STATE OF NEW YORK
________________________________________________________________________
172
2019-2020 Regular Sessions
IN ASSEMBLY(Prefiled)
January 9, 2019
___________
Introduced by M. of A. CAHILL, GARBARINO, STIRPE, HEVESI, MAGNARELLI,
ZEBROWSKI, STECK, QUART, RAIA, FRIEND, KOLB -- Multi-Sponsored by --
M. of A. FITZPATRICK, STEC -- 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 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:
19 (1) Notwithstanding any other provision of this chapter, no insurer,
20 subsidiary of an insurer, or controlled person of a holding company
21 system may act as an administrator or claims paying agent, as opposed to
22 an insurer, on behalf of small groups which, if they purchased insur-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01889-01-9
A. 172 2
1 ance, would be subject to this section. No insurer may provide stop
2 loss, catastrophic or reinsurance coverage to small groups which, if
3 they purchased insurance, would be subject to this section. Provided,
4 however, the provisions of this paragraph shall not apply to: (A) the
5 renewal of stop loss, catastrophic or reinsurance coverage issued and in
6 effect on January first, two thousand fifteen to small groups covering
7 between fifty-one and one hundred employees or members of the group; and
8 (B) the issuance between January first, two thousand sixteen and Decem-
9 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or
10 reinsurance coverage, and any renewal thereof, to a small group covering
11 between fifty-one and one hundred employees or members of the group,
12 provided that such group had stop loss, catastrophic or reinsurance
13 coverage issued and in effect on January first, two thousand fifteen.
14 For purposes of this subsection, "small group" shall mean a group
15 comprised of between one and fifty employees or members, exclusive of
16 spouses and dependents.
17 § 3. Paragraph 1 of subsection (h) of section 3231 of the insurance
18 law, as added by chapter 501 of the laws of 1992, is amended to read as
19 follows:
20 (1) Notwithstanding any other provision of this chapter, no insurer,
21 subsidiary of an insurer, or controlled person of a holding company
22 system may act as an administrator or claims paying agent, as opposed to
23 an insurer, on behalf of small groups which, if they purchased insur-
24 ance, would be subject to this section. No insurer, subsidiary of an
25 insurer, or controlled person of a holding company may provide stop
26 loss, catastrophic or reinsurance coverage to small groups which, if
27 they purchased insurance, would be subject to this section. For purposes
28 of this subsection, "small group" shall mean a group comprised of
29 between one and fifty employees or members, exclusive of spouses and
30 dependents.
31 § 4. Paragraph 1 of subsection (a) of section 4317 of the insurance
32 law, as amended by section 72 of part D of chapter 56 of the laws of
33 2013, is amended to read as follows:
34 (1) No individual health insurance contract and no group health insur-
35 ance contract covering between one and fifty employees or members of the
36 group, except as set forth in subsection (e) of this section, or between
37 one and one hundred employees or members of the group for policies
38 issued or renewed on or after January first, two thousand sixteen exclu-
39 sive of spouses and dependents, including contracts for which the premi-
40 ums are paid by a remitting agent for a group, hereinafter referred to
41 as a small group, providing hospital and/or medical benefits, including
42 Medicare supplemental insurance, shall be issued in this state unless
43 such contract is community rated and, notwithstanding any other
44 provisions of law, the underwriting of such contract involves no more
45 than the imposition of a pre-existing condition limitation if otherwise
46 permitted by this article.
47 § 5. Paragraph 1 of subsection (e) of section 4317 of the insurance
48 law, as amended by chapter 12 of the laws of 2016, is amended to read as
49 follows:
50 (1) Notwithstanding any other provision of this chapter, no insurer,
51 subsidiary of an insurer, or controlled person of a holding company
52 system may act as an administrator or claims paying agent, as opposed to
53 an insurer, on behalf of small groups which, if they purchased insur-
54 ance, would be subject to this section. No insurer may provide stop
55 loss, catastrophic or reinsurance coverage to small groups which, if
56 they purchased insurance, would be subject to this section. Provided,
A. 172 3
1 however, the provisions of this paragraph shall not apply to: (A) the
2 renewal of stop loss, catastrophic or reinsurance coverage issued and in
3 effect on January first, two thousand fifteen to small groups covering
4 between fifty-one and one hundred employees or members of the group; and
5 (B) the issuance between January first, two thousand sixteen, and Decem-
6 ber thirty-first, two thousand sixteen, of stop loss, catastrophic or
7 reinsurance coverage, and any renewal thereof, to a small group covering
8 between fifty-one and one hundred employees or members of the group,
9 provided that such group had stop loss, catastrophic or reinsurance
10 coverage issued and in effect on January first, two thousand fifteen.
11 For purposes of this subsection, "small group" shall mean a group
12 comprised of between one and fifty employees or members, exclusive of
13 spouses and dependents.
14 § 6. Paragraph 1 of subsection (e) of section 4317 of the insurance
15 law, as amended by section 72 of part D of chapter 56 of the laws of
16 2013, is amended to read as follows:
17 (1) Notwithstanding any other provision of this chapter, no insurer,
18 subsidiary of an insurer, or controlled person of a holding company
19 system may act as an administrator or claims paying agent, as opposed to
20 an insurer, on behalf of small groups which, if they purchased insur-
21 ance, would be subject to this section. No insurer, subsidiary of an
22 insurer, or controlled person of a holding company may provide stop
23 loss, catastrophic or reinsurance coverage to small groups which, if
24 they purchased insurance, would be subject to this section. For
25 purposes of this subsection, "small group" shall mean a group comprised
26 of between one and fifty employees or members, exclusive of spouses and
27 dependents.
28 § 7. This act shall take effect immediately; provided, however the
29 amendments to paragraph 1 of subsection (h) of section 3231 of the
30 insurance law made by section two of this act shall be subject to the
31 expiration and reversion of such paragraph pursuant to section 5 of
32 chapter 588 of the laws of 2015, as amended, when upon such date the
33 provisions of section three of this act shall take effect; and provided,
34 further, the amendments to paragraph 1 of subsection (e) of section 4317
35 of the insurance law made by section five of this act shall be subject
36 to the expiration and reversion of such paragraph pursuant to section 5
37 of chapter 588 of the laws of 2015, as amended, when upon such date the
38 provisions of section six of this act shall take effect.