senate Bill S2331B

2013-2014 Legislative Session

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

download bill text pdf

Sponsored By

Archive: Last Bill Status - Passed Senate


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

do you support this bill?

Actions

view actions (11)
Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 10, 2014 referred to insurance
delivered to assembly
passed senate
May 19, 2014 amended on third reading 2331b
May 07, 2014 advanced to third reading
May 06, 2014 2nd report cal.
May 05, 2014 1st report cal.489
Jan 23, 2014 print number 2331a
amend and recommit to insurance
Jan 08, 2014 referred to insurance
Jan 16, 2013 referred to insurance

Votes

view votes

Bill Amendments

Original
A
B (Active)
Original
A
B (Active)

Co-Sponsors

S2331 - Bill Details

See Assembly Version of this Bill:
A5302B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 3239, 4235, 4317 & 4326, Ins L; amd §4405, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
S4609, A8228

S2331 - Bill Texts

view summary

Authorizes health insurers and health maintenance organizations, subject to the approval of the superintendent of financial services, to provide actuarially appropriate reductions in health insurance premiums or other benefits or enhancements for an enrollee's or insured's participation in a qualified wellness program.

view sponsor memo
BILL NUMBER:S2331

TITLE OF BILL: An act to amend the insurance law and the public
health law, in relation to making actuarially appropriate reductions
in health insurance premiums in return for an enrollee's or insured's
participation in a qualified wellness program

PURPOSE: To help curtail future health insurance premium increases,
this bill authorizes health insurers and health maintenance
organizations (HMOs) to offer an actuarially appropriate premium
discount or other benefits or enhancements to covered persons that
participate in a qualified wellness program. Such program must be
approved by the Superintendent of Insurance.

SUMMARY OF PROVISIONS:

Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer
an actuarially appropriate premium discount or other benefits or
enhancements to those individuals that participate in a qualified
wellness program. Such qualified wellness program must be approved by
the Superintendent of Insurance. Further, such qualified Wellness
program can be either a risk management system that identifies at-risk
populations or any other systematic program or course of medical
conduct which helps to promote physical and mental fitness, helps to
prevent or mitigate acute or chronic sickness, disease or pain, 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.

Section 2: Amends Insurance Law section 4235(h) to permit insurers and
HMOs that offer accident and health insurance (large group policies)
to offer an actuarially appropriate premium discount or other benefits
or enhancements to those persons that participate in a qualified
wellness program approved by the Superintendent.

Section 3: Amends Insurance Law section 4317 to permit Article 43
insurers and HMOs that offer individual or small group contracts to
offer, subject to the approval of the Superintendent, an actuarially
appropriate premium discount or other enhancements to those persons
that participate in a qualified wellness program.

Section 4. Amends Insurance Law section 4326 to permit insurers and
HMOs that offer the subsidized "Healthy New York" policies to offer an
actuarially appropriate premium discount or other enhancements to
those persons that participate in a qualified wellness program.

Section 5. Amends Public Health Law section 4405 to provide for the
same actuarially appropriate reduction in HMO health policies for
those who participate in a qualified wellness program.

EXISTING LAW: Under current law, health insurers and HMOs are not
allowed to offer an actuarially appropriate discount in premium rates
to those persons that participate in a qualified wellness program.


JUSTIFICATION: Every year, health insurance rate payers axe
experiencing rapidly increasing premium rate increases. This increased
cost of purchasing health insurance continues to force small and large
businesses alike to drop health insurance coverage for their employees
and their families. This bill provides a new avenue to help keep
health insurance rates low. Further, it encourages persons, via a
financial incentive, to participate in qualified wellness programs to
enhance their physical and mental fitness and wellbeing.

We need to develop new and innovative ways to help to minimize future
rate increases so that individuals will be able to afford the health
care they need. Further, reducing or curtailing future health
insurance premium increases will help to keep New York's businesses
competitive with out of state firms.

LEGISLATIVE HISTORY: 2012 - S. 4609 - Referred to Insurance

FISCAL IMPLICATIONS: None.

LOCAL FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: 180 days after it shall have become law.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  2331

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 16, 2013
                               ___________

Introduced  by  Sens. KLEIN, CARLUCCI, SAVINO, VALESKY -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance

AN ACT to amend the insurance law and the public health law, in relation
  to  making  actuarially  appropriate  reductions  in  health insurance
  premiums in return for an enrollee's or insured's participation  in  a
  qualified wellness program

  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 FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06713-01-3

S. 2331                             2

CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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 2. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5) EACH 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 ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE  FOR  AN  ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM  CAN  BE  A  RISK  MANAGEMENT
SYSTEM  THAT  IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY OTHER SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-
MIZES  ADVERSE  HEALTH  CONSEQUENCES DUE TO LIFESTYLE.   SUCH A WELLNESS
PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS  TO  ADVANCE  THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETIES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES.  SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (I) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (II) PROMOTION OF HEALTHY EATING HABITS,
  (III) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (IV) INSTITUTING A PROPER FITNESS REGIMEN,
  (V) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (VI) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND

S. 2331                             3

  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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 FOR AN ACTUARI-
ALLY APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR
ENHANCEMENTS  APPROVED  BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S
OR INSURED'S ACTIVE PARTICIPATION IN A  QUALIFIED  WELLNESS  PROGRAM.  A
QUALIFIED  WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT IDENTI-
FIES AT-RISK POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM  OR  COURSE  OF
MEDICAL  CONDUCT  WHICH  HELPS  TO  PROMOTE PHYSICAL AND MENTAL FITNESS,
HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE  CONDITIONS  OF
ACUTE  OR  CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINIMIZES ADVERSE
HEALTH CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY  HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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 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 FOR AN  ACTUARIALLY  APPRO-

S. 2331                             4

PRIATE  REDUCTION  IN  PREMIUM  RATES  OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S  OR  INSURED'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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. Section 4405 of the public health law is amended by adding a  new
subdivision 5-a to read as follows:
  5-A. SUBJECT TO THE APPROVAL OF THE SUPERINTENDENT, MAY PROVIDE FOR AN
ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR
ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE  AN  ENROLLEE'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS PROGRAM CAN BE A RISK MANAGEMENT  SYSTEM  THAT  IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL
OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-

S. 2331                             5

CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE:
  (A) DISCOURAGING SUBSTANCE ABUSE, USE OF TOBACCO OR OVERINDULGENCE  OF
ALCOHOLIC BEVERAGES,
  (B) PROMOTION OF HEALTHY EATING HABITS,
  (C) EFFORTS TO REDUCE OBESITY AND THE INCIDENCE OF ASTHMA,
  (D) INSTITUTING A PROPER FITNESS REGIMEN,
  (E) MONITORING AND CONTROLLING EXCESS STRESS AND HYPERTENSION, AND
  (F) METHODS TO MANAGE AND COPE WITH CHRONIC PAIN; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE  GENERAL  GOOD  HEALTH AND WELL-BEING OF THE COVERED POPULATION. THE
HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 6. This act shall take effect on the one hundred eightieth day after
it shall have become a law; provided  that,  effective  immediately  any
rules  and regulations necessary to implement the provisions of this act
on its effective date are authorized and directed to be  added,  amended
and/or repealed on or before such date.

Co-Sponsors

S2331A - Bill Details

See Assembly Version of this Bill:
A5302B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 3239, 4235, 4317 & 4326, Ins L; amd §4405, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
S4609, A8228

S2331A - Bill Texts

view summary

Authorizes health insurers and health maintenance organizations, subject to the approval of the superintendent of financial services, to provide actuarially appropriate reductions in health insurance premiums or other benefits or enhancements for an enrollee's or insured's participation in a qualified wellness program.

view sponsor memo
BILL NUMBER:S2331A

TITLE OF BILL: An act to amend the insurance law and the public
health law, in relation to making actuarially appropriate reductions
in health insurance premiums in return for an enrollee's or insured's
participation in a qualified wellness program

PURPOSE:

To help curtail future health insurance premium increases, this bill
clearly authorizes health insurers and health maintenance
organizations (HMOs) to offer an actuarially appropriate Premium
discount or other benefits or enhancements to covered persons that
participate in a qualified wellness program. Such program must be
approved by the Superintendent of the Financial Services Department.

SUMMARY OF PROVISIONS:

Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer
an actuarially appropriate premium discount or other benefits or
enhancements to those individuals that Participate in a qualified
wellness program. Such qualified wellness program must be approved by
the Financial Services Department. Further, such qualified Wellness
program can be either a risk management system that identifies at-risk
populations or any other systematic program or course of medical
conduct which helps to promote physical and mental fitness, helms to
prevent or mitigate acute or chronic sickness, disease or Pain, or
which minimizes adverse health consequences due to lifestyle. To
protect all covered persons, the insurer or HMO shall not require
specific medical outcomes as a result of an insured's adherence to the
approved wellness program.

Section 2: Amends Insurance Law section 3239 which relates to Wellness
Programs that can be sponsored by a health insurance plan. This
provision expands the kinds of Wellness Programs that are covered
under the Insurance Law to include substance or alcohol abuse
cessation programs and programs to manage and cope with chronic pain.
In addition, the bill expands and provides for the full or partial
reimbursement for the cost of participating in programs that are
already currently authorized under this provision of the law, such as
programs related to stress and or hypertension, worker injury
prevention and nutrition education

Section 3: Amends Insurance Law section 4235(h) to permit insurers and
HMOs that offer accident and health insurance (large group policies)
to offer an actuarially appropriate premium discount or other benefits
or enhancements to those persons that participate in a qualified
wellness program approved by the Superintendent.

Section 4: Amends Insurance Law section 4317 to permit Article 43
insurers and HMOs that offer individual or small group contracts to
offer, subject to the approval of the Superintendent, an actuarially
appropriate premium discount or other enhancements to those persons
that participate in a qualified wellness program.


Section 5: Amends insurance Law section 4326 to permit insurers and
HMOs that offer the subsidized "Healthy New York" policies to offer an
actuarially appropriate premium discount or other enhancements to
those persons that participate in a qualified wellness program.

Section 6: Amends Public Health Law section 4405 to provide for the
same actuarially appropriate reduction in HMO health policies for
those who participate in a Qualified wellness program.

EXISTING LAW:

Under current law, health insurers and HMOs are not clearly allowed to
offer an actuarially appropriate discount in premium rates to those
persons that participate in a qualified wellness program.

JUSTIFICATION:

Every year, health insurance rate payers are experiencing rapidly
increasing premium rate increases. This increased cost of purchasing
health insurance continues to force small and large businesses alike
to drop health insurance coverage for their employees and their
families. This bill provides a new avenue to help keep health
insurance rates low. Further, it encourages persons, via a financial
incentive, to participate in qualified wellness programs to enhance
their physical and mental fitness and wellbeing.

We need to develop new and innovative ways to help to minimize future
rate increases so that individuals will be able to afford the health
care they need. Further, reducing or curtailing future health
insurance premium increases will help to keep New York's businesses
competitive with out of state firms.

LEGISLATIVE HISTORY:

2012 - S. 4609 - Referred to Insurance

IMPLICATIONS:

None.

LOCAL FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:

180 days after it shall have become law.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2331--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 16, 2013
                               ___________

Introduced  by  Sens. KLEIN, CARLUCCI, SAVINO, VALESKY -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Insurance  --  recommitted to the Committee on Insurance in accordance
  with Senate Rule 6, sec. 8  --  committee  discharged,  bill  amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the insurance law and the public health law, in relation
  to  making  actuarially  appropriate  reductions  in  health insurance
  premiums in return for an enrollee's or insured's participation  in  a
  qualified wellness program

  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 FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06713-05-4

S. 2331--A                          2

THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
ARTICLE; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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  2. Subsections (b) and (c) of section 3239 of the insurance law, as
added by chapter 592 of  the  laws  of  2008,  paragraphs  6  and  7  of
subsection (b) and subparagraph (C) and (D) of paragraph 2 of subsection
(c)  as  amended, and paragraph 8 of subsection (b) and subparagraph (E)
and (F) of paragraph 2 of subsection (c) as added by chapter 519 of  the
laws of 2013, are amended to read as follows:
  (b) A wellness program may include, but is not limited to, the follow-
ing programs or services:
  (1) the use of a health risk assessment tool;
  (2) a smoking cessation program;
  (3) a weight management program;
  (4) a stress AND/OR HYPERTENSION management program;
  (5) a worker injury prevention program;
  (6) a nutrition education program;
  (7) health or fitness incentive programs; [and]
  (8)  a coordinated weight management, nutrition, stress management and
physical fitness program to combat  the  high  incidence  of  adult  and
childhood obesity, asthma and other chronic respiratory conditions[.];
  (9) A SUBSTANCE OR ALCOHOL ABUSE CESSATION PROGRAM; AND
  (10) A PROGRAM TO MANAGE AND COPE WITH CHRONIC PAIN.
  (c)(1)  A  wellness program may use rewards and incentives for partic-
ipation provided  that  where  the  group  health  insurance  policy  or
subscriber  contract  is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or  a  rebate  or
refund  of  premium,  EXCEPT  AS  PROVIDED IN SECTION THREE THOUSAND TWO
HUNDRED THIRTY-ONE OF THIS ARTICLE, OR SECTION FOUR THOUSAND TWO HUNDRED
THIRTY-FIVE, FOUR THOUSAND THREE  HUNDRED  SEVENTEEN  OR  FOUR  THOUSAND
THREE  HUNDRED TWENTY-SIX OF THIS CHAPTER, OR SECTION FORTY-FOUR HUNDRED
FIVE OF THE PUBLIC HEALTH LAW.
  (2) Permissible rewards and incentives MAY include:
  (A) full or partial reimbursement of  the  cost  of  participating  in
smoking  cessation  [or], weight management, STRESS AND/OR HYPERTENSION,
WORKER INJURY PREVENTION,  NUTRITION  EDUCATION,  SUBSTANCE  OR  ALCOHOL
ABUSE CESSATION, OR CHRONIC PAIN MANAGEMENT AND COPING programs;
  (B)  full  or  partial  reimbursement  of  the cost of membership in a
health club or fitness center;

S. 2331--A                          3

  (C) the waiver or reduction of copayments, coinsurance and deductibles
for preventive services covered under the  group  policy  or  subscriber
contract;
  (D)  monetary  rewards in the form of gift cards or gift certificates,
so long as the recipient of the reward is encouraged to use  the  reward
for  a  product  or a service that promotes good health, such as healthy
cook books, over the counter vitamins or exercise equipment;
  (E) full or partial reimbursement of the cost of  participating  in  a
stress management program or activity; and
  (F)  full  or  partial reimbursement of the cost of participating in a
health or fitness program.
  (3) Where the reward involves a group  member's  meeting  a  specified
standard based on a health condition, the wellness program must meet the
requirements of 45 CFR Part 146.
  (4)  A reward or incentive which involves a discounted premium rate or
a rebate or refund of premium shall be based on actuarial  demonstration
that  the  wellness  program can reasonably be expected to result in the
overall good health and well being of the group AS PROVIDED  IN  SECTION
THREE  THOUSAND  TWO  HUNDRED  THIRTY-ONE OF THIS ARTICLE, SECTIONS FOUR
THOUSAND TWO HUNDRED THIRTY-FIVE, FOUR THOUSAND THREE HUNDRED  SEVENTEEN
AND  FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS CHAPTER, AND SECTION
FORTY-FOUR HUNDRED FIVE OF THE PUBLIC HEALTH LAW.
  S 3. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5) EACH 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 ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE  FOR  AN  ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM  CAN  BE  A  RISK  MANAGEMENT
SYSTEM  THAT  IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY OTHER SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-
MIZES  ADVERSE  HEALTH  CONSEQUENCES DUE TO LIFESTYLE.   SUCH A WELLNESS
PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS  TO  ADVANCE  THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES.  SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER;
  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.

S. 2331--A                          4

  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  4.  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 FOR AN  ACTUARI-
ALLY  APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS OR
ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE  AN  ENROLLEE'S
OR  INSURED'S  ACTIVE  PARTICIPATION  IN A QUALIFIED WELLNESS PROGRAM. A
QUALIFIED WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT  IDENTI-
FIES  AT-RISK  POPULATIONS  OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF
MEDICAL CONDUCT WHICH HELPS TO  PROMOTE  PHYSICAL  AND  MENTAL  FITNESS,
HEALTH  AND  WELL-BEING,  HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF
ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH  MINIMIZES  ADVERSE
HEALTH  CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-
CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES HEALTHY LIVING ACTIVITIES OR DISCOURAGES  UNHEALTHY  LIVING  ACTIV-
ITIES.  SUCH  ACTIVITIES  OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS
PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED  THIRTY-NINE  OF  THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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. Subsection (m) 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 FOR AN  ACTUARIALLY  APPRO-
PRIATE  REDUCTION  IN  PREMIUM  RATES  OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED BY THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S  OR  INSURED'S
ACTIVE  PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED WELL-
NESS PROGRAM CAN BE A RISK MANAGEMENT  SYSTEM  THAT  IDENTIFIES  AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH  HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND WELL-BE-
ING, HELPS TO PREVENT OR MITIGATE THE CONDITIONS  OF  ACUTE  OR  CHRONIC
SICKNESS,  DISEASE  OR  PAIN,  OR  WHICH MINIMIZES ADVERSE HEALTH CONSE-
QUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR  ALL

S. 2331--A                          5

OF  THE  FOLLOWING  ELEMENTS  TO  ADVANCE THE PHYSICAL HEALTH AND MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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  6. Section 4405 of the public health law is amended by adding a new
subdivision 5-a to read as follows:
  5-A. SUBJECT TO  THE  APPROVAL  OF  THE  SUPERINTENDENT  OF  FINANCIAL
SERVICES, THE POSSIBLE PROVIDING OF AN ACTUARIALLY APPROPRIATE REDUCTION
IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR ENHANCEMENTS APPROVED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES TO ENCOURAGE AN  ENROLLEE'S  ACTIVE
PARTICIPATION  IN  A  QUALIFIED  WELLNESS  PROGRAM. A QUALIFIED WELLNESS
PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT  IDENTIFIES  AT-RISK  POPU-
LATIONS  OR  ANY  OTHER  SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE  THOUSAND TWO HUNDRED THIRTY-NINE OF THE
INSURANCE LAW; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE GENERAL GOOD HEALTH AND WELL-BEING OF THE  COVERED  POPULATION.  THE

S. 2331--A                          6

HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 7. This act shall take effect on the one hundred eightieth day after
it  shall  have  become  a law; provided that, effective immediately any
rules and regulations necessary to implement the provisions of this  act
on  its  effective date are authorized and directed to be added, amended
and/or repealed on or before such date.

Co-Sponsors

S2331B (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A5302B
Current Committee:
Law Section:
Insurance Law
Laws Affected:
Amd §§3231, 3239, 4235, 4317 & 4326, Ins L; amd §4405, Pub Health L
Versions Introduced in 2011-2012 Legislative Session:
S4609, A8228

S2331B (ACTIVE) - Bill Texts

view summary

Authorizes health insurers and health maintenance organizations, subject to the approval of the superintendent of financial services, to provide actuarially appropriate reductions in health insurance premiums or other benefits or enhancements for an enrollee's or insured's participation in a qualified wellness program.

view sponsor memo
BILL NUMBER:S2331B

TITLE OF BILL: An act to amend the insurance law and the public
health law, in relation to making actuarially appropriate reductions
in health insurance premiums in return for an enrollee's or insured's
participation in a qualified wellness program

PURPOSE::

To help curtail future health insurance premium increases, this bill
clearly authorizes health insurers and health maintenance
organizations (HMOs) to offer an actuarially appropriate Premium
discount or other benefits or enhancements to covered persons that
participate in a qualified wellness program. Such program must be
approved by the Superintendent of the Financial Services Department.

SUMMARY OF PROVISIONS::

Section 1: Amends Insurance Law section 3231 to permit insurers and
HMOs that offer individual or small group insurance policies to offer
an actuarially appropriate premium discount or other benefits or
enhancements to those individuals that Participate in a qualified
wellness program. Such qualified wellness program must be approved by
the Financial Services Department. Further, such qualified Wellness
program can be either a risk management system that identifies at-risk
populations or any other systematic program or course of medical
conduct which helps to promote physical and mental fitness, helms to
prevent or mitigate acute or chronic sickness, disease or Pain, or
which minimizes adverse health consequences due to lifestyle. To
protect all covered persons, the insurer or HMO shall not require
specific medical outcomes as a result of an insured's adherence to the
approved wellness program.

Section 2: Amends Insurance Law section 3239 which relates to Wellness
Programs that can be sponsored by a health insurance plan. This
provision expands the kinds of Wellness Programs that are covered
under. the Insurance Law to include substance or alcohol abuse
cessation programs and programs to manage and cope with chronic pain.
In addition, the bill expands and provides for the full or partial
reimbursement for the cost of participating in programs that are
already currently authorized under this provision of the law, such as
programs related to stress and or hypertension, worker injury
prevention and nutrition education,. Bill section 2 of this bill was
recently amended such program could be contained in the policy or
ancillary separate document and to add access to preventative care as
one of the added benefits.

Section 3: Amends Insurance Law section 4235(h) to permit insurers and
HMOs that offer accident and health insurance (large group policies)
to offer an actuarially appropriate premium discount or other benefits
or enhancements to those persons that participate in a qualified
wellness program approved by the Superintendent.

Section 4: Amends Insurance Law section 4317 to permit Article 43
insurers and HMOs that offer individual or small group contracts to
offer, subject to the approval of the Superintendent, an actuarially


appropriate premium discount or other enhancements to those persons
that participate in a qualified wellness program.

Section 5: Amends insurance Law section 4326 to permit insurers and
HMOs that offer the subsidized "Healthy New York" policies to offer an
actuarially appropriate premium discount or other enhancements to
those persons that participate in a qualified wellness program.

Section 6: Amends Public Health Law section 4405 to provide for the
same actuarially appropriate reduction in HMO health policies for
those who participate in a Qualified wellness program.

EXISTING LAW::

Under current law, health insurers and HMOs are not clearly allowed to
offer an actuarially appropriate discount in premium rates to those
persons that participate in a qualified wellness program.

JUSTIFICATION::

Every year, health insurance rate payers are experiencing rapidly
increasing premium rate increases. This increased cost of purchasing
health insurance continues to force small and large businesses alike
to drop health insurance coverage for their employees and their
families. This bill provides a new avenue to help keep health
insurance rates low. Further, it encourages persons, via a financial
incentive, to participate in qualified wellness programs to enhance
their physical and mental fitness and well-being.

We need to develop new and innovative ways to help to minimize future
rate increases so that individuals will be able to afford the health
care they need. Further, reducing or curtailing future health
insurance premium increases will help to keep New York's businesses
competitive with out of state firms.

LEGISLATIVE HISTORY::

2012 - S.4609 - Referred to Insurance

IMPLICATIONS:

None.

LOCAL FISCAL IMPLICATIONS::

None.

EFFECTIVE DATE::

180 days after it shall have become law.

view full text
download pdf
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 2331--B
    Cal. No. 489

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                            January 16, 2013
                               ___________

Introduced  by  Sens.  KLEIN,  AVELLA, CARLUCCI, SAVINO, VALESKY -- read
  twice and ordered printed, and when printed to  be  committed  to  the
  Committee on Insurance -- recommitted to the Committee on Insurance in
  accordance  with  Senate  Rule 6, sec. 8 -- committee discharged, bill
  amended, ordered reprinted as amended and recommitted to said  commit-
  tee  --  reported  favorably from said committee, ordered to first and
  second report,  ordered  to  a  third  reading,  amended  and  ordered
  reprinted, retaining its place in the order of third reading

AN ACT to amend the insurance law and the public health law, in relation
  to  making  actuarially  appropriate  reductions  in  health insurance
  premiums in return for an enrollee's or insured's participation  in  a
  qualified wellness program

  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 FOR AN ACTUARIALLY
APPROPRIATE REDUCTION IN PREMIUM RATES OR OTHER BENEFITS OR ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD06713-07-4

S. 2331--B                          2

  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
ARTICLE; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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  2.  Subsections  (a),  (b) and (c) of section 3239 of the insurance
law, as added by chapter 592 of the laws of 2008, paragraphs 6 and 7  of
subsection  (b)  and  subparagraphs  (C)  and  (D)  of  paragraph  2  of
subsection (c) as amended, and paragraph 8 of subsection (b) and subpar-
agraphs (E) and (F) of paragraph 2 of subsection (c) as added by chapter
519 of the laws of 2013, are amended to read as follows:
  (a) An insurer licensed to write  accident  and  health  insurance,  a
corporation organized pursuant to article forty-three of this chapter, a
health maintenance organization certified pursuant to article forty-four
of  the  public  health  law and a municipal cooperative health benefits
plan may establish a wellness program in conjunction with  its  issuance
of  a  group  accident  and  health insurance policy or group subscriber
contract. A "wellness program" is a program designed to  promote  health
and  prevent disease that may contain rewards and incentives for partic-
ipation. Participation in the wellness program  shall  be  available  to
similarly-situated  members  of  the group and shall be voluntary on the
part of the member. The SPECIFIC terms of the wellness program shall  be
set  forth in the policy or contract, OR IN A SEPARATE DOCUMENT PROVIDED
TO INSUREDS AND MEMBERS WHICH SHALL BE CONSISTENT WITH THE PROVISIONS OF
THIS SECTION.
  (b) A wellness program may include, but is not limited to, the follow-
ing programs or services:
  (1) the use of a health risk assessment tool;
  (2) a smoking cessation program;
  (3) a weight management program;
  (4) a stress AND/OR HYPERTENSION management program;
  (5) a worker injury prevention program;
  (6) a nutrition education program;
  (7) health or fitness incentive programs; [and]
  (8) a coordinated weight management, nutrition, stress management  and
physical  fitness  program  to  combat  the  high incidence of adult and
childhood obesity, asthma and other chronic respiratory conditions[.];
  (9) ASSISTANCE, FINANCIAL OR OTHERWISE, PROVIDED TO  AN  EMPLOYER  FOR
HEALTH PROMOTION AND DISEASE PREVENTION;

S. 2331--B                          3

  (10) INCENTIVES FOR INSUREDS OR MEMBERS TO ACCESS PREVENTIVE SERVICES,
SUCH AS MAMMOGRAPHY SCREENING;
  (11) A SUBSTANCE OR ALCOHOL ABUSE CESSATION PROGRAM; AND
  (12) A PROGRAM TO MANAGE AND COPE WITH CHRONIC PAIN.
  (c)(1)  A  wellness program may use rewards and incentives for partic-
ipation provided  that  where  the  group  health  insurance  policy  or
subscriber  contract  is required to be community-rated, the rewards and
incentives shall not include a discounted premium rate or  a  rebate  or
refund  of  premium,  EXCEPT  AS  PROVIDED IN SECTION THREE THOUSAND TWO
HUNDRED THIRTY-ONE OF THIS ARTICLE, OR SECTION FOUR THOUSAND TWO HUNDRED
THIRTY-FIVE, FOUR THOUSAND THREE  HUNDRED  SEVENTEEN  OR  FOUR  THOUSAND
THREE  HUNDRED TWENTY-SIX OF THIS CHAPTER, OR SECTION FORTY-FOUR HUNDRED
FIVE OF THE PUBLIC HEALTH LAW.
  (2) Permissible rewards and incentives MAY include:
  (A) full or partial reimbursement of  the  cost  of  participating  in
smoking  cessation  [or], weight management, STRESS AND/OR HYPERTENSION,
WORKER INJURY PREVENTION,  NUTRITION  EDUCATION,  SUBSTANCE  OR  ALCOHOL
ABUSE CESSATION, OR CHRONIC PAIN MANAGEMENT AND COPING programs;
  (B)  full  or  partial  reimbursement  of  the cost of membership in a
health club or fitness center;
  (C) the waiver or reduction of copayments, coinsurance and deductibles
for preventive services covered under the  group  policy  or  subscriber
contract;
  (D)  monetary  rewards in the form of gift cards or gift certificates,
so long as the recipient of the reward is encouraged to use  the  reward
for  a  product  or a service that promotes good health, such as healthy
cook books, over the counter vitamins or exercise equipment;
  (E) full or partial reimbursement of the cost of  participating  in  a
stress management program or activity; and
  (F)  full  or  partial reimbursement of the cost of participating in a
health or fitness program.
  (3) Where the reward involves a group  member's  meeting  a  specified
standard based on a health condition, the wellness program must meet the
requirements of 45 CFR Part 146.
  (4)  A reward or incentive which involves a discounted premium rate or
a rebate or refund of premium shall be based on actuarial  demonstration
that  the  wellness  program can reasonably be expected to result in the
overall good health and well being of the group AS PROVIDED  IN  SECTION
THREE  THOUSAND  TWO  HUNDRED  THIRTY-ONE OF THIS ARTICLE, SECTIONS FOUR
THOUSAND TWO HUNDRED THIRTY-FIVE, FOUR THOUSAND THREE HUNDRED  SEVENTEEN
AND  FOUR THOUSAND THREE HUNDRED TWENTY-SIX OF THIS CHAPTER, AND SECTION
FORTY-FOUR HUNDRED FIVE OF THE PUBLIC HEALTH LAW.
  S 3. Subsection (h) of section 4235 of the insurance law is amended by
adding a new paragraph 5 to read as follows:
  (5) EACH 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 ACCIDENT AND HEALTH INSURANCE, MAY
PROVIDE  FOR  AN  ACTUARIALLY  APPROPRIATE REDUCTION IN PREMIUM RATES OR
OTHER BENEFITS OR ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOUR-
AGE AN ENROLLEE'S OR INSURED'S ACTIVE PARTICIPATION IN A QUALIFIED WELL-
NESS PROGRAM. A QUALIFIED WELLNESS PROGRAM  CAN  BE  A  RISK  MANAGEMENT
SYSTEM  THAT  IDENTIFIES  AT-RISK  POPULATIONS  OR  ANY OTHER SYSTEMATIC
PROGRAM OR COURSE OF MEDICAL CONDUCT WHICH HELPS TO PROMOTE PHYSICAL AND
MENTAL FITNESS, HEALTH AND WELL-BEING, HELPS TO PREVENT OR MITIGATE  THE
CONDITIONS OF ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH MINI-

S. 2331--B                          4

MIZES  ADVERSE  HEALTH  CONSEQUENCES DUE TO LIFESTYLE.   SUCH A WELLNESS
PROGRAM MAY HAVE SOME OR ALL OF THE FOLLOWING ELEMENTS  TO  ADVANCE  THE
PHYSICAL HEALTH AND MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (A)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (B) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES.  SUCH ACTIVITIES OR PRACTICES MAY INCLUDE WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER;
  (C) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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  4.  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 FOR AN  ACTUARI-
ALLY  APPROPRIATE  REDUCTION  IN  PREMIUM  RATES  OR  OTHER  BENEFITS OR
ENHANCEMENTS APPROVED BY THE SUPERINTENDENT TO ENCOURAGE  AN  ENROLLEE'S
OR  INSURED'S  ACTIVE  PARTICIPATION  IN A QUALIFIED WELLNESS PROGRAM. A
QUALIFIED WELLNESS PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT  IDENTI-
FIES  AT-RISK  POPULATIONS  OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF
MEDICAL CONDUCT WHICH HELPS TO  PROMOTE  PHYSICAL  AND  MENTAL  FITNESS,
HEALTH  AND  WELL-BEING,  HELPS TO PREVENT OR MITIGATE THE CONDITIONS OF
ACUTE OR CHRONIC SICKNESS, DISEASE OR PAIN, OR WHICH  MINIMIZES  ADVERSE
HEALTH  CONSEQUENCES DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE
SOME OR ALL OF THE FOLLOWING ELEMENTS TO ADVANCE THE PHYSICAL HEALTH AND
MENTAL WELL-BEING OF ITS PARTICIPANTS:
  (1) AN EDUCATION PROGRAM TO INCREASE  THE  AWARENESS  OF  AND  DISSEM-
INATION  OF  INFORMATION  ABOUT PURSUING HEALTHIER LIFESTYLES, AND WHICH
WARNS ABOUT RISKS OF PURSUING  ENVIRONMENTAL  OR  BEHAVIORAL  ACTIVITIES
THAT  ARE  DETRIMENTAL  TO HUMAN HEALTH. IN ADDITION, INFORMATION ON THE
AVAILABILITY OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY  IDENTIFI-
CATION  AND  TREATMENT OF DISEASES SUCH AS CANCER, HEART DISEASE, HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES HEALTHY LIVING ACTIVITIES OR DISCOURAGES  UNHEALTHY  LIVING  ACTIV-
ITIES.  SUCH  ACTIVITIES  OR PRACTICES MAY INCLUDE WELLNESS PROGRAMS, AS
PROVIDED UNDER SECTION THREE THOUSAND TWO HUNDRED  THIRTY-NINE  OF  THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR  HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE AND
MORAL SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN  THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.

S. 2331--B                          5

  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. Subsection (m) 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 FOR AN ACTUARIALLY APPRO-
PRIATE REDUCTION IN PREMIUM RATES  OR  OTHER  BENEFITS  OR  ENHANCEMENTS
APPROVED  BY  THE SUPERINTENDENT TO ENCOURAGE AN ENROLLEE'S OR INSURED'S
ACTIVE PARTICIPATION IN A QUALIFIED WELLNESS PROGRAM. A QUALIFIED  WELL-
NESS  PROGRAM  CAN  BE  A RISK MANAGEMENT SYSTEM THAT IDENTIFIES AT-RISK
POPULATIONS OR ANY OTHER SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL
OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE THOUSAND TWO HUNDRED THIRTY-NINE OF THIS
CHAPTER; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  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  6. Section 4405 of the public health law is amended by adding a new
subdivision 5-a to read as follows:
  5-A. SUBJECT TO  THE  APPROVAL  OF  THE  SUPERINTENDENT  OF  FINANCIAL
SERVICES, THE POSSIBLE PROVIDING OF AN ACTUARIALLY APPROPRIATE REDUCTION
IN  PREMIUM  RATES  OR  OTHER  BENEFITS  OR ENHANCEMENTS APPROVED BY THE
SUPERINTENDENT OF FINANCIAL SERVICES TO ENCOURAGE AN  ENROLLEE'S  ACTIVE
PARTICIPATION  IN  A  QUALIFIED  WELLNESS  PROGRAM. A QUALIFIED WELLNESS
PROGRAM CAN BE A RISK MANAGEMENT SYSTEM THAT  IDENTIFIES  AT-RISK  POPU-
LATIONS  OR  ANY  OTHER  SYSTEMATIC PROGRAM OR COURSE OF MEDICAL CONDUCT
WHICH HELPS TO PROMOTE PHYSICAL AND MENTAL FITNESS, HEALTH AND  WELL-BE-
ING,  HELPS  TO  PREVENT  OR MITIGATE THE CONDITIONS OF ACUTE OR CHRONIC
SICKNESS, DISEASE OR PAIN, OR  WHICH  MINIMIZES  ADVERSE  HEALTH  CONSE-
QUENCES  DUE TO LIFESTYLE.  SUCH A WELLNESS PROGRAM MAY HAVE SOME OR ALL

S. 2331--B                          6

OF THE FOLLOWING ELEMENTS TO ADVANCE  THE  PHYSICAL  HEALTH  AND  MENTAL
WELL-BEING OF ITS PARTICIPANTS:
  (1)  AN  EDUCATION  PROGRAM  TO  INCREASE THE AWARENESS OF AND DISSEM-
INATION OF INFORMATION ABOUT PURSUING HEALTHIER  LIFESTYLES,  AND  WHICH
WARNS  ABOUT  RISKS  OF  PURSUING ENVIRONMENTAL OR BEHAVIORAL ACTIVITIES
THAT ARE DETRIMENTAL TO HUMAN HEALTH. IN ADDITION,  INFORMATION  ON  THE
AVAILABILITY  OF HEALTH SCREENING TESTS TO ASSIST IN THE EARLY IDENTIFI-
CATION AND TREATMENT OF DISEASES SUCH AS CANCER, HEART  DISEASE,  HYPER-
TENSION, DIABETES, ASTHMA, OBESITY OR OTHER ADVERSE HEALTH AFFLICTIONS;
  (2) A PROGRAM THAT ENCOURAGES BEHAVIORAL PRACTICES THAT EITHER ENCOUR-
AGES  HEALTHY  LIVING  ACTIVITIES OR DISCOURAGES UNHEALTHY LIVING ACTIV-
ITIES. SUCH ACTIVITIES OR PRACTICES MAY INCLUDE  WELLNESS  PROGRAMS,  AS
PROVIDED  UNDER  SECTION  THREE  THOUSAND TWO HUNDRED THIRTY-NINE OF THE
INSURANCE LAW; AND
  (3) THE MONITORING OF THE PROGRESS OF EACH COVERED PERSON TO TRACK HIS
OR HER ADHERENCE TO SUCH WELLNESS PROGRAM AND TO PROVIDE ASSISTANCE  AND
MORAL  SUPPORT TO SUCH COVERED PERSON TO ASSIST HIM OR HER TO ATTAIN THE
GOALS OF THE COVERED PERSON'S WELLNESS PROGRAM.
  SUCH WELLNESS PROGRAM SHALL DEMONSTRATE ACTUARIALLY THAT IT ENCOURAGES
THE GENERAL GOOD HEALTH AND WELL-BEING OF THE  COVERED  POPULATION.  THE
HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE SPECIFIC OUTCOMES AS A
RESULT OF AN ENROLLEE'S ADHERENCE TO THE APPROVED WELLNESS PROGRAM;
  S 7. This act shall take effect on the one hundred eightieth day after
it  shall  have  become  a law; provided that, effective immediately any
rules and regulations necessary to implement the provisions of this  act
on  its  effective date are authorized and directed to be added, amended
and/or repealed on or before such date.

Comments

Open Legislation comments facilitate discussion of New York State legislation. All comments are subject to moderation. Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity or hate speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Comment moderation is generally performed Monday through Friday.

By contributing or voting you agree to the Terms of Participation and verify you are over 13.