LBD16250-05-2
A. 10801 2
CARE BY APPROXIMATELY FOUR BILLION DOLLARS THEREBY ALLOWING MORE BUSI-
NESSES TO OFFER COVERAGE TO EMPLOYEES.
THE LEGISLATURE RECOGNIZES THE NEED TO ENABLE AND ENCOURAGE GREATER
NUMBERS OF SMALL EMPLOYERS TO PROVIDE HEALTH CARE COVERAGE TO THEIR
EMPLOYEES.
THE LEGISLATURE THEREFORE DECLARES IT TO BE IN THE PUBLIC INTEREST TO
ESTABLISH THE SMALL BUSINESS HEALTH INSURANCE PROGRAM TO HELP REDUCE THE
COSTS OF HEALTH INSURANCE.
S 5003. DEFINITIONS. FOR PURPOSES OF THIS ARTICLE, THE FOLLOWING TERMS
SHALL HAVE THE FOLLOWING MEANINGS:
(A) "SMALL BUSINESS" MEANS ANY BUSINESS WHICH IS RESIDENT IN THIS
STATE, INDEPENDENTLY OWNED AND OPERATED, NOT DOMINANT IN ITS FIELD AND
WHICH EMPLOYS FIFTY OR FEWER EMPLOYEES ON A REGULAR BASIS.
(B) "INSURER" MEANS ANY INSURANCE COMPANY LICENSED TO WRITE HEALTH
INSURANCE IN THIS STATE, INCLUDING CORPORATIONS ORGANIZED UNDER ARTICLE
FORTY-THREE OF THIS CHAPTER AND HEALTH MAINTENANCE ORGANIZATIONS AUTHOR-
IZED PURSUANT TO ARTICLE FORTY-THREE OF THIS CHAPTER OR ARTICLE
FORTY-FOUR OF THE PUBLIC HEALTH LAW.
(C) "SUPERINTENDENT" MEANS THE SUPERINTENDENT OF FINANCIAL SERVICES.
(D) "ELIGIBLE EMPLOYEE" MEANS AN EMPLOYEE OF A SMALL BUSINESS WHO HAS
WORKED NINETY DAYS OR MORE AT AN AVERAGE OF THIRTY-FIVE HOURS OR MORE
PER WEEK. A SMALL BUSINESS MAY, IN ITS SOLE DISCRETION, REDUCE THIS
REQUIREMENT OF AN EMPLOYEE WORKING AN AVERAGE OF THIRTY-FIVE HOURS OR
MORE PER WEEK IN ORDER FOR ADDITIONAL EMPLOYEES TO QUALIFY AS AN ELIGI-
BLE EMPLOYEE. AN ELIGIBLE EMPLOYEE MAY ALSO BE A SOLE PROPRIETOR OR A
PARTNER OF A PARTNERSHIP PROVIDED SUCH SOLE PROPRIETOR OR PARTNER IS
INCLUDED AS AN EMPLOYEE UNDER THE HEALTH CARE PLAN OF THE SMALL BUSI-
NESS.
S 5004. REQUIREMENTS OF SMALL BUSINESS HEALTH INSURANCE. (A) ALL
INSURERS SHALL BE AUTHORIZED TO WRITE SMALL BUSINESS HEALTH INSURANCE
POLICIES FOR QUALIFIED SMALL BUSINESSES TO PROVIDE ONLY SUCH BENEFITS AS
ARE REQUIRED BY SECTION FIVE THOUSAND FIVE OF THIS ARTICLE AND AS MAY
MUTUALLY BE AGREED UPON BETWEEN THE POLICYHOLDER AND THE INSURER. THE
SUPERINTENDENT SHALL ONLY APPROVE A POLICY WHICH MEETS THE FOLLOWING
CRITERIA:
(1) THE POLICY PROVISIONS ARE NOT MISLEADING OR CONFUSING;
(2) THE POLICY CLEARLY STATES THE BENEFITS, LIMITATIONS AND EXCLU-
SIONS;
(3) THE BENEFITS PROVIDED BY THE POLICY MEET THE STANDARDS SPECIFIED
IN THIS SECTION AND SECTION FIVE THOUSAND FIVE OF THIS ARTICLE;
(4) THE PREMIUM RATES ARE REASONABLY RELATED TO THE BENEFITS PROVIDED
AND ARE SUFFICIENT TO SUPPORT THE POLICY;
(5) THE POLICY PROVISIONS INCLUDE CONVERSION AND CONTINUATION RIGHTS
AS DEFINED IN SUBSECTIONS (E), (M) AND (N) OF SECTION THREE THOUSAND TWO
HUNDRED TWENTY-ONE AND SUBSECTIONS (D), (E) AND (G) OF SECTION FOUR
THOUSAND THREE HUNDRED FIVE OF THIS CHAPTER; AND
(6) THE POLICY PROVIDES BOTH INDIVIDUAL AND, IF ELECTED BY THE EMPLOY-
EE, FAMILY COVERAGE. THE POLICY SHALL COVER ALL ELIGIBLE SPOUSES AND
DEPENDENT CHILDREN OF COVERED EMPLOYEES, IN ACCORDANCE WITH POLICY
PARTICIPATION REQUIREMENTS, EXCEPT THAT COVERAGE MAY BE WAIVED FOR
SPOUSES AND DEPENDENT CHILDREN WHO HAVE COVERAGE UNDER ANOTHER HEALTH
PLAN. THE EMPLOYEE SHALL PAY THE ENTIRE PREMIUM COST FOR SUCH DEPENDENT
COVERAGE UNLESS THE EMPLOYER, AT HIS OR HER OPTION, CHOOSES TO CONTRIB-
UTE TO THE EXPENSE OF SUCH ADDITIONAL PREMIUM.
(B) THE PREMIUM FOR A SMALL BUSINESS HEALTH INSURANCE POLICY SHALL BE
PAID BY THE SMALL BUSINESS FROM THE EMPLOYER'S FUNDS, FROM FUNDS
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CONTRIBUTED BY THE INSURED EMPLOYEES OR FROM FUNDS CONTRIBUTED JOINTLY
BY THE EMPLOYER AND THE EMPLOYEE.
S 5005. CORE BENEFITS. NOTWITHSTANDING ANY PROVISION OF LAW TO THE
CONTRARY, SMALL BUSINESS HEALTH INSURANCE POLICIES ISSUED PURSUANT TO
THIS ARTICLE SHALL NOT BE SUBJECT TO ANY OTHER MANDATED COVERAGES OR
SERVICES, EXCEPT FOR:
(A) AMBULATORY CARE AND FOR INPATIENT AND OUTPATIENT ACUTE MEDICAL AND
SURGICAL CARE. THE HOSPITAL AND MEDICAL SERVICES TO BE COVERED SHALL
INCLUDE, BUT NOT BE LIMITED TO:
(1) NO LESS THAN THIRTY DAYS HOSPITAL CONFINEMENT;
(2) DEDUCTIBLE AND CO-PAYMENT AMOUNTS WHICH MAY BE GREATER THAN THOSE
SPECIFIED IN THE DEPARTMENT REGULATIONS, PROVIDED THAT NO ANNUAL DEDUCT-
IBLE FOR AN INDIVIDUAL SHALL EXCEED ONE THOUSAND TWO HUNDRED DOLLARS,
AND NO ANNUAL DEDUCTIBLE FOR A FAMILY SHALL EXCEED TWO THOUSAND DOLLARS;
AND
(3) NO FEWER THAN SIX PHYSICIAN OFFICE VISITS PER YEAR PER COVERED
MEMBER.
(B) (1) MATERNITY CARE, AS DEFINED IN PARAGRAPH FIVE OF SUBSECTION (K)
OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE AND SUBSECTION (C) OF
SECTION FOUR THOUSAND THREE HUNDRED THREE OF THIS CHAPTER;
(2) NEWBORN CARE, AS DEFINED IN PARAGRAPH TWO OF SUBSECTION (F) OF
SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE AND PARAGRAPH ONE OF
SUBSECTION (C) OF SECTION FOUR THOUSAND THREE HUNDRED FIVE OF THIS CHAP-
TER;
(3) EMERGENCY MEDICAL SERVICES, AS DEFINED IN PARAGRAPH FOUR OF
SUBSECTION (K) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE AND
PARAGRAPH TWO OF SUBSECTION (A) OF SECTION FOUR THOUSAND THREE HUNDRED
THREE OF THIS CHAPTER; AND
(4) MAMMOGRAPHY SCREENING, AS DEFINED IN SUBPARAGRAPH (C) OF PARAGRAPH
ELEVEN OF SUBSECTION (L) OF SECTION THREE THOUSAND TWO HUNDRED
TWENTY-ONE AND PARAGRAPH THREE OF SUBSECTION (P) OF SECTION FOUR THOU-
SAND THREE HUNDRED THREE OF THIS CHAPTER.
(C) A SMALL BUSINESS HEALTH INSURANCE POLICY ISSUED PURSUANT TO THIS
ARTICLE MAY INCLUDE LIMITATIONS ON BENEFITS GREATER THAN THOSE SPECIFIED
IN THE DEPARTMENT REGULATIONS AND MAY INCLUDE PROVISIONS DESIGNED TO
CONTROL POLICY COSTS AND ENCOURAGE COST EFFECTIVE UTILIZATION OF
MEDICALLY NECESSARY HEALTH CARE SERVICES. SUCH PROVISIONS MAY INCLUDE,
BUT NEED NOT BE LIMITED TO:
(1) PREVENTIVE CARE SERVICES;
(2) PRIOR APPROVAL OF ELECTIVE HOSPITAL ADMISSIONS;
(3) SECOND SURGICAL OPINIONS;
(4) UTILIZATION REVIEW OF HEALTH CARE SERVICES;
(5) USE OF A PREFERRED PROVIDER PLAN, WHICH: (I) LIMITS THE PAYMENT OF
THE BENEFITS TO PROVIDERS OF SERVICES WHO HAVE SIGNED AN AGREEMENT WITH
THE INSURER, OR ANY INTERMEDIARY ORGANIZATION REPRESENTING THOSE PROVID-
ERS IN NEGOTIATIONS WITH THE INSURER, REGARDING THE AMOUNT OF SUCH
PAYMENTS, OR (II) OFFERS DIFFERENT BENEFITS TO THE PERSON COVERED WHEN
PROCURED THROUGH SUCH ORGANIZATION;
(6) PRE-ADMISSION TESTING; AND
(7) ANNUAL AND LIFETIME BENEFIT MAXIMUMS AS DETERMINED BY THE INSURER
AND THE SMALL BUSINESS.
(D) A SMALL BUSINESS MAY SELECT COVERAGE FOR ADDITIONAL BENEFITS,
INCLUDING BUT NOT LIMITED TO OPTICAL AND DENTAL CARE, FOR ALL ELIGIBLE
EMPLOYEES AND DEPENDENTS, IF AVAILABLE FROM THE INSURER. THE PROVISIONS
OF SUBSECTION (A) OF THIS SECTION MAY, AT THE OPTION OF THE INSURER, BE
APPLIED TO ANY ADDITIONAL BENEFITS FOR WHICH COVERAGE IS PROVIDED.
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(E) ANY MARKETING OR ADVERTISING MATERIAL UTILIZED TO FACILITATE
ENROLLMENT OR PURCHASE OF A SMALL BUSINESS HEALTH INSURANCE POLICY MUST
BE APPROVED BY THE SUPERINTENDENT AND MUST CLEARLY STATE WHICH CORE
BENEFITS ARE COVERED AND WHICH ARE NOT. THIS SHALL INCLUDE, BUT NOT BE
LIMITED TO A REQUIREMENT TO LIST ANY STATUTORILY REQUIRED COVERAGE UNDER
SECTIONS THREE THOUSAND TWO HUNDRED TWENTY-ONE OR FOUR THOUSAND THREE
HUNDRED THREE OF THIS CHAPTER WHICH IS NOT COVERED UNDER THE POLICY.
S 5006. NOTICE REQUIREMENTS. POLICIES APPROVED FOR USE PURSUANT TO
THIS ARTICLE SHALL HAVE PROMINENTLY STAMPED ON THE FACE OF EACH POLICY
AND CERTIFICATE THE FOLLOWING NOTICE: "THIS IS A SMALL BUSINESS LIMITED
BENEFITS HEALTH INSURANCE POLICY."
S 5007. REPORTING REQUIREMENTS. THE SUPERINTENDENT MAY ISSUE REGU-
LATIONS TO FACILITATE DATA COLLECTION CONCERNING THE POLICIES ISSUED
PURSUANT TO THIS ARTICLE AND SHALL REPORT ANNUALLY TO THE LEGISLATURE ON
THE PROGRESS OF POLICIES ISSUED PURSUANT TO THIS ARTICLE.
S 2. Paragraphs (b), (c) and (d) of subdivision 2 of section 2807-j of
the public health law, as amended by section 50 of part B of chapter 58
of the laws of 2009, are amended to read as follows:
(b) The total percentage allowance for each payor, other than govern-
mental agencies, or health maintenance organizations for services
provided to subscribers eligible for medical assistance pursuant to
title eleven of article five of the social services law, or approved
organizations for services provided to subscribers eligible for the
family health plus program pursuant to title eleven-D of article five of
the social services law, and other than payments for a patient that has
no third-party coverage in whole or in part for services provided by a
designated provider of services, shall be:
(i) the sum of (A) eight and eighteen-hundredths percent, provided,
however, that for services provided on and after July first, two thou-
sand three, the percentage shall be eight and eighty-five hundredths
percent, and further provided that for services provided on and after
January first, two thousand six, the percentage shall be eight and nine-
ty-five hundredths percent, [and further] provided that for services
provided on and after April first, two thousand nine, the percentage
shall be nine and sixty-three hundredths percent, PROVIDED THAT FOR
SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOUSAND THIRTEEN, THE
PERCENTAGE SHALL BE SIX AND FORTY-TWO HUNDREDTHS PERCENT, PROVIDED THAT
FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOUSAND FOURTEEN,
THE PERCENTAGE SHALL BE THREE AND TWENTY-ONE HUNDREDTHS PERCENT, AND
FURTHER PROVIDED, THAT FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST,
TWO THOUSAND FIFTEEN, THE PERCENTAGE SHALL BE ZERO plus (B) twenty-four
percent, provided, however, that for services provided on and after July
first, two thousand three, the percentage shall be twenty-five and nine-
ty-seven hundredths percent, and further provided that for services
provided on and after January first, two thousand six, the percentage
shall be twenty-six and twenty-six hundredths percent, [and further]
provided that for services provided on and after April first, two thou-
sand nine, the percentage shall be twenty-eight and twenty-seven
hundredths percent, PROVIDED THAT FOR SERVICES PROVIDED ON OR AFTER
APRIL FIRST, TWO THOUSAND THIRTEEN, THE PERCENTAGE SHALL BE EIGHTEEN AND
EIGHTY-FIVE HUNDREDTHS PERCENT, PROVIDED THAT FOR SERVICES PROVIDED ON
OR AFTER APRIL FIRST, TWO THOUSAND FOURTEEN, THE PERCENTAGE SHALL BE
NINE AND FORTY-THREE HUNDREDTHS PERCENT, AND FURTHER PROVIDED, THAT FOR
SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOUSAND FIFTEEN, THE
PERCENTAGE SHALL BE ZERO and plus (C) for a specified third-party payor
as defined in subdivision one-a of section twenty-eight hundred seven-s
A. 10801 5
of this article the percentage allowance applicable for a general hospi-
tal for inpatient hospital services pursuant to subdivision two of
section twenty-eight hundred seven-s of this article;
(ii) unless (A) an election in accordance with paragraph (a) of subdi-
vision five of this section to pay the allowance directly to the commis-
sioner or the commissioner's designee is in effect for a third-party
payor, and in addition (B) for a specified third-party payor an election
to pay the assessment in accordance with section twenty-eight hundred
seven-t of this article is in effect.
(c) If an election in accordance with subdivision five of this section
is in effect for a third-party payor and in addition in accordance with
section twenty-eight hundred seven-t of this article for a specified
third-party payor, the total percentage allowance factor shall be
reduced to eight and eighteen-hundredths percent, provided, however,
that for services provided on and after July first, two thousand three
the total percentage allowance factor shall be reduced to eight and
eighty-five hundredths percent, [and further] provided that for services
provided on and after January first, two thousand six, the total
percentage allowance factor shall be reduced to eight and ninety-five
hundredths percent, and further provided that for services provided on
and after April first, two thousand nine, the total percentage allowance
factor shall be reduced to nine and sixty-three hundredths percent
PROVIDED THAT FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOU-
SAND THIRTEEN, THE PERCENTAGE SHALL BE SIX AND FORTY-TWO HUNDREDTHS
PERCENT, PROVIDED THAT FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST,
TWO THOUSAND FOURTEEN, THE PERCENTAGE SHALL BE THREE AND TWENTY-ONE
HUNDREDTHS PERCENT, AND FURTHER PROVIDED, THAT FOR SERVICES PROVIDED ON
OR AFTER APRIL FIRST, TWO THOUSAND FIFTEEN, THE PERCENTAGE SHALL BE
ZERO.
(d) The total percentage allowance for payments by governmental agen-
cies, as determined in accordance with paragraphs (a) and (a-1) of
subdivision one of section twenty-eight hundred seven-c of this article
as in effect on December thirty-first, nineteen hundred ninety-six, or
health maintenance organizations for services provided to subscribers
eligible for medical assistance pursuant to title eleven of article five
of the social services law, or approved organizations for services
provided to subscribers eligible for the family health plus program
pursuant to title eleven-D of article five of the social services law,
shall be five and ninety-eight-hundredths percent, provided, however,
that for services provided on and after July first, two thousand three
the total percentage allowance shall be six and forty-seven hundredths
percent, and further provided that for services provided on and after
January first, two thousand six, the total percentage allowance shall be
six and fifty-four hundredths percent, and [further] provided that for
services provided on and after April first, two thousand nine, the total
percentage allowance shall be seven and four hundredths percent PROVIDED
THAT FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOUSAND THIR-
TEEN, THE PERCENTAGE SHALL BE SIX AND FORTY-TWO HUNDREDTHS PERCENT,
PROVIDED THAT FOR SERVICES PROVIDED ON OR AFTER APRIL FIRST, TWO THOU-
SAND FOURTEEN, THE PERCENTAGE SHALL BE THREE AND TWENTY-ONE HUNDREDTHS
PERCENT, AND FURTHER PROVIDED, THAT FOR SERVICES PROVIDED ON OR AFTER
APRIL FIRST, TWO THOUSAND FIFTEEN, THE PERCENTAGE SHALL BE ZERO.
S 3. Subdivision 1 of section 138 of chapter 1 of the laws of 1999,
constituting the New York Health Care Reform Act of 2000, as amended by
section 2 of part C of chapter 59 of the laws of 2011, is amended to
read as follows:
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1. sections 2807-c, 2807-j, 2807-s, and 2807-t of the public health
law, as amended by this act, shall expire on December 31, [2014] 2015,
and shall be thereafter effective only in respect to any act done before
such date or action or proceeding arising out of such act including
continued collections of funds from assessments and allowances and
surcharges established pursuant to sections 2807-c, 2807-j, 2807-s and
2807-t of the public health law, and administration and distributions of
funds from pools established pursuant to sections 2807-c, 2807-j,
2807-k, 2807-l, 2807-m, 2807-s, 2807-t, 2807-v and 2807-w of the public
health law, as amended or added by this act, related to patient services
provided before December 31, [2014] 2015, and continued expenditure of
funds authorized for programs and grants until the exhaustion of funds
therefor;
S 4. Section 2807-t of the public health law is amended by adding a
new subdivision 1-a to read as follows:
1-A. FINANCING. NOTWITHSTANDING ANY OTHER PROVISION OF LAW TO THE
CONTRARY ALL ASSESSMENTS AUTHORIZED BY THIS SECTION SHALL BE COLLECTED
IN COMPLIANCE WITH THE PROVISIONS OF THIS SECTION FROM GENERAL HOSPITALS
THROUGH APRIL FIRST, TWO THOUSAND FIFTEEN; THE FISCAL COSTS ASSOCIATED
WITH THE OPERATION OF ALL PROGRAMS PREVIOUSLY FUNDED THROUGH THE ASSESS-
MENT SHALL BE FUNDED THROUGH THE SUBMISSION OF FUNDS IN THE EXECUTIVE
BUDGET. THE COMMISSIONER SHALL DEVELOP ANY LEGISLATION NECESSARY TO
ACCOMPLISH SUCH CHANGES.
S 5. Section 1502-b of the tax law is REPEALED.
S 6. Subparagraph (i) of paragraph 5 of subdivision (f) of section
1515 of the tax law, as amended by section 16 of part FF-1 of chapter 57
of the laws of 2008, is amended to read as follows:
(i) In the case of a combined return, the tax shall be measured by the
combined entire net income or combined capital of all the corporations
included in the return, including any captive REIT or captive RIC. In
computing combined entire net income intercorporate dividends shall be
eliminated, in computing combined business and investment capital inter-
corporate stockholdings and intercorporate bills, notes and accounts
receivable and payable and other intercorporate indebtedness shall be
eliminated and in computing combined subsidiary capital intercorporate
stockholdings shall be eliminated. No taxpayer subject to the tax
imposed by section fifteen hundred two-a [or section fifteen hundred
two-b] of this article may be required or permitted to be included in a
combined return.
S 7. Paragraph 6 of subsection (a) of section 7008 of the insurance
law, as added by section 146 of part A of chapter 389 of the laws of
1997, is amended to read as follows:
(6) refusal or failure to pay the taxes as required by section seven
thousand twelve of this article [and section fifteen hundred two-b of
the tax law];
S 8. This act shall take effect immediately; provided however that the
amendments to section 2807-j of the public health law made by section
two of this act shall not affect the expiration of such section and
shall be deemed to expire therewith provided, further, that the amend-
ments to section 2807-t of the public health law made by section four of
this act shall not affect the expiration of such section and shall be
deemed to expire therewith.