    17    (9) a substance or alcohol abuse cessation program;
    18    (10) a program to manage and cope with chronic pain;
    19    (11)  a  [preventative] preventive care program, screenings (including
    20  biometric screenings), or chronic disease management program; and
    21    (12) a stress management program, including participation in  a  medi-
    22  tation[,] or sleep improvement [or similar] program [or service].
    23    (c)(1)  A  wellness program may use rewards and incentives for partic-
    24  ipation provided  that  where  the  group  health  insurance  policy  or
    25  subscriber  contract  is required to be community-rated, the rewards and
    26  incentives shall not include a discounted premium rate or  a  rebate  or
    27  refund of premium.
    28    (2) Permissible rewards and incentives may include:
    29    (A)  full  or  partial  reimbursement  of the cost of participating in
    30  smoking cessation, weight management, stress and/or hypertension, worker
    31  injury prevention,  nutrition  education,  substance  or  alcohol  abuse
    32  cessation,  [preventative]  preventive  care  programs, [or] screenings,
    33  chronic disease management programs,  or  chronic  pain  management  and
    34  coping programs;
    35    (B)  full  or  partial  reimbursement  of  the cost of membership in a
    36  health club or fitness center;
    37    (C) (1) the waiver or reduction of copayments, coinsurance and deduct-
    38  ibles for preventive services covered under the group  health  insurance
    39  policy or subscriber contract;
    40    (2)  a  premium  refund,  discount,  or  policy value credit, or other
    41  increase in benefits or decrease in charges under a life insurance poli-
    42  cy;
    43    (D) monetary rewards in the form of  gift  cards,  gift  certificates,
    44  vouchers  or  discounts  on  products  or services [that are intended to
    45  incent behavioral changes that improve the health or reduce the risk  of
    46  death of the insured] in return for engaging in healthy behaviors;
    47    (E)  full  or  partial reimbursement of the cost of participating in a
    48  stress management program or  activity,  including  participation  in  a
    49  meditation[,]  or  sleep  improvement [or similar] program [or service],
    50  provided that such program or  activity  shall  be  based  on  data  and
    51  research  that  the  program  or  service  can be reasonably expected to
    52  result in overall good health, well being, or improved mortality risk;
    53    (F) full or partial reimbursement of the cost of  participating  in  a
    54  health or fitness program; and
    55    (G) full or partial reimbursement of the cost of a wearable device and
    56  any associated subscription membership [that can be used] to track phys-
        A. 8504                             3

     1  ical activity or biometric data, and which incents behavioral changes to
     2  improve [the] health or [reduce the risk of death of the insured; and
     3    (H)  full  or partial reimbursement of biometric screenings] mortality
     4  risk.
     5    (3) Where the reward involves a group  member's  meeting  a  specified
     6  standard  based  on  a  health  condition,  the wellness program under a
     7  health insurance policy [must] shall meet the  requirements  of  45  CFR
     8  Part 146.
     9    (4)  A  reward or incentive [which] that involves a discounted premium
    10  rate or a rebate or refund of premium  under  [a]  accident  and  health
    11  insurance  [policy]  policies  shall be based on actuarial demonstration
    12  that the wellness program can reasonably be expected to  result  in  the
    13  overall  good health and well being of the group. A [reward or incentive
    14  that involves a discounted premium rate or rebate or refund of]  premium
    15  refund,  discount, or policy value credit, or other increase in benefits
    16  or decrease in charges under [a] life insurance [policy shall be actuar-
    17  ially supported by data and research that such incentives or rewards, in
    18  the aggregate, are directed to sharing the benefit of improving expected
    19  mortality risk] policies in connection with a wellness program shall  be
    20  based  on  sound  actuarial  principles  related to actual or reasonably
    21  anticipated experience.  [Data collected]
    22    (d) Fair collection and use of  personal  information.  (1)  Nonpublic
    23  personal  information,  including  health  data, an insurer collects and
    24  shares in connection with a wellness program shall  be  subject  to  all
    25  state  and federal privacy and security laws and regulations promulgated
    26  thereunder, including 11 NYCRR 420.
    27    (2) Wellness program participants shall have the  right  to  obtain  a
    28  copy of their wellness program information and an opportunity to correct
    29  any inaccuracies.
    30    (3)  An insurer may contract with a third party for purposes of admin-
    31  istering or operating  a  wellness  program  on  such  insurer's  behalf
    32  provided  that  the  insurer maintains a system of supervision to ensure
    33  compliance with this section, including procedures to  take  appropriate
    34  corrective  action  for  any  participant  harmed by a violation of this
    35  section by the insurer directly or by any  third  party  with  whom  the
    36  insurer contracts.
    37    § 2. Section 2 of a chapter of the laws of 2023 amending the insurance
    38  law   relating  to  authorizing  life  insurers  to  establish  wellness
    39  programs, as proposed in legislative bills  numbers  S.  5890-A  and  A.
    40  2853-B, is amended to read as follows:
    41    §  2.  This act shall take effect immediately and shall apply to poli-
    42  cies issued, renewed, modified, or amended on or  after  such  effective
    43  date.
    44    §  3.  This act shall take effect immediately; provided, however, that
    45  section one of this act shall take effect on the same date  and  in  the
    46  same  manner as a chapter of the laws of 2023 amending the insurance law
    47  relating to authorizing life  insurers to establish  wellness  programs,
    48  as  proposed in legislative bills numbers S. 5890-A and A. 2853-B, takes
    49  effect.