senate Bill S1869

2013-2014 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 08, 2014 referred to insurance
Jan 09, 2013 referred to insurance

Co-Sponsors

S1869 - Bill Details

Current Committee:
Senate Insurance
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 4235, 4317 & 4326, Ins L
Versions Introduced in Previous Legislative Sessions:
2011-2012: S3991
2009-2010: S651

S1869 - Bill Texts

view summary

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:S1869

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 well-
ness 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 organ-
izations (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 actuari-
ally 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 sick-
ness 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 appropri-
ate 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 recommenda-
tions on developing a comprehensive wellness program that can be imple-

mented 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: 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 insur-
ance 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 citi-
zens. 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 well-
ness programs may be developed in conjunction with the Advisory Commit-
tee.

LEGISLATIVE HISTORY: 2011-2012: A.3133/S.3991 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
________________________________________________________________________

                                  1869

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD05865-01-3

S. 1869                             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 financial
services shall convene an advisory committee on wellness to examine  and
make  recommendations to the governor and legislature on issues, includ-
ing 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

S. 1869                             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 financial services, 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 repre-
sentatives 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  conserva-
tion, and agriculture and markets, county and other local health depart-
ment  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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