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A00791 Summary:

BILL NOA00791
 
SAME ASSAME AS S02684
 
SPONSORHunter
 
COSPNSR
 
MLTSPNSR
 
Amd §4224, Ins L
 
Allows for insurance providers and corporations to create and offer reward or incentive programs to eligible members.
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A00791 Actions:

BILL NOA00791
 
01/11/2023referred to insurance
01/03/2024referred to insurance
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A00791 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A791
 
SPONSOR: Hunter
  TITLE OF BILL: An act to amend the insurance law, in relation to the offering of reward or incentive programs to eligible members   PURPOSE: The purpose of this bill is to allow insurers to apply to the super- intendent of the Department of Financial Services superintendent for approval to offer optional, voluntary, incentive or reward programs.   SUMMARY OF PROVISIONS: Section 1: Amends Subsection (c) of section 4224 of the insurance law to allow for an insurer licensed to write accident and health insurance in New York to offer an incentive or reward program to support wellness, primary and preventative care, population health, care coordination, case management, disease management, mental health and substance misuse disorder treatment initiatives, evidence-based treatment, or quality and cost containment initiatives. Offers under these programs shall not be considered an inducement. Section 2: Establishes the effective date.   JUSTIFICATION: This legislation would allow certain accident and health insurance companies to apply to the superintendent of the Department of Financial Services (DFS) to be allowed to offer voluntary incentives or rewards programs to support wellness, primary or preventative care, population health, care coordination, care management, disease management, mental health and substance use disorder treatment initiatives, evidence-based treatment, or quality and cost containment activities. Currently, health insurance companies are prohibited from offering incentive based programs through DFS regulation. This proposal would allow for voluntary rewards based programs to be offered by health plans in the same way that car insurance companies and employers can currently offer similar services.   LEGISLATIVE HISTORY: 2020: A.9867-A 2021-22: A4329   FISCAL IMPLICATIONS: None.   EFFECTIVE DATE: This act shall take effect immediately.
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A00791 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                           791
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 11, 2023
                                       ___________
 
        Introduced by M. of A. HUNTER -- read once and referred to the Committee
          on Insurance
 
        AN ACT to amend the insurance law, in relation to the offering of reward
          or incentive programs to eligible members
 
          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 4224 of  the  insurance  law,  as
     2  amended  by  chapter  496  of  the  laws of 2013, is amended and two new
     3  subsections (g) and (h) are added to read as follows:
     4    (c) Except as permitted by section three thousand two hundred  thirty-
     5  nine  of  this  chapter  or [subsection] subsections (f), (g) and (h) of
     6  this section, no such life insurance company and  no  such  savings  and
     7  insurance bank and no officer, agent, solicitor or representative there-
     8  of  and no such insurer doing in this state the business of accident and
     9  health insurance and no  officer,  agent,  solicitor  or  representative
    10  thereof,  and  no  licensed  insurance  broker  and no employee or other
    11  representative of any such insurer, agent or broker, shall pay, allow or
    12  give, or offer to pay, allow or give,  directly  or  indirectly,  as  an
    13  inducement  to any person to insure, or shall give, sell or purchase, or
    14  offer to give, sell or purchase, as such inducement,  or  interdependent
    15  with any policy of life insurance or annuity contract or policy of acci-
    16  dent  and  health  insurance, any stocks, bonds, or other securities, or
    17  any dividends or profits accruing or to accrue thereon, or any  valuable
    18  consideration  or  inducement  whatever  not specified in such policy or
    19  contract other than any valuable consideration, including but not limit-
    20  ed to merchandise or periodical subscriptions, not exceeding twenty-five
    21  dollars in value; nor shall any person in this state  knowingly  receive
    22  as  such  inducement, any rebate of premium or policy fee or any special
    23  favor or advantage in the dividends or other benefits to accrue  on  any
    24  such  policy  or  contract,  or knowingly receive any paid employment or

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02621-01-3

        A. 791                              2
 
     1  contract for services of any kind,  or  any  valuable  consideration  or
     2  inducement whatever which is not specified in such policy or contract.
     3    (g)  (1)  Notwithstanding  subsection  (c) of this section, an insurer
     4  licensed to write accident and health  insurance  in  this  state  or  a
     5  corporation organized pursuant to article forty-three of this chapter or
     6  a  health  maintenance organization certified pursuant to article forty-
     7  four of the public health law may offer an incentive or  reward  program
     8  to  support  wellness, primary and preventative care, population health,
     9  care coordination, case management, disease  management,  mental  health
    10  and substance use disorder treatment initiatives, evidenced-based treat-
    11  ment,  or  quality and cost containment initiatives.  With the exception
    12  of incentives or  rewards  related  to  wellness  programs  governed  by
    13  section  three  thousand  two  hundred  thirty-nine of this chapter, the
    14  total value of such incentives may not exceed an aggregate average value
    15  to the insured of six hundred dollars per year.
    16    (2) Wellness programs offered pursuant to section three  thousand  two
    17  hundred  thirty-nine  of  this  chapter and incentive or reward programs
    18  offered pursuant to this subsection may (i)  target  populations  deter-
    19  mined based on age, sex, or health status; (ii) be offered for a limited
    20  period  or duration that does not align with the policy or contract term
    21  and may include a  sweepstakes,  raffle  or  contest;  and  (iii)  offer
    22  rewards  or  incentives  that  do  not  involve a tangible benefit to be
    23  available to all enrollees or a direct benefit to the enrollee.
    24    (h)(1) This subsection shall apply only with respect to a group  acci-
    25  dent  and health insurance policy issued by an insurer licensed to write
    26  accident and health insurance in this state or a group  contract  issued
    27  by a corporation organized pursuant to article forty-three of this chap-
    28  ter,  excluding  community-rated  policies  or  contracts subject to the
    29  requirements of section three thousand two hundred  thirty-one  or  four
    30  thousand three hundred seventeen of this chapter.
    31    (2)  Notwithstanding  subsection  (c)  of  this  section,  no  insurer
    32  licensed to write accident and health  insurance  in  this  state  or  a
    33  corporation  organized  pursuant to article forty-three of this chapter,
    34  or officer, agent, solicitor or representative thereof shall be  consid-
    35  ered  to be offering an impermissible inducement or rebate if it adjusts
    36  its premiums to reflect payment  of  a  commission  within  a  range  of
    37  commission  options filed with the superintendent in its premium rate or
    38  rate manual. Nor shall a producer or any other person be  considered  to
    39  be  in  violation of this section for accepting or paying a premium rate
    40  that reflects a commission within a permissible range set forth  in  the
    41  premium rate or rate manual filed with the superintendent.
    42    (3)  An  insurer  or  corporation  may  include  a range of commission
    43  options in the premium rate or rate manual filed with the superintendent
    44  to permit adjustment of premiums to  reflect  the  cost  of  commissions
    45  within  the filed ranges. Within the filed range, the applicable commis-
    46  sion may reflect an amount agreed upon by and between a policy holder or
    47  contract holder and the insurer or corporation or  producer  engaged  in
    48  the sale.  The applicable commission may vary by group and a single-case
    49  filing  may  be  submitted  to  the  superintendent  if needed to obtain
    50  approval of a distinct  commission  arrangement.  The  requirements  set
    51  forth in section two thousand one hundred nineteen of this chapter shall
    52  not  apply  where the premium and commission is collected by the insurer
    53  or corporation and consistent with amounts set forth in the premium rate
    54  or rate manual approved by the superintendent.
    55    (4) If a range of commission options is included in the  premium  rate
    56  or  rate  manual  filed with the superintendent for a policy or contract

        A. 791                              3

     1  that is  subject  to  guaranteed  issuance  requirements  set  forth  in
     2  subsection  (t)  of  section  three  thousand two hundred twenty-one and
     3  subsection (n) of section four thousand three hundred five of this chap-
     4  ter,  then  the full range of commission options included in the premium
     5  rate or rate manual filed with the superintendent must be made available
     6  to all similarly situated groups seeking to purchase the coverage.
     7    § 2. This act shall take effect immediately.
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