Bill Text: NY S03072 | 2009-2010 | General Assembly | Introduced


Bill Title: Alters requirements applicable to health insurance secured by qualifying small businesses; expands the availability of health care coverage.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-01-06 - REFERRED TO INSURANCE [S03072 Detail]

Download: New_York-2009-S03072-Introduced.html
                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         3072
                              2009-2010 Regular Sessions
                                   I N  S E N A T E
                                    March 10, 2009
                                      ___________
       Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
         printed to be committed to the Committee on Insurance
       AN ACT to amend the insurance law, in relation  to  standardized  health
         insurance contracts for qualifying small employers and individuals
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Subsection (c) of section 4326 of  the  insurance  law,  as
    2  added  by chapter 1 of the laws of 1999, subparagraph (A) of paragraph 1
    3  and subparagraph (C) of paragraph 3 as amended by  chapter  419  of  the
    4  laws of 2000, is amended to read as follows:
    5    (c)  The  following  definitions  shall be applicable to the insurance
    6  contracts offered under the program established by this section:
    7    (1) A qualifying small employer is an employer that is either:
    8    (A) An individual proprietor who is the only  employee  of  the  busi-
    9  ness[:
   10    (i)  without  health  insurance  which provides benefits on an expense
   11  reimbursed or prepaid basis in effect during  the  twelve  month  period
   12  prior  to  application  for a qualifying group health insurance contract
   13  under the program established by this section; and
   14    (ii)] WHO resides in a household having a net household income  at  or
   15  below  two  hundred  eight percent of the non-farm federal poverty level
   16  (as defined and updated by the federal department of  health  and  human
   17  services) or the gross equivalent of such net income;
   18    [(iii)  except  that  the  requirements  set forth in item (i) of this
   19  subparagraph shall not be applicable where an individual proprietor  had
   20  health  insurance  coverage  during  the previous twelve months and such
   21  coverage terminated due to one of the reasons set  forth  in  items  (i)
   22  through  (viii) of subparagraph (C) of paragraph three of subsection (c)
   23  of this section;] or
   24    (B) An employer with:
   25    (i) not more than fifty eligible employees; AND
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD04177-01-9
       S. 3072                             2
    1    (ii) [no group health insurance which provides benefits on an  expense
    2  reimbursed  or  prepaid  basis  covering  employees in effect during the
    3  twelve month period prior to application for a qualifying  group  health
    4  insurance contract under the program established by this section; and
    5    (iii)]  at  least  thirty  percent of its eligible employees receiving
    6  annual wages from the employer at a level equal to or less  than  thirty
    7  thousand  dollars.  The  thirty thousand dollar figure shall be adjusted
    8  periodically pursuant to subparagraph [(F)] (D) of this paragraph.
    9    [(C) The requirements set forth in item (i)  of  subparagraph  (A)  of
   10  this  paragraph  and  in item (ii) of subparagraph (B) of this paragraph
   11  shall not be applicable where an individual proprietor  or  employer  is
   12  transferring from a health insurance contract issued pursuant to the New
   13  York  state  small  business health insurance partnership program estab-
   14  lished by section nine hundred twenty-two of the public  health  law  or
   15  from  health  care  coverage issued pursuant to a regional pilot project
   16  for the uninsured established by section one thousand one hundred  eigh-
   17  teen of this chapter.
   18    (D)  The twelve month period set forth in item (i) of subparagraph (A)
   19  of this paragraph and in item (ii) of subparagraph (B) of this paragraph
   20  may be adjusted by the superintendent from  twelve  months  to  eighteen
   21  months  if he determines that the twelve month period is insufficient to
   22  prevent inappropriate substitution of other health  insurance  contracts
   23  for qualifying group health insurance contracts.
   24    (E)]  (C)  An  individual  proprietor  or employer shall cease to be a
   25  qualifying small employer if any health insurance which  provides  bene-
   26  fits  on  an expense reimbursed or prepaid basis covering the individual
   27  proprietor or an  employer's  employees,  other  than  qualifying  group
   28  health  insurance  purchased  pursuant  to this section, is purchased or
   29  otherwise takes effect subsequent to purchase of qualifying group health
   30  insurance under the program established by this section.
   31    [(F)] (D) The wage levels utilized in subparagraph (B) of  this  para-
   32  graph  shall  be  adjusted  annually, beginning in two thousand two. The
   33  adjustment shall take effect on July first of each year. For July first,
   34  two thousand two, the adjustment shall be a  percentage  of  the  annual
   35  wage  figure specified in subparagraph (B) of this paragraph. For subse-
   36  quent years, the adjustment shall be a percentage  of  the  annual  wage
   37  figure which took effect on July first of the prior year. The percentage
   38  adjustment  shall  be  the  same  percentage by which the current year's
   39  non-farm federal poverty level, as defined and updated  by  the  federal
   40  department  of  health  and  human  services,  for a family unit of four
   41  persons for the forty-eight  contiguous  states  and  Washington,  D.C.,
   42  changed from the same level established for the prior year.
   43    (2)  A  qualifying group health insurance contract is a group contract
   44  purchased from a health maintenance organization, corporation or insurer
   45  by a qualifying small employer which provides the benefits set forth  in
   46  subsection  (d)  of this section. The contract must insure not less than
   47  fifty percent of the employees eligible for coverage.
   48    (3)[(A)] A qualifying individual is an employed person[:
   49    (i) who does not have and has not had health insurance  with  benefits
   50  on an expense reimbursed or prepaid basis during the twelve month period
   51  prior  to  the  individual's  application for health insurance under the
   52  program established by this section;
   53    (ii) whose employer does not provide group health  insurance  and  has
   54  not  provided  group  health insurance with benefits on an expense reim-
   55  bursed or prepaid basis covering employees in effect during  the  twelve
       S. 3072                             3
    1  month  period prior to the individual's application for health insurance
    2  under the program established by this section;
    3    (iii)]  WHO resides in a household having a net household income at or
    4  below two hundred eight percent of the non-farm  federal  poverty  level
    5  (as  defined  and  updated by the federal department of health and human
    6  services) or the gross equivalent of such net income; and
    7    [(iv)] WHO is ineligible for Medicare.
    8    [(B) The requirements set forth in items (i) and (ii) of  subparagraph
    9  (A)  of  this  paragraph  shall not be applicable where an individual is
   10  transferring from a health insurance contract  issued  pursuant  to  the
   11  voucher  insurance  program  established  by  section  one  thousand one
   12  hundred twenty-one of this chapter, a health insurance  contract  issued
   13  pursuant  to the New York state small business health insurance partner-
   14  ship program established by  section  nine  hundred  twenty-two  of  the
   15  public  health law or health care coverage issued pursuant to a regional
   16  pilot project for the uninsured established by section one thousand  one
   17  hundred eighteen of this chapter.
   18    (C)  The  requirements set forth in items (i) and (ii) of subparagraph
   19  (A) of this paragraph shall not be applicable where  an  individual  had
   20  health  insurance  coverage  during  the previous twelve months and such
   21  coverage terminated due to:
   22    (i) loss of employment due to factors other than voluntary separation;
   23    (ii) death of a family member which results in termination of coverage
   24  under a health insurance contract under which the individual is covered;
   25    (iii) change to a new employer that  does  not  provide  group  health
   26  insurance with benefits on an expense reimbursed or prepaid basis;
   27    (iv)  change  of  residence so that no employer-based health insurance
   28  with benefits on an expense reimbursed or prepaid basis is available;
   29    (v) discontinuation of a group health insurance contract with benefits
   30  on an expense reimbursed or prepaid basis covering the qualifying  indi-
   31  vidual as an employee or dependent;
   32    (vi)  expiration  of the coverage periods established by the continua-
   33  tion provisions of the  Employee  Retirement  Income  Security  Act,  29
   34  U.S.C.    section  1161  et  seq.  and the Public Health Service Act, 42
   35  U.S.C.  section 300bb-1 et seq. established by the Consolidated  Omnibus
   36  Budget  Reconciliation  Act  of  1985,  as  amended, or the continuation
   37  provisions of subsection (m) of section three thousand two hundred twen-
   38  ty-one, subsection (k) of section four thousand three hundred  four  and
   39  subsection (e) of section four thousand three hundred five of this chap-
   40  ter;
   41    (vii)  legal  separation, divorce or annulment which results in termi-
   42  nation of coverage under a health insurance  contract  under  which  the
   43  individual is covered; or
   44    (viii) loss of eligibility under a group health plan.
   45    (D) The twelve month period set forth in items (i) and (ii) of subpar-
   46  agraph  (A) of this paragraph may be adjusted by the superintendent from
   47  twelve months to eighteen months if he determines that the twelve  month
   48  period  is  insufficient  to prevent inappropriate substitution of other
   49  health insurance contracts for qualifying  individual  health  insurance
   50  contracts.]
   51    (4) A qualifying individual health insurance contract is an individual
   52  contract  issued  directly to a qualifying individual and which provides
   53  the benefits set forth in subsection (d) of this section. At the  option
   54  of  the  qualifying  individual,  such contract may include coverage for
   55  dependents of the qualifying individual.
   56    S 2. This act shall take effect January 1, 2010.
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