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A05858 Summary:

BILL NO    A05858 

SAME AS    No same as 

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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A05858 Actions:

BILL NO    A05858 

03/02/2011 referred to insurance
01/03/2012 enacting clause stricken
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A05858 Text:

                           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.
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