Bill Text: NY S03726 | 2011-2012 | General Assembly | Introduced
Bill Title: Defines the term "genetic predisposition" for purposes of individual and small group health insurance policies; requires that genetic predisposition be disregarded in community rating; provides that no pre-existing condition exclusion in such a policy shall exclude coverage on the basis of any genetic predisposition.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-03-02 - REFERRED TO INSURANCE [S03726 Detail]
Download: New_York-2011-S03726-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ S. 3726 A. 5858 2011-2012 Regular Sessions S E N A T E - A S S E M B L Y March 2, 2011 ___________ IN SENATE -- Introduced by Sen. KRUGER -- read twice and ordered print- ed, and when printed to be committed to the Committee on Insurance IN ASSEMBLY -- Introduced by M. of A. KAVANAGH -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to genetic predisposition THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subsection (a) of section 107 of the insurance law is 2 amended by adding a new paragraph 54 to read as follows: 3 (54) "GENETIC PREDISPOSITION" SHALL MEAN THE PRESENCE OF A VARIATION 4 IN THE COMPOSITION OF THE GENES OF AN INDIVIDUAL OR AN INDIVIDUAL'S 5 FAMILY MEMBER WHICH IS SCIENTIFICALLY OR MEDICALLY IDENTIFIABLE AND 6 WHICH IS DETERMINED TO BE ASSOCIATED WITH AN INCREASED STATISTICAL RISK 7 OF BEING EXPRESSED AS EITHER A PHYSICAL OR MENTAL DISEASE OR DISABILITY 8 IN THE INDIVIDUAL OR HAVING OFFSPRING WITH A GENETICALLY INFLUENCED 9 DISEASE, BUT WHICH HAS NOT RESULTED IN ANY SYMPTOMS OF SUCH DISEASE OR 10 DISORDER. 11 S 2. Subsection (a) of section 3231 of the insurance law, as amended 12 by chapter 661 of the laws of 1997, is amended to read as follows: 13 (a) No individual health insurance policy and no group health insur- 14 ance policy covering between two and fifty employees or members of the 15 group exclusive of spouses and dependents, hereinafter referred to as a 16 small group, providing hospital and/or medical benefits, including medi- 17 care supplemental insurance, shall be issued in this state unless such 18 policy is community rated and, notwithstanding any other provisions of 19 law, the underwriting of such policy involves no more than the imposi- 20 tion of a pre-existing condition limitation as permitted by this arti- 21 cle. Any individual, and dependents of such individual, and any small 22 group, including all employees or group members and dependents of 23 employees or members, applying for individual health insurance coverage, EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07054-01-1 S. 3726 2 A. 5858 1 including medicare supplemental coverage, or small group health insur- 2 ance coverage, including medicare supplemental insurance, must be 3 accepted at all times throughout the year for any hospital and/or 4 medical coverage offered by the insurer to individuals or small groups 5 in this state. Once accepted for coverage, an individual or small group 6 cannot be terminated by the insurer due to claims experience. Termi- 7 nation of an individual or small group shall be based only on one or 8 more of the reasons set forth in subsection (g) of section three thou- 9 sand two hundred sixteen or subsection (p) of section three thousand two 10 hundred twenty-one of this article. Group hospital and/or medical cover- 11 age, including medicare supplemental insurance, obtained through an 12 out-of-state trust covering a group of fifty or fewer employees or 13 participating persons who are residents of this state must be community 14 rated regardless of the situs of delivery of the policy. Notwithstanding 15 any other provisions of law, the underwriting of such policy may involve 16 no more than the imposition of a pre-existing condition limitation as 17 permitted by this article, and once accepted for coverage, an individual 18 or small group cannot be terminated due to claims experience. Termi- 19 nation of an individual or small group shall be based only on one or 20 more of the reasons set forth in subsection (p) of section three thou- 21 sand two hundred twenty-one of this article. For the purposes of this 22 section, "community rated" means a rating methodology in which the 23 premium for all persons covered by a policy or contract form is the same 24 based on the experience of the entire pool of risks covered by that 25 policy or contract form without regard to age, sex, health status, 26 INCLUDING ANY GENETIC PREDISPOSITION, or occupation. 27 S 3. The opening paragraph of subsection (b) of section 3232 of the 28 insurance law, as amended by chapter 661 of the laws of 1997, is amended 29 to read as follows: 30 No pre-existing condition provision shall exclude coverage for a peri- 31 od in excess of twelve months following the enrollment date of coverage 32 for the covered person and may only relate to a condition (whether phys- 33 ical or mental), regardless of the cause of the condition, for which 34 medical advice, diagnosis, care or treatment was recommended or received 35 within the six-month period ending on the enrollment date. NO PRE-EX- 36 ISTING CONDITION PROVISION SHALL EXCLUDE COVERAGE ON THE BASIS OF ANY 37 GENETIC PREDISPOSITION. For purposes of this section "enrollment date" 38 means the first day of coverage of the individual under the policy or, 39 if earlier, the first day of the waiting period that must pass with 40 respect to an individual before such individual is eligible to be 41 covered for benefits. If an individual seeks and obtains coverage in the 42 individual market, any period after the date the individual files a 43 substantially complete application for coverage and before the first day 44 of coverage is a waiting period. For purposes of this section genetic 45 information shall not be treated as a pre-existing condition in the 46 absence of a diagnosis of the condition related to such information. No 47 pre-existing condition limitation provision shall exclude coverage in 48 the case of: 49 S 4. Subsection (a) of section 4317 of the insurance law, as amended 50 by chapter 661 of the laws of 1997, is amended to read as follows: 51 (a) No individual health insurance contract and no group health insur- 52 ance contract covering between two and fifty employees or members of the 53 group exclusive of spouses and dependents, including contracts for which 54 the premiums are paid by a remitting agent for a group, hereinafter 55 referred to as a small group, providing hospital and/or medical bene- 56 fits, including Medicare supplemental insurance, shall be issued in this S. 3726 3 A. 5858 1 state unless such contract is community rated and, notwithstanding any 2 other provisions of law, the underwriting of such contract involves no 3 more than the imposition of a pre-existing condition limitation as 4 permitted by this article. Any individual, and dependents of such indi- 5 vidual, and any small group, including all employees or group members 6 and dependents of employees or members, applying for individual or small 7 group health insurance coverage must be accepted at all times throughout 8 the year for any hospital and/or medical coverage, including Medicare 9 supplemental insurance, offered by the corporation to individuals or 10 small groups in this state. Once accepted for coverage, an individual or 11 small group cannot be terminated by the insurer due to claims experi- 12 ence. Termination of coverage for individuals or small groups may be 13 based only on one or more of the reasons set forth in subsection (c) of 14 section four thousand three hundred four or subsection (j) of section 15 four thousand three hundred five of this article. For the purposes of 16 this section, "community rated" means a rating methodology in which the 17 premium for all persons covered by a policy or contract form is the 18 same, based on the experience of the entire pool of risks covered by 19 that policy or contract form without regard to age, sex, health status, 20 INCLUDING ANY GENETIC PREDISPOSITION, or occupation. 21 S 5. The opening paragraph of subsection (b) of section 4318 of the 22 insurance law, as amended by chapter 661 of the laws of 1997, is amended 23 to read as follows: 24 No pre-existing condition provision shall exclude coverage for a peri- 25 od in excess of twelve months following the enrollment date for the 26 covered person and may only relate to a condition (whether physical or 27 mental), regardless of the cause of the condition for which medical 28 advice, diagnosis, care or treatment was recommended or received within 29 the six month period ending on the enrollment date. For purposes of 30 this section "enrollment date" means the first day of coverage of the 31 individual under the contract or, if earlier, the first day of the wait- 32 ing period that must pass with respect to an individual before the indi- 33 vidual is eligible to be covered for benefits. If an individual seeks 34 and obtains coverage in the individual market, any period after the date 35 the individual files a substantially complete application for coverage 36 and before the first day of coverage is a waiting period. For purposes 37 of this section, genetic information shall not be treated as a pre-ex- 38 isting condition in the absence of a diagnosis of the condition related 39 to such information. NO PRE-EXISTING CONDITION PROVISION SHALL EXCLUDE 40 COVERAGE ON THE BASIS OF ANY GENETIC PREDISPOSITION. No pre-existing 41 condition provision shall exclude coverage in the case of: 42 S 6. This act shall take effect on the sixtieth day after it shall 43 have become a law and shall apply to all policies issued, renewed, 44 altered or modified on or after such date.