senate Bill S2331

Amended

Authorizes health insurers to provide actuarially appropriate reductions in health insurance premiums for participation in a wellness program

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 16 / Jan / 2013
    • REFERRED TO INSURANCE
  • 08 / Jan / 2014
    • REFERRED TO INSURANCE
  • 23 / Jan / 2014
    • AMEND AND RECOMMIT TO INSURANCE
  • 23 / Jan / 2014
    • PRINT NUMBER 2331A
  • 05 / May / 2014
    • 1ST REPORT CAL.489
  • 06 / May / 2014
    • 2ND REPORT CAL.
  • 07 / May / 2014
    • ADVANCED TO THIRD READING
  • 19 / May / 2014
    • AMENDED ON THIRD READING 2331B
  • 10 / Jun / 2014
    • PASSED SENATE
  • 10 / Jun / 2014
    • DELIVERED TO ASSEMBLY
  • 10 / Jun / 2014
    • REFERRED TO INSURANCE

Summary

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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Bill Details

See Assembly Version of this Bill:
A5302
Versions:
S2331
S2331A
S2331B
Legislative Cycle:
2013-2014
Current Committee:
Assembly Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 3239, 4235, 4317 & 4326, Ins L; amd §4405, Pub Health L
Versions Introduced in 2011-2012 Legislative Cycle:
S4609, A8228

Sponsor Memo

BILL NUMBER:S2331

TITLE OF BILL: 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

PURPOSE: To help curtail future health insurance premium increases,
this bill authorizes health insurers and health maintenance
organizations (HMOs) to offer an actuarially appropriate premium
discount or other benefits or enhancements to covered persons that
participate in a qualified wellness program. Such program must be
approved by the Superintendent of Insurance.

SUMMARY OF PROVISIONS:

Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer
an actuarially appropriate premium discount or other benefits or
enhancements to those individuals that participate in a qualified
wellness program. Such qualified wellness program must be approved by
the Superintendent of Insurance. Further, such qualified Wellness
program can be either a risk management system that identifies at-risk
populations or any other systematic program or course of medical
conduct which helps to promote physical and mental fitness, helps to
prevent or mitigate acute or chronic sickness, disease or pain, or
which minimizes adverse health consequences due to lifestyle. To
ensure that the community rating laws are not affected, the insurer or
HMO shall not require specific medical outcomes as a result of an
insured's adherence to the approved wellness program.

Section 2: Amends Insurance Law section 4235(h) to permit insurers and
HMOs that offer accident and health insurance (large group policies)
to offer an actuarially appropriate premium discount or other benefits
or enhancements to those persons that participate in a qualified
wellness program approved by the Superintendent.

Section 3: Amends Insurance Law section 4317 to permit Article 43
insurers and HMOs that offer individual or small group contracts to
offer, subject to the approval of the Superintendent, an actuarially
appropriate premium discount or other enhancements to those persons
that participate in a qualified wellness program.

Section 4. Amends Insurance Law section 4326 to permit insurers and
HMOs that offer the subsidized "Healthy New York" policies to offer an
actuarially appropriate premium discount or other enhancements to
those persons that participate in a qualified wellness program.

Section 5. Amends Public Health Law section 4405 to provide for the
same actuarially appropriate reduction in HMO health policies for
those who participate in a qualified wellness program.

EXISTING LAW: Under current law, health insurers and HMOs are not
allowed to offer an actuarially appropriate discount in premium rates
to those persons that participate in a qualified wellness program.


JUSTIFICATION: Every year, health insurance rate payers axe
experiencing rapidly increasing premium rate increases. This increased
cost of purchasing health insurance continues to force small and large
businesses alike to drop health insurance coverage for their employees
and their families. This bill provides a new avenue to help keep
health insurance rates low. Further, it encourages persons, via a
financial incentive, to participate in qualified wellness programs to
enhance their physical and mental fitness and wellbeing.

We need to develop new and innovative ways to help to minimize future
rate increases so that individuals will be able to afford the health
care they need. Further, reducing or curtailing future health
insurance premium increases will help to keep New York's businesses
competitive with out of state firms.

LEGISLATIVE HISTORY: 2012 - S. 4609 - Referred to Insurance

FISCAL IMPLICATIONS: None.

LOCAL FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: 180 days after it shall have become law.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2331

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 16, 2013
                               ___________

Introduced  by  Sens. KLEIN, CARLUCCI, SAVINO, VALESKY -- read twice and
  ordered printed, and when printed to be committed 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:

  Section 1. Section 3231 of the insurance law, as added by chapter  501
of the laws of 1992, is amended by adding a new subsection (c-1) to read
as follows:
  (C-1)  SUBJECT  TO  THE  APPROVAL OF THE SUPERINTENDENT, AN INSURER OR
HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL  OR  GROUP  HEALTH
INSURANCE POLICY PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06713-01-3

S. 2331                             2

CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 2. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5) EACH INSURER DOING BUSINESS IN THIS STATE, WHEN  FILING  WITH  THE
SUPERINTENDENT  ITS SCHEDULES OF PREMIUM RATES, RULES AND CLASSIFICATION
OF RISKS FOR USE IN CONNECTION WITH THE  ISSUANCE  OF  ITS  POLICIES  OF
GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE  FOR  AN  ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM  CAN  BE  A  RISK  MANAGEMENT
SYSTEM  THAT  IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY OTHER SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-
MIZES  ADVERSE  HEALTH  CONSEQUENCES DUE TO LIFESTYLE.   SUCH A WELLNESS
PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS  TO  ADVANCE  THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETIES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES.  SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (I) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (II) PROMOTION OF HEALTHY EATING HABITS,
  (III) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (IV) INSTITUTING A PROPER FITNESS REGIMEN,
  (V) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (VI) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND

S. 2331                             3

  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 3. Section 4317 of the insurance law is  amended  by  adding  a  new
subsection (c-1) to read as follows:
  (C-1)  SUBJECT  TO  THE  APPROVAL OF THE SUPERINTENDENT, AN INSURER OR
HEALTH MAINTENANCE ORGANIZATION ISSUING AN INDIVIDUAL  OR  GROUP  HEALTH
INSURANCE  CONTRACT PURSUANT TO THIS SECTION MAY PROVIDE FOR AN ACTUARI-
ALLY APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR
ENHANCEMENTS  APPROVED  BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S
OR INSURED'S ACTIVE PARTICIPATION IN A  QUALIFIED  WELLNESS  PROGRAM.  A
QUALIFIED  WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTI-
FIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM  OR  COURSE  OF
MEDICAL  CONDUCT  WHICH  HELPS  TO  PROMOTE PHYSICAL AND MENTAL FITNESS,
HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE  CONDITIONS  OF
ACUTE  OR  CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE
HEALTH CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY  HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 4. Subsection (n) of section 4326 of the insurance law is amended by
adding a new paragraph 4 to read as follows:
  (4) APPROVAL OF THE SUPERINTENDENT, AN INSURER OR  HEALTH  MAINTENANCE
ORGANIZATION  ISSUING A CONTRACT FOR QUALIFYING SMALL EMPLOYERS OR INDI-
VIDUALS PURSUANT TO THIS SECTION MAY PROVIDE FOR AN  ACTUARIALLY  APPRO-

S. 2331                             4

PRIATE  REDUCTION  IN  PREMIUM  RATES  OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S  OR  INSURED'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL  NOT  REQUIRE  SPECIFIC
OUTCOMES  AS  A  RESULT  OF  AN ENROLLEE'S OR INSURED'S ADHERENCE TO THE
APPROVED WELLNESS PROGRAM.
  S 5. Section 4405 of the public health law is amended by adding a  new
subdivision 5-a to read as follows:
  5-A. SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, MAY PROVIDE FOR AN
ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR
ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE  AN  ENROLLEE'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS PROGRAM CAN BE A RISK MANAGEMENT  SYSTEM  THAT  IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL
OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-

S. 2331                             5

CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided  that,  effective  immediately  any
rules  and regulations necessary to implement the provisions of this act
on its effective date are authorized and directed to be  added,  amended
and/or repealed on or before such date.

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