A03781 Summary:

BILL NO    A03781 

SAME AS    SAME AS S00935

SPONSOR    Kavanagh

COSPNSR    

MLTSPNSR   

Amd SS107, 3231, 3232, 4317 & 4318, Ins L

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.
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A03781 Actions:

BILL NO    A03781 

01/28/2009 referred to insurance
01/06/2010 referred to insurance
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A03781 Text:

                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________

                                         3781

                              2009-2010 Regular Sessions

                                 I N  A S S E M B L Y

                                   January 28, 2009
                                      ___________

       Introduced by M. of A. KAVANAGH -- read once and referred to the Commit-
         tee 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,
   24  including medicare supplemental coverage, or small group  health  insur-
   25  ance  coverage,  including  medicare  supplemental  insurance,  must  be
   26  accepted at all times  throughout  the  year  for  any  hospital  and/or

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06461-01-9
       A. 3781                             2

    1  medical  coverage  offered by the insurer to individuals or small groups
    2  in this state. Once accepted for coverage, an individual or small  group
    3  cannot  be  terminated  by  the insurer due to claims experience. Termi-
    4  nation  of  an  individual  or small group shall be based only on one or
    5  more of the reasons set forth in subsection (g) of section  three  thou-
    6  sand two hundred sixteen or subsection (p) of section three thousand two
    7  hundred twenty-one of this article. Group hospital and/or medical cover-
    8  age,  including  medicare  supplemental  insurance,  obtained through an
    9  out-of-state trust covering a group  of  fifty  or  fewer  employees  or
   10  participating  persons who are residents of this state must be community
   11  rated regardless of the situs of delivery of the policy. Notwithstanding
   12  any other provisions of law, the underwriting of such policy may involve
   13  no more than the imposition of a pre-existing  condition  limitation  as
   14  permitted by this article, and once accepted for coverage, an individual
   15  or  small  group  cannot  be terminated due to claims experience. Termi-
   16  nation of an individual or small group shall be based  only  on  one  or
   17  more  of  the reasons set forth in subsection (p) of section three thou-
   18  sand two hundred twenty-one of this article.  For the purposes  of  this
   19  section,  "community  rated"  means  a  rating  methodology in which the
   20  premium for all persons covered by a policy or contract form is the same
   21  based on the experience of the entire pool  of  risks  covered  by  that
   22  policy  or  contract  form  without  regard  to age, sex, health status,
   23  INCLUDING ANY GENETIC PREDISPOSITION, or occupation.
   24    S 3. The opening paragraph of subsection (b) of section  3232  of  the
   25  insurance law, as amended by chapter 661 of the laws of 1997, is amended
   26  to read as follows:
   27    No pre-existing condition provision shall exclude coverage for a peri-
   28  od  in excess of twelve months following the enrollment date of coverage
   29  for the covered person and may only relate to a condition (whether phys-
   30  ical or mental), regardless of the cause of  the  condition,  for  which
   31  medical advice, diagnosis, care or treatment was recommended or received
   32  within  the  six-month period ending on the enrollment date.  NO PRE-EX-
   33  ISTING CONDITION PROVISION SHALL EXCLUDE COVERAGE ON THE  BASIS  OF  ANY
   34  GENETIC  PREDISPOSITION.  For purposes of this section "enrollment date"
   35  means the first day of coverage of the individual under the  policy  or,
   36  if  earlier,  the  first  day  of the waiting period that must pass with
   37  respect to an individual  before  such  individual  is  eligible  to  be
   38  covered for benefits. If an individual seeks and obtains coverage in the
   39  individual  market,  any  period  after  the date the individual files a
   40  substantially complete application for coverage and before the first day
   41  of coverage is a waiting period. For purposes of  this  section  genetic
   42  information  shall  not  be  treated  as a pre-existing condition in the
   43  absence of a diagnosis of the condition related to such information.  No
   44  pre-existing  condition  limitation  provision shall exclude coverage in
   45  the case of:
   46    S 4. Subsection (a) of section 4317 of the insurance law,  as  amended
   47  by chapter 661 of the laws of 1997, is amended to read as follows:
   48    (a) No individual health insurance contract and no group health insur-
   49  ance contract covering between two and fifty employees or members of the
   50  group exclusive of spouses and dependents, including contracts for which
   51  the  premiums  are  paid  by  a remitting agent for a group, hereinafter
   52  referred to as a small group, providing hospital  and/or  medical  bene-
   53  fits, including Medicare supplemental insurance, shall be issued in this
   54  state  unless  such contract is community rated and, notwithstanding any
   55  other provisions of law, the underwriting of such contract  involves  no
   56  more  than  the  imposition  of  a  pre-existing condition limitation as
       A. 3781                             3

    1  permitted by this article.  Any individual, and dependents of such indi-
    2  vidual, and any small group, including all employees  or  group  members
    3  and dependents of employees or members, applying for individual or small
    4  group health insurance coverage must be accepted at all times throughout
    5  the  year  for  any hospital and/or medical coverage, including Medicare
    6  supplemental insurance, offered by the  corporation  to  individuals  or
    7  small groups in this state. Once accepted for coverage, an individual or
    8  small  group  cannot  be terminated by the insurer due to claims experi-
    9  ence. Termination of coverage for individuals or  small  groups  may  be
   10  based  only on one or more of the reasons set forth in subsection (c) of
   11  section four thousand three hundred four or subsection  (j)  of  section
   12  four  thousand  three hundred five of this article.  For the purposes of
   13  this section, "community rated" means a rating methodology in which  the
   14  premium  for  all  persons  covered  by a policy or contract form is the
   15  same, based on the experience of the entire pool  of  risks  covered  by
   16  that  policy or contract form without regard to age, sex, health status,
   17  INCLUDING ANY GENETIC PREDISPOSITION, or occupation.
   18    S 5. The opening paragraph of subsection (b) of section  4318  of  the
   19  insurance law, as amended by chapter 661 of the laws of 1997, is amended
   20  to read as follows:
   21    No pre-existing condition provision shall exclude coverage for a peri-
   22  od  in  excess  of  twelve  months following the enrollment date for the
   23  covered person and may only relate to a condition (whether  physical  or
   24  mental),  regardless  of  the  cause  of the condition for which medical
   25  advice, diagnosis, care or treatment was recommended or received  within
   26  the  six  month  period  ending on the enrollment date.  For purposes of
   27  this section "enrollment date" means the first day of  coverage  of  the
   28  individual under the contract or, if earlier, the first day of the wait-
   29  ing period that must pass with respect to an individual before the indi-
   30  vidual  is  eligible  to be covered for benefits. If an individual seeks
   31  and obtains coverage in the individual market, any period after the date
   32  the individual files a substantially complete application  for  coverage
   33  and  before  the first day of coverage is a waiting period. For purposes
   34  of this section, genetic information shall not be treated as  a  pre-ex-
   35  isting  condition in the absence of a diagnosis of the condition related
   36  to such information.  NO PRE-EXISTING CONDITION PROVISION SHALL  EXCLUDE
   37  COVERAGE  ON  THE  BASIS  OF ANY GENETIC PREDISPOSITION. No pre-existing
   38  condition provision shall exclude coverage in the case of:
   39    S 6. This act shall take effect on the sixtieth  day  after  it  shall
   40  have  become  a  law  and  shall  apply to all policies issued, renewed,
   41  altered or modified on or after such date.
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