S02331 Summary:

BILL NOS02331B
 
SAME ASSAME AS A05302-B
 
SPONSORKLEIN
 
COSPNSRAVELLA, CARLUCCI, SAVINO, VALESKY
 
MLTSPNSR
 
Amd SS3231, 3239, 4235, 4317 & 4326, Ins L; amd S4405, Pub Health L
 
Authorizes health insurers and health maintenance organizations, subject to the approval of the superintendent of financial services, to provide actuarially appropriate reductions in health insurance premiums or other benefits or enhancements for an enrollee's or insured's participation in a qualified wellness program.
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S02331 Actions:

BILL NOS02331B
 
01/16/2013REFERRED TO INSURANCE
01/08/2014REFERRED TO INSURANCE
01/23/2014AMEND AND RECOMMIT TO INSURANCE
01/23/2014PRINT NUMBER 2331A
05/05/20141ST REPORT CAL.489
05/06/20142ND REPORT CAL.
05/07/2014ADVANCED TO THIRD READING
05/19/2014AMENDED ON THIRD READING 2331B
06/10/2014PASSED SENATE
06/10/2014DELIVERED TO ASSEMBLY
06/10/2014referred to insurance
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S02331 Floor Votes:

There are no votes for this bill in this legislative session.
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S02331 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2331--B
            Cal. No. 489
 
                               2013-2014 Regular Sessions
 
                    IN SENATE
 
                                    January 16, 2013
                                       ___________
 
        Introduced  by  Sens.  KLEIN,  AVELLA, CARLUCCI, SAVINO, VALESKY -- read
          twice and ordered printed, and when printed to  be  committed  to  the
          Committee on Insurance -- recommitted to the Committee on Insurance in
          accordance  with  Senate  Rule 6, sec. 8 -- committee discharged, bill

          amended, ordered reprinted as amended and recommitted to said  commit-
          tee  --  reported  favorably from said committee, ordered to first and
          second report,  ordered  to  a  third  reading,  amended  and  ordered
          reprinted, retaining its place in the order of third reading
 
        AN ACT to amend the insurance law and the public health law, in relation
          to  making  actuarially  appropriate  reductions  in  health insurance
          premiums in return for an enrollee's or insured's participation  in  a
          qualified wellness program
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 3231 of the insurance law, as added by chapter  501
     2  of the laws of 1992, is amended by adding a new subsection (c-1) to read
     3  as follows:

     4    (c-1)  Subject  to  the  approval of the superintendent, an insurer or
     5  health maintenance organization issuing an individual  or  group  health
     6  insurance policy pursuant to this section may provide for an actuarially
     7  appropriate reduction in premium rates or other benefits or enhancements
     8  approved  by  the superintendent to encourage an enrollee's or insured's
     9  active participation in a qualified wellness program. A qualified  well-
    10  ness  program  can  be  a risk management system that identifies at-risk
    11  populations or any other systematic program or course of medical conduct
    12  which helps to promote physical and mental fitness, health and  well-be-
    13  ing,  helps  to  prevent  or mitigate the conditions of acute or chronic

    14  sickness, disease or pain, or  which  minimizes  adverse  health  conse-
    15  quences  due to lifestyle.  Such a wellness program may have some or all
    16  of the following elements to advance  the  physical  health  and  mental
    17  well-being of its participants:
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD06713-07-4

        S. 2331--B                          2
 
     1    (1)  an  education  program  to  increase the awareness of and dissem-
     2  ination of information about pursuing healthier  lifestyles,  and  which
     3  warns  about  risks  of  pursuing environmental or behavioral activities

     4  that are detrimental to human health. In addition,  information  on  the
     5  availability  of health screening tests to assist in the early identifi-
     6  cation and treatment of diseases such as cancer, heart  disease,  hyper-
     7  tension, diabetes, asthma, obesity or other adverse health afflictions;
     8    (2) a program that encourages behavioral practices that either encour-
     9  ages  healthy  living  activities or discourages unhealthy living activ-
    10  ities. Such activities or practices may include  wellness  programs,  as
    11  provided  under  section  three thousand two hundred thirty-nine of this
    12  article; and
    13    (3) the monitoring of the progress of each covered person to track his
    14  or her adherence to such wellness program and to provide assistance  and

    15  moral  support to such covered person to assist him or her to attain the
    16  goals of the covered person's wellness program.
    17    Such wellness program shall demonstrate actuarially that it encourages
    18  the general good health and well-being of the  covered  population.  The
    19  insurer  or  health  maintenance organization shall not require specific
    20  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
    21  approved wellness program.
    22    §  2.  Subsections  (a),  (b) and (c) of section 3239 of the insurance
    23  law, as added by chapter 592 of the laws of 2008, paragraphs 6 and 7  of
    24  subsection  (b)  and  subparagraphs  (C)  and  (D)  of  paragraph  2  of
    25  subsection (c) as amended, and paragraph 8 of subsection (b) and subpar-

    26  agraphs (E) and (F) of paragraph 2 of subsection (c) as added by chapter
    27  519 of the laws of 2013, are amended to read as follows:
    28    (a) An insurer licensed to write  accident  and  health  insurance,  a
    29  corporation organized pursuant to article forty-three of this chapter, a
    30  health maintenance organization certified pursuant to article forty-four
    31  of  the  public  health  law and a municipal cooperative health benefits
    32  plan may establish a wellness program in conjunction with  its  issuance
    33  of  a  group  accident  and  health insurance policy or group subscriber
    34  contract. A "wellness program" is a program designed to  promote  health
    35  and  prevent disease that may contain rewards and incentives for partic-
    36  ipation. Participation in the wellness program  shall  be  available  to
    37  similarly-situated  members  of  the group and shall be voluntary on the

    38  part of the member. The specific terms of the wellness program shall  be
    39  set  forth in the policy or contract, or in a separate document provided
    40  to insureds and members which shall be consistent with the provisions of
    41  this section.
    42    (b) A wellness program may include, but is not limited to, the follow-
    43  ing programs or services:
    44    (1) the use of a health risk assessment tool;
    45    (2) a smoking cessation program;
    46    (3) a weight management program;
    47    (4) a stress and/or hypertension management program;
    48    (5) a worker injury prevention program;
    49    (6) a nutrition education program;
    50    (7) health or fitness incentive programs; [and]
    51    (8) a coordinated weight management, nutrition, stress management  and
    52  physical  fitness  program  to  combat  the  high incidence of adult and

    53  childhood obesity, asthma and other chronic respiratory conditions[.];
    54    (9) assistance, financial or otherwise, provided to  an  employer  for
    55  health promotion and disease prevention;

        S. 2331--B                          3
 
     1    (10) incentives for insureds or members to access preventive services,
     2  such as mammography screening;
     3    (11) a substance or alcohol abuse cessation program; and
     4    (12) a program to manage and cope with chronic pain.
     5    (c)(1)  A  wellness program may use rewards and incentives for partic-
     6  ipation provided  that  where  the  group  health  insurance  policy  or
     7  subscriber  contract  is required to be community-rated, the rewards and
     8  incentives shall not include a discounted premium rate or  a  rebate  or

     9  refund  of  premium,  except  as  provided in section three thousand two
    10  hundred thirty-one of this article, or section four thousand two hundred
    11  thirty-five, four thousand three  hundred  seventeen  or  four  thousand
    12  three  hundred twenty-six of this chapter, or section forty-four hundred
    13  five of the public health law.
    14    (2) Permissible rewards and incentives may include:
    15    (A) full or partial reimbursement of  the  cost  of  participating  in
    16  smoking  cessation  [or], weight management, stress and/or hypertension,
    17  worker injury prevention,  nutrition  education,  substance  or  alcohol
    18  abuse cessation, or chronic pain management and coping programs;
    19    (B)  full  or  partial  reimbursement  of  the cost of membership in a

    20  health club or fitness center;
    21    (C) the waiver or reduction of copayments, coinsurance and deductibles
    22  for preventive services covered under the  group  policy  or  subscriber
    23  contract;
    24    (D)  monetary  rewards in the form of gift cards or gift certificates,
    25  so long as the recipient of the reward is encouraged to use  the  reward
    26  for  a  product  or a service that promotes good health, such as healthy
    27  cook books, over the counter vitamins or exercise equipment;
    28    (E) full or partial reimbursement of the cost of  participating  in  a
    29  stress management program or activity; and
    30    (F)  full  or  partial reimbursement of the cost of participating in a
    31  health or fitness program.
    32    (3) Where the reward involves a group  member's  meeting  a  specified
    33  standard based on a health condition, the wellness program must meet the
    34  requirements of 45 CFR Part 146.

    35    (4)  A reward or incentive which involves a discounted premium rate or
    36  a rebate or refund of premium shall be based on actuarial  demonstration
    37  that  the  wellness  program can reasonably be expected to result in the
    38  overall good health and well being of the group as provided  in  section
    39  three  thousand  two  hundred  thirty-one of this article, sections four
    40  thousand two hundred thirty-five, four thousand three hundred  seventeen
    41  and  four thousand three hundred twenty-six of this chapter, and section
    42  forty-four hundred five of the public health law.
    43    § 3. Subsection (h) of section 4235 of the insurance law is amended by
    44  adding a new paragraph 5 to read as follows:
    45    (5) Each insurer doing business in this state, when  filing  with  the

    46  superintendent  its schedules of premium rates, rules and classification
    47  of risks for use in connection with the  issuance  of  its  policies  of
    48  group accident, group health or group accident and health insurance, may
    49  provide  for  an  actuarially  appropriate reduction in premium rates or
    50  other benefits or enhancements approved by the superintendent to encour-
    51  age an enrollee's or insured's active participation in a qualified well-
    52  ness program. A qualified wellness program  can  be  a  risk  management
    53  system  that  identifies  at-risk  populations  or  any other systematic
    54  program or course of medical conduct which helps to promote physical and
    55  mental fitness, health and well-being, helps to prevent or mitigate  the

    56  conditions of acute or chronic sickness, disease or pain, or which mini-

        S. 2331--B                          4
 
     1  mizes  adverse  health  consequences due to lifestyle.   Such a wellness
     2  program may have some or all of the following elements  to  advance  the
     3  physical health and mental well-being of its participants:
     4    (A)  an  education  program  to  increase the awareness of and dissem-
     5  ination of information about pursuing healthier  lifestyles,  and  which
     6  warns  about  risks  of  pursuing environmental or behavioral activities
     7  that are detrimental to human health. In addition,  information  on  the
     8  availability  of health screening tests to assist in the early identifi-

     9  cation and treatment of diseases such as cancer, heart  disease,  hyper-
    10  tension, diabetes, asthma, obesity or other adverse health afflictions;
    11    (B) a program that encourages behavioral practices that either encour-
    12  ages  healthy  living  activities or discourages unhealthy living activ-
    13  ities.  Such activities or practices may include wellness  programs,  as
    14  provided  under  section  three thousand two hundred thirty-nine of this
    15  chapter;
    16    (C) the monitoring of the progress of each covered person to track his
    17  or her adherence to such wellness program and to provide assistance  and
    18  moral  support to such covered person to assist him or her to attain the
    19  goals of the covered person's wellness program.

    20    Such wellness program shall demonstrate actuarially that it encourages
    21  the general good health and well-being of the  covered  population.  The
    22  insurer  or  health  maintenance organization shall not require specific
    23  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
    24  approved wellness program.
    25    §  4.  Section  4317  of  the insurance law is amended by adding a new
    26  subsection (c-1) to read as follows:
    27    (c-1) Subject to the approval of the  superintendent,  an  insurer  or
    28  health  maintenance  organization  issuing an individual or group health
    29  insurance contract pursuant to this section may provide for an  actuari-
    30  ally  appropriate  reduction  in  premium  rates  or  other  benefits or

    31  enhancements approved by the superintendent to encourage  an  enrollee's
    32  or  insured's  active  participation  in a qualified wellness program. A
    33  qualified wellness program can be a risk management system that  identi-
    34  fies  at-risk  populations  or any other systematic program or course of
    35  medical conduct which helps to  promote  physical  and  mental  fitness,
    36  health  and  well-being,  helps to prevent or mitigate the conditions of
    37  acute or chronic sickness, disease or pain, or which  minimizes  adverse
    38  health  consequences due to lifestyle.  Such a wellness program may have
    39  some or all of the following elements to advance the physical health and
    40  mental well-being of its participants:

    41    (1) an education program to increase  the  awareness  of  and  dissem-
    42  ination  of  information  about pursuing healthier lifestyles, and which
    43  warns about risks of pursuing  environmental  or  behavioral  activities
    44  that  are  detrimental  to human health. In addition, information on the
    45  availability of health screening tests to assist in the early  identifi-
    46  cation  and  treatment of diseases such as cancer, heart disease, hyper-
    47  tension, diabetes, asthma, obesity or other adverse health afflictions;
    48    (2) a program that encourages behavioral practices that either encour-
    49  ages healthy living activities or discourages  unhealthy  living  activ-
    50  ities.  Such  activities  or practices may include wellness programs, as

    51  provided under section three thousand two hundred  thirty-nine  of  this
    52  chapter; and
    53    (3) the monitoring of the progress of each covered person to track his
    54  or  her adherence to such wellness program and to provide assistance and
    55  moral support to such covered person to assist him or her to attain  the
    56  goals of the covered person's wellness program.

        S. 2331--B                          5
 
     1    Such wellness program shall demonstrate actuarially that it encourages
     2  the  general  good  health and well-being of the covered population. The
     3  insurer or health maintenance organization shall  not  require  specific
     4  outcomes  as  a  result  of  an enrollee's or insured's adherence to the

     5  approved wellness program.
     6    § 5. Subsection (m) of section 4326 of the insurance law is amended by
     7  adding a new paragraph 4 to read as follows:
     8    (4)  approval  of the superintendent, an insurer or health maintenance
     9  organization issuing a contract for qualifying small employers or  indi-
    10  viduals  pursuant  to this section may provide for an actuarially appro-
    11  priate reduction in premium rates  or  other  benefits  or  enhancements
    12  approved  by  the superintendent to encourage an enrollee's or insured's
    13  active participation in a qualified wellness program. A qualified  well-
    14  ness  program  can  be  a risk management system that identifies at-risk
    15  populations or any other systematic program or course of medical conduct

    16  which helps to promote physical and mental fitness, health and  well-be-
    17  ing,  helps  to  prevent  or mitigate the conditions of acute or chronic
    18  sickness, disease or pain, or  which  minimizes  adverse  health  conse-
    19  quences  due to lifestyle.  Such a wellness program may have some or all
    20  of the following elements to advance  the  physical  health  and  mental
    21  well-being of its participants:
    22    (1)  an  education  program  to  increase the awareness of and dissem-
    23  ination of information about pursuing healthier  lifestyles,  and  which
    24  warns  about  risks  of  pursuing environmental or behavioral activities
    25  that are detrimental to human health. In addition,  information  on  the

    26  availability  of health screening tests to assist in the early identifi-
    27  cation and treatment of diseases such as cancer, heart  disease,  hyper-
    28  tension, diabetes, asthma, obesity or other adverse health afflictions;
    29    (2) a program that encourages behavioral practices that either encour-
    30  ages  healthy  living  activities or discourages unhealthy living activ-
    31  ities. Such activities or practices may include  wellness  programs,  as
    32  provided  under  section  three thousand two hundred thirty-nine of this
    33  chapter; and
    34    (3) the monitoring of the progress of each covered person to track his
    35  or her adherence to such wellness program and to provide assistance  and
    36  moral  support to such covered person to assist him or her to attain the

    37  goals of the covered person's wellness program.
    38    Such wellness program shall demonstrate actuarially that it encourages
    39  the general good health and well-being of the  covered  population.  The
    40  insurer  or  health  maintenance organization shall not require specific
    41  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
    42  approved wellness program.
    43    §  6. Section 4405 of the public health law is amended by adding a new
    44  subdivision 5-a to read as follows:
    45    5-a. subject to  the  approval  of  the  superintendent  of  financial
    46  services, the possible providing of an actuarially appropriate reduction
    47  in  premium  rates  or  other  benefits  or enhancements approved by the

    48  superintendent of financial services to encourage an  enrollee's  active
    49  participation  in  a  qualified  wellness  program. A qualified wellness
    50  program can be a risk management system that  identifies  at-risk  popu-
    51  lations  or  any  other  systematic program or course of medical conduct
    52  which helps to promote physical and mental fitness, health and  well-be-
    53  ing,  helps  to  prevent  or mitigate the conditions of acute or chronic
    54  sickness, disease or pain, or  which  minimizes  adverse  health  conse-
    55  quences  due to lifestyle.  Such a wellness program may have some or all

        S. 2331--B                          6
 
     1  of the following elements to advance  the  physical  health  and  mental
     2  well-being of its participants:

     3    (1)  an  education  program  to  increase the awareness of and dissem-
     4  ination of information about pursuing healthier  lifestyles,  and  which
     5  warns  about  risks  of  pursuing environmental or behavioral activities
     6  that are detrimental to human health. In addition,  information  on  the
     7  availability  of health screening tests to assist in the early identifi-
     8  cation and treatment of diseases such as cancer, heart  disease,  hyper-
     9  tension, diabetes, asthma, obesity or other adverse health afflictions;
    10    (2) a program that encourages behavioral practices that either encour-
    11  ages  healthy  living  activities or discourages unhealthy living activ-
    12  ities. Such activities or practices may include  wellness  programs,  as

    13  provided  under  section  three  thousand two hundred thirty-nine of the
    14  insurance law; and
    15    (3) the monitoring of the progress of each covered person to track his
    16  or her adherence to such wellness program and to provide assistance  and
    17  moral  support to such covered person to assist him or her to attain the
    18  goals of the covered person's wellness program.
    19    Such wellness program shall demonstrate actuarially that it encourages
    20  the general good health and well-being of the  covered  population.  The
    21  health maintenance organization shall not require specific outcomes as a
    22  result of an enrollee's adherence to the approved wellness program;
    23    § 7. This act shall take effect on the one hundred eightieth day after

    24  it  shall  have  become  a law; provided that, effective immediately any
    25  rules and regulations necessary to implement the provisions of this  act
    26  on  its  effective date are authorized and directed to be added, amended
    27  and/or repealed on or before such date.
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