Bill Text: NY S06740 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to a health insurance demonstration program for early retirees.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2012-08-01 - SIGNED CHAP.362 [S06740 Detail]
Download: New_York-2011-S06740-Introduced.html
S T A T E O F N E W Y O R K
________________________________________________________________________
6740
I N S E N A T E
March 15, 2012
___________
Introduced by Sen. ROBACH -- 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 a health insurance
demonstration program for early retirees; and providing for the repeal
of such provisions upon expiration thereof
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
1 Section 1. The insurance law is amended by adding a new section 1123-a
2 to read as follows:
3 S 1123-A. HEALTH INSURANCE DEMONSTRATION PROGRAM FOR FORMER EMPLOY-
4 EES. (A) PURPOSE OF THE DEMONSTRATION PROGRAM. THE LEGISLATURE RECOG-
5 NIZES THAT FORMER EMPLOYEES WHO HAVE RELIED ON EMPLOYER-SPONSORED HEALTH
6 INSURANCE COVERAGE, AND IN SOME CASES, THE PROMISE OF CONTINUED HEALTH
7 INSURANCE, HAVE BEEN ADVERSELY AFFECTED BY THE ECONOMY AND THE INABILITY
8 OF THEIR FORMER EMPLOYERS TO CONTINUE TO PROVIDE HEALTH INSURANCE.
9 THESE INDIVIDUALS OFTEN FIND THEMSELVES WITHOUT ACCESS TO OTHER EMPLOY-
10 ER-SPONSORED COVERAGE AND ARE TOO YOUNG TO ENROLL IN MEDICARE. THE
11 DIRECT PAY MARKET IS NOT ALWAYS A VIABLE OPTION FOR THESE INDIVIDUALS
12 BECAUSE OF COST. THE DEMONSTRATION PROGRAM AUTHORIZED BY THIS SECTION IS
13 INTENDED TO PROVIDE A MECHANISM TO ALLOW THESE INDIVIDUALS TO PARTIC-
14 IPATE IN THEIR OWN GROUP HEALTH INSURANCE PROGRAMS THAT MEET THEIR
15 SPECIAL NEEDS, WHILE ENSURING COMPLIANCE WITH THIS CHAPTER AND ANY REGU-
16 LATIONS PROMULGATED THEREUNDER, INCLUDING BENEFIT MANDATES. THE DEMON-
17 STRATION PROGRAM WILL ENABLE THE LEGISLATURE AND THE SUPERINTENDENT TO
18 ASSESS WHETHER TO PERMIT AN ASSOCIATION OF FORMER EMPLOYEES TO CONTINUE
19 TO HAVE HEALTH INSURANCE COVERAGE UNDER SIMILAR TERMS AS THEY HAVE
20 ENJOYED WHILE EMPLOYED UNTIL THEY ARE ELIGIBLE FOR COVERAGE UNDER TITLE
21 XVIII OF THE SOCIAL SECURITY ACT (MEDICARE) OR UNTIL OTHER COMPARABLE
22 GROUP HEALTH INSURANCE COVERAGE BECOMES AVAILABLE.
23 (B) DEFINITIONS. IN THIS SECTION:
24 (1) "ELIGIBLE ASSOCIATION" MEANS AN ENTITY THAT: (A) IS EXEMPT FROM
25 FEDERAL TAXATION UNDER SECTION 501(C)(3) OR (C)(4) OF THE INTERNAL
26 REVENUE CODE; (B) WAS INCORPORATED ON OR BEFORE JANUARY FIRST, TWO THOU-
27 SAND TEN; (C) MEETS THE CRITERIA SET FORTH IN SUBPARAGRAPH (K) OF PARA-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15057-01-2
S. 6740 2
1 GRAPH ONE OF SUBSECTION (C) OF SECTION FOUR THOUSAND TWO HUNDRED THIR-
2 TY-FIVE OF THIS CHAPTER; AND (D) HAS BEEN ESTABLISHED FOR THE BENEFIT OF
3 FORMER EMPLOYEES OF A COMPANY IN THIS STATE.
4 (2) "ELIGIBLE INSURER" MEANS A HEALTH SERVICE CORPORATION ORGANIZED
5 PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER THAT, AS OF THE EFFEC-
6 TIVE DATE OF THIS SECTION, HAS ITS PARENT HEADQUARTERS IN THE SAME COUN-
7 TY AS THE ELIGIBLE ASSOCIATION AND THAT HAS A NATIONAL NETWORK OF
8 PROVIDERS ABLE TO PROVIDE SERVICES TO MEMBERS OF THE ELIGIBLE ASSOCI-
9 ATION.
10 (3) "FORMER EMPLOYEE" MEANS AN INDIVIDUAL: (A) WHO WAS FORMERLY
11 EMPLOYED BY A COMPANY HEADQUARTERED IN THIS STATE AND WHICH HAS BEEN IN
12 OPERATION FOR OVER ONE HUNDRED YEARS; (B) WHO HAS HERETOFORE RECEIVED
13 HEALTH INSURANCE COVERAGE THROUGH THE FORMER EMPLOYER, (C) WHOSE FORMER
14 EMPLOYER FILED FOR CHAPTER ELEVEN BANKRUPTCY IN JANUARY TWO THOUSAND
15 TWELVE, AND (D) WHO IS NOT ELIGIBLE FOR MEDICARE OR FOR GROUP HEALTH
16 INSURANCE COVERAGE THROUGH ANOTHER EMPLOYER.
17 (4) "GROUP HEALTH INSURANCE" MEANS INSURANCE PROVIDING HOSPITAL,
18 SURGICAL OR MEDICAL EXPENSE COVERAGE OR OTHER SIMILAR COMPREHENSIVE
19 HEALTH INSURANCE COVERAGE.
20 (C) DEMONSTRATION PROGRAM FOR FORMER EMPLOYEES. (1) BOTH THE INSURER
21 AND THE GROUP HEALTH INSURANCE POLICIES ISSUED TO THE ELIGIBLE ASSOCI-
22 ATION SHALL BE SUBJECT TO THE PROVISIONS OF THIS CHAPTER AND ANY REGU-
23 LATIONS PROMULGATED THEREUNDER, EXCEPT THAT THE ELIGIBLE ASSOCIATION
24 SHALL NOT BE CONSIDERED A SMALL GROUP UNDER THIS CHAPTER.
25 (2) SUBJECT TO PARAGRAPH THREE OF THIS SUBSECTION, THE SUPERINTENDENT
26 MAY ISSUE AN APPROVAL TO AN ELIGIBLE INSURER IF: (A) THE ELIGIBLE INSUR-
27 ER DEMONSTRATES THAT IT SATISFIES ALL FINANCIAL, OPERATIONAL AND OTHER
28 REQUIREMENTS OF THIS CHAPTER AND REGULATIONS PROMULGATED THEREUNDER,
29 OTHER THAN ANY REQUIREMENTS EXPRESSLY WAIVED BY THIS SECTION, AND SHALL
30 OPERATE THE DEMONSTRATION PROGRAM IN ACCORDANCE WITH THE REQUIREMENTS OF
31 THIS SECTION; AND (B) THE SUPERINTENDENT DETERMINES THAT THE DEMON-
32 STRATION PROGRAM FURTHERS THE PUBLIC POLICY GOALS OF THIS SECTION.
33 (3) ANY ELIGIBLE INSURER SEEKING THE SUPERINTENDENT'S APPROVAL UNDER
34 PARAGRAPH TWO OF THIS SUBSECTION SHALL SUBMIT A WRITTEN REQUEST TO THE
35 SUPERINTENDENT WITHIN THIRTY DAYS OF THE EFFECTIVE DATE OF THIS SECTION.
36 THE ELIGIBLE INSURER'S APPLICATION SHALL: SPECIFY THE IDENTITY AND
37 COMPOSITION OF THE ELIGIBLE ASSOCIATION, THE ELIGIBLE ASSOCIATION'S
38 MEMBERSHIP RULES, AND THE TERMS UNDER WHICH THE ELIGIBLE INSURER SHALL
39 PROVIDE GROUP HEALTH INSURANCE TO THE ELIGIBLE ASSOCIATION; DEMONSTRATE
40 THAT THE ELIGIBLE INSURER AND THE ELIGIBLE ASSOCIATION THE REQUIREMENTS
41 SET FORTH IN THIS SECTION; AND IDENTIFY THE GROUP HEALTH INSURANCE POLI-
42 CY FORMS THAT THE ELIGIBLE INSURER WILL ISSUE TO THE ELIGIBLE ASSOCI-
43 ATION. THE SUPERINTENDENT SHALL MAKE A DETERMINATION ON ANY REQUEST
44 WITHIN NINETY DAYS OF RECEIPT OF ALL NECESSARY INFORMATION. THE SUPER-
45 INTENDENT SHALL ISSUE AN APPROVAL TO ONLY ONE ELIGIBLE INSURER.
46 (4) THE SUPERINTENDENT MAY REVOKE AN APPROVAL ISSUED UNDER PARAGRAPH
47 TWO OF THIS SUBSECTION IF: THE INSURER THAT RECEIVED SUCH APPROVAL NO
48 LONGER QUALIFIES AS AN ELIGIBLE INSURER OR IS OTHERWISE OPERATING IN A
49 MANNER INCONSISTENT WITH THE PROVISIONS OF THIS CHAPTER OR REGULATIONS
50 PROMULGATED THEREUNDER; OR THE ASSOCIATION TO WHICH THE ELIGIBLE INSURER
51 ISSUED THE GROUP HEALTH INSURANCE POLICY NO LONGER QUALIFIES AS AN
52 ELIGIBLE ASSOCIATION. AN ELIGIBLE INSURER THAT RECEIVES APPROVAL UNDER
53 PARAGRAPH TWO OF THIS SUBSECTION SHALL SUBMIT PERIODIC REPORTS TO THE
54 SUPERINTENDENT SUFFICIENT TO ENABLE THE SUPERINTENDENT TO EVALUATE THE
55 EFFECTIVENESS OF THE DEMONSTRATION PROGRAM. SUCH REPORTS SHALL INCLUDE A
56 COMPARISON OF THE COST OF HEALTH INSURANCE OBTAINED UNDER THE PROGRAM TO
S. 6740 3
1 OTHER AVAILABLE INSURANCE OPTIONS, INCLUDING GROUP HEALTH INSURANCE
2 POLICIES DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE, DEMOGRAPHIC AND
3 GEOGRAPHIC ANALYSIS OF THE ENROLLED POPULATION AND ANY OTHER INFORMATION
4 REQUIRED BY THE SUPERINTENDENT.
5 S 2. This act shall take effect immediately and shall expire December
6 31, 2013 when upon such date the provisions of this act shall be deemed
7 repealed.
