Bill Text: NY S08500 | 2017-2018 | General Assembly | Introduced
Bill Title: Redefines "small group" for the purposes of certain provisions of sections 3231 and 4317 of the insurance law.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2018-05-09 - REFERRED TO INSURANCE [S08500 Detail]
Download: New_York-2017-S08500-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8500 IN SENATE May 9, 2018 ___________ Introduced by Sen. SEWARD -- 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 rating of individual and small group health insurance contracts and policies 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, except as set forth in subsection (h) of this section, or between 7 one and one hundred employees or members of the group for policies 8 issued or renewed on or after January first, two thousand sixteen exclu- 9 sive of spouses and dependents, hereinafter referred to as a small 10 group, providing hospital and/or medical benefits, including medicare 11 supplemental insurance, shall be issued in this state unless such policy 12 is community rated and, notwithstanding any other provisions of law, the 13 underwriting of such policy involves no more than the imposition of a 14 pre-existing condition limitation if otherwise permitted by this arti- 15 cle. 16 § 2. Paragraph 1 of subsection (h) 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) Notwithstanding any other provision of this chapter, no insurer, 20 subsidiary of an insurer, or controlled person of a holding company 21 system may act as an administrator or claims paying agent, as opposed to 22 an insurer, on behalf of small groups which, if they purchased insur- 23 ance, would be subject to this section. No insurer may provide stop 24 loss, catastrophic or reinsurance coverage to small groups which, if 25 they purchased insurance, would be subject to this section. Provided, 26 however, the provisions of this paragraph shall not apply to: (A) the 27 renewal of stop loss, catastrophic or reinsurance coverage issued and in 28 effect on January first, two thousand fifteen to small groups covering EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01398-02-8S. 8500 2 1 between fifty-one and one hundred employees or members of the group; and 2 (B) the issuance between January first, two thousand sixteen and Decem- 3 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or 4 reinsurance coverage, and any renewal thereof, to a small group covering 5 between fifty-one and one hundred employees or members of the group, 6 provided that such group had stop loss, catastrophic or reinsurance 7 coverage issued and in effect on January first, two thousand fifteen. 8 For purposes of this subsection, "small group" shall mean a group 9 comprised of between one and fifty employees or members, exclusive of 10 spouses and dependents. 11 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance 12 law, as added by chapter 501 of the laws of 1992, is amended to read as 13 follows: 14 (1) Notwithstanding any other provision of this chapter, no insurer, 15 subsidiary of an insurer, or controlled person of a holding company 16 system may act as an administrator or claims paying agent, as opposed to 17 an insurer, on behalf of small groups which, if they purchased insur- 18 ance, would be subject to this section. No insurer, subsidiary of an 19 insurer, or controlled person of a holding company may provide stop 20 loss, catastrophic or reinsurance coverage to small groups which, if 21 they purchased insurance, would be subject to this section. For purposes 22 of this subsection, "small group" shall mean a group comprised of 23 between one and fifty employees or members, exclusive of spouses and 24 dependents. 25 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance 26 law, as amended by section 72 of part D of chapter 56 of the laws of 27 2013, is amended to read as follows: 28 (1) No individual health insurance contract and no group health insur- 29 ance contract covering between one and fifty employees or members of the 30 group, except as set forth in subsection (e) of this section, or between 31 one and one hundred employees or members of the group for policies 32 issued or renewed on or after January first, two thousand sixteen exclu- 33 sive of spouses and dependents, including contracts for which the premi- 34 ums are paid by a remitting agent for a group, hereinafter referred to 35 as a small group, providing hospital and/or medical benefits, including 36 Medicare supplemental insurance, shall be issued in this state unless 37 such contract is community rated and, notwithstanding any other 38 provisions of law, the underwriting of such contract involves no more 39 than the imposition of a pre-existing condition limitation if otherwise 40 permitted by this article. 41 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance 42 law, as amended by chapter 12 of the laws of 2016, is amended to read as 43 follows: 44 (1) Notwithstanding any other provision of this chapter, no insurer, 45 subsidiary of an insurer, or controlled person of a holding company 46 system may act as an administrator or claims paying agent, as opposed to 47 an insurer, on behalf of small groups which, if they purchased insur- 48 ance, would be subject to this section. No insurer may provide stop 49 loss, catastrophic or reinsurance coverage to small groups which, if 50 they purchased insurance, would be subject to this section. Provided, 51 however, the provisions of this paragraph shall not apply to: (A) the 52 renewal of stop loss, catastrophic or reinsurance coverage issued and in 53 effect on January first, two thousand fifteen to small groups covering 54 between fifty-one and one hundred employees or members of the group; and 55 (B) the issuance between January first, two thousand sixteen, and Decem- 56 ber thirty-first, two thousand sixteen, of stop loss, catastrophic orS. 8500 3 1 reinsurance coverage, and any renewal thereof, to a small group covering 2 between fifty-one and one hundred employees or members of the group, 3 provided that such group had stop loss, catastrophic or reinsurance 4 coverage issued and in effect on January first, two thousand fifteen. 5 For purposes of this subsection, "small group" shall mean a group 6 comprised of between one and fifty employees or members, exclusive of 7 spouses and dependents. 8 § 6. Paragraph 1 of subsection (e) of section 4317 of the insurance 9 law, as amended by section 72 of part D of chapter 56 of the laws of 10 2013, is amended to read as follows: 11 (1) Notwithstanding any other provision of this chapter, no insurer, 12 subsidiary of an insurer, or controlled person of a holding company 13 system may act as an administrator or claims paying agent, as opposed to 14 an insurer, on behalf of small groups which, if they purchased insur- 15 ance, would be subject to this section. No insurer, subsidiary of an 16 insurer, or controlled person of a holding company may provide stop 17 loss, catastrophic or reinsurance coverage to small groups which, if 18 they purchased insurance, would be subject to this section. For 19 purposes of this subsection, "small group" shall mean a group comprised 20 of between one and fifty employees or members, exclusive of spouses and 21 dependents. 22 § 7. This act shall take effect immediately; provided, however the 23 amendments to paragraph 1 of subsection (h) of section 3231 of the 24 insurance law made by section two of this act shall be subject to the 25 expiration and reversion of such paragraph pursuant to section 5 of 26 chapter 588 of the laws of 2015, as amended, when upon such date the 27 provisions of section three of this act shall take effect; and provided, 28 further, the amendments to paragraph 1 of subsection (e) of section 4317 29 of the insurance law made by section five of this act shall be subject 30 to the expiration and reversion of such paragraph pursuant to section 5 31 of chapter 588 of the laws of 2015, as amended, when upon such date the 32 provisions of section six of this act shall take effect.