STATE OF NEW YORK
________________________________________________________________________
99--A
2017-2018 Regular Sessions
IN ASSEMBLY(Prefiled)
January 4, 2017
___________
Introduced by M. of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI,
ZEBROWSKI, STECK, QUART, RAIA, BRINDISI, OAKS, FRIEND, KOLB -- Multi-
Sponsored by -- M. of A. FITZPATRICK, STEC -- read once and referred
to the Committee on Insurance -- recommitted to the Committee on
Insurance in accordance with Assembly Rule 3, sec. 2 -- committee
discharged, bill amended, ordered reprinted as amended and recommitted
to said committee
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:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01398-03-8
A. 99--A 2
1 (1) Notwithstanding any other provision of this chapter, no insurer,
2 subsidiary of an insurer, or controlled person of a holding company
3 system may act as an administrator or claims paying agent, as opposed to
4 an insurer, on behalf of small groups which, if they purchased insur-
5 ance, would be subject to this section. No insurer may provide stop
6 loss, catastrophic or reinsurance coverage to small groups which, if
7 they purchased insurance, would be subject to this section. Provided,
8 however, the provisions of this paragraph shall not apply to: (A) the
9 renewal of stop loss, catastrophic or reinsurance coverage issued and in
10 effect on January first, two thousand fifteen to small groups covering
11 between fifty-one and one hundred employees or members of the group; and
12 (B) the issuance between January first, two thousand sixteen and Decem-
13 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or
14 reinsurance coverage, and any renewal thereof, to a small group covering
15 between fifty-one and one hundred employees or members of the group,
16 provided that such group had stop loss, catastrophic or reinsurance
17 coverage issued and in effect on January first, two thousand fifteen.
18 For purposes of this subsection, "small group" shall mean a group
19 comprised of between one and fifty employees or members, exclusive of
20 spouses and dependents.
21 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance
22 law, as added by chapter 501 of the laws of 1992, is amended to read as
23 follows:
24 (1) Notwithstanding any other provision of this chapter, no insurer,
25 subsidiary of an insurer, or controlled person of a holding company
26 system may act as an administrator or claims paying agent, as opposed to
27 an insurer, on behalf of small groups which, if they purchased insur-
28 ance, would be subject to this section. No insurer, subsidiary of an
29 insurer, or controlled person of a holding company may provide stop
30 loss, catastrophic or reinsurance coverage to small groups which, if
31 they purchased insurance, would be subject to this section. For purposes
32 of this subsection, "small group" shall mean a group comprised of
33 between one and fifty employees or members, exclusive of spouses and
34 dependents.
35 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance
36 law, as amended by section 72 of part D of chapter 56 of the laws of
37 2013, is amended to read as follows:
38 (1) No individual health insurance contract and no group health insur-
39 ance contract covering between one and fifty employees or members of the
40 group, except as set forth in subsection (e) of this section, or between
41 one and one hundred employees or members of the group for policies
42 issued or renewed on or after January first, two thousand sixteen exclu-
43 sive of spouses and dependents, including contracts for which the premi-
44 ums are paid by a remitting agent for a group, hereinafter referred to
45 as a small group, providing hospital and/or medical benefits, including
46 Medicare supplemental insurance, shall be issued in this state unless
47 such contract is community rated and, notwithstanding any other
48 provisions of law, the underwriting of such contract involves no more
49 than the imposition of a pre-existing condition limitation if otherwise
50 permitted by this article.
51 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance
52 law, as amended by chapter 12 of the laws of 2016, is amended to read as
53 follows:
54 (1) Notwithstanding any other provision of this chapter, no insurer,
55 subsidiary of an insurer, or controlled person of a holding company
56 system may act as an administrator or claims paying agent, as opposed to
A. 99--A 3
1 an insurer, on behalf of small groups which, if they purchased insur-
2 ance, would be subject to this section. No insurer may provide stop
3 loss, catastrophic or reinsurance coverage to small groups which, if
4 they purchased insurance, would be subject to this section. Provided,
5 however, the provisions of this paragraph shall not apply to: (A) the
6 renewal of stop loss, catastrophic or reinsurance coverage issued and in
7 effect on January first, two thousand fifteen to small groups covering
8 between fifty-one and one hundred employees or members of the group; and
9 (B) the issuance between January first, two thousand sixteen, and Decem-
10 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or
11 reinsurance coverage, and any renewal thereof, to a small group covering
12 between fifty-one and one hundred employees or members of the group,
13 provided that such group had stop loss, catastrophic or reinsurance
14 coverage issued and in effect on January first, two thousand fifteen.
15 For purposes of this subsection, "small group" shall mean a group
16 comprised of between one and fifty employees or members, exclusive of
17 spouses and dependents.
18 § 6. Paragraph 1 of subsection (e) of section 4317 of the insurance
19 law, as amended by section 72 of part D of chapter 56 of the laws of
20 2013, is amended to read as follows:
21 (1) Notwithstanding any other provision of this chapter, no insurer,
22 subsidiary of an insurer, or controlled person of a holding company
23 system may act as an administrator or claims paying agent, as opposed to
24 an insurer, on behalf of small groups which, if they purchased insur-
25 ance, would be subject to this section. No insurer, subsidiary of an
26 insurer, or controlled person of a holding company may provide stop
27 loss, catastrophic or reinsurance coverage to small groups which, if
28 they purchased insurance, would be subject to this section. For
29 purposes of this subsection, "small group" shall mean a group comprised
30 of between one and fifty employees or members, exclusive of spouses and
31 dependents.
32 § 7. This act shall take effect immediately; provided, however the
33 amendments to paragraph 1 of subsection (h) of section 3231 of the
34 insurance law made by section two of this act shall be subject to the
35 expiration and reversion of such paragraph pursuant to section 5 of
36 chapter 588 of the laws of 2015, as amended, when upon such date the
37 provisions of section three of this act shall take effect; and provided,
38 further, the amendments to paragraph 1 of subsection (e) of section 4317
39 of the insurance law made by section five of this act shall be subject
40 to the expiration and reversion of such paragraph pursuant to section 5
41 of chapter 588 of the laws of 2015, as amended, when upon such date the
42 provisions of section six of this act shall take effect.