NY State Senate Bill 2009-S51104

Senate Bill S51104

2009-2010 Legislative Session

Provides for the extension of health insurance coverage to the unmarried child of an insured through the age of 29 years

download bill text pdf

Archive: Last Bill Status - In Senate Committee Rules Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 24, 2009	referred to rules

2009-S51104 (ACTIVE) - Details

See other versions of this Bill:: S6030 ,; A9038 ,
Current Committee:: Senate Rules
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221, 4235, 4304 & 4305, Ins L

2009-S51104 (ACTIVE) - Summary

Provides for the extension of health insurance coverage to the unmarried child of an insurered through the age of 29 years.

2009-S51104 (ACTIVE) - Sponsor Memo

                                 BILL NUMBER:  S51104

 TITLE OF BILL :

An act to amend the insurance law, in relation to the provision of
health insurance coverage to the unmarried child of an insured through
the age of twenty-nine years


 PURPOSE :

This bill expands access to health insurance by allowing unmarried
children through age 29, regardless of financial dependence, to be
covered under a parent's group health insurance policy.

 SUMMARY OF PROVISIONS :

Section 1 of the bill amends Insurance Law § 3216 to require
commercial insurers to make available an option for consumers
purchasing individual health insurance to cover unmarried dependents
through age 29 without regard to financial dependence. The young
adults must not be eligible for coverage under employer sponsored
insurance and they must live, work or reside in New York State or in
the service area of the insurer.  The option must be extended at
policy inception and at the first anniversary date following the
effective date of the provisions.

Section 2 amends Insurance Law § 3221 to require commercial insurers
that provide group health insurance coverage to extend an option to
continue coverage to unmarried children who have "aged off' of their
parents' group health insurance policies.  The "dependent children"
may continue to be covered under their parents' group policy through
age 29 as long as they are not eligible for employer sponsored health
insurance coverage and are not covered by Medicare. Such children are
not required to be financially dependent on their parents to elect
this benefit.

Section 2 of the bill also provides that employers shall not be
required to pay the premiums for dependent children electing this
continuation option. This section of the bill also allows an employee,
group member or dependent child to elect to purchase group health
insurance coverage: (1) within 60 days following the date coverage
would otherwise terminate due to age, under the terms of the parent's
policy; (2) within 60 days after meeting the definition of "dependent
child;" or (3) during an annual 30-day open enrollment period.
Dependent children whose coverage terminated prior to the effective
date of the bill would have a period of 12 months from the effective
date to elect coverage.

Section 2 of the bill additionally requires an insurer to submit
reports as the Superintendent of Insurance ("Superintendent") may
request, in a form and manner to be prescribed by the Superintendent.

Section 3 of the bill amends Insurance Law § 4235 to require
commercial insurers to make available an option for consumers of group
health insurance to cover unmarried dependents through age 29 without
regard to financial dependence. The option must be extended at policy
inception and annually upon the policy's anniversary date.

Section 4 of the bill amends Insurance Law § 4304 to require
not-for-profit corporations and health maintenance organizations
("HMOs") to extend the same make available option for consumers of
group health insurance to cover dependents through age 29 without
regard to financial dependence as is extended by section 1 for
commercial insurers.

Sections 5 and 6 of the bill amend Insurance Law § 4304 to require
not-for-profit corporations and HMOs that offer individual and group
remittance contracts to include coverage options for unmarried
dependent children through age 29 under the same terms and conditions
as commercial insurers.

Section 7 of the bill amends Insurance Law § 4305 to require
not-for-profit corporations and HMOs that offer group contracts to
include a continuation option for unmarried dependent children through
age 29, also under the same terms and conditions as commercial
insurers.

Section 8 of the bill provides that the bill take effect on September
1, 2009 and apply to contracts issued, renewed, modified, altered or
amended on or after that date.

 EXISTING LAW :

Current law pertaining to group contracts does not delineate a minimum
age to which an insurer must extend dependent coverage in a family
contract.

With regard to group remittance contracts, Insurance Law § 4304(d)(1)
limits coverage to children under the age of 25, at the option of the
insurer. If the child is incapable of self-sustaining employment due
to disability, the age limitations do not apply and the child would be
eligible to remain covered under the contract.

 LEGISLATIVE HISTORY :

This is a new bill.

 STATEMENT OF SUPPORT :

Uninsured young adults between the age of 19 through 29 represent 31
percent of New York State's total uninsured population. These
individuals -- sometimes referred to as "young invincibles" -- often
lose their health coverage at the age of 19, or upon graduation from
high school or college. Young adults are often employed in entry-level
jobs and may work for employers that do not provide (or contribute to
the cost of) health insurance.  As such, young adults are often unable
to afford individual direct payment insurance and frequently choose to
go uninsured.

This bill expands access to health insurance through a COBRA-like
benefit for young adults by requiring commercial insurers, non-profit
corporations and HMOs to offer an option to continue coverage for
unmarried young adults through age 29, regardless of financial
dependence, under a parent's group health insurance policy. The bill
would not require employers to contribute to the cost of coverage.

This bill also extends a make available option to individuals,
employers and other group health insurance consumers to permit them to
buy family coverage which includes coverage for dependents through age
29 subject to certain criteria. Insurers must extend the option to
purchase at policy inception and, for group policies, upon each
anniversary date.

 BUDGET IMPLICATIONS :

This bill will not have a fiscal impact to the State.

 EFFECTIVE DATE :
This bill takes effect September 1, 2009 and will apply to contracts
issued, renewed, modified, altered and amended on or after such date.

2009-S51104 (ACTIVE) - Bill Text download pdf

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

                                   104

                      Second Extraordinary Session

                            I N  S E N A T E

                              June 24, 2009
                               ___________

Introduced by COMMITTEE ON RULES -- (at request of the Governor) -- read
  twice  and  ordered  printed,  and when printed to be committed to the
  Committee on Rules

AN ACT to amend the insurance law,  in  relation  to  the  provision  of
  health insurance coverage to the unmarried child of an insured through
  the age of twenty-nine years

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 4 of subsection (a) of section 3216 of the insur-
ance law is amended by adding a new subparagraph (C) to read as follows:
  (C) IN ADDITION TO THE REQUIREMENTS OF SUBPARAGRAPHS (A)  AND  (B)  OF
THIS  PARAGRAPH, EVERY INSURER ISSUING A POLICY PURSUANT TO THIS SECTION
THAT PROVIDES COVERAGE FOR DEPENDENT CHILDREN MUST MAKE  AVAILABLE  AND,
IF REQUESTED BY THE POLICYHOLDER, EXTEND COVERAGE UNDER THE POLICY TO AN
UNMARRIED  CHILD  THROUGH  AGE  TWENTY-NINE, WITHOUT REGARD TO FINANCIAL
DEPENDENCE WHO IS NOT INSURED BY  OR  ELIGIBLE  FOR  COVERAGE  UNDER  AN
EMPLOYER  SPONSORED  HEALTH BENEFIT PLAN COVERING THEM AS AN EMPLOYEE OR
MEMBER, WHETHER INSURED OR SELF-INSURED, AND WHO LIVES, WORKS OR RESIDES
IN NEW YORK STATE OR THE SERVICE AREA  OF  THE  INSURER.  SUCH  COVERAGE
SHALL  BE MADE AVAILABLE AT THE INCEPTION OF ALL NEW POLICIES AND AT THE
FIRST ANNIVERSARY DATE OF A POLICY FOLLOWING THE EFFECTIVE DATE OF  THIS
SUBPARAGRAPH.  WRITTEN NOTICE OF THE AVAILABILITY OF SUCH COVERAGE SHALL
BE DELIVERED TO THE POLICYHOLDER THIRTY DAYS PRIOR TO THE  INCEPTION  OF
SUCH  GROUP  POLICY  AND THIRTY DAYS PRIOR TO THE FIRST ANNIVERSARY DATE
FOLLOWING THE EFFECTIVE DATE OF THIS SUBPARAGRAPH.
  S 2. Section 3221 of the insurance law is  amended  by  adding  a  new
subsection (r) to read as follows:
  (R)(1)  AS  USED IN THIS SUBSECTION, "DEPENDENT CHILD" MEANS AN UNMAR-
RIED CHILD THROUGH AGE TWENTY-NINE OF  AN  EMPLOYEE  OR  MEMBER  INSURED
UNDER  A  GROUP  POLICY,  REGARDLESS OF FINANCIAL DEPENDENCE, WHO IS NOT
INSURED BY OR ELIGIBLE FOR COVERAGE UNDER ANY  EMPLOYEE  HEALTH  BENEFIT

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD12119-01-9

S. 104                              2

PLAN  AS AN EMPLOYEE OR MEMBER, WHETHER INSURED OR SELF-INSURED, AND WHO
LIVES, WORKS OR RESIDES IN NEW YORK STATE OR THE  SERVICE  AREA  OF  THE
INSURER  AND  WHO  IS NOT COVERED UNDER TITLE XVIII OF THE UNITED STATES
SOCIAL SECURITY ACT (MEDICARE).
  (2) IN ADDITION TO THE CONVERSION PRIVILEGE AFFORDED BY SUBSECTION (E)
OF  THIS  SECTION  AND THE CONTINUATION PRIVILEGE AFFORDED BY SUBSECTION
(M) OF THIS SECTION, EVERY GROUP POLICY DELIVERED OR ISSUED FOR DELIVERY
IN THIS STATE THAT PROVIDES HOSPITAL, SURGICAL OR MEDICAL  COVERAGE  FOR
OTHER  THAN  SPECIFIC  DISEASES  OR  ACCIDENTS  ONLY, AND WHICH PROVIDES
DEPENDENT COVERAGE THAT TERMINATES  AT  A  SPECIFIED  AGE,  SHALL,  UPON
APPLICATION  OF THE EMPLOYEE, MEMBER OR DEPENDENT CHILD, AS SET FORTH IN
SUBPARAGRAPHS (B) OR (C) OF THIS  PARAGRAPH,  PROVIDE  COVERAGE  TO  THE
DEPENDENT  CHILD  AFTER  THAT  SPECIFIED AGE AND THROUGH AGE TWENTY-NINE
WITHOUT EVIDENCE OF INSURABILITY, SUBJECT TO ALL OF THE TERMS AND CONDI-
TIONS OF THE GROUP POLICY AND THE FOLLOWING:
  (A) AN EMPLOYER SHALL NOT BE REQUIRED TO PAY ALL OR PART OF  THE  COST
OF COVERAGE FOR A DEPENDENT CHILD PROVIDED PURSUANT TO THIS SUBSECTION;
  (B) AN EMPLOYEE, MEMBER OR DEPENDENT CHILD WHO WISHES TO ELECT CONTIN-
UATION OF COVERAGE PURSUANT TO THIS SUBSECTION SHALL REQUEST THE CONTIN-
UATION IN WRITING:
  (I)  WITHIN  SIXTY  DAYS  FOLLOWING  THE DATE COVERAGE WOULD OTHERWISE
TERMINATE DUE TO REACHING THE SPECIFIED AGE SET FORTH IN THE GROUP POLI-
CY;
  (II) WITHIN SIXTY DAYS AFTER MEETING THE  REQUIREMENTS  FOR  DEPENDENT
CHILD STATUS SET FORTH IN PARAGRAPH ONE OF THIS SUBSECTION WHEN COVERAGE
FOR THE DEPENDENT CHILD PREVIOUSLY TERMINATED; OR
  (III) DURING AN ANNUAL THIRTY-DAY OPEN ENROLLMENT PERIOD, AS DESCRIBED
IN THE POLICY;
  (C)  FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION, AN
EMPLOYEE, MEMBER OR DEPENDENT CHILD MAY ELECT PROSPECTIVE COVERAGE UNDER
THIS SUBSECTION FOR A DEPENDENT CHILD WHOSE  COVERAGE  TERMINATED  UNDER
THE  TERMS  OF  THE  GROUP POLICY PRIOR TO THE INITIAL EFFECTIVE DATE OF
THIS SUBSECTION;
  (D) AN EMPLOYEE, MEMBER OR DEPENDENT CHILD  ELECTING  CONTINUATION  AS
DESCRIBED  IN  THIS  SUBSECTION  SHALL  PAY TO THE GROUP POLICYHOLDER OR
EMPLOYER, BUT NOT MORE FREQUENTLY THAN ON A MONTHLY  BASIS  IN  ADVANCE,
THE  AMOUNT  OF  THE  REQUIRED  PREMIUM  PAYMENT ON THE DUE DATE OF EACH
PAYMENT. THE WRITTEN ELECTION OF CONTINUATION, TOGETHER WITH  THE  FIRST
PREMIUM PAYMENT REQUIRED TO ESTABLISH PREMIUM PAYMENT ON A MONTHLY BASIS
IN  ADVANCE, SHALL BE GIVEN TO THE GROUP POLICYHOLDER OR EMPLOYER WITHIN
THE TIME PERIODS SET FORTH IN SUBPARAGRAPHS (B) AND (C)  OF  THIS  PARA-
GRAPH.  ANY  PREMIUM RECEIVED WITHIN THE THIRTY-DAY PERIOD AFTER THE DUE
DATE SHALL BE CONSIDERED TIMELY;
  (E) FOR ANY DEPENDENT CHILD ELECTING COVERAGE WITHIN SIXTY DAYS OF THE
DATE THE DEPENDENT CHILD WOULD OTHERWISE LOSE COVERAGE DUE TO REACHING A
SPECIFIED AGE, THE EFFECTIVE DATE OF THE CONTINUATION COVERAGE SHALL  BE
THE  DATE  COVERAGE  WOULD  HAVE OTHERWISE TERMINATED. FOR ANY DEPENDENT
CHILD ELECTING TO RESUME COVERAGE DURING AN ANNUAL OPEN ENROLLMENT PERI-
OD OR DURING THE TWELVE-MONTH INITIAL OPEN ENROLLMENT  PERIOD  DESCRIBED
IN SUBPARAGRAPH (C) OF THIS PARAGRAPH, THE EFFECTIVE DATE OF THE CONTIN-
UATION COVERAGE SHALL BE PROSPECTIVE NO LATER THAN THIRTY DAYS AFTER THE
ELECTION AND PAYMENT OF FIRST PREMIUM;
  (F)  COVERAGE  FOR A DEPENDENT CHILD PURSUANT TO THIS SUBSECTION SHALL
CONSIST OF COVERAGE THAT IS IDENTICAL TO THE COVERAGE  PROVIDED  TO  THE
EMPLOYEE  OR MEMBER PARENT. IF COVERAGE IS MODIFIED UNDER THE POLICY FOR

S. 104                              3

ANY GROUP OF SIMILARLY SITUATED EMPLOYEES OR MEMBERS, THEN THE  COVERAGE
SHALL ALSO BE MODIFIED IN THE SAME MANNER FOR ANY DEPENDENT CHILD;
  (G) COVERAGE SHALL TERMINATE ON THE FIRST TO OCCUR OF THE FOLLOWING:
  (I)  THE  DATE THE DEPENDENT CHILD NO LONGER MEETS THE REQUIREMENTS OF
PARAGRAPH ONE OF THIS SUBSECTION;
  (II) THE END OF THE PERIOD FOR WHICH PREMIUM PAYMENTS  WERE  MADE,  IF
THERE  IS A FAILURE TO MAKE PAYMENT OF A REQUIRED PREMIUM PAYMENT WITHIN
THE PERIOD OF GRACE DESCRIBED IN SUBPARAGRAPH (D) OF THIS PARAGRAPH; OR
  (III) THE DATE ON  WHICH  THE  GROUP  POLICY  IS  TERMINATED  AND  NOT
REPLACED BY COVERAGE UNDER ANOTHER GROUP POLICY; AND
  (H) THE INSURER SHALL PROVIDE WRITTEN NOTIFICATION OF THE CONTINUATION
PRIVILEGE  DESCRIBED  IN THIS SUBSECTION AND THE TIME PERIOD IN WHICH TO
REQUEST CONTINUATION TO THE EMPLOYEE OR MEMBER:
  (I) IN EACH CERTIFICATE OF COVERAGE;
  (II) AT LEAST SIXTY DAYS PRIOR TO TERMINATION AT THE SPECIFIED AGE  AS
PROVIDED IN THE POLICY; AND
  (III)  WITHIN  THIRTY  DAYS  OF THE EFFECTIVE DATE OF THIS SUBSECTION,
WITH RESPECT TO INFORMATION CONCERNING A DEPENDENT CHILD'S  OPPORTUNITY,
FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION, TO MAKE A
WRITTEN  ELECTION TO OBTAIN COVERAGE UNDER A POLICY PURSUANT TO SUBPARA-
GRAPH (C) OF THIS PARAGRAPH.
  (3)(A) INSURERS SHALL SUBMIT SUCH REPORTS AS MAY BE REQUESTED  BY  THE
SUPERINTENDENT  TO  EVALUATE  THE  EFFECTIVENESS OF COVERAGE PURSUANT TO
THIS SUBSECTION INCLUDING, BUT  NOT  LIMITED  TO,  QUARTERLY  ENROLLMENT
REPORTS.
  (B) THE SUPERINTENDENT MAY PROMULGATE REGULATIONS TO ENSURE THE ORDER-
LY  IMPLEMENTATION  AND  OPERATION OF THE CONTINUATION COVERAGE PROVIDED
PURSUANT TO THIS SUBSECTION, INCLUDING PREMIUM RATE ADJUSTMENTS.
  S 3. Paragraph 1 of subsection (f) of section 4235  of  the  insurance
law,  as  amended by chapter 593 of the laws of 2000, is amended to read
as follows:
  (1) (A) Any policy of group accident, group health or  group  accident
and  health  insurance  may  include  provisions  for the payment by the
insurer of benefits  for  expenses  incurred  on  account  of  hospital,
medical  or  surgical  care  or  physical  and  occupational  therapy by
licensed physical and occupational therapists upon the  prescription  or
referral  of a physician for the employee or other member of the insured
group, his spouse, his child  or  children,  or  other  persons  chiefly
dependent  upon  him for support and maintenance; provided that a policy
under which coverage of a dependent of an employee or  other  member  of
the  insured  group terminates at a specified age shall not so terminate
with respect to an unmarried child who is incapable  of  self-sustaining
employment by reason of mental illness, developmental disability, mental
retardation,  as defined in the mental hygiene law, or physical handicap
and who became so incapable prior to attainment  of  the  age  at  which
dependent  coverage would otherwise terminate and who is chiefly depend-
ent upon such employee or member for support and maintenance, while  the
insurance  of  the employee or member remains in force and the dependent
remains in such condition, if the insured employee or member has  within
thirty-one  days  of  such dependent's attainment of the termination age
submitted proof of such dependent's incapacity as described herein.
  (B) IN ADDITION TO THE REQUIREMENTS OF SUBPARAGRAPH (A) OF THIS  PARA-
GRAPH,  EVERY  INSURER  ISSUING  A GROUP POLICY PURSUANT TO THIS SECTION
THAT PROVIDES COVERAGE FOR DEPENDENT CHILDREN, MUST MAKE  AVAILABLE  AND
IF REQUESTED BY THE POLICYHOLDER, EXTEND COVERAGE UNDER THE POLICY TO AN
UNMARRIED  CHILD  THROUGH  AGE  TWENTY-NINE, WITHOUT REGARD TO FINANCIAL

S. 104                              4

DEPENDENCE WHO IS NOT INSURED BY OR  ELIGIBLE  FOR  COVERAGE  UNDER  ANY
EMPLOYER  HEALTH  BENEFIT PLAN AS AN EMPLOYEE OR MEMBER, WHETHER INSURED
OR SELF-INSURED, AND WHO LIVES, WORKS OR RESIDES IN NEW  YORK  STATE  OR
THE  SERVICE  AREA OF THE INSURER. SUCH COVERAGE SHALL BE MADE AVAILABLE
AT THE INCEPTION OF ALL NEW POLICIES AND WITH RESPECT TO ALL OTHER POLI-
CIES AT ANY ANNIVERSARY DATE. WRITTEN NOTICE OF THE AVAILABILITY OF SUCH
COVERAGE SHALL BE DELIVERED TO THE POLICYHOLDER PRIOR TO  THE  INCEPTION
OF SUCH GROUP POLICY AND ANNUALLY THEREAFTER.
  S  4.  Paragraph  1 of subsection (d) of section 4304 of the insurance
law, as amended by section 65-e of part A of chapter 58 of the  laws  of
2007, is amended to read as follows:
  (1) (A) No contract issued pursuant to this section shall entitle more
than  one person to benefits except that a contract issued and marked as
a "family contract" may provide that benefits will  be  furnished  to  a
husband  and  wife,  or husband, wife and their dependent child or chil-
dren, or any child or children not over nineteen years of age,  provided
that  an  unmarried student at an accredited institution of learning may
be considered a dependent until he becomes twenty-three  years  of  age,
provided that the coverage of any such "family contract" may include, at
the option of the insurer, any unmarried child until attaining age twen-
ty-five,  and  provided  also  that  the  coverage  of  any such "family
contract" shall include any other unmarried child,  regardless  of  age,
who  is  incapable  of  self-sustaining  employment  by reason of mental
illness, developmental disability, mental retardation, as defined in the
mental hygiene law, or physical handicap and  who  became  so  incapable
prior  to attainment of the age at which dependent coverage would other-
wise terminate, so that such child may be considered a dependent.
  (B) IN ADDITION TO THE REQUIREMENTS OF SUBPARAGRAPH (A) OF THIS  PARA-
GRAPH,  EVERY  CORPORATION ISSUING A CONTRACT THAT PROVIDES COVERAGE FOR
DEPENDENT CHILDREN MUST MAKE AVAILABLE AND IF REQUESTED BY THE CONTRACT-
HOLDER, EXTEND COVERAGE UNDER THE CONTRACT TO AN UNMARRIED CHILD THROUGH
AGE TWENTY-NINE, WITHOUT REGARD  TO  FINANCIAL  DEPENDENCE  WHO  IS  NOT
INSURED  BY  OR  ELIGIBLE FOR COVERAGE UNDER ANY EMPLOYEE HEALTH BENEFIT
PLAN AS AN EMPLOYEE OR MEMBER, WHETHER INSURED OR SELF-INSURED, AND  WHO
LIVES,  WORKS  OR  RESIDES  IN NEW YORK STATE OR THE SERVICE AREA OF THE
CORPORATION. SUCH COVERAGE SHALL BE MADE AVAILABLE AT THE  INCEPTION  OF
ALL  NEW  CONTRACTS, AT THE FIRST ANNIVERSARY DATE OF A POLICY FOLLOWING
THE EFFECTIVE DATE  OF  THIS  SUBPARAGRAPH,  AND  FOR  GROUP  REMITTANCE
CONTRACTS AT ANY ANNIVERSARY DATE. WRITTEN NOTICE OF THE AVAILABILITY OF
SUCH  COVERAGE  SHALL  BE  DELIVERED  TO THE CONTRACTHOLDER PRIOR TO THE
INCEPTION OF SUCH GROUP CONTRACT, THIRTY DAYS PRIOR TO THE  FIRST  ANNI-
VERSARY  DATE  OF A POLICY FOLLOWING THE EFFECTIVE DATE OF THIS SUBPARA-
GRAPH, AND FOR GROUP REMITTANCE CONTRACTS ANNUALLY THEREAFTER.
  (C) Notwithstanding any rule, regulation or law to the  contrary,  any
"family  contract"  shall  provide  that  coverage  of  newborn infants,
including newly born infants adopted by the  insured  or  subscriber  if
such  insured  or  subscriber  takes physical custody of the infant upon
such infant's release from the hospital and files a petition pursuant to
section one hundred fifteen-c of the domestic relations law within thir-
ty days of birth; and provided further that no notice of  revocation  to
the adoption has been filed pursuant to section one hundred fifteen-b of
the  domestic  relations  law  and  consent to the adoption has not been
revoked, shall be effective from the moment of birth for injury or sick-
ness including the necessary care and treatment of  medically  diagnosed
congenital  defects  and  birth abnormalities including premature birth,
except that in cases of adoption, coverage of the initial hospital  stay

S. 104                              5

shall not be required where a birth parent has insurance coverage avail-
able for the infant's care. This provision regarding coverage of newborn
infants  shall not apply to two person coverage. In the case of individ-
ual  or two person coverages the corporation must also permit the person
to whom the policy is issued to elect such coverage of  newborn  infants
from  the  moment  of  birth. If notification and/or payment of an addi-
tional premium or contribution is required to  make  coverage  effective
for  a  newborn infant, the coverage may provide that such notice and/or
payment be made within no less than thirty days of the day of  birth  to
make  coverage  effective  from the moment of birth. This election shall
not be required in the case of student  insurance  or  where  the  group
remitting agent's plan does not provide coverage for dependent children.
  S  5.  Section  4304  of  the insurance law is amended by adding a new
subsection (m) to read as follows:
  (M)(1) AS USED IN THIS SUBSECTION, "DEPENDENT CHILD" MEANS  AN  UNMAR-
RIED  CHILD  THROUGH  AGE  TWENTY-NINE  OF AN EMPLOYEE OR MEMBER INSURED
UNDER A GROUP REMITTANCE CONTRACT, REGARDLESS OF  FINANCIAL  DEPENDENCE,
WHO IS NOT INSURED BY OR ELIGIBLE FOR COVERAGE UNDER ANY EMPLOYEE HEALTH
BENEFIT  PLAN,  WHETHER INSURED OR SELF-INSURED, AND WHO LIVES, WORKS OR
RESIDES IN NEW YORK STATE OR THE SERVICE AREA OF THE CORPORATION AND WHO
IS NOT COVERED UNDER TITLE XVIII OF THE UNITED  STATES  SOCIAL  SECURITY
ACT (MEDICARE).
  (2) IN ADDITION TO THE CONVERSION PRIVILEGE AFFORDED BY SUBSECTION (E)
OF  THIS  SECTION AND THE CONTINUATION PRIVILEGE AFFORDED BY SUBSECTIONS
(E) AND (K) OF THIS SECTION,  A  HOSPITAL  SERVICE,  HEALTH  SERVICE  OR
MEDICAL  EXPENSE  CORPORATION  OR  HEALTH  MAINTENANCE ORGANIZATION THAT
PROVIDES COVERAGE FOR WHICH THE PREMIUMS ARE PAID BY THE REMITTING AGENT
OF A GROUP THAT PROVIDES DEPENDENT COVERAGE THAT TERMINATES AT A  SPECI-
FIED  AGE  SHALL,  UPON APPLICATION OF THE EMPLOYEE, MEMBER OR DEPENDENT
CHILD, AS SET FORTH IN  SUBPARAGRAPH  (B)  OR  (C)  OF  THIS  PARAGRAPH,
PROVIDE  COVERAGE  TO  THE  DEPENDENT CHILD AFTER THAT SPECIFIED AGE AND
THROUGH AGE TWENTY-NINE WITHOUT EVIDENCE OF INSURABILITY, SUBJECT TO ALL
OF THE TERMS AND CONDITIONS OF THE GROUP  REMITTANCE  CONTRACT  AND  THE
FOLLOWING:
  (A)  AN  EMPLOYER SHALL NOT BE REQUIRED TO PAY ALL OR PART OF THE COST
OF COVERAGE FOR A DEPENDENT CHILD PROVIDED PURSUANT TO THIS SUBSECTION;
  (B) AN EMPLOYEE, MEMBER OR DEPENDENT CHILD WHO WISHES TO ELECT CONTIN-
UATION OF COVERAGE PURSUANT TO THIS SUBSECTION SHALL REQUEST THE CONTIN-
UATION IN WRITING:
  (I) WITHIN SIXTY DAYS FOLLOWING  THE  DATE  COVERAGE  WOULD  OTHERWISE
TERMINATE  DUE  TO  REACHING  THE  SPECIFIED  AGE SET FORTH IN THE GROUP
CONTRACT;
  (II) WITHIN SIXTY DAYS AFTER MEETING THE  REQUIREMENTS  FOR  DEPENDENT
CHILD STATUS SET FORTH IN PARAGRAPH ONE OF THIS SUBSECTION WHEN COVERAGE
FOR THE DEPENDENT CHILD PREVIOUSLY TERMINATED; OR
  (III)  DURING AN ANNUAL THIRTY-DAY OPEN ENROLLMENT PERIOD AS DESCRIBED
IN THE CONTRACT.
  (C) FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION,  AN
EMPLOYEE,  MEMBER  OR DEPENDENT CHILD MAY ELECT PROSPECTIVE CONTINUATION
COVERAGE UNDER THIS SUBSECTION FOR  A  DEPENDENT  CHILD  WHOSE  COVERAGE
TERMINATED UNDER THE TERMS OF THE GROUP REMITTANCE CONTRACT PRIOR TO THE
INITIAL EFFECTIVE DATE OF THIS SUBSECTION;
  (D)  AN  EMPLOYEE,  MEMBER OR DEPENDENT CHILD ELECTING CONTINUATION AS
DESCRIBED IN THIS SUBSECTION SHALL PAY TO THE GROUP REMITTING  AGENT  OR
EMPLOYER,  BUT  NOT  MORE FREQUENTLY THAN ON A MONTHLY BASIS IN ADVANCE,
THE AMOUNT OF THE REQUIRED PREMIUM PAYMENT  ON  THE  DUE  DATE  OF  EACH

S. 104                              6

PAYMENT.  THE  WRITTEN ELECTION OF CONTINUATION, TOGETHER WITH THE FIRST
PREMIUM PAYMENT REQUIRED TO ESTABLISH PREMIUM PAYMENT ON A MONTHLY BASIS
IN ADVANCE, SHALL BE GIVEN TO THE  GROUP  REMITTING  AGENT  OR  EMPLOYER
WITHIN  THE  TIME PERIODS SET FORTH IN SUBPARAGRAPHS (B) AND (C) OF THIS
PARAGRAPH. ANY PREMIUM RECEIVED WITHIN THE THIRTY-DAY PERIOD  AFTER  THE
DUE DATE SHALL BE CONSIDERED TIMELY;
  (E) FOR ANY DEPENDENT CHILD ELECTING COVERAGE WITHIN SIXTY DAYS OF THE
DATE THE DEPENDENT CHILD WOULD OTHERWISE LOSE COVERAGE DUE TO REACHING A
SPECIFIED  AGE, THE EFFECTIVE DATE OF THE CONTINUATION COVERAGE SHALL BE
THE DATE COVERAGE WOULD HAVE OTHERWISE  TERMINATED.  FOR  ANY  DEPENDENT
CHILD ELECTING TO RESUME COVERAGE DURING AN ANNUAL OPEN ENROLLMENT PERI-
OD  OR  DURING THE TWELVE-MONTH INITIAL OPEN ENROLLMENT PERIOD DESCRIBED
IN SUBPARAGRAPH (C) OF THIS PARAGRAPH, THE EFFECTIVE DATE OF THE CONTIN-
UATION COVERAGE SHALL BE PROSPECTIVE NO LATER THAN THIRTY DAYS AFTER THE
ELECTION AND PAYMENT OF FIRST PREMIUM;
  (F) COVERAGE FOR A DEPENDENT CHILD PURSUANT TO THIS  SUBSECTION  SHALL
CONSIST  OF  COVERAGE  THAT IS IDENTICAL TO THE COVERAGE PROVIDED TO THE
EMPLOYEE OR MEMBER PARENT. IF COVERAGE IS MODIFIED  UNDER  THE  CONTRACT
FOR  ANY  GROUP  OF  SIMILARLY  SITUATED  EMPLOYEES OR MEMBERS, THEN THE
COVERAGE SHALL ALSO BE MODIFIED IN THE SAME  MANNER  FOR  ANY  DEPENDENT
CHILD;
  (G) COVERAGE SHALL TERMINATE ON THE FIRST TO OCCUR OF THE FOLLOWING:
  (I)  THE  DATE THE DEPENDENT CHILD NO LONGER MEETS THE REQUIREMENTS OF
PARAGRAPH ONE OF THIS SUBSECTION;
  (II) THE END OF THE PERIOD FOR WHICH PREMIUM PAYMENTS  WERE  MADE,  IF
THERE  IS A FAILURE TO MAKE PAYMENT OF A REQUIRED PREMIUM PAYMENT WITHIN
THE PERIOD OF GRACE DESCRIBED IN SUBPARAGRAPH (D) OF THIS PARAGRAPH; OR
  (III) THE DATE ON WHICH THE GROUP REMITTANCE  CONTRACT  IS  TERMINATED
AND  NOT  REPLACED  BY  COVERAGE UNDER ANOTHER GROUP OR GROUP REMITTANCE
CONTRACT; AND
  (H) THE CORPORATION OR HEALTH MAINTENANCE ORGANIZATION  SHALL  PROVIDE
WRITTEN  NOTIFICATION  OF  THE  CONTINUATION PRIVILEGE DESCRIBED IN THIS
SUBSECTION AND THE TIME PERIOD IN WHICH TO REQUEST CONTINUATION  TO  THE
EMPLOYEE OR MEMBER:
  (I) IN EACH CERTIFICATE OF COVERAGE;
  (II)  AT LEAST SIXTY DAYS PRIOR TO TERMINATION AT THE SPECIFIED AGE AS
PROVIDED IN THE CONTRACT;
  (III) WITHIN THIRTY DAYS OF THE EFFECTIVE  DATE  OF  THIS  SUBSECTION,
WITH  RESPECT TO INFORMATION CONCERNING A DEPENDENT CHILD'S OPPORTUNITY,
FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION, TO MAKE A
WRITTEN ELECTION TO OBTAIN COVERAGE UNDER A CONTRACT PURSUANT TO SUBPAR-
AGRAPH (C) OF THIS PARAGRAPH.
  (3)(A) CORPORATIONS AND HEALTH MAINTENANCE ORGANIZATIONS SHALL  SUBMIT
SUCH  REPORTS  AS MAY BE REQUESTED BY THE SUPERINTENDENT TO EVALUATE THE
EFFECTIVENESS OF COVERAGE PURSUANT TO THIS SUBSECTION INCLUDING, BUT NOT
LIMITED TO, QUARTERLY ENROLLMENT REPORTS.
  (B) THE SUPERINTENDENT MAY PROMULGATE REGULATIONS TO ENSURE THE ORDER-
LY IMPLEMENTATION AND OPERATION OF THE  CONTINUATION  COVERAGE  PROVIDED
PURSUANT TO THIS SUBSECTION, INCLUDING PREMIUM RATE ADJUSTMENTS.
  S  6.  Paragraph  1 of subsection (c) of section 4305 of the insurance
law, as amended by chapter 312 of the laws of 2002, is amended  to  read
as follows:
  (1)(A)  Any  such contract may provide that benefits will be furnished
to a member of a covered group, for himself, his spouse,  his  child  or
children,  or  other  persons chiefly dependent upon him for support and
maintenance; provided that a contract under which coverage of a  depend-

S. 104                              7

ent  of a member terminates at a specified age shall, with respect to an
unmarried child who is incapable of self-sustaining employment by reason
of mental illness,  developmental  disability,  mental  retardation,  as
defined  in  the mental hygiene law, or physical handicap and who became
so incapable prior to attainment of the age at which dependent  coverage
would  otherwise terminate and who is chiefly dependent upon such member
for support and maintenance, not so terminate while the contract remains
in force and the dependent remains in such condition, if the member  has
within thirty-one days of such dependent's attainment of the termination
age submitted proof of such dependent's incapacity as described herein.
  (B)  IN ADDITION TO THE REQUIREMENTS OF SUBPARAGRAPH (A) OF THIS PARA-
GRAPH, EVERY CORPORATION ISSUING  A  GROUP  CONTRACT  PURSUANT  TO  THIS
SECTION  THAT PROVIDES COVERAGE FOR DEPENDENT CHILDREN, MUST MAKE AVAIL-
ABLE AND IF REQUESTED BY THE CONTRACTHOLDER, EXTEND COVERAGE UNDER  THAT
CONTRACT  TO  AN UNMARRIED CHILD THROUGH AGE TWENTY-NINE, WITHOUT REGARD
TO FINANCIAL DEPENDENCE WHO IS NOT INSURED BY OR ELIGIBLE  FOR  COVERAGE
UNDER ANY EMPLOYEE HEALTH BENEFIT PLAN AS AN EMPLOYEE OR MEMBER, WHETHER
INSURED  OR  SELF-INSURED,  AND  WHO LIVES, WORKS OR RESIDES IN NEW YORK
STATE OR THE SERVICE AREA OF THE CORPORATION.  SUCH  COVERAGE  SHALL  BE
MADE AVAILABLE AT THE INCEPTION OF ALL NEW CONTRACTS AND WITH RESPECT TO
ALL  OTHER  CONTRACTS  AT  ANY ANNIVERSARY DATE.   WRITTEN NOTICE OF THE
AVAILABILITY OF SUCH COVERAGE SHALL BE DELIVERED TO  THE  CONTRACTHOLDER
PRIOR TO THE INCEPTION OF SUCH GROUP CONTRACT AND ANNUALLY THEREAFTER.
  (C)  Notwithstanding  any rule, regulation or law to the contrary, any
contract under which a member elects coverage for himself,  his  spouse,
his children or other persons chiefly dependent upon him for support and
maintenance  shall  provide  that coverage of newborn infants, including
newly born infants adopted by the insured or subscriber if such  insured
or  subscriber  takes  physical custody of the infant upon such infant's
release from the hospital and files a petition pursuant to  section  one
hundred  fifteen-c  of  the domestic relations law within thirty days of
birth; and provided further that no notice of revocation to the adoption
has been filed pursuant to section one hundred fifteen-b of the domestic
relations law and consent to the adoption has not been revoked, shall be
effective from the moment of birth for injury or sickness including  the
necessary  care  and treatment of medically diagnosed congenital defects
and birth abnormalities including premature birth, except that in  cases
of adoption, coverage of the initial hospital stay shall not be required
where  a  birth parent has insurance coverage available for the infant's
care. This provision regarding coverage of  newborn  infants  shall  not
apply  to  two  person coverage. In the case of individual or two person
coverages the corporation must  also  permit  the  person  to  whom  the
certificate is issued to elect such coverage of newborn infants from the
moment of birth. If notification and/or payment of an additional premium
or  contribution  is  required  to make coverage effective for a newborn
infant, the coverage may provide that such notice and/or payment be made
within no less than thirty days of the day of  birth  to  make  coverage
effective from the moment of birth.  This election shall not be required
in  the  case  of  student  insurance or where the group's plan does not
provide coverage for dependent children.
  S 7. Section 4305 of the insurance law is  amended  by  adding  a  new
subsection (l) to read as follows:
  (L)(1)  AS  USED IN THIS SUBSECTION, "DEPENDENT CHILD" MEANS AN UNMAR-
RIED CHILD THROUGH AGE TWENTY-NINE OF  AN  EMPLOYEE  OR  MEMBER  INSURED
UNDER  A  GROUP CONTRACT, REGARDLESS OF FINANCIAL DEPENDENCE, WHO IS NOT
INSURED BY OR ELIGIBLE FOR COVERAGE UNDER ANY  EMPLOYEE  HEALTH  BENEFIT

S. 104                              8

PLAN,  WHETHER  INSURED OR SELF-INSURED, AND WHO LIVES, WORKS OR RESIDES
IN NEW YORK STATE OR THE SERVICE AREA OF THE CORPORATION AND WHO IS  NOT
COVERED  UNDER  TITLE  XVIII  OF  THE  UNITED STATES SOCIAL SECURITY ACT
(MEDICARE).
  (2) IN ADDITION TO THE CONVERSION PRIVILEGE AFFORDED BY SUBSECTION (D)
OF  THIS  SECTION  AND THE CONTINUATION PRIVILEGE AFFORDED BY SUBSECTION
(E) OF THIS SECTION, A  HOSPITAL  SERVICE,  HEALTH  SERVICE  OR  MEDICAL
EXPENSE  CORPORATION  OR  HEALTH  MAINTENANCE ORGANIZATION THAT PROVIDES
GROUP COVERAGE UNDER WHICH DEPENDENT COVERAGE TERMINATES AT A  SPECIFIED
AGE  SHALL, UPON APPLICATION OF THE EMPLOYEE, MEMBER OR DEPENDENT CHILD,
AS SET FORTH IN SUBPARAGRAPH (B)  OR  (C)  OF  THIS  PARAGRAPH,  PROVIDE
COVERAGE TO THE DEPENDENT CHILD AFTER THAT SPECIFIED AGE AND THROUGH AGE
TWENTY-NINE  WITHOUT  EVIDENCE  OF  INSURABILITY,  SUBJECT TO ALL OF THE
TERMS AND CONDITIONS OF THE GROUP CONTRACT AND THE FOLLOWING:
  (A) AN EMPLOYER SHALL NOT BE REQUIRED TO PAY ALL OR PART OF  THE  COST
OF COVERAGE FOR A DEPENDENT CHILD PROVIDED PURSUANT TO THIS SUBSECTION;
  (B) AN EMPLOYEE, MEMBER OR DEPENDENT CHILD WHO WISHES TO ELECT CONTIN-
UATION OF COVERAGE PURSUANT TO THIS SUBSECTION SHALL REQUEST THE CONTIN-
UATION IN WRITING:
  (I)  WITHIN  SIXTY  DAYS  FOLLOWING  THE DATE COVERAGE WOULD OTHERWISE
TERMINATE DUE TO REACHING THE SPECIFIED  AGE  SET  FORTH  IN  THE  GROUP
CONTRACT;
  (II)  WITHIN  SIXTY  DAYS AFTER MEETING THE REQUIREMENTS FOR DEPENDENT
CHILD STATUS SET FORTH IN PARAGRAPH ONE OF THIS SUBSECTION WHEN COVERAGE
FOR THE DEPENDENT CHILD PREVIOUSLY TERMINATED; OR
  (III) DURING AN ANNUAL THIRTY-DAY OPEN ENROLLMENT PERIOD, AS DESCRIBED
IN THE CONTRACT;
  (C) FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION,  AN
EMPLOYEE,  MEMBER  OR DEPENDENT CHILD MAY ELECT PROSPECTIVE CONTINUATION
COVERAGE UNDER THIS SUBSECTION FOR  A  DEPENDENT  CHILD  WHOSE  COVERAGE
TERMINATED  UNDER THE TERMS OF THE GROUP CONTRACT PRIOR TO THE EFFECTIVE
DATE OF THIS SUBSECTION;
  (D) AN EMPLOYEE, MEMBER OR DEPENDENT CHILD  ELECTING  CONTINUATION  AS
DESCRIBED  IN  THIS  SUBSECTION SHALL PAY TO THE GROUP CONTRACTHOLDER OR
EMPLOYER, BUT NOT MORE FREQUENTLY THAN ON A MONTHLY  BASIS  IN  ADVANCE,
THE  AMOUNT  OF  THE  REQUIRED  PREMIUM  PAYMENT ON THE DUE DATE OF EACH
PAYMENT. THE WRITTEN ELECTION OF CONTINUATION, TOGETHER WITH  THE  FIRST
PREMIUM PAYMENT REQUIRED TO ESTABLISH PREMIUM PAYMENT ON A MONTHLY BASIS
IN ADVANCE, SHALL BE GIVEN TO THE GROUP CONTRACTHOLDER OR EMPLOYER WITH-
IN THE TIME PERIODS SET FORTH IN SUBPARAGRAPHS (B) AND (C) OF THIS PARA-
GRAPH.  ANY  PREMIUM RECEIVED WITHIN THE THIRTY-DAY PERIOD AFTER THE DUE
DATE SHALL BE CONSIDERED TIMELY;
  (E) FOR ANY DEPENDENT CHILD ELECTING COVERAGE WITHIN SIXTY DAYS OF THE
DATE THE DEPENDENT CHILD WOULD OTHERWISE LOSE COVERAGE DUE TO REACHING A
SPECIFIED AGE, THE EFFECTIVE DATE OF THE CONTINUATION COVERAGE SHALL  BE
THE  DATE  COVERAGE  WOULD  HAVE OTHERWISE TERMINATED. FOR ANY DEPENDENT
CHILD ELECTING TO RESUME COVERAGE DURING AN ANNUAL OPEN ENROLLMENT PERI-
OD OR DURING THE TWELVE-MONTH INITIAL OPEN ENROLLMENT  PERIOD  DESCRIBED
IN SUBPARAGRAPH (C) OF THIS PARAGRAPH, THE EFFECTIVE DATE OF THE CONTIN-
UATION COVERAGE SHALL BE PROSPECTIVE NO LATER THAN THIRTY DAYS AFTER THE
ELECTION AND PAYMENT OF FIRST PREMIUM;
  (F)  COVERAGE  FOR A DEPENDENT CHILD PURSUANT TO THIS SUBSECTION SHALL
CONSIST OF COVERAGE THAT IS IDENTICAL TO THE COVERAGE  PROVIDED  TO  THE
EMPLOYEE  OR  MEMBER  PARENT. IF COVERAGE IS MODIFIED UNDER THE CONTRACT
FOR ANY GROUP OF SIMILARLY  SITUATED  EMPLOYEES  OR  MEMBERS,  THEN  THE

S. 104                              9

COVERAGE  SHALL  ALSO  BE  MODIFIED IN THE SAME MANNER FOR ANY DEPENDENT
CHILD;
  (G) COVERAGE SHALL TERMINATE ON THE FIRST TO OCCUR OF THE FOLLOWING:
  (I)  THE  DATE THE DEPENDENT CHILD NO LONGER MEETS THE REQUIREMENTS OF
PARAGRAPH ONE OF THIS SUBSECTION;
  (II) THE END OF THE PERIOD FOR WHICH PREMIUM PAYMENTS  WERE  MADE,  IF
THERE  IS A FAILURE TO MAKE PAYMENT OF A REQUIRED PREMIUM PAYMENT WITHIN
THE PERIOD OF GRACE DESCRIBED IN SUBPARAGRAPH (D) OF THIS PARAGRAPH; OR
  (III) THE DATE ON WHICH THE  GROUP  CONTRACT  IS  TERMINATED  AND  NOT
REPLACED BY COVERAGE UNDER ANOTHER GROUP CONTRACT; AND
  (H)  THE  CORPORATION OR HEALTH MAINTENANCE ORGANIZATION SHALL PROVIDE
WRITTEN NOTIFICATION OF THE CONTINUATION  PRIVILEGE  DESCRIBED  IN  THIS
SUBSECTION  AND  THE TIME PERIOD IN WHICH TO REQUEST CONTINUATION TO THE
EMPLOYEE OR MEMBER:
  (I) IN EACH CERTIFICATE OF COVERAGE;
  (II) AT LEAST SIXTY DAYS PRIOR TO TERMINATION AT THE SPECIFIED AGE  AS
PROVIDED IN THE CONTRACT;
  (III)  WITHIN  THIRTY  DAYS  OF THE EFFECTIVE DATE OF THIS SUBSECTION,
WITH RESPECT TO INFORMATION CONCERNING A DEPENDENT CHILD'S  OPPORTUNITY,
FOR TWELVE MONTHS AFTER THE EFFECTIVE DATE OF THIS SUBSECTION, TO MAKE A
WRITTEN ELECTION TO OBTAIN COVERAGE UNDER A CONTRACT PURSUANT TO SUBPAR-
AGRAPH (C) OF THIS PARAGRAPH.
  (3)(A)  CORPORATIONS AND HEALTH MAINTENANCE ORGANIZATIONS SHALL SUBMIT
SUCH REPORTS AS MAY BE REQUESTED BY THE SUPERINTENDENT TO  EVALUATE  THE
EFFECTIVENESS OF COVERAGE PURSUANT TO THIS SUBSECTION INCLUDING, BUT NOT
LIMITED TO, QUARTERLY ENROLLMENT REPORTS.
  (B) THE SUPERINTENDENT MAY PROMULGATE REGULATIONS TO ENSURE THE ORDER-
LY  IMPLEMENTATION  AND  OPERATION OF THE CONTINUATION COVERAGE PROVIDED
PURSUANT TO THIS SUBSECTION, INCLUDING PREMIUM RATE ADJUSTMENTS.
  S 8. This act shall take effect September 1, 2009 and shall  apply  to
contracts issued, renewed, modified, altered or amended on or after such
date.

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