STATE OF NEW YORK
________________________________________________________________________
7439
2015-2016 Regular Sessions
IN ASSEMBLY
May 12, 2015
___________
Introduced by M. of A. CAHILL -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, in relation to rating of individual
and small group health insurance policies
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (A) of paragraph 1 of subdivision (e) of
2 section 3231 of the insurance law, as amended by chapter 107 of the laws
3 of 2010 and as further amended by section 104 of part A of chapter 62 of
4 the laws of 2011, is amended to read as follows:
5 (A) An insurer desiring to increase or decrease premiums for any poli-
6 cy form subject to this section shall submit a rate filing or applica-
7 tion to the superintendent.
8 An insurer shall send written notice of the proposed rate adjustment,
9 [including the specific change requested,] to each policy holder and
10 certificate holder affected by the adjustment on or before the date the
11 rate filing or application is submitted to the superintendent. The
12 notice shall prominently include mailing and website addresses for both
13 the department of financial services and the insurer through which a
14 person may, within thirty days from the date the rate filing or applica-
15 tion is submitted to the superintendent, contact the department of
16 financial services or insurer to receive additional information or to
17 submit written comments to the department of financial services on the
18 rate filing or application. The superintendent shall establish a process
19 to post on the department's website, in a timely manner, all relevant
20 written comments received pertaining to rate filings or applications.
21 The insurer shall provide a copy of the notice to the superintendent
22 with the rate filing or application. The superintendent shall immediate-
23 ly cause the notice to be posted on the department of financial
24 services' website. The superintendent shall determine whether the filing
25 or application shall become effective as filed, shall become effective
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD10031-01-5
A. 7439 2
1 as modified, or shall be disapproved. The superintendent may modify or
2 disapprove the rate filing or application if the superintendent finds
3 that the premiums are unreasonable, excessive, inadequate, or unfairly
4 discriminatory, and may consider the financial condition of the insurer
5 when approving, modifying or disapproving any premium adjustment. [The]
6 Provided, however, any adjustment to a rate filing or application must
7 be in accordance with generally accepted actuarial principles and prac-
8 tices, and must be appropriate for the population to be covered and
9 services to be furnished under the policy. An initial determination [of]
10 regarding the rate filing or application shall be made by the super-
11 intendent [shall be supported by sound actuarial assumptions and meth-
12 ods, and shall be rendered in writing between] no later than thirty [and
13 sixty] days from the date the rate filing or application is submitted to
14 the superintendent. The superintendent's initial determination shall be
15 provided to an insurer in writing within the thirty day time period and
16 shall describe in detail the actuarial assumptions and methods used in
17 the superintendent's determination. Should the superintendent require
18 additional information from the insurer in order to make [a] an initial
19 determination, the superintendent shall require the insurer to furnish
20 such information, and in such event, the [sixty] thirty days shall be
21 tolled and shall resume as of the date the insurer furnishes the infor-
22 mation to the superintendent. [If the superintendent requests additional
23 information less than ten days from the expiration of the sixty days
24 (exclusive of tolling), the superintendent may extend the sixty day
25 period an additional twenty days to make a determination. The] Following
26 the issuance of the initial determination, an insurer shall have fifteen
27 days to appeal the determination in writing. If an initial rate determi-
28 nation is appealed, the superintendent shall have fifteen days to issue
29 a revised determination. If the initial determination is not appealed by
30 an insurer, it shall become final fifteen days after it is issued. All
31 final rate determinations shall be certified by an actuary designated by
32 the superintendent who meets the qualification standards established by
33 the American academy of actuaries and follow the practice standards
34 established by the actuarial standards board. Notwithstanding the fore-
35 going, the application or rate filing will be deemed approved if a
36 determination is not rendered within the time allotted under this
37 section. An insurer shall not implement a rate adjustment that is
38 approved by the superintendent unless the insurer provides at least
39 [sixty] thirty days advance [written] notice of the [premium rate
40 adjustment approved by the superintendent] adjustment, either through a
41 posting on its website or by written notice to each policy holder and
42 certificate holder affected by the rate adjustment.
43 § 2. Paragraph 2 of subdivision (c) of section 4308 of the insurance
44 law, as amended by chapter 107 of the laws of 2010 and as further
45 amended by section 104 of part A of chapter 62 of the laws of 2011, is
46 amended to read as follows:
47 (2) A corporation desiring to increase or decrease premiums for any
48 contract subject to this subsection shall submit a rate filing or appli-
49 cation to the superintendent. A corporation shall send written notice of
50 the proposed rate adjustment, [including the specific change requested,]
51 to each contract holder and subscriber affected by the adjustment on or
52 before the date the rate filing or application is submitted to the
53 superintendent. The notice shall prominently include mailing and website
54 addresses for both the department of financial services and the corpo-
55 ration through which a person may, within thirty days from the date the
56 rate filing or application is submitted to the superintendent, contact
A. 7439 3
1 the department of financial services or corporation to receive addi-
2 tional information or to submit written comments to the department of
3 financial services on the rate filing or application. The superintendent
4 shall establish a process to post on the department's website, in a
5 timely manner, all relevant written comments received pertaining to rate
6 filings or applications. The corporation shall provide a copy of the
7 notice to the superintendent with the rate filing or application. The
8 superintendent shall immediately cause the notice to be posted on the
9 department of financial services' website. The superintendent shall
10 determine whether the filing or application shall become effective as
11 filed, shall become effective as modified, or shall be disapproved. The
12 superintendent may modify or disapprove the rate filing or application
13 if the superintendent finds that the premiums are unreasonable, exces-
14 sive, inadequate, or unfairly discriminatory, and may consider the
15 financial condition of the corporation in approving, modifying or disap-
16 proving any premium adjustment[. The]; provided, however, any adjustment
17 to a rate filing or application must be in accordance with generally
18 accepted actuarial principles and practices, and must be appropriate for
19 the population to be covered and services to be furnished under the
20 contract. An initial determination [of] regarding the rate of filing or
21 application shall be made by the superintendent [shall be supported by
22 sound actuarial assumptions and methods, and shall be rendered in writ-
23 ing between] no later than thirty [and sixty] days from the date the
24 rate filing or application is submitted to the superintendent. The
25 superintendent's initial determination shall be provided to a corpo-
26 ration in writing within the thirty day time period and shall describe
27 in detail the actuarial assumptions and methods used in the superinten-
28 dent's determination. Should the superintendent require additional
29 information from the corporation in order to make [a] an initial deter-
30 mination, the superintendent shall require the corporation to furnish
31 such information, and in such event, the [sixty] thirty days shall be
32 tolled and shall resume as of the date the corporation furnishes the
33 information to the superintendent. [If the superintendent requests addi-
34 tional information less than ten days from the expiration of the sixty
35 days (exclusive of tolling), the superintendent may extend the sixty day
36 period an additional twenty days, to make a determination. The] Follow-
37 ing the issuance of the initial determination, a corporation shall have
38 fifteen days to appeal the determination in writing. If an initial rate
39 determination is appealed, the superintendent shall have fifteen days to
40 issue a revised determination. If the initial determination is not
41 appealed by a corporation, it shall become final fifteen days after it
42 is issued. All final rate determinations shall be certified by an actu-
43 ary designated by the superintendent who meets the qualification stand-
44 ards established by the American academy of actuaries and follow the
45 practice standards established by the actuarial standards board.
46 Notwithstanding the foregoing, the application or rate filing will be
47 deemed approved if a determination is not rendered within the time
48 allotted under this section. A corporation shall not implement a rate
49 adjustment that is approved by the superintendent unless the corporation
50 provides at least [sixty] thirty days advance [written] notice of the
51 [premium rate adjustment approved by the superintendent] adjustment,
52 either through a posting on its website or by written notice to each
53 contract holder and subscriber affected by the rate adjustment.
54 § 3. This act shall take effect immediately.
