senate Bill S3991

2011-2012 Legislative Session

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

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Archive: Last Bill Status - In Committee


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

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jan 04, 2012 referred to insurance
Mar 11, 2011 referred to insurance

S3991 - Bill Details

See Assembly Version of this Bill:
A3133
Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 4235, 4317 & 4326, Ins L
Versions Introduced in 2009-2010 Legislative Session:
S651, A2867

S3991 - Bill Texts

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Authorizes health insurers, subject to the approval of the superintendent of insurance, to provide actuarially appropriate reductions in health insurance premiums for an enrollee's or insured's participation in a wellness program (defined); provides for the appointment of an advisory committee on wellness to be co-chaired by the commissioner of health and the superintendent of insurance and to report on the development and effectiveness of wellness programs.

view sponsor memo
BILL NUMBER:S3991

TITLE OF BILL:
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

PURPOSE:
To help curtail future health insurance premium increases, this
legislation permits health insurers and health maintenance
organizations (HMOs) to offer an actuarially appropriate premium
discount to covered persons that participate in a bona fide wellness
program that is approved by the Superintendent of Insurance.

SUMMARY OF PROVISIONS:
§ 1- Amends §3231 of the Insurance Law to permit insurers and HMOs
that offer individual or small group insurance policies to offer an
actuarially appropriate premium discount to those individuals that
participate in a bona fide wellness program. A bona fide wellness
program is one that is approved by the Superintendent of Insurance
and which 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. 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.

§2- Amends subsection (h) of §4235 of the Insurance Law to permit
insurers and HMO's that offer accident and health insurance (large
group policies) to offer an actuarially appropriate premium discount
to those persons that participate in a bona fide wellness program
approved by the Superintendent.

§3- Amends §4317 of the Insurance Law to permit Article 43 insurers
and HMO's that offer individual or small group contracts to offer,
subject to the approval of the Superintendent, an actuarially
appropriate premium discount to those persons that participate in a
bona fide wellness program.

§4- Amends subsection (n) of §4326 of the Insurance Law to permit
insurers and HMO's that offer the new subsidized "Healthy New York"
policies to offer an actuarially appropriate premium discount to
those persons that participate in a wellness program.

§5- Creates a 15 member Blue Ribbon Advisory Committee on Wellness to
be chaired by the Commissioner of Health and Superintendent of
Insurance or their designees. This Committee shall look into and make
recommendations on developing a comprehensive wellness program that
can be implemented by New York State, local county health
departments, hospitals, physicians, insurers, HMOs and other health
care providers.


§6- Effective date.

EXISTING LAW:
Currently, the Insurance Law does not authorize insurers and HMOs to
offer an actuarially appropriate discount in premium rates to those
persons that participate in a bona fide wellness program.

JUSTIFICATION:
This year in the Hudson Valley and in other parts of this state, many
health insurance rate payers are experiencing rate increases of
between 10 to 20 percent. This significantly increased cost of health
insurance may encourage small and large businesses to drop health
insurance coverage for their employees and make the cost of health
insurance even more prohibitive for those in the individual direct
pay market.

New York State needs to develop more innovative ways to help to
minimize future rate increases so that individuals will be able to
obtain the health care they need. This bill establishes a blue ribbon
advisory committee on wellness whose charge shall be to investigate
and develop innovative ways to alter how health care is provided and
financed so as to encourage general good health and well-being of
this state's citizens. Encouraging a more systematic approach to
increasing the good health of the state's population will not only
enhance quality of life, it will also help to reduce health care
costs and hence premiums charged to individuals and large & small
employers. In addition, reducing or curtailing subsequent health
insurance premium increases will assist New York's businesses to
remain competitive in this world market and keep down the cost of
doing business in this state.

This legislation is not an insurance mandate bill in that it merely
permits, it does not require, insurers and HMOs to develop or
implement Wellness programs for its insureds. It is hoped that some
of the wellness programs may be developed in conjunction with the
Advisory Committee.

LEGISLATIVE HISTORY:
2009-2010: A.2867/S.651; 2007-2008: A.2357/S.204; 2005-2006:
A.3683/S.413; 2003-2004: A.3344/S.1223, 2001-2002: A.5851/S.2186.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This act shall take effect immediately.

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

                                  3991

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 11, 2011
                               ___________

Introduced  by  Sen.  LARKIN -- read twice and ordered printed, and when
  printed to be committed 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
ISSUANCE OF ITS POLICIES OF GROUP ACCIDENT, GROUP HEALTH OR GROUP  ACCI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06180-01-1

S. 3991                             2

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
other  incentives,  both  monetary and non-monetary, can be developed to

S. 3991                             3

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.

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