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

                                  2867

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                            January 21, 2009
                               ___________

Introduced  by M. of A. SCHIMMINGER, PEOPLES, SWEENEY -- Multi-Sponsored
  by -- M. of A.  BARCLAY, COLTON, DelMONTE, EDDINGTON,  MAGEE  --  read
  once and referred to the Committee on Insurance

AN  ACT  to  amend  the insurance law, in relation to making actuarially
  appropriate reductions in health insurance premiums in return  for  an
  enrollee's or insured's participation in a bona fide wellness program;
  and to establish an advisory committee on wellness to report thereon

  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 AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES IN RETURN FOR  AN  ENROLLEE'S  OR
INSURED'S  ADHERENCE  TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELL-
NESS PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS  TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE
OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE. SUCH WELLNESS PROGRAM SHALL DEMONSTRATE  ACTU-
ARIALLY 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 DOMESTIC, FOREIGN OR ALIEN 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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD03806-01-9
              

A. 2867                             2

ISSUANCE  OF ITS POLICIES OF GROUP ACCIDENT, GROUP HEALTH OR GROUP ACCI-
DENT AND HEALTH INSURANCE, MAY PROVIDE FOR  AN  ACTUARIALLY  APPROPRIATE
REDUCTION  IN  PREMIUM  RATES  IN  RETURN FOR AN ENROLLEE'S OR INSURED'S
ADHERENCE  TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELLNESS PROGRAM
IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES  AT-RISK  POPULATIONS
OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS
TO  PROMOTE  GOOD  HEALTH, HELPS TO PREVENT OR MITIGATE ACUTE OR CHRONIC
SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES  DUE
TO  LIFESTYLE.  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  AN  ACTUARIALLY
APPROPRIATE  REDUCTION  IN  PREMIUM RATES IN RETURN FOR AN ENROLLEE'S OR
INSURED'S ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA  FIDE  WELL-
NESS  PROGRAM IS EITHER A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR  MITIGATE  ACUTE
OR CHRONIC SICKNESS OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTU-
ARIALLY 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 AN ACTUARIALLY  APPROPRIATE
REDUCTION  IN  PREMIUM  RATES  IN  RETURN FOR AN ENROLLEE'S OR INSURED'S
ADHERENCE TO A BONA FIDE WELLNESS PROGRAM. A BONA FIDE WELLNESS  PROGRAM
IS  EITHER  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK POPULATIONS
OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS
TO PROMOTE GOOD HEALTH, HELPS TO PREVENT OR MITIGATE  ACUTE  OR  CHRONIC
SICKNESS  OR DISEASE, OR WHICH MINIMIZES ADVERSE HEALTH CONSEQUENCES DUE
TO LIFESTYLE. 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. a. The commissioner of health and the superintendent of insurance
shall convene an advisory committee on  wellness  to  examine  and  make
recommendations to the governor and legislature on issues, including but
not limited to:
  (1)  methods  to  more  efficiently disseminate information about more
healthful  lifestyles  to  promote  a  reduction  in  acute  or  chronic
illnesses,  how  to  develop  innovative  wellness  programs that can be
implemented by insurers, health  maintenance  organizations,  hospitals,
physicians and other health care providers, whether or not the provision
of health care and its financing can be restructured to encourage gener-
al  good  health and well-being of this state's citizens, whether or not

A. 2867                             3

other incentives, both monetary and non-monetary, can  be  developed  to
encourage persons to pursue more healthy lifestyles, and survey and make
suggestions  on  how  to improve the effectiveness of programs currently
being  administered  by state, county and local governments that promote
good health.
  (2) the cost effectiveness of developing or expanding current wellness
programs administered by state and local governments, hospitals,  public
and  private schools and clinics, health insurers and health maintenance
organizations that provide for early prenatal care,  cancer  screenings,
asthma  and  diabetes identification and treatments, childhood immuniza-
tions, and early risk  management  systems  to  identify  at-risk  popu-
lations.
  (3) whether or not more research should be encouraged, to be conducted
by  private  organizations and the department of health, to determine if
disparities exist in the diagnosis and medical treatment of  individuals
based  on  variables  such  as  age,  race,  gender,  ethnicity or other
cultural factors, and whether or not it is advisable to  establish  age,
race, gender or ethnic based testing and screening examination schedules
to identify the early onset of illness or disease.
  b.  The  advisory  committee on wellness shall be comprised of fifteen
members, and co-chaired by the commissioner of  health  and  the  super-
intendent  of  insurance, or their designees. The governor shall appoint
seven members to the committee and the temporary president of the senate
and the speaker of the assembly shall each appoint three members to  the
committee,  and  the  minority  leaders of the senate and assembly shall
each appoint one member. The  appointees  shall  be  representatives  of
health  insurers,  hospitals,  physicians,  clinics,  other  health care
providers such as those that  specialize  in  the  provision  of  mental
health,  chiropractic  and  homeopathic care, state agencies such as the
office of mental health, the departments of environmental  conservation,
and  agriculture  and  markets, county and other local health department
personnel, and school board officials. The appointees shall be named  no
later  than  120  days  after the effective date of this section.  After
evaluating the issues stated in  subdivision  a  of  this  section,  the
committee  shall deliver a report within a year of the effective date of
this section on its findings on such issues to the  governor,  temporary
president of the senate, speaker of the assembly, and the minority lead-
ers of the senate and assembly. Such report shall contain the results of
its evaluation and any findings or recommendations on enhancing the good
health and well-being of the state's residents.
  S 6. This act shall take effect immediately.