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A05535 Summary:

BILL NOA05535
 
SAME ASSAME AS S01783
 
SPONSORGjonaj (MS)
 
COSPNSRJaffee, Stirpe, Benedetto, Colton, Crespo, Otis, Raia, Skoufis, Steck, Lupardo, McDonald, Gottfried, Hooper, Pichardo, Garbarino, Cook
 
MLTSPNSRBarclay, Blankenbush, Braunstein, D'Urso, Englebright, Friend, Galef, Peoples-Stokes, Perry, Rivera, Sepulveda, Skartados, Titone, Wright
 
Amd §§3231, 3239, 4235, 4317 & 4326, Ins L; amd §4405, 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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A05535 Actions:

BILL NOA05535
 
02/10/2017referred to insurance
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A05535 Committee Votes:

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A05535 Floor Votes:

There are no votes for this bill in this legislative session.
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A05535 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          5535
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    February 10, 2017
                                       ___________
 
        Introduced  by M. of A. GJONAJ, JAFFEE, STIRPE, BENEDETTO, COLTON, CRES-
          PO, KEARNS, OTIS, RAIA, SKOUFIS, STECK, LUPARDO, McDONALD,  GOTTFRIED,
          HOOPER, PICHARDO, GARBARINO -- Multi-Sponsored by -- M. of A. BLANKEN-
          BUSH, BRAUNSTEIN, GALEF, LOPEZ, LUPINACCI, McLAUGHLIN, PEOPLES-STOKES,
          PERRY,  RIVERA,  SEPULVEDA,  SIMANOWITZ,  SKARTADOS, TITONE, WRIGHT --
          read once and referred to the Committee on Insurance
 
        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:
    18    (1) an education program to increase  the  awareness  of  and  dissem-
    19  ination  of  information  about pursuing healthier lifestyles, and which
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD07344-01-7

        A. 5535                             2
 
     1  warns about risks of pursuing  environmental  or  behavioral  activities
     2  that  are  detrimental  to human health. In addition, information on the
     3  availability of health screening tests to assist in the early  identifi-
     4  cation  and  treatment of diseases such as cancer, heart disease, hyper-
     5  tension, diabetes, asthma, obesity or other adverse health afflictions;
     6    (2) a program that encourages behavioral practices that either encour-
     7  age healthy living activities or discourage unhealthy living activities.
     8  Such activities or practices may include wellness programs, as  provided
     9  under  section  three  thousand two hundred thirty-nine of this article;
    10  and
    11    (3) the monitoring of the progress of each covered person to track his
    12  or her adherence to such wellness program and to provide assistance  and
    13  moral  support to such covered person to assist him or her to attain the
    14  goals of the covered person's wellness program.
    15    Such wellness program shall demonstrate actuarially that it encourages
    16  the general good health and well-being of the  covered  population.  The
    17  insurer  or  health  maintenance organization shall not require specific
    18  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
    19  approved wellness program.
    20    §  2.  Subsections  (a),  (b) and (c) of section 3239 of the insurance
    21  law, subsection (a) as added by chapter 592 of the  laws  of  2008,  and
    22  subsections  (b)  and (c) as amended by chapter 180 of the laws of 2016,
    23  are amended to read as follows:
    24    (a) An insurer licensed to write  accident  and  health  insurance,  a
    25  corporation organized pursuant to article forty-three of this chapter, a
    26  health maintenance organization certified pursuant to article forty-four
    27  of  the  public  health  law and a municipal cooperative health benefits
    28  plan may establish a wellness program in conjunction with  its  issuance
    29  of  a  group  accident  and  health insurance policy or group subscriber
    30  contract. A "wellness program" is a program designed to  promote  health
    31  and  prevent disease that may contain rewards and incentives for partic-
    32  ipation. Participation in the wellness program  shall  be  available  to
    33  similarly-situated  members  of  the group and shall be voluntary on the
    34  part of the member. The specific terms of the wellness program shall  be
    35  set  forth in the policy or contract, or in a separate document provided
    36  to insureds and members which shall be consistent with the provisions of
    37  this section.
    38    (b) A wellness program may include, but is not limited to, the follow-
    39  ing programs or services:
    40    (1) the use of a health risk assessment tool;
    41    (2) a smoking cessation program;
    42    (3) a weight management program;
    43    (4) a stress and/or hypertension management program;
    44    (5) a worker injury prevention program;
    45    (6) a nutrition education program;
    46    (7) health or fitness incentive programs;
    47    (8) a coordinated weight management, nutrition, stress management  and
    48  physical  fitness  program  to  combat  the  high incidence of adult and
    49  childhood obesity, asthma and other chronic respiratory conditions;
    50    (9) a substance or alcohol abuse cessation program; [and]
    51    (10) a program to manage and cope with chronic pain[.] ;
    52    (11) assistance, financial or otherwise, provided to an  employer  for
    53  health promotion and disease prevention; and
    54    (12) incentives for insureds or members to access preventive services,
    55  such as mammography screening.

        A. 5535                             3
 
     1    (c)(1)  A  wellness program may use rewards and incentives for partic-
     2  ipation provided  that  where  the  group  health  insurance  policy  or
     3  subscriber  contract  is required to be community-rated, the rewards and
     4  incentives shall not include a discounted premium rate or  a  rebate  or
     5  refund  of  premium,  except  as  provided in section three thousand two
     6  hundred thirty-one of this article, or section four thousand two hundred
     7  thirty-five, four thousand three  hundred  seventeen  or  four  thousand
     8  three  hundred twenty-six of this chapter, or section forty-four hundred
     9  five of the public health law.
    10    (2) Permissible rewards and incentives may include:
    11    (A) full or partial reimbursement of  the  cost  of  participating  in
    12  smoking cessation, weight management, stress and/or hypertension, worker
    13  injury  prevention,  nutrition  education,  substance  or  alcohol abuse
    14  cessation, or chronic pain management and coping programs;
    15    (B) full or partial reimbursement of  the  cost  of  membership  in  a
    16  health club or fitness center;
    17    (C) the waiver or reduction of copayments, coinsurance and deductibles
    18  for  preventive  services  covered  under the group policy or subscriber
    19  contract;
    20    (D) monetary rewards in the form of gift cards or  gift  certificates,
    21  so  long  as the recipient of the reward is encouraged to use the reward
    22  for a product or a service that promotes good health,  such  as  healthy
    23  cook books, over the counter vitamins or exercise equipment;
    24    (E)  full  or  partial reimbursement of the cost of participating in a
    25  stress management program or activity; and
    26    (F) full or partial reimbursement of the cost of  participating  in  a
    27  health or fitness program.
    28    (3)  Where  the  reward  involves a group member's meeting a specified
    29  standard based on a health condition, the wellness program must meet the
    30  requirements of 45 CFR Part 146.
    31    (4) A reward or incentive which involves a discounted premium rate  or
    32  a  rebate or refund of premium shall be based on actuarial demonstration
    33  that the wellness program can reasonably be expected to  result  in  the
    34  overall  good health and well being of the group  as provided in section
    35  three thousand two hundred thirty-one of  this  article,  sections  four
    36  thousand  two hundred thirty-five, four thousand three hundred seventeen
    37  and four thousand three hundred twenty-six of this chapter, and  section
    38  forty-four hundred five of the public health law.
    39    § 3. Subsection (h) of section 4235 of the insurance law is amended by
    40  adding a new paragraph 5 to read as follows:
    41    (5)  Each  insurer  doing business in this state, when filing with the
    42  superintendent its schedules of premium rates, rules and  classification
    43  of  risks  for  use  in  connection with the issuance of its policies of
    44  group accident, group health or group accident and health insurance, may
    45  provide for an actuarially appropriate reduction  in  premium  rates  or
    46  other benefits or enhancements approved by the superintendent to encour-
    47  age an enrollee's or insured's active participation in a qualified well-
    48  ness  program.  A  qualified  wellness  program can be a risk management
    49  system that identifies  at-risk  populations  or  any  other  systematic
    50  program or course of medical conduct which helps to promote physical and
    51  mental  fitness, health and well-being, helps to prevent or mitigate the
    52  conditions of acute or chronic sickness, disease or pain, or which mini-
    53  mizes adverse health consequences due to lifestyle.    Such  a  wellness
    54  program  may  have  some or all of the following elements to advance the
    55  physical health and mental well-being of its participants:

        A. 5535                             4
 
     1    (A) 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    (B) a program that encourages behavioral practices that either encour-
     9  age healthy living activities or discourage unhealthy living activities.
    10  Such  activities or practices may include wellness programs, as provided
    11  under section three thousand two hundred thirty-nine of this chapter;
    12    (C) the monitoring of the progress of each covered person to track his
    13  or her adherence to such wellness program and to provide assistance  and
    14  moral  support to such covered person to assist him or her to attain the
    15  goals of the covered person's wellness program.
    16    Such wellness program shall demonstrate actuarially that it encourages
    17  the general good health and well-being of the  covered  population.  The
    18  insurer  or  health  maintenance organization shall not require specific
    19  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
    20  approved wellness program.
    21    §  4.  Section  4317  of  the insurance law is amended by adding a new
    22  subsection (c-1) to read as follows:
    23    (c-1) Subject to the approval of the  superintendent,  an  insurer  or
    24  health  maintenance  organization  issuing an individual or group health
    25  insurance contract pursuant to this section may provide for an  actuari-
    26  ally  appropriate  reduction  in  premium  rates  or  other  benefits or
    27  enhancements approved by the superintendent to encourage  an  enrollee's
    28  or  insured's  active  participation  in a qualified wellness program. A
    29  qualified wellness program can be a risk management system that  identi-
    30  fies  at-risk  populations  or any other systematic program or course of
    31  medical conduct which helps to  promote  physical  and  mental  fitness,
    32  health  and  well-being,  helps to prevent or mitigate the conditions of
    33  acute or chronic sickness, disease or pain, or which  minimizes  adverse
    34  health  consequences due to lifestyle.  Such a wellness program may have
    35  some or all of the following elements to advance the physical health and
    36  mental well-being of its participants:
    37    (1) an education program to increase  the  awareness  of  and  dissem-
    38  ination  of  information  about pursuing healthier lifestyles, and which
    39  warns about risks of pursuing  environmental  or  behavioral  activities
    40  that  are  detrimental  to human health. In addition, information on the
    41  availability of health screening tests to assist in the early  identifi-
    42  cation  and  treatment of diseases such as cancer, heart disease, hyper-
    43  tension, diabetes, asthma, obesity or other adverse health afflictions;
    44    (2) a program that encourages behavioral practices that either encour-
    45  age healthy living activities or discourage unhealthy living activities.
    46  Such activities or practices may include wellness programs, as  provided
    47  under  section  three  thousand two hundred thirty-nine of this chapter;
    48  and
    49    (3) the monitoring of the progress of each covered person to track his
    50  or her adherence to such wellness program and to provide assistance  and
    51  moral  support to such covered person to assist him or her to attain the
    52  goals of the covered person's wellness program.
    53    Such wellness program shall demonstrate actuarially that it encourages
    54  the general good health and well-being of the  covered  population.  The
    55  insurer  or  health  maintenance organization shall not require specific

        A. 5535                             5
 
     1  outcomes as a result of an enrollee's  or  insured's  adherence  to  the
     2  approved wellness program.
     3    § 5. Subsection (m) of section 4326 of the insurance law is amended by
     4  adding a new paragraph 4 to read as follows:
     5    (4)  approval  of the superintendent, an insurer or health maintenance
     6  organization issuing a contract for qualifying small employers or  indi-
     7  viduals  pursuant  to this section may provide for an actuarially appro-
     8  priate reduction in premium rates  or  other  benefits  or  enhancements
     9  approved  by  the superintendent to encourage an enrollee's or insured's
    10  active participation in a qualified wellness program. A qualified  well-
    11  ness  program  can  be  a risk management system that identifies at-risk
    12  populations or any other systematic program or course of medical conduct
    13  which helps to promote physical and mental fitness, health and  well-be-
    14  ing,  helps  to  prevent  or mitigate the conditions of acute or chronic
    15  sickness, disease or pain, or  which  minimizes  adverse  health  conse-
    16  quences  due to lifestyle.  Such a wellness program may have some or all
    17  of the following elements to advance  the  physical  health  and  mental
    18  well-being of its participants:
    19    (A)  an  education  program  to  increase the awareness of and dissem-
    20  ination of information about pursuing healthier  lifestyles,  and  which
    21  warns  about  risks  of  pursuing environmental or behavioral activities
    22  that are detrimental to human health. In addition,  information  on  the
    23  availability  of health screening tests to assist in the early identifi-
    24  cation and treatment of diseases such as cancer, heart  disease,  hyper-
    25  tension, diabetes, asthma, obesity or other adverse health afflictions;
    26    (B) a program that encourages behavioral practices that either encour-
    27  age healthy living activities or discourage unhealthy living activities.
    28  Such  activities or practices may include wellness programs, as provided
    29  under section three thousand two hundred thirty-nine  of  this  chapter;
    30  and
    31    (C) the monitoring of the progress of each covered person to track his
    32  or  her adherence to such wellness program and to provide assistance and
    33  moral support to such covered person to assist him or her to attain  the
    34  goals of the covered person's wellness program.
    35    Such wellness program shall demonstrate actuarially that it encourages
    36  the  general  good  health and well-being of the covered population. The
    37  insurer or health maintenance organization shall  not  require  specific
    38  outcomes  as  a  result  of  an enrollee's or insured's adherence to the
    39  approved wellness program.
    40    § 6. Section 4405 of the public health law is amended by adding a  new
    41  subdivision 5-a to read as follows:
    42    5-a.  subject  to  the  approval  of  the  superintendent of financial
    43  services, the possible providing of an actuarially appropriate reduction
    44  in premium rates or other  benefits  or  enhancements  approved  by  the
    45  superintendent  of  financial services to encourage an enrollee's active
    46  participation in a qualified  wellness  program.  A  qualified  wellness
    47  program  can  be  a risk management system that identifies at-risk popu-
    48  lations or any other systematic program or  course  of  medical  conduct
    49  which  helps to promote physical and mental fitness, health and well-be-
    50  ing, helps to prevent or mitigate the conditions  of  acute  or  chronic
    51  sickness,  disease  or  pain,  or  which minimizes adverse health conse-
    52  quences due to lifestyle.  Such a wellness program may have some or  all
    53  of  the  following  elements  to  advance the physical health and mental
    54  well-being of its participants:
    55    (1) an education program to increase  the  awareness  of  and  dissem-
    56  ination  of  information  about pursuing healthier lifestyles, and which

        A. 5535                             6
 
     1  warns about risks of pursuing  environmental  or  behavioral  activities
     2  that  are  detrimental  to human health. In addition, information on the
     3  availability of health screening tests to assist in the early  identifi-
     4  cation  and  treatment of diseases such as cancer, heart disease, hyper-
     5  tension, diabetes, asthma, obesity or other adverse health afflictions;
     6    (2) a program that encourages behavioral practices that either encour-
     7  age healthy living activities or discourage unhealthy living activities.
     8  Such activities or practices may include wellness programs, as  provided
     9  under  section  three  thousand two hundred thirty-nine of the insurance
    10  law; and
    11    (3) the monitoring of the progress of each covered person to track his
    12  or her adherence to such wellness program and to provide assistance  and
    13  moral  support to such covered person to assist him or her to attain the
    14  goals of the covered person's wellness program.
    15    Such wellness program shall demonstrate actuarially that it encourages
    16  the general good health and well-being of the  covered  population.  The
    17  health maintenance organization shall not require specific outcomes as a
    18  result of an enrollee's adherence to the approved wellness program;
    19    § 7. This act shall take effect on the one hundred eightieth day after
    20  it  shall have become a law; provided that if chapter 180 of the laws of
    21  2016 shall not have taken effect on such effective  date,  then  section
    22  two  of  this  act  shall  take  effect on the same date and in the same
    23  manner as such chapter takes effect; provided  further  effective  imme-
    24  diately  any rules and regulations necessary to implement the provisions
    25  of this act on its effective date are  authorized  and  directed  to  be
    26  added, amended and/or repealed on or before such date.
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