STATE OF NEW YORK
________________________________________________________________________
1768
2009-2010 Regular Sessions
IN ASSEMBLY
January 12, 2009
___________
Introduced by M. of A. MORELLE, DESTITO, MAGEE, SCHIMMINGER, SCHROEDER,
GUNTHER -- Multi-Sponsored by -- M. of A. CAHILL, DIAZ, ESPAILLAT,
GALEF, HOOPER, HOYT, V. LOPEZ, MARKEY, McENENY, MILLMAN, ORTIZ, PHEF-
FER, P. RIVERA, WALKER, WEISENBERG -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, in relation to standardized health
insurance contracts for qualifying small employers and individuals
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subsection (c) of section 4326 of the insurance law, as
2 added by chapter 1 of the laws of 1999, subparagraph (A) of paragraph 1
3 and subparagraph (C) of paragraph 3 as amended by chapter 419 of the
4 laws of 2000, is amended to read as follows:
5 (c) The following definitions shall be applicable to the insurance
6 contracts offered under the program established by this section:
7 (1) A qualifying small employer is an employer that is either:
8 (A) An individual proprietor who is the only employee of the busi-
9 ness[:
10 (i) without health insurance which provides benefits on an expense
11 reimbursed or prepaid basis in effect during the twelve month period
12 prior to application for a qualifying group health insurance contract
13 under the program established by this section; and
14 (ii)] who resides in a household having a net household income at or
15 below two hundred eight percent of the non-farm federal poverty level
16 (as defined and updated by the federal department of health and human
17 services) or the gross equivalent of such net income;
18 [(iii) except that the requirements set forth in item (i) of this
19 subparagraph shall not be applicable where an individual proprietor had
20 health insurance coverage during the previous twelve months and such
21 coverage terminated due to one of the reasons set forth in items (i)
22 through (viii) of subparagraph (C) of paragraph three of subsection (c)
23 of this section;] or
24 (B) An employer with:
25 (i) not more than fifty eligible employees; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD04177-01-9
A. 1768 2
1 (ii) [no group health insurance which provides benefits on an expense
2 reimbursed or prepaid basis covering employees in effect during the
3 twelve month period prior to application for a qualifying group health
4 insurance contract under the program established by this section; and
5 (iii)] at least thirty percent of its eligible employees receiving
6 annual wages from the employer at a level equal to or less than thirty
7 thousand dollars. The thirty thousand dollar figure shall be adjusted
8 periodically pursuant to subparagraph [(F)] (D) of this paragraph.
9 [(C) The requirements set forth in item (i) of subparagraph (A) of
10 this paragraph and in item (ii) of subparagraph (B) of this paragraph
11 shall not be applicable where an individual proprietor or employer is
12 transferring from a health insurance contract issued pursuant to the New
13 York state small business health insurance partnership program estab-
14 lished by section nine hundred twenty-two of the public health law or
15 from health care coverage issued pursuant to a regional pilot project
16 for the uninsured established by section one thousand one hundred eigh-
17 teen of this chapter.
18 (D) The twelve month period set forth in item (i) of subparagraph (A)
19 of this paragraph and in item (ii) of subparagraph (B) of this paragraph
20 may be adjusted by the superintendent from twelve months to eighteen
21 months if he determines that the twelve month period is insufficient to
22 prevent inappropriate substitution of other health insurance contracts
23 for qualifying group health insurance contracts.
24 (E)] (C) An individual proprietor or employer shall cease to be a
25 qualifying small employer if any health insurance which provides bene-
26 fits on an expense reimbursed or prepaid basis covering the individual
27 proprietor or an employer's employees, other than qualifying group
28 health insurance purchased pursuant to this section, is purchased or
29 otherwise takes effect subsequent to purchase of qualifying group health
30 insurance under the program established by this section.
31 [(F)] (D) The wage levels utilized in subparagraph (B) of this para-
32 graph shall be adjusted annually, beginning in two thousand two. The
33 adjustment shall take effect on July first of each year. For July first,
34 two thousand two, the adjustment shall be a percentage of the annual
35 wage figure specified in subparagraph (B) of this paragraph. For subse-
36 quent years, the adjustment shall be a percentage of the annual wage
37 figure which took effect on July first of the prior year. The percentage
38 adjustment shall be the same percentage by which the current year's
39 non-farm federal poverty level, as defined and updated by the federal
40 department of health and human services, for a family unit of four
41 persons for the forty-eight contiguous states and Washington, D.C.,
42 changed from the same level established for the prior year.
43 (2) A qualifying group health insurance contract is a group contract
44 purchased from a health maintenance organization, corporation or insurer
45 by a qualifying small employer which provides the benefits set forth in
46 subsection (d) of this section. The contract must insure not less than
47 fifty percent of the employees eligible for coverage.
48 (3)[(A)] A qualifying individual is an employed person[:
49 (i) who does not have and has not had health insurance with benefits
50 on an expense reimbursed or prepaid basis during the twelve month period
51 prior to the individual's application for health insurance under the
52 program established by this section;
53 (ii) whose employer does not provide group health insurance and has
54 not provided group health insurance with benefits on an expense reim-
55 bursed or prepaid basis covering employees in effect during the twelve
A. 1768 3
1 month period prior to the individual's application for health insurance
2 under the program established by this section;
3 (iii)] who resides in a household having a net household income at or
4 below two hundred eight percent of the non-farm federal poverty level
5 (as defined and updated by the federal department of health and human
6 services) or the gross equivalent of such net income; and
7 [(iv)] who is ineligible for Medicare.
8 [(B) The requirements set forth in items (i) and (ii) of subparagraph
9 (A) of this paragraph shall not be applicable where an individual is
10 transferring from a health insurance contract issued pursuant to the
11 voucher insurance program established by section one thousand one
12 hundred twenty-one of this chapter, a health insurance contract issued
13 pursuant to the New York state small business health insurance partner-
14 ship program established by section nine hundred twenty-two of the
15 public health law or health care coverage issued pursuant to a regional
16 pilot project for the uninsured established by section one thousand one
17 hundred eighteen of this chapter.
18 (C) The requirements set forth in items (i) and (ii) of subparagraph
19 (A) of this paragraph shall not be applicable where an individual had
20 health insurance coverage during the previous twelve months and such
21 coverage terminated due to:
22 (i) loss of employment due to factors other than voluntary separation;
23 (ii) death of a family member which results in termination of coverage
24 under a health insurance contract under which the individual is covered;
25 (iii) change to a new employer that does not provide group health
26 insurance with benefits on an expense reimbursed or prepaid basis;
27 (iv) change of residence so that no employer-based health insurance
28 with benefits on an expense reimbursed or prepaid basis is available;
29 (v) discontinuation of a group health insurance contract with benefits
30 on an expense reimbursed or prepaid basis covering the qualifying indi-
31 vidual as an employee or dependent;
32 (vi) expiration of the coverage periods established by the continua-
33 tion provisions of the Employee Retirement Income Security Act, 29
34 U.S.C. section 1161 et seq. and the Public Health Service Act, 42
35 U.S.C. section 300bb-1 et seq. established by the Consolidated Omnibus
36 Budget Reconciliation Act of 1985, as amended, or the continuation
37 provisions of subsection (m) of section three thousand two hundred twen-
38 ty-one, subsection (k) of section four thousand three hundred four and
39 subsection (e) of section four thousand three hundred five of this chap-
40 ter;
41 (vii) legal separation, divorce or annulment which results in termi-
42 nation of coverage under a health insurance contract under which the
43 individual is covered; or
44 (viii) loss of eligibility under a group health plan.
45 (D) The twelve month period set forth in items (i) and (ii) of subpar-
46 agraph (A) of this paragraph may be adjusted by the superintendent from
47 twelve months to eighteen months if he determines that the twelve month
48 period is insufficient to prevent inappropriate substitution of other
49 health insurance contracts for qualifying individual health insurance
50 contracts.]
51 (4) A qualifying individual health insurance contract is an individual
52 contract issued directly to a qualifying individual and which provides
53 the benefits set forth in subsection (d) of this section. At the option
54 of the qualifying individual, such contract may include coverage for
55 dependents of the qualifying individual.
56 § 2. This act shall take effect January 1, 2010.
